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Why Can't I Eat Before Surgery?
If you’re having surgery on your shoulder, why does it matter what’s in your stomach? We asked Dr. Matthew Hoberg to explain more about pre-surgery directives, including fasting. If you have an upcoming surgery, your care team likely gave you instructions to fast before your procedure. But why? We asked Matthew Hoberg, M.D., medical director of Renown Surgical Services, to explain why it’s important to forgo food and drinks before surgery. Why are patients instructed to fast before surgery? Regardless of surgery type or site, we want the stomach to be empty before having anesthesia, because anesthesia can reduce your body’s ability to protect and prevent food or acids from the stomach from entering the lungs. Normally, your body is able to prevent this, but anesthesia medicines make it harder for your body to do so. When food or liquids from the stomach get into the lungs, doctors call it “aspiration.” This is rare, but can be dangerous if it does happen. Solid foods and liquids leave the stomach at different rates too. Solid food takes longer to empty from the stomach than liquids, so the time to stop eating solids (eight hours) is longer than that for clear liquids (two hours). The body has energy reserves to produce needed nutrients and fuel during fasting. Recently, studies have shown it is important to stay hydrated and have some carbohydrates in clear liquids up to two hours before surgery, so clear liquids are allowed until two hours before surgery. There are also special rules for babies and young children who need surgery. For example, you may give breast milk up to four hours before surgery. If your baby drinks formula, you should stop six hours before surgery, and all solid foods you should stop eight hours before. Your child’s doctor or nurse will give you exact instructions. What if you show up for surgery and have broken the no-eating rule? Will surgery be re-scheduled? If patients have not followed the fasting guidelines, surgery will be postponed or rescheduled due to the possible increased risk associated with not having an empty stomach. The exception would be emergency surgery that cannot be delayed in which case special precautions are taken to help prevent anything from getting into the lungs. What other pre-operative rules should be followed to the letter? All instructions given to patients before their surgery or procedure should be followed. There are specific medical reasons behind all the instructions and they are designed for safety — to minimize risks, lower complications like infections and enhance the recovery process to help patients get back to normal as quickly as possible. Also, many patients ask if they should continue taking medications before surgery. The answer is: It depends. Your doctor or nurse will tell you which medicines you should take and when. Some medicines need to be stopped before surgery. But for others, it’s important you keep taking them as usual. You may also get new medicines to take before surgery. You may be asked to take some medications before surgery as part of advanced pain management protocols. If you need to take medicine right before your surgery, you can take it with a sip of water.
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Saving More Lives; Renown Expands Breast Cancer Care, Adding Two Best-In-Class Breast Surgeons
Renown Medical Group is thrilled to welcome two distinguished breast surgical oncologists, Colleen O'Kelly-Priddy, MD and Michelle K. Chu, MD to the team. These highly skilled breast surgeons will solely focus on providing breast care and therefore play a pivotal role in Renown Health’s William N. Pennington Cancer Institute’s commitment to provide subspecialized care to the people living in our community and beyond. Dr. Colleen O'Kelly-Priddy is a fellowship-trained, board-certified breast surgical oncologist with an impressive background in breast cancer surgery. Dr. Priddy was born at Washoe Medical Center (which later became Renown Regional Medical Center) and grew up in Susanville, CA before attending Stanford University for her undergraduate studies. She is a graduate of the University of Nevada, Reno School of Medicine. "I am thrilled to return to Reno to help increase access to world-class surgical breast cancer care,” said Dr. Priddy. “My focus is to provide exceptional care, particularly for young people with breast cancer. I am excited to continue my mission here in northern Nevada." Dr. Michelle K. Chu, a board-certified general surgeon, brings her extensive experience in advanced breast cancer treatment to the Renown team. Dr. Chu received her undergraduate degree from the University of Pennsylvania and her medical degree from Western Reserve School of Medicine in Cleveland, OH. Dr. Chu specializes in oncoplastic breast conserving surgery and nipple sparing mastectomies. "I believe in tailoring treatment options to each patient's unique needs,” Dr. Chu said. “Whether it's preserving the natural shape of the breast or supporting the 'Going Flat' movement, our team strives to provide the best possible outcome for every patient." The newest addition to the William N. Pennington Cancer Institute, Renown Breast Surgery Care provides comprehensive breast surgery care at 1500 E. 2nd Street in Reno, adjacent to the Renown Regional Medical Center campus. "Breast cancer accounts for approximately 20% of newly diagnosed cancer cases in Washoe County, with roughly 520 new cases annually, establishing it as the most prevalent cancer type within our community,” says Brian Erling, MD, MBA, President & CEO, Renown