Leading Medicine Fall 2021, Houston Methodist Hospital edition

LEADING MEDICINE FA LL 2021

Tips on Eating Healthy When Ordering Takeout

Find Relief From Painful Kidney Stones

MAMMOGRAM FAQs

Your Breast Cancer Screening Questions Answered Visit houstonmethodist.org/lmn/fall-2021 to read more online.

CORONAVIRUS RESOURCE CENTER The COVID-19 information you need to know right now on houstonmethodist.org/coronavirus

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

COLON CANCER IN YOUNGER ADULTS: KNOW THE RISKS

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t may be hard to believe that colon cancer could develop in your 20s, 30s or 40s — but the risks are real. In 2020, the death of actor Chadwick Boseman at age 43 from colon cancer underscored the threat of colon cancer to younger adults. With colon cancer increasing in younger adults, it’s important to raise awareness about the risks and be proactive about Dr. Maen prevention and early detection.

Abdelrahim The American Cancer Society estimates that 12% of all new colon cancer cases in the U.S. will be diagnosed in patients younger than 50. “Lifestyle factors, such as having a poor diet and being overweight may be contributing to the increase in cases in younger adults; however, much is not known yet,” said Dr. Maen Abdelrahim, gastrointestinal oncologist with Houston Methodist. “Adults ages 50 and older are still the highest risk group for colon cancer, but the risk of colon cancer for younger adults is rising faster.”

COLORECTAL CANCER SCREENING

Early screenings and detection of colorectal cancer make it possible to find the disease early when it’s more treatable. The National Cancer Institute recommends colorectal cancer screening, including a colonoscopy, starting at age 45 for people with an average risk of colon cancer. If you have an increased risk for colorectal cancer, screening should start before age 45. You may be at increased or high risk for colon cancer if you have: A strong family history of colon cancer A personal history of colorectal polyps A hereditary syndrome that increases your risk Inflammatory bowel disease, including ulcerative colitis or Crohn’s disease Radiation to your abdomen or pelvic area to treat a prior cancer.

How do you know if you have a strong family history of colon cancer? Having a first-degree relative (parent, sibling or child) diagnosed with colorectal cancer increases your risk. The risk goes up if your relative was diagnosed before age 50 or more than one relative was diagnosed.

LOWER YOUR RISKS

“Some of the factors that increase your risk for colon cancer are beyond your control,” said Abdelrahim. “However, you have the power to make healthy lifestyle choices to help reduce your risk.”

Abdelrahim recommends the following: Eat a healthy diet. A healthy diet with plenty of fruits, vegetables and whole grains may help prevent colon cancer.

Avoid highly processed foods. Lunch meats and foods containing added chemicals and preservatives may increase colon cancer risk.

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Get Peace of Mind

If you’re having symptoms — at any age — you should take it seriously and see your doctor to schedule a colonoscopy.

If you or a loved one has been diagnosed with colon cancer and would like to request an appointment with Dr. Abdelrahim or another oncologist with Houston Methodist, visit houstonmethodist.org/cancer-tmc or call 713.790.2700.

Exercise regularly. Having a sedentary lifestyle has been linked to colon cancer.

Lose weight. Being overweight or obese can also increase the risk of colon cancer.

Quit tobacco and limit alcohol. Both are linked to many cancers including colon cancer.

WATCH FOR WARNING SIGNS

Colon cancer is more likely to be overlooked in younger people and tends to be more aggressive, so it’s important to get checked out if you have concerns. Some of the warning signs include: Rectal bleeding A change in bowel habits Unusual abdominal pains Unexpected weight loss.

Find Relief From Painful Kidney Stones

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idney stones are hard deposits, which range in size, that can form when the fluid, minerals and acids contained in your urine are unbalanced. The minerals can crystallize, stick together and solidify, resulting in a kidney stone.

If your doctor suspects you have a kidney stone, they may recommend drinking plenty Dr. Monica of liquids to help it pass on its own.

Morgan Passing kidney stones in your urine can be extremely painful, but they don’t usually cause permanent damage. “However, if the stone is too big to pass on its own, or if you develop a fever, nausea or vomiting, seek medical treatment,” said Dr. Monica Morgan, a board-certified urologist at Houston Methodist Hospital, specialized in minimally invasive surgery and stone disease.

U reteroscopy — a small instrument (ureteroscope) is passed into the ureter through the bladder and laser energy is directed through the scope to shatter the stone.

P ercutaneous nephrolithotomy — for very large stones or when less invasive treatments aren’t effective, the stone may be removed through a small incision in the back.

“Once the kidney stone is removed, we may follow up with urine tests to check how much urine you’re passing, the urine pH and the mineral levels in your urine,” Morgan said. “You may need a course of antibiotics if an infection is present. You will be followed in our specialized Stone Clinic where you will meet with your surgeon, a dietitian and nephrologist and you will learn ways to help prevent kidney stones in the future.” * S ource: National Kidney Foundation, kidney.org.

