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If you’re a parent, you’ve probably been there — the sometimes-nightly struggle to get your little ones off to bed. Elaina Lantrip, an APRN with Renown Pediatrics, offers some tips and explains how your child’s electronics may be getting in the way of a good night’s sleep. These days, kids are consuming media from a very early age on all types of devices — from tablets and phones to TVs. While they can benefit from some media use, it can have a negative impact on bedtime. We asked Elaina Lantrip, an advanced nurse practitioner with Renown Pediatrics, for some advice on downloading a better bedtime routine. What are the most important practices for parents to establish for their children’s bedtime routines? I often have parents tell me that their child won’t go to bed — or to sleep. Parents frequently ask for tips on bedtime routines that work. My first question is whether their regular bedtime routine involves television, iPad, tablet, phone or anything with a screen. It’s very important that bedtime includes a bath, reading a story, talking, singing and bonding with young ones, rather than using any devices. Why shouldn’t children have a device at bedtime? A growing body of research supports that screen time at bedtime contributes to delays in a child’s falling to sleep; overall inability to reach the important REM, or deep sleep; waking up during the night; nightmares and night terrors. For older youth, engaging with social media before bedtime can bring up stresses, emotions and relationship issues with peers that don’t exactly create peaceful bedtime thoughts. Bedtime should be a screen-free, stress-free, peaceful time of day. It’s a great time for parents to promote self-esteem, talk through things going on in the child’s life, to encourage and build them up. Children grow up fast — bedtime is a great the opportunity with younger children to cuddle up and read a story or sing a lullaby. What are other major considerations in making bedtime smooth and relaxing for kids and their parents? Another factor that contributes to positive sleep habits includes children getting enough activity during the the day so they’re genuinely tired at night. Also helpful are ambient noise makers, peaceful music, avoiding sugar two hours prior to bedtime, consistency in bedtime routine, comfortable pajamas and comfortable temperature in the home. Is it important to keep the child’s bedroom dark? Dimming the lights is important, regardless of the time of year. This is another reason to ban screens, as they emit light that stimulates wakefulness.

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Many millennials are fortunate to have good health, but it’s important to be prepared for your next doctor’s visit. Here are three things that millennials should stay on top of for tracking and maintaining their health. For many millennials, doctor visits and preventive healthcare fall by the wayside. Alison Lynch, MD, a family medicine provider with Renown Medical Group says there are a few key things you can do now to set yourself up for a healthy future. 1. Establish with a Primary Care Provider Millennials are more likely to go to urgent care or consult the internet when a healthcare issue arises. While these are helpful tools, here’s a better one: a primary care provider. The benefit of establishing with a primary care provider is that your medical records, history and a baseline for your health will be documented. That means that when a problem or question comes up, your doctor will already have helpful information on file and can help you navigate your needs. Having a primary care provider is often required for prescription refills and referrals to a specialist. By establishing now, you’ll be able to get what you need in the future much faster. Make an Appointment Today 2. Protect Yourself and Your Community There are a few vaccinations and screenings that Dr. Lynch recommends for millennials. Flu Shots: These are available every year and are recommended for protecting not only yourself against the flu but also others you may come into contact with. Flu shots are usually available from August through December through your healthcare provider, pharmacies and pop-up events. Tetanus or Tdap: Most people receive a tetanus shot as a child, but it’s recommended that everyone get a booster every 10 years. If you are overdue, talk to your primary care provider or pharmacist about getting updated. Pap smear: If you’re a woman, a pap smear is recommended every three years in your 20s and every five years in your 30s. HPV vaccine: This vaccine helps prevent the virus that causes cervical cancer as well as the majority of head and neck cancers and warts. The HPV vaccine is recommended for all genders up until age 45. STD screening: Consider an STI/STD screening if you’re sexually active.

