Leading Medicine Spring Summer 2018, Houston Methodist The Woodlands Hospital edition

LEADING MEDICINE SPRI N G/SUM M ER 2018

AT THE HEART OF ARRHYTHMIA STAYING HEALTHY THIS SUMMER

BREAKING THE BARRIERS TO JOINT REPLACEMENT

What’s holding you back from considering a joint replacement?

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

AT THE HEART OF

ARRHYTHMIA

H

eart beating too fast or skipping beats?

Most people have experienced an arrhythmia, or irregular heartbeat, at least once. Arrhythmia is extremely common, especially as you get older.

“While the majority of arrhythmias are harmless, some may be a sign of a more serious heart condition or require treatment,” Dr. Rajesh said Dr. Rajesh Venkataraman, cardiac Venkataraman electrophysiologist at Houston Methodist The Woodlands Hospital.

TYPES OF ARRHYTHMIA

There are many types of arrhythmia, including: Atrial fibrillation (AFib). Your heart beats too fast and irregularly in the upper chambers. This can increase your risk of stroke and requires treatment.

Bradycardia. Your heart beats too slowly. This can be caused by another health problem, such as an underactive thyroid, or by taking medication, such as beta blockers. If your slow heart rate is associated with fatigue, you may require a pacemaker.

Tachycardia. Your heart beats too fast.

Ventricular fibrillation. Your heart quivers instead of pumping as it should, leading to loss of consciousness or even death if not treated immediately with a shock to the heart.

Ectopic beats. Your heart has an extra beat or beats.

TREATMENT OPTIONS

Not all arrhythmias require treatment, but patients who experience significant symptoms may be at an increased risk for more serious conditions. Certain types of arrhythmia may also impair the heart’s efficiency and ability to circulate blood.

Treatment depends on the type and degree of the arrhythmia.

Options include: Lifestyle measures. Your doctor may recommend more exercise, an improved diet, better stress management, not smoking and limiting caffeine and alcohol as ways to reduce episodes.

Medication. Sodium-channel blockers, beta blockers, potassium-channel blockers, calcium-channel blockers and digitalis may slow or control tachycardia. However, these drugs may produce unwanted side effects.

Cardioversion. Drugs or an electrical shock reset the heart’s regular rhythm.

2 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

Catheter ablation. Catheters are threaded through blood vessels to the heart and deliver radiofrequency energy to carefully destroy (ablate) portions of the heart causing the arrhythmia.

Left atrial appendage occlusion. Many patients who have atrial fibrillation are unable to take blood thinners to lower stroke risk. In these patients, the left atrial appendage can be blocked off to reduce stroke risk.

Implantable devices. Surgery to implant an artificial pacemaker is a common treatment for bradycardia. Houston Methodist The Woodlands offers the world’s smallest pacemaker.

The MicraTM Transcatheter Pacing System provides patients with advanced pacing technology at one-tenth the size of a traditional pacemaker. The device is directly attached to the heart through a catheter, and sends an electrical impulse whenever the heart rhythm slows or becomes erratic. “Patients who have a traditional pacemaker will go home with their left arm in a sling for 10 days, which can be very restricting,” Venkataraman said.

“Patients with this new, smaller pacemaker return home with no restrictions. This is a great benefit of the device.”

Get Screened for AFib

The heart specialists at Houston Methodist The Woodlands Hospital can test your heartbeat to see whether or not you have an arrhythmia. For more information about our arrhythmia treatment options, call 936.270.3933.

Understanding Minimally Invasive Neurological Care

M

inimally invasive interventional neuroradiology is not something you’d want to say three times fast, but it is something you’ll want to learn more about if you have a neurovascular condition, such as a brain aneurysm, requiring treatment.

Interventional neuroradiology is a specialty in which highly trained doctors, called interventional neuroradiologists, use state-of-the-art diagnostic imaging and technologies to diagnose and treat patients with conditions, such as brain aneurysms, strokes and artery blockages. Endovascular procedures are used to treat problems affecting blood vessels, and in some cases may be used to help decrease the blood supply of certain tumors before surgery.

“Our interventional neuroradiology team has extensive expertise in providing minimally invasive treatments for a diverse range of problems of the brain, neck, head and spine,” said Dr. Mario Polo, an interventional neuroradiologist at Houston Methodist The Woodlands Hospital.

The benefits of minimally invasive neurological treatments are many. “Minimally invasive treatments are often less risky and less painful, and offer shorter recovery times than traditional open surgery,” Polo said.

INTERVENTIONAL NEURORADIOLOGY PROCEDURES

Some of the most commonly performed procedures in interventional neuroradiology include: C arotid stenting. This treatment involves inserting a small metal tube (stent) to widen blockages of the carotid artery (one of the vessels responsible for blood flow to the brain) if blood flow has been hindered by plaque buildup.

C erebral angiography. This therapy uses a contrast dye, along with X-rays, to provide a detailed look at blood flow within the brain. It helps diagnose and evaluate conditions, such as brain aneurysms and vascular malformations.

E ndovascular treatment of aneurysms. This procedure uses X-rays to guide a catheter through an artery to an aneurysm.

Brain aneurysms may be treated by placing metallic coils inside the aneurysm sac, or by using specially designed devices to redirect blood flow.