TYPES OF KIDNEY STONES

Kidney stones may have more than one type of crystal and can be a combination of calcium compounds. The most common are calcium stones. Other types include uric acid stones, struvite stones (almost always the result of urinary tract infections) and cystine stones, which may run in families.* “Analyzing the types of crystals in a kidney stone helps us find the best approach to prevent kidney stones in the future,” Morgan said.

RISK FACTORS

Dehydration is a common cause of kidney stones. Making simple lifestyle changes, such as drinking more fluids — especially water — can help prevent kidney stones.

Your urine should appear very light yellow or almost clear.

Darker urine may mean that you’re dehydrated, which can increase the risk of kidney stones. Be sure to talk with your doctor about how much liquid you should drink every day.

Other risk factors for kidney stones include diabetes, obesity, diet and family history.

DIAGNOSIS AND TREATMENT

Your doctor may recommend a CT scan to check for kidney stones. This imaging test can show if you have one or more stones, the size and location.

If kidney stones are too large to pass on their own, treatment options include: E xtracorporeal shock wave lithotripsy — this common and painless procedure uses shock waves to break stones into tiny pieces that can be passed.

SIGNS YOU MAY HAVE A KIDNEY STONE Contact your doctor right away if you experience one or more of these symptoms: Sharp pain in the side, back, lower abdomen or groin Pain when urinating Cloudy or discolored urine; blood in the urine Urgent and frequent need to urinate Passing only small amounts of urine at a time Nausea, vomiting, fever or chills (often a sign of infection)

Schedule an Appointment

If you’re experiencing problems related to kidney stones or other urinary issues, make an appointment with one of our urologists at Houston Methodist Hospital.

Visit houstonmethodist.org/kidney-stones or call 713.441.6455.

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

MAMMOGRAM FAQs

YOUR BREAST CANCER SCREENING QUESTIONS ANSWERED

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hen life is busy, it’s easy to put everyone else’s needs before your own. But it’s important to make time for yourself — and your annual screening mammogram. If you’re not sure when to start getting mammograms or what to expect, we’re here to help.

Dr. Luz Venta, a specialist and Medical Dr. Luz Venta Director with Houston Methodist Breast Care Center, answered some common questions women have about getting mammograms.

PREPARING FOR YOUR MAMMOGRAM When should I start getting screening mammograms and how often?

Your doctor may recommend annual mammograms starting at age 40 if you have an average risk for breast cancer. Ask your doctor about your risk for breast cancer and the screening schedule that’s right for you.

Why should I get an annual mammogram?

Getting regular mammograms makes it possible to detect breast cancers when they are small and easier to treat. It’s also helpful to be able to review your mammogram history and track any changes in the breasts over time.

What do I need to know about scheduling my mammogram?

It may be helpful to avoid scheduling a mammogram the week before your period, when breasts may be more tender. However, it’s important to get in for a mammogram whenever it works with your schedule.

What should I wear for my exam?

Life is busy and it’s OK if you show up as you are for your mammogram. Wearing a two-piece outfit makes it easier to remove your top for your mammogram and it’s best to avoid wearing deodorant, powders or lotions. You’ll be offered wipes to remove deodorant, if needed.

Learn More Online Visit us online at houstonmethodist.org/lmn/fall-2021 to read more about Houston Methodist services and screening options.

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TYPES OF MAMMOGRAPHY AND BREAST IMAGING Whether you need a screening mammogram or other breast imaging test, we have the technology and expertise to guide you through the next steps.

3D mammogram digital technology is used to identify smaller tumors sooner for earlier breast cancer detection.

Breast ultrasound is an imaging test that does not use radiation to determine if a lump or mass is filled with fluid.

Does my insurance cover a mammogram?

Most major insurance plans cover an annual screening mammogram, but it’s important to call and verify your coverage.

CREATING A COMFORTABLE EXPERIENCE What should I expect during my visit?

B reast MRI is an extremely sensitive test to look for breast cancer and may also be used for breast cancer treatment planning.

C ontrast-enhanced mammogram detects abnormal blood supply in tumors of the breast.

Molecular breast imaging (MBI) is a nuclear medicine study that is used to identify tumors in breasts.

screening mammogram, you may be asked to come back for further testing. A diagnostic mammogram may be ordered after a screening mammogram shows a questionable area, if you feel a lump in your breast or have other symptoms.

GETTING YOUR RESULTS

You can get a mammogram done quickly. Prior to your appointment, you’ll be asked to complete your registration through the patient portal MyChart. After checking in, you’ll be escorted to a private room to change into a robe before meeting with the mammography technologist.

Who will review my images?

What happens during a screening mammogram?