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When it comes to intimidating procedures such as surgery, cardiac catheterization (Cath) or interventional radiology (IR), there can be a lot of unknowns. What can I expect on the big day? What will happen after I’m all done? Will I have to worry about my orders not being in the system? Who can I call if I have any last-minute questions? It’s easy for your thoughts to race as you approach your procedure date, but luckily, there is a team who puts your mind at ease.  With Renown Health’s Surgery & Procedure Scheduling department, patients can breathe a sigh of relief knowing that all the nitty-gritty is taken care of before they step foot in the procedure room. This team operates in the mindset of a complex Tetris board – fitting in all the pieces to make sure every patient is set on the path for surgery success.  Consistent Contact Our Surgery & Procedure Scheduling team has a unique history. Initially operating as two separate teams, over the last year, our leaders skillfully combined the two teams together under one umbrella. That allows the now singular team to have line of sight across every surgery and Cath or IR procedure plan and be better stewards of the resources they have at their fingertips to provide streamlined, more-connected care for patients.  As one might imagine, with the merger of the two teams, the day-in-the-life of each team member is full of a variety of crucial checklist items to cross off – all supporting constant communication from patients to providers.  On the surgery scheduling front, these team members are resource rockstars. From working with referring providers to get patients scheduled appropriately to ensuring rooms and equipment are available for every patient, this team makes sure everything and everyone is in place when the time comes to help create a successful procedure and the best possible patient experience.   “In surgery scheduling, we handle inbound calls for the outside offices to get time scheduled for each patient in the operating room (OR),” said Lydia Sharkey, Senior Scheduler. “We make sure there are plenty of anesthesia resources and equipment for every surgery, including any important information that we need to schedule patients appropriately and adding all documents to the OR board. If we need to swap rooms or move patients around, we handle that process too.”  Over on the IR/Cath scheduling side of things, this team is on the frontlines of patient communication. They are experts in helping patients navigate their procedure from start (seeing their provider and obtaining the proper referrals) to finish (the day of the procedure and post-procedure process).  “My day is a little different than the hospital schedulers; our part of the team handles the outpatient aspect,” said Adrienne White, Senior Scheduler. “We are in constant contact with patients and the IR and Cath departments. We help them navigate their procedure, including what to expect during and after the procedure. We get them through the process as easily as possible and ease their minds, so they know what is going to happen every step of the way. It’s all about communication, communication, communication!”  This department has a significant overarching role: make sure all documents and ancillary information is set up for all our clinical teams that help with surgeries and procedures. This critical work means that every process is followed, and no important details are left out.  “No one wakes up and says, ‘I want to have surgery;” our team goes above and beyond to make sure every single detail is taken care of so that when patients arrive, everything is in place,” said Trisha White. “Our team works hard to ensure everything runs as efficiently as possible because we want to use our resources in the best way possible to serve our patients without delays. We make sure we receive all the orders, codes and insurance and that the teams that follow after us – including our pre-admit team and nurses – have all the information they need to do their job seamlessly."  With all the work they accomplish daily – not to mention how they wholeheartedly support each other through it all – it’s no question that the entire team has a lot to be proud of. Besides helping make patient care possible, the team puts their departmental merger and the move to fully remote work at the top of the list.  “We’re most proud of merging the surgery scheduling and procedure scheduling teams together and therefore more cohesive,” said Mary Gray, Senior Scheduler. “The merger has made our team blossom and be able to connect with and rely on one another even more. We aren’t afraid to speak up and say something. At the end of the day, we’re here to take care of the patient, but we also help each other out. Our morale has gone up, and everybody is happier. Even though we all work remotely, we are more connected and have a great work-life balance.”  “Along with transitioning the two teams into one big team, the move to being fully remote was huge," added Patricia Cruz-Hernandez, Surgical RN Scheduling Coordinator. “We worked through all the glitches, and it was a seamless transition to move into a remote setting. What’s great is that it did not affect patients at all; everything still gets done exactly as it should.”  No matter how busy the days may get, Renown’s surgery and procedure schedulers always remember one thing: they are incredibly grateful for their fellow team members.  “We have a very efficient and hard-working team of women,” said Pam Chapa Valencia, Senior Scheduler.  “I could not have handpicked better people for our team,” added Trisha White. “I feel so lucky to have the team that we have.”  