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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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There are nearly 1 million adults living with MS in the United States alone. For comparison, that is roughly the entire population of the Reno/Sparks and Las Vegas areas combined. MS is a neurological autoimmune condition which means that the immune system of patients with MS attacks the body’s myelin, a protective substance that covers your nerves. When this happens, the unprotected nerves can be damaged. Patients with MS may experience many different symptoms ranging from mild to severe, such as mobility and vision problems, fatigue and difficulty thinking. MS is usually diagnosed between the ages of 20-50, but late onset MS can occur in patients over 50 years old. While there is no cure for MS, there are effective treatments that can help reduce the burden of patients’ symptoms and create a positive quality of life. At Renown Health, we have joined the fight against MS through a partnership between advanced neurology programs and providers and our research office. We are proud to offer newly diagnosed MS patients the opportunity to choose between standard care treatment options or participating in an open label clinical trial, the AGNOS study. This study is assessing the impact of a new medication, ofatumumab, as the first disease modifying therapy participants receive for managing relapsing remitting MS, the most common form of MS.

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Hygiene in healthcare is an essential backbone to providing the safest, most optimal care to every patient. From everyday handwashing techniques and getting all necessary vaccinations to surveilling our health system before the onset of outbreaks, at Renown Health, creating and maintaining a low-infection environment is a group effort. From ensuring fundamental infection prevention practices are carried out to identifying process improvement opportunities, Renown’s Infection Prevention (IP) department is here to help care teams be successful in their role. This effort is led by members who are devoted in sharing evidence-based best practices to our patients, employees, healthcare organization partners and community. Making “Zero” A Reality Reducing healthcare-associated infections is possible when core infection prevention practices are incorporated into the daily care of our patients. These team members are dedicated to Renown’s commitment to creating a culture of Excellence, caring for our healthcare environment, and our care teams. “Often times, when asked what we do in our work it can be a challenge to answer because unpredictability is built into almost every day; and in that, we as a team must divide and conquer,” said Susanne James, Manager of Infection Prevention. Every day, each team member is assigned a day to perform required surveillance activities. Whether they are reviewing patients’ infections and isolation and evaluating lab orders for possible infectious processes or reporting communicable diseases to the local health authorities and the CDC, every Infection Preventionist participates in improvement projects and address issues as they arise. The Infection Prevention team plans, organizes, manages and evaluates the Infection Prevention Program and ensures IP policies reflect current best practice. They work closely with all departments at Renown in order to achieve high levels of standards that are implemented to reduce transmission of infection. “As a team, we perform ‘Infection Prevention Environment of Care Rounding’ on all units and departments to ensure our environment complies with regulatory requirements,” said Erika Clark, Operations Analyst at Renown Health. "We work together with Facilities and Site Practice Leaders to ensure a safe environment.” The pandemic challenged all Renown teams to find creative solutions for issues no one ever imagined. Our Infection Prevention department worked tirelessly alongside Renown's Hospital Incident Command Structure (HICS) and care teams in creating several lines of defense against COVID-19, including: Launching Renown's Alternate Care Site to meet the need for critical patients. Bringing on the new lab tests and specimen collection criteria. Managing demand for personal protective equipment (PPE). Bringing vaccines to staff and then to the community. Managing ill employees and our visitors. Keeping all locations informed on pandemic status and changes (which were occurring at breakneck speed). These initiatives enabled Renown's care teams to focus on providing the safest care possible to patients saving countless lives. This solidified the fact that together, the team can accomplish anything. “Infection Prevention is proud to be a valued and respected member of the care team,” said Susanne James. “We appreciate being a trusted resource and take this responsibility seriously as this enables us to provide staff the best possible tools to be successful.” Fight the Good Fight Against the Spread of Disease Educating patients and providers plays a huge part on the Infection Prevention stage. This team provides educational materials on a range of topics, some of the most important are, proper hand hygiene and the use of PPE. All these materials can be found throughout our health system and serve as an important reminder – infection prevention starts with all of us. “We partner with every aspect of the health