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Embarking on the path to bariatric surgery is a unique and deeply personal journey. Individuals like Mary Escobar choose this life-changing route for reasons ranging from improved cardiovascular health to managing diabetes or finding relief from various health complications. In Mary's case, her two-decade-long healthcare journey not only underscores the challenges she faced but also highlights the support and expertise that ultimately led to her successful transformation through bariatric surgery. Mary's Resilience: December 2002 through February 2003 More than two decades ago, Mary experienced unforeseen health complications just days after giving birth via c-section. Septic shock, hemolytic uremic syndrome, thrombocytopenia, renal failure and a blood clot in her lung plunged her into a critical state. Intensive care, plasma exchange and a long recovery followed. After being discharged with compromised kidney function, Mary faced complete renal failure two years later, leading to dialysis and a spot on the donor list. Mary's brother, a perfect match, selflessly donated his kidney on Dec. 14, 2007, marking a turning point in Mary's health. However, the post-transplant period brought new challenges, including diabetes, high blood pressure and a significant weight gain, reaching 230 pounds. Determined to regain control, Mary explored various diets without success until she consulted with a bariatric doctor. Journey to Bariatric Surgery: November 2009 - April 2021 In November 2009, Mary opted for a gastric band, shedding 40 pounds within a year. Despite initial success, issues with the gastric band arose, prompting a consultation with Dr. John Ganser at Renown Health in April 2021. Together, they decided to transition to a gastric sleeve, with comprehensive education provided to ensure long-term success.

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Managing weight is a complicated and often difficult journey for many individuals, and obesity stands as a common and serious chronic health condition. In fact, the Center for Disease Control and Prevention reports that the prevalence of obesity in the US is greater than 40% in adults and 20% in children, and those numbers are continuing to climb. In Nevada, according to the 2020 Behavioral Risk Factor Surveillance System, 28.7% of adults reported being obese. By 2030, almost 80% of American adults may be overweight and half of them will be obese. But obesity isn't just about the numbers on the scale; it's a multifaceted, lifelong, neurobehavioral disease triggered by a combination of factors. These include abnormal eating patterns, reduced physical activity levels, environmental stressors, genetics and various other contributors. Obesity extends far beyond appearance, often leading to the development of numerous medical conditions such as diabetes, heart disease, elevated blood pressure, stroke, sleep apnea, liver disease, various cancers and infertility. Join us as we delve into the complexities of obesity and explore strategies for effective weight management available right here in northern Nevada. Why Can Losing Weight be so Difficult? The challenge behind weight loss finds its roots in the Set-Point Theory of Obesity, a concept that says our bodies have a predetermined weight, or fat mass, within a defined set-point range. In other words, when an individual's weight deviates from this set point, the body initiates mechanisms to bring it back to the established range. So, if someone loses weight below their set point, the body may respond by increasing hunger and reducing metabolism, making it challenging to sustain weight loss. There Isn’t One Right Answer, But Renown is Here to Help Various weight management strategies can be utilized by patients struggling with obesity, which may lead to substantial weight loss, resolution of associated medical conditions and improved psychosocial health. In fact, the most successful strategy involves a multidisciplinary approach under the guidance of trained specialists that includes a combination of tactics, including: Behavioral adaptations Dietary modifications Physical exercise  Anti-obesity medications  Weight loss surgery

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Health systems across the country recently celebrated Patient Access Week from April 2-8. Join us in recognizing our Patient Access team at Renown!  Fighting the Good Fight starts the moment a patient steps onto the grounds of our health system. When patients visit Renown on their healthcare journey, they look to the experts to not only help them navigate through the complexities of the process but also ensure their experience with us starts off on the right foot.  Renown Health’s Patient Access Representatives (also referred to as “PARs”) are the faces of this entire process. As the key links between patients, providers and insurers, they strive to create a welcoming and respectful environment for everyone. PARs are committed to providing all of Renown’s patients access to the quality care when needed. After all, it’s in their name!  