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Compassionate Care in the Comfort of Your Home When you or someone you love has a life-limiting illness and is ready to focus on comfort over treatment, it may be time to consider hospice. Hospice care is specialized care that provides physical comfort and emotional, social and spiritual support for those near the end of life. At Renown Hospice, we use a family-centered approach to provide quality of life care in the comfort of home. We know that the decision to pursue hospice is one of the most challenging times – please note our team is available 24/7 to answer any questions. The Renown Hospice Difference Renown Hospice is the only not-for-profit hospice in the region, founded on a mission to care for and support those in our community.  We take the time to listen and respond to each patient’s own definition of quality of life and specific care needs. We’re proud to be one of the highest rated quality care and experience agencies in northern Nevada

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Low back pain is not only a problem most people have at some point in life, but also the leading cause of disability in the U.S. Whether it is a sharp spasm from lifting something heavy or a daily constant ache, there are various treatments available to relieve your pain. Jessica Ryder PT, DPT, cert VRS, with Renown Health Outpatient Therapy, explains some common causes of this pain, how to treat it and ways to prevent pain flare-ups. It’s important to realize most cases of low back pain are short term. Frequently lasting only a few days or weeks. In general these cases leave no long-term damage to the spine, muscles, discs or nerves. “However, it can become episodic or chronic (lasting longer than 12 weeks) if it is not properly understood or managed by the individual, ” cautions Ryder. Causes of Pain Specifically back discomfort can be related to: Wear and tear on the spine due to age or poor movement patterns Injury to spinal discs Sprains (overstretching or tearing of ligaments) and strains (tears in tendons or muscles) Trauma Irregularities of the spine present at birth (example: scoliosis)Notably the above issues may result in a “pinched nerve” or sciatica, causing pain to extend down the leg. Risk Factors for Pain In particular, your chance of developing low back pain increases with the risk factors below: Age Being overweight Low fitness level or occasional physical activity (“weekend warrior”) Family history Pregnancy Poor posture Jobs requiring heavy physical work (landscaping, plumbers, construction, etc.)

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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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Getting the COVID-19 booster is the best way to protect yourself from severe illness or death due to COVID-19, and both the CDC and the FDA have approved booster shots for people ages 18 and older. So, with the holidays right around the corner and infection rates on the rise both in Nevada and nationally, the best thing you can do to prevent the continued spread of this deadly virus is to get boosted today. The Basics: Who: It is recommended that everyone 18 years or older get a COVID-19 booster shot. When: At least 6 months after completing your primary COVID-19 vaccination series. What: Any of the COVID-19 vaccines authorized in the United States. The CDC allows for mix and match dosing for booster shots. How: To make an appointment for your COVID-19 vaccine booster, please visit vaccines.gov today. Appointment Reminders: Don’t forget to bring your CDC vaccination record card to your appointment. Refresh yourself on the potential side effects and remember that these are normal signs your body is building up protection. Commonly Asked Questions: Q: Does anything change if I received the Johnson & Johnson as my first COVID-19 vaccine? A: If you received the Johnson & Johnson COVID-19 vaccine, you are elidable for a booster two months after completing your primary vaccine. Q: Is the formula the same for the boosters as it was for the primary vaccine? A: COVID-19 booster shots are the same formulation as the current COVID-19 vaccines. However, in the case of the Moderna COVID-19 vaccine booster shot, it is half the dose of the vaccine people get for their primary series. Q: Am I still considered “fully vaccinated” if I don’t receive a COVID-19 booster shot. A: Yes, everyone is still considered fully vaccinated two weeks after their second dose in a two-shot series, such as the Pfizer-BioNTech or Moderna vaccines, or two weeks after a single-dose vaccine, such as the J&J/Janssen vaccine. All information courtesy of the Center for Disease Control and Prevention. All information courtesy of the Center for Disease Control and Prevention

