Leading Medicine Fall 2019, Houston Methodist Hospital edition

LEADING MEDICINE FA LL 201

Treating AFib:

Tips for Staying Healthy This Fall

Getting Back in Rhythm WIN A $100 AMAZON GIFT CARD See inside for details.

Breast Cancer Surgery

A Treatment Plan Designed

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

NEWS & EVENTS JOIN US AT THESE UPCOMING FALL EVENTS

Get the answers you need to empower a healthier you.

Houston Methodist Hospital physician experts will be featured at the following educational events this fall.

A WOMEN’S HEALTH AND WELLNESS EVENT Engage with an all-female panel of doctors during a Q&A discussion focusing on the most relevant health matters impacting women today. Topics will include gynecologic health, breast care, heart disease and neurological health.

COMPREHENSIVE NEUROSCIENCE SEMINAR Join Houston Methodist Hospital’s panel of neurologists and neurosurgeons for a Q&A discussion focusing on the top neurological health concerns affecting people today.

Q&A LUNG EVENT Lung disorders, such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary hypertension and cancer, affect quality of life for many people. Our panel of pulmonary experts will address today’s top lung concerns during a Q&A session.

Appointment scheduling and free valet parking are available at all events. Refreshments and light bites will also be served. Visit events.houstonmethodist.org to register for these events and to check out other upcoming seminars.

Injuries Don’t Happen on a Schedule SPECIALIZED ORTHOPEDIC CARE FOR UNEXPECTED INJURIES

Date: Monday – Thursday | Time: 8 a.m. – 5:30 p.m.

Date: Friday | Time: 8 a.m. – 3 p.m.

At the Houston Methodist Orthopedic Injury Clinic in Bellaire, you can see a specialist without making an appointment. We’re expanding our services to better serve the needs of the community.

When you need immediate orthopedic care, count on our experts to evaluate and treat your injury, so you can get back to your active life.

The clinic provides treatment for: Acute orthopedic injuries Fractures Injured tendons Joint pain

Minor dislocations Sports injuries Sprains and strains Torn ligaments

No appointment required Office visit pricing | Major insurance plans accepted Conveniently located at 5505 W. Loop S. To learn more, visit houstonmethodist.org/osm/bellaire or call 346.238.5300.

Tips for Staying Healthy This Fall

A

utumn is a great time to get healthy.

With kids going back to school and the air feeling cooler, it can be a great time for new beginnings. Start by making simple changes to your Dr. Angela Chen eating habits.

MAKE GOOD CHOICES

“While fats are essential to a healthy diet, eating too much saturated fat and transfat can contribute to high cholesterol and obesity, which can lead to heart disease, diabetes and stroke,” said Dr. Angela Chen, primary care physician with Houston Methodist Primary Care Group in Memorial Green.

Choose heart-healthy fats like canola, corn, olive, peanut or safflower oils. Omega-3 fatty acids found in fish are also beneficial to health. Try sautéing in olive oil instead

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of butter, and serve fish, such as lake trout, salmon and sardines, at least twice a week.

Grains are an important part of a healthy diet. Brown rice, whole-grain breads and pasta, and grains, such as barley and quinoa, are delicious, healthy alternatives to refined grains and white flour.

Eating more fruits and vegetables is another great way to protect your heart. They are low in calories, full of antioxidants, vitamins, minerals and fiber. Try adding a few of these tasty fall foods to your diet: Apples — fiber and vitamin C Brussels sprouts — vitamin C, vitamin A and folate Cranberries — vitamin B6, fiber, potassium and vitamin C Sweet potatoes — vitamin A, vitamin C, vitamin B6, fiber and potassium Swiss chard — vitamins A and C, and iron By making a few small tweaks to your diet, you’ll reap big rewards.

Make Time for Your Flu Shot In addition to eating a healthy diet to help keep your immune system strong, it’s important to guard against the flu by getting an annual flu shot in the fall.

Houston Methodist Primary Care Group can help you be prepared for this year’s flu season with a flu shot.

Visit houstonmethodist.org/pcg or call 832.522.7800 to learn more or schedule an appointment.

PELVIC FLOOR TREATMENT

HELPS MENOPAUSAL AND POSTPARTUM WOMEN

P

elvic floor disorders, commonly viewed as a normal part of aging, include urinary incontinence, accidental bowel leakage and pelvic organ prolapse. But these symptoms should not be taken lightly.

“Women often feel as if they are the only ones suffering from pelvic floor disorders,” said Dr. Kathryn Williams, a urogynecologist at Dr. Kathryn Houston Methodist Urogynecology Associates, Williams “As a result, women often ignore their symptoms until they reduce quality of life.”

