Leading Medicine Winter 2019, Houston Methodist Sugar Land Hospital edition

LEADING MEDICINE W INT ER 219

PATHWAY TO HEALING Comprehensive Wound Care Personalized For You

Strength in Numbers:

LOSING WEIGHT TOGETHER Joint Surgery Requires a Joint Effort YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN FORT BEND AND SURROUNDING COUNTIES

NEWS & EVENTS

JOIN US FOR A WEIGHT-LOSS SEMINAR

Thursday, Feb. 7 at 6 p.m.

Brazos Pavilion Conference Center Join Dr. Nabil Tariq for a weight-loss seminar to learn about the different programs offered at the Houston Methodist Weight Management Center, get tips on grocery shopping and meal planning, and speak with a dietitian, exercise specialist and bariatric surgeon. Registration is required.

Visit events.houstonmethodist.org/weightloss-sl or call 281.205.4514 for more information or to register.

LOSE WEIGHT

Extra weight puts more pressure on your knees than you may think. It’s estimated that for every extra pound we carry, we add 4 pounds of pressure to our knees. That means a loss of even 10 pounds can relieve 40 pounds of pressure.

By staying within a healthy body mass index (BMI) range, usually from 18.5 to 24.9, you can prevent extra wear on your knees and ankles. Read more about ways to lose weight together on pages 6-7.

HEART HEALTH SCREENINGS

Thursday, Feb. 21 from 5-7:30 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.

WEDNESDAY, APRIL 17 6 P.M.

BACK AND NECK PAIN SEMINAR

Brazos Pavilion Conference Center Orthopedic spine surgeon Dr. Jeffrey Wood and interventional pain management specialist Dr. Christian Peccora will discuss causes, latest treatment options and prevention. Registration is required. Register at events.houstonmethodist.org/ backpain-sl or call 281.205.4514 to reserve your spot.

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DIGESTIVE HEALTH SEMINAR

Thursday, March 21 at 6 p.m.

Brazos Pavilion Conference Center You no longer need to suffer in silence. Join us for a digestive health seminar led by Dr. Charles Phan, gastroenterologist, and Dr. Kirtan Nautiyal, hematologyoncology, who will discuss acid reflux, chronic GERD, irritable bowel syndrome (IBS) and gastrointestinal cancer. Registration is required. Register online at events.houstonmethodist.org/digestive-sl or call 281.205.4514.

DID YOU KNOW? The American Cancer Society (ACS) recently updated its colorectal screening guideline, reducing the recommended age for regular screening from 50 to 45 for individuals with average risk of colorectal cancers. Colorectal cancer is the third most common cancer diagnosed in men and women in the U.S. 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. Get screened for colon cancer.

Schedule your appointment today with Dr. Charles Phan or another gastroenterologist in your area by calling 281.205.4514.

HOW TO GET

PAST THE PAIN

A

Dr. Marvin Chang

re you resigned to living with nagging aches or debilitating pain? Here’s why you shouldn’t: Whether caused by arthritis, injury, cancer or headaches, chronic pain is a problem for millions of people its not just a symptom.

Chronic pain is a recognized disorder — one that can frequently be managed with a combination of pain-management techniques.

SELF-CARE FOR PAIN

“Often, stimulating the painful area can ease discomfort,” said Dr. Marvin Chang, a board-certified interventional pain specialist with the Houston Methodist Neuroscience & Spine Center at Sugar Land. Effective treatments include: H eat and ice. Stiff muscles can benefit from heat in the form of warm showers or hot packs. Cold packs can also help by numbing pain-sensing nerves in the affected area. Always place a towel between your skin and the source of heat or cold for no longer than 20 minutes.

Exercise. Besides strengthening muscles, improving stamina and promoting a positive attitude, exercise increases the amount of endorphins (natural painkillers produced by the brain) your body releases.

Acupuncture and acupressure. Both cause the brain to release endorphins by stimulating nerve endings. Acupuncture uses special needles inserted at specific points. Acupressure is direct pressure applied to trigger areas.

“When pain can’t be completely eliminated, learning how to control it can be key to helping people resume normal, active lives,” Chang said. These therapies may help.

