Leading Medicine Spring Summer 2018, Houston Methodist Hospital edition

LEADING MEDICINE SPRI N G/SUM M ER 2018

WHEN SUMMERTIME FUN LEADS TO INJURY THE LATEST IN HIGH-TECH CARE COMES TO HOUSTON

BREAKING THE BARRIERS TO JOINT REPLACEMENT

What’s holding you back from considering a joint replacement?

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

IN THIS ISSUE - SPRING/SUMMER 2018

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O pening This Summer at Houston Methodist Hospital The new Paula and Joseph C. “Rusty” Walter III Tower at Houston Methodist Hospital opens.

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N ews & Events Houston Methodist Hospital News L iving with Advanced Heart Failure Approximately 10 percent of the 6 million Americans living with heart failure have an advanced case. Here is a look at treatment options.

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Breaking the Barriers to Joint Replacement What’s holding you back from considering a joint replacement?

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T he Latest in High-Tech Care Comes to Houston The opening of Walter Tower at Houston Methodist Hospital this summer will offer the newest, most precise imaging and surgical equipment for complex heart and brain surgeries.

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Reducing Your Risk of Stroke Stroke may be the fifth leading cause of death in the United States, but that doesn’t mean you can’t fight back.

When Summertime Fun Leads to Injury Use these basic safety tips to avoid illness and injury when engaging in summertime fun.

Spaghetti and Spinach Pesto Try a new spin on spaghetti with whole-wheat noodles, spinach and feta cheese.

Number of servings: 8

INGREDIENTS

1 pound whole-wheat spaghetti, uncooked (or your favorite pasta shape) 1 package (10-ounce) frozen spinach, thawed, well drained 2 tablespoons canola oil ¼ cup grated Parmesan cheese 2 tablespoons chopped parsley 2 cloves garlic ½ teaspoon salt ½ teaspoon dried basil 2 tablespoons margarine ⅓ cup water 2 ounces crumbled feta cheese

DIRECTIONS

1. In a blender (or food processor), combine spinach, oil, Parmesan cheese, parsley, garlic, salt and basil. Mix at medium speed until finely chopped.

2. Melt margarine in water. With blender or processor running, gradually pour in melted margarine mixture until blended.

3. Cook pasta according to package directions.

4. Toss pesto with cooked pasta.

5. Sprinkle feta on top and serve.

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

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NUTRITIONAL INFORMATION PER SERVING: 294 calories; 9 g total fat; 3 g saturated fat; 8 mg cholesterol; 417 mg sodium; 45 g carbohydrates; 8 g dietary fiber; 2 g total sugars; 0 g added sugars; 12 g protein; 1 mcg vitamin D; 202 mg calcium; 2 mg iron; 203 mg potassium.

NEWS & EVENTS

Opening This Summer at Houston Methodist Hospital Paula and Joseph C. “Rusty” Walter III Tower is a 22-story, $700-million, state-of-the-art building that will greatly enhance patient care. Every aspect of this space was designed with you and your family in mind.

PRIVATE ROOMS 366 expansive rooms with windows provide patients with a peaceful healing environment.

ADVANCED TECHNOLOGY & IMAGING

2 high-tech operating rooms and 4 hybrid operating rooms enhance surgical precision and patient recovery.

Family and visitors can relax and stay connected with TV and Wi-Fi.

COMFORTABLE & SPACIOUS WAITING AREA

DINING OPTIONS & GIFT SHOP

Convenient on-site eating and shopping keep you close to your loved ones.

CONCIERGE SERVICES TO GUIDE YOU GIFT SHOP BLUE SKY CAFE HEART ICU IMAGING LAB NEUROLOGY

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Our staff is here to help you easily find your destination inside Walter Tower.

EASY VALET & SELF-PARKING

We get you in and out quickly with valet service or nearby self-parking at Texas Medical Center Garage 7 at 1120 John Freeman Blvd.

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

NEWS & EVENTS A CLOSER LOOK AT NEW BLOOD PRESSURE GUIDELINES

One of the nation’s leading cardiologists is challenging the new hypertension guidelines, perhaps sparing up to 10 million people from unnecessarily aggressive blood pressure treatments.

