Leading Medicine Fall 2017, Houston Methodist The Woodlands Hospital edition

LEADING MEDICINE FA LL 2017

BREAST CANCER:

Is Prevention Possible?

A PARENT’S GUIDE TO CONCUSSION A CLOSER LOOK AT PROSTATE CANCER TESTS

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN THE WOODLANDS AND MONTGOMERY COUNTY

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FIGHT THE FLU!

Dr. Kent Erickson

FLU FACTS

he flu is a very contagious disease. It is airborne, which makes it highly spreadable at public places, work settings, schools and gatherings.

“Young children and the elderly are more susceptible to catching the virus and typically have a more severe case of the illness,” said Dr. Kent Erickson, a primary care, family medicine physician with Houston Methodist Primary Care Group. “It can even be deadly.

Vaccination is proven to be an effective method for prevention.”

PEOPLE WHO GET THE FLU Up to 20% of people in the U.S. get the flu each year.

SYMPTOMS Flu symptoms can include: body aches diarrhea chills fatigue cough fever

Adults 18-64 make up almost 60% of flu hospitalizations. headache runny or stuffy nose sore throat vomiting

Up to 56,000 people die each year from the flu.

You’re contagious starting 1 day before symptoms show and 5 to 7 days after. You can be sick up to 2 weeks.

THE FLU SHOT BY THE NUMBERS weeks

2

3 to 4

How long it takes after vaccination for your body to develop antibodies that protect against the flu

5 million

Number of flu strains the vaccine protects against each year

Estimated number of flu-related illnesses prevented by the flu vaccine during the 2015-16 season

WHAT YOU CAN DO

Get a flu shot Get vaccinated unless you’ve had Guillain-Barré syndrome or you’re under 6 months old, allergic to the flu shot or sick (wait until you get better).

Wash your hands

Avoid sick people

Don’t touch your eyes, nose or mouth

Practice healthy habits

Keep washing for as long as it takes to sing “Happy Birthday” twice.

And stay home if you’re sick.

Flu viruses can survive on surfaces like telephones and doorknobs for up to 8 hours.

Get plenty of sleep and exercise, manage stress, drink fluids and eat healthy foods.

TAKE ACTION

Ready to get a flu shot?

To find a primary care physician, visit houstonmethodist.org/woodlands or call 936.270.3333.

Sources: The Centers for Disease Control and Prevention and the CDC Foundation.

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PERIPHERAL ARTERY DISEASE: Take Steps to Protect Your Heart

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f you experience pain and cramping in your legs when you walk, this may be a symptom of peripheral artery disease (PAD). Find out if PAD is the reason for your discomfort and what you can do to relieve pain and protect your heart, if it is.

“When someone develops peripheral artery disease, the legs don’t get enough blood flow,” Dr. Paul said Dr. Paul Cunningham, interventional Cunningham cardiologist at Houston Methodist The Woodlands Hospial. “The arteries that supply blood to the limbs are damaged, usually by a buildup of plaque that blocks or narrows them, and you may have pain when walking or exercising.”

TREATMENT HELPS YOUR HEART

It’s important to get treatment for PAD for two reasons: 1 Reduce symptoms, such as leg pain, so physical activities can be resumed.

2 Stop the progression of atherosclerosis (buildup of plaque in arteries) to decrease the risk of heart attack and stroke.

Treatment may include aspirin therapy and prescription medications, which can help improve blood flow through narrowed vessels. In some cases, surgery or cardiac catheterization may be necessary to restore blood flow.

“Angioplasty involves inserting a catheter (a small, hollow tube) with a tiny balloon on its tip into an artery. Using a type of X-ray that projects moving pictures on a screen, the catheter is guided through the blood vessel to the area that’s narrowed or blocked.

The balloon is inflated to flatten the blockage into the blood vessel wall, while at the same time stretching the artery open to increase blood flow,” Cunningham explained.