R elaxation training. Meditation, deep-breathing exercises and visualization techniques can release muscle tension and distract you from the pain.

B iofeedback. You can manage your pain by learning to control your heart rate and other bodily functions with the help of a special machine.

Physical therapy.

INTERVENTIONAL PAIN MANAGEMENT

When pain can’t be controlled with self-care, interventional pain management strategies may be key to helping people resume their active lives. These procedures may help.

E pidural steroid injections deliver powerful anti-inflammatory medication directly to irritated nerve roots.

R adiofrequency denervation (also called neuroablation) uses an electrode to heat up painful nerves and stop the transmission of pain messages to the brain.

P ain pumps and electrical stimulation may be appropriate for pain that fails to respond to all other treatment.

ASK ABOUT OTC MEDICATIONS

Talk to your doctor about taking over-the-counter (OTC) medications, such as acetaminophen, aspirin or ibuprofen to relieve pain. Find out how — and if — these medications can work with your pain-management plan.

PHYSICAL THERAPY CAN HELP EASE PAIN Personalized physical therapy can effectively ease pain, promote mobility and enhance function after an injury or surgery.

At Houston Methodist Sugar Land Hospital, our highly skilled therapists use evidence-based treatments and advanced equipment to help you return to a productive lifestyle. Choose from three convenient locations in Fort Bend County.

Visit houstonmethodist.org/therapy-sl for more information or call 281.274.0123 to schedule.

Schedule Today

Visit houstonmethodist.org/neuro-sl to request an appointment online with one of our Neuroscience & Spine Center specialists or call 281.205.4662.

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A Guide for EXPECTANT MOMS Getting over the pregnancy hump.

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ike many of life’s milestones, pregnancy comes with its own challenges. If you’re having trouble keeping your meals down or figuring out how to get Dr. Lorelei a good night’s sleep Capocyan between trips to the bathroom, there’s hope. There are practical ways to ease your discomfort and enjoy this special time.

MORNING SICKNESS: Don’t be misled by the inaccurate name. Morning sickness can strike at anytime of day.

“Fortunately, the nausea and vomiting that commonly occur during the first 12 to 14 weeks of pregnancy rarely interfere with proper nutrition,” said Dr. Lorelei Capocyan, a board-certified obstetriciangynecologist at Houston Methodist Sugar Land Hospital.

What you can do: Eat smaller, more frequent meals throughout the day, and drink plenty of fluids. Avoid overfilling your stomach during meals by limiting your fluid intake while eating. If sickness is worse in the morning, eat a few crackers and sip herbal tea before you slowly rise out of bed. If the sight or smell of a particular food makes you feel sick, avoid it completely. Don’t be surprised if it’s a food that never bothered you before.

Bonus: Your new eating strategy will also help combat heartburn, another pregnancy-related difficulty. Also, avoid bending over or lying down abruptly.

“If heartburn continues to be a problem, ask your doctor to prescribe an antacid, but don’t take one — prescription or not — without his or her consent,” Capocyan said.

CONSTIPATION: Crowding and pressure from a growing uterus can be hard on your intestines. Not surprisingly, half of all pregnant women suffer from constipation, and those who experienced it before pregnancy are more susceptible.

What you can do: Filling up on fiber — bran, fresh and dried fruits, raw or lightly cooked vegetables like broccoli or spinach, whole-grain products — is a delicious and healthy strategy for mom and baby. “Daily exercise stimulates bowel activity and keeps food moving through the intestines,” Capocyan explained.

Bonus: Keeping constipation at bay is a surefire way to prevent hemorrhoids — varicose veins of the rectum. If you develop the painful condition, try witchhazel soaks and avoid straining during a bowel movement. Don’t use over-thecounter medications without consulting your doctor.

BACKACHE: During pregnancy, the joints in your pelvis begin to soften to start making room for your baby to pass through, and your expanding uterus causes your center of gravity to shift.

Before you know it, you’re walking like a duck, belly thrust forward, back curved.

Usually the result is back pain.

