Leading Medicine Fall 2018, Houston Methodist Hospital edition

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Your Journey for

CANCER

CARE 4 Ways to Stay at the Top of Your Exercise Game Understanding Concussions

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

IN THIS ISSUE - FALL 2018

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M anaging Severe Persistent Asthma Coughing, wheezing, choking — about 25 million Americans deal with the symptoms of asthma, a lung disease that makes it difficult to breathe.

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C hoosing a Hospital for Cancer Care Knowing where to turn for support after a cancer diagnosis can help you move forward with confidence.

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4 Ways to Stay at the Top of Your Exercise Game Physical activity can help people live longer and lower their risk for many health conditions. Here are four tips for exercising safely.

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nderstanding Concussions U Much attention has been paid in recent years to the consequences of repeated head injuries among professional athletes.

But, even one concussion can have an impact.

Pumpkin Smoothie Blend up a refreshing smoothie that’s brimming with fall flavors.

Number of servings: 6

INGREDIENTS

1 can (15 ounces) low-sodium pumpkin, chilled 1 can (12 ounces) evaporated low-fat milk, chilled 1½ cups orange juice 1 banana, small, sliced 1/3 cup light brown sugar, packed, or 1/3 cup regular sugar 2 dozen ice cubes (optional) 2 teaspoons ground cinnamon (optional)

DIRECTIONS

1. Place pumpkin, evaporated milk, orange juice, banana and sugar in blender.

2. Cover and blend until smooth.

3. If using ice, pour mixture over ice. Sprinkle cinnamon if desired.

Recipe courtesy of the U.S. Department of Agriculture, whatscooking.fns.usda.gov.

Empowering a Healthier You A WOMEN’S HEALTH AND WELLNESS EVENT

NUTRITIONAL INFORMATION PER SERVING: 160 calories; 1 g total fat; 1 g saturated fat; 10 mg cholesterol; 70 mg sodium; 34 g carbohydrates; 3 g dietary fiber; 27 g total sugars; 5 g protein; 178 mg calcium; 1 mg iron; 566 mg potassium.

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Join Houston Methodist Hospital’s panel of women’s health experts as they discuss the latest in breast care, pelvic health, heart health, ovarian cancer, cervical cancer and HPV. Participate in a Q&A session with our doctors as they share essential health and wellness information. Treat yourself and someone you love to an evening all about women’s health and enjoy refreshments and light bites. Complimentary valet parking is available.

To register, visit houstonmethodist.org/womens or call 713.790.3599.

Date: Sept. 5, 2018 Time: 6-8 p.m.

Location: Hotel Zaza, 5701 Main St., Houston, TX 77005

Managing Severe PERSISTENT ASTHMA

C Dr. Lisa Kopas

oughing, wheezing, choking — about 25 million Americans deal with the symptoms of asthma, a lung disease that makes it difficult to breathe. Of those, it’s estimated as many as 10 percent have uncontrolled or severe persistent asthma.*

IDENTIFYING SEVERE ASTHMA

There is no one test to determine if an Dr. Ghassan A. individual has asthma.

Noureddine “Diagnosis begins with listening to the patient and getting a complete medical history and physical,” said Dr. Lisa Kopas, pulmonologist and member of the Houston Methodist Lung Center. “We start with ruling out other causes for their symptoms.”

Lung function and other tests are used to confirm the diagnosis. “We have a full range of state-of-the-art diagnostic tools available at the Houston Methodist Lung Center,” said Dr. Ghassan A. Noureddine, pulmonologist and member of the Houston Methodist Lung Center.

These include: Spirometry, which measures the speed and how much air flows in and out of the lungs C hallenge tests, which help determine lung reaction to irritants, allergens and methacholine (a drug that can induce asthma symptoms) E xhaled nitrous oxide, which measures the amount of nitrous oxide in the breath Imaging, such as X-rays and CT scans

TREATING SEVERE ASTHMA

Once the diagnosis of severe asthma is confirmed, the patient may be put on some combination of an inhaled corticosteroid, a rescue inhaler

WHAT ASTHMA SEVERITY LEVEL ARE YOU? Here’s a chart for learning the differences between common and severe asthma.

