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Chronic pain can be one of the most distressing feelings someone may encounter – and more likely than not, you know someone who is managing their pain as a part of their healthcare journey. In fact, according to the Centers for Disease Control and Prevention, about 1 in 5 U.S. adults have experienced chronic pain in recent years. One of the most common methods of treating pain is through prescription pain medications; however, with the rise of the opioid epidemic across the country, leveraging other interventions to help patients manage their chronic pain has become increasingly more important. What if there was a way to treat pain directly without the automatic need for pain medication? Luckily for patients in northern Nevada, our Special Procedures department at Renown Rehabilitation Hospital specializes in exactly that: interventional pain mitigation sans painkillers. With nearly 95% of their patients who come in with pain-related mobility issues being able to physically walk out of the hospital after their treatment, much-needed relief is clearly in store. Tight-knit and forever-caring, the Special Procedures team knows how to transform the purpose of pain management. A Penchant for Pain Alleviation Renown's Special Procedures team offers a wide variety of pain management solutions that are uniquely tailored to each individual patient’s needs. With the help of a team of 14 attentive nurses, interventional radiology technologists and a surgical technician – plus a dedicated patient access representative ensuring everything goes smoothly behind-the-scenes – these lifechanging interventions include: Epidurals (including steroid epidurals) Nerve blocks Ablations Tenotomies Spinal cord stimulator trials Peripheral nerve stimulator trials The nurses on this specialized team guide patients before, during and after their procedures, making sure they are at ease throughout the entire process. Each nurse emulates both expertise and empathy to help light the path towards healing.  “Before each procedure, we get the patient’s vitals, health history and work with the doctor to answer any questions they may have about what is going to happen in the procedure room,” said Michon Edgington, RN. “After they’re all done, they come back to me, and I make sure they are ready to go home by educating them on their discharge. Our goal is to get them back to their families very quickly.”  “In the actual procedure room, we perform safety checks, do charting, prepare the sterile tray for the doctor and give medication for conscious sedations, all while consistently monitoring the patient and helping the doctor out along the way to help the procedure go well,” added Shannon Boelow, RN.  This team’s dedicated imaging professionals harness expertise that goes beyond capturing images. Their skillful utilization of X-ray technology serves as a guide for doctors administering treatments for pain – and according to our own physicians, our imaging technologists are some of the best in the business.  “Our X-ray skills here are specialized,” said Julie Smith, Imaging Lead. “Visually, the doctor needs to see what’s going on inside the body so they can accurately place needles and steroids. We all work together collectively and work with each doctor to accommodate their preferences, helping the treatments go much faster and minimizing the patient’s exposure to radiation.”  Serving as the ideal representation of both precision and support, the surgical technician on this team is an important collaborator in the procedure room, helping to ensure the success of every interventional procedure with a meticulous eye for detail.  “As the Special Procedures surgical technician, I get the room ready with all the necessary instruments, including making sure everything is sterile,” said Carrie Crow, Surgical Technician. “I enjoy keeping the team organized.”  Overseeing it all are the physicians, who are eternally grateful for the team for the life-changing interventions they offer every day.  “Our physicians are so phenomenal,” said Brittney Summerfield, Manager of Nursing. “They are very supportive and collaborative, and they always do the right thing. They have total confidence in us.”  Seeing patients walk out of the hospital happy and healthy is a driving motivator for this team. Whether they had significant experience in pain management or were ready for a completely new challenge, each team member comes to work every day inspired to move mountains.  “I had worked in pain management in other facilities, and I was extremely excited to come here and solely focus on pain,” said Jodi Eldridge, Supervisor of Special Procedures. “I enjoy seeing the patients so happy when they leave no longer in pain. I feel immediate gratification, because you truly feel like you’re doing something big for the patient. It’s very rewarding.”  “I decided to come work here because I worked in the inpatient setting for a long time, and I was ready to see a different side of healthcare and provide a different type of care to our community; plus, my coworkers are the best,” added Lisa Dunnivant, RN.  There’s no question that the realm of pain management is a delicate one – and there is no team better suited to take on that challenge than Special Procedures, working harmoniously to bring relief and a renewed sense of livelihood for every patient they serve.  “Some people believe pain management is just all about pills, and that is simply not true,” said Carrie Crow. “Our procedures are yet another way to help them manage their pain and find relief.”

