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Heart Care, Close to Home Telecardiology is an alternative to an in-person visit with a heart specialist. It connects you to a Renown cardiologist by using a secure, video-enabled device. It can be used for consultations, examinations and follow-up appointments. Patients are seen from their local rural community clinic, close to work, home and family, minimizing the cost and time of long-distance travel for heart care.  Your Telecardiology Visit Before Your Visit You may need to have a heart test or blood draw prior to your visit. In most cases, you can have the test done locally and our heart doctor will have the results when they meet with you via telecardiology. If this is your first visit, your doctor will determine if you need any tests.   During Your Visit After check-in, a medical assistant will check your vital signs in a telecardiology room. Videoconferencing equipment will then connect you to a medical assistant to review your health information. Your cardiologist will talk with you remotely. When it is time for a physical examination, the medical assistant in the room with you will follow the doctor's instructions, facilitating the examination. A digital stethoscope will be used so the doctor can hear your heart and lung sounds.   After Your Visit Your heart doctor will talk then review their findings and you will be able to ask questions.

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While February is recognized as American Heart Month, it’s important to prioritize your heart health 365 days a year. Cardiologists play an integral role in our overall health and wellbeing – they are the experts when it comes to preventing and treating heart and vascular diseases. Dr. Jad Al Danaf of Renown Institute for Heart & Vascular Health shares eight reasons to visit a cardiologist. 1. Abnormal EKG The American Heart Association states an electrocardiogram, abbreviated as EKG or ECG, is a recording of the heart’s electrical activity to measure the rate and rhythm of the contractions in the upper and lower chambers of the heart. An EKG detects heart problems or abnormalities. If you have an EKG that shows abnormal results, you’ll want to see a cardiologist. An abnormal EKG can mean many things, such as irregular heart rate, heart rhythm abnormalities in the shape or size of the heart, medication side effects, and more. A cardiologist is most qualified to evaluate an abnormal EKG and determine the cause. 2. Immediate family history of heart disease or sudden cardiac death Knowing your family health history is essential to identify if you’re at risk for certain health conditions such as heart disease. For example, if you’re aware of anyone in your immediate family who had or has had heart problems or passed away from sudden cardiac death. In that case, you’ll want to discuss it with a cardiologist so they can determine if screenings, medications, or lifestyle changes are needed to help lower your risk. 3. Chest pain or shortness of breath with exertion If you have chest pain or shortness of breath that starts or worsens with activity, it may indicate a heart problem, and you should schedule a visit with a cardiologist immediately. Severe chest pain might be a sign of a heart attack or other serious medical emergency. If you’re experiencing severe chest pain, shortness of breath, or any other signs of a heart attack, call 911 immediately. 4. High blood pressure Have you had a high blood pressure reading? If so, it’s recommended to consult with a cardiologist for further evaluation. High blood pressure puts you at risk for heart disease and stroke, as uncontrolled high blood pressure can damage arteries, reducing blood flow and oxygen to your heart and brain.

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Renown Health patient, Alden Nash, hiking Death Valley National Park just three months after a Transcatheter Aortic Valve Replacement. Alden Nash isn’t your average 80-year-old. For much of his life, he could be found outdoors enjoying nature and hiking some of the west coast’s highest elevations. A husband and father of two, Alden turned his passion into a career as a Yellowstone park ranger in 1965. Alden believes his passion for the outdoors is responsible for his many years of health – until the unavoidable happened. The Hardest Climb The number one doctor recommendation for a healthy heart – lead a healthy, active lifestyle. Any cardiologist would be thrilled to have Alden as a patient due to his robust physical activity regimen. “Don’t have a TV set or a lounge chair in your house and you’re all set,” said Alden when asked how he has remained so fit throughout his senior years. Unfortunately, many other factors come into play when it comes to heart health, one of which is the reason we are telling Alden’s story today. Familial history - it’s a hot topic in the world of medicine. Understanding your genetic risk factors can help care providers develop updated care plans based on your results. Alden’s family has a long history of high cholesterol, which he avoided for much of his life by staying active. This combined with his age resulted in his first heart attack in December 2021. Doctors later determined that Alden was suffering from a type of heart valve disease known as aortic valve stenosis. Aortic stenosis is the narrowing of your aortic valve opening that impedes normal blood flow. Over time, the leaflets of your aortic valve become stiff, reducing their ability to fully open and close. When the leaflets don’t fully open, your heart must work harder to push blood through the aortic valve of your body. Eventually, your heart gets weaker, increasing the risk of heart failure. People who are most at risk for aortic stenosis include those who have had certain heart conditions present at birth, have chronic kidney disease or have heart disease risk factors such as high cholesterol and high blood pressure. However, generally, aortic stenosis is a degenerative process of aging with no modifiable risk factors. The incidence of aortic stenosis increases rapidly with age and is very common above the age of 80 – with 1/10 having the condition and 1/50 with a problem severe enough to warrant surgery. When symptoms are present, the disease can be rapidly disabling or even deadly, often progressing over several months unless treated.