Components of severity for ages 12+

Persistent Intermittent

Mild

Moderate

Severe

Need to use rescue inhaler

Less than 2 days per week

More than 2 days per week

Daily

Several times per day

Nighttime awakenings

Less than 2x/month

3-4x/month

1x/week

Often 7x/week

Exacerbations*

0-1 per year

2 or more per year

* Severe asthma attacks requiring urgent care/hospitalization and oral systemic corticosteroids.

Source: National Heart, Lung, and Blood Institute

(generally, a beta-agonist bronchodilator) and perhaps oral medication.

“Some patients are put on medicine that works with the immune system to help block asthma attacks,” Noureddine said. “If all else fails, we may consider bronchial thermoplasty.”

“With bronchial thermoplasty, we deliver heat inside the airway. The heat helps prevent the muscle from constricting,” Kopas explained. “In a clinical study of patients with severe asthma, 79 percent treated with bronchial thermoplasty saw a significant improvement and far fewer ER visits.”

Kopas, an expert on bronchial thermoplasty, has performed more procedures than anyone in Texas and perhaps throughout the United States.

Acid reflux and obesity may also trigger symptoms or make them worse, so controlling those conditions is important. Of course, anyone who is smoking should stop.

“For those affected by exercise-induced asthma, performing a slow warmup and using the rescue inhaler before exercise may be beneficial and allow them to continue an exercise routine safely,” Kopas said.

“The bottom line is we want to help improve the long-term outlook for patients with uncontrolled asthma,” Noureddine explained. “With careful monitoring and treatment, they may have a better quality of life and fewer ER visits.” * Source: American Academy of Allergy Asthma & Immunology, aaaai.org.

AVOIDING ASTHMA TRIGGERS

Asthma patients can make certain lifestyle changes that may help reduce their symptoms. For example, they can limit their exposure to allergens that trigger their asthma. If symptoms are triggered by occupational exposure, they may seek accommodation from their employer.

Get Relief To request an appointment with one of our pulmonologists at Houston Methodist Lung Center, visit houstonmethodist.org/ lung-center or call 713.441.7779.

CHECK OUT OUR DIGITAL MAGAZINE AT HOUSTONMETHODIST.ORG/NEWSROOM/NEWSLETTERS 3

Support for Your Journey

from Diagnosis to Survivorship Choosing a hospital for cancer care

H

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START YOUR SEARCH

Choosing where to go for cancer treatment is a big decision, and you want to feel secure about your choice.

Most of all, you’re focused on finding the best path to treatment — as quickly as possible.

If you live in the Houston area, you have choices about where to go for cancer care, with convenient access to top-ranked physicians and cancer specialists, advanced treatments and research, and comprehensive services and support. Within Houston Methodist Cancer Center, our specialists are renowned for their research and treatment of cancer, and we are dedicated to providing each patient with the most advanced and collaborative care, all in a compassionate environment. In 2017, more than 2,000 patients from all over the United States and 37 countries traveled from outside of the Greater Houston area to Houston Methodist for their cancer treatment.

“Patients come from all over the world because we have leading cancer experts integrating the latest research and treatments on the forefront of the battle against cancer. Our commitment to providing high-quality and compassionate care comes through in everything we do,” said Dr. Maen Abdelrahim, a gastrointestinal oncologist at Houston Methodist Cancer Center and director

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of the Cockrell Center for Advanced Therapeutics at Houston Methodist Hospital.

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STEP

STEP

earing the news that you or a loved one has been diagnosed with cancer can turn life upside down. A thousand questions, worries and what-ifs may come to mind. Knowing where to turn for support after a cancer diagnosis can help you move forward with confidence by: M eeting with your doctor to ask questions Dr. Maen about your diagnosis and make sure you Abdelrahim understand his or her recommendations for treatment.

