Leading Medicine Spring Summer 2019, Houston Methodist Hospital edition

LEADING MEDICINE SPRI N G/SUM M ER 201

How’s Your Gut Health?

You’re Only as Old as Your Blood Vessels

Orthopedic and Sports Injuries

PROTECT YOURSELF FROM HEAD TO TOE

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

NEWS & EVENTS AFib PATIENT SEMINAR

Date: May 15 | Time: 6-7:30 pm Location: Houston Methodist Research Institute 6670 Bertner Avenue John F. Bookout Auditorium, Floor 2 Houston, TX 77030 Join Houston Methodist DeBakey Heart & Vascular Center physician experts to learn about atrial fibrillation (AFib) and the right treatment options for you. This event is for those who: Are at risk for AFib or experience symptoms Have been diagnosed with AFib and are looking for treatment options Have had an unsuccessful AFib treatment and are looking for a second opinion Parking validated at Texas Medical Center Parking Garage 1.

Register at events.houstonmethodist.org/afib or call 713.DEBAKEY.

WOMEN’S HEALTH AND WELLNESS EVENT

VIRTUAL URGENT CARE

Date: May 22 | Time: 6-8 pm Location: Hotel Zaza, 5701 Main St., Houston, TX 77005 Join an all-female panel of doctors for a Q&A discussion focusing on the most relevant health matters impacting women today. Get expert advice about breast care, gynecologic and pelvic health, heart disease and brain health.

The next time you get sick, you can skip the waiting room. See our providers via video visit — 24/7, from wherever you are. Virtual Urgent Care is available through the MyMethodist app. Download it today or visit houstonmethodist.org/virtual-care to learn more.

Complimentary valet parking is available. To register, visit events.houstonmethodist.org/womens or call 713.790.3599.

The Hidden Dangers of VAPING

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Dr. Jun Zhang

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lectronic cigarettes, or e-cigarettes, have only been on the market for about a decade, but their popularity has risen quickly. E-cigarettes are inhalers filled with a liquid that generally contains nicotine, flavoring and/or other additives.

A heater within the device creates a vapor, which is inhaled — or “vaped” — just like cigarette smoke but without the tar and certain other chemicals. But how much is really known about vaping? Here are five of the dangers you may not be aware of.

Is Lung Cancer Screening for You? While you work with your doctor to stop smoking, consider scheduling a lung cancer screening. To find out if you’re a candidate for the Lung Cancer Screening Program at Houston Methodist Hospital, visit houstonmethodist.org/ lung-screening or call 713.441.5864.

e-Cigarettes are unregulated by the Food and Drug Administration.

This means that the chemicals and toxins found in nicotine liquids vary widely depending on the product. You really can’t know what you are inhaling or how it is affecting your lungs.

nicotine and other organic compounds. This is dangerous for children, whose developing lungs and brains are vulnerable to toxins.

The American Lung Association reports that e-cigarettes are the most commonly used tobacco product among kids. “Kids’ brains are particularly susceptible to the highly addictive nature of nicotine,” said Dr. Jun Zhang, a thoracic medical oncologist at Houston Methodist Hospital, “which puts them at the greatest risk to graduate to cigarette smoking.”

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Secondhand e-cigarette “smoke” is not just harmless vapor. The vapor emitted from e-cigarettes contains harmful chemicals, like

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There is substantial evidence that exposure to certain chemicals in e-cigarettes (like formaldehyde) may cause lung tissue damage, DNA damage and genetic mutations.

Because they are so new, there are no studies to measure the long-term health effects of vaping. That means that the greatest hidden danger is still hidden. “The best advice is to steer clear of e-cigs,” said Zhang. “While there is still much to be learned about the long-term effects of vaping, one thing we do know is that nicotine is highly addictive.”

How’s Your Gut Health?

When to See a Gastroenterologist

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igestive problems often strike at the worst possible time. You might have a gas attack at the movies, indigestion at a dinner party or diarrhea while Dr. Sunil Dacha on vacation. Unpleasant gastrointestinal (GI) symptoms are bound to happen from time to time. However, if GI distress becomes part of your everyday life, there could be something more going on.

WHAT’S CAUSING YOUR SYMPTOMS?

If you’re struggling with unexplained symptoms, your doctor may recommend seeing a gastroenterologist, a specialist who has experience diagnosing and treating diseases affecting the esophagus, stomach, intestines, liver, pancreas and gallbladder.

GI disorders can be classified into two main groups: Functional GI disorders occur when the GI tract isn’t functioning as it should.

“When there’s a functional problem, the GI tract typically looks normal and diagnostic tests show normal results, making it harder to pinpoint the cause of persistent and recurrent symptoms,” said Dr. Sunil Dacha, a gastroenterologist with Houston Methodist Hospital. Irritable bowel syndrome (IBS) and chronic constipation are examples of functional

disorders. Treatments may include lifestyle changes, medicines and other therapies to keep the digestive system in balance.

