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Ask the Expert: What is Scoliosis?
Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.
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8 Financial & Wellness Benefits for Employees
Listening to what employees need most now and for the future; ensuring families are healthy, financially secure The Federal Reserve raised its benchmark interest rate last week for the first time since March 2020. This will mean a higher cost of borrowing on credit cards, student and home loans, car financing and more. It could also mean more returns from savings accounts, depending on the institution. This news, coupled with concerns about mental health and physical well-being as caregivers come through the pandemic has presented leaders at Renown with a unique opportunity to reframe approaches to how to help their employees grow, feel financially supported and engage as part of a healthy and thriving team. After listening to concerns of employees and their leaders, Renown Health’s Human Resources department and leading industry partners have announced a number of additional benefits to promote ways to increase work/life balance; support rest-and-recuperation strategies, and new financial resources essential to sustaining happy, high-performing teams. Renown Health is hiring key roles to support the health and well-being of our community, and encouraging those with a passion for service to join the Renown family to Fight the Good Fight, by applying on line at careers.renown.org. Expanded and new employee benefits for 2022 include: 1. Expanded Physical Health, Medical and Dental Plan Benefits. The MOBE program, offered at no charge, offers each employee a personal Health Guide to support four core elements of health; diet, sleep, physical movement and emotional well-being to help build healthy habits, fuel a better life, provide energy and promote healing. This year, Renown expanded its Medical Plan coverage, adding new benefits, without increasing rates paid by employees. Renown offers health insurance benefits through Hometown Health, northern Nevada’s largest and only locally owned not-for-profit insurance company with wide-ranging medical coverage. Hometown Health offers access to the largest network and highest quality clinical services provided by 1,200 medical doctors and specialists in 150 sites of care, including those with Renown Medical Group; urgent care centers; lab and imaging services; and the state’s #1 Us News & World Report hospitals, Renown Regional Medical Center (2022) and Renown South Meadows Medical Center (2021). New medical benefits added this year include telehealth visits with a $0 copay; Renown Pharmacy prescriptions with no deductible; and if employees and their families need to travel out of the area for essential care, there is now a travel stipend offered for University Medical Center in Las Vegas or to University of Utah Health. The organization also reduced the cost for health insurance premiums paid by part-time employees (20-30 hours). In addition to improved health benefits, the dental network was expanded through MetLife Dental, with no increases in dental rate premiums paid by employees in 2022. As a non-profit organization, Renown is able to offer employees the ability to establish Flexible Spending Accounts as way to use tax-free dollars to pay medical expenses not covered by other health plans. 2. Enhanced Wellness and Mental Health support programs. Renown Health is home to the Stacie Mathewson Behavioral Health & Addictions Institute. As leaders, they are working to remove the stigma and barriers to using mental health services when needed; reinforcing that seeking help indicates strength, not weakness. This includes encouraging team members to take a day off to refresh and recharge or take advantage of confidential, mental health counseling visits at no charge. Renown updated their policy to include mental and emotional well-being as eligible for use of sick leave. Through the pandemic, to be sure employees had the time should needed, leadership added 80 hours of sick time to employee’s sick banks as well as $0 copay for Teladoc behavioral health sessions and nutrition services (virtual). Renown encourages physical fitness and inspires the health and well-being of employees by supporting participation in races (on foot or via bike) in their communities. Employee who race, run, walk, triathlon or bike may submit for reimbursement for an individual entry fee up to $100. 3. Appreciating and Engaging Employees. Many teams may now be working on-site, hybrid and remotely, which means getting together to make new memories is more complicated. Renown Health leaders continue to bring camaraderie and bonding into the workplace by investing in holding monthly Pride events for staff, hosting everything from online socials to game nights to help re-establish bonds. At Renown, employee engagement also takes the form of employee recognition programs. The Everyday Amazing program encourages employees to thank each other for outstanding service via an online platform, and earn certificates and points towards gift cards and prizes. Employee and organization-led leadership and career education programs are encouraged, as well as paid volunteer opportunities (four hours each quarter), and matches of up to $1000 for non-profit organization boards on which Renown Health employees serve. Renown offers events and yearbooks to help employees celebrate their history and accomplishments, as well as Celebrate Amazing, a special event to honor Service Milestones, Top Talent and Women of Achievement award winners. Renown supports the community and engages medical providers and employees to attend events with the Reno Aces, UNR football and basketball games, the Great Reno Balloon Race and hundreds of community events each year. 4. Living Debt Free with Financial Wellness Programs. A free financial wellbeing program from Salary Finance is available at no cost to employees, with a