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SOGI stands for sexual orientation and gender identity. Being a SOGI-inclusive medical facility means regardless of our differences, we treat others with dignity and respect. Sean Savoy, Renown Health Manager of Spiritual Care, explains SOGI terms and their importance in a healthcare setting below. SOGI History Although the UN passed a historic resolution on SOGI in 2016, it is still a relatively new term for some. Above all, an inclusive environment where every patient feels safe and valued, improves the quality of care in our community. In reality, defining gender and sexuality can be confusing. However, the terms we use to define gender and sexuality are an important influence on how we relate to each other. Generally, "sex" refers to the biological differences between males and females. Still the term “sex” doesn’t fully capture the complex biological, anatomical and chromosomal variations that can occur. Accordingly, having only two (binary) options – biological male or biological female – might not describe what’s going on inside a person’s body. In essence, assigned sex (also called "biological sex) is given at birth based on medical factors. These include your hormones, chromosomes and genitals. Most people are assigned male or female, and this is what’s put on their birth certificate. When someone’s sexual and reproductive anatomy isn’t clearly female or male, that person may be described as “intersex.”  However, a person’s biological or assigned sex may be different from a person’s actual or perceived gender identity or expression. The word “gender,” therefore, is more difficult to define. It could refer to the gender or sex role society determines is acceptable, desirable or appropriate based on a person’s perceived sex. Likewise, it could refer to an individual’s own gender identity or preferred gender expression. What is Gender Identity? To summarize, gender identity is one's innermost concept of self as male, female, a blend of both or neither. To clarify - how individuals perceive themselves and what they call themselves. Of course sometimes a person's genetically assigned sex does not line up with their gender identity. These individuals might refer to themselves as transgender, non-binary, or gender-nonconforming, for example. Another key point is the process of gender transition. This specifically refers to more closely aligning your internal knowledge of gender with your outward appearance. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the term – which replaces Gender Identity Disorder – "is intended to better capture the experiences of affected children, adolescents, and adults." What is Sexual Orientation? Sexual orientation is an internal or enduring emotional, romantic or sexual attraction to other people. For example, you could be heterosexual (straight), gay, lesbian, bisexual or even pansexual. SOGI Terms to Know Below are some common SOGI terms according to the National LGBT Health Education Center and the Human Rights Campaign. The following list is not meant to represent every term (or definition) used by the LGBTQ+ community. LGBTQ+ Stands for lesbian, gay, bisexual, transgender and queer (or questioning). The plus encompasses other identities that fall under the queer umbrella with one common theme: they are not strictly straight or cisgender. Queer An umbrella term used by some to describe people who think of their sexual orientation or gender identity as outside of societal norms. Some people view the term “queer” as more fluid and inclusive than traditional SOGI identities. Due to its history as a derogatory term, the term is not always embraced or used by all members of the LGBTQ+ community. Sexual Orientation Terms Asexual (adj.) – Describes a person who experiences little or no sexual attraction to others. Asexuality is not the same as celibacy. Bisexual (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders. Gay (adj.) – A sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender. It can be used regardless of gender identity, but is more commonly used to describe men attracted to other men. Heterosexual or Straight (adj.) – A sexual orientation that describes a person whose sexual or emotional attractions and behaviors focus exclusively or mainly on members of the opposite sex or gender identity. Lesbian (adj., noun) – A sexual orientation that describes a woman who is emotionally and sexually attracted to other women. Pansexual or Omnisexual (adj.) – A sexual orientation that describes a person who is sexually and emotionally attracted to people of any sex or gender identity. Pansexual people may refer to themselves as gender-blind, asserting that gender and sex are insignificant or irrelevant in determining whether they will be sexually attracted to others. Gender Identity Terms Bigender or Binary (adj.) – Describes a person whose gender identity is a combination of two genders. Cisgender (adj.) – A person whose gender identity aligns with the assigned sex at birth or biological sex. Gender non-conforming (adj.) – Describes a gender expression that differs from a given society’s norms for males and females. Gender transition (noun) - The process by which some people strive to more closely align their internal knowledge of gender with its outward appearance. Some people socially transition, whereby they might begin dressing, using names and pronouns and/or be socially recognized as another gender. Others undergo physical transitions in which they modify their bodies through medical interventions. Intersex (adj.) - A variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female. Non-binary Alternate terms are gender queer and gender non-conforming. Transgender (adj.) – Describes a person whose gender identity and assigned sex at birth do not correspond. Also used as an umbrella term to include gender identities outside of male and female. Sometimes abbreviated as trans. SOGI Awareness Again, not all people use the above terms in the same way, so respect and sensitivity are key. And the healthcare setting is an especially vulnerable one. Maintaining the dignity and humanity of every individual during a medical interaction is essential. The U.S. Department of Health and Human Services requires all Electronic Health Record (EHR) systems be able to collect SOGI information from patients. This promotes better understanding of health treatment outcome disparities in order to reduce them. Renown Health’s mission is to make a genuine difference in the health and well-being of the people and communities we serve.

