Leading Medicine Spring-Summer 2017, Houston Methodist Hospital edition

LEADING MEDICINE SPRI N G/SUM M ER 207

IS JOINT REPLACEMENT SURGERY RIGHT FOR YOU? Get Answers to Common Joint Health Questions

SUMMER SAFETY GUIDE ZIKA UPDATE What Pregnant Women Need to Know

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

8You Need to Know ASTHMA TRIGGERS

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f you have asthma, your airways — the tubes that carry air in and out of your lungs — are inflamed and narrowed.

During an asthma flare-up or attack, the airways become even more swollen and the muscles around the airways can tighten. This often triggers wheezing, coughing, tightness in the chest and shortness of breath.

CONTROL EXPOSURE TO YOUR ASTHMA TRIGGERS

Identifying and reducing exposure to asthma triggers can help minimize flare-ups and improve your quality of life. Common asthma triggers include

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Air pollution, vehicle exhaust, smog, strong odors and fumes

Allergens, such as house dust mites, animal dander, molds, pollen, cockroach droppings and certain foods — if you have allergies, as many people with asthma do

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Certain medications, including aspirin or other nonsteroidal antiinflammatory drugs, such as ibuprofen, and beta-blockers, which are used to treat heart disease, high blood pressure, migraine headaches or glaucoma

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Emotions, including anger, fear, stress, anxiety and laughing or crying too hard

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Exercise, but since you shouldn’t avoid it, you may be able to manage symptoms by using a quickrelief medicine, if prescribed, before physical activity

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Medical conditions such as colds, flu, sinus infections, acid reflux and pregnancy hormones

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Smoke from cigarettes, fireplaces, campfires and burning leaves

Weather conditions such as cold, dry air; high humidity; and sudden or extreme temperature changes

MANAGING YOUR ASTHMA

Asthma can’t be cured, but it can be managed so you can live a normal, healthy life. A comprehensive approach to managing asthma is required because it’s a complex, chronic disease and it’s different for every person.

In addition to controlling your exposure to triggers, using medications properly is another key to managing asthma. Most people with asthma need two kinds: quick-relief medicines to stop asthma symptoms and long-term control medicines to prevent symptoms. Also vital is maintaining a healthy lifestyle. Proper rest, diet and exercise are not only good for your overall health, but also can help you manage your asthma.

Take Advantage of Our Special Expertise

At Houston Methodist Lung Center, we offer comprehensive asthma services to evaluate and manage asthma. We provide the most advanced treatment options — some of which are not offered everywhere — and also participate in research to further advance pulmonary treatments.

To learn more about Houston Methodist Lung Center, visit houstonmethodist.org/lung-center or call 713.441.7779 to schedule an appointment.

Play It Safe

Summer Safety Guide W Dr. Veronica Vittone

arm weather and sunshine are a perfect setting for picnics, parades and pool parties. But they also call for taking a few precautions.

Dr. Veronica Vittone, an internal medicine physician at Houston Methodist Hospital, offers tips for staying safe as you enjoy summer’s pleasures.

BE MINDFUL OF HEAT EXPOSURE

“Heat-related illness is progressive. It may start with cramps and progress to heat exhaustion and heat stroke, which are severe forms of dehydration,” Vittone said. “The young, the elderly and pets are particularly vulnerable.” To prevent heat-related illness: Stay hydrated. Hydration starts before you begin your activity.

You need to drink enough water that you’re not feeling thirsty right away when you go into the heat.

Never leave children or pets unattended in a car.

Avoid strenuous activities during peak temperatures.

LIMIT SUN EXPOSURE

Ultraviolet rays can damage the skin in only 15 minutes. Limit exposure to sunshine. If you anticipate prolonged exposure, wear sunscreen with an SPF greater than 15 and protective clothing, wide-brimmed hats and sunglasses.

DEFEND AGAINST INJURY

People are out and about more in the summer, and any number of activities, such as swimming, biking or boating, can potentially result in injury. The best defense is to be prepared.

Wear appropriate protective gear, such as helmets and life vests.

Never leave children unattended near pools or bodies of water.

Swim in designated areas only and never swim alone.

If shooting off fireworks, position yourself out in the open, use protective eyewear and keep away from children.

Avoid alcohol and drugs, which can impair judgment, balance and coordination, increasing injury risk.

