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© Africa Images via Canva.com Do you find yourself struggling to stay awake during the day or having no energy? You’re not alone. Whether you’re a full-time employee, a student or retiree, that “I’m tired” feeling comes in all shapes and sizes. What’s even more frustrating is not knowing the source of your exhaustion.  Dr. Brandon Flores, a sleep medicine physician with Renown Medical Group, breaks down nine key reasons why you may be feeling so fatigued.  You did not get enough sleep, or your quality of sleep is poor. This may seem obvious, but in today’s “rise and grind” culture, sleep can be considered a luxury rather than what it really is: a necessity. Ensuring you get adequate hours of sleep between 6-9 hours and quality sleep is essential. You may not be breathing well during sleep. Interruptions to your breathing, such as snoring, can decrease airflow at night causing your sleep to be less restorative. This is often due to Obstructive Sleep Apnea (OSA). OSA can lead to daytime fatigue and sleepiness and can also impact other chronic health conditions, such as hypertension, diabetes, acid reflux, migraines and heart rhythm. You are not getting enough regular exercise, or you are exercising too much. Incorporating at least 30 minutes a day of physical activity can help keep you energized throughout the day. It has also been shown to increase deep slow wave sleep, which is often associated with feeling rested. On the other hand, getting too much exercise can tire you out more easily and heighten stress levels. You drink too much caffeine. This one may seem counterintuitive – caffeine is supposed to keep you awake, right? Well, overdoing it with your favorite coffee or soda could affect your sleep quality. Pay attention to your caffeine limits and have a cut-off time, as most caffeine should not be consumed past noon. You have a food allergy or intolerance. If you find yourself feeling especially tired after eating a lot of a certain food, you could have an allergy or intolerance to it – and vice versa. Consider speaking with your primary care provider (PCP) about a food allergy test or being referred to an allergist. You’re drinking too many alcoholic beverages. Alcohol is a depressant, which as the word implies, can make you feel especially tired during the day. It can also affect your breathing at night and disrupt your sleep cycle. Cutting back on alcoholic drinks may be beneficial to your overall health. You are anemic. This is the leading cause of fatigue in women but can affect people of all genders. It can be associated with low iron. Eating foods high in iron, including leafy greens and many different meats, can help your iron levels. A blood test ordered by your PCP can help you understand if you are iron deficient. You are experiencing depression or anxiety. Emotional exhaustion can be just as taxing as physical exhaustion. Prolonged feelings of sadness, hopelessness, nervousness or panic can be signs and symptoms of depression or anxiety. Speak with your provider about the many resources available to help you. You have an underactive thyroid. Feeling fatigued can also be a symptom of hypothyroidism, which affects your metabolism and energy levels. Medication can help get your thyroid back to normal. Your PCP can order a blood test to determine your thyroid levels.  If you experience severe exhaustion that lasts six months or longer, worsens after physical or mental exertion and does not get better after resting, it could be a sign of myalgic encephalomyelitis, otherwise known as chronic fatigue syndrome (CFS). This is a diagnosis of exclusion, and other causes must be ruled out. While there are no tests that detect CFS, your provider can order blood and urine tests to rule out other causes of your fatigue and help develop a care plan.