Dr. Robert A. Phillips, Houston Methodist’s Dr. Robert A. chief medical officer, and his colleagues Phillips investigated the impact of new guidelines issued by the American College of Cardiology and American Heart Association in November that redefine high blood pressure. The new guidelines classify hypertension as a reading of 130 over 80, rather than 140 over 90. Under these new tightened rules, 46 percent of U.S. adults are now considered hypertensive, up from 32 percent.

Phillips, who is an expert in hypertension and cardiovascular disease, says while patients at higher risk for cardiovascular disease benefited from the stricter guidelines, those with lower risk had more harm than benefit from the intensive treatment recommendations. “Classifying patients by degree of future risk might be the best way to identify who could benefit most from intensive treatment,” Phillips said.

The findings are described in a paper titled “Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension,” that appeared in the Journal of the American College of Cardiology, a leading medical journal in the field of cardiovascular disease.

ADVANCES IN BREAST CANCER RESEARCH

Researchers at Houston Methodist used computer modeling to find an existing investigational drug compound for leukemia patients to treat triple negative breast cancer once it spreads to the brain.

They culled through thousands of existing drugs to determine if they could identify a compound that would prevent cancer cells from spreading further, or metastasizing. They discovered edelfosine, which has been FDA-approved as an investigational leukemia treatment, and has also been used in clinical research for primary brain tumors.

Dr. Stephen T. Wong, chair of systems medicine and bioengineering at Houston Methodist Research Institute, and Dr. Hong Zhao, assistant professor of systems medicine and bioengineering at Houston Methodist Research Institute, collaborated on research published in the March 22 online issue of Cancer Research.

Wong and his lab want to see if edelfosine could be incorporated into future clinical research focused on other tumor sites, such as lung, ovarian and pancreatic cancers.

HOUSTON METHODIST RESEARCHER RELEASES NANOTECH ‘RECIPE’

In a rare move, a Houston Methodist researcher is sharing his recipe for a new, more affordable way to make nanoparticles.

Dr. Ennio Tasciotti, director of the Center for Biomimetic Medicine at the Houston Methodist Research Institute, published an article on March 7 in Advanced Materials.

Dr. Ennio In the article, Tasciotti and his colleagues Tasciotti show how to standardize nanoparticle production to guarantee stability and reproducibility, while increasing yield.

“Nanoparticles are generally made through cryptic protocols, and it’s very often impossible to consistently or affordably reproduce them,” Tasciotti said. “You usually need special, custom-made equipment or procedures that are available to only a few laboratories. We provide step-by-step instructions so that now everybody can do it.”

4 LEADING MEDICINE FROM HOUSTON METHODIST

For decades nanoparticles have been made out of bioinert, or inorganic, substances that don’t interact with the body. In more recent years, nanoparticles were made to be bioactive, meaning they could respond to the environment. Now, Tasciotti is pushing the field forward by creating biomimetic nanoparticles that resemble cell composition and work in synergy with the laws that govern the physiology of the body.

Eliminating the need for multimillion-dollar facilities, Tasciotti and his team demonstrate this using a readily available and relatively affordable piece of benchtop equipment to manufacture nanoparticles in a controlled, adjustable and low-cost manner. This will empower any laboratory in the world to easily create similar nanoparticles and could lead to a whole new way of delivering biotherapeutic drugs and do it more quickly.

Living with Advanced

HEART FAILURE

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pproximately 10 percent of the 6 million Americans living with heart failure have an advanced case, meaning conventional treatments to improve Dr. Myung H. heart function and Park symptoms are not working. But there are still many options available to these patients depending on their preferences and goals, according to Dr. Myung H. Park, Chief, Division of Heart Failure and Transplant, Houston Methodist DeBakey Heart & Vascular Center.

OPTIONS FOR CARE

Treatment options for people with advanced heart failure include: Nonsurgical procedures that access the heart through blood vessels, such as valve repair or replacement Implantable devices, such as a pacemaker or cardiac defibrillator, which help maintain proper heart rhythm Open-heart surgery to perform a coronary artery bypass graft, valve repair or replacement, or removal of the stiff pericardium sac around the heart Mechanical-support devices to boost heart function, such as left ventricular assist devices (LVADs) Heart transplant that replaces a failing heart with a healthy donor heart

COMMUNICATION IS KEY “It’s also very important for advanced heart failure patients to have detailed conversations with their doctor about the type of care they wish to receive.