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Did you know an estimated 1.9 million neurons and 14 billion synapses are lost per minute during a stroke? That’s why every second counts. Anyone can have a stroke, but your chances increase if you have certain risk factors. That’s why the best way to protect yourself or your loved ones from a stroke is to know the risks and how to manage them. You can make changes to your lifestyle to lower your risk of stroke by asking yourself the following questions: 1. Is my blood pressure normal? High blood pressure is the leading cause of stroke and the most important controllable risk factor. If you’ve had a stroke, lowering your blood pressure can help prevent future strokes. 2. Can I quit smoking? Smoking damages blood vessels, clogs arteries and raises blood pressure — doubling your risk of stroke. If you want to reduce your risk of stroke and heart attack, quitting smoking is the first step — and Renown can help you with this. Learn more: Renown Health Quit Tobacco Program. 3. Do I make time to exercise 30 minutes a day? Many studies link consistent exercise habits with lower stroke risk. Also, being overweight contributes to high cholesterol, high blood pressure, heart disease and diabetes, all increasing your stroke risk. You don’t need to run a marathon — just commit to making time to move each day. 4. Do I regularly eat processed food and sugar? Eating less cholesterol and fat, especially saturated and trans fats, may reduce the fatty deposits (plaque) in your arteries. Also, eating five or more servings of fruits and vegetables per day may reduce your stroke risk. If you are diabetic, follow recommendations to get your diabetes under control.

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Stroke is unfortunately common, with 1 in 5 American women experiencing it each year. When it comes to a stroke the phrase “time is brain” speaks to the urgency of getting rapid care. In fact, a woman may lose nearly 2 million neurons per minute of oxygen loss to the brain. The Renown Health Comprehensive Stroke Center experts share the importance of timely treatment and how stroke symptoms can differ in women. Women and Stroke – Surprising Symptoms  Each year stroke affects more women than men. Even more concerning, women are less likely to recover from a stroke. The following non-traditional, less common, warning signs can be common in women: Hiccups with chest pain Sudden disorientation, drowsiness, confusion or a general altered mental status Nausea or vomiting A sudden headache that feels like the ‘worst headache of your life’ Unusual chest pain (especially with hiccups) Body numbness or weakness, such as an arm or leg suddenly ‘falling asleep’ Fainting or loss of consciousness Stroke Diagnosis The first step is neuroimaging by CT scan. This allows for rapid identification of any bleed, and also assists in determining candidacy for the early clot busting medication. MRI brain imaging is much higher resolution, and can better determine the core stroke size, assisting in prognosis and recovery. Since strokes have several different origins, an inpatient workup is essential to determine the underlying cause. Whether the stroke is secondary to plaque in the large vessels, clots being thrown in the setting of atrial fibrillation (an abnormal heart rhythm), or small vessel disease from years of uncontrolled vascular risk factors (high blood pressure, smoking, high cholesterol, diabetes), determining the cause is essential to implementing a management plan to reduce risk for further strokes. Quick Treatment for Stroke is Key Early recognition of stroke symptoms and seeking prompt attention is paramount. There are interventions that can be instituted to minimize the stroke and increase likelihood of recovery, but only if a patient presents to the hospital early. A clot busting medication, called tPA, can be given to patients with stroke if given within 4-5 hours from time of onset. Renown Regional Health Center is designated as a Comprehensive Stroke Center, the highest level of stroke certification available. To earn the designation of comprehensive stroke center, a hospital has to meet stringent requirements, including biannual on-site evaluations. This includes care for ischemic stroke patients (lack of blood flow), hemorrhagic stroke patients (bleeds), and determining the underlying cause to guide secondary stroke management prevention. Stroke Symptoms Remember “B.E.F.A.S.T.” to recognize the symptoms of a stroke below: B – Balance Being off balance or dizzy, is common. E – Eyes An eyesight change such as blurring or double vision may occur. F – Face droop One side of the face, or lip, droops A – Arm weakness Does one arm drift down? S – Speech Talking may slur or sound strange. T – Time Time to call 911. Call an ambulance immediately if you or anyone else, experiences any of these symptoms.