C onsidering getting a second opinion so you can feel wellinformed and confident with your treatment decisions.

T alking to family and friends about your diagnosis and how this may impact family life and work or school schedules.

F inding support to help you navigate next steps. Before you even begin treatment, a support group can help you learn how to share the news with your loved ones or give you an idea of what to expect throughout treatment.

CONNECT WITH YOUR CARE TEAM

The doctor who diagnosed your cancer might refer you to a medical oncologist or surgeon who specializes in treating certain cancers. Before you visit a specialist, write out a list of questions and bring a support person who can help you take notes on the doctor’s advice. If there’s something you don’t understand, make sure to ask. It’s important that you feel comfortable communicating with the doctors and nurses involved in your care.

There’s no question you want the best team on your side when fighting cancer. At Houston Methodist Cancer Center, top-ranked physicians and cancer specialists have a high level of expertise and input on your treatment plan. Whether your cancer diagnosis is common, rare, or in an early or advanced stage, you can benefit from the leading-edge research, knowledge and experience of an academic medical center. “If you have multiple health complications or conditions, it is even more critical to have a team of specialists working together on a treatment plan for your unique needs,” Abdelrahim said.

Oncologists, surgeons, pulmonologists, pathologists, radiologists, internal medicine doctors and other specialists at

STEP

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LEARN ABOUT TREATMENT OPTIONS

With an experienced team on your side, you’re ready to review your treatment options. “We treat common and complex cases of cancer that touch every organ of the body — and every aspect of your life. Our specialists customize treatment plans to fight your cancer so we can achieve the best outcomes possible; that’s part of being a top hospital in Texas,” Abdelrahim said. Treatment options may include: A dvanced immunotherapy I maging technology Bone marrow transplant advancements Chemotherapy Latest radiation techniques Clinical trials Leading surgical techniques Targeted therapies Choosing a research-focused hospital system opens the door to new therapies not available outside of a research setting. For example, you may decide that you want to participate in clinical trials that involve medications as well as gene and cell therapy.

“We offer immunotherapy clinical trials to stimulate a stronger immune response to kill cancer cells in lung cancer, gastrointestinal cancers, breast cancer and brain tumors. We also have a triple-negative breast cancer clinic, sarcoma of the heart program and other programs designed for specific types of cancer,” Abdelrahim explained.

“In addition to the research and clinical trials offered at our campus in the Texas Medical Center, we have research programs at our community cancer center locations, and we are dedicated to bringing research and clinical trials closer to home. Our researchers are actively working on every aspect of cancer treatment and bringing that integration to the communities across Houston,” Abdelrahim said.

STEP

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START YOUR TREATMENT PLAN

Moving into the treatment phase of your journey takes courage, stamina and patience. The various components of a treatment plan may be spread out over weeks or months — and timing is key. That’s why it helps to choose a hospital system with convenient access to appointments for radiation therapy, infusion therapy and other treatments you may need.

“The specialists at all of our cancer center locations are connected with the same research, treatments and technology available throughout Houston Methodist,” Abdelrahim shared.

You keep your physician throughout your journey and receive treatments at the location that’s most convenient for you.

“When you receive care locally, you benefit in many ways — being close to work, home, family and friends can minimize the interruption to your life. Our goal is for you to be able to get back to yourself so you can focus on your life. Your cancer should not be the center of your life; that's what we’re trying to accomplish,” Abdelrahim said.

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STEP

Houston Methodist collaborate and consult on treatment plans for patients. This team aspect is a powerful tool in the fight against cancer.

BEYOND CANCER TREATMENT

Care for cancer patients doesn’t end when treatment does. At the end of treatment, you’ll have a survivorship care plan to help continue your ongoing care and help you follow your doctor’s recommendations. The Houston Methodist Cancer Survivorship Program addresses common quality-of-life issues related to cancer treatment so you can focus on surviving, thriving and living your best life.