FIGHT BACK WITH HEALTHY MOVES

You can also take steps at home to prevent and control the symptoms of PAD. “Walking helps your muscles get the most oxygen and nutrients they can from the reduced blood flow,” Cunningham explained. In addition to starting a walking program, the following steps can reduce the risks of PAD and improve heart health: Stop smoking Maintain a healthy weight Manage cholesterol Bring down high blood pressure Control diabetes Exercise and eat a healthy diet

HIGH-TECH FOR YOUR HEART Houston Methodist The Woodlands Hospital offers two cutting-edge technologies to aid physicians for treating heart disease: the MediGuide™ navigational system and EnSite Precision™.

The MediGuide navigational system automatically captures arrhythmias and records an enhanced image.

With this improved perspective, doctors can perform catheter-based procedures with greater precision in less time. This may improve not only patient outcomes, but also overall experience. Radiation exposure is also reduced, since live X-ray time is greatly decreased.

The MediGuide system integrates with EnSite Precision cardiac mapping that creates complex 3-D maps of the heart for ablation and other procedures.

Hospitals and catheterization labs outfitted with these technologies offer patients more options and greater flexibility when developing treatment plans.

For patients, that means care that’s personalized to your health and your condition.

Find a Heart Specialist

Find a heart specialist who’s right for you by visiting houstonmethodist.org/find-a-doctor or calling 936.270.3333.

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BREAST CANCER:

IS PREVENTION POSSIBLE?

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hen it comes to breast cancer, certain risk factors are out of your control, such as your genes and age as well as starting your first period young. Yet even more risk factors are within your control, and every day new research is emerging that suggests breast cancer may be more preventable than experts originally Dr. Magda thought. “Women can take steps to mitigate Ghobashy their risk of developing breast cancer and increase their chances of survival if it occurs,” said Dr. Magda Ghobashy, diagnostic radiologist and medical director of Houston Methodist Breast Care Center at The Woodlands. Here are some steps you can take to reduce your risk of breast cancer:

BE (REALLY) PHYSICALLY ACTIVE

Exercise, especially vigorous exercise, could be the single most important weapon in your arsenal.

“Exercise is a huge factor when it comes to reducing

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a woman’s risk of breast cancer,” Ghobashy emphasized. “Some studies estimate a 15–30 percent risk reduction with moderate exercise, and the more a woman exercises, the more her breast cancer risk drops.” Doctors think the exercise-estrogen link may account for the reduced risk. Here’s why: The greater your lifetime exposure to estrogen, the greater your risk for breast cancer.

Exercise suppresses estrogen production by promoting lean body mass.

MAINTAIN A HEALTHY WEIGHT

Being overweight increases your risk of developing a variety of serious diseases, and breast cancer is one of them. Women who have more fat cells produce more estrogen and tend to have higher insulin levels, both of which are linked to an increased breast cancer risk. “Maintaining a healthy body weight throughout her lifetime, with a body mass index of 18.5–24.9, has many health benefits,” Ghobashy said.

LIMIT ALCOHOL

In addition to exercise and maintaining a healthy body weight, limiting alcohol to three or less alcoholic drinks per week can lower a woman’s risk. Compared with nondrinkers, women who consume two to five alcoholic drinks a day have about 1.5 times the risk of developing breast cancer. Ghobashy recommended that women who don’t want to abstain take a daily multivitamin with folate (folic acid). Studies have shown that an adequate daily folate intake may mitigate the risk of breast cancer associated with alcohol consumption.

CHOOSE TO BREASTFEED

Ghobashy encouraged new mothers to breastfeed their babies if they’re able. “Evidence suggests that breastfeeding reduces a woman’s risk of developing breast cancer,” she said. “We know that the longer a woman breastfeeds, the greater the protective effect.” The reasons why aren’t clear, but one possible explanation is that women who breastfeed have fewer menstrual cycles throughout their lives, and thus less exposure to estrogen.