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Standing at the top of the stairs to the basement Sharon Sturtevant was chatting with her grandson in the kitchen. Suddenly, Sharon stumbled and fell down the stairs. “The last thing I remember was my head hitting the floor before everything went black,” she recalls. Her grandson, Oliver, quickly called 911 and paramedics arrived on the scene, taking her by ambulance to Renown Regional Medical Center where she was diagnosed with a broken collarbone and a neck fracture that would require complex surgery involving fusion of her neck. Fall Recovery Begins After her surgery, Sharon was transported to the Renown Rehabilitation Hospital and her recovery process began. Sharon smiles as she describes the rehab hospital team “They are fabulous here, I learned so much about how my body moves, and the proper way to move it. At home I wouldn’t have known what to do,” she confesses. “They set me up for success to return home and not get injured again.” At Renown Rehabilitation Hospital, different therapists coordinated a custom plan to help Sharon recover from her injuries. Ultimately, the goal of her physical therapy was to help restore and improve her strength, reduce pain and increase her mobility for stamina and balance. Physical Therapy Key to Successful Treatment of Falls “My recovery after the operation was an eye-opener,” Sharon declares. “I had no idea how much went into regaining everyday moment.” During her rehabilitation hospital stay, she had to re-learn how to swallow, go up and down stairs, as well as successfully get in and out of a wheelchair, which involved transferring her body weight safely. Due to hormonal changes after menopause women are 50% more at risk for falls than men, according to research. Sharon now has a greater awareness of how to move her body and is significantly stronger than before entering her physical rehabilitation sessions. Not everyone knows that everyday mobility is impacted by four basic skills: stepping, trunk flexibility, upright posture and weight shifting. “I don’t know how I could have gotten this far without the wonderful therapists here,” she shares. “They are so thorough. Proper alignment was encouraged helping me to walk and stand correctly. They were all so nice and patient with me,” she states. “I actually had less pain because I didn’t hurt myself moving the wrong way.” Falls Are Common Among Aging Adults As we age balance becomes more important. Unfortunately falls are common among older adults with negative quality of life effects, even fatalities. According to the Centers for Disease Control and Prevention (CDC), one in four seniors fall each year in the U.S. A comprehensive physical therapy plan for sudden falls or chronic conditions is a safe, effective alternative treatment to medication such as opioids. Today Sharon is back at home with a new banister installed on the basement stairs. As a music lover she is enjoying her musical grandchildren Oliver and Eliana who play instruments. She looks forward to attending their upcoming school concerts. Sharon remembers the staff at Renown Rehabilitation Hospital fondly, “They were unfailingly patient, supportive, informative and understanding.” Her advice to those unexpectedly finding themselves in the rehabilitation hospital is, “Listen to your therapists carefully and follow their instructions.”

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Millions suffer from urinary incontinence (urine leakage). Often people feel as if their bladders control their lives. But this doesn't have to be your story. Bladder control issues are treatable and you can take steps to help control your bladder. What is urinary incontinence? Men and women of all ages can have difficulty controlling their bladders. Urinary incontinence occurs when the muscles in the bladder that control the flow of urine contract or relax involuntarily. Is there more than one type of urinary incontinence? Yes, there are three main types: Stress incontinence is when the bladder leaks small amounts of urine as a result of physical stress or pressure on the muscles supporting the bladder caused by coughing, sneezing, laughing, lifting or any sudden physical exercise such as running or jumping. Urge incontinence is the inability to control a strong urge to go without advance warning, limiting the time needed to get to the bathroom. Overflow incontinence occurs when the bladder does not empty properly. As a result, over time, large quantities of urine are stored, causing the bladder to overflow (this is more common in men and is often the result of an enlarged prostate blocking the bladder opening). Are there any tests that can determine the cause and type of incontinence? Your doctor may have you track your fluid intake and output in a Bladder Diary. A urinalysis can be checked for infection, traces of blood, or other abnormalities. Blood tests can look for chemicals or substances that may relate to contributing causes. Other testing may be an ultrasound, cystogram or post voiding residual measurement. How is urinary incontinence treated? Exercises to strengthen the pelvic floor muscles or restrain the bladder to hold on for longer. Medication can relieve and control the troublesome symptoms. If there is an infection an antibiotic is used. Surgery can repair weakened muscles or remove blockage. Special products such as pants, pads, collection devices, and chair and bed protection may be needed if the problem cannot be controlled. How do you strengthen your pelvic floor muscles? To make your pelvic floor muscles stronger, alternate between squeezing and relaxing them. Following the steps below may help: Squeeze your muscles for one second and hold. Relax your muscles for two seconds. Each time you squeeze and relax, it counts as one set. Complete five sets. When you can do the exercises easily, increase to doing them 10 times per day. When that gets easy, try to squeeze and hold the muscles for three seconds and then relax the muscles for three seconds. As your pelvic muscles get stronger, you can progress to longer squeezes for about 10 seconds. Be sure to relax between squeezes so that your muscles can rest before squeezing again. You should do these exercises in three different positions. Do 10 sets lying down, 10 sitting and 10 standing. It is important that you develop the habit of doing the exercises every day. You may want to exercise just after you get up in the morning and right before you go to bed at night. What can I do to help control incontinence? Watch your weight, practice pelvic floor muscle exercises, eat plenty of fresh fruits, vegetables and fiber to prevent constipation. Most importantly, talk to your doctor regarding incontinence issues, don’t be embarrassed!