CANCER SURVIVORSHIP PROGRAM Maintaining your quality of life after surviving cancer involves more than medications and regular doctor visits. It may also include managing long-term side effects of treatment, like fatigue, memory problems and fertility issues. Having a dedicated team of experts focused on your well-being is important as you consider your long-term care needs.

The Cancer Survivorship Program at Houston Methodist Cancer Center includes the following services and resources: Acupuncture Financial assistance C ancer treatment Massage summary and P sychological survivorship care plan counseling E xecutive physical Speech therapy exam, including Support groups nutrition and Yoga social-work needs assessment The program also offers multiple clinical trials for common survivorship problems, such as “chemo brain,” cancer-related fatigue, joint pain and sexual dysfunction.

HELPING YOU THRIVE If you are a survivor of any type of cancer and would like to request a survivorship appointment, call 713.441.9948.

Your Journey Begins Here Visit houstonmethodist.org/cancer for more information about Houston Methodist Cancer Center. For a physician referral, call 713.790.2700.

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4 Ways to Stay at the

TOP OF YOUR EXERCISE GAME

A

ccording to the Centers for Disease Control and Prevention (CDC), physical activity can help people live longer and lower their risk for heart disease, stroke, type Dr. Joshua 2 diabetes, depression Harris and certain cancers. Some studies even suggest exercise can help prevent or slow the onset of dementia.* The benefits of exercise are clear.

However, if you’re planning to start a new exercise routine, first check with your doctor to make sure you have no underlying health issues. Then use these four tips to exercise safely and get the most from your regimen.

1. SLOW DOWN AND WARM UP

“Warming up helps loosen your muscles and joints,” said Dr. Joshua Harris, orthopedic surgeon at Houston Methodist Hospital. “A proper warmup may consist simply of walking five to 10 minutes.

Vigorous stretching should be avoided, as the muscles and tendons are not yet ‘warm’ and may increase injury risk.” When beginning a walking, biking, swimming or running regimen, it’s important to start slowly — perhaps limiting yourself to as few as 10 minutes a day. Gradually increase speed and distance over time in order to reach a pace that’s appropriate for your age, physical condition and fitness goals.

“If you exercise by playing golf or tennis, it’s especially important to warm up the muscles involved in the unique motions common to those sports,” Harris said.

2. DON’T SKIP THE COOL DOWN

After exercising, it’s important to cool down and gradually return your heart rate to normal. This may include walking, light calisthenics or gentle stretching. Again,

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as with the warmup, vigorous stretching should be avoided.

3. TRY CROSS-TRAINING

Cross-training simply means varying your exercise routine. A typical schedule may include: D ay 1: Aerobic activity like walking, running, biking or swimming to promote heart and lung function D ay 2: Weight lifting to strengthen muscles and bones D ay 3: Yoga, tai chi or activities as simple as stretching and standing on one foot develop flexibility and balance “By varying your routine, you reduce the risk of a variety of overuse injuries, including muscle strains, tendonitis and stress fractures, among several others,” said Harris, who also serves as a team physician for the Houston Ballet, team orthopedist for the Houston Dynamo and consulting orthopedist for Rice University Athletics. “It also can promote better all-around fitness.”

4. FINALLY, DON’T OVERDO IT

It’s common to experience achy muscles for a day or two after exercise, especially when starting a new routine or increasing intensity. However, it’s important to stop what you’re doing if you experience pain.

If the pain is severe, or it continues beyond a couple of days, see your doctor right away. Whether you are new to a workout program or have been doing it for decades, the best advice is to listen to your body. If you have pain that persists for several days that prevents you from performing simple activities of daily living or returning back to your exercise program, then you likely either need to reduce the intensity of the program or see a doctor. * Source: Time.com, “How Exercise May Help Protect Your Brain From Cognitive Decline and Dementia,” Feb. 16, 2018.

