Leading Medicine Fall 2020, Houston Methodist Hospital edition

LEADING MEDICINE FA LL 2020

Pay Attention to Your Heart Concussion: Tackling a Tough Issue

BE VIGILANT ABOUT RESPIRATORY ILLNESS YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS FROM HOUSTON METHODIST

IN THIS ISSUE - FALL 2020

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P ay Attention to Your Heart The risks for cardiovascular disease may be hidden and could lead to a heart attack or stroke without warning.

That’s why it’s important to identify the risks and be proactive about taking care of your heart.

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B e Vigilant About Respiratory Illness You've heard about the dangers of COVID-19, flu and other respiratory illnesses that affect the lungs, making it difficult to breathe. There are steps you can take today to prevent disease and boost your respiratory health.

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reast Cancer: 4 Key Facts for Women B All women are at risk for breast cancer, and risk increases with age. Knowing key facts about breast cancer can help a woman detect problems early, when chances of successful treatment are greatest.

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oncussion: Tackling a Tough Issue C Young athletes are particularly susceptible to concussion, and they may take longer than adults to recover. The key to a quick and complete recuperation is prompt medical attention.

TEXTING THUMB: IS IT REALLY A THING?

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Dr. Korsh Jafarnia

Dr. Shari Liberman

sing your smartphone might not seem like physical activity, but — when it comes to the tendons and muscles in your hands and thumb — it may be more of a workout than you think. We tap our thumbs to fire off texts and emails. We pinch our fingers together to zoom in on photos. But mostly, we may spend hours swiping our thumbs down the length of our smartphone screens. As a result, you may develop pain in your thumbs.

WHAT CAUSES IT?

“Texting thumb occurs when repetitive hand movements cause inflammation in the tendons of the thumb,” said Dr. Korsh Jafarnia, orthopedic surgeon at Houston Methodist Hospital. “These inflamed tendons then rub against the narrow tunnel in which they sit, causing thumb pain.”

“The thumb joint is not meant to move rapidly in a repetitive manner, and the

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confined space in this joint makes matters worse,” said Dr. Shari Liberman, orthopedic surgeon at Houston Methodist Hospital. “From tendinitis to trigger thumb, orthopedic surgeons have been diagnosing versions of texting thumb for decades.” Repetitive stress injuries that cause thumb pain are more formally called de Quervain’s tenosynovitis.

If you suspect you may have texting thumb, ask yourself: “How much have I been using my smartphone lately?” If your device has the capability, check your screen time to get a reliable answer. The next question to ask is: “When does my thumb hurt?”

“The pain from texting thumb is primarily present when the wrist is flexed or turned as well as when forming a fist or grabbing,” Jafarnia said. “There can also be pain when direct pressure is applied to the area.” If this sounds like you, it’s time to see an orthopedic specialist who can determine whether you have de Quervain’s tenosynovitis as well as its severity.

MINIMIZING SYMPTOMS

A repetitive stress injury like texting thumb can typically be treated conservatively. Liberman suggests the following: Limit texting Rest your thumbs Take nonsteroidal anti-inflammatory drugs (NSAIDs) Use audio commands Wear a thumb brace Severe cases of de Quervain’s tenosynovitis may require steroid injections. If the condition persists despite steroid injections, surgery may be used to release the pressure in the compartment to avoid permanent damage.

Keep Texting Thumb at Bay

Visit houstonmethodist.org/orthopedics to learn more or call 713.790.3333 to schedule an appointment with one of our orthopedic specialists.

Pay Attention

TO YOUR

HEART Uncover Hidden Cardiovascular Risks

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hink you’re too young for a heart attack or too healthy to have heart disease? The risks for cardiovascular disease may be hidden and could lead to a heart attack or Dr. Khurram stroke without warning.

Nasir That’s why it’s important to identify the risks and be proactive about taking care of your heart.

Dr. Khurram Nasir, a preventive cardiology specialist at Houston Methodist DeBakey Heart & Vascular Center, stresses the need to pay attention to your heart.

“You can take steps now to protect your heart, and it starts with getting a heart health checkup,” Nasir said.

HEART AND VASCULAR SCREENING

A few simple tests can check for early signs of heart disease. “First we look at blood pressure, cholesterol levels, body mass and lifestyle factors that may put you at risk for heart disease,” Nasir explained. “Next, we take an in-depth look at family history of heart disease to better understand your risk.”

A heart scan, also known as calcium scoring, provides a detailed image of the heart and blood vessels. “Getting a heart scan can uncover hidden signs of heart disease so we can take action to reduce the risk of having a heart attack or stroke,” Nasir said.

