Leading Medicine Fall 2019, Houston Methodist The Woodlands Hospital edition

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5 Ways to Boost Your Immune System

Is Your Thyroid Affecting Your Weight?

WIN A $00 AMAZON GIFT CARD See inside for details.

Breast Cancer Surgery

A Treatment Plan Designed

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

FASTER HEALING, LOWER RISK FOR

BRAIN AND SPINE PROCEDURES

A

brain aneurysm or arteriovenous malformation (AVM) can be a ticking time bomb, requiring skill and precision to treat. Once the only option to treat these conditions meant drilling into the skull and making an incision, damaging normal brain tissue. Now, with newer minimally invasive, image-guided procedures, patients Dr. Abhishek recover faster and better than ever.

Agrawal “Imaging equipment, such as a robotic biplane machine with dual mixed detectors and live 3D rotational angiogram, help ensure pinpoint accuracy during minimally invasive surgery,” said Dr. Abhishek Agrawal, neurointerventional surgeon and medical director of the Houston Methodist Neurointerventional Radiology Implementation Program at The Woodlands. “Minimally invasive techniques allow us to perform highly complex and sophisticated procedures in the brain and spine through tiny incisions in the artery of the arm or leg, typically 1 to 2 mm in length. Patients usually can go home in a couple of days. Compare that to open surgeries in the skull that may take up to 50 surgical staples to close and a week or more of postoperative hospital care.

“Although any surgery involves risk, minimally invasive techniques generally result in less postoperative pain without damage to normal brain tissue, lower risk of infection and faster healing and recovery time,” Agrawal said.

TREATING POTENTIALLY DANGEROUS BRAIN CONDITIONS

Two most common brain conditions that are responsive to minimally invasive surgery include: B rain aneurysm — a weakened area of a blood vessel that develops a bulge, which can rupture and result in massive brain bleeding, stroke or death.

A rteriovenous malformations (AVMs) — an abnormal tangle of blood vessels that can cause seizure, brain hemorrhage or neurological deficits.

“If it’s determined that image-guided minimally invasive treatment of an aneurysm is necessary and appropriate, we snake a very fine tube through a tiny incision through the femoral artery up to the aneurysm,” Agrawal said. “Whether it has ruptured — an emergency situation — or we are doing preventive treatment of an unruptured aneurysm, we use a balloon, stent or combination of coil and stent to block it and stop or prevent bleeding.”

With AVMs, a similar approach is used to reach the area of the abnormality. “We then typically inject a liquid embolic agent — think of it as a kind of brain super glue — to seal off the abnormal vessels that had bled,” Agrawal said.

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LESS PAINFUL, EFFECTIVE SPINE SURGERY

Another very common condition that may be successfully treated with image-guided treatment is a spinal compression fracture.

“Typically, this occurs in elderly patients with osteoporosis, who can develop fractures in the spine that can be debilitating,” Agrawal said. “Open surgery is especially hard on the elderly.

Image-guided treatments that allow us to inject bone cement into the vertebral body, through a very small incision, can help reduce pain, increase mobility and allow patients to resume activities of daily living with faster healing.”

EVER-WIDENING USES

“The term ‘image-guided treatment’ is used interchangeably with neurointerventional surgery, endovascular neurosurgery, interventional neuroradiology or minimally invasive neurosurgery,” said Agrawal.

“Using a variety of coils, braided stents, stent-retrievers, flow diverters, balloons, liquid embolic agents and other tools, we can provide minimally invasive treatment for a variety of conditions related to diseases of the brain, head, neck and spine.”

ANEURYSM AND AVM SYMPTOMS Aneurysms and arteriovenous malformations may cause no symptoms unless they rupture or press on a critical area of the brain. However, if left untreated, they can rupture and cause catastrophic consequences. See your doctor if you’re experiencing persistent headaches, tingling or numbness in extremities, visual symptoms or unusual sounds in one ear.

If pain is severe (the worst headache you’ve ever experienced) or accompanied by nausea, vomiting, stiff neck or seizure, seek emergency treatment immediately.