Patients, with input from close family members, should consider whether

they’re interested in pursuing aggressive treatment or comfort-based care, as well as bring up topics such as resuscitation,” Park said.

The American Heart Association recommends various shared decisionmaking tactics to build a care plan for advanced heart failure. These include an annual heart failure review and “milestone” discussions to reassess treatment goals in the event of a major medical setback.

“Shared decision-making helps advanced heart failure patients think through their goals for their lives as they face this chronic challenge,” Park said.

HOUSTON METHODIST PERFORMS 1,000TH HEART TRANSPLANT Joining an elite group of U.S. hospitals, Houston Methodist J.C. Walter Jr. Transplant Center in partnership with the Houston Methodist DeBakey Heart & Vascular Center achieved two major milestones in late 2017: their 1,000th heart transplant, followed just a few days later by their 7,000th transplant overall.

Houston Methodist carries a long tradition of transplant surgery, with Dr. Michael E. DeBakey completing the first heart transplant at the hospital half a century ago. The Transplant Center also performs lung, liver, kidney and pancreas transplants.

“It’s a great feeling to know we have been able to save the lives of many people over the past 50 years,” said Dr. George P. Noon, a cardiovascular surgeon with Houston Methodist DeBakey Heart & Vascular Center.

Dr. Noon has been involved in more than half of all heart transplants at Houston Methodist.

Tyler Wertz was the recipient of the 1,000th heart transplant. Wertz suffers from Becker muscular dystrophy, which slowly weakened his heart as well as his arms and legs. He had a left ventricular assist device, or LVAD, to boost his heart function for the last five years, but after his health began to deteriorate in late 2017, he was placed on the national transplant waiting list.

Wertz, a father of two, said he felt terrific after receiving his new heart and looks forward to watching his children grow up.

Take the Next Step

To find a heart failure specialist near you, visit houstonmethodist.org/ find-a-doctor or call 713.790.3599.

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BREAKING THE BARRIERS TO JOINT REPLACEMENT What’s holding you back from considering a joint replacement?

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f you’ve been living with chronic joint pain for months or years — making it difficult to move about easily or even just walk normally — you may keep a running list of Dr. Robert Neff reasons in your head why you haven’t had joint replacement surgery. But most of these are unnecessary barriers, because this highly common surgery usually vastly improves patients’ lives and allows them to resume their favorite activities without pain, according to Dr. Robert Neff, an orthopedic surgeon at Houston Methodist Hospital.

More than 7 million Americans are living with an artificial knee or hip, the two joints most often replaced through surgery, according to the National Institutes of Health. At Houston Methodist, orthopedic surgeons perform over 4,000 joint replacements each year, predominantly knees, hips and shoulders.

This high volume translates into high levels of experience and high success rates, Neff said.

“Joint replacement surgery is one of the true miracles of modern medicine,” Neff added. “It gets people back to their lives doing the things they want to do and used to take for granted. That’s good for society, for the workforce and for patients’ quality of life.”

WHY JOINT REPLACEMENT BECOMES NECESSARY

Affecting 1 in 5 Americans, arthritis is typically the culprit in causing joints to become so stiff, tender and painful

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GET RELIEF FROM YOUR JOINT PAIN At Houston Methodist, we offer a full spectrum of services, from conservative, nonsurgical treatment options to the most advanced surgical techniques, which include: Innovative pain control methods Physical therapy to improve mobility and range of motion Latest technology, including minimally invasive surgical techniques Presurgical education programs for joint replacement Partial knee replacement Complex joint revision surgery Hip- and knee-preservation surgery

that joint replacement surgery is considered. An artificial joint used in joint replacement surgery can be made of plastic, metal and/or ceramic, according to Neff. Either the usual “wear and tear” type of arthritis (osteoarthritis) is at play, he noted, or so-called traumatic arthritis brought on by an injury that makes the joint increasingly unstable over decades.

But the resulting pain can be so pervasive and excruciating that

nonsurgical measures meant to manage it — such as pain medications and creams, exercise, physical therapy, steroid or other injections, and bracing the joint — provide only brief relief, if at all.