What you can do: Practice good posture. Keep your bottom tucked under and your shoulders back. Sit with your feet slightly elevated, and avoid standing for long periods. If you must stand, prop one leg on a footstool. Lift by bending at the knees, not at the waist, and push up with your thighs, not your back. Avoid sudden, jerking movements, which can lead to muscle strain. A maternity girdle may offer relief, as well as massage, a heating pad and proper back-strengthening exercises.

4 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

Wear low-heeled, well-fitting shoes that provide support.

Bonus: Being aware of your posture now will help after baby is born. To avoid back, neck or shoulder pain, be mindful when lifting your growing baby in and out of places like the crib and car seat.

SLEEP DEPRIVATION: A bulging belly often means giving up your favorite sleeping position and making frequent nighttime visits to the toilet. Before long, it will be crying and 2 a.m. feedings disrupting your nights.

What you can do: If you normally sleep on your back or stomach, practice a new position — sleeping on your side (curled up or stretched out, it doesn’t matter) — before you’re forced into it. Sometime in your second or third trimester, you may need the support of a pillow to sleep comfortably. Try placing a pillow between your legs and crossing one leg over the other or using a rolled-up pillow behind your back or curling up in an oversized body pillow.

LEG CRAMPS: These are another nighttime annoyance. To keep painful leg cramps at bay, do calf-stretching exercises and avoid pointing your toes while stretching.

What you can do: Counter a cramp by straightening your leg and flexing your foot toward your nose. “Enjoy foods that contain magnesium, such as beans, dried fruits, nuts and seeds and whole grains. And ask your doctor if you should take a magnesium supplement,” Capocyan added.

MORE THAN A LITTLE DISCOMFORT Sometimes pregnancy-related symptoms signal trouble. Call your doctor right away if you experience: Blurred vision Burning upon urination Clear liquid vaginal discharge Clot-like vaginal discharge Cramping Extreme thirst Fainting Fever or chills Severe back or side pain Severe headache lasting longer than two hours Swollen face or fingers Vaginal bleeding W eight gain of more than two pounds in a 24-hour period

Here for You and Your Baby

Come see our facility and meet our dedicated nursing staff. We’re here to help you feel prepared and comfortable every step of the way. Sign up for a tour of our Childbirth Center or for one of our childbirth classes.

We also offer breastfeeding, infant CPR and first aid, prepared childbirth (available in both English and Spanish) and sibling classes. To schedule a tour or to sign up for one of our classes, visit houstonmethodist.org/ events or call 281.205.4514.

Visit houstonmethodist.org/childbirth-sl for more information about delivering at Houston Methodist Childbirth Center at Sugar Land.

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STRENGTH IN NUMBERS:

Losing Weight Together

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aybe it feels like you’ve tried everything to lose weight. But have you unleashed the power of your family and social network? Research Dr. Nabil Tariq suggests that people have a higher likelihood of losing weight when they team up with a friend or family member to adopt healthy behaviors. More research is needed to understand the power of community and its effects on weight loss, but it’s clear that friends and family have a strong influence in this area.

“When people decide to make a committed step to change their lives, it definitely has ripple effects on their relationships,” said Dr. Nabil Tariq, boardcertified bariatric surgeon at Houston Methodist Sugar Land Hospital. If you’re planning to lose weight and considering weight-loss surgery or needing a new outlook on weight loss, partnering can improve your odds of reaching your

Get Started Jump-start your weight loss by attending a free orientation at Houston Methodist Weight Management Center at Sugar Land. We can answer questions about our medical weight management, StepLITESM and surgical weight-loss programs to help you get started.

Visit houstonmethodist.org/ weight-management or call 832.667.LOSE (5673) to register.

goals. Weight loss with a partner provides motivation, support and even a little healthy competition.

1 MOTIVATION

“Motivation is often tied to experiences with our loved ones,” said Tariq. “We want to be there for the big moments in life, and we want to go places and enjoy time together. Whatever your motivation to lose weight, you can put more power behind it when your loved ones know what you’re fighting for.”

Picture this: A busy mom wants to lose weight so she can set a healthier example for her kids. The changes she makes with nutrition and exercise have an impact on her whole family. Try it: Keep a visual reminder, such as a family photo, vacation destination, etc. in a special place so you can stay motivated when you need it.