Leading the Way in Image-Guided Treatments

Houston Methodist The Woodlands has a full range of leading-edge technology to assist the best available image-guided treatments in the world with pinpoint accuracy. To request an appointment within our imaging department, call 936.270.3333.

IS YOUR THYROID

Affecting Your Weight?

A small organ can have a big impact on your metabolism

T

he thyroid, a butterfly-shaped organ located at the front of your neck, is only a few inches wide, but it is extremely important.

“The thyroid makes Dr. Mohammed hormones that are Ansari essential for the metabolism and function of virtually every organ in the body,” said Dr. Mohammed Ansari, a board-certified endocrinologist at Houston Methodist The Woodlands Hospital. “So when thyroid problems develop, they can affect every other part of the body.”

Women are more likely than men to develop thyroid problems, as are people who have diabetes, an autoimmune disease, a family history of thyroid problems or those who have received radiation to the chest or neck. Women who are pregnant or who recently gave birth are also susceptible.

Most thyroid problems fall into three categories: hyperthyroidism (the body makes too much thyroid hormone), hypothyroidism (the body makes too little thyroid hormone) and growths (cysts, nodules or cancer).

UNDERACTIVE THYROID

Having an underactive thyroid (hypothyroidism) slows down the body’s metabolism and often leads to weight gain and other symptoms, such as fatigue, mood swings, forgetfulness, depression, muscle aches, dry skin, brittle nails, hair loss, cold intolerance, slow heartbeat and constipation. If you’re experiencing symptoms or have difficulty losing weight, it’s worth asking

your doctor about checking your thyroid levels with a simple blood test. One study found that 25% of patients undergoing weight loss surgery had undiagnosed hypothyroidism, according to the Obesity Action Coalition.

“The slowing of metabolism in hypothyroidism can most certainly lead to weight gain,” Ansari said. “But not all people who are overweight have thyroid problems. Being overweight or obese may be due to other reasons like poor dietary habits, lack of exercise, side effects of some prescribed medications, and several other medical and psychiatric conditions.”

TYPES OF CONDITIONS ENDOCRINOLOGISTS TREAT Hormonal imbalances are the underlying reason for a wide range of medical conditions. Some of the more common conditions endocrinologists diagnose and manage include: Adrenal disorders Diabetes Heart problems (high cholesterol, triglycerides and blood pressure) Men’s health (low testosterone) Osteoporosis and bone health Pituitary disorders Thyroid disorders

Schedule Now

To schedule an appointment with Dr. Mohammed Ansari or another endocrinologist in your area, call 936.270.4400 for a physician referral.

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Breast Cancer Surgery

A Treatment Plan Designed Just for You A breast cancer diagnosis can stop you in your tracks and leave you wondering: What does this mean for my future? How will my body change? You Dr. S. Benjamin may be flooded with Albright emotions and this is completely natural.

If surgery is part of your treatment plan, you might worry about what you will look like afterward.

Surgery can leave scars, and for those who Dr. Liza need to have a significant Thalheimer part of their breast or breasts removed, it’s normal to have some anxiety about how your appearance may change. The psychological impacts of mastectomy can touch various aspects of your life, from body image and selfconfidence to sexuality and intimacy.

MORE OPTIONS, BETTER RESULTS

Women undergoing breast surgery have more options with far better results than in the past. A multidisciplinary approach facilitates the design of a treatment plan that is tailored to each individual's situation.

“When a patient is diagnosed with breast cancer, we have an initial consultation that typically takes about an hour where we review the pathology report, talk about surgical options and discuss how our multidisciplinary team works together,” said Dr. Liza Thalheimer, a breast surgical oncologist with Houston Methodist The Woodlands Hospital.

“Innovative surgical techniques and technological advancements make it possible to deliver improved outcomes,” said Dr. S. Benjamin Albright, a plastic

and reconstructive surgeon with Houston Methodist The Woodlands.

“These include breast conservation with oncoplastic techniques, pre-pectoral implant reconstruction, fat grafting and microsurgical flap options.”