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According to the Centers for Disease Control and Prevention (CDC), one out of four adults aged 65 or older, fall each year. But less than half of those who fall talk to their healthcare provider about it. What’s more, among older adults, falls are the leading cause of both fatal and nonfatal injuries. Senior Care Plus, a Medicare Advantage Plan by Hometown Health, and Renown Health Nurse Educator, Nicholas Mannering, worked together to provide a list with simple tips to help you prevent falls.  1. Exercise Exercise strengthens both your muscles and bones and improves balance which is a key factor to preventing falls. The stronger you are, the less likely you are to fall. And, if you do fall, you are less likely to be injured.   2. Vision Check Vision is an import part of fall prevention, have your eyes check by an eye doctor at least once a year. Update your vision prescription and replace your eyeglasses as needed.   3. Install Safety Equipment in Your Bathroom Installing grab bars in your home bathroom provides a way for you to help yourself in and out of challenging situations. It also provides support if you suddenly feel week or unstable. Having a grab bar to lean on or hold onto when you feel yourself falling or slipping can help prevent falls. Rubber mats eliminate slick surfaces that increase your risk of falling.   4. Helpful Items in Your Bedroom A light within reaching distance is an important item to have in your bedroom. One reason adults fall is because they wander through a dark room, often to get to the bathroom at night, and can’t see where they are walking. Having a light within reach that is quick and easy to turn on before walking around a room can make it safer and decrease your risk of falling. Having a bedroom that is organized and furnished in a way that is easy to navigate is also important. If your bedroom is cluttered and hard to walk around without tripping or running into things, it might be worth reorganizing the area to define a clear walking path.   5. Helpful Items in Your Living Room Similar to your bedroom, your living room should have a light that is easily accessible. Sofas with armrests are helpful for support when getting up and sitting down. Avoiding clutter in your walkways, rugs that are not secured down and unstable furniture are important to consider when preventing falls.   6. Actions to Avoid in Your Home There are other ways to fall besides slipping or tripping while walking. Never stand on chairs, boxes or other unstable items in your home. Walkways should be tidy and free of objects that you could trip on. Spills should be cleaned up right away to prevent slipping.   7. Wear Appropriate Footwear Wearing shoes with non-slip soles and closed toes can help prevent you from falling.  Having shoes that fit properly, are made from hard rubber (like tennis shoes) and provide good support help prevent tripping and falling. Shoes with a collar that support the ankle and a well-padded tongue for the top of your foot can also help prevent injury to your feet.   8. Review Your Health & Medications at your Annual Health Check-Up It is important to review your health and medications with your healthcare provider so they can assess if you are at risk for falls. You should discuss your vision, heart health and blood pressure at your annual health check-up. These things can play a role in the risk of falling. Reviewing your current medications is also important. If medications are making you dizzy, talk to your provider about adjusting the dosage so you can feel more stable and balanced. When talking to your doctor about medications be sure to include your vitamins and supplements. Finally, Have your healthcare provider check your feet and discuss proper footwear yearly.   9. Avoid Smoking and Alcohol Balance is important in preventing falls. Alcohol consumption negatively affects balance and increases your risk for falls and fractures. It also increases your risk for cancer, liver damage, osteoporosis, high blood pressure and strokes. Smoking is connected to frailty in older adults. It prevents the development of muscle tissue and breaks down healthy muscle tissue due to the lack of oxygen in your body.