2A STRONG SUPPORT SYSTEM

“When you embark on this journey together with family members or friends, you have a built-in support system,” Tariq said. “For anyone considering weight-loss surgery, it’s a big decision and a lifelong commitment that affects everyone you are close with. Having a great support system can amplify the benefits of surgical weight loss.”

Picture this: A husband struggling to lose weight on his own decides to explore weight-loss surgery. He signs up for an informational session. Try it: A spouse can provide mental and emotional support by attending the orientation session, going to appointments and committing to a mutually changed lifestyle after surgery.

3EAT BETTER TOGETHER

Changing the way you eat starts with meal planning, grocery shopping and a commitment to cooking meals at home.

“Food is central to our day-to-day life and

6 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

family interactions, so it’s vital to involve others in your life when making significant dietary changes,” Tariq said.

Picture this: A mother and daughter both had weight-loss surgery about six months apart. Planning meals and cooking together helped them adjust to their new diet plan. Try it: Attend a healthy cooking class or nutrition class with friends or family members.

4TEAM UP FOR EXERCISE

Being active together and exercising regularly is the key to success with weight loss. “Having someone else to hold you accountable might be exactly what you need to show up and challenge yourself more than you would when working out alone,” Tariq added.

Picture this: Two friends who played football in high school gained a lot of weight in their 20s and 30s. After one friend started a new exercise program, the other friend joined, too and they both lost weight. Try it: Transform couch time into something more active. Meet at the gym to watch your favorite TV shows while walking on a treadmill, or throw a football around before watching the game on TV.

5TRACK YOUR PROGRESS

Keeping track of total pounds and inches lost as a group can be highly motivating. “Also seeing health numbers improve and high blood pressure, cholesterol and blood sugar go down is our top priority,” Tariq said. “It’s really about achieving a better quality of life and a better state of health.”

Picture this: Co-workers start a weightloss challenge to lose 500 pounds total among the group. Try it: Talk to your doctor about your target numbers and attend support groups, nutrition or fitness classes, or start a friendly competition among friends.

APPLE OR PEAR SHAPE? What it means for your health

A HEALTHY 6MAINTAIN LIFESTYLE

“Losing weight and keeping it off requires working through a different relationship with food,” Tariq said. “Having someone on your side can help you get back on track after slip-ups or setbacks.”

Picture this: Three sisters join forces to plan healthy food alternatives for a family gathering. Try it: Keep the lines of communication open with family and friends so they understand what you’re doing to change old habits and why it matters to you.

You might be focused on trimming your tummy or slimming your thighs to feel good and fit in your favorite clothes. But it’s not all about looks.

The areas you carry extra fat can make a difference for your health, too.

With an apple shaped body, excess fat is stored around your abdomen. This type of fat (called visceral fat) lies beneath your muscles and surrounds your abdominal organs. It has been shown to increase the risk of cardiovascular disease, diabetes and other metabolic diseases.

Having a pear shaped body and carrying more weight around the hips doesn’t increase those health risks.

What can you do about it? Genetics, hormones and age all play a part in how your body stores fat. These factors are beyond your control, but you can combat belly fat with diet and exercise. Try adding more moderate-intensity exercise to your day, watching portion sizes, limiting sugar, refined carbohydrates and avoiding trans and saturated fats.

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JOINT SURGERY REQUIRES

A JOINT EFFORT I Dr. Michael Kent

f you’re considering joint replacement surgery, but concerned about how you’ll manage at home, we are here to help.

PREPARATION IS KEY

To ease your mind we’ve outlined what to expect before, during and after joint replacement surgery. Our strategies can help ensure a smooth transition from hospital to home.

Learn about your surgery.

Understanding the surgery and the reason for it can help lessen your worry and reduce your perception of pain. “Ask your surgeon how long the procedure normally takes, how much pain to expect afterwards and how to manage it. If Dr. Thomas you’re still nervous, ask for suggestions and Rivers relaxation exercises or to prescribe a medication to help calm you. Also ask about recovery and how long it may take until you’re back on your feet,” said Dr. Michael Kent, board-certified orthopedic surgeon with Houston Methodist Orthopedics & Sports Medicine at Sugar Land.