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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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Standing at the top of the stairs to the basement Sharon Sturtevant was chatting with her grandson in the kitchen. Suddenly, Sharon stumbled and fell down the stairs. “The last thing I remember was my head hitting the floor before everything went black,” she recalls. Her grandson, Oliver, quickly called 911 and paramedics arrived on the scene, taking her by ambulance to Renown Regional Medical Center where she was diagnosed with a broken collarbone and a neck fracture that would require complex surgery involving fusion of her neck. Fall Recovery Begins After her surgery, Sharon was transported to the Renown Rehabilitation Hospital and her recovery process began. Sharon smiles as she describes the rehab hospital team “They are fabulous here, I learned so much about how my body moves, and the proper way to move it. At home I wouldn’t have known what to do,” she confesses. “They set me up for success to return home and not get injured again.” At Renown Rehabilitation Hospital, different therapists coordinated a custom plan to help Sharon recover from her injuries. Ultimately, the goal of her physical therapy was to help restore and improve her strength, reduce pain and increase her mobility for stamina and balance. Physical Therapy Key to Successful Treatment of Falls “My recovery after the operation was an eye-opener,” Sharon declares. “I had no idea how much went into regaining everyday moment.” During her rehabilitation hospital stay, she had to re-learn how to swallow, go up and down stairs, as well as successfully get in and out of a wheelchair, which involved transferring her body weight safely. Due to hormonal changes after menopause women are 50% more at risk for falls than men, according to research. Sharon now has a greater awareness of how to move her body and is significantly stronger than before entering her physical rehabilitation sessions. Not everyone knows that everyday mobility is impacted by four basic skills: stepping, trunk flexibility, upright posture and weight shifting. “I don’t know how I could have gotten this far without the wonderful therapists here,” she shares. “They are so thorough. Proper alignment was encouraged helping me to walk and stand correctly. They were all so nice and patient with me,” she states. “I actually had less pain because I didn’t hurt myself moving the wrong way.” Falls Are Common Among Aging Adults As we age balance becomes more important. Unfortunately falls are common among older adults with negative quality of life effects, even fatalities. According to the Centers for Disease Control and Prevention (CDC), one in four seniors fall each year in the U.S. A comprehensive physical therapy plan for sudden falls or chronic conditions is a safe, effective alternative treatment to medication such as opioids. Today Sharon is back at home with a new banister installed on the basement stairs. As a music lover she is enjoying her musical grandchildren Oliver and Eliana who play instruments. She looks forward to attending their upcoming school concerts. Sharon remembers the staff at Renown Rehabilitation Hospital fondly, “They were unfailingly patient, supportive, informative and understanding.” Her advice to those unexpectedly finding themselves in the rehabilitation hospital is, “Listen to your therapists carefully and follow their instructions.”

