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When it comes to intimidating procedures such as surgery, cardiac catheterization (Cath) or interventional radiology (IR), there can be a lot of unknowns. What can I expect on the big day? What will happen after I’m all done? Will I have to worry about my orders not being in the system? Who can I call if I have any last-minute questions? It’s easy for your thoughts to race as you approach your procedure date, but luckily, there is a team who puts your mind at ease.  With Renown Health’s Surgery & Procedure Scheduling department, patients can breathe a sigh of relief knowing that all the nitty-gritty is taken care of before they step foot in the procedure room. This team operates in the mindset of a complex Tetris board – fitting in all the pieces to make sure every patient is set on the path for surgery success.  Consistent Contact Our Surgery & Procedure Scheduling team has a unique history. Initially operating as two separate teams, over the last year, our leaders skillfully combined the two teams together under one umbrella. That allows the now singular team to have line of sight across every surgery and Cath or IR procedure plan and be better stewards of the resources they have at their fingertips to provide streamlined, more-connected care for patients.  As one might imagine, with the merger of the two teams, the day-in-the-life of each team member is full of a variety of crucial checklist items to cross off – all supporting constant communication from patients to providers.  On the surgery scheduling front, these team members are resource rockstars. From working with referring providers to get patients scheduled appropriately to ensuring rooms and equipment are available for every patient, this team makes sure everything and everyone is in place when the time comes to help create a successful procedure and the best possible patient experience.   “In surgery scheduling, we handle inbound calls for the outside offices to get time scheduled for each patient in the operating room (OR),” said Lydia Sharkey, Senior Scheduler. “We make sure there are plenty of anesthesia resources and equipment for every surgery, including any important information that we need to schedule patients appropriately and adding all documents to the OR board. If we need to swap rooms or move patients around, we handle that process too.”  Over on the IR/Cath scheduling side of things, this team is on the frontlines of patient communication. They are experts in helping patients navigate their procedure from start (seeing their provider and obtaining the proper referrals) to finish (the day of the procedure and post-procedure process).  “My day is a little different than the hospital schedulers; our part of the team handles the outpatient aspect,” said Adrienne White, Senior Scheduler. “We are in constant contact with patients and the IR and Cath departments. We help them navigate their procedure, including what to expect during and after the procedure. We get them through the process as easily as possible and ease their minds, so they know what is going to happen every step of the way. It’s all about communication, communication, communication!”  This department has a significant overarching role: make sure all documents and ancillary information is set up for all our clinical teams that help with surgeries and procedures. This critical work means that every process is followed, and no important details are left out.  “No one wakes up and says, ‘I want to have surgery;” our team goes above and beyond to make sure every single detail is taken care of so that when patients arrive, everything is in place,” said Trisha White. “Our team works hard to ensure everything runs as efficiently as possible because we want to use our resources in the best way possible to serve our patients without delays. We make sure we receive all the orders, codes and insurance and that the teams that follow after us – including our pre-admit team and nurses – have all the information they need to do their job seamlessly."  With all the work they accomplish daily – not to mention how they wholeheartedly support each other through it all – it’s no question that the entire team has a lot to be proud of. Besides helping make patient care possible, the team puts their departmental merger and the move to fully remote work at the top of the list.  “We’re most proud of merging the surgery scheduling and procedure scheduling teams together and therefore more cohesive,” said Mary Gray, Senior Scheduler. “The merger has made our team blossom and be able to connect with and rely on one another even more. We aren’t afraid to speak up and say something. At the end of the day, we’re here to take care of the patient, but we also help each other out. Our morale has gone up, and everybody is happier. Even though we all work remotely, we are more connected and have a great work-life balance.”  “Along with transitioning the two teams into one big team, the move to being fully remote was huge," added Patricia Cruz-Hernandez, Surgical RN Scheduling Coordinator. “We worked through all the glitches, and it was a seamless transition to move into a remote setting. What’s great is that it did not affect patients at all; everything still gets done exactly as it should.”  No matter how busy the days may get, Renown’s surgery and procedure schedulers always remember one thing: they are incredibly grateful for their fellow team members.  “We have a very efficient and hard-working team of women,” said Pam Chapa Valencia, Senior Scheduler.  “I could not have handpicked better people for our team,” added Trisha White. “I feel so lucky to have the team that we have.”  