Find out what to quit. If you smoke, talk to your doctor about making a plan to quit at least one month before surgery. Avoid alcohol at least two days before and ask your surgeon which of your medicines, including over-the-counter (OTC) drugs and supplements, to modify or stop. “For instance, aspirin and vitamin E can affect blood clotting, so you should stop them a few days before surgery. Stop steroids a few months before the operation, since they can limit your ability to heal,” said Dr. Thomas Rivers, board-certified orthopedic surgeon at Houston Methodist Orthopedics & Sports Medicine at Sugar Land.

Designate a contact person. Your surgeon and other surgical staff need to know who to update about your condition or contact in case of emergency.

Provide your designated contact’s name and phone number.

8 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

Create a medical information file. “Place a list of all previous surgeries and conditions, plus allergies and diet restrictions, in a file,” Kent said. Include all medications you take and why as well as OTC drugs and supplements. Bring the file on the day of surgery for a smooth admission process.

Take care of business. Bring a copy of your insurance card or policy, and your living will if you have one. If you don’t have a living will or other advance directives, consider making one.

Visit houstonmethodist.org/advance-directives to access the forms online.

Shape up. Being fit before surgery shortens recovery time. Ask your doctor about exercises to tone your muscles and increase endurance.

Plan for homecoming. Because performing your usual routine, such as driving or shopping, may be difficult after surgery, plan to have household help.

If you live alone, you may need to hire home-care services or ask a loved one to stay with you. You may also want to shop for items to maximize your independence, such as a long-handled sponge for bathing or a grabbing tool. The better you plan, the easier coming home will be.

Schedule an Appointment

To schedule an appointment with a specialist at Houston Methodist Orthopedics & Sports Medicine at Sugar Land, visit houstonmethodist.org/orthopedics-sl or call us at 281.201.0409.

WORLD-CLASS JOINT CARE The Houston Methodist Joint Replacement Program at Sugar Land specializes in helping patients recover from joint replacement surgery. Our specialty trained staff, state-of-the-art facilities and advanced diagnostic and treatment techniques all contribute to optimal outcomes for our patients.

We believe that joint replacement surgery and recovery is a team effort, which is why we encourage you to be involved in every aspect of your care. Our dedicated team of physicians, joint coordinator, nurses, nutritionists, pharmacists and therapists will assist you throughout each step of the program. Virtually every detail — from preoperative teaching to postoperative exercising — will be considered and reviewed with you.

Our joint services include: Advanced techniques to minimize postoperative discomfort Partial knee replacement Total hip and knee replacement Complex joint-revision surgery Hip- and knee-preservation surgery After surgery, physical therapists work with you to encourage healing and jump-start your recovery.

Many patients are even able to be discharged within the same day of their total knee replacements.

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PATHWAY TO HEALING Comprehensive Wound Care Personalized for You

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t started with just a small insect bite on the left side of Jackie Mayfield’s left leg. After the bite failed to heal after several weeks, Mayfield went to her primary care doctor for help. She began to receive wound care at home from a home health nurse. Mayfield’s doctor also referred her to a local interventional radiologist, who performed an arteriogram — an X-ray Dr. Charlie that revealed blockage in Mayfield’s leg. She had Cheng stents placed in her artery to open the blockage and restore blood flow to her leg.

Despite revascularization and home care, the wound didn’t heal. Instead, Mayfield developed a second wound on the same foot. After nearly five months, Mayfield had another endovascular procedure. Two weeks later, she woke up and found the top of her left foot had erupted into ulcers. “My daughter and my home health nurse were worried,” said Mayfield. “They knew I needed additional help right away.”

Mayfield rushed to the Emergency Department at Houston Methodist Sugar Land Hospital where she was admitted and got intravenous (IV) antibiotics to begin treating her infection. Based on Mayfield’s health history and worsening wounds, she was at high risk for complications from infection. At that point, she was facing the possibility of having a below-the-knee amputation.