A Friendly Face  PARs are the front faces of almost all clinical areas at Renown. As the starting point for much of the patient experience, the day-in-the-life of PARs can vary. Checking patients in and out, getting demographic information, verifying insurance, answering phone calls, fostering communication between patients and their care teams, scheduling patients for follow-ups, explaining financial responsibilities and our financial aid programs, creating an overall positive experience and environment, the list goes on – but they all remain united under one goal: setting patients off on the right foot as they access care through our health system.  “Each day, PARs are met with new patients who are seeking solutions to different concerns,” said Macy Betts, PAR for Renown Women’s Health. “We are the front doors to this department. We are not just checking patients in and out; we are the first step to the patients receiving the care they deserve.”  “We take pride in our work,” added Tanya Quintanilla, Shari Longley and Nancy Arroyo Garcia, PARs for Renown Pediatrics. “Usually, we are the first point of contact within Renown, so we don’t take our role lightly. For example, when we see a newborn, we must ensure the registration has been verified, which consists of patient demographics, patient preferences and insurance verification. We need to be consistent and thorough because what we do affects every point of contact a patient may have within Renown.”  “As my team’s senior PAR, my day begins with gathering the outpatient therapy work queue numbers and assigning the team to work them,” added Logan Johnson, Senior PAR in Pre-Registration at Renown. “Our goal is to contact and schedule patients for physical, occupational and/or speech therapy as soon as possible so that they have the maximum benefit and can get back to a normal life as quickly as possible. Our encounters can make or break the entire experience.”  PARs never underestimate the power of good communication and compassion. Even during the busiest of times, our PARs work diligently to ensure all patients and their care teams fully understand the administrative side of whichever part of their journey they are about to embark on, lending a helping hand and a smile.  “Whether you’re communicating with patients, leaders or coworkers, communication is key,” said Jonathan Figueroa, PAR for the Renown Institute for Heart & Vascular Health (IHVH). “We try and make sure that we do everything possible to make their visit go as smoothly as possible.”  “Communication makes the world go round,” added Keith Madrona, Sherry Riley, Erika Rios and Andie Kilpatrick, PARs at Renown Urgent Care – Ryland. “Having a friendly attitude and demeanor is very important.  “The PARs in Labor & Delivery do so much more than just registering patients – from escorting expectant parents to their rooms, welcoming newborn babies, processing pre-estimates and more – and the patience and excellent communication I receive from other teams is what keeps me going,” added Nanci Barash-Vietti, PAR for Renown Labor & Delivery (L&D). “This is critical to the success and effectiveness of the PARs in our department.”  Shift changes for PARs mimic other teams at Renown, leveraging technology and both written and spoken communication to ensure the next shift begins successfully.  "When I come in, the night shift will give me a report on what is going on and what the schedule looks like during the day; then I log in to my computer and get everything that I will need for that day up on the screen,” said Allie Boracchia, PAR for Renown L&D. “Usually around this time we have a 7-8 a.m. induction scheduled for the first patient, so I will grab the pre-made packet that the night shift put together, the unit clerk will call the nurse to get a room number, and I take the patient to the room and have them sign all the forms. After the patient has the baby, then we admit them and finish registration. This is continuous all day long.”  Our PARs all agree that regardless of the setting, whether it be emergent or routine, every patient is looking for that advocate from the moment they enter through our doors.  “Being friendly, patient and understanding is a must,” said Sheryl Lundgren, PAR for the William N. Pennington Institute for Cancer. “It is so nice being able to brighten the days of patients who are living with a cancer diagnosis.”  “In the urgent care setting, a lot of the patients we see are not feeling their best, so it is important that we show them we care and are here to help make check in go smoothly,” added Sam Deithrich, PAR at the Renown Urgent Care – Los Altos.   “Patients are relieved that they are speaking to a real person that will help set up appointments,” added Rick Jordan and Celeste Landry, PARs in Lab Services at Renown South Meadows.   PARs embrace lifelong learning at Renown, especially as their roles differ day-to-day. They are always ready to jump in and assist on tasks that might be new for them, growing their skills on the job and never hesitating to say, “How can I help?”  “As a PAR, you are always learning new things, even when it seems like you know just about everything,” said Liz Cardenas-Ramos, PAR for Renown Endocrinology. “It’s been such a positive experience.”  “Giving yourself grace to learn and grow in Patient Access is the key,” said Maggie Savoie, PAR for Renown Primary Care – Fernley. “I find myself learning every day at Renown, and if you’re learning, you’re growing. Being able to take a breath and say, ‘this is a learning opportunity for me, and tomorrow I will be better a better PAR because I’ve gained this knowledge’ is an amazing way to stay positive in the position.”  “In L&D, we are all multi-tasking, and every day I am learning something new about my department and patients, as well as how to excel in my position,” added Nanci Barash-Vietti.  Renown PARs are the front lines to health care access, and they wear that badge with pride. Jeanette Flores, PAR in the Emergency Department at Renown South Meadows, sums up the role of Patient Access well: “Talk about first impressions!”  “I am proud of our team and the excellent care we give our patients,” said Dawn Linker, PAR for the Renown IHVH. “We want them to have a good experience.”  Impactful Accomplishments  The role of our Patient Access team members goes beyond the desk. A patient’s healthcare journey begins, and sometimes even ends, with the helping hands of our PARs, leaving a lasting positive impression of Renown.  "Our interactions with the patients make a difference before they see the provider, so we always demonstrate a welcoming and helpful atmosphere for the patients to feel like their needs are being met,” said Mary Dettling, PAR for Renown Endocrinology.  “I love seeing the difference we make in peoples’ lives,” added Shannon Leone, PAR for the Stacie Mathewson Behavioral Health & Addiction Institute. “We can get patients at their toughest and worst times. Watching them overcome their fears, traumas and addictions has been very rewarding.”  Our PARs don’t just make goals for themselves – time and time again, they surpass them, all in the name of patient experience and excellence.  “We have not only met our monthly point-of-sale scores, but we also have exceeded our stretch goal for the last eight months and our scores have been in the 50th percentile or higher,” said Jeanette Flores.  “Along with being the top point-of-sale collectors, we have also been known to be some of the sweetest and most helpful staff at South Meadows,” said Katie Morrill, PAR in the Emergency Department at Renown South Meadows.  As their teams grow, so does their impact on our patients. PARs are dedicated to providing the best customer service possible, and with their expanding teams, that service goes even further, even throughout the pandemic.  “A year ago, we only had one PAR; now, we have a full and amazing team,” said Alex Bucholz, PAR for Renown Advanced Wound Care. “We have come so far in a short amount of time.”  "During the pandemic, we have maintained a core group of individuals who come in every day and help keep this office and all its parts moving smoothly,” added Shannon Leone. “We have maintained a full patient load the last three years and never had to close our office for any reason. We have even had the opportunity to start our Medicated Assisted Treatment and Transcranial Magnetic Stimulation programs.”  "We successfully operated and maintained our pediatric COVID clinic, which is the only one within our five clinics,” added Tanya Quintanilla, Shari Longley and Nancy Arroyo Garcia. “We feel proud knowing our tiny humans are protected with the COVID vaccine.”  Like many other teams at Renown, our PARs are masters at teamwork. Despite any obstacles that may happen along the way, they are always there for each other to ensure every patient gets the care and attention they deserve.  “We call ourselves the ‘A-Team’ here in Pulmonary,” said Shannon Birnberg, PAR for Renown Pulmonary & Sleep Medicine. “We have persevered through changes, additions and departures. We are most proud of bringing different personalities to the team and being super strong and effective.”  “I have noticed the team always steps up whenever needed,” added Brittany Hughes, PAR for the Renown IHVH. “Everyone has a great attitude and is very positive!”  “While our team is fairly new, we are growing together, learning our strengths and weaknesses and always pushing for stronger unity,” added Angel Freer, PAR in the Emergency Department at Renown Regional.  When our PARs find ways to simplify a process or make a workflow run more efficiently, they don’t waste any time in making that happen. They take any opportunity to enhance patient experience.  “Our team came up with a solution on how to get patients registered faster,” said Jess Castillo-Marquez, PAR in Lab Services at Renown Regional. “We came up with modalities which assign each PAR their own procedure in which they will be registering for during their scheduled shift. It has been a great success, helping our productivity and keeping our patients satisfied with our service.”  “We are proud of our successful implementation of our new therapy workflow,” added Logan Johnson. “Patients are now waiting much less to be contacted about their care.”  Our PARs know that teamwork makes the dream work, and their commitment to the patients they serve – and the goals they continue to blow out of the water – continue to inspire them daily.   “You are only as strong as your team,” said Aundie Yonker, PAR in the Emergency Department at Renown Regional.