A Renown “Why” Our Surgery and Procedure Scheduling team members all have diverse stories to tell about their road to Renown and why they’ve stayed in the department for as long as they have. Whether they’ve been with us for two years or two decades, they all share the same strong calling to care for their community.  “I always wanted to help people, and my grandma was a nurse,” said Pam Chapa Valencia, Senior Scheduler.  “I loved hearing her stories, and it made me want to be involved in patient care.”  “I have a caring nature, and a hospital nature seemed like the right fit – I've been here for 25 years,” added Mary Gray.  Several of our schedulers recognized the influence Renown has within our community and the ability to grow professionally and personally, both of which were a driving factor in their decision to make our health system their long-term career.  “I’m originally from southern California, and I moved here about eight years ago; my husband always talked so positively about Renown, especially with how big it is and how it has the only level II trauma center in northern Nevada, so my goal was always to get a job here,” said Lydia Sharkey. “It’s been a great environment to be a part of.”  “I’ve been with Renown for 17 years, and I chose to come here because of the reputation of the services Renown provided and care they gave,” added Trisha White. “I also knew what opportunities there were for me professionally, and in doing so, we are taking care of our community. I’ve had the chance to grow within my own professional skills and leadership skillset.”  A profound feeling of ‘home’ is a common theme among this department. These team members appreciate the sense of community Renown has, the strides we’ve made in expanding our reach and how our health system gives healthcare professionals who are new to the field a chance to succeed.  “At the time, Renown was the only hospital that would train nurses, and as a brand-new nurse, I had no experience – Renown took a chance on me,” said Patricia Cruz-Hernandez. “I feel like this is home. Our health system is so community-based and people-first minded, keeping ‘mission over margin.’ We’re growing, we’re expanding, we’re everywhere!”  “I was a part of a transition as the cardiology private practice I worked with became a Renown practice, and it was great,” added Adrienne White. “This transition enabled us to provide more services and better care to patients. I stay here because I see the leaps and bounds we’ve been able to make in terms of procedures, accessibility and patient experience.”  As true advocates for both patients and each other, the team is proud to have found their niche – and the ultimate beneficiaries? Everyone undergoing a surgery or procedure at Renown.  A Culture of Kindness and Gratitude When you meet the Surgery & Procedure Scheduling team, you are greeted with warm smiles and an enthusiastic “Nice to meet you!” You can’t help but smile back and feel the infectious kindness they exude.  Renown operates with a People-First mindset, a vision that this department especially takes to heart. They emulate the exact definition of our “Collaboration” cultural commitment.  “We’ve built very good relationships and rapport with the OR managers and board runners,” said Lydia Sharkey. “The communication that we have at all three locations is very solid.”  “The OR leadership is always so willing to help out whenever they can, and the resources they’ve provided have been huge for us,” added Adrienne White.  “All the teams that see the patients after us – especially the surgical pre-admit team and the case managers, are fantastic about collaborating with us and reaching out to solve any issues they may have,” added Trisha White. “We all work so well together, especially since we all impact patient care.”  In any organization, strong and compassionate leadership is key to a thriving team. Luckily for our surgery and procedure schedulers, they have Trisha White on their side. They attribute a lot of their success to having a supportive leader who “gets it.”  “Trisha has been a scheduler like us, so she completely understands when we’re having an issue, because she’s struggled with the same thing and knows where we are coming from,” said Mary Gray. “It makes us feel like we are not alone – I can always reach out to her, or any of my other coworkers, to ask questions and figure out a solution together.”  Despite being a remote-only team that meets in-person only one or two times a month, this group never misses an opportunity to reconnect both online and offline. They frequently shout out their Culture Ambassadors, schedulers Pam Chapa Valencia and Roxanne Abundis, for their team’s high morale.  “Even though we all primarily work remotely, our in-person days are some of my favorite days of the month,” said Trisha White. “We feel so uplifted, we laugh and we have fun. We love being with each other. Pam and Roxanne are our Culture Ambassadors, and they both have been amazing at planning fun things for our teams. They go above and beyond to make our team feel cohesive and included.”  “Pam and Roxanne have been leaders in creating a fun environment and supportive culture for us,” added Lydia Sharkey. “Whether it’s creating care packages or making sure we all have a good time when we see each other in person, they deserve a lot of credit.”  As this team excels in their roles and foster a culture rooted in kindness and gratitude, we can trust that Renown’s surgeries and procedures will continue to thrive, and patients will continue to benefit from their diligent efforts and commitment to efficiency.  “We make the magic happen!” closes Mary Gray.

