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Abdominal pain is one of the most common reasons for an Emergency Room visit. The abdomen is an area that encompasses multiple organs and functions. So how would you know when the pain you are feeling is an ovarian cyst or something else, and when should you seek medical attention? Dr. Carilyn Hoffman, at Renown Women's Health, explains. Ovarian Function Defined Located on each side of the uterus, the ovaries are part of the female reproductive organs and produce eggs (ova), released during the menstrual cycle, allowing for fertilization and pregnancy. They also produce hormones such as estrogen and progesterone, which play an important role in female traits, bone health, cardiovascular health and pregnancy. Symptoms of an Ovarian Cyst Cysts are solid or fluid-filled masses. Ovarian cysts can be in the ovary or on its surface. When cysts are enlarged or rupture, they can create a dull ache or sharp pain below the belly button. Besides discomfort and pain, other symptoms of ovarian cysts may include bloating, fullness, pressure or heaviness. "Ovarian cysts are common; most are physiologic and will go away on their own. They are frequently found incidentally on ultrasound and are present in the middle of the menstrual cycle," says Dr. Hoffman. "However, if a woman experiences sudden and severe pelvic pain they should seek immediate medical attention. Sometimes ovarian cysts can become large and twist on themselves. This is called ovarian torsion and is a surgical emergency. Other times, cysts can rupture and bleed. This is called a hemorrhagic cyst and can also be a surgical emergency." Diagnosis and Treatment If an ovarian cyst is suspected, your doctor will perform a pelvic exam and order an ultrasound. There are certain ultrasound findings that suggest that the cyst is benign. There are other ultrasound findings that are concerning for cancer. Small simple cysts often resolve on their own, whereas solid or very large cysts may require surgery.

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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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Meet newly minted Dr. Majid Khan, PhD., a native of Reno, and current MD-PhD candidate and first-generation medical student at the University of Nevada, Reno School of Medicine, who is on his way to a career as a Neurosurgery. While most graduate students often choose between pursuing a medical degree (MD) or a doctorate in philosophy (PhD), Majid has boldly picked both. He is one of three medical students currently in the UNR Med MD-PhD Program run by Dr. Caroline Cobine, PhD and Dr. Violeta Mutafova-Yambolieva, MD, PhD. "Research is not merely an act of sitting at a computer and reading papers – it's about answering the thought-provoking questions about things we come across on a daily basis. By critically evaluating these ideas we can implement solutions to enhance various aspects of the medical field and patient care with an overall goal of improving patient outcomes," Majid said. Majid recognizes that modern research extends beyond academia and holds significant value for hospitals. “Research contributes to improving patient outcomes. By reviewing the data from peer-reviewed research studies, medical professionals can be better prepared to deliver effective care following the most up-to-date guidelines and data,” he said. Majid's journey to pursuing his MD-PhD with a goal of becoming a physician-scientist-surgeon began following a summer in the PathMaker Cancer Research Program at the Huntsman Cancer Institute at the University of Utah. "It was by fate that I stumbled into this field – ever since I saw my first brain surgery, I haven’t been able to look back," Majid said. Here are some of the valuable lessons that Majid has learned along the way. 1. Beyond the 9 to 5, Embrace both 5 to 9s To avoid burnout and nurture personal passions, make your time spent outside of work and school intentional. Harness any free time to reconnect with friends, pursue hobbies and engage with mentors and mentees. 2. Collaboration is Key Work collectively with colleagues locally, nationwide and even worldwide. Cultivate environments to share knowledge and innovation, as well as wisdom, which will evidently lead to more impactful outcomes. 3. Shine a Spotlight on Your Colleagues Acknowledge and celebrate your colleagues in group settings when you notice something outstanding that they’ve said or done – it could anything big or small. Shining the spotlight onto those who are making positive changes within the hospital can inspire a beautiful culture of academic healthcare, which ultimately improves patient outcomes. 4. Redefine Mentorship Mentorship does not need to be confined to traditional frameworks. Seek out guidance in unexpected and untraditional places; sometimes, the most enlightening lessons and opportunities emerge from the most unlikely sources. 5. Diversify Your Experiences Embracing a diverse range of experiences enriches one's medical acumen. You never know when a seemingly unrelated job or experience will help in a scenario in your career. 6. Live By the Mamba Mentality Follow the late Kobe Bryant’s approach to life and work, the Mamba Mentality. This includes planning long-term goals, placing meaning in everything, striving for constant personal growth, following your passions and focusing on the process rather than the end goal. 7. Make Time for Your Loved Ones Don’t forget who helped you get to where you are in your life, specifically your family, friends, teachers and mentors. By making time for the most important and loving people in your life, you will be surrounded by positivity which will help propel you to new heights. 8. Plan your Next Five Moves We all have the ability to come from nothing and become something. Take the time to plan out everything and execute your moves with careful precision. Majid has plans to return to the Biggest Little City after completing Neurological Surgery Residency Program. If you would like to get in touch with Majid, please reach out to him via email at majidk@med.unr.edu.