A Renown “Why” Our Surgery and Procedure Scheduling team members all have diverse stories to tell about their road to Renown and why they’ve stayed in the department for as long as they have. Whether they’ve been with us for two years or two decades, they all share the same strong calling to care for their community.  “I always wanted to help people, and my grandma was a nurse,” said Pam Chapa Valencia, Senior Scheduler.  “I loved hearing her stories, and it made me want to be involved in patient care.”  “I have a caring nature, and a hospital nature seemed like the right fit – I've been here for 25 years,” added Mary Gray.  Several of our schedulers recognized the influence Renown has within our community and the ability to grow professionally and personally, both of which were a driving factor in their decision to make our health system their long-term career.  “I’m originally from southern California, and I moved here about eight years ago; my husband always talked so positively about Renown, especially with how big it is and how it has the only level II trauma center in northern Nevada, so my goal was always to get a job here,” said Lydia Sharkey. “It’s been a great environment to be a part of.”  “I’ve been with Renown for 17 years, and I chose to come here because of the reputation of the services Renown provided and care they gave,” added Trisha White. “I also knew what opportunities there were for me professionally, and in doing so, we are taking care of our community. I’ve had the chance to grow within my own professional skills and leadership skillset.”  A profound feeling of ‘home’ is a common theme among this department. These team members appreciate the sense of community Renown has, the strides we’ve made in expanding our reach and how our health system gives healthcare professionals who are new to the field a chance to succeed.  “At the time, Renown was the only hospital that would train nurses, and as a brand-new nurse, I had no experience – Renown took a chance on me,” said Patricia Cruz-Hernandez. “I feel like this is home. Our health system is so community-based and people-first minded, keeping ‘mission over margin.’ We’re growing, we’re expanding, we’re everywhere!”  “I was a part of a transition as the cardiology private practice I worked with became a Renown practice, and it was great,” added Adrienne White. “This transition enabled us to provide more services and better care to patients. I stay here because I see the leaps and bounds we’ve been able to make in terms of procedures, accessibility and patient experience.”  As true advocates for both patients and each other, the team is proud to have found their niche – and the ultimate beneficiaries? Everyone undergoing a surgery or procedure at Renown.  A Culture of Kindness and Gratitude When you meet the Surgery & Procedure Scheduling team, you are greeted with warm smiles and an enthusiastic “Nice to meet you!” You can’t help but smile back and feel the infectious kindness they exude.  Renown operates with a People-First mindset, a vision that this department especially takes to heart. They emulate the exact definition of our “Collaboration” cultural commitment.  “We’ve built very good relationships and rapport with the OR managers and board runners,” said Lydia Sharkey. “The communication that we have at all three locations is very solid.”  “The OR leadership is always so willing to help out whenever they can, and the resources they’ve provided have been huge for us,” added Adrienne White.  “All the teams that see the patients after us – especially the surgical pre-admit team and the case managers, are fantastic about collaborating with us and reaching out to solve any issues they may have,” added Trisha White. “We all work so well together, especially since we all impact patient care.”  In any organization, strong and compassionate leadership is key to a thriving team. Luckily for our surgery and procedure schedulers, they have Trisha White on their side. They attribute a lot of their success to having a supportive leader who “gets it.”  “Trisha has been a scheduler like us, so she completely understands when we’re having an issue, because she’s struggled with the same thing and knows where we are coming from,” said Mary Gray. “It makes us feel like we are not alone – I can always reach out to her, or any of my other coworkers, to ask questions and figure out a solution together.”  Despite being a remote-only team that meets in-person only one or two times a month, this group never misses an opportunity to reconnect both online and offline. They frequently shout out their Culture Ambassadors, schedulers Pam Chapa Valencia and Roxanne Abundis, for their team’s high morale.  “Even though we all primarily work remotely, our in-person days are some of my favorite days of the month,” said Trisha White. “We feel so uplifted, we laugh and we have fun. We love being with each other. Pam and Roxanne are our Culture Ambassadors, and they both have been amazing at planning fun things for our teams. They go above and beyond to make our team feel cohesive and included.”  “Pam and Roxanne have been leaders in creating a fun environment and supportive culture for us,” added Lydia Sharkey. “Whether it’s creating care packages or making sure we all have a good time when we see each other in person, they deserve a lot of credit.”  As this team excels in their roles and foster a culture rooted in kindness and gratitude, we can trust that Renown’s surgeries and procedures will continue to thrive, and patients will continue to benefit from their diligent efforts and commitment to efficiency.  “We make the magic happen!” closes Mary Gray.

