Leading Medicine Winter 2018, Houston Methodist Sugar Land Hospital edition

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FIGHT BACK AGAINST COLON CANCER A LOOK AT STROKE IN YOUNGER PATIENTS

WHY WOMEN SHOULD LISTEN TO THEIR HEARTS Symptoms can vary when compared to men

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN FORT BEND AND SURROUNDING COUNTIES

MAKE YOUR PLAN FOR LOSING WEIGHT IN 2018

L Dr. Nabil Tariq

osing weight doesn’t have to mean daily trips to the gym and a strict calorie allotment. Sometimes what you need is to simply create healthy, sustainable changes in your daily life.

Dr. Nabil Tariq, bariatric surgeon with Houston Methodist Surgical Associates, helps patients discover new ways to lose weight and keep it off.

“With the right plan and support, you can make changes to improve your health,” Tariq said.

SMALL CHANGES ADD UP

Here are five small steps to help with weight loss: EAT SLOWLY Eat your meals more slowly and without distraction, such as watching TV. Your body will be better able to pick up on signals from your brain that you are full, which will help you eat less.

WATCH PORTION SIZE Trick yourself into easy portion control by using smaller plates, bowls and silverware, making it appear as though you’re eating more than you actually are. If you work, prep your meals. Most of the food available at a workplace is high calorie and high fat and you can really cut down on calories if you bring your own healthy meal. It will likely taste better too.

EMPHASIZE PROTEIN AND FIBER Reaching for protein or fiber-filled foods, like chicken or apples, can help you feel satisfied for longer than with other foods. Incorporate more plant-based proteins in your diet like chickpeas, beans and lentils. They have fiber and protein and have minimal to no fat in them.

DRINK PLENTY OF WATER It’s calorie-free and helps you feel full so you’ll eat less, but don’t skip meals — skipping meals can lower your metabolism and lead you to make poor food choices when you get very hungry.

ADD MOVEMENT TO YOUR DAY Physical activity burns calories and boosts your mood. If you’ve never exercised before, start slow.

Try going for a brisk walk every day, and work up to 30 minutes of moderate exercise three or more days a week. Try using a free app on your phone to count your steps. It can help motivate you and help you set progressively higher targets.

SURGICAL OPTIONS

“If diet and exercise alone haven’t resulted in permanent weight loss, you may benefit from weight management services,” Tariq said. Houston Methodist offers several weight-loss surgery options to patients with a body mass index (BMI) of 40 and higher, or a BMI of 35 or higher with obesity-related health conditions, such as type 2 diabetes and obstructive sleep apnea.

Types of bariatric surgeries we offer include gastric sleeve and gastric bypass procedures.

“Weight-loss surgery is a powerful tool,” Tariq said. “However, surgery alone can’t do it all. Patients still need to make healthy lifestyle changes to succeed long term.We can help them do that.”

Talk with your doctor to learn if weight-loss surgery is a good option for you.

Get Support for Weight Loss

Visit houstonmethodist.org/weight-management or call 832.667.LOSE (5673) to register for weight-loss surgery orientation sessions or to learn more.

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BENEFITS OF WEIGHT-LOSS SURGERY

Studies show that those who have weight-loss surgery experience several health benefits: 1 Lowered heart disease risk 2 Less risk of colon, breast, endometrial, kidney and esophageal cancers 3 Decreased risk of diabetes 4 Increased ability to become pregnant 5 Less sleep apnea 6 Less heartburn

JOIN US FOR A BARIATRIC SEMINAR Thursday, Feb. 8 at 6 p.m.

Brazos Pavilion Conference Center Join Dr. Nabil Tariq for a bariatric seminar to learn about the common types of weight-loss surgery and find out if bariatric surgery is right for you. Registration is required. Visit events.houstonmethodist.org/bariatric-sl or call 281.205.4514 for more information or to register.

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FIGHT BACK AGAINST

COLON CANCER

C Dr. Ali Mahmood

olorectal cancer is the third most common cancer diagnosed in men and women in the United States. It is the third leading cause of cancer-related deaths in women in the U.S. and the second leading cause of death in men. The good news is colorectal cancer is also highly treatable when caught early, and in some cases, even preventable. Here’s what you need to know to protect yourself.

TAKE AN ACTIVE APPROACH

According to Dr. Ali Mahmood, a board-certified colorectal surgeon with Houston Methodist Surgical Associates, being aware of the signs of colorectal cancer can make all the difference when it comes to your health. “Paying attention to just a few areas can dramatically cut your risk of colon cancer as well as improve your overall health,” he said. Here are some specific steps he recommends.