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Northern Nevada's stunning lakes, including Lake Tahoe, with its average summer water temperature of 50 degrees, present a potential risk of hypothermia. Unlike mild 50-degree air, water at the same temperature poses severe, life-threatening risks, including rapid-onset hypothermia and drowning. Awareness of the symptoms and taking proper precautions are crucial to prevent cold-water drowning. The 4 Phases of Cold-Water Drowning 1. Cold Shock Response: This response affects breathing and happens within the first minute. An automatic gasp reflex occurs in response to rapid skin cooling. If the head goes below water, water may be breathed into the lungs, resulting in drowning. A life jacket will help keep your head above water during this critical phase. Additionally, hyperventilation, like the gasp reflex, is a response to the cold and will subside. Panic will make this worse, so the key is to control breathing. 2. Cold Incapacitation: This response occurs within the first five to 15 minutes in cold water. In order to preserve core heat, vasoconstriction takes place decreasing blood flow to the extremities to protect the vital organs. The result is a loss of movement to hands, feet, arms and legs. Unless a life jacket is being worn, the ability to stay afloat is next to impossible. 3. Hypothermia: Important to note, it can take 30 minutes or more for most adults to become hypothermic. So there’s time to take action and survive. Keeping panic at bay is critical, as you have more survival time than you think. Symptoms include: Shivering Slow and shallow breathing Confusion Drowsiness or exhaustion Slurred speech Loss of coordination Weak pulse 4. Circum-rescue Collapse: This experience can happen just before rescue and is not well understood. Symptoms range anywhere from fainting to death. Some experts believe an abrupt drop in blood pressure may cause this final stage of cold water drowning, post-rescue. Additional Safety Tips and Helpful Resources Always wear a personal flotation device as well as a wetsuit or drysuit. Your personal flotation device is the most important piece of water safety gear. Try not to panic as the first phases will subside. Controlled breathing is to staying calm. Research suggests the body can withstand the cold longer than we think. The Heat Escape Lessening Posture (HELP) is a position which helps conserve energy if you’re wearing a personal flotation device. By hugging your knees to your chest, this posture helps maintain body heat for some time.

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Whether you're a parent, grandparent, caregiver, or sibling, it's vital to recognize that drowning is the second leading cause of death among children," states Dr. Leland Sullivan, of Northern Nevada Emergency Physicians. "While we diligently work to protect children from water-related accidents, there's a lesser-known threat that often goes unnoticed—dry drowning, also known as delayed drowning. Surprisingly, many people remain unaware of its existence and potential dangers. Dry drowning defined Dry drowning is a side-effect of a near-drowning experience and includes spasms of the vocal cords and larynx — known as a laryngospasm. This occurs when the body attempts to shut down the passage of any liquid into the lungs. Unfortunately, it can also shut down the passage of air into the lungs and force fluid into the stomach and lungs. Often the condition is not discovered until it's too late — severe cases can cause death within one to 24 hours after a water incident occurs. Who is susceptible? Novice or first-time swimmers are at increased risk, as are children with asthma and known breathing issues. In addition, children who have had pneumonia or experienced acute respiratory distress syndrome are also at greater risk. To reduce these factors, caregivers should be exceptionally watchful of inexperienced swimmers. According to Dr. Sullivan, children under the age of 5 are most susceptible to drowning and often drown in residential swimming pools. Infants less than 1-year-old most often drown in bathtubs. What are the signs of a dry drowning episode? If your child has a near-drowning incident, a few moments of coughing until they calm down is normal. However, you should know the more severe signs and symptoms to watch for during the 24 hours following the incident, including: Persistent coughing Difficulty breathing and/or shortness of breath Chest pains Extreme fatigue and/or lethargy Change in typical behavior Face becomes pale   What is the treatment and prognosis for dry drowning? Dr. Sullivan recommends that all victims of near-drowning incidents seek medical attention, even if they have no symptoms. If caught early, dry drowning can be treated. If you think your child is experiencing a dry drowning episode, go to the nearest emergency room as quickly as possible — do not attempt treatment at home. Healthcare professionals will work to supply oxygen to your child's lungs to restore and regulate breathing.

