Leading Medicine Fall 2017, Houston Methodist Hospital edition

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BREAST CANCER:

Is Prevention Possible?

QUIT SMOKING ON YOUR TERMS WHEN THE PROBLEM IS PROSTATE

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS FROM HOUSTON METHODIST

NEWS & EVENTS LADIES NIGHT OUT: POSITIVELY PINK FOR BREAST HEALTH

Join us for an evening dedicated to breast health. Houston Methodist breast experts provide the full spectrum of breast care from screening mammograms to advanced treatment of breast cancer, research and survivorship.

Learn about mammograms and the Houston Methodist Breast Care Center Hear Houston Methodist physicians discuss the latest options in breast cancer services:

• Breast cancer surgery and reconstruction

• Advanced treatments, research and clinical trials

• Survivorship, specialized programs and support services Participate in a Q&A with Houston Methodist breast specialists: radiologists, oncologists and surgeons Date: Tuesday, Oct. 10 Time: 6–8 p.m.

Hosted by: Houston Methodist Breast Care Center and Houston Methodist Cancer Center Location: Hotel ZaZa, 5701 Main St., Houston, TX 77005 Register: events.houstonmethodist.org/breast-hmh

THIRD ANNUAL ADULT CONGENITAL HEART SYMPOSIUM: PATIENT AND FAMILY CELEBRATION

Children born with congenital heart disease are now surviving and even thriving into adulthood, many with a normal life expectancy. This educational program for patients, families and caregivers focuses on advancements in treatment and management of adult congenital heart disease with discussions and a hands-on simulation lab.

Date: Saturday, Nov. 18 Hosted by: Houston Methodist DeBakey Heart & Vascular Center Location: Houston Methodist Institute for Technology, Innovation & Education, 6670 Bertner Ave., Houston, TX 77030 Register: events.houstonmethodist.org/ach-guest

LUNG CANCER AWARENESS EVENT

Learn about the importance of smoking cessation and the Houston Methodist Lung Cancer Screening Program.

Date: Saturday, Nov. 18 Time: 10 a.m.–noon Hosted by: Houston Methodist Cancer Center Location: Houston Methodist Outpatient Center, 1st Floor Lobby, 6445 Main St., Houston, TX 77030 Register: houstonmethodist.org/events

NORTH TOWER TOPPING OUT CEREMONY

Houston Methodist Hospital held a topping out ceremony for its new North Tower, scheduled to open in early 2018.

Steel beams signed by hundreds of doctors and staff were hoisted to the top of the 22-floor tower. When it’s complete, the tower will house state-of-the-art cardiovascular and neurosurgery operating rooms, a dedicated cardiology floor and 366 patient beds.

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DO YOUR HANDS AND WRISTS HURT?

EASE CARPAL TUNNEL WITH THE RIGHT MOVES

I

n our technology-driven world, spending hours upon hours, day after day on our computers, phones or tablets is resulting in new or more advanced “overuse” issues in our hands and wrists. Carpal tunnel syndrome, a disorder of the wrist and hand characterized by pain, tingling and thumb weakness, can strike anyone who uses their hands vigorously Dr. Todd Siff or repetitively — from office workers and mechanics to musicians and gardeners. In addition, carpal tunnel syndrome can affect pregnant women and elderly patients.

“In its early stages, carpal tunnel syndrome is not necessarily painful,” Dr. Todd Siff, orthopedic hand surgeon at Houston Methodist Hospital, said. “At first, you may notice tingling or numbness in your hand, wrist or fingers at nighttime or when you wake up in the morning. As carpal tunnel progresses, symptoms may become more noticeable during the day. In severe cases, you may experience weakness in your hands and loss of dexterity and fine motor skills.”

The following steps may help relieve symptoms of carpal tunnel syndrome and may slow down the progression: If you work at a computer, set up your desk and keyboard so that your wrists are in a neutral position — neither bent up nor down Use a headset instead of holding the phone to your ear If you use tools on the job, make sure they fit your hand correctly and use anti-vibration tool wraps and gloves as needed

Use automated tools (electric staplers, hole punches, can openers, etc.)

Take frequent breaks and alternate activities to give your hands a rest Do hand exercises and stretches several times a day. For example, make a fist and release it, then stretch wrists

GET RELIEF FROM PAINFUL SYMPTOMS

If left untreated, carpal tunnel syndrome may lead to permanent nerve damage, and the longer you wait, the worse it gets. “You should seek treatment if hand pain interferes with your normal activities or disrupts your sleep for more than three or four weeks,” Siff said. “At Houston Methodist, we can do a nerve study to find out if your carpal tunnel is mild, moderate or severe, which helps determine the right treatment plan. In some cases, anti-inflammatory medicines or cortisone injections may be used to ease symptoms.”

