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When it comes to your neurological health, seeking the expertise of a specialist is crucial. The Renown Institute for Neurosciences provides comprehensive care for complex diseases affecting brain, spinal cord and peripheral nerves. Let us help guide you through the appointment process to ensure a productive and informative first appointment. What to Expect at Your First Appointment at the Renown Institute for Neurosciences Duration and Purpose: Your first appointment will last approximately one hour. This time allows the doctor to ask specific questions, do a thorough neurological exam and discuss your concerns. Specialized Care: You will be matched with a provider who specializes in assessing and treating your specific ailment or condition. This tailored approach ensures that you receive care from an expert who has the specialized interest and expertise to address your needs effectively. Initial Assessment: During your visit, you will first see a medical assistant who reviews your medication history and standard screening questions provided by your doctor. Following this portion of your appointment, the neurologist will ask specific and detailed questions about your condition and conduct a non-invasive neurological examination to evaluate your brain and nervous system functioning. This exam involves painless tests assessing your cognitive function and nerve operation, including tests for sensation, strength and coordination. Treatment: After performing the neurological exam and addressing your questions, the neurologist will review the possible diagnosis and treatment plan, including any medication needs to help with your condition. Finally, your doctor may discuss the role of additional testing, including imaging studies (CT/MRIs), peripheral nerve testing (EMG) or brain wave testing (EEG), which will be scheduled for a later date. Making the Most of Your Visit To make your appointment as beneficial as possible, consider the following tips: Arrive Early: Plan to arrive at least 10 minutes early to fill out any necessary check-in items before your appointment's scheduled start time. This will ensure a smooth and timely visit. Bring Insurance Information: Have your insurance details readily available to facilitate the administrative process. This will help avoid any delays or confusion. Gather Medical Records: If you have received treatment or undergone tests with other healthcare providers relevant to your condition, bring along any medical records or test results. This information will assist your neurologist in gaining a comprehensive understanding of your medical history. Prepare Questions and Concerns: Consider noting the following, which can help you better answer questions the neurologist may ask during your appointment. The frequency, duration and severity of your symptoms. Share information about any medications or treatments you have tried for the condition and the outcomes. Prioritize questions to help the neurologist answer your most significant concerns during the initial visit. Your first appointment with a doctor at the Renown Institute for Neurosciences is an opportunity to receive expert care and gain insights into the best method of treatment for your condition. By understanding what to expect and following the tips provided, you can maximize your visit and be on your way to achieving overall health and wellness.

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Stroke is unfortunately common, with 1 in 5 American women experiencing it each year. When it comes to a stroke the phrase “time is brain” speaks to the urgency of getting rapid care. In fact, a woman may lose nearly 2 million neurons per minute of oxygen loss to the brain. The Renown Health Comprehensive Stroke Center experts share the importance of timely treatment and how stroke symptoms can differ in women. Women and Stroke – Surprising Symptoms  Each year stroke affects more women than men. Even more concerning, women are less likely to recover from a stroke. The following non-traditional, less common, warning signs can be common in women: Hiccups with chest pain Sudden disorientation, drowsiness, confusion or a general altered mental status Nausea or vomiting A sudden headache that feels like the ‘worst headache of your life’ Unusual chest pain (especially with hiccups) Body numbness or weakness, such as an arm or leg suddenly ‘falling asleep’ Fainting or loss of consciousness Stroke Diagnosis The first step is neuroimaging by CT scan. This allows for rapid identification of any bleed, and also assists in determining candidacy for the early clot busting medication. MRI brain imaging is much higher resolution, and can better determine the core stroke size, assisting in prognosis and recovery. Since strokes have several different origins, an inpatient workup is essential to determine the underlying cause. Whether the stroke is secondary to plaque in the large vessels, clots being thrown in the setting of atrial fibrillation (an abnormal heart rhythm), or small vessel disease from years of uncontrolled vascular risk factors (high blood pressure, smoking, high cholesterol, diabetes), determining the cause is essential to implementing a management plan to reduce risk for further strokes. Quick Treatment for Stroke is Key Early recognition of stroke symptoms and seeking prompt attention is paramount. There are interventions that can be instituted to minimize the stroke and increase likelihood of recovery, but only if a patient presents to the hospital early. A clot busting medication, called tPA, can be given to patients with stroke if given within 4-5 hours from time of onset. Renown Regional Health Center is designated as a Comprehensive Stroke Center, the highest level of stroke certification available. To earn the designation of comprehensive stroke center, a hospital has to meet stringent requirements, including biannual on-site evaluations. This includes care for ischemic stroke patients (lack of blood flow), hemorrhagic stroke patients (bleeds), and determining the underlying cause to guide secondary stroke management prevention. Stroke Symptoms Remember “B.E.F.A.S.T.” to recognize the symptoms of a stroke below: B – Balance Being off balance or dizzy, is common. E – Eyes An eyesight change such as blurring or double vision may occur. F – Face droop One side of the face, or lip, droops A – Arm weakness Does one arm drift down? S – Speech Talking may slur or sound strange. T – Time Time to call 911. Call an ambulance immediately if you or anyone else, experiences any of these symptoms.