CONSERVING THE BREAST

Radar and radioactive seeds are used to pinpoint abnormal tissue and preserve healthy breast tissue. “For nonpalpable tumors, we can use radioactive seeds or radar localization to pinpoint the cancer in the breast during surgery, without the need for wire localization,” Thalheimer said.

Hidden Scar™ surgery involves making an incision in a discreet location under the breast fold, in the axilla or around the areola, resulting in a scar that is hidden by the skin fold of the breast. “We can make incisions on hidden areas of the breast so the scars are not a constant reminder of surgery,” Thalheimer added.

BREAST RECONSTRUCTION

Women who opt for a mastectomy have a range of options available for breast reconstructive surgery with implants, natural tissue or a combination of both.

“The approach to reconstruction is truly a personalized one that considers cancer staging, family support, home or work concerns, and time for recovery,” Albright said.

Reconstruction techniques include: Autologous or flap reconstruction — uses tissue from another area of the body to reconstruct the breast, making it appear and feel natural. This procedure involves moving tissue, often from the abdomen, to the chest and reattaching the arteries and veins in the area. “This microsurgical procedure removes excess lower abdominal skin and fat that would normally be discarded in a tummy tuck and repurposes them to rebuild a breast,” Albright explained.

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Breast resensitization — helps restore sensation to the reconstructed breast.

“A mastectomy inherently removes the nerves that give sensation to the breast and nipple. This procedure aims to identify and reconnect the remaining nerve ends to a flap reconstructed breast,” Albright said.

CHOOSING WHAT’S RIGHT FOR YOU Together, you and your doctor can review the factors that will impact your choices: P hysical characteristics — age, your overall health, breast size, breast density, the size and location of your breast cancer and the amount of tissue available for reconstruction.

P ersonal preferences — aesthetic goals, such as how you want your breasts to look and feel, symmetry and breast reduction options.

L ogistical factors — timing of surgery, additional cancer treatments, having a support system and returning to work.

Breast cancer surgery and reconstructive surgery can often be done at the same time or in a staggered approach.

“Some patients choose to have a mastectomy without breast reconstruction, and that’s OK too,” Thalheimer added. Your treatment plan can be designed so you can keep living your life.

Take Control of Your Treatment

Rely on our expertise to help you personalize your breast cancer treatment.

Visit houstonmethodist.org/cancerwoodlands to learn about Houston Methodist Cancer Center at The Woodlands and our team of experts.

LUMPECTOMY VS. MASTECTOMY WITH RECONSTRUCTION What’s the difference?

Lumpectomy Surgery to remove the tumor while leaving healthy breast tissue surrounding it.

Total mastectomy Surgery to remove the entire breast, including the skin, nipple and areola.

Nipple-sparing mastectomy Surgery to remove the breast while leaving the skin, nipple and areola in place.

Why consider it: Breast cancer is detected early and the tumor is small.

Benefits: Conserving your natural breast; faster recovery times.

Why consider it: If you’re choosing breast reconstructive surgery immediately following the mastectomy.

Benefits: Preserving your breast skin and nipple; potential to regain sensation in the nipple when combined with flap surgery.

Flap reconstruction Surgery to reconstruct your breast after mastectomy using abdominal tissue through a tummy tuck incision.

Double (bilateral) mastectomy Surgery to remove both breasts.

Why consider it: May be best for treating invasive breast cancers.

Benefits: Breast reconstructive surgery may be performed at the same time or a later date.

Why consider it: If you are choosing preventive mastectomy to reduce the risk of breast cancer because you have a BRCA gene mutation.

Why consider it: It offers the most natural reconstruction possible, with hidden scars, and the possibility of returned sensation.

Benefits: This type of breast reconstruction involves hidden scars, the most natural result and a lasting outcome.

Benefits: Achieving a symmetrical appearance with options for breast reconstructive surgery.