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Every year, 170 Children's Miracle Network Hospitals (CMNH) across the country name a champion in each of their local communities who will serve as the face for children treated at their community’s children's hospital. Emmalee Sutton, 16, served as Renown Children’s Hospital Champion Child for the past two years, raising awareness for children’s healthcare in northern Nevada and across the nation. A Fighter from the Start Emmalee was diagnosed at age two with autoimmune hepatitis and Addison’s disease, which means her body underproduces critical hormones. It also means that, from an early age, Emmalee spent a lot of her time within the walls of Renown Children’s Hospital. She has endured a long road of illnesses and hospitalizations since, including her gallbladder being removed at age eight, port surgery at 13 and she has received several liver biopsies over the years. However, this disease does not define who Emmalee is; in fact it empowers her to be a fighter for herself and for other kids just like her who are battling disease and illness from a young age. Despite these challenges, Emmalee is a source of hope and inspiration to everyone she meets, never allowing her medical conditions to hold her back. Emmalee knows her story will inspire other young patients to continue fighting and believing in themselves. “Instead of complaining about all the things I can’t do, I celebrate all the things I can do,” Emmalee said. A Voice for Kids and Families Like Hers In her time as our Champion Child, and even well before the official title, Emmalee was a spokesperson for all the children in our community who need care. Since moving into the role of Champion Child in 2021, Emmalee has accomplished an impressive amount over the past two years. To name a few, here are some accomplishments Emmalee has achieved as Renown's Champion Child: Touring donors around Renown Children’s Hospital Promoting Renown’s Panda Cares Center for Hope Helping at Costco each year during their Miracle Balloon Campaign Making blizzards at Dairy Queen on Miracle Treat Day Standing on stage with The Beach Boys to share her experiences in the hospital and talk about the need for outstanding critical care close to home Attending Reno Health Foundation events announcing donations to Renown Children’s Hospital Working alongside NFL legend Steve Young, championing the importance of music therapy for kids staying in the hospital with the announcement of Sophie’s Place Being featured in a television show pilot with the National Automobile Museum In September 2021, Emmalee was awarded the Reno PBS Spotlight Award for Extraordinary Youth. She was highlighted as an individual who makes a positive impact on her community. For her efforts, Emmalee was honored with a $1,000 award, which she generously donated to Renown Children's Hospital. Emmalee’s commitment to Renown inspires us to continue Fighting the Good Fight for our youngest patients, so we can continue to provide the best care for kids like her. Dream it, Wish it, Do it While Emmalee’s tenure as Champion Child ends this month, her passion for helping members of our community is just getting started. Inspired by her drive to work with young girls, Emmalee is taking a counselor-in-training course with the Girl Scouts. She is excited to shape the future of these girls' lives by being a mentor and leader. She has been a Girl Scout for nine years and gives credit to the organization for making a positive impact on her life and contributing to many of the leadership qualities she possesses today. “The Girl Scouts has helped me understand that I am a strong, independent, compassionate young lady, and I use those thoughts whenever I am having all the health issues I have had to endure,” Emmalee said. What else is next for Emmalee? She hopes that being a Girl Scout and training to be a counselor will help her achieve her long-term goal of becoming a pediatric nurse. “I can’t thank the nurses and doctors at Renown enough for the love and care they have given me and continue to do so. They are my inspiration!” she said. But for us, Emmalee is the inspiration. From all of us at Renown, thank you, Emmalee. You motivate us to be our best. How You Can Help Make a Difference Renown Health is focused on being the destination for all your family’s health and healthcare needs. As a not-for-profit health system, Renown relies heavily on community funding. If you are interested in supporting Renown Children’s Hospital, and kids like Emmalee, please consider giving to Renown Health Foundation. Donations are accepted through the following ways: Make a gift at renown.org/give Call Renown Health Foundation at 775-982-5545 Mail a check to Renown Health Foundation, 1155 Mill St., 02, Reno, NV 89502

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Overcoming poverty is not a task of charity, it is an act of justice. Like slavery and apartheid, poverty is not natural. It is man-made and can overcome by the actions of human beings. Sometimes it falls on a generation to be great. You can be that great generation. Let your greatness bloom. – Nelson Mandela, February 2005, Make Poverty History Campaign in London Lifting away the curtain that symbolized the front door, I entered a dark, cinderblock room and instantly became overwhelmed by an unpleasant odor. Working with oncology patients as a Child Life Specialist and an Occupational Therapist for over ten years, I recognized that smell. I had arrived in Guatemala – more than 3,000 miles from Reno – and it was my first day of a week-long trip where I would be serving alongside physicians in low-income communities