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Feelings of grief can take on many forms and can occur in reaction to many situations, including the death of a loved one or a medical diagnosis for yourself or someone close to you. It is important to remember that this reaction is entirely natural, and many people who experience grief find outside help to be a valuable part of the healing process. Below is a list of both local and national grief and bereavement resources for all ages and specificities. If you or someone you know is experiencing grief, the trained professionals below are here to help. Solace Tree Support groups for children and teens (ages 3 to 18), young adults and their family members. For more information visits solacetree.org/grief-programs or call 775-324-7723. Healing Minds Counseling services for those coping with the loss of a loved one or major life change. For more information visit healingminds.com/grief-counseling-reno-nv or call 775-448-9760. Circle of Life Hospice Support groups open to the community held the first and third Tuesday of every month. Fore more information visits colhospice.com/bereavement-and-spiritual-care or call 775-827-2298. Summit View Hospice Grief and bereavement support open to the community-groups, memorials and by mail. For more information visit summitviewhospice.com or call 775-636-9598. The Compassionate Friends Monthly support group on the second Monday of each month for families after a child dies. Fore more information visit facebook.com/TheCompassionateFriendsofReno, compassionatefriends.org or call 775-750-7005. Healing for Survivors of Suicide Links and resources for those who have lost a loved one to suicide. For more information visit survivingsuicide.com GriefShare Grief recovery support groups meeting weekly both in-person and online with options in Reno/Sparks, Carson City and rural cities. For more information www.griefshare.org National Alliance for Grieving Children Resources for parents and caregivers to help children navigate the challenges of bereavement and grow into healthy adults. For more information visit nacg.org/resources-and-support/ Mourning Hope Grief Center Grief support groups, counseling, resources and COVID-19 support for children, adults and families before and after a death loss. For more information visit mourninghope.org Crisis Support Services of Nevada 24/7, free, confidential and caring support to people in crisis across Nevada and the U.S. For more information visit cssnv.org, call 775-784-8090 or text CARE to 839863 National Alliance on Mental Illness-Warmline A stigma-free, non-crisis phone service you can call or text that is staffed by trained peers in recovery. For more information visit namiwesternnevada.org/resources/ or call 775-241-4212. Vitas Healthcare Grief and bereavement resources and support groups both virtual and phone-in. For more information visit vitas.com/family-and-caregiver-support or call 866-489-0583. St. Mary’s - Hospice We Promise Resources on grief for all groups including children to adults, trauma, caregivers and more. For more information visit hospicewepromise.com/topics/grief or call 775-525-6700. Mountain View Mortuary Grief support and tools available to assist you in your healing journey including “365 Days of Healing” email list for daily support and comfort. For more information visit mountainviewmortuary.net/resources/grief-support or call 775-788-2199 Sesame Street – Helping Kids Grieve Discover games, videos and more on topics important to you and your child. For more information visit sesamestreetincommunities.org/topics/grie Trauma Intervention Program-Northern NV A national non-profit organization of volunteers dedicated to ensuring those emotionally traumatized receive assistance. For more information visit tipnnv.org/about-tip/resources Pregnancy & Infant Loss Support Organization A non-profit organization dedicated to the support of families who have lost a baby through miscarriage, stillbirth or neonatal death. For more information visit pilsos.org Caring Info A program of the National Hospice & Palliative Care Organization providing free resources to help people make decisions about end-of-life. For more information visit nhpco.org/patients-and-caregivers/

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Deciding on hospice care for a loved one is a deeply personal and challenging decision, balancing their wishes and medical realities. Rebecca Edwards, DNP, from Renown Hospice Care, explains the signs indicating when it might be time for hospice and offers guidance on navigating this decision with compassion and clarity. Understanding Hospice Care  Before exploring the decision-making process, it’s crucial to have a clear understanding of what hospice means. Hospice care represents a shift in how we approach living with a terminal condition, emphasizing comfort, dignity, and quality of life above all else. When there is no longer a pathway to a cure, side effects of treatment outweigh the benefits, or someone is simply tired of frequent hospital visits, then it may be time for hospice. Hospice care is mainly done in the home, where most people wish to be. It's a compassionate, team approach to care that focuses on meeting the physical, emotional, and spiritual needs, supporting their families, and honoring individual preferences. 5 Critical Signs to Be Aware Of Decline in Overall Health: When a loved one's health continues to decline despite ongoing medical interventions, this may be a sign that these treatments are no longer effective.  Increasing Pain and Symptoms: When managing symptoms such as pain, nausea, fatigue or shortness of breath becomes increasingly challenging, hospice can offer specialized support and expertise in symptom management.  Frequent Hospitalizations: Repeated hospitalizations or emergency room visits can signify that the disease has progressed to a point where managing symptoms and providing comfort at home or in a hospice setting is a more appropriate approach.  Difficulty with Daily Activities: If your loved one is experiencing difficult with activity of daily living such as dressing, bathing, or mobility, it may be a sign that they require additional support and assistance. Prognosis of Six to 12 Months: Hospice Care is typically recommended for patients with a prognosis of about one year or less if the disease follows its normal course. However, it’s important to remember that every individual is unique and prognosis can vary.