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Renown Health is one of the country’s first health systems to lift visitor restrictions for patients with COVID-19 and encourage the family to be at the patient’s bedside. Read Darlene and Dave’s story to understand why we’re updating our visitor policy. Dave and Darlene Randolph found joy in exploring antique shops and garage sales to find damaged or discarded vintage pieces. Dave would spend many hours scraping, cleaning, sanding, and refinishing items, transforming them into functional, beautiful pieces of furniture. Every piece in their home rekindles a memory and has a story to tell. On Thanksgiving, when Dave was too ill to gather around their antique dining room table, Darlene called the ambulance. Ailing with COVID-19 for two weeks, Dave had not been improving. When the EMTs reached her home and asked Darlene what underlying conditions he had, she said, “all of them.” David was seriously ill. Hospitalized for COVID-19, their communications options were limited. The only way Darlene could communicate with Dave was on a video call or by telephone. Dave spent 17 days hospitalized at Renown Regional Medical Center in Reno. Darlene spent 17 days waiting by the phone for more information on his condition. Darlene said he had “up days and down days,” but thought he might be home, sitting at their antique dinner table for Christmas. Sadly, Dr. David Randolph lost his battle with COVID-19 on December 13, 2020, and died as he slept in a hospital bed. When Darlene wrote his obituary for the newspaper, she gave thanks to the “tremendous nurses and doctors at Renown Regional Medical Center, for providing his care during a time when the family could not be with him.” Taking Action to Inspire Change Darlene wished she could have been there. Over their 45-year marriage, she had always been there. Darlene said, “I had always been at his bedside, as his advocate, to help communicate and straighten things out.” As a registered dietician, she worked in hospitals, knew the protocol, and knew that Renown had a restricted visitor policy to stop the virus’s spread- to other patients, staff, and their family members. Still, she wished she could have spent more time with him. On Christmas Eve, she sat down and wrote to Renown leadership. “As the wife of a COVID patient who recently passed away in your hospital, I want to express my thanks to you and your staff for the care he received in the last days of his life. I am aware that the nurses and staff are working under dangerous conditions and risking their health and lives by caring for multiple COVID patients. The staff is gracious, concerned, and doing everything they can.” She continued, “I know procedures are changing every hour to try to stay ahead of this dangerous virus, and I am sharing my experiences, hoping they will be helpful when establishing policies that impact families.” Darlene explained that despite receiving assurances that Dave’s nurse or a doctor would call daily, sometimes they would forget. She explains in her letter, “how important it is, in these times when the family cannot visit, and has only infrequent communication and is anxiously waiting at home for information about their loved one, how much it means to get a call from someone caring for him at the hospital. If there is a way you can help assure nurses have time to make calls or assist patients in making calls because it is an important part of patient care.” A Person-Centered Visitor Policy After receiving her letter, Renown leadership called Mrs. David Randolph to thank her, offer his sympathies and ask if Renown could help in any way. Darlene asked if he might reconsider allowing families to visit hospital patients during treatment for COVID-19. As the COVID-19 situation has evolved, the policy has as well. Renown hospitals and medical practices now encourage limited visitors for all patients, including those diagnosed with COVID-19. Renown also has extra safety measures to protect the health of patients, visitors and healthcare employees. Darlene is very pleased that her letter inspired this shift in visitor policies for patients with COVID-19. She says, “I have always tried to think of ways I could help other families. Especially those senior couples where one has been hospitalized and the other is home. My wish is to help others.” Renown Health Visitor Policy Renown Health patients may identify two healthy adult “patient supporters” to accompany them on their hospital stay. For more details, visit our Patient Supporter Guidelines page.

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Vaccines that provide protection against the COVID-19 virus are bringing us closer to the end of this deadly pandemic. Two different COVID-19 vaccines are currently available in the U.S. today: one from Pfizer and the other from Moderna. Kate Ward, PharmD, BCPS, Director of Clinical Pharmacy at Renown Health and Adam Porath, PharmD, Vice President of Pharmacy at Renown, share what you need to know about these vaccines. When two COVID-19 vaccines were approved by the U.S. Food & Drug Administration (FDA) in December 2020, it was cause for celebration. Why? Because according to the CDC, the vaccines are 94 percent or more effective in providing protection against the COVID-19 virus! Many people are seeking information about the new Moderna and Pfizer vaccines. Below, our pharmacy leaders provide answers to some commonly asked questions. How do the COVID-19 Vaccines Work? The Pfizer and Moderna vaccines are both mRNA vaccines that help your immune system develop antibodies against the COVID-19 virus. The vaccines use messenger RNA, or mRNA, to show our bodies’ protein-making cells how to make the spike proteins of the COVID-19 virus. Our immune system reacts to these spike proteins by creating antibodies that can recognize and destroy them. So when a person is exposed to the virus in the future, they will be less likely to get sick. What are the Differences between the Pfizer and Moderna Vaccines? The Pfizer and Moderna COVID-19 vaccines are very similar, with just a few small differences worth noting. The main difference between the two vaccines is when you should receive your follow-up dose. Patients who receive a first dose of Pfizer should receive their second dose about three weeks later. Those who receive a first dose of Moderna should receive their follow-up vaccination roughly four weeks after their first dose. People 18 years and older can receive the Moderna vaccine while people 16 years and older can receive the Pfizer vaccine. Dosage for the Moderna vaccine is 0.5 ml (100 mcg). Dosage for the Pfizer vaccine is 0.3 ml (30 mcg).

