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Neurosciences Clinical Trial Opportunities

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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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Breast milk. It's often referred to as liquid gold. And fortunately, it can be safely refrigerated or frozen for later use, which can allow you to be a bit more flexible in your new routine with baby. Whether you're getting ready to return to work, planning for the chance date night out or just exclusively pumping, it's crucial to understand the guidelines for proper breast milk storage. Storing Breast Milk Use clean bottles with screw caps, hard plastic cups that have tight caps or nursing bags (pre-sterilized bags meant for breast milk). Be sure to label each container with the date the milk was pumped and your baby's name if the milk is going to childcare providers. You can add fresh, cooled milk to milk that is already frozen, but add no more than is already in the container. For example, if you have two ounces of frozen milk, then you can add up to two more ounces of cooled milk. For healthy full-term infants, milk can be stored as follows: Room temperature - six to eight hours (no warmer than 77°F, or 25°C). Refrigerator - up to five days at 32°-39°F (0°-3.9°C). Freezer– Varies depending on freezer type. Up to two weeks in a freezer compartment located within the refrigerator. Three to six months in a freezer that is self-contained (standard kitchen fridge/freezer combination) and kept at 0°F (-18°C). Breast milk should be stored in the back of the freezer and not in the door. Six to 12 months in a deep freezer that is kept at -4°F (-20°C). Be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes. Thawing Breast Milk Place frozen breast milk in the refrigerator to thaw (about 24 hours) then warm by running warm water over the bag or bottle of milk and use it within the next 24 hours. If you need it immediately, remove it from the freezer and run warm water over it until it's at room temperature. Never microwave breast milk and do not refreeze it. Once your baby has started to drink from the bottle, you should use it within one hour. You may find that different resources provide different recommendations about the amount of time you can store breast milk at room temperature, in the refrigerator and in the freezer. Talk to your doctor or lactation consultant if you have any concerns or questions.

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While there used to be three basic treatment options for cancer -- surgery, radiation and chemotherapy, or a combination of the three -- there's a fourth option: clinical trials. Here, a Renown patient shares her successful battle with ovarian cancer, aided by a clinical trial. Shari Flamm's battle with ovarian cancer began in 2011. She was experiencing prolonged bleeding, irregular thyroid levels and anemia and was scheduled to undergo a hysterectomy. Before the surgery, her gynecologist ran routine tests to check for cancer as a precautionary measure. All tests were negative for cancer, expect her CA 125 test. A CA 125 test measures the amount of the protein CA 125 (cancer antigen 125) in the blood. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease. In most laboratories, the normal level is 0 to 35 units/ml. Flamm's CA 125 level was 121. As Flamm can attest, early diagnosis played a key role in her battle with ovarian cancer. September is Gynecologic Cancer and Ovarian Cancer Awareness Month – an important time to learn the signs, symptoms and risk factors of this type of cancer so your doctor can diagnosis the disease as early as possible. Ovarian Cancer: Round One Despite the elevated CA 125 results, her doctor recommended they move forward with the hysterectomy. But when surgery began, doctors discovered a mass. She had stage 4 cancer. The procedure was halted, the mass was biopsied and she was immediately seen by Dr. Peter Lim of the The Center of Hope. Following diagnosis, Flamm underwent surgery with Dr. Lim to remove the cancer, which had spread to part of diaphragm, spleen, colon and other organs. Three months after surgery, Flamm had recovered enough to start six rounds of chemotherapy in her hometown of Carson City. She continued working at a doctor's office during her treatment, and was grateful for Dr. Lim’s ability to co-manage her care so she could stay close to work and family. “To me, chemo was the scariest part because I didn’t like feeling sick,” Flamm says. Thankfully, her body responded well to the treatments and she was back to the things she loved. “I stated working out at the gym, even if it was only for 10 minutes,” she says. She also stayed positive by spending time with her grandchildren, attending a San Jose Sharks hockey game, going for walks and enjoying concerts. Ovarian Cancer: Round Two In November 2014, Flamm had a cancer check-up. That’s when doctors discovered three cancerous tumors. For this round, Flamm choose another treatment option -- clinical trials at Renown Institute for Cancer. Clinical trials are the studies that test whether drugs work, and inform doctors' decisions about how to treat their patients. Flamm participated in a clinical trial that featured oral-targeted therapy stronger than IV chemotherapy. The hope was for the drug to shrink her tumors, however the result was stabilization -- meaning the lumps weren’t growing or spreading. The best part of the clinical trial, Flamm says, was the constant monitoring. Between the CT scans every six weeks, a heart scan every three months and monthly doctor visits, she was confident that if the cancer started growing or spreading, her healthcare team would catch it right away. For Flamm, the benefits of the clinical trial included less hair loss, less fatigue and more time to focus on what’s important in her life -- her family. “I decided I wasn’t going to be that sick grandma on the couch with cancer,” Flamm says. After taking the oral medication for one year, Flamm developed a rash and discontinued treatment due to discomfort. Clinical Trials, Setbacks and Survival In June 2016, two of the three tumors began to grow and had to be surgically removed. Despite the setback, Flamm was determined to maintain a positive outlook. "You have to stay positive because cancer feeds off anger, depression and stress," Flamm says. Flamm was released to go home with clear margins, meaning the tumors were removed and are surrounded by a rim of normal tissue that does not have cancerous cells. Flamm says her outlook on life has changed drastically since her first cancer diagnosis. “Your whole mentality changes when cancer disturbs your life," Flann says. "The things that weren’t important, are now ever so important. I’m a lot calmer now,” Flamm says.