system – environmental services, nutrition services, lab services, facilities, pharmacy, physical therapy and occupational therapy, respiratory care, patient access, security, nurses, providers and quality...just to name a few!” said Susanne James. Our Infection Prevention team also partners with Washoe County Health District and other public health agencies to report – and in turn, stop the spread of – diseases and exposures. These close partnerships poise our team to do what we do best: Fight the Good Fight. “I greatly appreciate everyone in the IP department for sharing their expertise as I learned a new position,” said Erika Clark. “I love working with my team and how closely we work with other departments to ensure excellence in all we do.” Our health system is ever-changing. But according to the experts in our Infection Prevention department, the three main ways to prevent illness and disease that remain the same time and time again are to: Clean your hands. Hand hygiene is the most effective way of preventing the spread of infections. The CDC recommends washing your hands with warm soap and water for 15-20 seconds or using an alcohol-based hand sanitizer. Clean your hands often and assist our patients to do the same. Learn expert hand-washing advice here. Get vaccinated. Immunizations are one of the top methods you can embrace the fight against preventable diseases, such as COVID-19, flu, measles, tetanus and more. Discover how you can get vaccinated with Renown. Keep germs from spreading. Practice good hygiene by covering your cough or sneeze or wearing a mask and sanitizing frequently touched spaces. Stay home if you feel ill to prevent the spread of illness and infection. Be sure to bring up any illness concerns with your primary care provider. “Every aspect of our health system has an infection prevention component, and we work daily to ensure our staff, patients and visitors are providing and receiving care free from potential harm or infections,” said Susanne James. “We are often the first call staff make when they have questions, concerns or just need someone to help improve process or outcomes.” Reveling with Renown Proudly defining themselves as a “small but mighty” team, the six-person Infection Prevention department moves mountains to ensure the safety of anyone who walks through Renown’s doors. The tight-knit nature of this team can be felt from miles away, and to them, being “small but mighty” is not a hindrance, as they have the support of the IP Champions and the entire health system.   “I originally came to Renown in 2018 as a nurse traveler, the facility and people I worked with immediately made an impact on me,” said Brian Stroud, Infection Preventionist at Renown Health. “My wife and I chose Renown and Reno due to the positive impact the people had on us. Everyone is welcoming, helpful and caring. Now, I am a full-time employee, and the team has made my transition into infection prevention trouble-free." Renown’s mission of providing a genuine difference for the health and wellbeing of the community is heightened and echoed by the Infection Prevention team. “I chose Renown because of the reputation Renown has earned in the community because of the excellent care and level of services provided,” said Shannon Oriola, Infection Preventionist at Renown Health. “I absolutely love this team and my Renown family!” “What brought me to Renown was the opportunity to acquire diverse skills which then motivated me to pursue my master’s degree,” added Paul DeLeon, Infection Preventionist at Renown Health. “What keeps me here is the people – Renown attracts hard working, ethical and caring people.” "My wife and I loved coming out to the Nevada mountains on vacations," added Russ Laarman, Infection Preventionist at Renown Health. "After being in Michigan for 47 years, we took the plunge and made NV our home. The experience has been great! I work with a great team that is very knowledgeable and works hard to ensure positive outcomes for our patients and colleagues at Renown.” Their pride shines through with their own individual accolades, both inside and outside of work. This past year: Shannon Oriola received a scholarship from the Association for Professionals in Infection Control and Epidemiology (APIC) for “improving outcomes through knowledge and practice,” which provided her with a $1,000 scholarship to attend the annual APIC conference in Indianapolis. Paul DeLeon earned his Certification in Infection Control and Prevention from APIC. Erika Clark completed Renown’s High Potential program, a six-month program that gives employees hands-on learning experience with several competencies, including emotional intelligence, effective communication, building successful relationships and organizational knowledge. Brian Stroud and his wife Charla became official Nevada residents. Russ Laarman scaled Mount Whitney. ...And the list keeps growing! Charged with the goal of keeping disease spread at bay, our Infection Prevention team remains vigilant and dedicated to their mission. Their commitment to Renown and to keeping our health system clean and healthy proves the age-old saying true: not all heroes wear capes. “I’m so very proud of the work Infection Prevention does every day, working with the vast teams throughout the health system to improve lives,” said Susanne James. “We would like to thank all of you for protecting the health and safety of your colleagues, our patients and the community.”