providing free medical care for residents. My name is Brittany Jemmoua, I am an occupational therapist at Renown, and I recently volunteered with Kalan Kuxtal, a non-profit Guatemalan organization. I served alongside physicians by providing free primary care mobile clinics and home visits. The care we provided focused on prevention, intervention, education and lifestyle/medication management as we partnered with local entities, such as fire stations, community centers and schools to transform hundreds of lives. Speaking in both English and Spanish, I collected patient intake information, performed exams, tested for diabetes, and collaborated on a diabetes research project focused on daily risk assessment. Beyond these tasks, I immersed myself in the culture and learned more from the Guatemalan people than I could have ever imagined. Similar to Renown, Kalan Kuxtal Operates with Community at its Core Kalan Kuxtal, a Mayan expression meaning “life guardian,” is different from other volunteer medical trip organizations, and I took home valuable insights and lessons from their way of life that I now consider daily in my practice at Renown. I expanded my knowledge about diabetes, hypertension, pharmacology, infectious diseases, pregnancy complication, vector-borne illness and tuberculosis. We conducted home visits for socially neglected populations rather than expecting everyone to come to our clinics. I found that being welcomed into people’s homes gives you a different lens in which to view how their medical diagnoses interact with living conditions, occupations, and quality of life. This is when I met Mercedes and her mom. Her mom, Ms. Valencia, had jaundice skin and a substantial Basal Cell Carcinoma aggressively protruding from her face that impacted eating, hearing, seeing, sleep and social interactions. This opportunity to serve within their home led to an important palliative care conversation that would have been missed had we stayed in the clinic. We combed the rural neighborhoods assessing people’s risk for diabetes, taking glucose tests and educating families about their next steps. Many individuals had uncontrolled diabetes and misunderstandings regarding basic health management strategies. At the end of the day, many people demonstrated feelings of empowerment by actively offering solutions regarding how they will manage their day-to-day glucose with diet and exercise. Small actions can lead to big changes, and in the long-term, these health actions can help them avoid medication costs and focus on affording basic life necessities, such as water and electricity. Kalan Kuxtal organized a cultural day that included going to local businesses and community leaders to learn more about how they support the people of Guatemala. For example, Valhalla Macadamia Farm’s main goal is to help communities gain access to income, employment, and improved wellbeing by donating macadamia trees to families to grow and then sell macadamia products. A Weeklong Trip with Lifelong Impacts Each patient made a lasting impact on me, both personally and professionally. One specific family I saw in the clinic had a unique situation in that their two-year-old daughter, Margareth Elizabeth Cifuentes Bautista, was laboriously diagnosed with irregular corneal syndrome associated with glaucoma of congenital origin. Due to Guatemala’s limited prenatal screens and interventions, Elizabeth is nearly blind. While highly spirited and happy, she trips, bumps and feels her way through life. One barrier to her healthcare access is that her hard-working parents remain well below the poverty line, making less than $900/month. I am working to connect them with generous US Ophthalmologists and pediatric eye specialists to explore how we might save her sight and help her family. Their biggest dream is that she could recover her eyesight. “I know that this is not a life-threatening situation, but it is still something that never stops hurting me,” Jorge Cifuentes, Elizabeth’s father, said. “Unfortunately, our situation here is very hard. This country [Guatemala], although beautiful, it is very difficult to get ahead. We are people living in underprivileged conditions which complicates our situation even more. However, we are still trying to thrive by being kind and hardworking people. Thank you for helping us.” I have had the privilege of an opportunity for education, access to healthcare, employment and am aware that inequity and injustice prevail. This experience reinforced my understanding that medicine is a physically and mentally demanding profession that requires a commitment to service, continuous learning and adaptation both on local and global scales. I encourage everyone to please join me in serving the underserved by volunteering. Brittany is an experienced Occupational Therapist at Renown and volunteers with Kalan Kuxtal and other entities, such as The Robert Unsworth Foundation and Rock Steady Boxing to elevate communities. She loves being an Occupational Therapist; however, her life experiences confirm that her true calling is to become a physician. She is currently applying to medical school. Brittany is eager to earn the responsibility to improve lives and communities as their engaged physician. Brittany is tentatively scheduled to return to Guatemala at the end of this year to continue partnering with the people for a better future. You are welcome to join!

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Rich, dark and super chocolaty, these sweet potato brownies are perfect for those following a paleo, vegan, gluten-free or dairy-free lifestyle.

Read More About Recipes Healthy Flourless Sweet Potato Brownies