CONSUME OLIVE OIL

Studies have suggested that consuming more monounsaturated fats, such as olive oil, may help protect against breast cancer, too. Houston Methodist is conducting a clinical trial, led by Dr. Tejal Patel, examining how a major component of olive oil, hydroxytyrosol, affects breast density in women at high risk of breast cancer. Women with higher breast density have a higher breast cancer risk.

TAKE PREVENTIVE MEDICATIONS

If you’re at higher risk for breast cancer, your doctor may recommend medications such as tamoxifen and raloxifene to lower your risk. However, these medications can produce symptoms of menopause, so it’s important to discuss the risks and benefits with your doctor to make an informed decision.

The use of birth control pills has been shown in some studies to increase a woman’s risk of developing breast cancer. However, Ghobashy said the risk is slight. “I don’t advise against taking birth control pills, unless a woman is at high risk,” Ghobashy said.

GENETIC TESTING AND INTERVENTION

If you have a strong family history of breast cancer, talk with your doctor about whether genetic testing is right for you. Mutations in certain genes, such as the BRCA genes, increase the risk of breast cancer. Women with this gene mutation may opt for more frequent screenings or prophylactic surgery (breast removal). Removing the ovaries and fallopian tubes is also an option; in addition to reducing the risk of ovarian cancer, it helps prevent breast cancer by eliminating a source of hormones that can fuel some types of the disease.

CLINICAL TRIALS OFFER HOPE Houston Methodist is conducting numerous clinical trials to improve care for women suffering from triple-negative breast cancer (TNBC), a highly aggressive form of the disease that can be especially challenging to treat. Scientists from Houston Methodist and Weill Cornell Medical College have pinpointed a gene previously unassociated with breast cancer that plays a pivotal role in the growth and progression of TNBC. The research suggests that targeting the gene may be a new treatment approach. A drug once used to improve blood flow in damaged hearts is also being studied as a possible treatment option for TNBC. Researchers recently identified two proteins responsible for predicting overall patient survival and validated a therapeutic compound in animal models that slows tumor growth and increases the efficacy of chemotherapy.

In addition, Houston Methodist researchers are reviewing results of a clinical trial that evaluated three new drugs used in combination for the treatment of HER2-positive breast cancer. According to Ghobashy, the initial results look promising and could mean better outcomes for women with this form of breast cancer.

Visit houstonmethodist.org/research/clinicaltrials to learn more about breast cancer clinical trials at Houston Methodist.

Schedule Your Mammogram

Mammography is the most effective tool available in diagnosing breast cancer at an early stage, long before tumors are large enough to be felt or to cause any symptoms. Houston Methodist Breast Care Center at The Woodlands offers mammogram patients a comfortable experience in a relaxing environment. If further testing is needed, the center has the latest in diagnostic imaging and biopsy procedures. The center also provides breast care education, support programs, self-care and other cancer prevention screenings and treatment.

To schedule an appointment at Houston Methodist Breast Care Center at The Woodlands please visit houstonmethodist.org/breast-care or call 936.270.3600.

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A CLOSER LOOK AT PROSTATE CANCER TESTS

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hould you be screened for prostate cancer? The answer may be different for every man, so it’s important to discuss what’s right for you with your doctor.

The American Cancer Society recommends most men starting at age 50 consider the risks and benefits of prostate cancer screening. High-risk and very high-risk men should consider screening starting at ages 45 and 40, respectively. If you have symptoms, regardless of your age, you should see your doctor for evaluation. Symptoms of prostate cancer can include difficulty urinating, a decreased flow of the urine stream, more frequent urges to urinate, erectile dysfunction and blood in urine or semen.

STEP 1: SCREENING FOR PROSTATE CANCER

Two tests are commonly used first for prostate cancer screening: a digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test. With a DRE, your doctor inserts a gloved finger into the rectum to feel for any abnormalities in the prostate gland.

A PSA checks for high levels of a protein that the prostate produces.