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Becoming a caregiver or playing a more active role in another’s healthcare is a big responsibility. At some point, almost all adults will support an aging parent or a loved one in need. Keeping track of their needs and wellbeing, while also prioritizing your own can become overwhelming. It’s important to know: you are not alone, and help is available. Read on for 11 tips to help you manage your time, your own wellbeing and your loved one’s care. Self-care comes first. When your main priority is the person in your life who needs care, it’s easy for your own needs to take the backseat. Give yourself time each day to focus on your personal wellbeing. It’s hard to give a loved one the care they need if your own needs are not met. Prioritize the Activities of Daily Living (ADL). Make a note of what ADLs your loved one can do alone, what they need help with and what activities require the most help. This will help you work through the day with them, as well as plan out how the day’s activities will go. Do a home safety audit. Do showers, bathtubs and steps have safety grab bars? Look around the house for additional tripping hazards, like rugs or electrical cords. If your loved one struggles with day-to-day navigation of the home, consider scheduling an occupational therapy appointment. This type of therapy helps a person develop or maintain the motions required to accomplish daily tasks. You might also qualify for a referral to in-home healthcare, such as Home Care. Have the hard conversation. The best time to discuss views about end of life care and to learn what choices are available is before a life-limiting illness or crisis occurs. With advance care planning, you can help reduce the doubt and anxiety related to decision making at the end of life. Completing an Advance Directive is a great tool to sort out all these decisions before they’re needed. Attend a free workshop to learn more and complete this important document. Identify when you need respite. Respite care involves receiving a short-term break from caregiving. Organizing in-home care for your loved one will allow you to step away and tend to your needs. By identifying what kind of respite care you are seeking, you can find the right person to provide you with that much-needed break. Don’t wait until you feel overwhelmed, plan ahead. Write down insurance contact information. Have a direct connection to the right insurance professional for support and advice. If your loved one is eligible Medicare, this is a good opportunity to review their current selections and if they would benefit from a Medicare Advantage Plan or Medicare Supplement Insurance. Seeking out expert advice or information on Medicare options is a great way to navigate this. Consider calling a broker, or attend a free educational seminar with Senior Care Plus. Gather legal and financial information. Make a list of all existing legal documents and financial accounts that your loved one has. These might include a will, advance directive, power of attorney, bank accounts or investment accounts. If you have questions about how to manage them, or need assistance in setting up additional framework, reach out to a lawyer, legal service, financial adviser or bank representative. Create an inventory of medical information. Identify where all of your loved one’s medical records are, as well as a list of providers or healthcare practices where they have received care. Consider if you should have your loved one give you Proxy Access in MyChart, which allows you to access all the features in MyChart on their behalf, including viewing upcoming appointments, viewing test results and emailing a doctor on their behalf. Make a list of what others can do. Think about all the little (and big) things that need to happen, and write down tasks that others could take care of you. When someone says “let me know what I can do” you’ll be ready with a pre-written list of items they may be able to assist with. Tasks could include tackling around-the-house repairs, scheduling lawn work, helping to walk the dog, taking a car for an oil change and cleaning. Find programs and events for social enjoyment. If and when possible, seek an activity outside of the home. Look for community centers that have programs for seniors, recreational activities or meals that you can patriciate in together. If leaving the home is not an option, arrange for visits or in-home activities, such as movie nights, card games or time to visit with family. Research long-term options. If you will be considering a nursing home or assisted living, make a list of amenities that you and the person you are caring for would like. Take this list with you when visiting potential locations to make sure you don’t forget to ask about each item.