Structural GI disorders happen when there’s a structural problem in the digestive organs that needs medications or endoscopic procedures or surgery to be healed or repaired. This includes conditions, such as ulcers, anal fissures, hemorrhoids, colitis, diverticular disease, gallstones and colon polyps. “Improving bowel habits can help with symptoms of hemorrhoids and anal fissures, but surgery may be needed in some cases,” Dacha explained.

GI issues can be difficult to diagnose and treat, so it’s important to listen to your body and talk about your symptoms with a doctor. If you experience any of the following symptoms, it may be time to see your doctor or a gastroenterologist: Abdominal pain or bloating Changes in bowel habits Diarrhea Difficulty controlling bowel movement urges Excessive gas or belching Heartburn Loss of appetite Rectal bleeding Unexplained weight loss Vomiting “Abdominal pain can mean any number of things — from constipation to more serious conditions, like appendicitis or diverticulitis,” Dacha said. Call your doctor right away when abdominal pain

is severe, getting worse or recurring, or accompanied by dizziness, high fever or shortness of breath.

TRUST YOUR GUT

You know your digestive system better than anyone, and you may have the best insight (or at least a gut feeling) about what’s going on. Use this knowledge to your advantage by keeping a journal of your digestive episodes including what you are eating and drinking.

Record the time of day and frequency of symptoms, such as frequent or loose bowel movements, constipation, cramps or heartburn.

A gastroenterologist will review your symptoms, ask about your health history and perform a complete exam. “Blood tests, X-rays, ultrasound exams and GI endoscopic procedures may be ordered to determine the cause of symptoms,” Dacha explained. “If needed, GI motility tests may be recommended to evaluate for problems with gastric emptying.”

Uncover the Problem Our doctors at The Underwood Center for Digestive Disorders can uncover the cause of specific GI problems. Call 713.441.9770 to schedule an appointment.

WHAT DOES A GASTROENTEROLOGIST TREAT? A gastroenterologist has specialized training to treat and manage digestive disorders, including: Acid reflux Hemorrhoids Polyps or growths Celiac disease Irritable bowel syndrome Stones in the bile duct Crohn’s disease/Ulcerative Pancreatitis Ulcers colitis

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Orthopedic and Sports Injuries

Protect Yourself from HEAD TO TOE D ealing with orthopedic and sports injuries often comes with the territory for football players, marathon runners, gymnasts and other competitive athletes. But you don’t have to be on the field or court to end up with a painful or chronic injury. Everyday types of injuries — from carrying groceries or unloading the dishwasher — happen all the time and can also lead to long-term problems if not treated properly.

Dr. William Back problems, joint disorders and osteoarthritis are Bryan among the top reasons for seeing a doctor. “Musculoskeletal issues result in millions of orthopedic visits every year,” said Dr. William Bryan, orthopedic surgeon specializing in knee and hip surgery at Houston Methodist Hospital.

KNOW YOUR LIMITS

Bryan says it’s important to listen to your body when it’s telling you to slow down. “Sometimes we try to push through the pain, but you can end up doing more damage if you’re not careful. When you have joint and muscle pain, you can’t always walk off the pain or solve it by taking antiinflammatory medicines,” he noted.

“With age, our ability to heal is not as fast as it used to be and we don’t have as much elasticity in those tendons — like a rubber band that loses its elasticity over time. The best thing you can do is modify your activities or try a new activity that puts less stress on your body, such as biking or swimming,” Bryan added.

WHEN TO GET CHECKED

Injuries are bound to happen whether you’re competing in sports or just taking a walk around the block. Minor injuries can often be treated at home with rest, ice, compression and elevation. But there are times when it’s important to see a doctor so you can avoid further damage and ensure that you can heal properly.

It’s wise to get medical help if you experience the following symptoms after an injury: Instability (unable to bear weight on your knee or ankle) Limited range of motion Numbness or tingling Persistent joint pain Significant swelling or tenderness Weakness or lack of strength while moving a limb or muscle In addition, any impact to the head should be taken seriously, whether it’s from a sports collision or a minor fall at home. “When it comes to head injuries, always seek medical help for signs of concussion, such as any loss of consciousness, confusion or dizziness following a bump on the head,” Bryan said.

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ORTHOPEDIC INJURY CLINIC

Twisted ankle? Sprained knee?

Bad shoulder? You don’t need an appointment to see a specialist — go to the Houston Methodist Orthopedic Injury Clinic in Bellaire.

For immediate orthopedic care, count on our experts to evaluate and treat your injury, so you can get back to your active life. Major insurance plans are accepted.