STEP2: DIAGNOSING PROSTATE CANCER

If cancer is suspected based on a PSA level or DRE, additional tests may be needed.

Transrectal ultrasound (TRUS) uses a small probe placed into the rectum to produce an image of the prostate. Also used during a prostate biopsy, it guides needles to certain areas of the prostate.

Prostate biopsy is a procedure where the doctor inserts a thin, hollow needle through the wall of the rectum and into the prostate to remove small samples of prostate tissue. A biopsy may be done with TRUS as a guide to “see” the prostate gland. Conventional screening relies on PSA testing and TRUS biopsy; however, there are some limitations to these tests. If a PSA level remains elevated, multiple repeat biopsies may be required, increasing the risk for potential complications.

MRI-guided biopsy uses magnetic resonance imaging for highly targeted biopsies of the prostate for increased accuracy and reduced risks. MRI can also be useful for monitoring patients with persistent PSA elevation.

MRI-TRUS fusion biopsy involves collaboration between the radiologist and the urologist. Areas of suspicion in the prostate are marked by the radiologist on the MRI. Then using a sophisticated software platform, these MRI images are superimposed on the realtime TRUS images of the prostate, allowing biopsy needle sampling to be directed to the parts of the gland which were shown to be suspicious on MRI. Using MRI we can provide staging information by detecting invasion of adjacent structures to help the urologist in coming

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up with the appropriate treatment plan. Treatment options may include watchful waiting (regular monitoring), surgical removal of the prostate, radiation or testosterone-blocking hormone therapy.

PROSTATE CANCER SURGERY WITH A MINIMALLY INVASIVE APPROACH Dr. Steven Sukin

The da Vinci® Surgical System is a minimally invasive approach to prostate cancer surgery.

Using a tiny camera and robotic technology, the surgeon’s hand movements are translated into precise movements of tiny instruments.

“When considering prostate cancer surgery, patients want to know how quickly they will be able to return to work and how much discomfort they will go through,” said Dr. Steven Sukin, a urologist at Houston Methodist The Woodlands Hospital.

“The robotic-assisted da Vinci surgery is done as an outpatient procedure and recovery from surgery is very quick, allowing patients to return to work and other normal activities much faster than if they had open surgery.” With open surgery, recovery can take about four to six weeks.

Urinary function and sexual function are some of the top concerns for patients undergoing surgery. “The da Vinci system’s 3-D capabilities provide better views than we have with traditional surgery. This can allow for improved outcomes for patient recovery, urinary function and return of sexual function,” Sukin said. “Another new advancement, the latest MRI-targeted UroNav technology, uses special software that allows us to do precise, targeted biopsies of suspected tumors. This is beneficial because it eliminates multiple biopsies and frustration for men who have repeated high PSA levels but no found tumors.”

Questions About Prostate Cancer Screening?

Contact us for an appointment with a urologist by calling 936.270.3333.

A Parent’s Guide to

CONCUSSION Signs to Watch For, What to Do Next and How to Prevent

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t’s become increasingly clear that suffering a concussion is more serious than simply “having your bell rung.” The University Interscholastic League (UIL), an organization Dr. Alysia that provides guidance Robichau and oversight for extracurricular activities in Texas, has developed a policy that states a physician must evaluate a school or club athlete and the athlete must pass all return to play protocols before resuming an activity.

According to Dr. Alysia Robichau, a primary care and sports medicine specialist at Houston Methodist Orthopedics & Sports Medicine at The Woodlands, many parents don’t understand the new guidelines. “Things have changed since they were students, and now their child must go through a five-day graduated program before they can participate.”