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Feelings of grief can take on many forms and can occur in reaction to many situations, including the death of a loved one or a medical diagnosis for yourself or someone close to you. It is important to remember that this reaction is entirely natural, and many people who experience grief find outside help to be a valuable part of the healing process. Below is a list of both local and national grief and bereavement resources for all ages and specificities. If you or someone you know is experiencing grief, the trained professionals below are here to help. Solace Tree Support groups for children and teens (ages 3 to 18), young adults and their family members. For more information visits solacetree.org/grief-programs or call 775-324-7723. Healing Minds Counseling services for those coping with the loss of a loved one or major life change. For more information visit healingminds.com/grief-counseling-reno-nv or call 775-448-9760. Circle of Life Hospice Support groups open to the community held the first and third Tuesday of every month. Fore more information visits colhospice.com/bereavement-and-spiritual-care or call 775-827-2298. Summit View Hospice Grief and bereavement support open to the community-groups, memorials and by mail. For more information visit summitviewhospice.com or call 775-636-9598. The Compassionate Friends Monthly support group on the second Monday of each month for families after a child dies. Fore more information visit facebook.com/TheCompassionateFriendsofReno, compassionatefriends.org or call 775-750-7005. Healing for Survivors of Suicide Links and resources for those who have lost a loved one to suicide. For more information visit survivingsuicide.com GriefShare Grief recovery support groups meeting weekly both in-person and online with options in Reno/Sparks, Carson City and rural cities. For more information www.griefshare.org National Alliance for Grieving Children Resources for parents and caregivers to help children navigate the challenges of bereavement and grow into healthy adults. For more information visit nacg.org/resources-and-support/ Mourning Hope Grief Center Grief support groups, counseling, resources and COVID-19 support for children, adults and families before and after a death loss. For more information visit mourninghope.org Crisis Support Services of Nevada 24/7, free, confidential and caring support to people in crisis across Nevada and the U.S. For more information visit cssnv.org, call 775-784-8090 or text CARE to 839863 National Alliance on Mental Illness-Warmline A stigma-free, non-crisis phone service you can call or text that is staffed by trained peers in recovery. For more information visit namiwesternnevada.org/resources/ or call 775-241-4212. Vitas Healthcare Grief and bereavement resources and support groups both virtual and phone-in. For more information visit vitas.com/family-and-caregiver-support or call 866-489-0583. St. Mary’s - Hospice We Promise Resources on grief for all groups including children to adults, trauma, caregivers and more. For more information visit hospicewepromise.com/topics/grief or call 775-525-6700. Mountain View Mortuary Grief support and tools available to assist you in your healing journey including “365 Days of Healing” email list for daily support and comfort. For more information visit mountainviewmortuary.net/resources/grief-support or call 775-788-2199 Sesame Street – Helping Kids Grieve Discover games, videos and more on topics important to you and your child. For more information visit sesamestreetincommunities.org/topics/grie Trauma Intervention Program-Northern NV A national non-profit organization of volunteers dedicated to ensuring those emotionally traumatized receive assistance. For more information visit tipnnv.org/about-tip/resources Pregnancy & Infant Loss Support Organization A non-profit organization dedicated to the support of families who have lost a baby through miscarriage, stillbirth or neonatal death. For more information visit pilsos.org Caring Info A program of the National Hospice & Palliative Care Organization providing free resources to help people make decisions about end-of-life. For more information visit nhpco.org/patients-and-caregivers/