The injury clinic provides treatment for: Acute orthopedic injuries Fractures Injured tendons Joint pain Minor dislocations Sports injuries Sprains and strains Torn ligaments No Appointment Needed Monday – Thursday, 8 a.m. – 5:30 p.m.

Friday, 8 a.m. – 3 p.m.

Conveniently located at 5505 W. Loop S., Houston, TX 77081. Visit houstonmethodist.org/osm/ bellaire or call 346.238.5300.

Concussions, school physicals, spine injuries, motor vehicle accidents and workers’ compensation injuries are not treated at the injury clinic. Please call 713.441.9000 to schedule an appointment with the appropriate physician for those conditions.

HEAD AND NECK

INJURY PREVENTION TIPS

Concussion Whiplash Injury prevention: Stay fit and maintain good posture for a strong neck and upper back. Wear headgear for contact sports or safety equipment for your activity.

Corbin Hedt, a physical therapist at Houston Methodist Orthopedics & Sports Medicine, shared the following injury prevention tips.

BACK Herniated disk Repetitive strain Injury prevention: Protect your back from injuries by strengthening your core muscles (the muscles that wrap around your entire torso) by doing exercises, such as planks and/or abdominal bracing exercises.

SHOULDER Rotator cuff injury Shoulder instability Injury prevention: Lift properly by picking up objects in front of you and as close to your body as possible.

ARM AND ELBOW

HIP AND LEG

Bursitis Golfer’s elbow Tennis elbow

Hamstring strain Hip flexor strain Shin splints

Injury prevention: Mix up your routine by doing a variety of arm movements to avoid repetitive injuries. Learning the proper mechanics for throwing and swinging is key to avoiding upper extremity injuries.

Injury prevention: Take care of your muscles and joints by warming up and stretching before exercise.

KNEE ACL injuries Jumper’s knee (patellar tendonitis) Osteoarthritis of the knee Injury prevention: Lose weight or maintain a healthy weight to take pressure off the knee and reduce wear and tear over time. Staying active helps protect the knee because you’re building muscles in the hips, quads and thighs to support the knee.

WRIST AND HAND FOOT AND ANKLE Ankle sprains Tendonitis Turf toe Injury prevention: Wear good shoes with solid support to absorb impact and prevent ankle injuries. Balance activities can help with stability — it can be as simple as standing on one leg.

Carpal tunnel syndrome Jammed fingers Skier’s thumb Wrist sprains Injury prevention: Take breaks from activity to rest the hands and wrists. If you spend a lot of time at a desk, set a timer throughout the day for every half hour to remind you to stretch and move.

KEEP MOVING Hedt shared some additional tips to help you keep moving and stay injury-free: Warm up before you exercise — walking, squatting, cycling, jumping jacks, arm circles, shoulder rolls or lunges.

Get your heart rate up, such as a brisk walk in a park with friends.

A im for 30 minutes of exercise every day — you can break this up into smaller 10-minute bursts of exercise throughout the day.

B uild strength with weights a few times a week.

A dd balance activities at least once a week — stretching, yoga, tai chi.

F ocus on good posture — avoid the “head forward, rounded neck” posture when looking at your phone.

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A CLOSER LOOK AT COPD

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hronic obstructive pulmonary disorder (COPD) isn’t one disease but a group of conditions, such as emphysema and chronic Dr. Julie P. bronchitis that block Nguyen the flow of air and cause breathing difficulties.

The No. 1 risk factor for COPD is being a current or former smoker.

However, environmental pollutants, such as those found in some industrial work environments, Dr. Timothy A. can also increase your Connolly risk. “Working for years in an environment with poor air quality can add to your COPD risk, especially if you’re not wearing protective equipment,” said Dr. Julie P. Nguyen, pulmonologist and member of the Houston Methodist Lung Center.

SYMPTOMS AND DIAGNOSIS

The earliest symptoms of COPD are easy to mistake for other conditions.

Symptoms include breathlessness, difficulty breathing, chronic coughing, fatigue and loss of energy. These symptoms are often managed by rescue inhalers and other medications. “It’s usually once a person realizes they can no longer perform their everyday tasks, or their current medications no longer work, that they’re referred to me for a more complete evaluation of their COPD,” said Dr. Timothy A. Connolly, pulmonologist and member of the Houston Methodist Lung Center.

Diagnosing COPD requires a test to measure how much air you’re able to inhale and exhale, and how quickly you can exhale air in order to stage your condition. See “COPD Stages.” If needed, your doctor may also order lung X-rays.

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TREATMENT AND MANAGEMENT OF COPD

While there’s no cure for COPD, you can slow its progression, reduce flare ups and improve your quality of life by: Quitting smoking. It is the No. 1 thing you can do to manage COPD and avoid being anywhere near smoke.