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June offers an official welcome to summer and the height of outdoor activities in northern Nevada such as hiking, camping, days spent at the lake and embracing long days and warm evenings with friends and family. Enjoying all that the summer season has to offer may not be as easy for those living with chronic obstructive pulmonary disease, or COPD, which effects more than 15 million Americans. What is COPD? COPD is a group of lung diseases including emphysema and chronic bronchitis that result in airflow blockages from the lungs. People may experience frequent coughing and shortness of breath among other symptoms. COPD typically impacts adults ages 65 and older and is becoming increasingly more common among women. Although smoking plays a key role in the development of COPD, air pollution and indoor air quality, and respiratory infection also contribute to disease development. While there is no cure for COPD, limiting progression of disease and managing symptoms can be achieved through lifestyle changes, therapy, and medications. Tips for Living with COPD This Summer, and Always Stay Hydrated: Staying hydrated is extremely important for people with COPD, especially during the summer. Not drinking enough water can make breathing more difficult because it increases respiratory symptoms. Make sure to always keep a water bottle with you and aim to drink 8-10 glasses of water daily. Be Mindful of Temperature: COPD symptoms can be exacerbated by hot weather. It is best to participate in outdoor activities during the cooler times of day, like the morning or evening. Check Air Quality Before You Go: Before engaging in outdoor activities, be sure to check the air quality index and plan your activities accordingly. Pace Yourself: Exercising can be difficult for people who have COPD. To make the most of your summer, try not to push yourself too hard and take breaks when you need them. If you start to feel out of breath or tired, take a break in a cool, shaded area until you feel better. Take Matters Into Your Own Hands To address the needs of community members living with COPD, the Renown Health Research Office has teamed up with Pulmonary Medicine to provide patients who are former or current smokers and have a history of frequent exacerbations with an option to participate in the ARNASA study. "COPD exacerbations have a huge negative impact on patient’s lung function” states Dr. Farah Madhani-Lovely, Chief of Pulmonary Medicine at Renown Health and Assistant Dean of Clinical Research at the University of Nevada, Reno School of Medicine. “We have had inhalers and prednisone for decades but patients are still having exacerbations. Now we have a new pathway we think will prevent exacerbations which is what this clinical trial is designed to prove.” This study will evaluate the efficacy and safety of astegolimab compared with placebo in participants 40-80 years of age with COPD. “This study in particular is so exciting because of the enthusiasm from the sponsor’s end” says Katie Buckley, Lead Clinical Research Coordinator working on pulmonology studies at Renown’s Clinical Research Office. “Often times sites aren’t assigned particularly passionate or engaged personnel who aid in carrying out these studies, but you can tell Roche Genentech’s team truly cares about the success of the study, the safety of their participants, and proving the efficacy of the investigational agent. Working on a study like this takes a village, and when the individuals on all ends share similar mindsets and work towards success as a collective unit instead of as individual moving parts, it’s amazing to see everything we’re able to accomplish.” Renown’s team of expert pulmonologists and researchers are available to join patients with COPD in support of their healthcare journey. If you are interested in learning more about this clinical trial option at Renown Health, talk to your pulmonologist at your next appointment or contact us at 775-982-3646. At Renown Health, our goal is to make it easy for patients to access clinical research as a care opportunity where patients can access a variety of standard care treatment options for their health condition or choose to participate in a clinical trial. For more information about clinical trial opportunities available to you or to ask any questions, contact the Renown Research Office at Renown-CRD@renown.org or 775-982-3646.