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Dr. Max J. Coppes, Physician-in-Chief Renown Children’s Hospital, and Nell J. Redfield Chair of Pediatrics, UNR Med, talks about how much is too much when it comes to teens and social media. Social apps (Facebook, Instagram, Twitter, WhatsApp, Snapchat, TikTok, etc.) have become an integral part of most people’s lives. In contrast to traditional media — where one source goes to many receivers — social media operates in a dialogic transmission system. Many sources interact, sometimes simultaneously, with many receivers and provide for superior interactivity between its users. Not surprisingly, it also plays a significant role in our children’s lives once they are old enough to understand how to access and use these apps. On average, children start exploring social media at around ages 10 to 12. They rapidly discover that electronic communication allows for unique and personalized ways to make and keep friendships. They also use it to develop and expand family ties, get help with homework, share music, art, and experiences, and learn and discover the world. Social Media and Teens Surveys suggest that more than 90 percent of teenagers use social media. Additionally, approximately 75 percent have at least one active profile by age 17. Access to social media is greatly facilitated because more than two-thirds of teens have their own mobile devices with internet capabilities, a substantial change relative to previous generations. The use of social apps can have many positive aspects. But we now also recognize that it can also have negative impacts. The use of hazardous sites or the inherent risks of using social media (identity theft, being hacked, cyber-bullying, etc.) are indeed damaging to children. Any use of hazardous social apps is too much and carries serious hazards. But what about the use of “normal” and/or “safe” social media? Well, data suggest that too much use of “non-hazardous” apps can indeed affect health. How Much Do Teens Use Social Media? First, some basic data. For example, how much do normal teenagers use social media? A study from Pew Research found that more than 50 percent of 13- to 17 year-olds go online several times a day. This quickly increases during the teenage years to more than 70 minutes per day. Teenage girls have the highest usage at just over 140 minutes per day. It is important to recognize that non-school related use of the internet and social media is often beheld by teenagers as important for developing their self-esteem, their acceptance among peers, and their mental health in general. As parents, we recognize that the use of social media can indeed contribute, in many positive ways, to our children’s growth. At the same time, we also worry about them spending too much time online. We worry about their ability to communicate effectively in face-to-face settings or in writing. Many of us also feel and/or worry that our children are addicted. Social Media and Addiction Recent studies suggests that the overuse of social media indeed mirrors addiction. Reports now show that teenagers and college kids experience anxiety when deprived from their connected devices and consequently feel a compulsion to access their social applications. The emotional symptoms they experience are very similar to those seen in substance abuse. In fact, the American Psychiatric Association is considering making internet addition a bonafide diagnosis. Pediatricians therefore encourage limits on the use of social media, a recommendation more easily suggested than accomplished. So when should a parent consider seeking help? Aside from unhealthy use of these apps (cyber-bullying, sexting, online users asking for sexual relations, etc.), which should always trigger concern, the use of social media for more than 120 minutes per day should trigger parental concern. If you feel unable to address the overuse of social media, contact your pediatrician for help and guidance. Renown Children’s Hospital Whether it’s seeing a pediatrician, getting a sports physical or looking for advice, our care is centered around supporting and nurturing patients and families at our many locations. We have pediatricians dedicated to children who have experience recognizing children’s illnesses. They also have knowledge about tests and treatments for young ones to ensure your child gets the best care possible. Explore Children’s Services

