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Seeking specialized care for your teen from a sports medicine doctor is essential. Like a coach fine-tunes a player's skills, our experts fine-tune your teen's health, ensuring they stay at the top of their game. Luis Palacio, MD, a sports medicine physician with Renown Health, shares information to help young athletes safely push their boundaries and achieve their personal best. The Role of Sports Medicine Sports medicine is a specialized branch of healthcare that focuses on preventing, diagnosing and treating injuries related to physical activity and sports. Renown's Sports Medicine team consists of skilled professionals passionate about keeping young athletes performing at their peak while minimizing the risk of injury. With a comprehensive approach to care, our sports medicine doctors provide tailored guidance and solutions to help your teen reach their full potential. Injury Prevention and Education Prevention is the key to maintaining a long and successful athletic journey. Our sports medicine doctors collaborate with young athletes to educate them about proper warm-up techniques, body mechanics, and techniques to prevent overuse injuries. From understanding the importance of rest days to practicing correct form, our experts empower teen athletes with the knowledge they need to stay in the game.

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In this article reprinted with permission from the Galena Times,  Dr. Max J Coppes, Physician-in-Chief, Renown Children’s Hospital, and Nell J. Redfield, Chair of Pediatrics, UNR Med, talk about adolescents vaping, and how an estimated additional 10 million teens are at risk to start using e-cigarettes. What are E-cigarettes? E-cigarettes are battery-operated devices heating a liquid (e-juice) into an aerosol to be inhaled. Breathing in this flavor vapor, which usually contains nicotine, anti-freeze or other cancer-causing chemicals is called ‘vaping.’  There are many forms of these electronic nicotine delivery devices - and they're not always obvious. They not only appear to be cigarettes, cigars, or pipes, but also pass for everyday items, such as flashlights, flash drives or pens.   The Effects of Vaping and E-cigarettes Regardless of the nicotine delivery, vaping is addictive and is quickly becoming a public health concern. Nicotine levels in e-cigarettes vary greatly, and they may also contain toxic chemicals. Currently there is a wide range of variability among vaping products. In other words - they deliver different ingredients, hardware, levels of nicotine, and possible toxic chemicals to the user. This makes it challenging to create an overall public health recommendation on their use. Nevertheless, there is no confusion about the harmful effects of the chemicals used in e-cigarettes to the young brain, which develops until age 25. Studies show e-cigarette use serves as an introductory product for teens to go on using ‘regular’ tobacco products. The American Academy of Pediatrics has several recommendations on their use. Such as increasing the minimum age to buy tobacco products, including e-cigarettes, to age 21 nationwide. (Update: nationwide the age as of January 2, 2020 is now 21.) A common misunderstanding with teenagers is the belief e-cigarettes are less harmful than other tobacco products. Moreover, there is a wide range of flavor choices, from mint, mango, crème brûlée to cucumber to attract users. As of September 6, 2019, The Centers for Disease Control and Prevention is reporting over 450 possible cases of lung illness associated with the use of e-cigarette products in 33 states.    What Should Parents Know about Vaping? Parents and teachers should know JUUL is a very popular e-cigarette among teenagers, capturing about 68% of the market. JUUL is sleek, small, hides easily, and resembles a flash drive. Surprisingly it charges in an USB port, and can also instantly be mistaken for a real flash drive. One JUUL cartridge contains twice the nicotine found in other e-cigarette cartridges. This roughly equals the amount of nicotine in an entire pack of cigarettes. To repeat, the use of JUUL in young people continues to grow, and this is why parents and teachers need to be aware. Be alert, teach, communicate, and talk to your child about the serious risks of smoking in all forms, whether at home or parties. Tell them how difficult it is to quit and why they should not start. Loving your children is caring; caring for their current and future health and well-being.