Keeping silent is rarely a medical risk but can severely impact women’s well-being. Here are some common questions from women who have experienced pelvic floor issues — along with some helpful answers.

Q. I suffer from urinary leakage when I sneeze, laugh, cough or exercise. Is this normal?

A. It may feel as if you’re alone, but you’re not — 1 in 3 women will experience a pelvic floor disorder, including urinary incontinence in her lifetime. Generally, women suffer silently because these problems are not openly discussed in society. On average, women wait about five years from symptom onset to seek help and be evaluated.

Q. I s incontinence just a part of getting older and something I have to accept?

A. “Actually, incontinence can affect women of all ages,” said Williams, “but it is not normal — nor something you have to accept — as there are many treatment options available.”

Treatments include bladder training, pelvic floor muscle exercises, medications, vaginal inserts, office procedures and minimally invasive surgery. “We are fortunate to be able to offer many nonsurgical and surgical treatments at all our locations,” said Williams.

Q. I feel a bulge and heaviness down below. What’s causing this?

A. “When it comes to pelvic organ prolapse, women often feel those exact symptoms,” said Williams. Additionally, women often report feeling pressure or laxity in their pelvic floor. There are just as many treatment options for prolapse as there are for

Learn More If you have unanswered questions about pelvic floor disorders or other women’s health concerns, visit houstonmethodist.org/crpm or call 713.441.5800 to make an appointment.

incontinence. “As a urogynecologist I can offer the patient a personalized approach to her care based on the treatment options that best suit her needs,” said Williams.

Q. What’s the danger if I do nothing?

A. While pelvic floor disorders are rarely medical emergencies, both prolapse and urinary incontinence can greatly affect lifestyles. Women with incontinence may choose their clothing, schedules and activities around the fear of losing bladder control or discomfort from prolapse. These conditions may also impact sexual function and confidence during intimacy. “These are very personal topics; my goal is to make patients feel comfortable by reassuring them and informing them about what options are available for symptomatic relief. No woman likes to go the gynecologist and it can be difficult to talk about our most private health concerns, but fortunately, with so many options in my profession, patients rarely leave the office without a plan in place,” said Williams.

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Breast Cancer Surgery

A Treatment Plan Designed Just for You A breast cancer diagnosis can stop you in your tracks and leave you wondering: What does this mean for my future? How will my body change? You may Dr. Sherry J. be flooded with emotions Lim about the future, and this is completely natural.

If surgery is part of your treatment plan, you might worry about what you will look like afterward.

The psychological impacts of mastectomy Dr. Aldona J. can touch various aspects Spiegel of your life, from body image and self-confidence to sexuality and intimacy.

MORE OPTIONS, BETTER RESULTS Women undergoing breast surgery have more options with far better results than in the past. “Many new advancements in implant-based and natural tissue reconstruction have greatly improved the results we can deliver to patients,” said Dr. Aldona J. Spiegel, a plastic surgeon with Houston Methodist Hospital.

“Every woman’s goals are different, and we design each treatment plan based on your individual characteristics. We always consider patients’ wants and desires when planning their surgery,” said Dr. Sherry J. Lim, a breast surgeon with Houston Methodist Hospital.

CONSERVING THE BREAST

Radar and radiofrequency clips are used to pinpoint abnormal tissue and preserve healthy breast tissue. “New technology

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makes it possible to use a wire or tiny device implanted before surgery to pinpoint and remove breast cancers during surgery,” Lim said.

Hidden scar techniques involve making an incision in a discreet location under the breast fold or around the areola, resulting in a scar that is hidden by the skin fold of the breast. “With this approach, we can preserve a naturallooking breast while minimizing the appearance of visible scars,” Lim said.

BREAST RECONSTRUCTION

Women who opt for a mastectomy have a range of options available for breast reconstructive surgery with implants, natural tissue or a combination of both.

Surgical options include: Implant-based reconstruction involves rebuilding the breast using saline or silicone implants. "When combined with a nipple-sparing mastectomy, the result can be very natural with a well hidden scar in the crease under the breast," Spiegel said.

Autologous or flap reconstruction uses tissue from another area of the body to reconstruct the breast, making it appear and feel natural. This procedure involves moving tissue, often from the abdomen, to the chest and reattaching the arteries and veins in the area. “The most common microsurgical approach to breast reconstruction is using the excess lower tummy tissue, with careful preservation of the abdominal muscles, and replacing the breast tissue with natural skin and fat,” Spiegel explained.

Breast resensitization helps restore sensation to the reconstructed breast. “We use a method for connecting the nerves using a patient’s own tissue to improve breast sensation after mastectomy,” Spiegel said.