If more information is needed, a cardiologist may order additional blood

tests or lipid panels, 24-hour blood pressure monitoring, an ultrasound of the neck, imaging of smaller blood vessels, an exercise stress tests or other tests.

WHO NEEDS A HEART SCAN?

Nasir recommends monitoring your heart health earlier than you might think.

“If you’re over age 40, it’s time to check your heart health and consider getting a heart scan, especially if you have one or more risk factors for cardiovascular disease.” Risk factors include having high blood pressure, high cholesterol, diabetes or a family history of heart disease at an early age (before age 65 for women and before age 55 for men).

Even if you don’t have risk factors, a heart scan may be helpful in detecting heart disease. “Among those who don’t have a family history of heart disease or other known risk factors, 1 in 5 have

significant hidden risks, such as early signs of fat deposits in arteries,” Nasir said. “A heart scan is like a mammogram of the heart, and we should be thinking the same way about proactively checking for signs of heart disease.”

HELPING YOUR HEART

Having a picture of your heart health gives you an opportunity to take action to reduce your risk factors. “Your heart health factors are unique, and being able to focus on those factors is key to heart disease prevention,” Nasir said. “Knowing this helps us pinpoint next steps that may have the most benefit for you.”

Depending on your results, recommendations may include diet changes, an exercise plan, heart medications, heart monitoring or a combination of preventive measures.

How’s Your Heart Health?

If you have high cholesterol or other risk factors, we can perform a heart and vascular screening to analyze your risk for heart disease.

Please visit houstonmethodist.org/heartscans to learn more or call 713.DEBAKEY (332.2539) to schedule an appointment with a cardiologist at Houston Methodist.

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BE VIGILANT ABOUT RESPIRATORY ILLNESS

Y Dr. Faisal Zahiruddin

ou’ve heard about the dangers of COVID-19, flu and other respiratory illnesses that affect the lungs, making it difficult to breathe. There are steps you can take today to prevent disease and boost your respiratory health in case you do get sick. Taking good care of your lungs can improve your quality of life and protect against respiratory illnesses that can take a toll on your lungs.

RECOGNIZE SERIOUS SYMPTOMS

It’s important to know that anyone can have mild to severe symptoms with either COVID-19 or flu. “Although older adults and those who have underlying health conditions are at higher risk for having more serious complications from respiratory illness, it’s possible to experience severe symptoms at any age,” said Dr. Faisal Zahiruddin, pulmonologist with Houston Methodist Lung Center.

Monitor your symptoms if you’re not feeling well: Mild respiratory symptoms include having a low-grade fever, nasal congestion, runny nose, sore throat, mild cough and mild body aches. What to do: Get tested for COVID-19.

Stay home and isolate yourself from others to avoid spreading illness, even if you test negative for COVID-19.

Moderate respiratory symptoms include fever over 100.4 F, persistent cough, temporary shortness of breath and feeling like you need to stay in bed. What to do: Get

tested for COVID-19 and contact your doctor about worsening symptoms.

Severe respiratory symptoms include difficulty breathing, shortness of breath, wheezing, pain or pressure in the chest, confusion, trouble staying awake and bluish lips or face. What to do: Seek emergency medical care for severe respiratory symptoms.

Mild cases of respiratory illness can often be managed with rest, fluids and fever-reducing medicines at home. However, don’t wait to see a doctor if you’re in a high-risk group and experiencing worsening symptoms. Mild or moderate symptoms can quickly become severe for older adults and those who have heart disease, diabetes, cancer or chronic respiratory problems.

MANAGE YOUR HEALTH CONDITIONS

If you have chronic respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), it’s important to manage the condition closely with your doctor. Keeping up with your regular checkups is essential in controlling symptoms and protecting your health. Continue taking medications as directed and contact your doctor with any questions or concerns about managing your condition.

“We’re doing telehealth visits and video visits to help patients feel more comfortable and reduce exposure,” said Zahiruddin.

Ask your doctor for recommendations before going in for appointments and consider having medications sent directly to your home so you don’t have to make extra trips to the pharmacy.

LUNG CANCER SCREENING A respiratory condition that often goes undetected until it spreads is lung cancer. That's why staying on track with lung cancer screening is important. If you’re a current or former smoker, ask your doctor about lung cancer screening.

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Who Should Get Tested?

Testing may be recommended if you meet the following criteria: Age 55-77 years No current signs or symptoms of lung cancer Tobacco smoking history of at least 30 pack-years (calculated

by multiplying the number of packs smoked per day by the number of years smoked) Current smoker or former smoker, who has quit within the last 15 years Have not had a chest CT scan in the last year

Make an Appointment

A written order is required for all lung cancer screening procedures. Request an order or schedule an appointment by calling 713.441.LUNG (5864).