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While breastfeeding is natural, it's not always easy. We asked Certified Lactation Counselor Sarah Mitchell for some tips to help make the process easier for mom and baby. From increased infant immunity to improved maternal health and well-being, the benefits of breastfeeding are many. Still, only 60 percent of U.S. moms in the United States continue to breastfeed past their baby's first six months. There are for many reasons for why moms stop, including the mother's their need to return to work. We reached out spoke to Sarah Mitchell, a certified lactation counselor at The Lactation Connection at Renown, for some expert advice. Tip 1 At first, it's normal to expect obstacles. Even in cultures where close to 100 percent of moms breastfeed, they can experience issues, including getting the baby to "latch on," sore nipples, and milk production. In addition, it sometimes can take several weeks for mom and baby to get comfortable. Tip 2 Line up a coach, even before the baby is born. This can be a professional lactation coach, family member, or friend who is experienced and encouraging. While online videos can be helpful, most new moms need the one-on-one guidance that a coach can provide. Renown offers outstanding resources in its Lactation Connection center, including expert consultants, products, and support. Tip 3 Well ahead of the due date, set up a support network of friends, family members, or community groups such as La Leche League. Women historically have relied on extended support systems to help them with raising children, and breastfeeding is one of those areas that, while natural, still needs encouragement from the women who’ve been there. Tip 4 Don’t get discouraged if you need to supplement at times with formula. This, too, as it turns out, is not uncommon in other cultures. In other parts of the world, babies are given beverages and foods such as tea, broth, soup, juice, mashed bananas, and papaya. The American Academy of Pediatrics recommends supplementation only with approved formula -- but the point is, it’s ok to supplement if you need to. Finally, don’t forget the importance of breastfeeding for connecting with your baby. It’s essential to maintain breastfeeding over the weekends, preferably “on-demand,.” and will keep that special bond strong after you have returned to your job.