Add more vegetables, legumes, fruits and whole grains to your plate to cut fat and boost fiber intake. “Studies show that fiber helps by keeping the digestive process moving so cancercausing wastes spend less time in the colon,” Mahmood said.

Take a 30-minute walk just three times a week to help lower your risk significantly, and reduce your risk for other diseases.

Limit your alcohol intake to no more than two drinks a day — drinking more than that may contribute to your risk of getting cancer.

Take steps to stop smoking, which plays a role in 30 percent of all cancers.

EARLY DETECTION IS KEY

“Everyone should get screened for colon cancer at age 50,” Mahmood urged. “If you’re at high risk, talk to your doctor about possibly getting screened earlier and more often.”

You may be at higher risk if you: Have a family history of colon cancer Have a family or personal history of polyps Suffer from ulcerative colitis or Crohn’s disease Eat a high-fat, low-fiber diet Are 50 or older A colonoscopy is the gold standard. “During a colonoscopy, your doctor looks inside the colon using a special camera (colonoscope) that can diagnose and treat polyps when they are detected,” Mahmood said. “People who get screened regularly greatly reduce their risk of developing colorectal cancer.”

Ensure early detection by reporting any of the following symptoms to your doctor: Rectal bleeding Blood in the stool

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COLORECTAL CANCER SEMINAR Thursday, March 22 at 6 p.m.

Brazos Pavilion Conference Center Join Dr. Ali Mahmood, colorectal surgeon, and Dr. Nitesh Vichhani, gastroenterologist, to learn more about colorectal cancer and take home a free colorectal cancer screening kit. Registration is required. Register at events.houstonmethodist.org/colorectal-sl or call 281.205.4514.

Request an Appointment

To request an appointment with Dr. Ali Mahmood with Houston Methodist Surgical Associates, call 281.242.3300.

A change in bowel habits, including diarrhea and constipation Unexplained weight loss Anemia (low blood count) Fatigue

Sidestepping Deep Vein Thrombosis D

o you have pain and swelling in your lower leg or thigh? This could be a sign of a blood clot deep in your leg.

If ignored, the clot could damage your leg and possibly lead to serious heart and lung complications. Fortunately, this condition — called deep vein thrombosis (DVT) — is treatable, but early diagnosis is paramount.

Dr. Ulises “A blood clot can break away from its location Baltazar in the leg and travel to the lungs,” warned Dr. Ulises Baltazar, a board-certified vascular surgeon with Houston Methodist Cardiovascular Surgery Associates.

“Once there, it may block a lung artery and cause a potentially fatal pulmonary embolism. Patients diagnosed with DVT must be hospitalized promptly to receive treatment and avoid complications.”

PREVENT DVT WHEN TRAVELING

Sitting for long periods of time, either in an airplane or a car can limit circulation in the legs, leading to a clot forming in the vein. The clot can travel unnoticed through the blood stream and potentially lodge in the brain, lungs, heart and other areas causing severe damage to organs.

You can avoid DVT when traveling by getting up and walking around at least every two hours, and try not to sleep more than four hours at a time in an airplane or car. If you can’t get up every couple of hours, extend both legs and move feet back and forth in a circular motion periodically. For people with circulation problems, or the elderly, wearing compression stockings may help, too.

BLOOD CLOT CAUSES

“DVT can run in families, but many times these clots form for no apparent reason,” Baltazar said. “What we do know is that men and women of all ages and races can be at risk for a blood clot.”

Risk factors for DVT include: Obesity Inactivity An above-normal tendency for blood to clot Recent surgery Heart attack A recent hip or leg fracture Pancreatic and certain other cancer treatments in which blood-clotting agents form in the bloodstream

SIGNS OF DVT

The onset of DVT is usually marked by inflammation and swelling of the leg as well as redness, pain, tenderness and a sensation of heat radiating from the location of the clot.

VEIN SEMINAR Thursday, Jan. 25 at 6 p.m.

Brazos Pavilion Conference Center Join us for a vein seminar presented by Dr. Ulises Baltazar, who will be speaking on problems with blood flow in the legs: the causes, symptoms, who is at risk, treatments and prevention. Registration is required. Go to events.houstonmethodist.org/vein-sl or call 281.205.4514 for more information and to register.

Could You Have DVT?

If you’re concerned that you may have DVT or other vein problems, don’t wait to get help.

Call Houston Methodist Cardiovascular Surgery Associates at 281.240.8400 to make an appointment with Dr. Baltazar.

“Once DVT is diagnosed, usually through a simple scan at our Vein Clinic, a blood-thinning agent called heparin is given intravenously to keep the clot from getting bigger,” Baltazar said.