Visit houstonmethodist.org/lung-screening for more information.

PROTECT YOUR LUNGS EVERY DAY

Zahiruddin recommends taking these steps to keep your lungs healthy:

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Get regular exercise. Being physically active can increase lung capacity and improve lung function. Exercising makes your heart and lungs work harder, which increases oxygen and improves circulation around the lungs. Any form of exercise that involves taking deep breaths can help improve your lung capacity.

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Quit smoking and vaping. Smoking irritates the airways and impairs lung function. Vaping releases chemicals that also cause long-term damage to the lungs. Smoking and vaping can lead to lung cancer and COPD, and worsen complications due to COVID-19 or other serious respiratory infections. It’s never too late to quit, and the benefits of quitting kick in right away.

Talk to your doctor about getting support to quit smoking.

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Minimize exposure to allergens. Allergens can trigger respiratory problems and other issues. Keep allergies in check and improve indoor air quality with these tips:

Avoid mold spores Control dust mites Keep surfaces in home clean and uncluttered Minimize pet dander Prevent pollen from getting inside by keeping windows and doors closed Ventilate when using products with strong chemical odors

STAY HEALTHY

“We can all do our part in protecting ourselves and each other by practicing good respiratory etiquette,” said Zahiruddin. Stay vigilant with these tips to prevent the spread of illness: Stay home from work or school if you feel sick Practice social distancing Get a flu shot Wear a cloth mask in public Wash hands often Wipe down frequently touched surfaces

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BREAST CANCER: 4 Key Facts for Women

A Dr. Polly Niravath

ll women are at risk for breast cancer, and risk increases with age. Knowing key facts about breast cancer can help a woman detect problems early, when chances of successful treatment are greatest.

WARNING 1 RECOGNIZING SIGNS IS VITAL

“Regularly checking your breasts allows you to become familiar with how they normally look and feel,” said Dr. Polly Niravath, breast oncologist and director of the Cancer Survivorship Program at Houston Methodist Cancer Center. “If you know the warning signs of breast cancer, you’ll be better equipped to recognize when something has changed and it’s time to alert your doctor.” See “Symptoms of Breast Cancer.”

DETECTION 2 EARLY SAVES LIVES

Early detection means a better chance of treating it successfully, and annual screenings are essential to early breast cancer detection. Women in their 20s and 30s should have clinical breast examinations every three years during their routine physical exam, and around age 40 women should begin having an annual mammogram.

“Screening mammograms can detect breast cancer up to two years before a lump is felt,” Niravath said. “Cancers detected at early stages often means the cells are confined to the ducts and haven’t spread to surrounding breast tissue.”

Because of early detection as well as improvements in the way breast cancer is treated, 90% of women with breast cancer are alive five years after their diagnosis.

ARE SEVERAL TYPES 3 THERE OF BREAST CANCER

Many women think of breast cancer as a single disease. In fact, there are many different types. “Breast cancer is labeled based on where in the breast it originates. The ducts of the breasts are the most common place for cancer to start,” Niravath said.

The milk ducts of the breast are tubes that carry milk from the milk-producing glands (lobules) to the nipple. Breast cancers that start in the milk ducts are called ductal carcinomas, while breast cancers that start in the lobules are called lobular carcinomas.

CANCER CAN BE 4 BREAST NONINVASIVE OR INVASIVE

SYMPTOMS OF BREAST CANCER Symptoms of breast cancer include: A painless lump or mass in (or near) the breast A change in breast size or firmness A warm area in the breast Breast skin changes, such as dimpling, a sore or a rash Nipple itching, burning, rash, turning inward or discharge Pain in the breast Swelling under the armpit or of the arm

Noninvasive cancer, which is confined to the ducts of the breast, is called ductal carcinoma in situ, or DCIS, and is considered stage 0 breast cancer.

Noninvasive breast cancers rarely cause symptoms or lumps you can feel, but they may appear as tiny areas of calcification (tiny flecks of calcium) on a mammogram.

“When breast cancer has spread outside the duct and into surrounding breast tissue, it is classified as invasive,” Niravath explained. “It then may spread to other areas of the body.”

About 70-80% of breast cancers are invasive ductal carcinomas (IDCs).

IDC appears as a hard, firm lump. About 12% of breast cancers are invasive lobular carcinomas (ILCs). Rather than appearing as a hard lump, this cancer may feel like a thickening. ILC may be more difficult to detect on a mammogram than IDC.