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If you think sore nipples are just a normal part of breastfeeding, think again. Robin Hollen, APRN, and Breastfeeding Medicine Specialist, says that nursing can be an enjoyable experience for mom and baby without pain and discomfort. A top concern of nursing moms within the first week after delivery is how to prevent sore nipples. Even moms who’ve nursed before struggle with this common issue. While many women think it is a regular part of the nursing experience, it is actually a sign that something isn’t quite right. “Nursing your baby should be enjoyable,” says Robin Hollen, Breastfeeding Medicine Specialist with Renown Health. For over 30 years Robin has been supporting moms to breastfeed. Below she shares some valuable information and tips, helping you create a happy and healthy breastfeeding experience for you and your baby. What causes sore nipples? The most common cause of sore nipples involves incorrect latching. For a proper latch, a baby’s mouth takes in the entire nipple and some of the breast, so that the nipple rests at the back of the mouth where the palate is soft. With an improper latch, the mouth may slip down to the tip of the nipple while the baby nurses. This constant pressure on your sensitive skin may cause discomfort and pain. A board-certified lactation consultant can help assess if your baby is latched correctly and troubleshoot your breastfeeding concerns. Less common causes of sore nipples include: • Improper tongue placement of baby • Clenching • Incorrect breast pump use How can a mother prevent sore nipples from an improper latch? Breastfeeding is a learning experience for both mom and baby. Ask for help with the latch so your baby learns it correctly and maintains its depth. In the past, new mothers were surrounded by a community of women — their own mothers, grandmothers, or other family and friends — to provide assistance and guidance with every latch at the beginning of an infant’s life. In today’s culture, new moms can find themselves on their own with no extended family to lend their knowledge. Nurses, pediatricians and lactation consultants now fill that role; they are the eyes and hands along with the much-needed experience to guide new mothers. Our Breastfeeding Medicine experts assist nursing moms with latch every day. Even a single visit with a lactation consultant observing your breastfeeding baby can provide valuable insight on achieving, and maintaining, the proper latch - preventing future nipple soreness and discomfort. How to heal sore nipples from breastfeeding To heal sore nipples, you must first fix the cause, and correcting the latch prevents further damage. A lactation consultant can also help you address the pain. Below are some breast healing tips: • Your own expressed breast milk is excellent to rub into the nipple for anti-bacterial protection. • For those moms who need more lubricant or fat than breast milk offers, use a lanolin or a cream that is labeled safe for the baby. • Soothies are a gel pads providing comfort in between feedings, but should not be used with lanolin products. • Breast shells, not to be confused with shields, can guard the nipples from irritation or pressure in between feedings. If you have more questions about preventing and healing sore nipples or general breastfeeding concerns, talk to your pediatrician or a Renown Health Breastfeeding Medicine specialist at 775-982-6365.

