Leading Medicine Fall 2018, Houston Methodist West Hospital edition

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Your Journey for

CANCER

CARE Concussion: Tackling a Tough Issue Avoid Portion Distortion

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN WEST HOUSTON-KATY

Talking About Men’s Health:

COMMON UROLOGIC CONDITIONS

M

ale urology problems run the gamut from mild inconveniences to severe conditions with life-threatening consequences. Knowing Dr. Monty your risk factors and Aghazadeh symptoms may help you avoid serious health problems.

Dr. Monty Aghazadeh, urologist with Houston Methodist West Hospital, provides information on some of the most common urologic conditions affecting men.

KIDNEY STONES

Kidney stones are caused when high levels of minerals, such as calcium, form in the kidneys. “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,” Aghazadeh 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: While prevention is based on the type of stone and your individual lab work, general recommendations include increasing fluid intake and avoiding foods high in sodium (salt) and protein.

TREATMENT: Management of stones depends largely on the size of the stone and its location in the urinary tract.

While you can often pass a smaller stone on your own, larger stones may need to be surgically removed.

INCONTINENCE

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

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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; avoiding bladder irritants, such as caffeine, alcohol and acidic foods.

TREATMENT: Management of incontinence depends on the cause. A treatment strategy can be recommended only after an accurate evaluation to determine the type of incontinence.

Broadly speaking, treatment can include medications, dietary changes, weight loss, performing exercises to strengthen the pelvic floor muscles or surgery.

ERECTILE DYSFUNCTION

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,” Aghazadeh explained.

PREVENTION: Maintain a healthy weight through diet and exercise; get screened regularly for high cholesterol and high blood pressure; and avoid smoking and alcohol.

TREATMENT: Options range from medication to surgical options, in severe cases.

PROSTATE CANCER

Prostate cancer is one of the most common cancers in men, with approximately 160,000 cases diagnosed in the U.S. each year. Prostate cancer can range from a slow-growing cancer that never causes symptoms or affects your overall health, to an aggressive cancer that can spread to other organs. Often, most localized prostate cancer does not cause symptoms, and it’s typically diagnosed by routine PSA (prostate-specific antigen) screening.

PSA is a protein made by the prostate gland and secreted into the blood stream, and as such, can be checked through a routine blood draw.

PREVENTION: In general, the American Urological Association recommends PSA screening every other year between the ages of 55-69. Screening should be considered sooner if you have a family history of prostate cancer.

TREATMENT: Once there has been a diagnosis of prostate cancer, 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,” Aghazadeh said. “Careful monitoring (active surveillance), surgery to remove the prostate, radiation and testosteroneblocking hormone therapy may be options, depending on stage and grade.”

Take Charge of Your Health

To learn more about preventive screenings and to schedule an appointment with a Houston Methodist West Hospital urologist, visit houstonmethodist.org/ west or call 832.522.8300.

BREAST AND

OVARIAN CANCER Is there a connection?

K Dr. Candy Arentz

Dr. Tarrik Zaid

nowledge is power when it comes to understanding breast cancer. Being armed with the facts can help you make important decisions about your health.

Breast cancer is the most common cancer women face, other than skin cancer. One in 8 women, or about 12 percent, may develop breast cancer over her lifetime. Ovarian cancer is far less common, with a lifetime risk for the general population of just 2 percent.

“About 5 to 10 percent of breast cancers are attributed to genetic mutations, such as BRCA1 or BRCA2. One in 400 women have the BRCA mutation, making their chances of developing breast and ovarian cancer much greater,” said Dr. Candy Arentz, breast surgeon at Houston Methodist West and a member of the Cancer Center.

HEREDITARY BREAST AND OVARIAN CANCER SYNDROME

Some red flags in a patient’s medical record or family history may indicate a genetic tendency to develop ovarian cancer. If any of these apply to you, you may want to talk to your doctor about genetic testing and counseling.

A diagnosis of breast cancer at age 50 or earlier Bilateral breast cancers, either in you or in a close relative A close blood relation (mother, daughter, sister, grandmother, granddaughter, niece) diagnosed with ovarian cancer Father, brother, uncle or grandfather with male breast cancer Triple-negative breast cancer diagnosed at age 60 or younger (a tumor that lacks estrogen, progesterone and the HER2/neu gene) Ashkenazi Jewish ancestry A previously identified BRCA mutation in the family

SYMPTOMS OF OVARIAN CANCER

“Early symptoms are subtle and mimic other benign common conditions,” said Tarrik Zaid, gynecologic oncologist at Houston Methodist West Hospital. “But if you experience any of these for several weeks, a thorough work-up with your doctor may be needed to determine the underlying cause and to rule out the rare possibility of ovarian cancer.”