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Many factors are contributing to the rise of early onset puberty in girls. Learn what they are below and how you can support your daughter. The number of girls experiencing early puberty has increased dramatically over the last few years and continues to grow. More and more girls in the U.S. are starting to show signs of development before the age of 8. Recent studies show that up to 10 percent of Caucasian girls and 23 percent of African American girls are showing signs of puberty by age 7. What’s Contributing to Early Puberty in Girls? Determining the exact cause is difficult. But experts agree that several factors may be contributing to these growing numbers. Increasing rates of childhood overweight and obesity. Excess body fat alters the levels of hormones responsible for the acceleration of pubertal timing. Physical inactivity may decrease melatonin levels, which can also trigger pubertal development. Increased animal protein intake. Higher total protein, animal protein and meat intake in children ages 3 to 7 have been associated with earlier onset of menstruation. High protein intake elevates IGF-1 levels and promotes growth, which could accelerate the onset of puberty. Poor diet. Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals). EDCs are synthetic chemicals found in plastics, pesticides, fuels and other industrial chemicals that inhibit or alter the action of natural hormones. Because EDCs accumulate in the fatty tissues of animals, animal foods contain higher levels of these chemicals than plant foods. Exposure to BPA (bisphenol A). BPA is an industrial petrochemical found in a variety of products including plastics, tin-can linings and even cash register receipts. Because it acts as a synthetic estrogen it may speed up pubertal development. Soy products. Soy contain isoflavones which are converted to phytoestregens in the body, and are similar to the hormone estrogen, Dr. Chelsea Wicks says. “Soy consumed from natural food sources is likely safe and will not cause abnormal hormones levels. However, when consumed in large amounts, such as with soy supplements or in more processed foods, there have been links to chronic medical problems due to elevated estrogen levels. I feel a good answer to this is to continue working on eating fresh foods and trying to avoid the processed, packaged foods as this will be best for overall general nutrition as well,” she adds. What You Can Do While some genetic factors play a role in the early onset of puberty, parents can help lessen environmental causes of the condition. Encourage and help your child to maintain a healthy weight with proper nutrition and exercise. Avoid exposure to hormones such as estrogen and testosterone that may be found in hair products, medications and nutritional supplements. Avoid exposure to EDCs and BPA. Offer your child a diet centered around whole plant foods rather than animal foods, which will help keep protein intake within a safe range and reduce consumption of EDCs. Create a supportive environment for your daughter. Avoid commenting on her appearance and instead focus on her achievements, academic successes or artistic talents. Speak to her openly and honestly about the physical changes she’s experiencing — that although these changes are normal, she’s simply developing early — and that ultimately her peers will undergo the same changes. Encourage your daughter to continue participating in social activities and pursuing her interests, and reassure her you are always open to discuss any questions or worries. If you are concerned that your child may be going through these changes before expected, speak with your pediatrician. Sources: Early Puberty: Causes and Consequences When Is Puberty Too Early? Precocious Puberty (Early Puberty) Precocious Puberty

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When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, you must be especially mindful of what you put into your body. Whenever you pop a pill, you want to ensure you’re taking the correct dosage, waiting the right amount of time before taking another dose and not mixing certain medicines. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding.  It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid.  Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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Without a doubt, taking medications can not only be expensive, but also confusing. In the United States, generic prescriptions are widely used, with 9 out of 10 people choosing them over a name brand. Pharmacists are a great resource to help us understand the benefits and side effects of any medication. We asked Adam Porath, PharmD, Vice President of Pharmacy at Renown Health, to answer some common questions about generic drugs. What is a generic drug? A generic drug has the same active ingredients of brand-name drugs. Brand-name drugs have a patent (special license) protecting them from competition to help the drug company recover research and development costs. When the patent expires other manufacturers are able to seek approval for a generic drug. However, the color, shape and inactive elements may be different. Per the U.S. Food & Drug Administration (FDA), a generic medicine works in the same way and provides the same clinical benefit as its brand-name version. Why do they cost less? Generic drug makers do not have the expense of costly development, research, animal and human clinical trials, marketing and advertising. This savings is passed on to the public. Also after a patent expires, several companies will compete on a generic version of a drug, further driving down prices.

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