BREAST RESENSITIZATION TECHNIQUES AFTER MASTECTOMY If you have a mastectomy, the nerves that provide feeling to the breast and nipple are removed. This loss of sensation can feel unnatural and may alter the way you experience everyday activities like putting on clothes or hugging someone.

“It isn’t clear yet how much sensation can be consistently restored to the breast. However, it seems that this procedure offers the best chance for recovering the ability to feel a hug from a loved one and to forget the daily reminders of a previous mastectomy,” Albright said.

Breast resensitization can be performed during flap breast reconstruction surgery, a type of surgery that uses your own abdominal tissue to rebuild the breast. The procedure involves reconnecting the nerves on the chest to give the possibility of returning sensation to the breast.

Call 936.270.3680 to schedule an appointment with one of our reconstructive surgeons or visit houstonmethodist.org/breast-reconstruction to learn more about other innovative breast reconstruction treatments offered at Houston Methodist The Woodlands Hospital.

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When GERD Won’t Quit: You Have Options to Treat Your Acid Reflux

I

f you’ve ever been awakened in the middle of the night with a burning sensation in your throat or stomach, you know the pain of gastroesophageal reflux Dr. Drew disease, or GERD. Howard “GERD is caused by a relaxation of the sphincter muscles between the stomach and the esophagus,” said Dr. Drew Howard, surgeon, Houston Methodist The Woodlands Hospital. “Stomach acid can then reflux, or back up, into the esophagus.

Symptoms may include heartburn, a bitter taste in the mouth, belching, dry cough or trouble swallowing.”

WHY GERD CAN BE DANGEROUS Gastroesophageal reflux disease is more than just uncomfortable.

Untreated GERD may lead to: S wallowing problems.

Stomach acid can cause scar tissue to form and narrow the esophagus.

E sophageal ulcers. An open sore can form in the esophagus as stomach acid wears away tissue.

B arrett’s esophagus.

Continuous acid damage can cause precancerous changes in the tissue lining the esophagus and increase the risk for esophageal cancer.

CONSERVATIVE GERD TREATMENTS

There are a number of lifestyle changes you can make to help keep GERD at bay: Avoid alcohol and caffeine Avoid spicy or acidic foods, or any food that triggers your heartburn Don’t smoke Elevate the head of your bed Lose excess weight Wear nonconstricting clothing If these approaches don’t work, your doctor may recommend trying overthe-counter (OTC) antacids, an OTC or prescription-strength H2 receptor blocker or a proton-pump inhibitor to reduce stomach acid. “However, taking these medications just reduces the symptoms by decreasing the amount of acid reflux, but it does not fix the problem; it is a mechanical issue that needs a mechanical fix, which is usually surgery,” said Howard.

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EXPLORING SURGICAL TREATMENTS

Two common surgical options include: LINX® implant. With LINX, a ring of tiny beads is wrapped around the area where the stomach meets the esophagus. “The beads are weak magnets that attract each other to help prevent acid from refluxing up,” said Howard. “But they’re weak enough to allow food to pass through to the stomach.” A LINX implant can be accomplished with minimally invasive surgery.

Fundoplication. Fundoplication surgery helps support and strengthen the end of the esophagus where it meets the stomach. “This type of surgery involves wrapping the upper part of the stomach (the fundus) around the end of the esophagus and closing with stitches,” Howard said.

“This strengthens the lower part of the esophagus. It allows food and liquids to go down into the stomach but helps prevent stomach acid from going back up.” Fundoplication surgery is most often accomplished with minimally invasive laparoscopic surgery but may require conventional open surgery in some cases.

For many people, these surgical options can eliminate acid reflux, do away with dependence on medications and help prevent dangerous complications that can result from GERD.

Finding Relief

If you’re experiencing troublesome GERD symptoms, surgical treatment may provide lifelong relief.

To make an appointment with a gastroenterologist or reflux surgeon at Houston Methodist The Woodlands, call 936.270.GERD (4373).