CHOOSING WHAT’S RIGHT FOR YOU

When weighing your options, your doctor can help you make an informed decision based on facts, not fears. Together, you can review the factors that will impact your choices: P hysical characteristics — age, your overall health, breast size, breast density, the size and location of your breast cancer and the amount of tissue available for reconstruction.

P ersonal preferences — aesthetic goals, how you want your breasts to look and feel, symmetry and breast reduction options.

L ogistical factors — timing of surgery, additional cancer treatments, having a support system and returning to work.

Recovery time is an important factor if you need to get back to your life faster and have fewer restrictions. In those cases, breast conserving surgery may be a good option, especially for older women and those whose health can make recovery difficult.

Breast cancer surgery and reconstructive surgery can be done at the same time or separately. Your treatment plan can be designed so you can keep living your life.

Take Control of Your Treatment

Rely on our expertise to help you personalize your breast cancer treatment to fit your life.

Visit houstonmethodist.org/ breast-cancer to learn more or call 713.790.2700 to find a surgeon.

LUMPECTOMY VS. MASTECTOMY WITH RECONSTRUCTION What’s the difference?

Lumpectomy Surgery to remove the tumor while leaving healthy breast tissue surrounding it.

Total mastectomy Surgery to remove the entire breast, including the skin, nipple and areola.

Nipple-sparing mastectomy Surgery to remove the breast while leaving the skin, nipple and areola in place.

Why consider it: When breast cancer is detected early and the tumor is small.

Benefits: Conserving your natural breast; faster recovery times.

Why consider it: If you’re choosing breast reconstructive surgery immediately following the mastectomy.

Benefits: Preserving your breast skin and nipple; potential to regain sensation in the nipple when combined with flap surgery.

Flap reconstruction Surgery to reconstruct your breast after mastectomy using abdominal tissue through a tummy tuck incision.

Double (bilateral) mastectomy Surgery to remove both breasts.

Why consider it: May be best for treating invasive breast cancers.

Benefits: Breast reconstructive surgery may be performed at the same time or a later date.

Why consider it: An option for women choosing preventive mastectomy to reduce risk if they have a BRCA gene mutation.

Benefits: Achieving a symmetrical appearance with options for breast reconstructive surgery.

Why consider it: It offers the most natural reconstruction possible, with hidden scars, and the possibility of returned sensation.

Benefits: This type of breast reconstruction involves hidden scars, the most natural result, and a lifelong lasting outcome.

BREAST RESENSITIZATION AFTER MASTECTOMY If you have a mastectomy, the nerves that provide feeling to the breast and nipple are removed. This loss of sensation can feel unnatural and may alter the way you experience everyday activities like putting on clothes or hugging someone.

“The amount of sensation that returns after breast reconstruction is variable for most patients. However, the possibility of improving the sensibility and regaining natural sensation in the reconstructed breast is a very important goal,” Spiegel said.

Breast resensitization can be performed during flap breast reconstruction surgery, a type of surgery that uses your own abdominal tissue to rebuild the breast. The procedure involves reconnecting the nerves on the chest to give the possibility of returning sensation to the breast.

Visit houstonmethodist.org/breast-cancer to learn more about the innovative breast cancer treatments and procedures offered at Houston Methodist Hospital.

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GETTING BACK IN RHYTHM

A Dr. Nadim Nasir, Jr.

Dr. Miguel Valderrábano

Dr. Randall Wolf

trial fibrillation (AFib) is an irregular heart rhythm and the most common irregular heart rhythm problem for many Americans.

Normally, your heart pumps blood through four chambers by contracting and relaxing to a regular beat. With AFib, the upper chambers of the heart (the atria) beat irregularly or quiver instead of beating effectively to move blood into the lower chambers (the ventricles). To some, this will feel like a fluttering in the chest. Others will experience fatigue or shortness of breath.

Left untreated, AFib doubles the risk of heartrelated death and increases your risk of stroke five times. A new study indicates that AFib is now associated with heart failure, sudden cardiac death, heart attack and chronic kidney disease.

“I urge patients not to settle for a temporary fix.

AFib can be beat,” said Dr. Miguel Valderrábano, Division Chief of Cardiac Electrophysiology at Houston Methodist Hospital. “The optimal outcome for patients is to eliminate AFib, and it’s important to explore all options to determine the best approach for you.” The majority of people diagnosed with AFib can be treated noninvasively by an electrophysiologist.

FINDING THE TREATMENT RIGHT FOR YOU

“Patients with AFib need hope, and they want to feel better,” said Dr. Randall Wolf, cardiothoracic surgeon at Houston Methodist DeBakey Heart & Vascular Center. “At Houston Methodist, we offer comprehensive AFib treatment, which means even if you’ve had multiple failed treatment

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attempts at repair, it’s likely we can improve your condition.”