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Do you know your blood pressure numbers? Dr. Michael Bloch explains how maintaining healthy numbers are important for good quality of life and increasing longevity. High blood pressure, or hypertension, affects 85 million Americans – that’s one in three people. Left untreated, it can lead to serious and sometimes life-threatening health concerns such as vision loss, kidney disease, heart failure, heart attack and stroke. But what is it, exactly, what makes it go up and why is that increase in pressure so dangerous? All About Blood Pressure In order to function properly, your body requires a continual supply of oxygen rich blood, which is goes to organs and tissues via blood vessels called arteries. Your beating heart produces the force (or pressure) your vessels require to move blood. This is your blood pressure. Your blood pressure numbers reflect two forces at work – the pressure created as blood is pumped throughout the body (systolic) and the pressure when your heart is at rest in between beats (diastolic). A normal, healthy reading shows a systolic level at 120 or below over a diastolic level of 80 or less: 120/80. An increase in pressure occurs slowly over time, straining the circulatory system and forcing the heart, blood vessels and tissues to work harder. This friction damages blood vessel walls and lets plaque buildup from LDL cholesterol, setting the stage for hardening of the arteries. As more and more plaque builds up, your blood vessels narrow, further raising blood pressure, damaging the circulatory system and increasing your risk of serious health conditions. The Silent Killer High blood pressure is known as a “silent killer,” as most people with it have no symptoms. In fact, one in six of those affected don’t even know they have the condition. That’s why it’s so important to know your numbers. The only way to find out if you have high blood pressure is to have it measured, either by a health professional or using a home monitor. If your numbers are high, there are things you can do to help lower it – it is treatable, but not curable. You can manage it with medications and lifestyle changes including: Adhering to the Mediterranean diet Decreasing sodium intake Avoiding excessive alcohol consumption Increasing exercise and activity levels Losing weight Prevention and Genetics Even better? High blood pressure doesn’t just happen. You can prevent the condition altogether. How? Know your numbers and know your risk. Look at your family medical history. Genetics certainly increases the risk of it, but those same lifestyle choices that can improve poor blood pressure can also prevent you from developing it. So if your numbers are good, keep them that way – eat well, move your body, maintain a healthy weight and drink alcohol in moderation.

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You’ve likely heard about bariatric surgery — and perhaps even have friends who’ve done it. But is it a potential solution for you? Here, Dawn Remme, RN, Metabolic Bariatric Surgery Program Manager, provides insight. You may have been struggling with excess weight for years. You’ve tried high-protein diets, low-carb diets and more. Most patients considering weight loss surgery have tried numerous dieting methods. The truth is, some patients who suffer with obesity are successful dieters. Unfortunately though, excess weigh often returns. This impacts their health and the quality of their life. It can be a disheartening battle. Weight loss surgery is a big decision. In making this decision, keep in mind that surgery is only one step toward your goal of achieving better health. It is neither magic, nor is it the “easy way out.” Weight loss surgery can offer you a TOOL to help you become more successful in controlling the disease of morbid obesity. By combining this tool with a lifelong commitment to important lifestyle changes, medical follow-up and nutritional modifications, you have the potential to become a healthier you. Bariatric Surgery By the Numbers Exploring the facts about obesity, how it impacts your health, and how surgery can resolve or significantly improve your chronic medical conditions is the first step to making a decision. Obesity is medically defined as “excess body fat” and is measured by a mathematical ratio known as the Body Mass Index (BMI). To calculate your BMI, we consider your height, weight, age, gender and body build. Here are the standards: “Normal” BMI: less than 25 Overweight: 25 – 29.9 Obese: BMI of 30 – 39.9 Morbid obesity: BMI of 40 or more Morbid obesity (BMI over 40) is a lifelong, progressive disease, and the prevalence of morbidly obese Americans (100 or more pounds over a healthy weight) is increasing rapidly. According to the CDC, the disease of obesity affects 78 million Americans. Further estimates indicate about 24 million have morbid obesity. Serious medical problems known as co-morbidities often occur when someone is morbidly obese. Studies tell us conditions such as type 2 diabetes, high cholesterol, sleep apnea, high blood pressure and degenerative arthritis increase in severity as the BMI is increasing in patients. When may weight loss surgery be an option? When someone has a BMI greater then 40. If a person’s BMI is 35 – 39.9 and they have significant health problems such as type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, or other diagnosed health conditions related to obesity. Gastric Sleeve, Gastric Bypass Explained To resolve or significantly reduce these health conditions, bariatric surgery can be done when diet and exercise haven’t worked. Weight loss surgery makes changes to your digestive system to help you lose