Shortness of breath Abdominal bloating or swelling Pelvic, abdominal or lower back pain Painful intercourse Frequent need to urinate Difficulty eating or getting full quickly

“Early detection improves prognosis and cure rates; however, unfortunately most women present at an advanced stage due to the vague symptoms,” said Zaid, a member of Houston Methodist Cancer Center at West.

TREATMENT OPTIONS

Typically, treatment for ovarian cancer involves surgery to remove the tumor or tumors and chemotherapy to kill remaining cancer cells. Additional therapies may include Avastin (bevacizumab), which starves the tumor of its blood supply, and PARP inhibitors, a type of targeted therapy that may improve survival rates.

“Women diagnosed with mutations prior to the onset of cancer can undergo procedures to lower their risk,” Zaid said.

“Some women at very strong risk undergo preventive (prophylactic) surgery to help avoid future cancers,” Arentz said.

“For example, a preventive mastectomy may lower future breast cancer risk as much as 90 percent. Oophorectomy (surgical removal of the ovaries) may reduce ovarian cancer risk as much as 80 to 90 percent in women with a BRCA mutation.”

BE AWARE, BE IN CONTROL

It’s important to remember that not every woman who carries genetic mutations associated with breast and ovarian cancer will develop the disease. The best approach is to be aware of your risk and discuss it with your doctor, know the symptoms and have regular screenings, such as mammograms and gynecological exams.

Get Screened

Mammography is the most effective tool available in diagnosing breast cancer at an early stage, as well as having regular gynecological exams for detecting signs of ovarian cancer. To schedule your mammogram, visit houstonmethodist.org/imaging or call 832.522.PINK. For a physician referral, call 832.522.5522.

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Support for Your Journey

from Diagnosis to Survivorship Choosing a hospital for cancer care

H

1

START YOUR SEARCH

Choosing where to go for cancer treatment is a big decision, and you want to feel secure about your choice.

Most of all, you’re focused on finding the best path to treatment — as quickly as possible.

If you live in the Houston area, you have choices about where to go for cancer care, with convenient access to top-ranked physicians and cancer specialists, advanced treatments and research, and comprehensive services and support. Within Houston Methodist Cancer Center, our specialists are renowned for their research and treatment of cancer, and we are dedicated to providing each patient with the most advanced and collaborative care, all in a compassionate environment. In 2017, more than 2,000 patients from all over the United States and 37 countries traveled from outside of the Greater Houston area to Houston Methodist for their cancer treatment.

“Patients come from all over the world because we have leading cancer experts integrating the latest research and treatments on the forefront of the battle against cancer. Our commitment to providing high-quality and compassionate care comes through in everything we do,” said Dr. Alison Rome, medical oncologist and hematologist at Houston Methodist West Hospital.

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Rome is board certified by the American Board of Internal Medicine in medical oncology and hematology, and she sees patients at Houston Methodist West.

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STEP

STEP

earing the news that you or a loved one has been diagnosed with cancer can turn life upside down. A thousand questions, worries and what-ifs may come to mind. Knowing where to turn for support after a cancer diagnosis can help you move forward with confidence, which includes the following: M eet with your doctor to ask questions about Dr. Alison Rome your diagnosis and make sure you understand his or her recommendations for treatment.

C onsider getting a second opinion so you can feel well-informed and confident with your treatment decisions.

T alk to family and friends about your diagnosis and how this may impact family life and work or school schedules.

F ind support to help you navigate next steps. Before you even begin treatment, a support group can help you learn how to share the news with your loved ones or give you an idea of what to expect throughout treatment.

CONNECT WITH YOUR CARE TEAM

The doctor who diagnosed your cancer might refer you to a medical oncologist or surgeon who specializes in treating certain cancers. Before you visit a specialist, write out a list of questions and bring a support person or loved one who can help you take notes on the doctor’s advice. If there’s something you don’t understand, make sure to ask. It’s important that you feel comfortable communicating with the doctors and nurses involved in your care.

There’s no question you want the best team on your side when fighting cancer. At Houston Methodist, top-ranked physicians and cancer specialists have a high level of expertise and input on your treatment plan. Whether your cancer diagnosis is common, rare, or in an early or advanced stage, you can benefit from the leading-edge research, knowledge and experience of an academic medical center. “If you have multiple health complications or conditions, it is even more critical to have a team of specialists working together on a treatment plan for your unique needs,” Rome said.

Oncologists, surgeons, pulmonologists, pathologists, radiologists, internal medicine doctors and other specialists at Houston Methodist collaborate and consult on treatment plans for patients, and this team aspect is a powerful tool in the fight against cancer.

STEP

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COMPREHENSIVE SERVICES AND SUPPORT A full spectrum of programs and support is available to help patients through their treatment path, including: A high-risk program is available for patients with a higher-than-average chance of developing breast, gastrointestinal, ovarian or uterine cancer.

G enetic counseling is offered for patients at higher risk for developing hereditary cancers.