Read More About Eight Lessons from an MD-PhD Candidate at UNR Med

Managing weight is a complicated and often difficult journey for many individuals, and obesity stands as a common and serious chronic health condition. In fact, the Center for Disease Control and Prevention reports that the prevalence of obesity in the US is greater than 40% in adults and 20% in children, and those numbers are continuing to climb. In Nevada, according to the 2020 Behavioral Risk Factor Surveillance System, 28.7% of adults reported being obese. By 2030, almost 80% of American adults may be overweight and half of them will be obese. But obesity isn't just about the numbers on the scale; it's a multifaceted, lifelong, neurobehavioral disease triggered by a combination of factors. These include abnormal eating patterns, reduced physical activity levels, environmental stressors, genetics and various other contributors. Obesity extends far beyond appearance, often leading to the development of numerous medical conditions such as diabetes, heart disease, elevated blood pressure, stroke, sleep apnea, liver disease, various cancers and infertility. Join us as we delve into the complexities of obesity and explore strategies for effective weight management available right here in northern Nevada. Why Can Losing Weight be so Difficult? The challenge behind weight loss finds its roots in the Set-Point Theory of Obesity, a concept that says our bodies have a predetermined weight, or fat mass, within a defined set-point range. In other words, when an individual's weight deviates from this set point, the body initiates mechanisms to bring it back to the established range. So, if someone loses weight below their set point, the body may respond by increasing hunger and reducing metabolism, making it challenging to sustain weight loss. There Isn’t One Right Answer, But Renown is Here to Help Various weight management strategies can be utilized by patients struggling with obesity, which may lead to substantial weight loss, resolution of associated medical conditions and improved psychosocial health. In fact, the most successful strategy involves a multidisciplinary approach under the guidance of trained specialists that includes a combination of tactics, including: Behavioral adaptations Dietary modifications Physical exercise  Anti-obesity medications  Weight loss surgery

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© alessandrobiascioli via Canva.com Ensuring a healthier and more inclusive future for LGBTQIA+ children and teens is of utmost importance to health systems in our community, especially Renown. Supporting the physical and mental health of youth in this community is key to those efforts, especially as they face unique challenges in terms of identity acceptance and social integration.   Dr. Caroline Barangan, Adolescent Medicine Physician with Renown Children’s Pediatric Specialty Care, discusses what you as a parent, caregiver, friend or support system can do to be a safe space for children and teens who identify as LGBTQIA+. 1.  Create a Safe Space at Home The most important action you can take for your LGBTQIA+ teen or child is to accept and support them for who they are, regardless of how they identify. “Being a teenager is already difficult enough, especially within the LGBTQIA+ community, which puts them at risk of being stigmatized, rejected and targets for bullying,” said Dr. Barangan.  Your supportive words and actions can make a huge difference as a profound expression of love and understanding. Being patient and willing to learn are the foundations to a healthy and loving relationship with your LGBTQIA+ teen or child.  2.  Encourage Regular Check-Ups with a Primary Care Provider (PCP)  Establishing your child or teen with a PCP is not only important when an illness occurs but also for annual preventative visits and regular check-ups. “A primary care provider can screen for high-risk behaviors that would put a patient’s health in jeopardy, such as sexual experience, substance use, suicidality and self-harm,” said. Dr Barangan. “These screenings are an opportunity to provide the education and support these kids and teens need to stay healthy.”  One of the main concerns LGBTQIA+ youth often have is that they will experience judgment from their provider, or the PCP will disclose sensitive information, including their sexuality or gender identity to their parents, when they are not ready to do so. Dr. Barangan emphatically reminds us that this legally cannot happen. “If a patient asks me to keep something confidential, unless they disclose that they have plans to harm themselves or others, I am legally not allowed to share that information with anyone without their permission,” said Dr. Barangan.  3.  Locate Local Resources  Northern Nevada is home to a variety of resources for the LGBTQIA+ community at large, including youth members of this community. "Finding resources to help them develop in a positive way and provide them with the information they need, whether it be in school, the household, the community or through a medical or mental health provider, is incredibly important,” said Dr. Barangan.  Below is a list of local LGBTQIA+ community resources open to you and your children:  Our Center LGBTQIA+ Health Services at Northern Nevada HOPES Northern Nevada Pride Festival & Community Parade (happens every July in Reno) Sassabration (happens every September in Carson City) Lake Tahoe Pride (events and resources shared on Facebook)

Read More About 3 Ways to Foster the Wellbeing of LGBTQIA+ Kids and Teens

Did you know certain medications can interact with everyday food and drink? We asked VP of Pharmacy Services Adam Porath how to take these important medications safely. One in five Americans between the ages of 40 and 75 are currently taking a statin drug to reduce their cholesterol level or to prevent atherosclerosis (hardening of the arteries). Many others also take anticoagulants (blood thinners) to prevent blood clots from forming, which can increase the risk of stroke. Adam Porath, VP of Pharmacy Services at Renown Health, explains how to safely take these medications. What is a statin? A statin is a drug that can lower cholesterol by helping your body absorb cholesterol or by blocking a substance your body needs to make it. The American Heart Association cites a global study reporting the benefit of statins to help reduce heart attacks and strokes. Common statins include atorvastatin (Lipitor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). Which foods or drinks should be avoided while taking statin drugs? Grapefruit juice is the only food or drink that has a direct interaction with statins. Statins do not directly interact with any food but people taking statins should moderate their intake of saturated fats to help lower their LDL cholesterol and overall risk of cardiovascular disease. What is a blood thinning drug? Blood thinning drugs, such as warfarin, rivaroxaban (Xarelto), apixiban (Eliquis), dabigatran (Pradaxa) and edoxaban (Savaysa), are used to prevent stroke. Which foods or drugs should be avoided while taking blood thinning drugs? If taking warfarin, alcohol and cranberries (including juice) should be avoided. Patients taking warfarin should be aware of foods that contain Vitamin K (green leafy vegetables) and try to maintain a consistent diet of these foods. Warfarin interacts with many over the counter and prescription medications. Patients should consult a pharmacist when starting, stopping, or changing doses of any medication when taking warfarin. Also, patients taking any blood thinning medication should avoid over-the-counter pain relievers (i.e. aspirin, ibuprofen, etc.) How do I know whether to take my medication with food or not? Consulting with a pharmacist is the best resource to determine if a medication should be taken with or without food. In general, all statins and blood thinners can be taken with or without food. The only exception is Xarelto (rivaroxaban), which should be taken with the largest meal of the day If you are a Renown patient you can also review your prescriptions online, request a refill or ask a question via MyChart. With MyChart, you can access all your healthcare information securely 24/7.