SIDELINED BY AN INJURY? GET BACK IN THE GAME WITH LEADING SPORTS MEDICINE CARE Safely returning to an exercise routine after an injury warrants expert evaluation. The world-class team of specialists at Houston Methodist Orthopedics & Sports Medicine provides comprehensive care for common to complex injuries with advanced nonsurgical treatments, surgical procedures and state-of-the-art physical and occupational therapy to help you get back out there faster.

To schedule an appointment with a sports medicine doctor, visit houstonmethodist.org/ gameon or call 713.441.9000.

UNDERSTANDING CONCUSSIONS M uch attention has been paid in recent years to the consequences of repeated head injuries among professional athletes.

But, even one concussion can have a tremendous impact.

SIGNS OF CONCUSSION

A concussion can be caused by a fall, impact, such as from contact sports or an auto accident, or even violent shaking. “Although most concussions are mild and symptoms resolve quickly, anyone suspected of having a concussion should be medically evaluated,” said Dr. Rajan Gadhia, a vascular neurologist at Houston Methodist Hospital and medical director of the Houston Methodist Concussion Center.

Symptoms of concussion may include: Clumsiness Dazed or stunned appearance Headache or neck pain Inability to recall what happened before or after the impact Mental fogginess Nausea and dizziness Sensitivity to light or sound Evaluation may include a neurological exam to check balance, vision, coordination, reflexes and the ability to answer questions. However, symptoms may not necessarily appear right away.

“If symptoms worsen as time goes on, or the person shows more serious symptoms, get to an emergency room immediately,” Gadhia said.

More serious symptoms may include: Confusion and drowsiness Convulsions or seizures Double or blurred vision, or unequal pupils Loss of consciousness Numbness or weakness in arms or legs Slurred speech Vomiting more than twice Worsening headache Once diagnosed and treated for concussion, individuals should advance gradually through light, moderate and normal activity under the direction of their doctor. Student-athletes should not return to practice or play until cleared to do so by their clinician.

Dr. Rajan Gadhia

Reaching out to rural areas:

COMPREHENSIVE CONCUSSION CARE POSSIBLE THROUGH ONLINE TELEMEDICINE PROGRAM In a collaboration with the Houston Texans and GE, Houston Methodist Concussion Center is bringing concussion care to student-athletes in 19 rural school districts via an online telemedicine program.

“Since 2011, the diagnosis Kenneth Podell, and treatment of sports-related PhD concussions in Texas’ youth athletes has drastically improved,” said Kenneth Podell, PhD, neuropsychologist and director of the Houston Methodist Concussion Center. “Unfortunately, many athletes do not receive the comprehensive care needed to ensure a safe return to school and sports.”

When an athlete suspected of concussion is removed from play or practice, an athletic trainer administers a comprehensive concussion evaluation directed by a Houston Methodist Concussion Center doctor via an online video connection, which provides quicker access to diagnosis and a comprehensive care plan that may allow the athlete to return to practice or play sooner. If successful, the program may be expanded throughout the state.

USE YOUR HEAD, PROTECT YOUR BRAIN

Prevention is the best way to avoid concussion and potential longterm consequences, such as dizziness, emotional problems, headaches, and trouble with concentration and memory. Athletes of all ages and levels may help prevent concussions by using proper technique and not continuing to play if they suspect they have a concussion. Older individuals may benefit from balance exercises to help avoid falls. “You have only one brain,” Gadhia added. “Take steps to protect it.”

Schedule an Appointment If you suspect you or a loved one may have experienced a possible concussion, call 713.441.8277 or visit houstonmethodist.org/ concussion for more information.

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KEEPING YOU AT THE TOP OF YOUR GAME When an injury has you sidelined, the world-class team of specialists at Houston Methodist Orthopedics & Sports Medicine will help you get back out there faster, with: • Expertise to treat common to complex injuries

• Minimally invasive procedures • State-of-the-art physical and occupational therapy

• Latest imaging and technology • Advanced nonsurgical treatments

Schedule an appointment to discuss your options with a specialist.

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