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It seemed like a normal Wednesday, except Kimi Woolsey was feeling really stressed. On Sept. 4, 2019 she was rushing to get ready for an appointment when suddenly, she could not feel her legs. Kimi immediately knew something was wrong and called out to her fiancé, Paul, for help. After seeing a bright light in her right eye, she felt a severe, sharp pain in her head traveling down into her leg. Paul quickly called 911, the EMT’s arrived and her stroke survival journey began. At first the medical team thought she had a complicated migraine, but one of them suspected a stroke. On the way to the hospital Kimi felt numbness and her face drooping, then instantly, no pain. For a moment she thought she was dying, going from pain to numbness and realizing she couldn’t move or speak. Kimi didn’t know she was having another massive stroke in transit. Each year nearly 800,000 people in the U.S. suffer a stroke, or “brain attack” – that’s one every 40 seconds. Of those, about 75% occur in people over age 65. However, at only 45 years old, Kimi is proof that a stroke can happen at any age. Stroke Survival Begins for Kimi Upon arriving at the emergency department of Renown Regional Medical Center the Certified Comprehensive Stroke Center team went into action. Kimi received a brain MRI, then was wheeled into surgery for a thrombectomy (clot removal). She was in the intensive care unit for 11 days. She remembers someone telling her, “Generally people don’t survive this magnitude of stroke.” And a doctor saying, “You are here for a reason.” Kimi’s comeback journey began with the comprehensive care team at Renown Rehabilitation Hospital. “Literally I had the best day of my life that first day there…I was so happy because I couldn’t imagine being in a safer place with people that literally live for you,” she recalls. During her 41 days there, her biggest milestone was being able to get out of bed and walk. For Kimi the support she felt at the rehab hospital was key to her progress, ”I still feel loved and appreciated and they’re rooting for me still and I can feel it.” Although she left the rehab hospital on Oct. 18, 2019, she is still working on improving the left side of her body. Currently Kimi works with therapists in outpatient physical rehabilitation sessions, continuing to see improvement in both her hand and leg. Her advice to those currently in a rehab hospital setting is, “Stay as long as you can to get the most out of it and push, push, push.” Kimi’s Stroke Survival as a Warrior “Having a stroke is not for the faint of heart,” says Kimi. She experienced despair and felt discouraged. Many days she would ask herself, “Why am I here?” Today she proudly calls herself a stroke warrior and refuses to be a victim of her stroke. Alongside her tenacious spirit, Kimi actively helps others on their stroke survival journey. Before her stroke she never dreamed of starting a non-profit foundation. Now, each day you’ll find her texting inspiration to others, offering advice and connecting with other struggling stroke survivors on her Facebook page, Stroke Warrior Recovery Coach. Her goal is to become the person she needed to talk to after her stroke; she currently coaches several stroke survivors. “Stroke survivors need to know that they aren’t alone. Mental support and encouragement are so important for each person’s stroke journey,” Kimi said. Along with the physical changes, Kimi feels the stroke magnified her empathy. “I was always in a hurry in my life. People didn’t go fast enough for me – on the road, at the grocery store, in a line. Now I have more patience with myself and others." Kimi realizes most people cannot wrap their brain around the concept of a stroke. In fact, the brain fog, physical challenges and frustration are hard to explain… unless you’ve experienced them. “You need to find your tribe,” she explains. “I have a passion for helping people through this process.” Most of all, she encourages people to keep going and never stop. After her stroke, Kimi has a greater appreciation for her family, health and life. She is one of the patients featured in the current “Fight The Good Fight” trauma and physical rehab advertising campaign. “I wake up every day and fight,” she asserts. “Each day you have to fight for your recovery and fight for yourself.”

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Low back pain is not only a problem most people have at some point in life, but also the leading cause of disability in the U.S. Whether it is a sharp spasm from lifting something heavy or a daily constant ache, there are various treatments available to relieve your pain. Jessica Ryder PT, DPT, cert VRS, with Renown Health Outpatient Therapy, explains some common causes of this pain, how to treat it and ways to prevent pain flare-ups. It’s important to realize most cases of low back pain are short term. Frequently lasting only a few days or weeks. In general these cases leave no long-term damage to the spine, muscles, discs or nerves. “However, it can become episodic or chronic (lasting longer than 12 weeks) if it is not properly understood or managed by the individual, ” cautions Ryder. Causes of Pain Specifically back discomfort can be related to: Wear and tear on the spine due to age or poor movement patterns Injury to spinal discs Sprains (overstretching or tearing of ligaments) and strains (tears in tendons or muscles) Trauma Irregularities of the spine present at birth (example: scoliosis)Notably the above issues may result in a “pinched nerve” or sciatica, causing pain to extend down the leg. Risk Factors for Pain In particular, your chance of developing low back pain increases with the risk factors below: Age Being overweight Low fitness level or occasional physical activity (“weekend warrior”) Family history Pregnancy Poor posture Jobs requiring heavy physical work (landscaping, plumbers, construction, etc.)

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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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