AVOIDING AMPUTATION

Dr. Charlie Cheng, a board-certified vascular surgeon with Houston Methodist Cardiovascular Surgery Associates, evaluated the circulation in Mayfield’s leg. He recognized that she still had inadequate blood flow despite two procedures to open her blockage. Dr. Cheng performed an arteriogram that showed untreated blockage. He performed an endovascular procedure to restore blood flow to her foot. “If a blockage is not treated and prevents blood flow to the wound site, it won’t heal,” said Cheng.

When Cheng opened the blockage with stents, it restored blood flow to Mayfield’s foot, and the wound began to heal. “I was up and walking around in days,” said Mayfield, “and now there’s not even a scar!” Cheng credits the limb salvage program protocol for saving Mayfield’s leg.

A TEAM APPROACH

“A limb salvage program encompasses a multidisciplinary team that includes cardiovascular surgeons, general surgeons, podiatrists and the Wound Care Program,” said Cheng. “The protocol streamlines the patient’s care so we have the best chance of locating the root problem, and healing the wound before it progresses or gets infected.”

Risk factors, such as high blood pressure or vascular disease, increase the chances that even a small, accidental wound may not heal. “It’s the combination of all the disciplines in the Limb Salvage Program that promotes successful healing,” Cheng said.

10 LEADING MEDICINE IN FORT BEND AND SURROUNDING COUNTIES

Healing Starts Here

Protect your feet and legs. Seek treatment for a wound or ulcer right away.

Patients with symptoms of vascular disease in their legs should schedule an appointment with Houston Methodist Cardiovascular Surgery Associates by calling 713.352.1820.

Patients with a wound or ulcer should be examined by a specialist at the Houston Methodist Wound Care Program at Sugar Land. To schedule an appointment, call 281.275.0770.

Palliative Care Supports Patients

Undergoing Complex Health Needs

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hen faced with a serious injury or illness, many patients also suffer from stress, treatment side effects and coping issues. Palliative care is a medical specialty designed to help relieve those challenges during treatment, and is available to patients and their families at Houston Methodist Sugar Land Hospital.

Dr. Asha “Palliative care supports patients on multiple Wurdeman levels,” said Dr. Asha Wurdeman, a boardcertified hospice and palliative care specialist with Houston Methodist Sugar Land. “It offers relief from the side effects of treatment as well as spiritual, emotional and practical support to help patients and their families navigate complex, difficult treatments for serious illness or injury.

“The medical field realized we could apply some of the successful concepts of hospice care, which is comfort care specifically for the terminally ill, to patients receiving ongoing or lifelong treatment to improve their quality of life,” Wurdeman explained. “This realization has resulted in the growth of palliative care medicine.”

HOW PALLIATIVE CARE WORKS

BENEFITS OF PALLIATIVE CARE

Studies have shown that patients who received palliative care have a better quality of life and could better cope with their condition.* About 6 million people in the U.S. could benefit from receiving palliative care.** Palliative care can: Lessen side effects of treatment, such as nausea and fatigue in cancer patients Help patients adjust emotionally and physically to the reality of a serious diagnosis, such as diabetes or kidney, lung and heart disease, which may require lifelong treatment and significant lifestyle changes Make complicated care regimens as easy as possible for patients already overwhelmed with the stress of a serious illness or injury “As our aging population faces greater health issues, the need for palliative care is likely to increase,” Wurdeman said.

“Patients who’ve received palliative care alongside their regular treatment are very satisfied and often wish they had received the support sooner.” * Source: National Cancer Institute, cancer.gov. ** Source: Center to Advance Palliative Care, capc.org.

“Patients with major illnesses face pressures, not only from the side effects of their treatment, but also from the burdens placed on them and their families,” Wurdeman said. “Palliative care in the hospital setting involves a team of doctors, nurses, social workers and chaplains to provide physical, emotional and spiritual support, depending on patient needs.”

Palliative care doctors can serve as a bridge between medical specialists and the patient’s family by listening to concerns, explaining treatment options and answering questions to ensure patients’ needs are met.

Learn More

If you think you or a family member may benefit from palliative care at Houston Methodist Sugar Land Hospital, talk to your doctor or visit houstonmethodist.org/ palliative-care to learn more.

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