Page 1




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



5-a-Day Salad This nutrient-packed salad uses 10 different vegetables, and each serving is equal to five cups of vegetables! INGREDIENTS 4 cups fresh spinach 4 cups romaine lettuce 2 cups green pepper (chopped, or use red, yellow or orange) 2 cups cherry tomatoes 1 cup broccoli (chopped) 1 cup cauliflower (chopped) 1 cup yellow squash (sliced) 2 cups cucumber (sliced) 2 cups carrots (chopped) 1 cup zucchini (sliced) DIRECTIONS Wash all of the vegetables and mix them together in a large mixing bowl. Top this colorful meal with the nonfat or low-fat dressing of your choice. Note: Dressing is not included in the nutritional analysis.

NUTRITIONAL INFORMATION PER SERVING Number of servings: 4 99 calories; 1 g total fat; 0 g saturated fat; 0 mg cholesterol; 100 mg sodium; 21 g total carbohydrate; 8 g dietary fiber; 10 g total sugars; 0 g added sugars; 5 g protein; 0 mcg vitamin D; 119 mg calcium; 2 mg iron; 1,166 mg potassium.

Recipe courtesy of the U.S. Department of Agriculture,


3 4 5 6

K  now Your Risk for This Liver Disease Nonalcoholic fatty liver disease (NAFLD) may lead to very serious consequences. R  elief for Hernia Pain Advanced surgical procedures provide relief for patients suffering with hernia pain. U  nderstanding AFib If you or a loved one suffers from atrial fibrillation, or AFib, you’re not alone.

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



 Online Scheduling Offers Speed, Convenience Now you can make outpatient imaging procedure appointments quickly and easily with online scheduling.


A  dvanced Treatment for Nonhealing Wounds An estimated 29 million Americans live with diabetes, which has the potential to lead to dangerous wound situations. Advanced treatment for nonhealing wounds offers hope.


Talking About Men’s Health: Common Urologic Conditions Knowing your risk factors and symptoms for urologic conditions may help you avoid serious health problems.


5 reasons why you should




his condition can strike without warning or symptoms. Known as nonalcoholic fatty liver disease (NAFLD), it may lead to very Dr. Rashid Khan serious consequences. A common disease impacting nearly 100 million Americans, NAFLD describes a range of liver conditions affecting people who drink little to no alcohol. The main characteristic of NAFLD is that too much fat is stored in the liver.

Learn Your Risk

To learn more about your risk for NAFLD and to schedule an appointment with a gastroenterology specialist at Houston Methodist Gastroenterology Associates, visit or call 281.422.7970.


“While the exact cause of the condition is difficult to pinpoint, knowing your risk is vital,” said Dr. Rashid Khan, a gastroenterologist-hepatologist with Houston Methodist Gastroenterology Associates in Baytown. “The condition may be diagnosed in people of all ages, but it is especially prevalent in people in their 40s and 50s who are at high risk of heart disease due to the presence of such risk factors as obesity and type 2 diabetes,” Khan said. The condition is also closely linked to metabolic syndrome; a cluster of abnormalities, including: Increased abdominal fat Poor ability to use the hormone insulin High blood pressure High blood levels of triglycerides


Khan explained five reasons why people should take the condition seriously:


NAFLD may transform into liver cirrhosis. “Fatty liver disease is generally benign, but the development of cirrhosis becomes a game changer,” Khan said.


Studies have shown that liver cancer can occur in people with NAFLD even if they don’t have cirrhosis.



While the onset of nonalcoholic fatty liver disease often doesn’t include signs and symptoms, when symptoms are present they may include: Enlarged liver Fatigue Pain in the upper right abdomen



Cardiovascular disease (CVD) goes hand in hand with NAFLD. “Usually both exist in many patients. Fatty liver is known to be an independent predictor of CVD,” Khan added. Many studies have shown that people with diabetes can eventually develop NAFLD. “This association is bidirectional, in that some patients with fatty liver will develop diabetes,” Khan said.