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National Healthcare Decision Day is forthcoming. Here’s an easy and free way to commemorate the occasion: openly discussing how we want to be cared for at the end of our lives. Join Renown Health’s experts at a workshop about making decisions about an advance directive. Among the random national holidays, this one has significance: April 16 is National Healthcare Decision Day. And experts agree that the best time to discuss your views about end-of-life care and to learn what choices are available is before a life-limiting illness or crisis occurs. By preparing in advance, you can help reduce the doubt and anxiety related to decision making for your family if you cannot speak for yourself. “Completing your advance directive is a gift you give your family,” says Mary-Ann Brown, RN, MSN, director of Palliative Care. “The stress associated with these difficult decisions is decreased if everyone knows what is important to you and what you want the end of life.” What Are Advance Directives? An advance directive is a document that states your choices about medical treatment and names another person to make medical decisions on your behalf if you are unable to. This document allows you to make legally valid decisions about future medical care. Find more information about advance directives and the form online. The Conversation The first step in completing an Advance Directive is to think about what’s important to you and talk to your loved ones. The Conversation Project provides helpful tools to guide you and your family through this challenging topic. Getting this information together will help you fill out and complete your advance directives. Some things to consider and discuss with your family include: When you think about the last phase of your life, what’s most important to you? Who do you want involved in your care? Who should make decisions on your behalf if you’re not able to? Where do you want or not want to receive care? Are there specific treatments you would or would not want? Complete Your Advance Directive Planning In order to complete an advance directive, you will need either two witnesses or a notary to sign the form. Be sure to note restrictions on the witness process. When an advance directive is complete, you should keep the original. Copies should be given to your agent named in the form, your family, your doctor(s) and the location that you receive care. Renown Health offers four advance directive workshops every month to cover the details of filling out this document. A healthcare team is available to answer questions and work through the process with you. A notary is also present to finalize the process, which means you can complete your advanced directives during this workshop. Find the workshop by calling 775-982-RSVP for more information. Advance Care Planning Workshop April 17, 1-2:30 p.m. | Free Join Renown Health’s experts for a workshop about making decisions regarding end-of-life care. You will learn how to fill out an advance directive, receive one-on-one assistance and have your documents signed by a notary. Workshops are typically held several times each month. To RSVP, call 775-982-7787

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February is American Heart Month, but our incredible heart heroes are here to serve you all year long. So please join us in honoring the Cardiac Cath Lab team at Renown Health! At the core of who we all are, we find the heart: one of the largest sources of life that gives us the blood and oxygen we need to live full and healthy lives. When the heart doesn’t function to the best of its ability, a delicate approach led by cardiac experts might be necessary. These individuals can not only save lives but also help facilitate a higher quality of life.  The team entrusted to protect that vital source of life includes the hard-working and talented individuals in the Cardiac Catheterization Lab (a.k.a. “Cardiac Cath Lab” or “Cath Lab”) at Renown Health. These team members are known for their expertise, precision and quick-thinking in emergencies. When it comes to the function of your heart, you are in the best hands with this team. Their passion for Renown’s mission of making a genuine difference in the health and well-being of the people they serve is a testament to what they do every day.  Cardiac Champions  Whether the procedure is emergent or planned, the Cardiac Cath Lab wears many different hats. The team is a well-coordinated group of nurses, imaging professionals, electrophysiology technologists, interventional technologists and more who band together to provide a diverse array of services, including stent placements, pacemakers, balloon pumps, interventional angioplasties, TAVRs and of course, catheters.  “A day in the life in the Cath Lab can go various ways,” said Erica Drummer, RN at Renown Health. “Every day, you are either a part of the electrophysiology team, doing cardiac ablations and placing devises such as pacemakers; the structural heart team, which includes MitraClips for mitral regurgitation and TAVRs; or the heart catheterization team, which includes diagnostic angiograms, heart catheterizations, angioplasties and stents for clogged arteries.”  With the wide variety of cases the team sees daily, an average day in the Cath Lab consists of many moving parts.  “We handle cases from left and right heart catheterizations, where we can diagnose and fix the artery right then, to electrophysiology cases like heart ablations and pacemaker implants, all the way to emergency STEMI (heart attack) patients,” said Michael Blankenship, Electrophysiology Technologist at Renown Health.  “We do so many things in the Cath Lab,” added Laurel Douglas, RN, Imaging Manager at Renown Health. “We ensure we have 24/7 coverage for emergencies, as we often have to act at a moment’s notice to care for emergent situations.”  Many of those emergency situations involve heart catheterization.  If someone has a heart attack, the team immediately steps in to place stents to open the coronary arteries that are causing the attack. If a patient’s heart needs any assistance during an emergency, the team can place devices such as Impella (temporary ventricular support) or intra-aortic balloon pumps. Renown is a major advocate for advanced medical technology, and the Cardiac Cath Lab team embraces these technologies to perform life-saving procedures, all while working together as a cohesive unit.  “We work amongst each other to ensure sterility, safety and the best outcome for each patient,” said Zohra Benbrahim, RN at Renown Health. “We try to fit in as many cases as possible into the workday, and sometimes after hours, so patients can get the care they need.”  “Each team usually has 3-4 members, and each member has a critical job to carry out in order to implement excellent cardiac care,” added Erica Drummer, RN. “Many of our patients tell us that we all work well together, and I couldn’t agree more. We have become like a well-oiled machine or a NASCAR pit crew.”  Naturally, patients undergoing any heart procedure might feel frightened and anxious. Never fear – the compassionate Cardiac Cath Lab team is here to ease those fears throughout each patient’s entire visit. Their main solution? Communication.  “Being a patient in the Cath Lab can be daunting,” said Erica Drummer, RN. “When we have patients who may feel scared or have concerns, we try our best to connect with them, keep them informed and educate them on the procedure and the step-by-step process, including what they may feel before, during and after.”  “Overall, we try to keep spirits light,” said Zohra Benbrahim, RN. “Our team is excellent at explaining the procedure as it is happening. We also advocate for comfort throughout the procedure, which helps tremendously with anxiety, including giving patients warm blankets and music of their choice!”  Our experts in the cardiac Cath Lab make sure that no stone goes unturned when it comes to optimal heart function for every patient. Together, the team mends hearts and saves lives, day in, day out.  A Growth Mindset  Always learning, always improving, always reaching new heights – that's the Cardiac Cath Lab team.  This team’s accomplishments speak for themselves on both a local and national scale.  “Over the years, we have achieved several milestones, including becoming a STEMI Receiving Center, gaining our Chest Pain Center Accreditation (which is achieved by Cath Labs who provide emergent percutaneous coronary intervention for heart attack patients 24/7) and having our accredited electrophysiology program,” said Laurel Douglas, RN. “We also offer services that other facilities do not offer. We have brought in several new procedures to the Cath Lab over the years. This is impactful, as the community members get to stay here for treatment.”  The Cath Lab team is anything but ordinary. There is never a dull moment in this department, and despite an ever-growing caseload, the team is always ready to rise to the challenge and continue pushing to surpass the average.  “I am so proud of my team for providing care for such sick patients,” said Zohra Benbrahim, RN. “We never really know how the day is going to go because emergencies happen, and things always change. Recently, we had a record high volume of cases, and my team powered through these busy weeks like champs.”  “We strive to get our STEMI door-to-balloon times at or below 60 minutes,” added Erica Drummer, RN. “Door-to-balloon time refers to the time from when a patient arrives in the ER to the time the Cath Lab has a catheter guide wire crossing the culprit lesion in the coronary artery that is causing the heart attack. The national average (and current guideline) is 90 minutes, so our 60-minute time is a notable accomplishment for us.”  