“Eventually the body will dissolve the clot, and once that happens, an anti-clotting medication called warfarin is given to keep the clot from re-forming.”

Warfarin therapy usually lasts from three to six months, but the dosage levels occasionally need adjusting. Too much warfarin causes patients to bruise easily and bleed profusely, even from minor cuts.

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WHY WOMEN SHOULD LISTEN TO THEIR HEARTS Symptoms can vary when compared to men

New High Blood Pressure Guidelines

Are you at risk?

The American College of Cardiology and American Heart Association released new scientific guidelines on what’s considered high blood pressure, lowering the threshold from 140/90 mmHg to 130/80 mmHg. Recommendations focus on making healthy lifestyle changes to lower blood pressure, including quitting smoking, managing weight, being active and eating a heart-healthy diet. Some patients may also need medication.

The new blood pressure categories consider both systolic (top number) and diastolic (bottom number) pressure.

Normal: Less than 120/80 mmHg levated: Systolic between 120–129 and diastolic E less than 80 mmHg igh Stage 1: Systolic between 130–139 or diastolic H between 80–89 mmHg igh Stage 2: Systolic at least 140 or diastolic at least H 90 mmHg Talk to your doctor to learn if you’re at risk and how you can protect your heart.

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D

espite the perception that heart disease is a man’s disease, it’s the No. 1 killer of women, according to the American Heart Association.

Millions of women die of Dr. Kesavan heart disease every year, Shan yet many are unaware of their risk for the condition. Women often put off taking care of their health — and this inaction can put an extra burden on their hearts.

One form of heart disease, a heart attack, can strike suddenly and with no advance warning. Just like men, women often experience the crushing chest pain and discomfort typically associated with a heart attack. However, women are somewhat more likely than men to experience other common heart attack symptoms and often ignore them.

“A misunderstanding of gender-related heart attack symptoms could cause women to delay getting care because they aren’t sure if they’re having a heart attack, panic attack or indigestion,” according to Dr. Kesavan Shan, a board-certified cardiologist with Houston Methodist Cardiology Associates.

“It’s key to learn and watch for signs that something may be wrong — and if you’re ever in doubt, don’t hesitate to seek prompt medical care.”

Use these heart health facts for women to bolster your prevention and treatment efforts:

HOW A WOMAN’S HEART ATTACK MAY FEEL

You may already be familiar with classic heart attack symptoms for men, such as crushing chest pain that radiates down the left arm associated with sweatiness, paleness and shortness of breath. “Women are more likely than men to describe chest pain that is burning and sharp as well as experience extreme fatigue, pain in the neck, jaw, throat, abdomen or back,” Shan said.

“Breaking out in a cold sweat is also more common in women, as is lightheadedness,” Shan explained.

RISK FACTORS OFFER CLUES

Managing your risk factors for cardiovascular disease is only possible if you know what they are, and routine screening tests can reveal the answers.

At your next checkup, ask your doctor to

assess your weight and BMI (body mass index), waist circumference, blood pressure, cholesterol and fasting blood glucose level. “These tests offer important clues to cardiovascular health as well as your overall health,” Shan said.

HEART ATTACK NOT SOLE SETBACK

With all the focus on heart attacks, some aren’t aware that cardiovascular disease can take many forms. Other heart problems include heart failure, in which the heart isn’t pumping as efficiently as it should; arrhythmia, a too-slow or too-fast heartbeat that can affect its ability to meet the body’s needs; and heart valve problems, which can impede proper blood flow through the heart.

Nearly all of these conditions are easily detectable with routine medical checkups,” Shan said. “It’s yet another reason why establishing an ongoing relationship with a primary care physician is so critical to your heart health.”

MENOPAUSE TOO LATE TO PREPARE

Women with heart disease risk factors, such as high blood pressure, high cholesterol and a family history, shouldn’t wait until menopause to start a dialogue with their primary care physician about a prevention regimen to keep them healthy. A recent survey published in the Journal of the American College of Cardiology found that 74 percent of women in the United States had at least one heart disease risk factor, but only 16 percent told their doctor about it.

“Women have such a low prevalence of heart disease until menopause that often times, the topic is ignored until women are well into their 50s and 60s,” Shan said.

“But those with risk factors need to be 10 years ahead of the game when it comes to prevention. Unfortunately, too many women already have heart disease by the time they’re tested.”

SCHEDULE AN APPOINTMENT

To schedule an appointment with Dr. Kesavan Shan at Houston Methodist Cardiology Associates, call 713.776.9500.

LEARN ABOUT YOUR FAMILY HEALTH HISTORY The role of genetics and family history is becoming increasingly clear when evaluating our risks of developing heart disease, said Houston Methodist cardiologist Dr. Kesavan Shan.