Read More About Foods to Avoid When Taking Heart Medications

Heat and ice are two of the most common treatments used to relieve pain and reduce swelling in injuries. However, each one is better suited for certain types of injuries Dr. Luis Palacio, MD explores the differences between the two.  When it comes to treating aches and pains, the debate between heat and ice has been ongoing for quite some time. Both have their benefits making it crucial to understand which option is better suited for your specific needs.   Determining which method is better depends on various factors such as the type of injury or pain you are experiencing. For instance, if you have recently sprained your ankle or pulled a muscle during exercise, applying ice within the first 48 hours can help minimize swelling and alleviate discomfort.   It's worth noting that some individuals find alternating between heat and ice therapy beneficial as well. This approach combines the benefits of both methods by using heat to increase blood flow followed by ice to reduce inflammation.  Cold Therapy  Cold therapy can help to reduce inflammation after an injury, heat can have the opposite effect. Therefore, heat therapy should be reserved for those who have chronic pain issues and are not dealing with an acute injury. Cold therapy is often recommended immediately after an injury or during the initial stages of inflammation.  Cold therapy such as ice packs are especially effective in treating: Sprains  Strains Any injury that involves swelling Heat Therapy  Heat therapy is known for its ability to relax muscles, increase blood flow and soothe pain. It is often used for chronic conditions or injuries that are not inflamed. Applying heat can help alleviate stiffness, promote healing and provide a comforting sensation. This increased circulation can bring more nutrients and oxygen to the area, helping it to heal faster.  Heat therapy such as heating packs are especially effective in treating:  Stiffness with associated pain   Injuries that are not inflamed  Muscle pain

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© Niyazz via Canva.com Every patient, regardless of how they may identify, greatly benefits from preventive healthcare and early detection. Members of the LGBTQIA+ community face unique considerations when it comes to their health, and a proactive approach to preventive screenings and vaccines is important in order to address their individual health needs.  Dr. Karen Thiele, Family Medicine Physician with University Health and Assistant Professor of Family and Community Medicine at the University of Nevada, Reno School of Medicine, breaks down key steps that LGBTQIA+ patients should take to safeguard their health.  PrEP and PEP  Pre-exposure prophylaxis (PrEP) is a strategy to prevent human immunodeficiency virus (HIV) infection. It is an important measure for those who are HIV-negative but may be at risk of contracting it. The highest risk sexual practice is receptive anal intercourse, due to the relative fragility of rectal tissue. This medication can stop HIV from spreading in the body and help patients maintain their HIV-negative status. PrEP is available in both pill form, which is taken every day, and injection form, of which the first two injections are initiated one month after another while all other injections are initiated every two months.  Post-exposure prophylaxis (PEP) is an antiretroviral drug regimen taken after potential HIV exposure to prevent an HIV-negative individual from converting to HIV-positive status. PEP is only for emergency situations and must be started within 72 hours of exposure – sooner is always better than later – and must be taken for 28 days.  PrEP and PEP are available in many ways, including visiting your primary care provider (PCP) or an urgent care location.   HPV Immunization  All genders and identities can protect themselves against human papillomavirus (HPV), a sexually transmitted infection (STI) that can lead to the risk of cervical, mouth, head, neck, throat, anal, vaginal, penile and vulvar cancers. HPV is so common that nearly all sexually active people, regardless of sexual orientation and practices, will be exposed at some point in their lifetime.  The HPV vaccine (common brands include Gardasil and Cervarix) is a safe and effective method to prevent HPV, according to the Centers for Disease Control and Prevention (CDC). This vaccine protects against infections that can lead to HPV-related cancers and precancers, as well as genital warts. While patients should start receiving the vaccine at 9 years old years old, unvaccinated adults up to the age of 45 can also receive the vaccine through their PCP – better late than never!  STI Testing  Sexually-transmitted infections form from bacteria, viruses or parasites that can be transmitted by person-to-person sexual contact through semen, vaginal, blood and other bodily fluids. According to the U.S. Department of Health and Human Services, there are more than 20 million estimated new STI cases across the nation each year.   Luckily, most STIs are preventable. Annual STI testing for HIV, gonorrhea, chlamydia and syphilis is important to stay on top of your sexual health. Because these STIs may sometimes have no symptoms, screening is recommended regularly and with any change in sexual partners. Depending on the specific condition, tests for these infections include urine, swab and blood tests. Speak with your primary care provider on a screening schedule that works best for you.  Prostate Exams  Prostate exams look for early signs of prostate cancer in patients who still have a prostate. The CDC recommends those who are at least 55 years old get regular prostate screenings; however, for patients with a family history of prostate cancer, screenings may be recommended as early as 45 years old.  These exams are done via two common methods – a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE). Your provider can help you determine your risk and when you should start getting screened.  Pap Tests and Pelvic Exams  Patients of all genders who have a cervix, uterus, vagina and/or ovaries will benefit from regular pelvic exams and Pap screenings. A pelvic exam consists of a provider looking inside the vagina and at the cervix for anything unusual. A Pap test, also known as a Pap smear, involves your provider using a small, soft swab to collect cervical cells to check for early signs of cancer.  Generally speaking, people with these organs should have a Pap test every three years starting at age 21 through the age of 30. After age 30, patients should receive a Pap test with HPV co-testing every five years until age 65. These recommendations are changing based on new research, so it is important to have a conversation with your PCP about the current guidelines so you can make an informed choice about what schedule you should follow. A gynecologist or your primary care provider can counsel you and perform these screenings.  Mammograms and Breast Exams  People with breast tissue, especially dense breast tissue, are at risk for breast cancer, and regular breast screenings are your best line of defense. At-home breast self-exams are the first step – you will want to check your breasts for any lumps, changes, fluid leaks, irregular tissue thickening or anything else that feels unusual.  The Breast Cancer Risk Assessment tool, provided by the National Cancer Institute, is a good place to start to identify your risk. Talk with your primary care provider about the risks and benefits of starting screening at age 40 so you can make an informed decision about when to start. If you have any family history of breast or ovarian cancer, your PCP will offer you genetic testing for BRCA 1 and 2 mutations. Nevadans over the age of 18 can also get BRCA genetic test for free by enrolling in the Healthy Nevada Project.  Mammograms are important screening tools, but for a significant portion of people with breast tissue, density of the breast tissue may make mammograms less helpful in detecting cancer. Your primary care provider can help you decide what additional imaging (such as breast ultrasound) might be best for you.