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Lung cancer is the leading cause of cancer deaths in both men and women in the U.S. The good news is the five-year survival rate increases dramatically if lung cancer is treated before spreading to other parts of the body. Julie Locken, MD, of Renown Health Imaging, explains more. What are the signs and symptoms of lung cancer? As you might expect, most lung cancer symptoms appear in the chest and can affect your breathing. Watch for signs such as: Persistent cough Constant chest pain Shortness of breath Wheezing Bloody or rust-colored phlegm Hoarseness Swelling of the neck Pain or weakness in the shoulder, arm or hand Recurring pneumonia, bronchitis or other lung infections Loss of appetite and loss of weight can also be signs of lung cancer That said, there are usually no symptoms in the early stages of lung cancer, which means getting screened can truly be a lifesaver. If you have a history of smoking, you should get screened as a precaution.  What are the risk factors of lung cancer?  Around 80% of lung cancer cases stem from a history of smoking tobacco. But there are other known causes, such as secondhand smoke, radon, asbestos and diesel exhaust. It’s important to do what you can to eliminate exposure to all of these to reduce your lung cancer risk.  People with an immediate relative – a parent, sibling or child – diagnosed with lung cancer and people between 50 and 80 years old are also at higher risk and may need to consider screening.  People who are at the highest risk are those with a history of smoking tobacco, particularly smokers who averaged one pack of cigarettes per day for 20 years or more, as well as former heavy smokers who quit in the last 15 years.

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Many millennials are fortunate to have good health, but it’s important to be prepared for your next doctor’s visit. Here are three things that millennials should stay on top of for tracking and maintaining their health. For many millennials, doctor visits and preventive healthcare fall by the wayside. Alison Lynch, MD, a family medicine provider with Renown Medical Group says there are a few key things you can do now to set yourself up for a healthy future. 1. Establish with a Primary Care Provider Millennials are more likely to go to urgent care or consult the internet when a healthcare issue arises. While these are helpful tools, here’s a better one: a primary care provider. The benefit of establishing with a primary care provider is that your medical records, history and a baseline for your health will be documented. That means that when a problem or question comes up, your doctor will already have helpful information on file and can help you navigate your needs. Having a primary care provider is often required for prescription refills and referrals to a specialist. By establishing now, you’ll be able to get what you need in the future much faster. Make an Appointment Today 2. Protect Yourself and Your Community There are a few vaccinations and screenings that Dr. Lynch recommends for millennials. Flu Shots: These are available every year and are recommended for protecting not only yourself against the flu but also others you may come into contact with. Flu shots are usually available from August through December through your healthcare provider, pharmacies and pop-up events. Tetanus or Tdap: Most people receive a tetanus shot as a child, but it’s recommended that everyone get a booster every 10 years. If you are overdue, talk to your primary care provider or pharmacist about getting updated. Pap smear: If you’re a woman, a pap smear is recommended every three years in your 20s and every five years in your 30s. HPV vaccine: This vaccine helps prevent the virus that causes cervical cancer as well as the majority of head and neck cancers and warts. The HPV vaccine is recommended for all genders up until age 45. STD screening: Consider an STI/STD screening if you’re sexually active.

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There are a few simple ways to encourage healthy aging that can translate to an improved quality of life. Here are some expert tips.  What does healthy aging mean to you? If you’re like most people, you’re looking forward to removing the negative from your life — negative energy, thoughts, people and activities that don’t contribute to your best life.  And while that’s a noble goal, too often we forget about ways to strengthen the positive parts of our lives. Expert Herbert “Buddy” Coard III, Ed.D, psychologist with Renown Behavioral Health, provides us with five positive behaviors to focus on to improve happiness and life satisfaction. Healthy Aging in 5 Easy Steps: 1. Connect – Make connections with friends, family, colleagues and neighbors. When you build strong connections, they can help enrich your life with new experiences and opportunities. Besides, having a support system to call upon when you need a favor is valuable as you age. 2. Be Active – Make time to get moving and work those muscles. Being active can include walking, practicing yoga, playing a game of pickleball or dancing. Exercise makes you feel good and keeps you health. Pick a physical activity that you enjoy, and don’t make excuses. Not only will being active help you build stronger muscles, it also helps you build strong connections with others. If you need a workout buddy, Meetup is a great resource to find like-minded people that share common exercise goals. 3. Take Notice – Be mindful and become more curious. Like a child, see the wonder and beauty of the world. Notice the things around you — the weather, the landscape, the mood and feelings of the people around you. By taking notice, it’s easier to learn to appreciate the things that matter. 4. Keep Learning – We never stop learning. Keep trying something new — a new course you’ve always wanted to try or a more challenging task someone has solicited for your help. Challenges keep us on our toes and increase our confidence and excitement in our day. OLLI (Osher Lifelong Learning Institute at the University of Nevada, Reno), brings diverse educational and social opportunities to active older adult learners (50+). EPIC (Educational Programs Inspiring the Community), offers a divers curriculum ranging from art classes to Accelerated training certificate courses. 5. Give – Be generous with your time, your knowledge and your talents by giving to friends, family and even strangers. Some easy ways to give is to show thankfulness, smile at people and volunteer. Sharing of yourself to a wider audience gives you a greater reward than just doing things for yourself. Nevada Volunteers Volunteer at Renown Health Practice these five tips to improve happiness and quality of life at any age.