Health. “We are proud, as the community’s largest not-for-profit healthcare system, to invest in cancer prevention and early diagnoses, including mammography screening and genetic research. For those diagnosed with breast cancer, Renown now offers two superb breast surgeons specializing in breast preservation surgery, and a breast surgery center providing comprehensive, compassionate care. Our goal is to save women’s lives, save families and ensure better care and better outcomes. This is a major step forward for women’s healthcare and our community.” As part of this expansion, Renown is assuming operations of Reno Surgical Advocates, a respected private practice in Reno. "Access to expert breast cancer care close to home is crucial, and our dedicated team at Renown Breast Surgery Care will work tirelessly to provide the highest level of care to patients while working closely with our other cancer specialists," said Max Coppes, MD, PhD, MBA, Director, William N. Pennington Institute for Cancer. “With the exceptional expertise of Dr. Colleen O'Kelly-Priddy and Dr. Michelle K. Chu, coupled with our state-of-the-art facility; Renown Health is a true partner in the fight against breast cancer in northern Nevada.” "People are increasingly relocating to northern Nevada, and in fact, Washoe County experienced a 2.1% population growth from April 2020 to July 2022. Consequently, although northern Nevada does not exhibit an above-average cancer rate, we are observing a rise in cases at our facilities," said Dr. Lee Schwartzberg, MD, FACP, Section Chief of Medical Oncology at the William N. Pennington Cancer Institute. "Renown Health is positioned to meet this growing demand, and we take pride in consistently adding nationally renowned healthcare providers to our team to save the lives of women in northern Nevada. 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.
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Excellence in Heart Care Changes a Patient's Life
Being diagnosed with a chronic heart condition like atrial fibrillation (A-fib) can shift the course of your entire life. Embracing heart medications and lifestyle changes become your norm, and thanks to advancements in medicine and medical technology, managing the condition can bring you to a new sense of normalcy. But what if a different option was possible – one that would make medications and activity limits a thing of the past? This became the reality for Renown Health patient Richard Preyer after receiving a hybrid catheter ablation. Thanks to the vigilant surgical care of Shining Sun, MD, a cardiologist at the Renown Institute for Heart & Vascular Health, and his compassionate team, Richard has a new lease on life. Minimally Invasive with Maximal Results An A-fib patient since 2010 who had been living with an unfinished ablation, the 59-year-old Carson City resident turned to the internet to look for alternate solutions. He had heard that the Renown Institute for Heart & Vascular Health was a top-tier location for cardiovascular care. “I changed health insurance plans through Nevada Health Link to ensure I could see a Renown cardiologist,” said Richard. Choosing a cardiologist was an even easier decision for Richard. Dr. Sun’s introductory Find a Doctor video on Renown’s YouTube channel, where he displayed his expertise and determination, was more than enough for Richard to choose him as his cardiac care leader. At his first visit, Dr. Sun reviewed Richard’s records, and noted his prior unfinished ablation. The nine-hour procedure had been performed several years ago. With the enhanced technologies at Dr. Sun's disposal, Richard was excited at the thought of his life potentially being changed for good – with a minimally-invasive solution. Dr. Sun collaborated closely with Richard’s previous and current care teams – including a surgeon who performed a maze operation on him right before his surgery at Renown, to ensure his hybrid ablation was tailored uniquely to him. “Dr. Sun is clearly a very powerful cardiologist with many connections, and the coordination between his team and my other doctors was great,” said Richard. After working on the exterior of the heart in the first phase of the surgery and the interior of the heart during the second phase, Richard’s hybrid ablation was successful, completing the unfinished portion of his previous ablation. “Fixing A-fib can take one to three ablations, and sometimes it never holds,” said Richard. “That is one of the largest reasons why I am so thankful for this procedure and how it ended up.” Life After A-fib Now comes the long, arduous healing process, right? Not for Richard. With only eight incisions (four on each side of his chest), he was able to remove his bandages after two days, and he healed completely in one week. “I was even back to taking three-mile walks within a week of my operation,” said Richard. No more blood thinners. No more activity limits. And most importantly for Richard, no more heart-stabilizing medications that came with side effects he didn’t enjoy. He attributes his enhanced life to Dr. Sun and his team. “I highly recommend Dr. Sun and everyone that works with him,” he said. “Everyone in the group, from the nurses and anesthesiologists going above-and-beyond to the schedulers who helped me navigate the appointment process, made me have a lot of confidence. Their calm demeanors made so much difference.” Today, Richard now enjoys elongated walks in the northern Nevada outdoors, exotic vacations with his wife and, as he describes, “feeling like I’m in my 40’s again.” Learn more about the region's leader in cardiac health, heart and vascular care here.