A link between chronic kidney disease (CKD) and NAFLD. While the link between NAFLD and CKD is not as strong as with CVD and diabetes, it may be tied to metabolic syndrome, which involves dangerous plaque buildup in blood vessels throughout the body.

“Choosing a healthy diet rich in fruits, vegetables, whole grains and healthy fats, maintaining a healthy weight and getting regular exercise can lower your risk for developing NAFLD,” Khan said. Treatment generally starts with weight loss through healthy eating and regular exercise. Weight-loss surgery may be an option for those who are morbidly obese. “Because symptoms may not be present," Khan said, "regular screenings, including blood and liver enzyme and function tests, may be effective in early detection of the disease.”


RELIEF FOR HERNIA PAIN How robotic-assisted procedures can help


hile many people attempt to deal with a hernia by “toughing it out,” the agony often becomes too much to bear and begins to affect their quality of life. But there’s help available when you need it. Houston Methodist San Jacinto Hospital provides advanced surgical procedures for patients suffering with hernia pain. Dr. Boutros “Robotic-assisted, minimally invasive hernia Kahla repair surgery offers many advantages for patients,” said Dr. Boutros Kahla, general surgeon at Houston Methodist San Jacinto Hospital.


A hernia occurs when tissue pushes through an opening in the abdomen (ventral hernia) or groin area (inguinal hernia). The following are common hernia symptoms: Pain in the abdomen when coughing, bending, twisting or lifting objects A bulge or lump in the abdomen or groin Heaviness, weakness or dull pain in the groin or abdomen Nausea, vomiting or both Difficulty having a bowel movement or passing gas Men and women can develop hernias, which can be caused by a variety of factors, including a birth defect, age, chronic coughing, damage from injury or surgery, or lifting heavy objects. Pregnant women are prone to hernias as a result of muscles stretching, thinning and becoming weaker during pregnancy.


Surgeons performing robotic-assisted surgery with the da Vinci Surgical System can perform major surgeries using dime-sized incisions.


The operating console, equipped with tiny surgical instruments, translates the surgeon’s hand, wrist and finger movements into accurate movements inside the patient’s body. “The system increases the degree of surgical precision because you have multiple instruments functioning as your hands,” Kahla said. A high-definition vision system, including a lighted laparoscope with a tiny camera, offers a magnified, 3-D view of the surgical field. “The system’s camera allows me to see things I normally wouldn’t be able to,” Kahla added.


For patients, robotic-assisted procedures may offer many benefits, such as: Smaller incisions result in less scarring Less postsurgical pain Fewer complications and risk of infection Reduced loss of blood, which lessens the need for transfusion during surgery Shorter hospital stay and a faster recovery

Advanced Surgical Care

Visit or call 281.428.2273 for more information regarding minimally invasive surgical procedures at Houston Methodist San Jacinto Hospital.

Know the symptoms, get the right care



f you or a loved one suffers from atrial fibrillation, or AFib, you’re not alone. AFib is one of the most common heart conditions in the U.S., affecting an estimated Dr. Walter 2.7 million Americans.* O'Hara Recognizing AFib symptoms is crucial to getting treated for the disease in its earliest stages. “AFib — commonly referred to as an irregular heartbeat — occurs when the heart’s two upper chambers (atria) experience chaotic electrical signals, resulting in a fast and irregular rhythm,” said Dr. Walter O’Hara, a cardiovascular surgeon and director of the cardiovascular surgery (CV) team at Houston Methodist San Jacinto Hospital. With AFib, the heart rate may range from 100 to 175 beats per minute. A normal heart rate range is 60 to 100 beats per minute.


Symptoms of AFib may include shortness of breath, chest pain and palpitations. Once discovered, the first line of defense is typically medication therapy. “The symptoms of AFib may be very subtle in the beginning, so many people choose to not take immediate action to address it,” O’Hara said, “but recognizing those symptoms and getting treated as early as possible are key to preventing the condition from getting worse.”

Common causes of the condition include: Abnormal heart valves Congenital heart defects Coronary artery disease High blood pressure Lung diseases Overactive thyroid gland Previous heart attacks Sleep apnea Viral infections If not controlled, AFib may weaken the heart and lead to heart failure, along with an increased risk of stroke.