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Halloween is around the corner. So while you're prepping pumpkins for carving, putting together creative costumes and coordinating trick-or-treating plans, safety is one more detail to remember.   Masks, haunted houses, witches, ghosts and ghouls — it all spells Halloween, and what could be more frighteningly fun, right? For children, however, Halloween can indeed be frightening and not so fun.  According to Dr. Kristina Deeter, Physician-in-Chief of Renown Children’s Hospital and Chair of Pediatrics for the University of Nevada, Reno School of Medicine, it is common for younger children to express Halloween fears — being afraid of monsters, the dark or really anything out of the norm. “It's normal for children to struggle with separating reality from fantasy,” she explains.   For children who fall into this category, the month of October can be traumatizing. Halloween may not come until the end of the month. Still, in the weeks building up to the spookiest night of the year, little ones are bombarded on all sides with decorations — mummies, skeletons, coffins, vampires, you name it. For a child with a blossoming imagination who, as Dr. Deeter said, is still learning to differentiate real from pretend, this can cause additional fears and anxieties. In commemoration of Halloween Safety Month, Dr. Deeter shares safety tips for the spooky holiday from the American Academy of Pediatrics:  Dressing Up & Heading Out  Plan costumes that are bright and reflective. Ensure shoes fit well and that costumes are short enough to prevent tripping, tangling or coming into contact with flames.   Consider adding reflective tape or striping to costumes and trick-or-treat bags and baskets for greater visibility.  Masks can limit or block eyesight. Instead, consider non-toxic makeup and hats, which should fit properly to prevent them from sliding over the eyes. Test makeup ahead of time on a small patch of skin to test for allergies before full application.  When shopping for costumes, wigs and accessories, look for and purchase those with a label clearly indicating they are flame resistant.  If a sword, cane or stick is a part of your child's costume, make sure it is not sharp or long. A child may be easily hurt by these accessories if he stumbles or trips.  Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as "one size fits all," or "no need to see an eye specialist," obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, serious eye disorders and infections, which may lead to permanent vision loss.  Review with children how to call 9-1-1 (or their local emergency number) if they ever have an emergency or become lost.  Carving Pumpkins  Leave the carving to the grownups. Have children draw the pumpkin design with markers, but keep knives away.  Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.  Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and not on a porch or any path where visitors may pass close by. They should never be left unattended.  Prepping Your Home  Keep your entryway safe for trick-or-treaters by removing all items from the porch or front yard that a child could trip over, like garden hoses, toys, bikes and lawn decorations.  To ensure visibility, check outdoor lights and replace burned-out bulbs.  Sweep leaves (or snow) from sidewalks and steps.  If there are dogs in the home, take steps to ensure they don't jump on trick-or-treaters. Hunting for Treats  Young children should always be accompanied by a parent or responsible adult.   Give each child and adult a flashlight (with fresh batteries).  If older children are heading out to trick-or-treat alone, plan and review a route you can agree on, as well as a specific time they are supposed to return home.   Only visit homes with a lit porch light. Never enter a home or a car for a treat.  Notify law enforcement authorities of any suspicious or unlawful activity immediately.  Since pedestrian injuries are the most common injuries to children on Halloween, remind youngsters to take crosswalk safety precautions.  For more key tips regarding Halloween safety for your young trick-or-treaters, visit our partners at Safe Kids Worldwide for a variety of spooky safety resources.

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Participating in a clinical trial is voluntary and a personal choice. Clinical trials are research studies that involve people and are an important part of patient care. What is a clinical trial?  Clinical trials are research studies that involve people, and they are an important part of patient care. There are several different types of clinical trials; some are designed to understand trends in a disease or identify better ways to diagnose a condition, while others determine if a new treatment is safe and works when treating, improving or preventing a health condition. There are over 400,000 clinical trials currently being conducted in the United States, and even more across the world. This includes health conditions such as heart failure, cancer, Parkinson’s Disease, respiratory conditions like COPD, common infections, cystic fibrosis, and many more. Clinical trials lead the healthcare industry to new discoveries that contribute to reliable and exact care, improving healthcare quality and saving lives. Clinical trials are conducted by a team of researchers, including doctors, pharmacists and clinical research coordinators. These research teams are highly skilled in their specialty areas, often providing traditional patient care and seeing research patients in the same day. These teams are responsible for making sure the clinical trial is completed correctly, and their patients are their top priority. Why should I consider participating in a clinical trial? Participating in a clinical trial is voluntary and a personal choice. There are many reasons why patients decide to get involved in clinical research. While many clinical trials are designed for patients who have a certain health condition, many studies also ask healthy volunteers to contribute in order to compare health outcomes. Clinical trials are also for patients at all different stages of their diagnosis. Depending on the specific study, the patient may receive access to a new cutting-edge treatment before it is widely available. When patients join a clinical trial, the research team becomes a health partner dedicated to their health and well-being. When patients join a clinical trial, they make an informed decision in their healthcare by weighing all available options in addition to routine treatments. Research participants know that they are contributing meaningfully and helping other patients like them. Where can I find more information about clinical trials at Renown Health? Renown Health’s mission is to make a genuine difference in the health and well-being of the communities we serve. Renown’s clinical trial portfolio offers leading care options to patients in northern Nevada, close to home, in a variety of specialties. Contact the Renown Clinical Research Office for more information on clinical trials available to you!

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