Read More About 6 Healthcare Action Items for the LGBTQIA+ Community

© AndreyPopov via Canva.com Becoming a Hometown Health plan member opens you up to the largest provider network in our region. As northern Nevada’s only not-for-profit health insurance company, the hometown advantage goes beyond your health coverage – and you may not be using all the perks available to you. Here are three benefits that Hometown Health is proud to offer all members to enhance wellbeing and connect the dots between healthcare and technology.  MyChart  MyChart is Renown Health's and Hometown Health’s secure online member portal that gives you direct access to your health and benefit information. From 24/7 access to your benefits and important documents to scheduling an appointment with your provider, this free tool is a great way to keep track of your family’s health. If you have a Renown primary care provider, you can use MyChart to:  Securely email your healthcare provider. Get your test results faster and view your After Visit Summaries. Request prescription refills. Schedule and check-in for appointments. Pay your bill. Request your medical records and review immunization records. Manage designated health care agents and upload end-of-life documents, such as advance directives and a living will. View or download your documents: Member ID Card, Summary of Care, Explanation of Benefits, Referrals and Authorizations. Get in touch with our Customer Engagement Center.  Telehealth  Virtual visits have never been easier thanks to Renown Telehealth and Teladoc. These two tools are convenient options that allow members to be seen by a qualified doctor via phone or video chat who can diagnose, recommend treatment and prescribe medication for many non-emergent medical conditions – no matter where you are. Some of the health issues your virtual provider can treat include:   Cold and flu Allergies Sore throat Sinus infection Respiratory infection Stomach bug Ear infection Urinary tract infection  Both Renown Telehealth and Teladoc are also staffed with specialists in behavioral health, where you can speak with a therapist or psychiatrist on a wide variety of issues, including:  Stress and anxiety Depression Trauma Grief Burnout Medication management  Renown is also proud to offer access to top-level specialty care to address your ongoing condition and help guide you through illness maintenance and education. Through Renown Telehealth, Hometown Health members have access to a variety of specialties, including (but not limited to):  Adolescent Medicine Cardiology Hematology, Oncology and Pediatric Oncology Nephrology Pediatric Endocrinology Pediatric Neurology Pulmonary and Pediatric Pulmonary Sleep Medicine  New in recent years, Teladoc is now proud to offer both dermatology and nutrition visits. Teladoc dermatologists can treat conditions like acne, rosacea and rashes, while their registered dieticians can help you manage your nutrition and weight goals.  Booking an appointment with Renown Telehealth is easy by heading over to MyChart and selecting “Schedule an Appointment.” To book an appointment with a Teladoc provider, visit teladoc.com or download the Teladoc app.  Renown Telehealth is available within the state of Nevada, and Teladoc is available in all 50 states. Your copay can be as low as $0 for each visit; check your plan documents for more information.  Doctoroo  The house call has returned – avoid long urgent care waits with Doctoroo. Through Doctoroo, Hometown Health members have access to in-home urgent care services at the same price as your regular urgent care copay. A call to Doctoroo will dispatch a fully equipped medical team consisting of an EMT and either a nurse practitioner or physician assistant to your home within a few hours. Whether you need treatment or testing, each team is ready to provide care in the comfort of your own home with their over 60 medications and antibiotics, EKGs, wound dressings, IVs, catheters and more.  Doctoroo care teams can address and treat many non-emergent care areas and conditions, including (but not limited to): Respiratory Ear, Nose, Throat Eye Wound Care Cardiac Care Musculoskeletal Gastroenterology  Doctoroo is open year-round from 7 a.m. to midnight. Book a house call in minutes in the Doctoroo app or by calling (888) 888-9930.