Surgery is another option for moderate to severe cases, and for those who do not respond to conservative measures. “Carpal tunnel release is a simple procedure that can be done in just a few minutes under local anesthesia to relieve pressure on the median nerve,” Siff said.

Schedule an Appointment

We can help determine the cause of your pain and recommend treatment options for a fast recovery.

To schedule an appointment, call 713.441.HAND (4263).

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BREAST CANCER:

IS PREVENTION POSSIBLE?

W

hen it comes to breast cancer, certain risk factors are out of your control, such as your genes and age, as well as starting your first period young. Yet even more risk factors are within your control, and every day new research is emerging that suggests breast cancer may be more preventable than experts Dr. Polly originally thought. “Women can take steps Niravath to mitigate their risk of developing breast cancer and increase their chances of survival if it occurs,” said Dr. Polly Niravath, breast oncologist and director of the Cancer Survivorship Program at Houston Methodist Cancer Center. Here are some steps you can take to reduce your risk of breast cancer:

BE (REALLY) PHYSICALLY ACTIVE

Exercise, especially vigorous exercise, could be the single most important weapon in your arsenal.

“Exercise is a huge factor when it comes to reducing

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a woman’s risk of breast cancer,” Niravath emphasized. “Some studies estimate a 15–30 percent risk reduction with moderate exercise, and the more a woman exercises, the more her breast cancer risk drops.” Doctors think the exercise-estrogen link may account for the reduced risk. Here’s why: The greater your lifetime exposure to estrogen, the greater your risk for breast cancer.

Exercise suppresses estrogen production by promoting lean body mass.

MAINTAIN A HEALTHY WEIGHT

Being overweight increases your risk of developing a variety of serious diseases, and breast cancer is one of them. Women who have more fat cells produce more estrogen and tend to have higher insulin levels, both of which are linked to an increased breast cancer risk. “Maintaining a healthy body weight throughout her lifetime, with a body mass index of 18.5–24.9, has many health benefits,” Niravath said.

LIMIT ALCOHOL

In addition to exercise and maintaining a healthy body weight, limiting alcohol to three or less alcoholic drinks per week can lower a woman’s risk. Compared with nondrinkers, women who consume two to five alcoholic drinks a day have about 1.5 times the risk of developing breast cancer. Niravath recommended that women who don’t want to abstain take a daily multivitamin with folate (folic acid). Studies have shown that an adequate daily folate intake may mitigate the risk of breast cancer associated with alcohol consumption.

CHOOSE TO BREASTFEED

Niravath encouraged new mothers to breastfeed their babies if they’re able. “Evidence suggests that breastfeeding reduces a woman’s risk of developing breast cancer,” she said. “We know that the longer a woman breastfeeds, the greater the protective effect.” The reasons why aren’t clear, but one possible explanation is that women who breastfeed have fewer menstrual cycles throughout their lives, and thus less exposure to estrogen.

CONSUME OLIVE OIL

Studies have suggested that consuming more monounsaturated fats, such as olive oil, may help protect against breast cancer, too. Houston Methodist is conducting a clinical trial, led by Dr. Tejal Patel, examining how a major component of olive oil, hydroxytyrosol, affects breast density in women at high risk of breast cancer. Women with higher breast density have a higher breast cancer risk.

TAKE PREVENTIVE MEDICATIONS

If you’re at higher risk for breast cancer, your doctor may recommend medications such as tamoxifen and raloxifene to lower your risk. However, these medications can produce symptoms of menopause, so it’s important to discuss the risks and benefits with your doctor to make an informed decision.

The use of birth control pills has been shown in some studies to increase a woman’s risk of developing breast cancer. However, Niravath said the risk is slight. “I don’t advise against taking birth control pills, unless a woman is at high risk,” Niravath said.

GENETIC TESTING AND INTERVENTION

If you have a strong family history of breast cancer, talk with your doctor about whether genetic testing is right for you. Mutations in certain genes, such as the BRCA genes, increase the risk of breast cancer. Women with this gene mutation may opt for more frequent screenings or prophylactic surgery (breast removal). Removing the ovaries and fallopian tubes is also an option; in addition to reducing the risk of ovarian cancer, it helps prevent breast cancer by eliminating a source of hormones that can fuel some types of the disease.

CLINICAL TRIALS OFFER HOPE Houston Methodist is conducting numerous clinical trials to improve care for women suffering from triple-negative breast cancer (TNBC), a highly aggressive form of the disease that can be especially challenging to treat. Scientists from Houston Methodist and Weill Cornell Medical College have pinpointed a gene previously unassociated with breast cancer that plays a pivotal role in the growth and progression of TNBC. The research suggests that targeting the gene may be a new treatment approach. A drug once used to improve blood flow in damaged hearts is also being studied as a possible treatment option for TNBC. Researchers recently identified two proteins responsible for predicting overall patient survival and validated a therapeutic compound in animal models that slows tumor growth and increases the efficacy of chemotherapy.