O ncology nurse navigators guide patients through every step of the process from diagnosis to survivorship.

S ocial workers are here to support individuals and families with counseling and assisting with the transition to home.

P atient assistance for financial needs is available, including help with questions about health care coverage.

S upport groups provide a network of support for patients and their families coping with cancer.

“We are fighting the cancer with you, and we have a complete team of people to cover every aspect of life that can be affected by cancer,” Rome said. “We’re here to make sure you get the most comprehensive care possible.”

LEARN ABOUT TREATMENT OPTIONS

With an experienced team on your side, you’re ready to review your treatment options. “We treat common and complex cases of cancer that touch every organ of the body — and every aspect of your life. Our specialists customize treatment plans to fight your cancer so we can achieve the best outcomes possible; that’s part of being a top hospital in Texas,” Rome said.

Treatment options may include: A dvanced treatments in I maging technology immunotherapy advancements Bone marrow transplantation L atest radiation techniques Chemotherapy Leading surgical techniques Clinical trials Targeted therapies Choosing a research-focused hospital system opens the door to new therapies that are not available outside of a research setting. For example, you may decide that you want to participate in clinical trials that involve medications as well as gene and cell therapy.

“We offer immunotherapy clinical trials to stimulate a stronger immune response to kill cancer cells in lung cancer, gastrointestinal cancers, breast cancer and brain tumors. We also have a triple-negative breast cancer clinic, sarcoma of the heart program and other programs designed for specific types of cancer,” Rome explained.

“In addition to the research and clinical trials offered at our campus in the Texas Medical Center,® we have research programs at our community cancer center locations, and we are dedicated to bringing research and clinical trials closer to home.

Our researchers are actively working on every aspect of cancer treatment and bringing that integration to the communities across Houston,” Rome said.

Moving into the treatment phase of your journey takes courage, stamina and patience. The various components of a treatment plan may be spread out over weeks or months — and timing is key. That’s why it helps to choose a hospital system with convenient access to appointments for radiation therapy, chemotherapy and other treatments you may need, including support programs, such as support groups, art therapy and pet therapy.

“The specialists at all of our cancer center locations are connected with the same research, treatments and technology available throughout Houston Methodist,” Rome shared. You keep your physician throughout your journey and receive treatments at the location that’s most convenient for you.

“When you receive care locally, you benefit in many ways — being close to work, home, family and friends can minimize the interruption to your life. Our goal is to be able to get you back to yourself so you can focus on your life. Your cancer should not be the center of your life. That’s what we’re trying to accomplish,” Rome said.

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STEP

STEP

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START YOUR TREATMENT PLAN

BEYOND CANCER TREATMENT

Care for cancer patients doesn’t end when treatment does. At the end of treatment, you’ll have a survivorship care plan to help continue your ongoing care and help you follow your doctor’s recommendations. The Houston Methodist Cancer Survivorship Program addresses common quality-of-life issues related to cancer treatment so you can focus on surviving, thriving and living your best life.

Your Journey Begins Here Contact us at 832.522.5522 or visit houstonmethodist.org/west to find a doctor at Houston Methodist Cancer Center at West, which is accredited by the American College of Surgeons Commission on Cancer.

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CONCUSSION:

Tackling a Tough Issue

B

umps, tumbles and falls are a normal part of growing up.

However, when a blow is severe enough to move the brain back and forth within the skull, it can Dr. Peter Timothy cause a concussion — Sprockel a temporary loss of normal brain function. Young athletes are particularly susceptible to concussion, and they may take longer than adults to recover. The key to a quick and complete recuperation is prompt medical attention.

“Diagnosing the condition early helps ensure that the brain has time to heal properly,” said Dr. Peter Timothy Sprockel, a primary care and sports medicine specialist at Houston Methodist Orthopedics & Sports Medicine at West. “A second head injury sustained before the brain has fully healed can be severe, sometimes causing swelling of the brain and long-term disability.” What’s more, having one concussion increases the odds of sustaining a second concussion, and repeated head injuries can cause serious problems, including headaches and chronic difficulty concentrating, remembering and even balancing.

WHAT TO WATCH FOR

“You do not need to lose consciousness to have a concussion,” Sprockel said.

“Symptoms of a concussion often appear right away, but may also emerge a few days after the injury.” Signs usually fall into four categories, according to the Centers for Disease Control and Prevention: Thinking/remembering Difficulty thinking clearly or concentrating Feeling slowed down Difficulty remembering new information Physical Headache Fuzzy or blurry vision Nausea or vomiting

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Dizziness Sensitivity to noise or light Balance problems Feeling tired, having no energy Emotional/mood Irritability Sadness More emotional Nervousness or anxiety Sleep Sleeping more or less than usual Trouble falling asleep If a young athlete experiences one or more of these symptoms after a blow to the head, he or she should stay out of play until a trained health care professional can assess his or her condition.