Read More About 3 Unexpected Perks of Choosing a Hometown Health Plan

May 20 is National Clinical Trials Day. Celebrate with us by recognizing the Clinical Research team at Renown Health!  The root of every medication, treatment and procedure in healthcare can be traced back to research. From the beginning of the history of medicine, research has always played a crucial role in improving the lives of patients around the world, leaving a permanent mark on how we expand our medical capabilities to this day.  Renown Health’s Clinical Research team, in partnership with the University of Nevada, Reno School of Medicine (UNR Med), are leading that effort in our very own community. As our in-house leaders of clinical trials, this team is dedicated to advancing the science of medicine to help further our bottom line of making a genuine difference in the health and well-being of the patients they serve.   Trial by (Medical) Jury  Every day looks different for the Clinical Research team, especially when it comes to interacting with patients, providers and “sponsors,” which are the organizations providing the treatment for the study. One fact always remains true: communication and collaboration are key, especially among the team who act as the face of this process.  Meet Lisa English (pictured above on the far right in a blue shirt), a Lead Clinical Research Coordinator at Renown who serves as the study "project manager." One aspect of Lisa’s day-to-day is seeing patients through their clinical trials from start to finish.  It all begins with the setup.  “Before we can launch a study, there is a lot of back-and-forth dialogue between everyone involved to ensure the best fit,” said Lisa. “Sponsors will come to us with novel treatments, such as medications or devices, and the inclusion criteria that patients need to meet in order to qualify for the study. We then immediately jump into working with the providers, looking closely at the science and comparing the treatments to what is on the market already.”  From there, Lisa coordinates conversations between the providers, sponsors and study teams to gauge everyone’s capacity based on the length of the study, ensuring everyone involved has the time to dedicate to the process. Next, the providers identify patients that meet the criteria for the study, and together, the team decides where the patient visits will happen and discusses any potential barriers that may affect patient retention. The budget is clearly defined at this stage, set up to make sure no patient is ever billed for medical costs incurred as a result of the study.  Often, research participants are seen within the specialty clinics throughout the health system, while other times the Clinical Research Coordinators see patients at the recently centralized Clinical Research Office at Renown Regional Medical Center. This location provides an essential public-facing space for the community to learn more about clinical trials and demonstrates the breadth of resources available at Renown to sponsors to strengthen external partnerships and research funding opportunities.  Once the study officially begins, team members like Lisa will set patients up for a “screening/qualifying visit.” During this appointment, she makes sure patients get scheduled for their lab work, imaging scans and anything else the provider may need to make an executive decision on whether or not the patient is a good candidate for the study.  “I build it all in Epic,” said Lisa. “The study information, directions, requirements and next steps are all loaded in Epic for easy tracking. We are also required to input any notes in the sponsor’s electronic data capture website. All the information I track is inputted without protected health information (PHI), so every patient is completely anonymous.”  After the patient officially qualifies, the study goes full steam ahead. Team members like Lisa and the providers receive continual updates from sponsors on the status of the study.  “Throughout the entire process, I make sure patients get scheduled for everything that meets the requirements for the study,” said Lisa. “I meet with patients one-on-one to discuss their needs and concerns and ask questions about the study, organize their appointments and charts and deal with any issues or pivots that may arise. It’s very important that every patient fully understands what is going to happen with their care.”  The Clinical Research department strives to serve as a care partner to patients, providers and clinics they work with. The majority of our Clinical Research Coordinators are trained phlebotomists and medical assistants, performing their own assessments such as lab draws and electrocardiograms (ECGs) to streamline the research visit process and reduce resource constraints on the clinics and health system.  Lisa typically sees a couple of patients per week, depending on the study and where patients are in the cycle. Depending on the complexity of the trial, patients may see the research team only one time or several times over many years. Typically, clinical trial patients are seen in clinic every 2-4 weeks. There are many tasks required before, during and after a research visit to ensure everything runs smoothly, so Clinical Research Coordinators dedicate an average of 5-11 hours of work per patient, per visit.  Regardless of patient load, each employee in the Clinical Research department – as well as participating teams across Renown and UNR Med – always step in to help each other out. According to Lisa, the environment is immensely supportive.  “We have a program here at Renown to train employees who have never done clinical trials,” said Lisa. “We love seeing people get more engaged with the important work we do, and every department has been great at collaborating with us. Everyone brings a different perspective.”  At the end of the study, Lisa gathers all the information and collects notes into a zip drive or paper binder for archiving. The sponsor lets the Clinical Research team, providers and patients know whether they are on the trial drug or on the placebo. The teams use the data gathered during the study to publish a report or present at conferences, promoting the critical research done to better the lives of patients in our community, and potentially, the world.  “I appreciate the time everyone gives us to make sure our research is successful,” said Lisa. “It feels great to work together to make a difference, improve healthcare quality and save lives.”  Behind-the-Scenes, Yet on the Frontlines  The impact of research studies transcends hospital walls, and this can all be attributed to the dedication of our Clinical Research department. The constant collaboration between this team, lab science, medical assistants and providers, cardiology technologists, sonographers, finance teams and our partners at UNR Med is crucial to safeguarding the success of the studies.  Devoted to keeping research close to home, Renown and UNR Med teamed up to form the Clinical Research Office (CRO) in 2021. With the strength of northern Nevada's largest not-for-profit health system and Nevada’s first medical school, this team is dedicated to giving our community access to the latest care innovations.  “At UNR Med, we are working with students, residents and academic faculty; on the Renown side, we are working with clinicians and community participants,” said Amber Emerson, Manager for Community Outreach and Research Engagement for UNR Med.  “Everything we do is data-driven,” added Kristen Gurnea, Manager of Clinical Research for Renown. “Our main goal is to optimize our impact and provide a community benefit for our patients. The scope of our roles in the Clinical Research office is very diverse.”  