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Becoming a caregiver or playing a more active role in another’s healthcare is a big responsibility. At some point, almost all adults will support an aging parent or a loved one in need. Keeping track of their needs and wellbeing, while also prioritizing your own can become overwhelming. It’s important to know: you are not alone, and help is available. Read on for 11 tips to help you manage your time, your own wellbeing and your loved one’s care. Self-care comes first. When your main priority is the person in your life who needs care, it’s easy for your own needs to take the backseat. Give yourself time each day to focus on your personal wellbeing. It’s hard to give a loved one the care they need if your own needs are not met. Prioritize the Activities of Daily Living (ADL). Make a note of what ADLs your loved one can do alone, what they need help with and what activities require the most help. This will help you work through the day with them, as well as plan out how the day’s activities will go. Do a home safety audit. Do showers, bathtubs and steps have safety grab bars? Look around the house for additional tripping hazards, like rugs or electrical cords. If your loved one struggles with day-to-day navigation of the home, consider scheduling an occupational therapy appointment. This type of therapy helps a person develop or maintain the motions required to accomplish daily tasks. You might also qualify for a referral to in-home healthcare, such as Home Care. Have the hard conversation. The best time to discuss views about end of life care and to learn what choices are available is before a life-limiting illness or crisis occurs. With advance care planning, you can help reduce the doubt and anxiety related to decision making at the end of life. Completing an Advance Directive is a great tool to sort out all these decisions before they’re needed. Attend a free workshop to learn more and complete this important document. Identify when you need respite. Respite care involves receiving a short-term break from caregiving. Organizing in-home care for your loved one will allow you to step away and tend to your needs. By identifying what kind of respite care you are seeking, you can find the right person to provide you with that much-needed break. Don’t wait until you feel overwhelmed, plan ahead. Write down insurance contact information. Have a direct connection to the right insurance professional for support and advice. If your loved one is eligible Medicare, this is a good opportunity to review their current selections and if they would benefit from a Medicare Advantage Plan or Medicare Supplement Insurance. Seeking out expert advice or information on Medicare options is a great way to navigate this. Consider calling a broker, or attend a free educational seminar with Senior Care Plus. Gather legal and financial information. Make a list of all existing legal documents and financial accounts that your loved one has. These might include a will, advance directive, power of attorney, bank accounts or investment accounts. If you have questions about how to manage them, or need assistance in setting up additional framework, reach out to a lawyer, legal service, financial adviser or bank representative. Create an inventory of medical information. Identify where all of your loved one’s medical records are, as well as a list of providers or healthcare practices where they have received care. Consider if you should have your loved one give you Proxy Access in MyChart, which allows you to access all the features in MyChart on their behalf, including viewing upcoming appointments, viewing test results and emailing a doctor on their behalf. Make a list of what others can do. Think about all the little (and big) things that need to happen, and write down tasks that others could take care of you. When someone says “let me know what I can do” you’ll be ready with a pre-written list of items they may be able to assist with. Tasks could include tackling around-the-house repairs, scheduling lawn work, helping to walk the dog, taking a car for an oil change and cleaning. Find programs and events for social enjoyment. If and when possible, seek an activity outside of the home. Look for community centers that have programs for seniors, recreational activities or meals that you can patriciate in together. If leaving the home is not an option, arrange for visits or in-home activities, such as movie nights, card games or time to visit with family. Research long-term options. If you will be considering a nursing home or assisted living, make a list of amenities that you and the person you are caring for would like. Take this list with you when visiting potential locations to make sure you don’t forget to ask about each item.

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National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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The Acute Care Rehab Therapists at Renown Regional and South Meadows serve a wide variety of patients and their families with varying acuity levels and diagnoses. The 2 departments (inpatient and outpatient) are made up of around 80 employees, including 14 therapists with over 20+ years of experience and over 700 years of combined experience.    What is Acute Care Therapy? The acute care setting is a very fast paced environment with a high volume of therapy orders and fluctuating census.  The therapists are considered a consult service with a primary goal of helping with discharge planning and moving patients throughout our system.  Depending on location, the therapists generally cover 1-3 floors within the hospital and manage a daily caseload of about 15-20 patients.  Our general population ranges from Neonates to Geriatrics. The therapists provide comprehensive diagnostic and therapeutic rehabilitative services (Physical Therapy, Occupational Therapy, and Speech Language Pathology for the treatment of patients with various disorders and related medical conditions. Treatment may include a variety of activities and exercises to maximize a patient’s functional independence.  Renown Outpatient Rehab Therapy Services Outpatient Physical, Occupational, and Speech Therapy services to help individuals improve & regain function to allow for higher quality of life and a more active lifestyle. We provide treatment for: Orthopedic Conditions Nerve Injuries Spinal Cord Injuries Sport-Related Injuries Worker’s Compensation Injuries Trauma and Post-Surgical Recovery Vestibular Dysfunction Hand Injuries Speech/Language Difficulties Swallowing Dysfunctions Cognitive Issues Specialty Services Include: Lymphedema Therapy Dry Needling Chronic Pain LSVT Big and LSVT Loud Modified Barium Swallow Studies (MBSS) South Meadows Campus Lite Gait & Solo Step Systems Pre-Driving Assessments and Computer Driving Simulation Wheelchair Evaluations-Basic and Complex Custom Splinting All treatments are one-on-one with a licensed Outpatient Therapist