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Excess amounts of sodium doesn’t just increase your risk of a heart attack, it can also increase your risk of a stroke. Unfortunately, avoiding that saltshaker may not be enough. Did you know that the average American consumes 3,400 milligrams of sodium each day? That’s a dangerous number considering that the American Heart Association recommends limiting daily sodium intake to 1,500 milligrams (about half the weight of a penny) to reduce the risk of heart disease and stroke. The problem is not necessarily that you’re putting too much salt on your food, it’s that salt is already in the foods you’re regularly eating. To help keep your sodium intake at a healthy level, make sure you’re aware of “The Salty Six,” six sneaky foods that are surprisingly high in sodium. Breads, Rolls and Tortillas: Although breads and tortillas may not initially appear to be high in sodium, we often consume several servings. Make sure to keep track of your total servings to see how they add up. Deli Meat, Cured Meats and Poultry: It may surprise you that six thin slices of deli meat can add up to more than half of your daily limit, so be mindful when building those sandwiches. Also, do your best to avoid cured meats, which often means the meat has been salted. Substitute uncured, skinless meats instead. Cheese: Salt is an important addition in the cheese-making process, as it prevents bacterial growth. Unfortunately, that added salt can increase your health risks. Limit the amount of cheese you add to meals to keep your sodium content down. Pizza: Take a quick look at the first three items above and it should be no surprise as to why pizza made the list. One slice and you’ve met at least half of your daily limit. Go easy on the cheese and try adding more veggies instead of meat. Canned Soup: One cup of canned soup can be as high as nearly 1,000 milligrams of sodium. When shopping for canned soup it’s important to check the label – not just on sodium content but serving size as well. Always select low-sodium options when possible or cook your own soup at home. Sandwiches and Burgers: A sandwich or burger from your favorite restaurant can contain more than 100 percent of your daily sodium limit. When dining out, it is best to select low-sodium options or eat a half portion to limit the amount of salt. If some of your favorite foods are on this Salty Six list, don’t panic. Although these foods can be high in sodium, it isn’t necessary to cut these foods out of your diet completely. It’s just important to eat them in moderation and be mindful of your daily sodium intake. Look for low-sodium options, use herbs and spices instead of table salt and do your best to stay under the recommended daily limit of 1,500 milligrams.”

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Alzheimer’s disease is not normal forgetfulness as we age. Instead, it is a specific form of mental decline. And according to the Alzheimer’s Association it accounts for nearly 80 percent all dementia cases. Natasa Dragicevic, MD, PhD., behavioral neurologist and Alzheimer’s disease specialist with Renown Institute for Neurosciences, weighs in on diagnosing it and the importance of early medical action. How to Diagnose Alzheimer’s Disease In general, the signs of Alzheimer’s disease occur slowly, getting worse over time. For example, forgetfulness is a daily search – for shoes, keys and other misplaced items. Not only is memory affected, but also speech patterns and behavior. There is no single test for Alzheimer’s disease. “Specifically, a neurologist should be the one to diagnose Alzheimer’s disease given differences in presentation,” clarifies Dr. Dragicevic. “And ideally a behavioral neurologist (Alzheimer’s sub-specialist) will be managing the treatment,” she adds. Brain Imaging Diagnosing Alzheimer’s disease involves multiple approaches and medical providers. In short, medical history is reviewed along with a physical exam, lab tests and other diagnostic testing. “A medical workup includes a variety of tests. These include MRI and other brain imaging, as well as neurological and psychological testing. Furthermore, a lumbar puncture is performed to look for markers of the disease,” she states. What Causes Alzheimer’s disease? Although no one knows the cause, researchers think many factors play a role. Uncontrollable risk factors include your genetics and having a family member with the disease. However, the controllable risk factors include: reducing the risk of head injury and keeping your heart healthy. It’s important to realize that high blood pressure, high cholesterol, stroke and diabetes play a role in brain health. Blood loss to the brain causes vascular dementia, leading to long-term blood vessel damage. Symptoms of Alzheimer’s disease Generally speaking, the signs of this disease differ in each person. Yet noticeable behaviors include: • Losing the way to familiar places • Forgetting to pay bills • Trouble finding the right words when talking • Repeating questions • General confusion • Social withdrawal Alzheimer’s Disease – Benefits of Early Diagnosis Equally important, spotting Alzheimer’s disease early allows more time to benefit from medications and possible clinical trials. Likewise, nutrition and exercise changes can be made, increasing blood flow to the body, and perhaps delaying symptoms. Early diagnosis also allows for personal health decisions and quality-of-life conversations to take place.   According to the Alzheimer’s Association, these benefits include: 1. Medical advantage 2. Emotional and social comfort 3. Time to plan ahead 4. Cost savings A Brain Supporting Lifestyle “At the present time, treatment is limited,” explains Dr. Dragicevic. “Usually Alzheimer’s is a progressive ongoing disease – any management at this time is purely symptomatic.” However, she states the following lifestyle changes can help support brain health: • New hobbies such as painting, pottery, music classes or learning a new language • Crosswords, puzzles and playing games, such as Scrabble • Brain challenging mobile apps, such as Luminosity • 30-45 minutes of mild to moderate physical activity per day, such as walking • Eating a Mediterranean diet (primarily plant based foods)

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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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