Patients who don’t respond to medication, or continue to have problems despite taking medication, may be candidates for treatment involving electrophysiology (EP), including ablation therapy. This catheter-based technique uses a vein in the patient’s leg to access the heart.

Get Screened for AFib

To learn more about your risk of AFib and services provided by the Cardiac Catheterization Lab at Houston Methodist San Jacinto Hospital, visit or call 281.428.2273.

“Ablation therapy creates scar tissue in the heart, which ultimately interrupts the irregular heartbeat. It’s shown to have better long-term results for symptomatic AFib patients than medication therapy alone,” O’Hara said. Along with traditional ablation therapy, Houston Methodist San Jacinto cardiologists perform a procedure called “convergence.” This two-part treatment involves the skills of a CV surgeon and an electrophysiologist (EP). The new procedure may provide relief for patients whose AFib is difficult to treat through standard procedures. “The treatment first involves a surgical ablation of the left atrium, which is performed by the CV surgeon,” O’Hara said. “The second part of the procedure involves a catheter ablation performed by the EP cardiologist. Convergence is reserved for patients with treatment-resistant forms of AFib, which can develop in patients who have the condition over a long period of time.” * Source: American Heart Association.


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


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. Karthik reasons in your head why Jonna 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. Karthik Jonna, an orthopedic surgeon at Houston Methodist San Jacinto 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, Jonna said. “Joint replacement surgery is one of the true miracles of modern medicine,” Jonna 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.”


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


GET RELIEF FROM YOUR JOINT PAIN At Houston Methodist San Jacinto Hospital, we offer a full spectrum of services, from conservative, nonsurgical treatment options to the most advanced surgical techniques, which include: Minimally invasive knee replacement Advanced techniques to minimize postoperative discomfort and accelerate recovery Partial knee replacement Complex joint revision surgery Physical therapy for arthritic knees 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 Jonna. 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,” Jonna 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.”


While many would say their joint pain is difficult and debilitating, surgery is often viewed as an absolute last resort. Here, Jonna 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.


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,” Jonna 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 orthopedic surgeons at Houston Methodist San Jacinto Hospital, visit or call 281.427.7400.


Busy households

Online Scheduling Offers Speed, Convenience


echnological advances are credited with bringing many improvements to the health care industry, including making it easier for patients to schedule outpatient procedures or appointments. Patients at Houston Methodist San Jacinto Hospital can make appointments quickly and easily for outpatient imaging procedures, such as CT and MRI scans, mammograms, ultrasound and bone density scans. Our easy-to-use online scheduling tool allows you to see available time slots, select one that fits your schedule and confirm, all with just a few clicks.


Follow these steps to schedule your outpatient imaging exam. 1 Visit to log on. 2 Click on "Schedule an Appointment" at the top of the page and

select "Imaging Appointments."

3 Go to the pull-down menu under “What Type of Imaging 

Appointment?” and select the type of imaging procedure you desire. Enter your location in the “What is Your Location?” box.

4 Enter your information regarding your insurance carrier, the 

distance you are willing to travel for the procedure and the timeframe you would like to schedule the appointment in the boxes marked “Insurance,” "Distance" and “Time Frame.”

5 Select your desired appointment date and time from the list 

of available dates that will appear.

Schedule Your Imaging Test

If your doctor recommends diagnostic imaging, you can rely on the expertise of the boardcertified radiologists and advanced technology at Houston Methodist San Jacinto Hospital. Visit to schedule an appointment. For additional assistance, call 281.428.2273.