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Nationally Recognized Heart Surgeons Join Renown Health
Two Open-Heart Surgeons and Two Advanced Practitioners Bring Nearly 70 Years of Local Experience. As part of a continuing focus on offering comprehensive care for patients experiencing cardiac and vascular disease across northern Nevada, Renown Health Department of Surgery and Renown Institute for Heart & Vascular Health have developed Renown’s first division of cardiothoracic surgery dedicated to heart surgery patients. “Today, I am proud to announce cardiothoracic surgeons, Athan Roumanas, M.D., FACS, and Joseph Brandl, M.D., FACS, who have more than 45 years of combined experience caring for northern Nevadans in need of open-heart surgery, will lead this new practice at Renown,” said Anthony Slonim, M.D., Dr.PH., FACHE, President and CEO of Renown Health. “Advanced practitioners Cindy Powers and Ashley White bring another 23 years of expert care to our community and the new division of cardiothoracic surgery.” Dr. Roumanas has 18 years of experience in northern Nevada. He is a clinical associate professor of surgery at the University of Nevada, Reno School of Medicine (UNR Med) and currently serves as medical director of cardiothoracic surgery for Renown Regional Medical Center. Since 1991, Dr. Brandl has cared for our region and held numerous positions throughout the community including Renown’s director of cardiac surgery and community adjunct faculty for UNR Med. Renown Institute for Heart & Vascular Health offers the most highly-skilled and experienced heart and vascular team and the most advanced heart center in the region. Renown has long been the region’s heart care leader – performing the area’s first open-heart surgery, angioplasty, stent and valve replacements decades ago. In 2015, Renown Regional became the first hospital in the region to offer transcatheter aortic valve replacement (TAVR), a lifesaving alternative to open-heart surgery for patients considered high-risk or inoperable. Renown is among the nation’s top-performing hospitals for heart attack treatment and one of only 105 hospitals nationwide to receive the American College of Cardiology ACTION Registry Silver Performance Achievement Award recognizing success in implementing a higher standard of care for heart attack patients. Additionally, Renown’s Roseview, Sierra and Cardiac Intensive Care Units (ICUs) were the only ICUs in Nevada to receive the Beacon Award of Excellence from the American Association of Critical Care Nurses. This distinction is based on sustained unit performance and patient outcomes that exceed national benchmarks. As Reno’s only locally-owned, charitable, not-for-profit integrated health network, Renown continues to meet customer demand for affordable healthcare and enhanced service and access by keeping the highest levels of clinical quality care right here in our community. Patients in need of advanced heart care can speak with their care provider about Renown Medical Group – Specialty Care, which can be reached at 775-982-6270 or visit renown.org/HeartCare.
Read More About Nationally Recognized Heart Surgeons Join Renown Health
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Optimizing Mammogram Screenings: A Genetic Approach to a Personalized Screening Schedule
© Arthon Meekodong via Canva.com Breast cancer screening has long been a cornerstone of women's healthcare. With 1 in 8 women diagnosed with breast cancer in their lifetime1, the United States Preventive Services Task Force (USPSTF) has developed screening recommendations to help detect early-stage cancer. Notably in 2023, the USPSTF revised the recommended age for biennial mammogram screenings for women with average risk to start at age 40 instead of 502, estimated to result in 19% more lives being saved3 by starting screening earlier. While initiating screening at an earlier age offers advantages to a wide demographic, concerns about the potential of over-screening prompted research into the feasibility of identifying women with lower breast cancer risk who could safely delay mammograms. While guidelines address high-risk individuals, a notable gap exists in providing recommendations tailored to those at lower risk. To gain insight into a patient's risk level, physicians are able to utilize genetic testing to understand an individual's genetic makeup, providing precise insights into their predisposition to various health conditions, including breast cancer. Armed with this genetic information, healthcare providers could craft tailored screening strategies that align with an individual’s specific risk profile. This genetic risk-based approach underscores the value of genetics in individualizing the onset of screening to help avoid over-screening and its associated costs. Surprisingly, genetic information is not currently being widely utilized to identify women at risk of breast cancer or other diseases in clinical practice, despite its potential to make a significant positive impact for patients. A recent retrospective analysis of 25,591 women from the Healthy Nevada Project4 sheds light on the potential benefits of this genetic risk-based approach. The study classified 2,338 (9.1%) of these women as having a low genetic risk for breast cancer. What's remarkable is that these women exhibited a significantly lower and later onset of breast cancer compared to their average or high-risk counterparts. This finding suggests that it might be safe for low-risk women to delay mammogram screening by 5 to 10 years without compromising their health.