“By the time people get to a conversation about joint replacement, they have pain on a daily basis and it’s occupying a disproportionate part of their lives,” Neff explained. “It’s the kind of pain that leads them to become less active, whether athletically or socially, and can include everything from going grocery shopping to going to church, being able to prepare their own meals or even being able to walk outside.”

“It basically narrows their lives and limits their movement,” he added. “A lot of people get to the point where mentally, the pain becomes such a big part of their lives they become unhappy.”

JOINT SURGERY FACTS

While many would say their joint pain is difficult and debilitating, surgery is often viewed as an absolute last resort. Here, Neff debunks the most common misconceptions.

Short-term discomfort from surgery beats a lifetime of debilitating pain.

For every person who says joint replacement is a miserable procedure, many more have said they’re glad they had it done, and the majority of their pain is now gone. We’re also able to better control patients’ pain before, during and after surgery with new medications and by using older medications a bit differently depending on the patient’s needs.

Recovery doesn’t take as long as it used to.

Improvements in surgical techniques and technology have reduced recovery time making it more efficient, predictable and generally less painful. This enables a more rapid return to function. Many patients are concerned they won’t get back to work in a prescribed amount of time, but national and international data show they usually return to their jobs within six weeks.

Most insurance covers it.

While insurance plans vary, joint replacement is one of the most established procedures in the United States, meaning reimbursement isn’t often a problem regardless of age.

Newer technology means longer lasting artificial joints.

As technology improves, joint durability continues to improve as well. An artificial joint probably has a life expectancy that matches the patient’s most of the time, and most who receive one will never need another.

READY? NO NEED TO WAIT

Regardless of what misconceptions may hold them back, most patients who need joint replacement typically reach the point where they’re ready to do it.

“It’s not uncommon for a patient to be ready to commit to joint replacement within a year or so of an arthritis diagnosis,” Neff said. “There’s not necessarily a medical rush for this, a time frame where a patient’s outcome will be sacrificed as a result of waiting.

However, the decision to proceed with joint replacement — sooner than later — will eliminate the pain and suffering of a prolonged waiting period.

“I schedule a follow-up visit with every patient one year after joint replacement surgery, and during this visit, I commonly hear ‘I wish I had done this sooner.’”

Considering Joint Replacement Surgery?

To schedule an appointment with one of our joint specialists at Houston Methodist Hospital, visit houstonmethodist.org/ jointpain or call 713.441.9000.

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THE LATEST IN HIGH-TECH CARE COMES TO HOUSTON The opening of Walter Tower at Houston Methodist Hospital this summer will offer the newest, most precise imaging and surgical equipment for complex heart and brain surgeries.

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H Dr. Gavin Britz

Dr. Alan Lumsden

ouston Methodist Hospital soon will open the Paula and Joseph C. “Rusty” Walter III Tower, a 22-story, $700 million patient tower housing new beds and state-of-the-art technology to better serve the community and the institution’s growing patient population.

The nationally ranked Houston Methodist DeBakey Heart & Vascular Center and Houston Methodist Neurological Institute will move into the new building. Cardiovascular surgeons, cardiologists, neurosurgeons and neurologists from these centers believe that the advanced technology in this building will transform clinical care for the future and will serve as the new standard for similar facilities around the country.

WORLD-CLASS OPERATING ROOMS

The opening of Walter Tower at Houston Methodist Hospital this summer will offer the newest, most precise imaging and surgical equipment for complex heart and brain surgeries. Enhancements will include four new hybrid operating rooms (ORs) with robotic-assisted technology and imaging scan capabilities during surgery.

“In neurosurgery, we will have the most state-of-the-art equipment in the world,” added Dr. Gavin Britz, chair of the Department of Neurosurgery and director of the Neurological Institute.

“It’s a transformational moment,” said Dr. Alan Lumsden, chair of Houston Methodist DeBakey Heart & Vascular Center and the Department of Cardiovascular Surgery. The upgraded facility has what he describes as “the most advanced cardiothoracic operating rooms that exist.”

HIGH-TECH HIGHLIGHTS

The new hybrid ORs have advanced imaging capabilities built right in to the operating rooms. Intraoperative imaging technology including MRI, CT and angiography may be used during surgery for patients with tumors, aneurysms or strokes.