Treatment varies for each patient; options include: L ifestyle changes, such as reducing or eliminating caffeine and alcohol in your diet, and losing weight.

M edications, including blood thinners, heart rate controllers and heart rhythm controllers.

C atheter ablation that sends radio waves through a catheter to destroy abnormal heart tissue that disrupts the normal flow of electrical signals.

M aze surgery using small incisions, radio waves, freezing or ultrasound energy to create scar tissue in the atria of the heart to prevent the spread of disorganized electrical signals.

M ini-Maze, a minimally invasive alternative to the Maze procedure. Patients who undergo this procedure have less pain, heal faster and are able to return to normal life much more quickly than those who undergo a more invasive surgical procedure.

“Our goal in treating AFib is to improve the quality of life for the patient, while reducing the risks of stroke balanced against the risks of treatment,” said Dr. Nadim Nasir, Jr., Medical Director, Cardiac Electrophysiology Lab at Houston Methodist DeBakey Heart & Vascular Center. “AFib can be cured or controlled, and the effect on health and lifestyle well-managed.”

We’re Here to Help If you have been diagnosed with AFib, we can help you choose the right treatment option. Contact 713.DEBAKEY (332.2539) or houstonmethodist.org/afib to find a Houston Methodist specialist near you.

Ways to Improve Chronic

NECK AND BACK PAIN

W

hen you’re living with chronic neck or back pain (generally, pain that lasts more than three months), even simple movements like getting up from a Dr. Sean Barber chair can be a challenge.

Enjoying activities, like dancing, gardening or golfing, can be next to impossible.

Pain in the neck (cervical spine) or back may be due to an obvious cause, such as a recent accident or strain from lifting a heavy object, or, it could be due to stress, caused from hunching over a desk for hours each day. Other common causes are osteoarthritis (normal wear and tear of joints), osteoporosis, a pinched nerve, herniated disk or spinal malformations.

“Whatever the cause, we work with you to discover the source of the pain and recommend a therapeutic plan,” said Dr. Sean Barber, spinal neurosurgeon at Houston Methodist Neurological Institute.

A RANGE OF TREATMENT OPTIONS

“Most neck and back pain will resolve with self-care and time,” said Barber.

Conservative treatments may help provide relief and include: Ice and/or heat at recommended intervals Over-the-counter or prescription pain relievers or anti-inflammatory drugs Physical therapy or at-home stretching and other exercises Spinal manipulation or massage

“However, if pain continues, worsens or interferes with your quality of life, or we suspect certain conditions are present, we may consider more aggressive treatments,” Barber added. “Before deciding on next steps, we will perform imaging tests, such as X-ray or MRI, to help determine what’s causing the pain and how to treat it.”

WHAT HAPPENS NEXT?

Depending on the imaging results, your doctor may recommend a surgical or less-invasive treatment option. These can include image-guided injectionbased therapies, such as steroids or nerve blocks, or surgery to repair or replace

damaged disks or correct malformations.

“If indicated, minimally invasive surgery may result in faster healing and less pain than conventional surgery,” Barber said. “However, the surgical team will determine which approach is likely to produce the best outcome for you.”

SEEING A SPECIALIST EARLY There are benefits to seeing a specialist early when experiencing chronic neck or back pain, as a more serious condition may be the underlying cause. At Houston Methodist, a multidisciplinary team assesses the severity of the pain and attempts to find the source of the problem before determining a course of treatment.

Some conditions may call for spinal neurosurgery when health or quality of life is at stake and other treatments are unsuccessful. Among them:

Spinal deformities, such as scoliosis, when the curve in the spine is severe Benign or malignant tumors in the spinal canal or on the bones of the spine Spasticity, a muscle control condition that may be caused by disease or injury; it can interfere with normal movement or speech If surgical intervention is needed, minimally invasive surgery offers many advantages, such as the potential for faster healing and less pain.

Time to Take Action If you’re dealing with chronic neck or back pain, take action to get relief. Our spine experts at the Spine and Peripheral Nerve Center at Houston Methodist help you get back to enjoying everyday activities with less pain. Visit houstonmethodist.org/spine or call 713.441.3850 for more information or to schedule an appointment.

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The expertise to

KEEP YOU MOVING At Houston Methodist Orthopedics & Sports Medicine, we know every movement matters.

Our specialists offer: • The latest imaging and technology • Advanced nonsurgical treatments • Minimally invasive procedures

• Customized treatment plans • State-of-the-art physical and occupational therapy

Whether you’re suffering from simple aches and pains or dealing with a complex injury, we can get you back on your feet — and keep you moving.

Schedule an appointment at a convenient location: houstonmethodist.org/sportsmed | 713.441.9000

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