In addition, Houston Methodist researchers are reviewing results of a clinical trial that evaluated three new drugs used in combination for the treatment of HER2-positive breast cancer. According to Niravath, the initial results look promising and could mean better outcomes for women with this form of breast cancer.

Visit houstonmethodist.org/research/ clinical-trials to learn more about breast cancer clinical trials at Houston Methodist.

Schedule Your Mammogram

Mammography is the most effective tool available to diagnose breast cancer at an early stage, long before tumors are large enough to be felt or to cause any symptoms. Houston Methodist Breast Care Centers offer mammogram patients a comfortable experience in a spa-like atmosphere.

If further testing is needed, the center offers the latest in diagnostic imaging and biopsy procedures.

The center also provides breast care education, support programs, self-care and other breast cancer prevention screenings and treatment.

To schedule an appointment at the Houston Methodist Breast Care Center, please visit houstonmethodist.org/breast-care or call 713.441.PINK (7465).

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QUITTING ON YOUR TERMS T he average smoker tries to quit at least seven times before succeeding. “Many people find quitting so hard because of their body’s physical addiction to nicotine,” said Dr. Eric Bernicker, a Houston Methodist Hospital medical oncologist. “That’s when nicotine replacement therapy, or NRT, can help.”

By replacing cigarettes with alternative sources of low-dose nicotine, you can stop smoking without the Dr. Eric worst effects of withdrawal. And studies have found Bernicker that NRT can increase your chance of quitting by 50 to 70 percent. Ask your doctor about the nicotine replacement therapy options listed below to make the choice that’s best for you:

PATCH An over-the-counter option, nicotine patches deliver a small, steady amount of nicotine through the skin, and you can use either a 16-hour or 24-hour patch to alleviate withdrawal symptoms.

Some brands offer step-down patches, which have you progress from higher dosages of nicotine to lower dosages over several weeks.

GUM Nicotine gum is a quick-relief, over-the-counter NRT. It’s slowly chewed until the user notices a tingling feeling or peppery taste, at which point the gum is placed between the cheek and gums so the nicotine can be absorbed. Not only is the release of nicotine quicker than patches, but it can also help satisfy the oral urge of smoking.

LOZENGE Available without a prescription, nicotine is slowly absorbed through the mouth as the lozenge dissolves, similar to hard candy. It should take about 20 to 30 minutes for the lozenge to fully dissolve.

INHALER A nicotine inhaler is an NRT that can be obtained with a prescription. It looks like a plastic cigarette holder and comes with nicotine cartridges. You can “puff ” the inhaler over a period of 20 minutes or for just a few minutes at a time.

NASAL SPRAY Nicotine nasal spray is another prescription-only NRT. It immediately relieves withdrawal symptoms by providing nicotine rapidly. Most people are told to use one or two sprays in each nostril once or twice every hour, with at least eight doses per day when first starting.

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Are You a Candidate for Lung Cancer Screening?

We all know that smoking increases your chance of lung cancer. It’s one of the many reasons you’ve tried to quit over the years. As you work with your doctor to successfully beat your nicotine addiction, it’s also a good idea to schedule a lung cancer screening. To find out if you’re a candidate for a screening, visit houstonmethodist.org/cancer/lung-cancer/ screening or call 713.441.5864 to schedule an appointment.

When the Problem

IS YOUR PROSTATE

M

ost men probably don’t think about their prostate, the walnutshaped gland under the bladder, until they get older and begin Dr. Brian Miles experiencing problems with it,” said Dr. Brian Miles, a urologist with Houston Methodist Hospital. “Such problems can include a frequent need to urinate, painful urination, incomplete emptying of the bladder and more.”

The three most common problems men face with the prostate include prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer.

PROSTATITIS

Prostatitis is inflammation of the prostate usually stemming from an infection. It’s a common condition that can lead to difficulty passing urine, sexual problems and more.

How it’s treated: Depending on whether the infection comes on suddenly (acute) or is more chronic, antibiotics may be needed for one to two weeks or longer.

Anti-inflammatory medication and medications that relax prostate muscle tissue to ease urine passage may also be recommended if the prostatitis is chronic.

BPH OR ENLARGED PROSTATE

Many men experience prostate enlargement as they age. This condition can cause a squeezing of the urethra and eventual weakening of the bladder, which can result in urine being left in the bladder.