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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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March is Child Life Month, meaning this is the perfect time to ask: What exactly does a Child Life Specialist do? To find out, we “virtually” tagged along with one for a day. This is what a typical day looks like in this important role. For Child Life Specialist Brittany Best, play is a natural part of her work day. She approaches her role with a keen understanding of how the seemingly small tasks she performs every day — comforting children prior to a procedure, writing thank-you notes to donors, training interns — positively impact the lives of the children she serves and their families. So what does it take to work in Renown’s Child Life Program? Best shares some of the highlights from a “typical” shift. A Child Life Specialist’s Day 7:30 a.m. Clock in, put my belongings in my office, and print the patient census information. This helps me to get a sense of the day ahead, as I’m covering three areas today. 8-9 a.m. I look over the census sheets for all three areas and check in with the nurses in each area and then try to prioritize my day. 9:00 a.m. I attend Interdisciplinary Rounds for the Pediatric Intensive Care Unit, where the most critically ill or injured children are treated. Additionally, Interdisciplinary Rounds enable several key members of a patient’s care team to come together and offer expertise in patient care. 10:00 a.m. I come up to the specialty clinic/infusion center to check on the patients that have arrived already and see how things have been going since I had last seen them. We see patients frequently up here, as they are receiving treatment for cancer or other disease processes. 10:55 a.m. I’m notified by an RN that a patient needs an IV started, so I go meet with the patient and their family. I meet with a 6-year-old and mother to explain what an IV is and why it is needed. We go through an IV prep kit, looking at all the different items the nurse will use including cold stinky soap, a tight rubber band and also a flexible straw. I also teach this patient a breathing exercise to help them relax during the procedure with a simple exercise known as “smell flowers, blow out candles.” I demonstrate how to take a deep breath in through the nose — like smelling flowers — then how to blow that breath out — like blowing out birthday candles. 11:10 a.m. I walk with the patient and mom to the procedure room on the Children’s Patient Floor for an IV procedure. The Vecta distraction station is set up and running with its bright lights and water tube that bubbles with plastic fish swimming. The parent holds the patient in their lap, and with the distraction and medical preparation, we are successful! I give the patient a toy and provide emotional support to both the young patient and his mom. It’s easy to forget that these procedures can be stressful for the parents as well. 11:30 a.m. I finish rounding with staff to catch up on patients. In addition, I introduce myself to patients and put my contact number on the board in each room so the families know how to get a hold of me should they need anything. With support from volunteers, we distribute movies, games, and “All About Me” forms to patients and their families. These forms help us get to know our patients with things like their favorite foods and televisions shows. 12:45 p.m. I help with a lab draw in Children’s Specialty Care. A 3-year-old patient is very anxious about the “shot,” so I meet with the patient and parents to discuss coping techniques. The patient holds the Buzzy Bee and does well during the lab draw. The mom is relieved, and the patient is excited for a toy. The Buzzy Bee actually helps block the transmission of sharp pain on contact through icy numbing and also tingly vibration. 1 p.m. Joan, an artist with our Healing Arts Program, arrives on the Children’s Patient Floor to perform art therapy with patients. She helps two young patients who are interested in watercolor paintings. 1:15 p.m. Time for lunch and also a trip to Starbucks. 1:45 p.m. I finishing rounding and introducing myself and our services to the patients I have not met yet. 3 p.m. At this time, I meet with the parents of a newly diagnosed diabetic patient who is in intensive care. A new chronic diagnosis is always difficult, so I am there to provide emotional support. It’s instances like this that remind me every day why I love the work I do. 3:30 p.m. I meet with a new volunteer, discuss their role and also give the new volunteer a tour of the units. We are very thankful for all our volunteers on the floor, as their contributions help us provide a variety of basic services to a larger number of children. This also allows the Child Life Specialist to devote time to children who require more intense or specialized service. 4-5 p.m. I finish charting on patients and help two newly admitted families before I start to wrap up for the day. This evening we have a volunteer covering the times during shift change, which is helpful as it makes for a smooth transition for families during the meal time and change of shift. During this time, I write a note for this volunteer indicating the patients I want her to focus on. 5-5:30 p.m. Check in with critical patients and families before leaving for the day. All-in-all, it was a good day.

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