For example, surgeons can scan patients halfway through a procedure and react to each patient’s specific needs in that moment. They can also take CT scans done weeks ago and fuse those images in real time to images scanned during surgery, to identify any changes that may have developed in the short span since images were taken. Also, in the tower, is the latest generation of the Gamma Knife that delivers high doses of radiation to the brain with pinpoint accuracy without harming healthy tissue.

For patients facing intricate brain surgeries, imaging technology guides surgeons in locating and removing diseased areas, such as blood clots from strokes or cancerous tumors. The technology allows real-time imaging, enabling surgeons to deftly navigate the complex terrain of the brain.

Houston Methodist’s new robotic-assisted technology, which minimizes tissue damage and maximizes surgical precision, can

be used for up to 80 percent of procedures involving the lungs and esophagus.

Every form of open-heart surgery can be performed in the expansive OR suites, with minimally invasive cardiac procedures done in the tower’s 14 interventional catheterization labs. These treatments, which include cardiac bypass and valve replacement, among others, involve threading a catheter through an artery from the groin or other area to the heart, avoiding the need for lengthy incisions.

Additionally, the four hybrid operating rooms will combine features of a catheterization lab and a traditional OR, allowing doctors to rapidly convert from a minimally invasive procedure to an open version in the rare case it’s necessary.

BENEFITS FOR PATIENTS

The facility’s enhanced technology enables heart and brain surgeons to deliver state-of-the-art treatment when precision matters, and every second counts. The following benefits provide peace of mind for patients and their families.

R obotic-assisted technology makes the surgery quicker and safer due to smaller incisions. Patients get out of the hospital and back to normal faster — a two or three-day stay may be reduced to 24 hours.

R eal-time visibility with intraoperative imaging maximizes a surgeon’s precision during surgery, so they can better locate and remove diseased areas, such as blood clots from strokes or cancerous tumors.

W ith imaging technology available right in the OR, efficiency leads to better results. Instead of transporting patients to radiology and then back again, doctors can diagnose and perform procedures in the same place.

I mage-guided precision and less invasive surgery means fewer repeat procedures, faster recovery times and potentially improved outcomes.

A ll patients will be given private rooms, an amenity offering extra peace and comfort as they recover. The larger room sizes also allow family and friends more space while visiting.

The number of brain procedures performed at Houston Methodist — already robust at more than 5,500 each year — will certainly expand with the tower’s opening as well, Britz said. “We needed space to grow and needed the most up-to-date technology in the world to provide the best patient care possible,” he said.

“This puts us in the top tier.”

Leading the Way Learn more about how Houston Methodist Hospital is leading medicine with Walter Tower by visiting houstonmethodist.org/walter-tower, or find a doctor in your area by calling 713.790.3599.

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Reducing Your

RISK OF STROKE

S

troke may be the fifth leading cause of death in the United States, but that doesn’t mean you can’t fight back. Up to 80 percent of strokes are preventable. Lower your risk by making these simple lifestyle changes today.

KICK THE STICKS

Smoking doubles the risk of stroke. Don’t be afraid to ask for help, and don’t give up if you aren’t successful the first time.

Do It Today: Talk to your doctor about nicotine patches, prescription medication, counseling and other programs that may be available.

SKIP THE DRIVE-THRU

Those high-calorie, high-convenience foods can lead to extra pounds, which can make you more likely to have high cholesterol, high blood pressure and diabetes, all of which can increase your risk for stroke.

Do It Today: On busy days, let your slow cooker do the work for you. Put in boneless skinless chicken breasts, a couple cans of low-sodium black beans and a jar of low-sodium salsa. Cook on low for six to eight hours, and serve with whole-wheat tortillas.

TAKE A HIKE

Even a brisk walk can improve your health. According to the National Stroke Association, a recent study showed that people who exercise five or more times per week have a reduced stroke risk.

Do It Today: Break 30 minutes of exercise into three doable 10-minute walking sessions.

NIX THE NIGHTCAP

Overindulging in alcohol can increase blood pressure and the risk of stroke, so if you do drink, do it in moderation: no more than two drinks a day for men and one drink a day for women.

Do It Today: Substitute your usual evening drink with a cup of calming herbal tea.