The Houston Methodist San Jacinto Hospital Department of Imaging Services offers a full range of diagnostic and therapeutic imaging procedures that are fully accredited by the American College of Radiology (ACR). In addition, the ACR has recognized the hospital as a Breast Imaging Center of Excellence and a Designated Lung Cancer Screening facility. Residents of Baytown and the surrounding communities benefit from a team of highly trained radiologists, nurses and staff who provide diagnostic services using the most advanced technological tools available. These state-of-the-art imaging services include 3-D mammography, the most powerful MRI machine in Baytown, a new interventional radiology suite and an enhanced highdefinition CT scan device. Offering the most advanced diagnostic services in the Baytown area is an important part of our mission to provide safety, quality, service and innovation to our patients, and making it easy for people to access these services is equally important.




n estimated 29 million Americans live with diabetes, and for some even the smallest scrape can lead to potentially dangerous circumstances. Not Nancy Kibbe only does high blood sugar damage nerves, causing numbness in the legs and feet, but sometimes a narrowing and hardening of blood vessels results in less oxygen being circulated throughout the body to aid in healing. At the Houston Methodist Wound Care and Hyperbaric Medicine Program at San Jacinto, a multidisciplinary approach is used to treat wounds that won’t heal. “Understanding your diabetes risk and knowing diabetes symptoms are critical to preventing complications triggered by the disease,” said Nancy Kibbe, the program’s clinical manager.


“I encourage everyone to become aware of their family history of diabetes and to get checked for the condition on a regular basis,” Kibbe said. The most common symptoms of diabetes are: Frequent urination Extreme fatigue Blurry vision Unexplained weight loss Cuts and bruises that are slow to heal


According to the Centers for Disease Control and Prevention (CDC), diabetes accounts for about 60 percent of lowerlimb amputations not related to injury in adults. That’s why diabetic patients need to closely monitor their health and get care for even the smallest wound, especially in the feet. Warning signs of a nonhealing wound include: Persistent pain in the area of the wound Discoloration of the wound’s edges Increased drainage from the wound site Redness or swelling around the wound


The program’s wound care medicinecertified doctors and nurses work with patients and their primary care team to monitor, manage and provide advanced wound care. Treatments include compression wraps, antimicrobial dressings, bioengineered skin substitutes and hyperbaric oxygen therapy (HBOT). “HBOT supplies oxygen under pressure that supersaturates red blood cells and plasma with oxygen to help repair the wound, kill infection, generate new blood vessels and tissue growth,” Kibbe explained.

PREVENT PROBLEMS For people with diabetes, managing wounds to prevent complications requires Dr. Jacobo Nurko care and diligence. Dr. Jacobo Nurko, medical director of the Houston Methodist Wound Care and Hyperbaric Medicine Program at San Jacinto, offered some suggestions. Inspect and wash your feet daily, and watch for wounds. Keep wounds clean and dry to reduce risk of infection. File — don’t clip — your toe nails. Wear proper-fitting shoes and socks at all times. Control your blood sugar, blood pressure and cholesterol to reduce diabetes complications. If a wound doesn’t show signs of healing, see a wound specialist.

DID YOU KNOW? Our Wound Care and Hyperbaric Medicine Program is one of just two such programs in the Houston area certified by the Undersea & Hyperbaric Medical Society.

World-Class Wound Care

For more information on the advanced wound care treatments offered by the Houston Methodist Wound Care and Hyperbaric Medicine Program at San Jacinto, visit or call 281.425.2160.


Talking About Men’s Health:



ale urology problems run the gamut from mild inconveniences to severe conditions with life-threatening consequences. Knowing Dr. Bayo your risk factors and Tojuola symptoms may help you avoid serious health problems. Dr. Bayo Tojuola, urologist with Houston Methodist San Jacinto Hospital, provides information on some of the most common urologic conditions affecting men.


Kidney stones are caused when high levels of minerals, such as calcium, occur in the urine. “Small stones may pass on their own, but larger ones can lodge in the urinary tract, blocking the flow of urine and causing intense pain,” Tojuola said. About 12 percent of men and 7 percent of women experience kidney stones at some point in their lifetime. The condition most often affects men between the ages of 30 and 50. PREVENTION: Drink six to eight, 8-ounce glasses of water every day (unless your doctor advises differently). Avoid foods that are high in sodium (salt) and try to get your calcium from foods (milk, cheese, yogurt, etc.) rather than from supplements. TREATMENT: Smaller stones may pass on their own. But, if you’re passing a larger stone drink lots of water and use antiinflammatory medicines. Surgery may be suggested for more severe cases.