Once reviewed by a doctor, you can view your results in the patient portal. If further testing is needed, your doctor will order these tests and you can call the breast care center to schedule additional testing.

The technologist will ask you some questions related to your health, including birth control, family history of breast cancer and any symptoms you may be experiencing. These questions are important to help make sure we’re doing the right type of mammogram. Next, you’ll be asked to stand in front of a 3D mammography machine and the technologist will take X-rays of two different views of each breast.

Are mammograms painful?

Some women may find the breast compression to be uncomfortable or painful, but the experience is different for everyone. The compression takes about 10 seconds for each image, and our technologists are trained to listen to you and make the experience as comfortable as possible.

UNDERSTANDING MAMMOGRAM TECHNOLOGY What is a 3D mammogram?

A 3D mammogram is the latest, most advanced technology to detect breast cancer with the greatest accuracy. 3D technology uses a low dose of radiation, yet allows for more targeted views that help find small cancers. At Houston Methodist Breast Care Center both screening and diagnostic mammograms are done with 3D images.

What is the purpose of a screening mammogram vs. diagnostic mammogram?

A screening mammogram is done when you have no symptoms of breast cancer. The purpose is to find cancers in an early stage before you can feel a lump. If we find an irregularity on a

Board-certified breast imaging specialists are specially trained to interpret breast mammograms, ultrasounds and all breast imaging biopsy procedures.

How will I get my results?

What does it mean to have dense breast tissue on a mammogram?

Density refers to how much fibrous and glandular tissue is in the breast. Having high density on a mammogram makes it more difficult to see a mass. In some cases, your doctor will order a breast ultrasound in addition to a mammogram for women with high breast density.

What if I get called back for a second mammogram?

Getting called for a second mammogram doesn’t mean you have cancer. It means we need more information to see what’s going on. When you come in for a diagnostic mammogram, a breast imaging specialist will meet with you to share the results and answer your questions.

Scheduling Your Mammogram To schedule your mammogram at a Houston Methodist Breast Care Center, visit houstonmethodist.org/breast-care or call 346.395.6171.

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HOW TO EAT HEALTHY

WHEN ORDERING TAKEOUT

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ome days, you just don’t have the time or the energy to cook a meal. This used to mean stopping for fast food. Now, it means firing up your favorite Dr. David food delivery app and Victor III choosing from the numerous restaurant options available.

Meal delivery services are convenient, but is ordering from a delivery service any healthier than picking up fast food?

“It’s possible to eat healthy when ordering from a delivery service, but, unfortunately, it’s easier to order an unhealthy meal than a healthy one,” said Dr. David Victor III, hepatologist and director of the Metabolic Liver Disease Program at Sherrie and Alan Conover Center for Liver Disease & Transplantation at Houston Methodist J.C. Walter Jr. Transplant Center. “Most meal delivery apps don’t offer calorie counts or nutrition facts, which makes it hard to know what’s healthy and what’s not.”

Try these five tips for eating healthier when ordering takeout from a delivery service:

about not feeling full, ask for extra veggies or order another vegetable. This will give you more food and variety, and help you feel full,” Victor said.

1. CHOOSE GRILLED OVER FRIED

“The more food you order, the likelier you are to overeat. If you want something in addition to your main meal, opt for a small side salad, instead of an appetizer, and ask for the dressing on the side,” said Victor. “As for dessert, these items are

“Deep frying food in oil adds calories, carbs and fat to food,” said Victor. “Not only is eating fried food an easy way to overdo your daily calorie intake, but it’s also adding unhealthy fats. And if the frying oil has been used over and over, which is common in restaurants, you may be eating unhealthy trans fats. Lean proteins, such as chicken or fish, that are grilled are the healthiest choices.”

2. SUBSTITUTE YOUR SIDES

“If your meal comes with fries, substitute with a nonstarchy veggie option, such as broccoli, Brussels sprouts, carrots, green beans or a side salad. If you’re worried

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3. ALL SALADS ARE NOT CREATED EQUAL

There’s always a way to turn a healthy menu item into one that’s less-thanhealthy and salads are the perfect example. What should be a great source of veggies and lean protein can turn into a creamy, cheesy, calorieladen meal. “The most important thing with a salad is to check what’s actually in it. Or, if you’re building it yourself, making healthy choices. Unhealthy toppings, like bacon bits, and dressings can quickly add on the calories,” Victor said.

Here are some tips: C hoose salads with plenty of leafy greens.

A dd nonstarchy veggies, such as bell peppers, tomatoes, cucumbers and carrots.

S elect a lean protein, like grilled chicken, turkey or shrimp.

A sk for dressing on the side.

4. SKIP THE APPETIZER AND DESSERT

Make Good Choices

often packed with added sugar, simple carbs and saturated fat — none of which are particularly healthy. Avoid them.”