RECOVERY

“The main course of treatment for a concussion is often physical and mental rest until symptoms subside,” Sprockel said. “It may be necessary to keep children home from school or adults home from work, with a gradual return to normal activities.” Student-athletes often follow a five-step process for returning to play: baseline (no concussion symptoms for at least 24 hours), light aerobic exercise, moderate exercise, noncontact exercise, practice, and finally, return to competition.

PREVENTION

The following steps can help reduce the chances of experiencing a concussion or other brain injury.

Wear a helmet when riding a bicycle, skateboard, scooter or motorcycle; playing contact sports, such as football, hockey or boxing; batting or running the bases in baseball or softball; riding a horse; or skiing or snowboarding.

Buckle up. Make sure everyone in the vehicle is wearing a seat belt or is secured in a child safety seat.

Keep your home safe. Install window guards so children cannot fall out, and use safety gates to keep young children away from steps. Remove tripping hazards and add handrails to stairways.

Consider a Baseline Concussion Test If you have questions about concussion symptoms, treatment or prevention, talk with your doctor. A preseason baseline concussion test for young athletes involved in contact sports may help doctors diagnose a concussion. Visit houstonmethodist.org/find-a-doctor or call 832.522.BONE (2663).

Avoid Portion Distortion

C

TIPS FOR AT HOME OR ON THE GO

ontrolling your weight calls for choosing a healthy variety of foods and watching how much and how often you eat. But how? To start, it’s helpful to know the difference between a portion and a serving size.

THE SKINNY ON SERVING SIZES

“A portion is how much food you eat at one time, while a serving size is the standardized amount of food — such as cups or pieces and grams or ounces — that appears on the Nutrition Facts label on most packaged foods,” said Dr. Tina Luu, a family medicine and primary care doctor with Houston Methodist Primary Care Group and Houston Methodist West Hospital. Check the “Servings per Container” section underneath the “Serving Size” listed at the top of the Nutrition Facts label. Keep in mind that most packaged foods contain more than a single serving.

Dr. Tina Luu

WHAT ARE YOU EATING?

It’s hard for most people to judge how much they’re eating, but the following can get you on track: Keep a food diary. Luu recommends writing down when, what, how much, where and why you eat can help you be aware of how much you’re eating and the times and situations when you tend to eat too much. “This knowledge can help you make different choices in the future,” Luu said.

Measure your food. When cooking for yourself, use measuring cups and spoons for a week or so to measure your usual food portions. Then put the suggested serving size from the Nutrition Facts label on your plate and compare it to how much you usually eat.

Whether you’re eating at home, at a restaurant or on the road, try these tips for keeping your portion sizes reasonable: Eat your food off a plate instead of out of the box or bag.

Avoid eating while watching TV or doing other activities.

Eat slowly and stop eating when you start to feel full.

Cut meal servings in half. Have at least half of your meal boxed up or order a half-portion or an appetizer as a main meal.

Eat at regular intervals. Skipping meals or waiting a long time between meals might lead you to eat more later.

Other ideas: Freeze food you won’t serve right away when cooking in large batches; when buying snacks, go for singleserving prepackaged foods and healthier options like low-fat or fat-free yogurt, smoothies, fruit or whole-grain crackers; and take seconds of vegetables and salads instead of higher-fatand-calorie foods.

Avoid large or “supersize” sugar-sweetened beverages or entrees; when traveling, pack a small cooler of healthy foods that are hard to find on the road, such as fresh fruit, sliced raw vegetables and fat-free or low-fat yogurt. Also pack a few bottles of water.

With just a few simple changes you’ll be on your way to taking control of your portion sizes.

Find a Doctor Visit houstonmethodist.org/pcg or call 713.394.6724 to find a primary care doctor near you.

REAL-WORLD SERVING SIZES Are the portion sizes you’re eating just right? Check out this helpful chart comparing serving sizes to everyday objects.

1 cup of cereal

½ cup of cooked rice, pasta or potato

1 baked potato

1 medium fruit

½ cup of fresh fruit

A fist

½ baseball

A fist

A baseball

½ baseball

1½ ounces of low-fat or fat-free cheese

½ cup of ice cream

2 tablespoons of peanut butter

¼ cup raisins

3 ounces of meat or poultry

4 stacked dice

½ baseball

Ping-Pong ball

Large egg

Deck of playing cards

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KEEPING YOU AT THE TOP OF YOUR GAME When an injury has you sidelined, the world-class team of specialists at Houston Methodist Orthopedics & Sports Medicine will help you get back out there faster, with: • Expertise to treat common to complex injuries

• Minimally invasive procedures • State-of-the-art physical and occupational therapy

• Latest imaging and technology • Advanced nonsurgical treatments

Schedule an appointment to discuss your options with a specialist.

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