A concussion is a head injury characterized by a cluster of symptoms, including: Balance or coordination problems Dizziness or vision issues Fatigue Headache Nausea or vomiting Problems sleeping Sensitivity to light or noise Other symptoms might affect your child’s behavior, such as: Difficulty concentrating Feeling mentally slow or foggy Irritability, sadness or nervousness Memory problems Changes in behavior or mental clarity are often harder to detect, as they may also mirror symptoms of mental illness or behavioral issues, said Robichau. “This is why it’s so important to have your child

SATURDAY SPORTS INJURY CLINICS FOR STUDENT-ATHLETES Houston Methodist’s world-class sports medicine specialists are offering Saturday Sports Injury Clinics: When: Every Saturday, 8–10:30 a.m., through Nov. 18 Location: Houston Methodist Orthopedics & Sports Medicine at The Woodlands,17183 I-45 South, Suite 210, The Woodlands The clinics are open to student-athletes who have suffered an injury and require prompt evaluation, including on-site X-ray and imaging capabilities.

Student-athletes can be seen immediately by a board-certified Houston Methodist Orthopedics & Sports Medicine specialist. Visit houstonmethodist.org/athlete to learn more. examined, because diagnosing a concussion can be complicated by a number of factors.”

WHAT TO DO NEXT

If you suspect your child has suffered a concussion during sports practice or competition, Robichau recommends the following actions: Remove your child from play.

Inform your child’s coach of the injury and diagnosis.

Have your child evaluated by a primary care physician, pediatrician or sports medicine doctor.

Follow the recommended return to play protocol.

PREVENTION

Preventing concussion in studentathletes is difficult, but using proper mouthguards and helmets can help.

“Equipment must be properly and consistently worn, age-appropriate, certified and well-maintained,” cautioned Robichau. Following guidelines for hitting and sparring as well as strengthening neck muscles can also help minimize risk.

“There’s no rule about how many head injuries your child can sustain before damage is done,” added Robichau. “This is why it’s so important to have your child evaluated, to avoid long-term losses.”

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MAKING TIME FOR YOUR MAMMOGRAM MAY ADD YEARS TO YOUR LIFE. At Houston Methodist Breast Care Centers, scheduling your mammogram online is an important first step for early detection. It’s easy, and — with eight locations across the Greater Houston area — more convenient than ever.

Our Breast Care Centers offer: • Specially trained breast imaging radiologists • Advanced technology in a spa-like atmosphere HOSPITALS SPECIALTY HOSPITAL EMERGENCY CARE CENTERS IMAGING CENTERS COMPREHENSIVE CARE CENTERS

Just around the corner

• Access to our breast specialists at Houston Methodist Cancer Center Visit houstonmethodist.org/breast-care and schedule your mammogram at a location near you.

Houston Methodist has locations throughout the Greater Houston area to best serve you near your home or workplace.

HOSPITALS

SPECIALTY HOSPITAL

1. Houston Methodist Hospital 2. Houston Methodist San Jacinto Hospital 3. Houston Methodist St. John Hospital 4. Houston Methodist Sugar Land Hospital 5. Houston Methodist The Woodlands Hospital Now Open . Houston Methodist West Hospital 7. Houston Methodist Willowbrook Hospital

8. Houston Methodist St. Catherine Hospital

IMAGING CENTERS . Houston Methodist Breast Care Center 17. Houston Methodist Imaging Center

COMPREHENSIVE CARE CENTERS 18. Houston Methodist Comprehensive Care Center in Conroe 1. Houston Methodist Comprehensive Care Center in Pearland

EMERGENCY CARE CENTERS

TEXAS MEDICAL CENTER • BAY AREA • BAYTOWN • SUGAR LAND THE WOODLANDS • UPPER KIRBY • WEST HOUSTON • WILLOWBROOK

713.441.ER24 (3724) . Houston Methodist Emergency Care Center at Kirby 10. Houston Methodist Emergency Care Center at Voss 11. Houston Methodist Emergency Care Center in Cinco Ranch 12. Houston Methodist Emergency Care Center in Cypress 13. Houston Methodist Emergency Care Center in Pearland 14. Houston Methodist Emergency Care Center in Sienna Plantation 15. Houston Methodist Emergency Care Center in Spring 1. Houston Methodist Emergency Care Center in The Woodlands

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