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Millions suffer from urinary incontinence (urine leakage). Often people feel as if their bladders control their lives. But this doesn't have to be your story. Bladder control issues are treatable and you can take steps to help control your bladder. What is urinary incontinence? Men and women of all ages can have difficulty controlling their bladders. Urinary incontinence occurs when the muscles in the bladder that control the flow of urine contract or relax involuntarily. Is there more than one type of urinary incontinence? Yes, there are three main types: Stress incontinence is when the bladder leaks small amounts of urine as a result of physical stress or pressure on the muscles supporting the bladder caused by coughing, sneezing, laughing, lifting or any sudden physical exercise such as running or jumping. Urge incontinence is the inability to control a strong urge to go without advance warning, limiting the time needed to get to the bathroom. Overflow incontinence occurs when the bladder does not empty properly. As a result, over time, large quantities of urine are stored, causing the bladder to overflow (this is more common in men and is often the result of an enlarged prostate blocking the bladder opening). Are there any tests that can determine the cause and type of incontinence? Your doctor may have you track your fluid intake and output in a Bladder Diary. A urinalysis can be checked for infection, traces of blood, or other abnormalities. Blood tests can look for chemicals or substances that may relate to contributing causes. Other testing may be an ultrasound, cystogram or post voiding residual measurement. How is urinary incontinence treated? Exercises to strengthen the pelvic floor muscles or restrain the bladder to hold on for longer. Medication can relieve and control the troublesome symptoms. If there is an infection an antibiotic is used. Surgery can repair weakened muscles or remove blockage. Special products such as pants, pads, collection devices, and chair and bed protection may be needed if the problem cannot be controlled. How do you strengthen your pelvic floor muscles? To make your pelvic floor muscles stronger, alternate between squeezing and relaxing them. Following the steps below may help: Squeeze your muscles for one second and hold. Relax your muscles for two seconds. Each time you squeeze and relax, it counts as one set. Complete five sets. When you can do the exercises easily, increase to doing them 10 times per day. When that gets easy, try to squeeze and hold the muscles for three seconds and then relax the muscles for three seconds. As your pelvic muscles get stronger, you can progress to longer squeezes for about 10 seconds. Be sure to relax between squeezes so that your muscles can rest before squeezing again. You should do these exercises in three different positions. Do 10 sets lying down, 10 sitting and 10 standing. It is important that you develop the habit of doing the exercises every day. You may want to exercise just after you get up in the morning and right before you go to bed at night. What can I do to help control incontinence? Watch your weight, practice pelvic floor muscle exercises, eat plenty of fresh fruits, vegetables and fiber to prevent constipation. Most importantly, talk to your doctor regarding incontinence issues, don’t be embarrassed!

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According to the Centers for Disease Control and Prevention (CDC), one out of four adults aged 65 or older, fall each year. But less than half of those who fall talk to their healthcare provider about it. What’s more, among older adults, falls are the leading cause of both fatal and nonfatal injuries. Senior Care Plus, a Medicare Advantage Plan by Hometown Health, and Renown Health Nurse Educator, Nicholas Mannering, worked together to provide a list with simple tips to help you prevent falls.  1. Exercise Exercise strengthens both your muscles and bones and improves balance which is a key factor to preventing falls. The stronger you are, the less likely you are to fall. And, if you do fall, you are less likely to be injured.   2. Vision Check Vision is an import part of fall prevention, have your eyes check by an eye doctor at least once a year. Update your vision prescription and replace your eyeglasses as needed.   3. Install Safety Equipment in Your Bathroom Installing grab bars in your home bathroom provides a way for you to help yourself in and out of challenging situations. It also provides support if you suddenly feel week or unstable. Having a grab bar to lean on or hold onto when you feel yourself falling or slipping can help prevent falls. Rubber mats eliminate slick surfaces that increase your risk of falling.   4. Helpful Items in Your Bedroom A light within reaching distance is an important item to have in your bedroom. One reason adults fall is because they wander through a dark room, often to get to the bathroom at night, and can’t see where they are walking. Having a light within reach that is quick and easy to turn on before walking around a room can make it safer and decrease your risk of falling. Having a bedroom that is organized and furnished in a way that is easy to navigate is also important. If your bedroom is cluttered and hard to walk around without tripping or running into things, it might be worth reorganizing the area to define a clear walking path.   5. Helpful Items in Your Living Room Similar to your bedroom, your living room should have a light that is easily accessible. Sofas with armrests are helpful for support when getting up and sitting down. Avoiding clutter in your walkways, rugs that are not secured down and unstable furniture are important to consider when preventing falls.   6. Actions to Avoid in Your Home There are other ways to fall besides slipping or tripping while walking. Never stand on chairs, boxes or other unstable items in your home. Walkways should be tidy and free of objects that you could trip on. Spills should be cleaned up right away to prevent slipping.   7. Wear Appropriate Footwear Wearing shoes with non-slip soles and closed toes can help prevent you from falling.  Having shoes that fit properly, are made from hard rubber (like tennis shoes) and provide good support help prevent tripping and falling. Shoes with a collar that support the ankle and a well-padded tongue for the top of your foot can also help prevent injury to your feet.   8. Review Your Health & Medications at your Annual Health Check-Up It is important to review your health and medications with your healthcare provider so they can assess if you are at risk for falls. You should discuss your vision, heart health and blood pressure at your annual health check-up. These things can play a role in the risk of falling. Reviewing your current medications is also important. If medications are making you dizzy, talk to your provider about adjusting the dosage so you can feel more stable and balanced. When talking to your doctor about medications be sure to include your vitamins and supplements. Finally, Have your healthcare provider check your feet and discuss proper footwear yearly.   9. Avoid Smoking and Alcohol Balance is important in preventing falls. Alcohol consumption negatively affects balance and increases your risk for falls and fractures. It also increases your risk for cancer, liver damage, osteoporosis, high blood pressure and strokes. Smoking is connected to frailty in older adults. It prevents the development of muscle tissue and breaks down healthy muscle tissue due to the lack of oxygen in your body.