“That’s why it’s imperative to delve into your family tree and determine what your ancestors died from — especially if they died at a young age — as well as what your family members may be living with right now,” Shan emphasized. “Take the time to sit down with family elders and ask questions about what led to Great-Uncle Henry’s and Grandma Mary’s deaths, for example. The answers may surprise you.”

If you learn that heart disease runs in your genes — especially through several generations — share that information with your doctors. They may recommend certain dietary or lifestyle changes, prescribe medications, and/or perform various heart disease screening tests earlier or more frequently. You may also be referred to a cardiologist for regular care.

Heart Health Screenings Thursday, Feb. 22 at 6 p.m.

Brazos Pavilion Conference Center Schedule an appointment to learn your 10-year risk for heart disease and receive cholesterol and blood pressure screenings.

Registration is required.

Register online at events. houstonmethodist.org/ heart-sl or call 281.205.4514.

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A LOOK AT STROKE IN YOUNGER PATIENTS Me? At risk for stroke? No way!

S

troke is often considered a condition that almost exclusively strikes older people. Although people over 50 still comprise the vast majority of stroke patients, research findings published in 2016 in the Journal of the American Heart Association suggest a disturbing trend that indicates an increase in stroke in younger age groups.

Dr. Rony Ninan “When people think of stroke, they think of grandpa who smokes and has hypertension,” said Dr. Rony Ninan, a board-certified neurologist at the Houston Methodist Neuroscience & Spine Center at Sugar Land, “And while he certainly carries a higher risk of stroke, it doesn’t mean that if you’re young and healthy you can’t be at risk of stroke, too.”

BE ALERT TO THE RISKS

Research indicates that 10 percent of all ischemic strokes (the most common type of stroke) now occur in adults under age 50. U.S. researchers attribute the apparent rise in strokes among younger adults to many of the same lifestyle risk factors commonly found in older patients: high blood pressure, obesity, high cholesterol levels, diabetes and smoking.

Ninan said younger patients may have additional stroke risk factors, such as congenital or structural heart defects or injuries to the arteries in the neck possibly caused by even minor trauma. Another factor may be illicit drug use, including abuse of substances like cocaine and methamphetamines. Young

8 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

people with blood coagulation defects or conditions, such as sickle cell disease, are more susceptible to stroke, and the risk also increases if they have developmental anomalies of the blood vessels of the brain.

TAKE STEPS TO PROTECT AGAINST STROKE

While the symptoms of stroke are the same for both older and younger adults (see “The FAST Test”), people may not readily recognize the symptoms in younger patients, which may lead to a delay in diagnosis that can cause permanent damage.

Ninan said young adults should be aware of their stroke risk factors and the importance of maintaining a healthy weight, avoiding smoking and scheduling regular blood pressure, cholesterol and diabetes screenings.

THE FAST TEST

Stroke Seminar

F A S T Face

Arms

Speech

Time

The “FAST” test from the National Stroke Association may help you determine if someone is having a stroke: Face: Ask the person to smile. Does one side of the face droop?

Thursday, May 3 at 6 p.m.

Brazos Pavilion Conference Center Join Dr. Rony Ninan to learn about stroke which is the fifth leading cause of death in U.S. and the leading cause of disability. Dr. Ninan will discuss prevention, symptoms and risk factors and answer your questions. Registration is required. To register, visit events.houstonmethodist.org/stroke-sl or call 281.205.4514.

Arms: Does one arm drift downward when you ask the person to raise both arms?

Speech: Can he or she repeat a simple sentence correctly? Are the words slurred?

Time: If a person shows any of these symptoms, call 911 immediately. Carefully note the time when the first symptoms appeared. This information is critical for treatment decisions.

SCHEDULE AN APPOINTMENT

To schedule an appointment with Dr. Rony Ninan or another specialist at our Houston Methodist Neuroscience & Spine Center at Sugar Land, call 281.205.4662.

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Reasons Your BACK HURTS

And how to stop the pain

Y

our back is a feat of biological engineering: More than 33 vertebrae form the column that runs from skull to tailbone; between each is a cushiony disk, all held together by a web of ligaments and muscles. With all those moving parts, plenty can go wrong.

“Back pain is incredibly common, especially Dr. Jeffrey Wood as we age,” said Dr. Jeffrey Wood, a boardcertified orthopedic spine surgeon at the Houston Methodist Neuroscience & Spine Center at Sugar Land.

“Fortunately, we can treat most cases of back pain without surgery.”

Below are some of the most common causes of back pain.