5. CONSIDER SPLITTING HEAVIER MEALS Sometimes, you may be craving a burger and fries. And that’s OK — sometimes.

“When you do order something less healthy, try splitting the meal with someone. If you’re worried you’ll still be hungry, order a side of veggies. Then you get a little of everything,” Victor said.

“Most restaurant serving sizes are more than a single serving. If you don’t have someone to share with, save what doesn’t fit on your plate for another meal.”

Whether cooking from home or ordering delivery takeout, now is a great time to improve your health by making better food choices. If you should be diagnosed with a liver disease due to dietary or metabolic issues, we have specialists to help.

Visit houstonmethodist.org/metabolic-liver-disease-program to learn more or call 713.441.4345 to schedule an appointment with Dr. David Victor III or another liver specialist.

WHAT TO DO WHEN A

COUGH WON’T QUIT A cough with a cold is expected and typically goes away soon after you feel better. But what does it mean when you have a cough that sticks around for several weeks or months? Learn about potential causes of chronic cough and when to consider seeing a doctor.

Dr. Apurva Thekdi

ABOUT CHRONIC COUGH

When a cough lasts eight weeks or longer for an adult, or four weeks for a child, it’s considered a chronic cough. “Continual coughing not only can be a source of worry, but also can interrupt sleep, leaving you tired and with impaired concentration and performance. Some cases of chronic cough can even lead to a loss of bladder control, vomiting, lightheadedness, shortness of breath, fainting and rib fractures,” Dr. Yin Yiu said Dr. Apurva Thekdi, laryngologist and otolaryngologist (an ear, nose, and throat specialist or ENT) with Houston Methodist Hospital.

CAUSES OF A CHRONIC COUGH

Most instances of a chronic cough can be explained by the following causes. They may occur alone or together: Blood pressure and congestive heart failure drugs.

Angiotensin-converting enzyme (ACE) inhibitors include drugs such as captopril, enalapril, lisinopril and moexipril. While ACE inhibitors have few side effects, about 20% of people taking an ACE inhibitor experience a persistent cough.*

Postnasal drip. “When your nose produces too much mucus, it can drip down the back of your throat and cause throat clearing and coughing,” said Dr. Yin Yiu, laryngologist and otolaryngologist with Houston Methodist Hospital. “Most people with postnasal drip cough more at night and feel a tickle at the back of their throats.”

Gastroesophageal reflux disease (GERD). GERD is when stomach acid flows up into your esophagus. “Common symptoms of GERD include heartburn and a sour taste in the mouth, but GERD can also cause a chronic cough without typical heartburn symptoms. This can be from either direct irritation of the throat, or a reflex caused by irritation in the esophagus. Coughing can then worsen the GERD, in turn leading to worse coughs,” said Thekdi.

Asthma. Wheezing and breathing difficulties are the most common symptoms of asthma. But asthma can also lead to chronic cough in some people. “An asthma-related cough can be seasonal, be due to an infection or get worse in cold air,” said Yiu. Chronic obstructive pulmonary disease (COPD).

The constant irritation of your airways present in chronic bronchitis can lead to regular productive, or “wet,” coughs.

Most people who develop chronic bronchitis have a history of smoking.

Post-infection inflammation. Long after your pneumonia, pertussis, flu or cold is gone, you may continue to cough.

WHEN TO SEE A DOCTOR

Visit a doctor if you are: C oughing up blood or phlegm.

E xperiencing night sweats.

F eeling short of breath.

L osing sleep due to coughing.

R unning a fever, especially if it’s high or prolonged.

W heezing.

Th e cough lasts more than 8 weeks. * Source: Harvard Health Publishing.

Get the Care You Need for Your Cough

If you’re suffering from a cough that won’t go away, contact us. Our ENT doctors can help you. For more information or to schedule an appointment with an ENT doctor, visit houstonmethodist.org/throat-disorders or call 713.441.1368.

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Early Detection Starts With Your

ANNUAL MAMMOGRAM Advanced Breast Screenings Close to Home

The Woodlands

At Houston Methodist Breast Care Centers, our specialists review your mammogram history and track results over time — detecting changes earlier.

That’s why getting your mammogram starting at age 40 — or earlier, if you have a family history — is so important.

Our Breast Care Centers offer:

• The latest 3D mammogram technology • Board-certified breast imaging radiologists

Towne Lake*

Willowbrook

West Houston-Katy

• Acceptance of most

Baytown

Texas Medical Center

major insurance plans

Your health is our priority. To better protect you, we took it one step further by requiring COVID-19 vaccinations for all of our physicians, staff and employees.

Kirby

*Towne Lake offers screening mammograms only.

Sugar Land

Clear Lake

Scan the QR code, visit houstonmethodist.org/breast-care or call 346.356.7465 to schedule your mammogram today.

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