weight. The gastric sleeve limits how much you can eat, whereas gastric bypass limits how much you can eat and reduces the absorption of certain nutrients. Other Benefits of Surgery You can greatly increase life expectancy by resolving or significantly improving conditions like diabetes, high cholesterol, high blood pressure, sleep apnea, and obesity itself. Infertility can also be positively affected. A significant weight loss and relief from serious health conditions and diseases will greatly improve your quality of life. Studies tell us that type 2 diabetes is resolved or significantly improved in 84 percent of patients following bariatric surgery. Cholesterol levels dropped in 95 percent of patients. And hypertension and sleep apnea showed improvement in 68 and 80 percent of patients, respectively, following bariatric surgery. Bariatric Surgery at Renown In making the decision to move forward to better health, it is important to remember: Obesity is a disease, and the desire to have a healthier, longer, more fulfilling life is possible. If you are interested in learning more, please visit the Bariatric Surgery Program page to view more information about Renown Regional Medical Center’s MBSAQIP accredited bariatric program, as well as information about upcoming educational seminars. Or call 775-982-RSVP (7787) to reserve your seat. Learn More

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There are some important numbers to know when it comes to good health. Learn more and receive a free blood pressure check at a primary care open house Feb. 27 at Renown Medical Group – Double R. Know Your Numbers Adults are pretty good at knowing and memorizing numbers — from passwords and PINs to addresses and phone numbers. But what about the numbers that could help save your life? Heart disease remains the leading cause of death in the U.S., with 633,842 deaths attributed to the disease in 2016, according to the National Center for Health Statistics. The American Heart Association lists the vital numbers you need to monitor to help prevent heart disease as blood pressure, total cholesterol, blood sugar and body mass index (BMI). With these numbers, your doctor can assess your risk of developing heart issues such as atherosclerosis, which can lead to other serious heart conditions. Atherosclerosis is a condition wherein plaque builds up in the arteries — the blood vessels that transport oxygen-rich blood to cells, the heart and other organs. These fatty deposits clog the arteries, inhibiting blood flow and reducing the amount of much-needed oxygen the body receives. These blockages can lead to angina, coronary heart disease, peripheral artery disease and even heart attack or stroke. But knowing your numbers and keeping them in healthy ranges can mitigate your risk of atherosclerosis and other heart conditions. First things first: Make an appointment with your healthcare provider to see how you’re doing. Learn your numbers and discuss how they may increase your personal risk of heart disease: Total Cholesterol Because cholesterol contributes to the buildup of plaque, keeping your numbers in check means keeping your arteries free of blockages. Check LDL (bad) cholesterol and HDL (good) cholesterol. Your body needs low levels of LDL, but not enough good cholesterol in your system can also increase risk. You can maintain healthy numbers by staying physically active and consuming a heart-healthy diet low in cholesterol and sodium. Statins, the class of drugs used to reduce LDL cholesterol, have proven so effective that the U.S. Preventive Service Task Force recommended in November that all adults older than 40 with one or more risk factors consider taking them. Blood Pressure High blood pressure places undue strain on your heart and arteries to move blood and oxygen throughout the body. And a heart that’s working too hard can lead to stroke, heart attack and heart failure. High blood pressure cannot be cured, but it can be managed by eating a heart-healthy diet low in alcohol, staying active and maintaining a healthy weight. Blood sugar Given that the body converts most of the food we eat into glucose, or blood sugar, for energy, adding sugar to the diet can raise blood sugar to unhealthy levels and damage the heart, increasing risk of cardiovascular disease and obesity. Opt for foods that are low in fat and added sugars and, instead, get your sweets in naturally occurring foods. Let added sugars be a treat and not the norm. Body Mass Index (BMI) Your BMI is used to determine whether you’re at a healthy weight. If you’re carrying extra pounds, the heart has to work harder, which increases risk of heart disease. Losing those pounds and maintaining a healthy weight reduces the burden on your heart and blood vessels and improves your blood pressure and cholesterol levels. So eat a heart-healthy diet and get active — even if you simply walk for 30 minutes a day. Because no symptoms indicate that you have poor cholesterol numbers, high blood pressure or high blood sugar levels, getting screened and learning your numbers is vital. Your doctor can determine what healthy levels look like for you individually and work with you to develop a plan for staying in optimum ranges. That plan will include heart-healthy eating, exercise, abstaining from smoking and, in some cases, medication. It’s up to you to stick with that plan between doctor visits. Do it for yourself, but consider making a pact for a more heart-healthy, active life with a buddy. Research shows people stick with exercise plans longer when they have a partner. This article also appeared in the Reno Gazette-Journal’s Health Source Aug. 27.

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