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Even when fires burn outside our area, the air quality in the region can reach dangerous levels. Our expert explains how to maintain your lung health when fire season strikes. It’s a sight we know all too well as northern Nevadans — a hazy or thick layer on the horizon when smoke rolls in from nearby fires. Sometimes the smoke is more evident than others, but it’s important to remember, even when the smoke may not be as visible across the valley, it still impacts our air quality. The last week or so, our air quality has been in the “unhealthy for sensitive groups” range, which can be dangerous for people who are sensitive to air pollution. Air Quality Changes: Who’s at Risk? Renown Pediatric Pulmonologist Sonia Budhecha, M.D., explains certain people are especially at risk when smoke moves in: Older people, whose lungs are not as healthy as they used to be Young children, whose lungs are still developing People with heart and lung disease including asthma, COPD and emphysema “Smoke and haze from fires carry particulates that can get into your respiratory system and eyes, which can be a danger for all ages,” Dr. Budhecha says. How You Can Protect Yourself Until the smoke clears and the air returns to the “good” range, it is best to follow these tips to protect yourself and your family: Stay indoors and keep windows closed Turn on the air conditioning to recirculate clean air Drink plenty of fluids to help your body flush out any toxins you inhale Additionally, all community members should reduce their physical activity and try to prevent heavy exertion outside. If you or a loved one has a heart or lung disease, avoid physical exertion altogether because smoke can aggravate these conditions. “People with heart disease may experience shortness of breath, chest pain, palpitations or fatigue,” Dr. Budhecha says. “People with lung disease may also have shortness of breath, chest discomfort, wheezing, phlegm or a cough.” Smoky Signs and Symptoms Smoke can also impact healthy people — irritating your eyes, nose or throat. And in some cases, inhaling smoke can lead to bronchitis. When haze moves into our area, keep an eye out for these symptoms: Burning or stinging eyes Runny nose Cough or scratchy throat Headaches Wheezing Shortness of breath Difficult taking a full breath Chest heaviness Lightheadedness Dizziness If experiencing any of the above symptoms, seek medical attention or call your doctor for advice. Sometimes, these symptoms do not appear for as long as 24 to 48 hours after smoke inhalation. For those that have pre-existing lung or heart conditions, consult with a health care provider on action or management plans. To schedule an appointment Visit Renown Pulmonary Medicine, or call 775-982-5000. Understanding Our Air Quality The Air Quality Index (AQI) is broken down by large (PM10) and small (PM2.5) particulates. According to Dr. Budhecha, large particulates are usually ones that can be seen and smelled. They can damage your eyes and nose but don’t often get deep in the lungs or blood vessels.   “The more dangerous ones are PM2.5, which can’t always be seen or smelled,” Dr. Budhecha says. “Any time the AQI is above 51, children with lung or heart disease should not be outdoors.” For the latest air quality update in your area, visit AirNow.gov or call (775) 785-4110.

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Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.