Take Charge of Your Health

To learn more about preventive screenings and to schedule an appointment with an urologist at Houston Methodist San Jacinto Hospital, visit or call 832.556.6046.


Accidental or involuntary urination is often a symptom of other urologic disorders. Stress incontinence may occur while walking, jogging, laughing, coughing or during other normal activities. Urge incontinence, or overactive bladder, causes an immediate need to urinate. Overflow incontinence is the result of an overfull bladder, often without the urge to urinate. Men with prostate problems, including enlarged prostate, also known as benign prostatic hyperplasia (BPH), are at increased risk of urge and overflow incontinence. Neurological conditions, such as Parkinson’s disease, stroke or multiple sclerosis, may interfere with nerves involved in bladder control. PREVENTION: While not always preventable, your risk may be reduced by maintaining a healthy weight and avoiding bladder irritants, such as caffeine, alcohol and acidic foods, and avoiding or quitting smoking. TREATMENT: Making dietary changes, performing exercises to strengthen the pelvic floor muscles, medications, including alpha blockers, and surgery to remove excess prostate tissue, may be recommended.


Difficulty in getting and maintaining an erection is known as erectile dysfunction, or ED. Experiencing ED periodically is often nothing to worry about, but if it happens frequently, talk to your doctor, as it could be a sign of other health problems. “Many factors can contribute to ED, including high blood pressure, diabetes, kidney disease and prostate cancer, as well as psychological causes, including stress, depression and anxiety,” Tojuola explained. PREVENTION: Maintain a healthy weight to avoid diabetes; get screened regularly for high cholesterol and high blood pressure; quit smoking; and drink alcohol in moderation (two drinks a day for men) or not at all. TREATMENT: Options range from medication to testosterone replacement. In severe cases, surgical options, including penile pumps and implants, and blood vessel surgery may be needed.


An inflammation of the prostate caused by a bacterial infection, prostatitis is a common condition that can lead to difficulty passing urine, sexual problems and more.

PREVENTION: It is unknown whether the condition is preventable, but seeing your doctor promptly if you have symptoms, drinking plenty of water and avoiding bladder irritants, such as alcohol or caffeine may help. TREATMENT: Depending on whether prostatitis is acute or more chronic in nature, antibiotics may be prescribed. Anti-inflammatory medication and medication that relaxes muscle tissue to ease urine flow may also be recommended.


For most men, prostate cancer — a slow-growing cancer that develops in the prostate gland — will never cause symptoms or pose a health risk. However, symptoms, such as a frequent urge to urinate (especially at night), pain when urinating and blood in the urine or semen, may signal an advanced stage of prostate cancer. PREVENTION: Eating a low-fat diet with lots of fruits and vegetables, and getting regular exercise may be the first line of defense against prostate cancer. TREATMENT: Options depend on where the cancer is located or if it has spread, as well as your age and your overall health. “Discuss treatments with your doctor before making a decision, as some treatments have potentially severe side effects,” Tojuola said. “Careful monitoring (watchful waiting), surgical removal of the prostate, radiation and testosterone-blocking hormone therapy may be options.”





Houston Methodist San Jacinto Hospital 4401 Garth Rd. Baytown, TX 77521-2122






JOINT PAIN We can help you get there.

Conroe The Woodlands

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

Memorial City Bellaire



Texas Medical Center Pearland Sugar Land

Clear Lake

Schedule an appointment to discuss your options with a joint specialist. Houston Methodist Orthopedics & Sports Medicine at Baytown 4201 Garth Road, Suite 111 | Baytown, TX 77521 | 281.427.7400

Leading Medicine Spring Summer 2018, Houston Methodist San Jacinto Hospital edition  

Read about nonalcoholic fatty liver disease (NAFLD) and its risk factors, five reasons NAFLD should be taken seriously, common signs and sym...

Leading Medicine Spring Summer 2018, Houston Methodist San Jacinto Hospital edition  

Read about nonalcoholic fatty liver disease (NAFLD) and its risk factors, five reasons NAFLD should be taken seriously, common signs and sym...