PREVENT BITES AND STINGS

“It’s a good idea to carry an emergency kit so you’re prepared,” Vittone suggested. “Include items like Benadryl, topical steroid cream, an EpiPen if someone has a severe allergy, plus aloe vera for sunburns.” To avoid attracting insects, steer clear of scented soaps and lotions.

To protect against mosquito bites and mosquito-borne diseases such as Zika, eliminate exposure to mosquitoes. Wear EPA-registered repellent and destroy mosquito breeding grounds by emptying any containers holding stagnant water, such as birdbaths, toys, kids’ pools and planters.

WHEN TO VISIT THE ER The Houston Methodist Emergency Care Centers, with convenient locations at Pearland, Kirby and Voss, are open 24/7 and have short wait times.

If needed, patients can easily be transferred to Houston Methodist Hospital.

Symptoms that may warrant a trip to the ER include shortness of breath, difficulty breathing, sudden confusion or a deep wound. Board-certified emergency physicians; an on-site laboratory; and full-service X-ray, CT and ultrasound are available at each location.

To find the Houston Methodist Emergency Care Center closest to you, visit houstonmethodist.org/er and remember to always call 911 in the case of life-threatening emergencies.

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IS JOINT REPLACEMENT SURGERY RIGHT FOR YOU? Dr. Stephen Incavo

Get Answers to Common Joint Health Questions

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ur joints are pretty impressive.

They can hold weight, help us move and link the bones in the body. But over time — or even through trauma — joints can wear down and become damaged. If that happens, it can cause joint stiffness, swelling or even pain.

In these cases, it’s important to know your options. That’s why we’ve enlisted the help of Dr. Stephen Incavo, section chief of adult reconstructive surgery at Houston Methodist Hospital, who specializes in joint procedures. Here, he answers questions about joint health and leading-edge techniques in joint replacement surgery.

THE BASICS

Q

How do joints become damaged?

A: Joints can wear down in a variety of ways, but the most common way is through osteoarthritis, known as wear and tear arthritis. Osteoarthritis occurs

over time and can result from getting older; being overweight; from a joint injury from sports or other activities; or genetic predisposition.

Q

hat are a few ways W people keep joints healthy as they age?

A: There’s a lot of interest around this, especially as it relates to diet and nutrition.

But there isn’t great proof that dietary or nutrition changes make a definitive impact on joint health. And while joint injuries should be avoided, no one goes out intending to cause damage to one area or another. Still, excessive weight can put undue pressure on joints, so it’s important to maintain an ideal weight as you age.

Q

What are some warning signs that tell people they should see a doctor?

A: As we age, we feel achy and sore after activity. That’s natural. When you feel like your knee is swollen, have trouble getting

in and out of a chair or car, or it limits your activity, it’s time to see a doctor.

JOINT REPLACEMENT TALK

Q

hat makes someone W a good candidate for a joint replacement?

A: It’s preferable if a patient is 55 years old or older since the lifespan of a replacement is around 20 to 25 years.

Also, it helps when a person is a healthy weight, with minimal medical problems, is a nonsmoker and comes in with a positive attitude about the recovery process.

Q

What is a new joint made of?

A: Metal, plastic or both, depending on the replacement. In a knee replacement, for example, the femoral (femur or thigh bone) and tibial (tibia or shinbone) components are made of metal. A plastic bearing surface is snapped into the tibial base plate.

RAPID RECOVERY PROGRAM Over the last few years, we’ve transformed our joint replacement recovery process to get otherwise healthy people back to their lives sooner by reducing their hospital stay. While not for everyone, the Rapid Recovery Program is for those joint replacement candidates who are at an ideal weight, are nonsmokers and aren’t managing other medical conditions.

This program involves using intravenous sedation during joint replacement surgery, instead of traditional general

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anesthesia, with the intention you’ll wake up more alert and with less nausea. This method allows you to begin physical therapy almost immediately, which can help speed healing. Rapid Recovery Program participants are up and walking with a nurse up to three times the same day as surgery.

While all recoveries take time, this program can help get you home more quickly, so you can continue healing where you’re most comfortable.

Q

Can someone be too old for a joint replacement?

A: This is determined on a case-by-case basis. While surgery becomes riskier as we age, there isn’t an age limit on joint replacement. To decide whether or not to perform a joint replacement, we’ll ask you about your medical history, risk factors and how old your parents are now or when they passed.