To help meet the growing need locally for healthcare and cutting-edge treatment solutions, the CRO has continued to grow, expanding its research capabilities and helping bring new medications, medical devices and more to patients across northern Nevada and northeastern California.  “Once upon a time, our team had only six members; today we have grown to a team of 25,” added Diana Torres, Research Resource Analyst for Renown. “We used to be considered one department, including Medical Education, and we have since branched off into our own cost center. We branched off even further and created a separate Genetics department that runs the Healthy Nevada Project. Throughout this process, the Clinical Research department was always the main point of the umbrella.”  “We participate in hospital-wide outreach and marketing, and we feel this has really helped us get the word out about our department,” added Raul Arellano, Research Resource Analyst for Renown. “In fact, we doubled our clinical trial portfolio from last year.”  The CRO currently operates over 100 clinical trials locally in cardiology, endocrinology, infectious disease, neurology, pediatric and adult oncology, pediatric sub-specialties and pulmonology.   Behind the curtains of in-person research, the CRO is home to several experts who help turn our research studies into a reality, from budgeting and billing to barrier-breaking and building relationships.  “I help with barriers patients and Clinical Research Coordinators are facing, building connections and relationships inside and outside of our health system,” said Kristen Gurnea. “I enjoy handling all the supporting pieces that are required for studies to happen.”  “My role changes every day,” added Jenna Berger, Administrative Assistant for the CRO at Renown. “Some days, I’ll be helping coordinate patient stipends and going through document management to ensure we have all necessary signatures. Other days, I will be planning events – like Clinical Trials Week – for our department and creating marketing materials and fliers.”  “Our day-to-day involves going over anything related to research financials,” added Diana Torres. “We handle sponsor billings, process efficiency and collecting revenue for research contracts, and we collaborate closely with our Finance department and Revenue Integrity in order to accomplish this. It’s important for us to make sure all billing on both the sponsor and patient side is taken care of, especially because patients should never receive a bill for medical services they receive for the trial. A year and a half ago, we started doing budget negotiations for research contracts,” said Diana Torres. “We are proud to help clinical teams with any training they may need on these negotiations as well as billing reviews and allocations.”  Seeing patients progress during a study and transform before their eyes inspires the CRO team to continue doing what they do every day.  “I’ve been here for many years, first working on the floor as an oncology nurse and transitioning to oncology research in 2005,” said Anna Winchell, Cancer Protocol Nurse for Renown. “I love getting to know the patients and seeing them progress into a healthy lifestyle.”  Medical students and residents at UNR Med also play a significant role in the research process, advancing medicine by exploring causes and novel treatments for a wide range of conditions, including HIV, muscular dystrophy, gastrointestinal disorders, infectious diseases and more. Medical research at UNR Med is headed by committed research coordinators, community outreach managers, grants managers, pharmacists and physicians.  “I oversee scientific review and help the physicians that come to us for those resources,” said Amil Trujillo-King, Medical Research Coordinator at UNR Med. “I guide medical students in their research protocols and help with different projects to improve research activities for both students and medical residents.”  It takes a village to make clinical research happen. Because of that, the ACRO cannot thank the following teams enough for moving mountains for the future of medicine:  Renown Health and UNR Med leadership for demonstrating the integrated health system’s commitment to expanding access to clinical research in our community within both the Renown / UNR Med affiliation and Renown active strategic plans.  Renown Pharmacy especially Research Clinical Pharmacist Tim Morton, who supports all clinical trial medication dispensing and patient education across all clinical trials at Renown.  Accounts Payable for having a huge impact on patient and employee reimbursement.  Renown Medical Group for their participating providers, especially in oncology, cardiology, pulmonology, pediatrics, endocrinology and neurology, who are involved in research year after year.  Marketing and Communications for helping with printed materials and raising awareness for clinical research at Renown and UNR Med.  An Affiliation to Last Through the Ages  A collective, shared vision of exploring community health – that is the impetus behind the affiliation between Renown and UNR Med. By leveraging resources across both institutions, the CRO has maximized their impact, giving the people of northern Nevada greater access to new interventions and treatments and promoting an impassioned culture with patients, providers, residents and medical students.  “Community-based research always sat well with me,” said Amber Emerson. “As Renown and UNR Med, we have this unique opportunity to shape clinical research here in northern Nevada. We always make sure we present research in a meaningful way that speaks to the work we produce and demonstrates the opportunities we offer. After all, participating in clinical research doesn’t mean our patients are ‘guinea pigs’ – quite the opposite! They are partners in their health care, and we support them through providing access to novel treatments.”  “Research is my passion, and my career has spanned broadly from grants administration to study coordination,” added Valerie Smith, Clinical Research Center Administrative Manager at UNR Med. “I am excited to be at the forefront of research frontiers in northern Nevada.”  Through robust engagement and collaboration with healthcare providers, department administrators, internal research team members and leadership, the strength of this affiliation is unmeasurable. The CRO’s ultimate goal is to have clinical trials be the standard of care for every condition that Renown and UNR Med treats. Clinical research participation is all about patient autonomy, shared decision-making between patients and their providers and advancing medicine to save lives. From their beginnings as a small group of passionate researchers to their present reality as a leader in the research space in northern Nevada, their efforts do not go unnoticed.  “The success of our department is inspiring,” said Amil Trujillo-King. “Renown and UNR Med supports the wellbeing of all employees and contributes directly to the growth of the department.”  “When I first joined Renown in Patient Access, I didn’t realize that we had a research department; with a strong healthcare background in my family, I knew I wanted to grow in my career, and our expanding Clinical Research office was that next step,” said Raul Arellano. “With our affiliation with UNR Med, it’s especially inspiring to be able to apply what I learned as a Patient Access Representative to help further outcomes for our patients through managing our finances.”  Through their unwavering commitment to research excellence and patient-centered care, the CRO will continue to pave the way for groundbreaking medical discoveries and improved outcomes for patients for years to come.  “Fundamentally, we’re working to build a culture of research in our community because we believe it is the right thing to do. Our community deserves to have access to clinical trials and novel care close to home with a dedicated team to support them every step of the way,” closes Kristen Gurnea.