BPH is not cancerous but can lead to difficulty voiding, bladder or kidney infections, urinary blockages or kidney failure. However, many of these symptoms can be similar to prostate cancer.

How it’s treated: Not all men will need treatment for their BPH; for some, lifestyle changes, such as limiting alcohol or caffeine, can lessen symptoms. For others, medication or surgery can help with symptoms related to discomfort and urine flow. Several noninvasive therapies are now available including green light laser procedures, transurethral resection of the prostate (TURP) or the Button procedure.

These therapies allow for minimal trauma to the body and a quick recovery.

PROSTATE CANCER

Prostate cancer can be a slow-growing cancer that, for many men, will never cause symptoms or threaten their health. For some, however, the cancer can be aggressive and definitive treatment may be in order.

How it’s treated: Prostate cancer treatment depends on the cancer’s location, whether it has spread, the man’s age and overall health. Some treatments can lead to side effects, such as erectile dysfunction and bladder control issues — men should weigh options with their doctor before making a treatment decision. Watchful waiting (regularly monitoring symptoms), surgical removal of the prostate, high-intensity focused ultrasound (HIFU) treatment, radiation therapy and medications, including chemotherapy, and testosteroneblocking hormone therapy may be options.

Many treatment options have advanced in recent years, allowing patients to experience quicker recovery times and significantly fewer side effects. Patients are encouraged to discuss their options with their doctor before making a treatment decision.

MEN’S HEALTH CENTER HELPS MEN MANAGE THEIR HEALTH Houston Methodist Hospital launched a new Men’s Health Center to provide a range of services geared to men. Dr. Brian Miles, a urologist, and Dr. Nathan Starke, an andrologist, provide diagnosis and treatment of prostate issues, prostate cancer, erectile dysfunction, low testosterone and other medical issues affecting men. This unique approach to men’s health involves managing underlying causes, such as heart disease, diabetes, weight management, and measuring body fat and muscle, to help men take charge of their health.

The Houston Methodist Men’s Health Center provides a platform for the latest technologies, clinical research trials, support groups and other advancements in care.

Drs. Miles and Starke are currently seeing patients, and a dedicated space for the Center will open in mid-2018 in the Texas Medical Center.

To learn more about the Men’s Health Center, visit houstonmethodist.org/ mens-health-center or call 346.238.1210.

Concerned About Prostate Symptoms?

To schedule a preventive prostate screening with a Houston Methodist urologist, call 713.441.6455.

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LEADING MEDICINE IN GREATER HOUSTON

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MAKING TIME FOR YOUR MAMMOGRAM MAY ADD YEARS TO YOUR LIFE. At Houston Methodist Breast Care Centers, scheduling your mammogram online is an important first step for early detection. It’s easy, and — with eight locations across the Greater Houston area — more convenient than ever.

Our Breast Care Centers offer: • Specially trained breast imaging radiologists • Advanced technology in a spa-like atmosphere HOSPITALS SPECIALTY HOSPITAL EMERGENCY CARE CENTERS IMAGING CENTERS COMPREHENSIVE CARE CENTERS

Just around the corner

• Access to our breast specialists at Houston Methodist Cancer Center Visit houstonmethodist.org/breast-care and schedule your mammogram at a location near you.

Houston Methodist has locations throughout the Greater Houston area to best serve you near your home or workplace.

HOSPITALS

SPECIALTY HOSPITAL

. Houston Methodist Hospital 2. Houston Methodist San Jacinto Hospital 3. Houston Methodist St. John Hospital . Houston Methodist Sugar Land Hospital 5. Houston Methodist The Woodlands Hospital Now Open 6. Houston Methodist West Hospital 7. Houston Methodist Willowbrook Hospital

. Houston Methodist St. Catherine Hospital

IMAGING CENTERS . Houston Methodist Breast Care Center 7. Houston Methodist Imaging Center

COMPREHENSIVE CARE CENTERS . Houston Methodist Comprehensive Care Center in Conroe . Houston Methodist Comprehensive Care Center in Pearland

EMERGENCY CARE CENTERS

TEXAS MEDICAL CENTER • BAY AREA • BAYTOWN • SUGAR LAND THE WOODLANDS • UPPER KIRBY • WEST HOUSTON • WILLOWBROOK

713.441.ER24 (3724) . Houston Methodist Emergency Care Center at Kirby 0. Houston Methodist Emergency Care Center at Voss . Houston Methodist Emergency Care Center in Cinco Ranch 2. Houston Methodist Emergency Care Center in Cypress 3. Houston Methodist Emergency Care Center in Pearland . Houston Methodist Emergency Care Center in Sienna Plantation 5. Houston Methodist Emergency Care Center in Spring 6. Houston Methodist Emergency Care Center in The Woodlands

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