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November is National Alzheimer’s Disease Awareness Month. At Renown Health, we know that Alzheimer's safety for your loved one is a priority, as the symptoms can sometimes lead to unsafe situations. We asked Dr. Jonathan Artz – a neurology physician with Renown Health and an assistant professor of clinical neurology at the University of Nevada, Reno School of Medicine – for tips on keeping loved ones safe and secure.  According to the Alzheimer’s Association, Alzheimer’s disease affects safety in various ways, specifically due to body and brain adjustments. These changes can include: Judgment, including forgetfulness  Sense of place – getting lost on the way home  Behavior – being suspicious or fearful  Body difficulty – losing balance Sensing ability – noticeable sensitivity in hearing, seeing or temperature  Dr. Artz gives us four major tips to ensure your loved one’s safety as you both navigate this disease together.  Watch for Wandering  Those experiencing Alzheimer’s disease tend to wander and get lost. Try the following tips to reduce the risk of wandering:  Get your loved one an ID bracelet and have them wear it at all times. You can also enroll your loved one in “Wandering Support.”  Install door chimes so you know when exterior doors are open.  Ask neighbors to call you if they see your loved one out alone. Go with your loved one when they insist on leaving the house. Don’t argue or yell. Instead, use distraction or gentle hints to get them to return home.  Discourage Driving  Driving can be unsafe for someone with this disease. With this in mind, ask a doctor whether it’s safe for your loved one to drive. For example, on a case-by-case basis, there are certain situations where doctors are required to report individuals with particular cognitive impairments, wherein a form of a driving assessment will be recommended.  Limit access to the car. Keep the keys with you or lock them away.  Ask an authority figure, such as an insurance agent or a doctor, to tell them not to drive.  Adult-Proof Your Abode  A simple living space is a safe living space. This means reducing clutter and removing any issues that may pose a safety concern. You may also want to get advice from an occupational therapist (home safety expert). Keep in mind that some changes may not be needed right away. Focus on major safety concerns first.  Try the following tips:  Add lighting (or glow-in-the-dark tape) to brighten dark areas, including stairways and halls.  Use color contrast or texture indicators for dials, knobs and appliance controls.  Remind your loved one not to carry items while walking to avoid a fall.  Remove sharp objects from drawers and countertops.  Avoid using small throw rugs or doormats, as they are easy to trip on.  Move frequently used items so that they are easy to reach.  Lock away alcohol and tobacco products, as they are not recommended for dementia patients.  Install handrails in the shower, tub and near the toilet. Bathroom falls are especially common.  Adjust the setting on your hot water heater so water does not scald. Those with Alzheimer’s can lose their sensitivity to temperature.  Move and lock up hazardous chemicals and cleaning supplies, such as bleach and insecticides.  Disable and remove guns or any weapons. Supervise any medication taken by your loved one.  Promote a Positive & Healthy Lifestyle  Continually emphasize the strengths of your loved one by promoting participation in meaningful activities, wellness visits and healthy habits to help them improve their well-being. Here are some ways to keep them physically and mentally active:   Maintain regular vision and hearing screenings and make necessary adaptations.  Establish a routine for daily activities.  Encourage participation in self-care and leisure activities.  Work with your loved one’s doctor to establish a healthy diet.  Ensure proper hydration. It may help to set reminders for your loved one to drink fluids.  Encourage regular exercise. Exercise delivers oxygen to the brain, improving brain health. Promote good sleep habits. Good quality sleep can increase overall brain health and has been associated with improving memory, attention and concentration.  Resources and support are available with the Renown Memory Disorders Program. Providers within this program are specifically dedicated to treating several different memory-related disorders. Memory Disorders Resources & Support.

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Renown Neurosurgery Using a collaborative approach, our experts use leading-edge diagnostic tools to identify neurological conditions and treat them with the most effective surgical and non-surgical treatment techniques available.    What is a Neurosurgeon? A neurosurgeon is a doctor that specializes in surgical treatment and management of conditions for the nervous system, including the brain, spinal cord and nerves. In addition to the nervous system, neurosurgeons can also treat conditions that impact the surrounding supporting structures, including your skull, spinal vertebrae, spinal disks, and blood vessels. If your care team determines surgery is the best plan of treatment, you will be referred to a neurosurgeon for consult. Conditions We Treat

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What is Physiatry? Physiatry (fuh·zee·a·tree) encompasses the diagnosis, prevention and treatment of all disabilities related to the brain, nerves, bones and muscles.  The goal is to maximize physical functioning, significantly decrease or eliminate pain, foster independence and improve the quality of life for those with a disability, chronic pain and physical impairments.

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