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Renown Health recently wrapped up the twentieth annual Nursing Excellence and Excellence in Critical Care Conferences, the conference theme was the Courageous Calling and over 400 nurses from specialty fields across the region attended to learn, reflect, build relationships and obtain continuing education units (CEUs).   Celebrating The Courageous Calling During the first day of the Nursing Excellence Conference, local and national leaders presented topics including redefining resilience, documentation liability, transgender healthcare and caring for the homeless population. Among the list of impressive speakers were Chief Nurse Executive at Renown Health, Melodie Osborn, and Nora McInerny, writer and host of the "Terrible Thanks for Asking" podcast.   On day two,speakers focused on the critical care specialties within nursing, including intensive care, emergency room, pediatric intensive care and neonatal intensive care. Topics covered included post-COVID-19 pulmonology with Dr. Graham, traumatic brain injuries with Dr. Demers, COVID-19 reflections with Anicia Beckwith, a discussion about "Mis C” with Dr. Healy, innovations in imaging with Dr. Rangaswamy and cardiology with Dr. Danaf. Thank you to our sponsors and raffle donors for making this event possible: Erik Olson and Larry Duncan, Jana Elliott, Melodie Osborn, Becky Haase, Lori Tuntland, Dr. Akbar, Dr. Lous, Mel Morris, Grand Sierra Resort, Renown Health Gift Shops, Renown Health Directors of Nursing, Renown Health Marketing & Communications Department, Renown Health Dermatology, Laser, & Skin Care and Renown Health Foundation.   Learn more about finding purpose in the health of our community when working at Renown Health here.

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September is National Healthy Aging Month, which is described by Healthy Aging Magazine as a “month designed to focus national attention on the positive aspects of growing older.”   What does healthy aging mean to you? If you're like most people, you're looking forward to removing the negative from your life – negative energy, thoughts, people and activities that don't contribute to your best life.   While we remain focused on ridding ourselves of the negatives, we can forget about ways to strengthen the positive parts of our lives. Dr. Shruti Basho, a family medicine physician at Renown Health’s senior-focused medical group, provides us with five positive behaviors to focus on to improve happiness and life satisfaction.  Healthy Aging in 5 Easy Steps  Connect – Humans are naturally social creatures! Build connections with friends, family, colleagues and neighbors. Strong interpersonal connections help enrich your life with new experiences and opportunities. Having a support system to call upon in both times of need and times of celebration is priceless, especially as you age. Forming these bonds helps you stay healthier and happier well into your aging journey. Joining the Sterling Silver Club is a great place to meet more people in the community who want to live a healthy, fulfilled life just like you. Be Active – Regular exercise, particularly as you grow older, is vital to increase and maintain your endurance, strength and balance. But exercise doesn’t have to be a chore! Pick a physical activity that you enjoy – whether it be enjoying a nature walk, taking a power weightlifting class or anything in between. Being active will also help you build strong connections with others. If you need a workout buddy in your neighborhood, Nextdoor is a great resource to find people who live right around the block from you and may be looking for their next exercise partner.   Take Notice – Curiosity and mindfulness can be an impactful motivator in positive cognition and behavior as you age. Like a child, see the wonder and beauty of the world. Notice the things around you – the weather, the landscape, the mood and the feelings of people. According to Harvard Medical School, changes in the aging brain "enable us to become better at detecting relationships between diverse sources of information, capturing the big picture, and understanding the global implications of specific issues.” By taking notice, it’s easier to learn to appreciate the things that matter.  Keep Learning – Engaging with lifelong learning is one of the best ways to keep your mind active. Keep trying something new! Challenges keep you on your toes and increase your confidence and excitement in your day. Don’t know where to start? EPIC (Educational Programs Inspiring the Community) offers a diverse personal enrichment and professional development curriculum at Truckee Meadows Community College ranging from art classes to accelerated training certificate courses.  Give – Be generous with your time, your knowledge and your talents by giving to friends, family and the community when you have the capacity. Lending yourself to others doesn’t have to be taxing – saying thank you and even just giving someone a smile can change the course of someone’s day. If you’re looking for a hands-on way to give back, Nevada Volunteers is a great place to find volunteer opportunities near you. Renown Health is also always looking for volunteers who are passionate about making an unforgettable difference to the people and communities we serve.   Practice these five tips to improve happiness and quality of life at any age.

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