Managing medications. “Over time, patients can be prescribed a lot of different medications, nebulizers and inhalers,” said Connolly. “We review all prescriptions and make sure they understand what to use and when.”

Avoiding triggers. “Patients can improve their quality of life by learning COPD triggers and how to avoid them,” said Nguyen.

Participating in pulmonary rehab.

Patients work with respiratory therapists to perform everyday tasks. “Learning how to use the right muscles and move with more economy can improve a COPD patient’s life significantly,” said Connolly.

A cutting-edge minimally invasive procedure is available for patients who suffer from hyperinflation, using a device called Zephyr® Valve that helps patients breathe easier. “The Lung Center was part of the original clinical trial for this procedure. We are the first hospital in Texas to offer this option for the specific group of COPD patients who qualify,” said Connolly.

COPD STAGES Stage 1: Mild COPD with slight airflow limitation

80% FEV1/FVC

Stage 2: Moderate COPD with symptoms of coughing, wheezing and shortness of breath

50-80% FEV1/FVC

Stage 3: Severe COPD including emphysema and decreased quality of life

30-50% FEV1/FVC

Stage 4: Very severe or end-stage COPD with low blood oxygen levels and life-threatening flare-ups

Less than 30% FEV1/ FVC or FEV1 lower than 50% with chronic respiratory failure

COPD staging is based on a ratio of forced expiratory volume (FEV1) — the amount you can breathe out in the first second of exhaling after a deep breath — to forced vital capacity (FVC) — the total amount that you can exhale after inhaling a deep breath.

Get Relief from COPD To request an appointment with one of our pulmonologists at Houston Methodist Lung Center, visit houstonmethodist.org/lung-center or call 713.441.7779.

YOU’RE ONLY AS OLD AS YOUR BLOOD VESSELS

W Dr. Mohammed Chamsi-Pasha

ith every year that goes by, you might notice a few more wrinkles that give away your age when you look in the mirror. But when it comes to living a long and healthy life, what matters most is what’s on the inside. The condition of your blood vessels says a lot about your heart health and your “vascular age.”

WHAT’S YOUR VASCULAR AGE?

Vascular age is a measure of the apparent age of your arteries. Your doctor can use different methods to calculate your vascular age based on risk factors (cholesterol, blood pressure, smoking, age, gender) and using a calcium score of the heart, which quantifies the amount of hard cholesterol deposits in the arteries. For example, if your real age is 40 Dr. Linda Le and your vascular age is 50, this means the condition of your arteries is similar to a healthy person at age 50.

“Atherosclerosis (hardening and thickening of the artery walls) happens slowly and silently, and it can start as early as 20 years of age when small cholesterol (fatty deposits) start building on the walls,” said Dr. Mohammed Chamsi-Pasha, a cardiologist with Houston Methodist DeBakey Heart & Vascular Center.

“Risk factors, such as tobacco use, uncontrolled hypertension and diabetes, can cause severe damage to blood vessels even in young people,” added Dr. Linda Le, a vascular surgeon with Houston Methodist DeBakey Heart & Vascular Center.

Take the following six steps to keep your blood vessels in good shape:

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Don’t smoke. “Smoking constricts blood vessels and accelerates cholesterol buildup in the arteries,” ChamsiPasha said. “We are seeing more heart attacks in young people, and smoking poses a major threat. When you quit smoking, the benefits on heart and overall health are seen within 24 hours.”

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Be active. “Exercise increases blood flow to the blood vessels, which helps prevent stiffness and also increases your HDL (good) cholesterol,” Chamsi-Pasha said. Strive for at least 30 minutes of moderate physical activity, such as brisk walking, at least five days a week.

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Eat a healthy diet. Focus on eating a “heart-healthy diet,” which entails more fruits and vegetables, whole-grain foods, fish and low fat dairy products. Limit foods with added sugars, saturated fats and processed meat.

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Prevent or treat other health conditions. Follow your doctor’s instructions to control high blood pressure or high cholesterol through lifestyle modifications and, perhaps, medication. “If you have diabetes, controlling your blood sugar levels can improve the health of your blood vessels,” Le said.

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Control your weight. Reaching and maintaining a healthy weight eases the burden on your heart and improves blood cholesterol and blood sugar levels. Losing just 10 pounds if you’re overweight can help lower high blood pressure.

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Limit alcohol. Women should average no more than one drink per day, and men no more than one to two drinks.

Do You Need a Heart Screening?

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/heart-scans to learn more or call 713.790.3333 to schedule your appointment.

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KEEP YOU MOVING

At Houston Methodist Orthopedics & Sports Medicine, we know your body is made to move.

Our specialists use the latest technology, perform minimally invasive procedures and develop customized treatment plans, including physical therapy. Whether you’re getting back in shape or back to work, we can help get you back on your feet — and keep you moving. houstonmethodist.org/orthopedics 20 convenient locations

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