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With front-line workers receiving the first COVID-19 vaccinations, many of us are feeling hope, but also worry. As a result, we are joining with the Ad Council, the COVID Collaborative, HHS, CDC and NIAID (along with top health and medical organizations) to address your vaccine concerns and questions. Will the vaccine be available to everyone in Nevada? The Nevada Department of Health and Human Services (DHHS) is collaborating with health systems about the use of initially available, limited supplies of COVID-19 vaccines. They will provide guidance on the prioritization order of who will receive the vaccine. This will be based on available quantities, high-risk locations of work and certain other risk factors, and recommendations and guidance for public health agencies. The CDC has provided guidance to initially focus on the following groups: Healthcare personnel likely to be exposed to or treat people with COVID-19, nursing home residents and others in institutional settings; People at risk for severe illness from COVID-19 due to underlying medical conditions; People 65 years of age and older; Other essential workers. I worry the vaccine has been rushed The U.S. national vaccine safety system ensures that all vaccines are as safe as possible, and because vaccines are given to millions of healthy people to prevent serious diseases, they’re held to very high safety standards. COVID-19 vaccines are undergoing a rigorous development process that includes vaccinating tens of thousands of people who participate in a study to generate the needed clinical data. These clinical trials generate scientific data for the FDA to determine the safety and efficacy of each vaccine. It’s worth noting that the clinical studies to establish the safety and efficacy of the Covid-19 vaccines were as big and thorough as recent studies for other licensed vaccines (for example, the shingles vaccine). I'm concerned about the vaccine's side effects The most common side effects are very similar to those seen with most vaccines, such as: sore arms, fevers, and tiredness within 72 hours after the vaccine. These side effects usually mean that the vaccine is generating an immune response, indicating it is working. Short-term side effects observed in the leading COVID-19 vaccine trials include: Injection site pain and redness Fatigue Muscle aches and pains Joint pain Headache I’m afraid I’ll get COVID-19 from the vaccine None of the authorized and recommended COVID-19 vaccines, or COVID-19 vaccines currently in development in the United States, contain the live virus that causes COVID-19. This means that a COVID-19 vaccine cannot make you sick with COVID-19. Can children receive the COVID-19 vaccine? Not at the moment. In early clinical trials for various COVID-19 vaccines, only non-pregnant adults at least 18 years of age participated. However, clinical trials continue to expand those recruited to participate. The groups recommended to receive the vaccines could change in the future. As of now, it is recommended that children do not receive the vaccine. More information will be available from the vaccine manufacturers. I do not believe vaccines are effective Both this disease and the vaccine are new. We don’t know how long protection lasts for those who get infected or those who are vaccinated. What we do know is that COVID-19 has caused very serious illness and death for a lot of people. If you get COVID-19, you also risk giving it to loved ones who may get very sick. Getting a COVID-19 vaccine is a safer choice. The FDA is responsible for making sure that, just like any other medications, any FDA-authorized or approved COVID-19 vaccines are safe and they work. The EUA (Emergency Use Authorization) will not be provided if the FDA feels that the vaccine is unsafe. I can't get vaccines to due to a medical condition Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine. The following information aims to help people in the groups listed below make an informed decision about receiving the mRNA COVID-19 vaccine. It is extremely important to speak with your doctor regarding your specific medical condition, and always follow their strict advice regarding the COVID-19 vaccine, or any other vaccines. Sources: Renown COVID-19 Ad Council COVID Collaborative U.S. Department of Health & Human Services Centers for Disease Control and Prevention National Institute of Allergy and Infectious Disease

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