SEEK OUT EXPERT STROKE CARE

Should you or a loved one experience a stroke, there is no better place to receive care than at Houston Methodist Hospital. You can take advantage of the following stroke expertise: D NV-accredited Comprehensive Stroke Center. The Eddy Scurlock Stroke Center at Houston Methodist Neurological Institute was one of the first DNV-certified Comprehensive Stroke Centers in the nation. The center offers stroke sufferers the most advanced treatments and rehabilitation available.

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INTRODUCING

DR. RAJAN GADHIA Dr. Rajan Gadhia is a vascular neurologist at Houston Methodist Hospital. As new Co-Director of Dr. Rajan Gadhia Teleneurology Services, Gadhia is spearheading Houston Methodist’s program that connects our stroke experts with community medical doctors to share treatment guidance in real time for patients who can’t make it to our doors in time.

Be Stroke Smart For more information about Houston Methodist Eddy Scurlock Stroke Center, visit houstonmethodist.org/eddy-scurlock-strokecenter or call 832.667.5867.

C linical Trials. Various stroke clinical trials are also available at Houston Methodist Hospital for patients who have experienced a stroke.

When Summertime Fun

LEADS TO INJURY Know where to go for sudden health care needs

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ou can spend more time being active outdoors with friends and family when you know how to protect yourself and your loved ones from injury.

Before heading outside, apply sunscreen with an SPF of 30 or higher, and reapply often. Drink plenty of water to prevent dehydration and seek shade during the hottest times of the day to avoid heat-related illness.

Use these basic safety tips to avoid illness and injury when engaging in summertime fun.

Riding bikes, skateboarding, roller-skating. Wear a helmet that

fits properly; wrist, elbow and knee guards. When bike riding, follow the rules of the road and learn proper hand signals.

Boating and swimming. Never leave a child unattended at the ocean, lake or poolside. Follow safety rules posted at the beach and at public pools. Everyone on a boat should wear a Coast Guard-approved personal flotation device.

Never drink alcohol when operating a boat.

Using fireworks. Follow instructions and read safety warnings. Stand several feet from lit fireworks, and have a bucket of water or a fire extinguisher nearby.

Hiking and camping. Wear insect repellent containing picaridin or DEET, and follow instructions for proper use. Check everyone for ticks at least once a day.

Enjoying playgrounds and water parks. Supervise children

closely and inspect equipment to make sure it is in good working condition. Avoid swallowing water to prevent waterborne illnesses.

While taking precautions can help you prevent mishaps, it’s crucial to know where to go for medical care when unexpected illness or injury occurs. Use the accompanying chart to decide which level of care is best for your medical needs.

HOUSTON METHODIST EMERGENCY CARE CENTERS Quick, convenient access 24/7 Short wait times Care for all ages B oard-certified emergency medicine physicians and specialty trained staff D irect admission to Houston Methodist Hospital, if necessary O n-site imaging and diagnostic technology C o-pay: Hospital emergency room co-pay applies Easy access and free parking

URGENT CARE CENTERS M ay not be open 24 hours a day, 365 days a year May not treat pediatrics and elderly Co-pay: Urgent care co-pays apply O ften staffed with nonemergency medicine board-trained practitioners May require payment to be treated May not have a doctor on site

Houston Methodist Emergency Care Centers 713.441.ER24 (3724) houstonmethodist.org/ER 1. Kirby 2615 Southwest Fwy. Houston, TX 77098

2. Voss 1635 S. Voss Rd. Houston, TX 77057 3. Pearland 11525 Broadway St. Pearland, TX 77584

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LEADING MEDICINE IN GREATER HOUSTON

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LIVE A LIFE WITHOUT

JOINT PAIN We can help you get there.

Conroe

If you’ve suffered from years of joint pain and struggled to find relief, we have the joint care expertise to get you back to your everyday life. With treatment plans customized for you, our specialists offer a full range of advanced nonsurgical and surgical techniques, including: • • • •

Innovative pain control methods Physical therapy to improve mobility and range of motion Latest technology, including minimally invasive surgical techniques Presurgical education programs for joint replacement

The Woodlands

Willowbrook

Memorial City Bellaire

Katy

Baytown

Texas Medical Center Pearland Sugar Land

Clear Lake

Schedule an appointment to discuss your options with a joint specialist.

Houston Methodist Orthopedics & Sports Medicine 713.441.9000 | houstonmethodist.org/jointpain

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