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Your provider wants to send you to a specialist. Now what?  You are about to enter the referral process. A referral is your provider’s recommendation for you to see a specialist or receive specialized treatment. When it comes to referrals, the process can seem like the wild west for people not familiar with it. At Hometown Health and Senior Care Plus, we make the process simple for all our members. We know that access to specialists is a vital aspect of total health, and our goal is to break down those barriers to care at every level.   Here is a step-by-step guide to how the referral process with your Hometown Health or Senior Care Plus provider works:  1.   Your primary care provider (PCP) or urgent care provider will send a referral to the specialist’s office. A referral can also be sent from another specialist or after discharge from the hospital. This is usually done via email or fax.   2.   As your referral is sent, now would be the ideal time to discuss with your provider’s office how the specialist will receive your medical records prior to your appointment. Your provider’s office will most likely send these records to the specialist for you, but it is always a good idea to double-check with them directly.  At Renown, the referrals team will send the following items to your specialist’s office when available:  ID Insurance card Most recent and relevant office notes to support the referral The referral order Any relevant labs or imaging pertaining to the referral Demographics information  3.   The specialist’s office will call you to schedule the appointment after they receive the referral. Each office processes the referrals they receive in a slightly different time frame, so if you have any questions about the status of your referral, it is best to call their office directly. At Renown, if you are enrolled in MyChart, you can access the phone number for your specialist as soon as the team processes the referral. Those not enrolled MyChart will receive a letter in the mail with scheduling information.  4.   The specialist will start to develop a course of treatment. That may include procedures, diagnostic tests or medications. Some of these treatments may require prior authorization from your insurance plan, so don’t forget to discuss how and when your specialist will receive the authorizations before you begin your course of care to avoid any surprise bills.  What can I expect if I have a Renown specialist?  At Renown, we handle a lot of the behind-the-scenes nitty-gritty so you don’t have to. After the referral is placed, it routes to Renown’s centralized referrals team and triaged to make sure you are scheduled with one of our providers with the right specialization for your specialty care needs. This team will also obtain the prior authorization you need and will you to a specialist that is in your network and based on you and/or your provider’s preference and continuity of care. The referrals team will attempt to find you a Renown provider first if you are not yet established elsewhere.   For Hometown Health and Senior Care Plus members, prior authorization is not required for certain services if you are being referred to a Renown provider. This makes the scheduling process go quicker for both the provider and the patient.   Our referrals team strives to keep their turnaround time for referrals within three business days, not including prior authorization wait times. If your referral is marked as ‘urgent,’ it will be reviewed within one business day so you are seen as soon as possible based on the needs of your medical condition, and you will receive a direct phone call with scheduling information.   After prior authorization is obtained, the Renown scheduling team will call you through an automated phone system or via a message in MyChart with a direct link to schedule your appointment. To speak with a Renown scheduler or if you have any questions, please call 775-982-5000.  What does prior authorization mean?  Prior authorization isn’t as scary as it sounds! Essentially, prior authorization is your provider “going to bat” for you to receive this specialty level of care. Some medical services, including many specialists, are covered only if your ordering provider (usually your PCP) submits an authorization request to your insurance plan. They will include specific details about the type and duration of treatment they would like you to receive and any medical records that support your need for the specialist.  After your insurer receives the request, a licensed medical professional will review the request, your records and your plan benefits. They will decide whether the specialty treatment is considered medically necessary based on recognized standards of care.  Where can I go for more information?  Your referrals and authorizations can be viewed in MyChart. To view them, navigate to Your Menu in the upper left corner of the page, scroll to the Insurance section and click on “Referrals.”   The Renown referrals team is available to answer your questions and address any concerns. Give them a call at 775-982-2707 Monday through Friday from 8 a.m. to 5 p.m.  Any questions you may have related to referrals and authorizations, including outside-of-Renown providers, can be directed to our expert Hometown Health or Senior Care Plus customer engagement representatives.