Early Detection Starts with Your Mammogram Visit houstonmethodist.org/breast-care or call 713.441.PINK (7465) to schedule your mammogram today.

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CONCUSSION: Tackling a Tough Issue

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umps, tumbles and falls are a normal part of growing up. But when a blow is severe enough to move the brain within the skull, it can cause a concussion — Kenneth Podell, a temporary loss of PhD normal brain function.

Young athletes are particularly susceptible to concussion, and they may take longer than adults to recover. The key to a quick and complete recuperation is prompt medical attention.

“Diagnosing the condition early helps ensure that we treat the brain and give it time to heal properly,” said Kenneth Podell, PhD, neuropsychologist and director of the Houston Methodist Concussion Center. “A second head injury sustained before the brain has fully healed can be severe, sometimes causing swelling of the brain and long-term disability.” Repeated head injuries can cause serious long-term problems, including headaches and chronic difficulty concentrating, remembering and even balancing.

WATCH FOR THESE SIGNS

“Most concussions don’t involve a loss of consciousness,” said Podell. “Symptoms of a concussion often appear right away, but may also emerge over several hours after the injury.” Signs usually fall into four categories, according to the Centers for Disease Control and Prevention: Thinking and Remembering Difficulty thinking clearly or concentrating, or feeling mentally slow Difficulty remembering new information Physical Headache Fuzzy or blurry vision with eye pain Nausea or vomiting Dizziness or feeling off balance Sensitivity to noise or light

Feeling tired, having no energy Emotions and Mood Irritability Sadness More emotional Nervousness or anxiety Sleep Sleeping more or less than usual Trouble falling asleep If a young athlete experiences one or more of these symptoms after a blow to the head, they must stay out of play until a trained health care professional can assess their condition.

IMPORTANCE OF EVALUATION AND TREATMENT FOR RECOVERY

Concussions are a multisystem injury that is treatable. A quick and accurate evaluation by an experienced concussion expert will pinpoint the deficits and lead to treatment options that will help speed-up recovery.

The main and initial course of treatment for a concussion is often physical and mental rest for the first few days with a gradual return to schoolwork and exercising as long as symptoms do not worsen. It may be necessary to keep children home from school or adults home from work initially, with a gradual return to normal activities. Student athletes often follow a six-step process before returning to sport: Light aerobic exercise, such as walking or using a stationary bike with no resistance training for 10-15 minutes Moderate aerobic exercise with resistance training for 20-25 minutes, such as running or using light weights

CONCUSSION PREVENTION The following steps can help reduce the chances of experiencing a concussion or other brain injury.

Wear a helmet. Always use a proper helmet when riding a bicycle, skateboard, scooter or motorcycle; playing contact sports such as football, hockey or boxing; batting or running the bases in baseball or softball; riding a horse; or skiing or snowboarding.

Buckle up. Make sure everyone in the vehicle is wearing a seat belt or is secured properly in a child safety seat.

Keep your home safe. Install window guards so children can’t fall out, and use safety gates to keep young children away from steps.

Remove tripping hazards and add handrails to stairways and in showers for older adults.

N eck strengthening. Having a strong neck and upper back can help reduce sports-related concussions, especially in female athletes. Visit bit.ly/neck-strengthening for neck strengthening exercises.

S port-specific activity and noncontact training drills for 30-40 minutes Full noncontact practice Full practice with light contact A return to competition

Learn More

If you have questions about concussion symptoms, treatment or prevention, talk with your doctor. A preseason baseline concussion test for young athletes involved in contact sports may help doctors diagnose a concussion. Learn more at houstonmethodist.org/concussion or call 713.441.8277 to find a doctor near you.

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LEADING MEDICINE IN GREATER HOUSTON

Getting your annual mammogram is still important.

Houston Methodist can see you safely.

Getting your annual mammogram is one of the most important steps you can take to stay healthy. That’s why our Breast Care Centers are taking every necessary precaution during the coronavirus pandemic to keep you and our staff members safe.

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During the coronavirus pandemic, we are:

Screening all patients, ensuring only those without COVID-19 symptoms are seen in the office.

Wearing masks and other personal protective equipment while providing patient care.

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Implementing additional sanitation processes to disinfect all equipment and surfaces.

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HOUSTON METHODIST BREAST CARE CENTER AT TEXAS MEDICAL CENTER

Redesigning waiting rooms and check-in procedures to ensure social distancing.

Visit houstonmethodist.org/breast-care or call 713.441.PINK to schedule your mammogram today.

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