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WAYS TO BOOST YOUR IMMUNE SYSTEM

W

hen your immune system is strong, you can fight invaders, such as bacteria, viruses and harmful chemicals. A tough immune system also helps fight free radicals — molecules in the body that can contribute to cancer, heart disease, atherosclerosis (hardening of the arteries), dementia and other chronic illnesses. For older Dr. Ojomah adults, having a strong immune system is vital, Emono since illnesses and infections can last longer and be more debilitating than in younger years.

By following a healthy lifestyle, you can help fortify your immune system. Follow these five steps to help fight infection and disease: Eat right. Hit the produce aisle for a variety of antioxidantrich fruits and vegetables, such as broccoli, spinach, yams, citrus fruits, apples and berries. Aim for a balanced diet that includes whole grains like brown rice and cereal, lean protein like chicken and fish, and plenty of water. “Even small nutrient deficiencies make it harder for the body to prevent and recover from disease,” said Dr. Ojomah Emono, a primary care and board-certified, family medicine physician with Houston Methodist Primary Care Group in Kingwood. “Take a multivitamin — especially if you are on a diet, eat an unbalanced diet, suffer from a chronic disease, or take medications such as corticosteroids, thyroid hormones, antibiotics or diuretics.”

Exercise often. To fend off infections, put on your walking shoes. A 30-minute brisk walk five days a week helps maintain a healthy immune response and lowers your risk of heart disease, stroke, diabetes, osteoporosis and cancer. Add more activity to your day any way you can. Do yard work. Take the stairs. Go line dancing or bowling.

Get some zzzs. While your body rests, your immune system is recharged. Aim for seven to nine hours of sleep a night. Schedule downtime before going to bed so you can relax and let sleepiness take over. Cut out naps if they interfere with your nighttime sleep.

Dump bad habits. Smoking, overeating and drinking alcohol tax your immune system. Emono recommends putting yourself in the right frame of mind to quit — even if you’re not ready to commit. Sit in on a support group for smoking cessation, weight loss or substance abuse and think of a “quit date.”

Relax! “Depression, anxiety and high levels of stress hormones also affect your immune function,” Emono said.

“To restore emotional balance, take a yoga or tai chi class, pray, meditate or perform simple breathing exercises. Restore your energy by making time for things you enjoy.”

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THE TRUTH ABOUT VACCINES Vaccine safety issues are a concern for many people.

Weighing the benefits against the risks with your health care provider is a key step in understanding the facts about vaccines.

Vaccines protect from serious, often fatal diseases.

Vaccines are safe and effective.

Vaccine Information Statements outline the benefits and risks of a vaccine and are given to patients or their parents before any vaccination is administered.

Health care professionals remain the most trusted source of vaccine information.

Source: Centers for Disease Control and Prevention

GET THESE SHOTS! Adults are 100 times more likely to die than children from vaccine-preventable diseases. The Centers for Disease Control and Prevention recommends these vaccines for adults. Talk to your doctor about what’s right for you.

VACCINATION

HOW OFTEN?

Influenza (flu)

Once every year

Pneumonia If you never received a pneumonia vaccine before age 65; at 65 you should receive a dose of Prevnor 13 first, followed by a dose of Pneumovax 23, at least one year later.

Tetanus booster

Once every 10 years

Shingles (zoster) Two-dose series for adults ages 50 and older

Take Action

Being up-to-date with recommended vaccinations can go a long way in keeping healthy. Houston Methodist has seven primary care locations in Montgomery County and the Northen Houston Region. To find a primary care doctor close to you, visit houstonmethodist.org/pcg/north or call 936.270.4680.

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The expertise to

KEEP YOU MOVING At Houston Methodist Orthopedics & Sports Medicine in The Woodlands, we know every movement matters. Our specialists offer: • The latest imaging and technology • Advanced nonsurgical treatments • Minimally invasive procedures

Conroe The Woodlands

• Customized treatment plans • State-of-the-art physical and occupational therapy

Whether you’re suffering from simple aches and pains or dealing with a complex injury, we can get you back on your feet — and keep you moving.

Schedule an appointment: houstonmethodist.org/sportsmed | 936.321.8000

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