salary-linked loan product. This benefit enables employees to borrow or save money directly through their paycheck. Salary-linked loans allow employees to access affordable credit that they can easily repay through their salary, helping them pay down existing debt or avoid high-interest credit cards, overdraft fees, or payday loans. Salary Finance provides affordable borrowing options in times of need, as well as a financial education component, which helps employees understand their current level of financial content specific to their needs. Since launching, over 40% of employees have engaged with the Salary Finance offering, and over 500 have accessed affordable credit through Renown's custom-branded Salary Finance Financial Wellbeing Hub. “It has made a wonderful impact and has lessened my frequent stress regarding my debt," said a Renown employee enrolled in the program. In total, it is estimated that employees have saved nearly $275,000 on interest, and that number continues to grow as more employees take advantage of the benefit. The Greater Perks program from Greater Nevada Credit Union, the official credit union for Renown employees, offers a number of benefits including a $100 bonus for opening a new checking account, $25 when opening a new “I Can Save” account, $500 credit towards an appraisal for a home loan, low-cost rates on short-term personal loans and auto loans, and regular online financial wellness seminars. Membership with the credit union is not required to take advantage of Greater Nevada Mortgage’s offerings. In addition, donors have supported, through the Renown Health Foundation, funds for help employees who have suffered a personal financial catastrophe, and are in need for emergency funding to pay bills, with no repayment required. 5. Educational Assistance Reimbursement, Student Loan Repayment, Continuing Education for Learners. Renown values and encourages employees to continue their education and supports career aspirations and goals. The education assistance program offers loan reimbursement and repayment opportunities as well as educational and financial guidance from experts. College tuition, certification and certificate reimbursement is provided for employees who are currently enrolled in college/university or taking the extra steps to receive a professional certification or certificate. In addition, the organization supports employees who have previously completed their education and are now managing the burden of student loans. Employees also have the option to invest in a 529 college savings plan, an investment program designed to help people save for future education expenses for children/dependents at almost any private or public college or accredited higher education institution. 6. Onsite Childcare & Adult Care Assistance. Figuring out the childcare puzzle has been a hurdle for working parents through the pandemic. Renown is one of a select number of health systems that offer onsite childcare. Renown Health Child Care Center welcomes employees' children ages six weeks to six years (and not yet in kindergarten). The center is licensed for 176 children and features 11 classrooms: three infant classrooms, four toddler and four preschool classrooms. Staff help parents with resources to find care for their children onsite, or with licensed daycare providers in the community. Employees increasingly are caring for older adults in their families. As a non-profit organization, employees are able to contribute to tax-free savings FSA accounts that cover dependent care for children and older adults. 7. Flexible Schedules and Locations. Renown now provides the ability for medical providers and employees to work on-site, hybrid and remotely. This year as many employees working remotely moved out of state to be closer to friends or family, Renown kept pace, employing a Professional Employment Organization called Tri Net, in a co-employment model to assist with national benefits and tax administration. Renown is now able to recruit and retain remote employees from Maine to Minnesota and offer, for a wide range of positions in IT, finance and other support services, remote and flexible schedules that are attractive to many across the country. For clinicians, there are a large variety of positions now available at over 100 locations across the state. On March 7, Renown increased the cap of shift differential to 10% up to $6 an hour and added a weekend differential for staff for up to 5%. At Renown’s hospitals, there are employment positions available 24 hours a day, 7 days a week to serve the community. Other providers and employees take advantage of a compressed workweek, 12-hour shifts and other options, which allow them the flexibility to live their best life at work and at home. 8. Renown’s Retirement Savings Plan. Retirement savings plans including a full 401(k) plan through Vanguard are available for employees to save for retirement. Employees can contribute from1-75% of pre-tax pay (up to annual IRS limit) and receive a matching contribution from Renown of 4% when you contribute 4% or more to a 401(k) plan. Rollovers of a former employer's 401(k), 403(b), 457 or other qualified plan can be made into a Vanguard plan at any time. In addition, in-service withdrawals are allowed at age 59 1/2 from 401(k), and a new Roth 401(k) option was added. Join the Renown team: Renown Health is now hiring key roles in our organization to support the health and well-being of our community. To join the Renown family to Fight the Good Fight, apply on line at careers.renown.org. About Renown Health Renown Health is the region’s largest, locally governed, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the region’s largest, locally owned not-for-profit insurance company, Hometown Health. Renown is currently enrolling participants in the world’s largest community-based genetic population health study, the Healthy Nevada Project®. For more information, visit renown.org.
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