The importance of staying on top of your heart health comes center stage during American Heart Month, which is a prime opportunity for our cardiology professionals to educate the community and help them grow their cardiac knowledge. The cardiac quality team participates in community events throughout the month (and beyond!) to raise awareness for cardiac health. The team also outreaches to other health systems and healthcare partners to highlight what Renown has to offer in the way of heart care. Each Cath Lab team member always reminds patients about lifestyle choices and diet changes that can improve cardiovascular health, and they take this outreach with them all around Renown Regional Medical Center as well, walking through the hallways promoting many different ways of living a heart-healthy life.  The journey continues! The team will soon welcome a new Cardiac Cath Lab at Renown South Meadows Medical Center. The new lab will allow our experts in heart care to treat patients at our South Meadows location experiencing a heart attack and needing immediate intervention to open vessels in their hearts. The team is looking forward to embracing even more access to emergent cardiac care for our community at large.   Learn more about how Renown is building more ways to care for our community.  Now Hiring for Heart Heroes  Those looking to join a caring, committed and tight-knit group of cardiac care professionals will be in good company with the Cath Lab team. According to the members of this department, being a quick-thinking, dependable team member is key to predicting a successful Cath Lab professional.  “A good coworker communicates with everyone and is able to be flexible when things get hectic,” said Zohra Benbrahim, RN. “Our team stays so close with each other because of everyone’s ability to recognize where help is needed. Especially in the Cath Lab, it is important to be always aware of the patient’s vitals and clinical presentation so you can speak up if you notice changes. There are always new procedures or products coming out that become integrated into our practices, so it’s also good to welcome new policies and be adaptive.”  “We are a small team, and everyone sees each other as a friend,” added Laurel Douglas, RN. “We all know we will need help at some point, whether it be covering an on-call shift or helping during a procedure, so we all help each other. Teamwork and positive attitude are really what makes you a good team member.”  Not only are these individuals dedicated to impacting the lives of patients with the very organ that beats life into them, but they also are devoted to Renown – and it shows.  “I started working for Renown when I was 19 years old, and Renown was the medical system I went to for care; as I spent more time working here and becoming a part of the community, I could not see myself working anywhere else or getting care at any other hospital,” said Zohra Benbrahim, RN. “I truly believe Renown provides the best care and best serves the growing community of northern Nevada.”  The Cath Lab team members agree that Renown is a great place to both start and continue your career. Many of them have taken advantage of Renown’s training and educational opportunities, which in turn have helped them expand their knowledge to better serve the community.  “I chose to work at Renown because it gave me the place to grow in my career and experience different avenues within my career,” said Michael Blankenship. “I first started off as a student here, and I quickly realized that everybody I worked with genuinely cares for our patients. I started off in x-ray seeing patients and eventually did rotations up in the operating room, and I got hired full time in the Cath Lab.  After a short time being here, I was crossed trained in the electrophysiology lab, where I furthered my knowledge in my career.”  This dynamic department is actively hiring, and many open positions are sign-on bonus eligible. The team cannot wait to welcome you to their, as Erica Drummer puts it, “well-oiled machine.”  “Being a Cath Lab nurse is very rewarding, especially when you’re able to be a part of a team that can save someone’s life,” Erica closes.

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Cardiac Imaging Heart imaging plays a vital role in healthcare, offering critical insights into the structure, function and overall health of the heart. By utilizing advanced imaging techniques, imaging specialists can accurately diagnose, monitor and treat various cardiac conditions. At Renown Health we offer comprehensive diagnostic imaging services, including echocardiogram (echo), nuclear imaging, Coronary CT angiography and vascular ultrasound. Follow-up imaging can also be completed for post-surgical procedures to measure success rates.

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