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Some people drive for hundreds of miles just to pitch a tent in what we're fortunate enough to call our backyard. From alpine hiking trails and miles of remote forest to desert lakes and spectacular night skies, there's no better way to unwind and explore the outdoors than camping. If you've been daydreaming of hiking trails and swimming holes or looking for a tranquil and adventurous family vacation,  it's time to clear your schedule, pack up the car and venture into the Great Outdoors.  We've got six fun and beautiful camping getaways you need to experience this summer that will leave you feeling relaxed and rejuvenated. And best of all, they're just a short drive away.  Emerald Bay State Park South Lake Tahoe, Calif. Highway 89 Summer Boat-In Camping: Available by reservation. Accessible by boat or foot.  Cost: $35 per night Dogs? Allowed in campground on a 6 foot leash. They cannot be on trails or roads into Emerald Bay or on the beach.  Information/Reservations: 530-525-7232 or www.reserveamerica.com To say this camping location is stunning is an understatement. If you're seeking a view from your campsite of blue lake waters, thick forest and jutting rocks, than this is the spot for you. This campsite is located on the north side of Emerald Bay, at old Emerald Bay Resort, and offers hiking and walking trails and easy access to Lake Tahoe. There are also large rocks you can jump from into the lake.   Davis Creek Regional Park West Side of Washoe Valley US 395 South  Cost: $20, cash only Dogs? Yes. $1 per night fee per pet and they must be leashed. Information/Reservations: (775) 823-6501 or www.washoecounty.us/parks Located in the foothills of the Carson Range 20 miles south of Reno, Davis Creek campground offers over 60 overnight sites along with equestrian trailheads that provide access to the Toiyabe National Forest. The campsite is well-known for outstanding views of Washoe Valley and Slide Mountain and includes picnic areas, a small pond and nature trails. Showers are also available.  Donner Memorial State Park Truckee, Calif.  12593 Donner Pass Road Cost: $35 per night Dogs? Contact for information. Information/Reservations: (530) 582-7892 or www.parks.ca.gov If you're looking for a little more to your camping adventure than what nature has to offer, Donner Memorial State Park may be the ideal campground for you. The park includes the Emigrant Trail Museum, with historical and regional exhibits including the Donner Party tragedy during the severe winter of 1846, as well as hiking trails, Donner Lake swimming and picnic areas. Fallen Leaf Campground South Lake Tahoe, Calif. 2165 Fallen Leaf Road Cost: $33 to $84/day Dogs? Allowed at tent and RV sites (a maximum of two pets per site); prohibited on beaches. Information/Reservations: (530) 544-0426 Nestled among pine and aspen trees and wildflower meadows, Fallen Leaf offers campers the best of both worlds: mountain landscapes and lake recreation. Located less than a mile away from the south shore of Lake Tahoe, the campground features more than 200 camping sites including tent, RV and several yurt rentals.   There are many shady campsites for campers to choose from, as well as food lockers, toilets, showers and a general store. The lake is only a short walk from the sites and features views of Cathedral Peak (8,200 feet) and Mount Tallac (9,738 feet) and there are several trails for hikers. Pyramid Lake Marina & Beach Camping Pyramid Lake Pyramid Lake Store, 29555 Pyramid Lake Road Cost: $9 per day Dogs? Allowed without restrictions. Information/Reservations: 775-476-0555 or www.pyramidlake.us The largest natural lake in Nevada, just 40 miles from Reno, is located between the Virginia and Lake Mountains on Paiute Indian land -- the Pyramid Lake Reservation. It's an ideal locale for boating and fishing and for those who are looking for remote beach camping and easy access to swimming. There are multiple camping spots around the lake -- including an RV park and designated and open camping -- but campers must obtain a tribal camping permit prior to settling in. Note: This is a desert lake and therefore, has limited shade. Campers should plan accordingly with shade sails and pop up shade tents.  Camp Richardson Resort South Lake Tahoe, Calif.  1900 Jameson Beach Road Cost: Contact for specifics.  Dogs? No.   Information/Reservations: 800-544-1801, reservations@camprichardson.com  Whether you're seeking the solace of a shaded forest or craving lazy beach days, Camp Richardson offers a wide variety of camping and lodging needs. Located on the south shore of Lake Tahoe, Camp Richardson features over 30 cabins, 26 lodge hotel rooms, a beachside inn, duplex and house, as well as 200 tent camping sites and 100 RV sites.  The resort campground offers year-round camping and a wide variety of services, including a marina, sports center, restaurant and a store.

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