Q

What are the alternatives to joint replacement?

A: If you have early arthritis, the focus should be on maintaining an ideal weight with exercises that safely stretch and strengthen your joints. People can also add anti-inflammatory medicine, like ibuprofen and naproxen, if necessary. In more advanced cases, a doctor may recommend injections that mimic joint fluid or provide pain relief for six to 12 months.

SURGERY SPECIFICS

Q

How does joint replacement surgery improve someone’s health?

A: The main goal is to reduce pain so you can perform the natural activities of living.

Surgery won’t turn a sedentary person into a world-class athlete, but you can become much more physically functional and stable when your joints no longer hurt.

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hat should people W know about the recovery process?

A: You’ll typically be on your feet soon after surgery with physical therapy to follow for as long as necessary. Pain can also be an obstacle when someone leaves the hospital, so it’s important to stay ahead of it with the medication we prescribe.

Q

Are there any permanent restrictions after surgery?

A: You can pursue what you want. But most people don’t return to heavy sports activities like running or basketball.

However, things like walking, elliptical training, swimming, bicycling, tennis and skiing can be fine.

Take the First Step

To schedule an appointment, call 713.441.9000 or visit houstonmethodist.org/ rapidrecovery to learn more.

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ZIKA UPDATE What Pregnant Women Need to Know

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n Nov. 28, 2016, the Texas Department of State Health Services reported the state’s first case of local mosquito-borne Zika virus infection in Brownsville, Texas.

While that’s far from the Houston area, those who are pregnant could feel apprehensive about the news, given the birth defects linked to the virus.

“In our area, there’s really no need to panic,” said Dr. Mae K. Dr. Mae K. Borchardt, an obstetrician-gynecologist Borchardt at Houston Methodist Hospital. “If you are pregnant or considering conceiving, it is important to talk with your doctor about how to minimize your risks. We are doing this by counseling patients on the travel advisories to protect themselves with bug spray and to follow updates from the Centers for Disease Control and Prevention (CDC). The CDC has a complete list of countries affected and in the United States, areas of Florida and Brownville, Texas, are the only locations with a travel advisory. It is important to remember that the travel advisory also applies to women’s significant others as well because the virus can be sexually transmitted. In fact, the experts are recommending that men traveling to an affected area wait up to six months and women wait eight weeks before trying to conceive.

Zika guidelines are constantly being updated and the CDC website has the most up-to-date information.”

ARE YOU AT RISK?

Anyone who hasn’t had Zika before can be infected; being pregnant doesn’t necessarily make you more susceptible. In addition to mosquito bites and sexual transmission, the Centers for Disease Control and Prevention says it’s likely it can be spread through blood transfusions.

Many people who are infected don’t know they are because Zika doesn’t always produce symptoms. Common symptoms include fever, rash and joint pain, among others.

Since there’s currently no vaccine for Zika, the best way to prevent it includes these tips: Avoid areas where the virus is present.

Use EPA-approved insect repellants (such as those containing DEET or picaridin).

Wear clothing treated with permethrin that covers your arms and legs.

Spend time indoors in spaces protected by window and door screens.

Be diligent about removing areas of standing water around your home, where mosquitoes can lay eggs.

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A CHILDBIRTH CENTER SECOND TO NONE At Houston Methodist Hospital, we know deciding where to have a baby is a big decision, and when moms choose us, it’s an honor we take to heart.

From childbirth and breastfeeding education classes that help women transition from pregnancy to motherhood with ease to a wide array of pain relief options available 24/7 for the big day, our goal is compassionate care of you and your newborn. We’re unique in that our moms are able to experience labor, delivery, recovery and postpartum in the same room, encouraging mother-baby bonding.

And should your baby need additional medical support, our level II special care nursery is staffed with highly trained neonatologists and nurses who are committed to helping your baby get strong enough to go home.

Schedule a Tour

Want more information on classes or to schedule a tour of our Childbirth Centers?

Visit houstonmethodist.org/birth-tours or call 713.790.3333.

Discuss Prevention with Your Doctor

If you’re pregnant and concerned about your Zika risk or planning to travel to an affected area, make sure to call your doctor to discuss prevention. Looking for an OB-GYN? Visit houstonmethodist.org or call 713.790.3333 to find a doctor in your area.

ARE YOU A

Victim of Fashion?