1

2

eavy lifting or improper sports or exercise techniques.

H Repeated lifting or simply an awkward movement could cause a muscle or ligament strain.

3 4 5 6

Bad posture. Sit at a desk all day? If you’re hunched over papers or using a chair with little support, your back bears the brunt of it.

Herniated disk. The vertebrae in your spine are cushioned by disks between each bone. When the soft material inside bulges or ruptures, it can cause pain by pressing on a nerve.

Scoliosis. Adults experience pain from scoliosis (a sideways curve in the spine) when an existing curve worsens with age or a new curve develops.

Arthritis. In its most common form, osteoarthritis, the cartilage breaks down around joints, making movement painful.

Osteoporosis, thinning of the bones, predisposes a person to fractures. Compression fractures may cause pain when bones become brittle and porous.

FINDING RELIEF

Minor back problems — primarily those associated with strains or spasms — can be successfully treated at home with a combination of hot and cold compresses, rest and antiinflammatory medications.

“Although you may be tempted to spend a few days recuperating in bed, movement is actually better for your pain,” Wood said.

“Try to keep up with your regular activities.”

If your pain is debilitating, a spine specialist can perform an exam to help determine the source of your discomfort and prescribe a treatment plan that may include medications, physical therapy or injections to relieve pain. In severe cases, surgery may be needed.

“At our Neuroscience & Spine Center, doctors work together to get you back to a pain-free life,” Wood added. We offer expedited appointments, including second opinions, with our renowned specialists.

FREE BACK AND NECK PAIN SEMINAR Thursday, April 12 at 6 p.m.

Brazos Pavilion Conference Center Dr. Jeffrey Wood will discuss causes, the latest treatment options and prevention. Registration is required. Register at events.houstonmethodist.org/ backpain-sl or call 281.205.4514 to reserve your spot.

Find Out What’s Causing Your Pain

To schedule an appointment with Dr. Jeffrey Wood or another specialist at the Houston Methodist Neuroscience & Spine Center at Sugar Land, email neuroscience@houstonmethodist.org* or call 281.205.4662. * Please note that email is not a secure means to communicate confidential or health-related information, including Social Security number, date of birth, financial information, etc.

10 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

Help for Chronic

HEADACHES A Dr. Carisa Liew

ccording to the World Health Organization, 1 in 20 adults has a headache every day. Dr. Carisa Liew, a neurologist with Houston Methodist Neuroscience & Spine Center at Sugar Land, wants headache sufferers to know that an effective therapy plan can help. “It’s a misconception that it’s OK to just live with headaches. They’re a major cause of missed time at work and school, and can affect many areas of your life,” she said.

UNDERSTANDING YOUR HEADACHE

People can be affected by different types of headaches, such as migraines, tension headaches and cluster headaches.

Migraines typically

Tension headaches typically

Cluster headaches typically

ffect one A side of the head

Wrap around the head

Affect one side of the head

Create throbbing and pounding pain

Cause pressure or tightness (nonthrobbing pain)

Cause sharp, stabbing pain over the temple or behind the eyes

Are associated with light or sound sensitivity

Tend to come on later in the day

Come in a cluster, often several times a day, for a period of time and then disappear

ause nausea C or vomiting

Are not associated with nausea or vomiting

May cause nasal congestion, watery eyes and flushing of the forehead and face on the same side as the headache

reate visual C auras, such as kaleidoscope vision

May be associated with stress and fatigue

Cause sudden onset of pain that may awaken you from sleep

Liew sees another type of headache known as a medication overuse headache, also known as a rebound headache. “Many patients develop worsening headaches over time partially due to too frequent use of pain medications,” she explained. “If you take pain medication for headaches often, and the headache returns, you might be experiencing a medication overuse headache.” Your doctor can help you manage the dosages and frequency of any prescription and over-the-counter medications you take to avoid medication overuse.

SPECIALIZED TREATMENT FOR BETTER RESULTS

When it comes to headaches, finding the right treatment for your unique symptoms is vital. A neurologist is trained to identify your headache and offer treatments for your specific needs.

Treatment options are diverse and include over-the-counter and prescription medications, dietary supplements, noninvasive medical devices, cranial nerve blocks, BOTOX® injections, infusions, psychological techniques and physical therapies.

Prior to your appointment, it’s a good idea to keep a headache diary for several weeks, jotting down details about each headache’s onset. It may offer important clues to what may be triggering your headaches — a major step in preventing the pain.

Get Relief

If you’re suffering from headaches, we can help. To schedule an appointment with Dr. Carisa Liew or another specialist at our Houston Methodist Neuroscience & Spine Center at Sugar Land, call 281.205.4662.

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