Read More About How Referrals Work at Hometown Health and Senior Care Plus

Dr. Nariman Rahimzadeh’s career path has been anything but typical. From humble beginnings as a shuttle bus driver for Renown Regional Medical Center, then named Washoe Medical Center, to his service as Chief of Staff for Renown South Meadows Medical Center, the steps and detours he took along the way – and the strong support from his colleagues and family members – make up a tale of perseverance, conviction, compassion and inspiration.  However, his healthcare career journey began several years before he even joined Washoe Medical Center in the 1990s.  It all began 7,446 miles away in Iran.  This is Dr. Rahimzadeh’s story.  Defining Moments  The moment Dr. Rahimzadeh knew he wanted to dedicate his career to the healthcare field started during his childhood. Growing up in Iran during the midst of the Iranian Revolution, a thought that often came to mind was, “Who is helping all the people injured in the war?”  The answer? The doctors.  “In Iranian society, doctors are extremely valued, as they are the first to help people in need,” said Dr. Rahimzadeh. “I knew I wanted to give back to society in some way, and I see my time in Iran as very formative in my future career. I just didn’t know it yet.”  After immigrating to the U.S. with his family during his preteen years, he only had one mission: to support his family. “My desires were to help my family not fall behind,” he said. “I didn’t have career aspirations at the time. All I knew is that I wanted to help my family and my community, which immediately opened its arms up to us, as well as be a good student and a good ambassador for Iran.”  Dr. Rahimzadeh remembers several influential people that helped solidify his aspiration from “helping people” to “helping people as a healthcare professional.” Their family physician and other medical professionals in the family’s lives were monumental in helping him make this decision. Coupled with his natural love for the sciences, the decision to become a doctor became clear.   But the question remained, “How do I get started in the healthcare field?”  No Links to Healthcare? No Problem  With no physicians in his immediate family and no direct connections to healthcare, Dr. Rahimzadeh set off to follow the advice he received from the influential people in his life: get a job at a healthcare facility, regardless of what the job title is.  Some of his friends had recently joined Washoe Medical Center as patient transporters and mentioned job openings that were available. He sprang into action and headed to Washoe Medical Center to apply.  Just one problem – he didn’t have the EMT certification requirement.   Enter Barry O’Sullivan, who would be Dr. Rahimzadeh’s first supervisor at Washoe Medical Center (and a friend he still speaks with to this day). Barry saw promise in Dr. Rahimzadeh immediately. As a result, Barry made a suggestion to him that would ultimately set him on the course towards medicine.  “Barry told me that he had an open position that I could work while completing the senior year of my undergraduate degree and studying for my EMT certification and eventually becoming a patient transporter. He told me Washoe Medical Center would support me in this endeavor. So, I asked what the job was and learned it was driving a shuttle bus.”  Without hesitation, Dr. Rahimzadeh responded, “I’ll take it.”  And so, his fulfilling journey with Washoe Medical Center, and eventually Renown Health, began.  While he finished up the last few months of his degree at the University of Nevada, Reno, (UNR) Dr. Rahimzadeh proudly drove the shuttle bus a few days a week. The job not only helped him pay for his degree and put food on the table, but it also allowed him to begin living out his passion for helping people in the healthcare field.  Dr. Rahimzadeh graduated with his bachelor's degree in Pre-Medicine from UNR and finished his EMT certification program. Sure enough, Barry and Washoe Medical Center lived up to their promises and helped him secure his first direct healthcare job as an EMT and Patient Transporter with REMSA. But he didn’t stop there – after several years as a ground transporter, his career literally took flight. He joined REMSA Ground Ambulance and eventually Care Flight as a Flight EMT II, caring for patients that were flying to Washoe Medical Center from nearby communities that needed lifesaving medical care.  Helping save lives every day as a member of the emergency medical team is an ultimate feat, especially when it comes to Dr. Rahimzadeh. And he didn’t stop there.  Valuing One-on-One Connections  In the 1990s, as it is today, the U.S. experienced a significant primary care provider shortage which resulted in many medical schools encouraging students to complete their residencies in a primary care specialty, like internal medicine – which is precisely what Dr. Rahimzadeh set out to do at the University of Connecticut.   However, his mind would soon change about the course of his career.   “I had a deep, introspective conversation with my residency program director, openly and honestly chatting about my future,” Dr. Rahimzadeh said. “I ended up taking a week off of my residency and wrote a long pros and cons list about what I wanted to do with my life in the medical field.”  Eventually he decided on anesthesiology because of the opportunity to have a one-on-one relationship with every surgery patient, regardless of their procedure.  “Even though it’s for a short duration of time, it is a very impactful relationship,” he said. “I feel I am making a difference in the outcomes and lives of patients every day.”  Dr. Rahimzadeh finished his internal medicine residency in three years and passed his board exam, and he went on to do the same thing for anesthesiology. He then ventured back home to Reno.  Career Progression at Its Finest  Dr. Rahimzadeh knows that people don’t always get to settle down in a place that influenced their upbringing, care and dream, yet he was able to make that vision a reality for himself.  “I feel like Renown Health and myself have this intertwined relationship that led to my growth as a person and as a physician,” he said. “For that, I feel very blessed."  Upon his arrival back to Reno with two residencies under his belt, Dr. Rahimzadeh was quickly hired at one of the two anesthesiology groups in town at the time. He started his career with Sierra Anesthesia and after working for the group for several years, he joined Associated Anesthesiologists of Reno in 2014, which went on to become one of the largest anesthesiology groups in northern Nevada. The group continuously worked very closely with Renown, taking care of all of its surgical patient needs and eventually becoming Renown Medical Group employees as of April 1, 2022, with Dr. Rahimzadeh setting up his home base at the Renown South Meadows campus.  Today, Dr. Rahimzadeh wears three “hats” at Renown. As a medical professional first and foremost, his largest “hat” is his general anesthesiologist role, where he cares for patients in the operating room. Another significant “hat” is his role as the Medical Director for Surgical Services, where he reviews surgical patient charges alongside his dedicated team of nurses and ensures optimal patient outcomes by verifying they have had the appropriate workup to proceed with surgery in a safe manner. To round out his immense responsibilities with Renown, he serves as Chief of Staff for Renown South Meadows, where he makes connections with colleagues and collaborates with leaders to review protocols, policies and address concerns that arise.  Outside of Renown, Dr. Rahimzadeh is still a contributor within his own anesthesiology practice. He also is the current President of the Nevada State Society of Anesthesiologists and the Director to the Board of Directors of the American Society of Anesthesiologists, helping bridge the gap in anesthesia concerns between his northern and southern Nevada colleagues.  He reflects on the opportunities Renown and our local community have extended to him by saying, “If you can dream big enough and continue to chase your dreams, you can make it happen right here.”  On the COVID-19 Frontlines Nothing could prepare us for the dire situation hospitals on the east coast – especially those in Livingston, New Jersey – were experiencing at the beginning of the pandemic. Livingston was known as the “second hardest hit area” by COVID-19 in April of 2020. Hospitals were overwhelmed with patients in the ICU fighting for their lives. They needed help, and they needed help now.   Unable and unwilling to sit idly by, Dr. Rahimzadeh and six of his colleagues from his practice traveled to Livingston to help. They jumped in on the frontlines alongside other anesthesiologists and intensivists to offset the sudden influx of COVID-19 patients. Many lives were saved, and Dr. Rahimzadeh was a direct part of that.  “When you care and work with people that also care, you can move the needle a lot – it doesn’t matter where you're from,” he said.  Home Means Nevada – and Renown  Renown Health is deeply rooted in the northern Nevada community. Dr. Rahimzadeh is proud to be among a diverse team who have taken responsibility for its community for generations.   "We live in a very passionate and caring community, which is often underestimated,” he said. “It’s clear to me that Renown refuses to settle. Renown is incredibly progressive in providing the best for the community. We never remain stagnant, we keep moving forward and we take care of your loved ones. This health system has never been able to sit still and settle for the status quo. That stands out to me.”  One story especially sticks out to Dr. Rahimzadeh as the moment when he knew that Renown was home. In 1997 while working as a patient transporter, his grandmother passed away on the sixth floor of the Sierra Tower at what is now Renown Regional Medical Center. At the funeral, a huge bouquet of flowers arrived. Not being especially close to anyone in Reno yet, Dr. Rahimzadeh's family had no idea who sent the beautiful arrangement. Turns out, it was Rod Callahan, the Chief Operating Officer (COO) of Washoe Medical Center at the time.   “At that point, I knew I wasn’t just a part of a workforce with thousands of employees,” said Dr. Rahimzadeh. “The COO cared so much about me that he felt compelled to send such a wonderful gift during a tragic time. That’s the value of a local, community-focused hospital; the people here know you and care about you. There’s a reason why people stay at Renown for so long – we feel that connection.”  Dr. Rahimzadeh also reflected on how far Renown South Meadows has come, from the time he immigrated to the U.S. to today. “Growing up, Renown South Meadows was kind of a ‘mom and pop shop’ primarily serving senior citizens in one wing and surgical patients in the other,” he said. “Now, I am so proud to see how far it has come. It really made its niche in the community in a great way. The future is bright!”  It’s clear that Dr. Rahimzadeh is leaving a lasting legacy with his family, from the local community to global medicine. His son is a senior at Baylor University in Texas with a strong desire to go into medicine, just like his dad. His daughter is a junior at Bishop Manogue Catholic High School in Reno and enjoys being involved in her community. His loving wife is a speech therapist in the area. The Rahimzadeh family is thriving together, and they all share the same conviction about northern Nevada and Renown:  “This is home.”

Read More About A Renown Anesthesiologist's Unique Journey