T Dr. Paul Holman

he fashion police have recruited a new cop, and you may be surprised to learn who it is: your doctor! If the desire to be fashionable has you spending long hours in high heels or tight belts, pants or skirts, or carrying a heavy bag on one side of your body, it’s time for a makeover.

Don’t become a victim of fashion. Being comfortable helps you look your best and never goes out of style. Read on to learn about fashion culprits that may cause pain and how you can beat them.

PROBLEM: HIGH-HEELED SHOES

“High heels don’t provide good support when you walk, and they change the stability of your gait,” said Dr. Paul Holman, neurosurgeon at Houston Methodist Hospital.

“Your spine, hips, knees and feet all work together to help you walk smoothly. When one of those elements is out of balance — as it is when you wear high heels — your body compensates for it in some way, and that’s when problems arise.”

Choose flat shoes. Shoes that have a gel insole or some shock-absorbing capability can be helpful in alleviating pain. If you must wear high heels, limit the amount of time you spend in them and change into athletic shoes if you’ll be walking very far.

RX

PROBLEM: TIGHT BELTS, PANTS AND SKIRTS

Wearing a tight-cinched belt or tight pants or skirts can compress the nerve that supplies sensation to the skin surface of your thigh. The result can be a condition called meralgia parasthetica, which produces tingling, numbness and burning pain in your outer thigh.

RX

Choose belts that are adjustable and buckle them a little looser. Purchase pants and skirts the next size larger. You should be able to walk, sit and breathe comfortably.

PROBLEM: HEAVY BAGS

“Heavy bags are a two-part problem,” Holman said. “The first part is that some people simply carry too much stuff in their bag or briefcase, making it heavier than it needs to be. The second is that people tend to always carry the bag on their dominant side. This leads to uneven stress on the neck and can cause neck and shoulder pain.”

RX

Lighten your load, if possible. Remove items from your bag that you don’t need to carry with you. Also, switch the bag from side to side.

WATCH OUT FOR ‘TEXT NECK’ Think you or your child’s posture is suffering from constantly looking down at a cellphone? It probably is.

A condition called “text neck” is a repetitive strain injury that’s becoming more common, especially among teens and young adults. It can cause pain in the neck, shoulders and sometimes the back.

“The old-school version of this was people who had pain from constantly cradling a telephone between their ear and shoulder by bending their neck sideways,” said Dr. Paul Holman, neurosurgeon at Houston Methodist Hospital. “Now, people drop the head forward, texting and using social media on their smartphones, sometimes for many hours a day.”

Just as headsets and Bluetooth devices allowed phone users to free up their hands without getting a sore neck, Holman believes technological advances will lead to greater use of voice-to-text software, solving the text neck problem. “In the meantime, just hold your device up to eye level so you aren’t dropping your neck forward all the time,” he said. “Look down with your eyes, not your neck.”

Still Have Pain?

If simple wardrobe changes don’t alleviate your pain, it’s time to see a doctor who can help discover the cause and prescribe treatment. Call 713.790.3333 to find a doctor in your area.

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EXPERT JOINT REPLACEMENT ACCELERATES YOUR RECOVERY. At Houston Methodist, our Rapid Recovery program for joint replacement gets you back to your active lifestyle — faster. Personalized to your specific needs, this comprehensive approach: • Utilizes the latest pain control methods before, during and after surgery • Starts rehabilitation sooner to accelerate recovery HOSPITALS EMERGENCY CARE CENTERS SPECIALTY HOSPITALS IMAGING CENTERS COMPREHENSIVE CARE CENTER

Just around the corner

• Gets you home quickly, often in one day To find a joint doctor in your area, call 713.790.3333 or visit houstonmethodist.org/rapidrecovery to learn more.

Houston Methodist has locations throughout the Greater Houston area to best serve you near your home or workplace. Our locations include hospitals, emergency care and imaging centers.

HOSPITALS . 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 Opening July 1, 2017 6. Houston Methodist West Hospital 7. Houston Methodist Willowbrook Hospital

SPECIALTY HOSPITAL . Houston Methodist St. Catherine Hospital

IMAGING CENTERS 5. Houston Methodist Breast Care Center at The Woodlands

EMERGENCY CARE CENTERS 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

. Houston Methodist Breast Care Center

COMPREHENSIVE CARE CENTER

6. Houston Methodist Imaging Center

7. Houston Methodist Comprehensive Care Center at Pearland

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