E ndovascular treatment of AVM and AV fistulas. AVMs and AV fistulas occur when there’s an abnormal connection between arteries and veins. They may be treated with catheter-based

INTRODUCING DR. MARIO POLO Dr. Mario J. Polo, a leading interventional neuroradiologist, is one of several dedicated specialists at Houston Methodist The Woodlands Hospital.

Dr. Mario Polo If you have a neurological condition, Dr. Polo will work with you to assess your condition and recommend a personalized treatment plan.

Help for Blocked Vessels

The interventional neuroradiologists at Houston Methodist The Woodlands provide advanced, minimally invasive care to patients with potentially life-threatening neurological conditions. Call 936.270.3333 for more information or to schedule an appointment.

procedures that close the abnormal connection by injecting special materials inside of the vessel.

I ntracranial stenting. An alternative to bypass surgery, intracranial stenting may be an alternative to treat a condition called intracranial atherosclerosis, which occurs when blood vessels at the base of the brain become narrowed by plaque buildup.

S pinal angiography. This procedure evaluates the blood vessels that surround and supply the spinal cord. It can help diagnose and evaluate abnormal connections between vessels surrounding the spinal cord.

T umor embolization. Embolization guided by imaging techniques is used to shut down or decrease blood supply to a tumor before surgery.

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BREAKING THE BARRIERS TO JOINT REPLACEMENT What’s holding you back from considering a joint replacement?

I

f you’ve been living with chronic joint pain for months or years — making it difficult to move about easily or walk normally — you may keep a running list of Dr. Eric Price reasons in your head why you haven’t had joint replacement surgery. But most of these are unnecessary barriers, because this highly common surgery usually vastly improves patients’ lives and allows them to resume their favorite activities without pain, according to Dr. Eric Price, an orthopedic surgeon at Houston Methodist The Woodlands Hospital.

More than 7 million Americans are living with an artificial knee or hip, the two joints most often replaced through surgery, according to the National Institutes of Health. At Houston Methodist, orthopedic surgeons perform over 4,000 joint replacements each year, predominantly knees, hips and shoulders.

This high volume translates into high levels of experience and high success rates, Price said.

“Joint replacement surgery is one of the true miracles of modern medicine,” Price added. “It gets people back to their lives doing the things they want to do and used to take for granted. That’s good for society, for the workforce and for patients’ quality of life.”

WHY JOINT REPLACEMENT BECOMES NECESSARY

Affecting 1 in 5 Americans, arthritis is typically the culprit in causing joints to become so stiff, tender and painful

GET RELIEF FROM YOUR JOINT PAIN At Houston Methodist The Woodlands Hospital, we offer a full spectrum of services, from conservative, nonsurgical treatment options to the most advanced surgical techniques, which include: Minimally invasive knee replacement Advanced techniques to minimize postoperative discomfort and accelerate recovery Partial knee replacement Complex joint revision surgery Physical therapy for arthritic knees Knee-preservation surgery

that joint replacement surgery is considered. An artificial joint used in joint replacement surgery can be made of plastic, metal and/or ceramic, according to Price. Either the usual “wear and tear” type of arthritis (osteoarthritis) is at play, he noted, or so-called traumatic arthritis brought on by an injury that makes the joint increasingly unstable over decades.

But the resulting pain can be so pervasive and excruciating that nonsurgical measures meant to manage

4 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

it — such as pain medications and creams, exercise, physical therapy, steroid or other injections, and bracing the joint — provide only brief relief, if at all.

“By the time people get to a conversation about joint replacement, they have pain on a daily basis and it’s occupying a disproportionate part of their lives,” Price explained. “It’s the kind of pain that leads them to become less active, whether athletically or socially, and can hinder everything from going grocery shopping to going to church, being able to prepare their own meals or even being able to walk outside.”

“It basically narrows their lives and limits their movement,” he added. “A lot of people get to the point where mentally, the pain becomes such a big part of their lives that they become unhappy.”

JOINT SURGERY FACTS

While many would say their joint pain is difficult and debilitating, surgery is often viewed as an absolute last resort. Here, Price debunks the most common misconceptions.

Short-term discomfort from surgery beats a lifetime of debilitating pain.

For every person who says joint replacement is a miserable procedure, many more have said they’re glad they had it done, and the majority of their pain is now gone. We’re also able to better control patients’ pain before, during and after surgery with new medications and by using older medications a bit differently, depending on the patient’s needs.

Recovery doesn’t take as long as it used to.

Improvements in surgical techniques and technology have reduced recovery time making it more efficient, predictable and generally less painful. This enables a more rapid return to function. Many patients are concerned they won’t get back to work in a prescribed amount of time, but national and international data show they usually return to their jobs within six weeks.

Most insurance covers it.

While insurance plans vary, joint replacement is one of the most established procedures in the United States, meaning reimbursement isn’t often a problem regardless of age.

Newer technology means longer lasting artificial joints.

As technology improves, joint durability continues to improve as well. An artificial joint probably has a life expectancy that matches the patient’s most of the time, and a majority of those who receive one will never need another.

READY? NO NEED TO WAIT

Regardless of what misconceptions may hold them back, most patients who need joint replacement typically reach the point where they’re ready to do it.

“It’s not uncommon for a patient to be ready to commit to joint replacement within a year or so of an arthritis diagnosis,” Price said. “There’s not necessarily a time frame where a patient’s outcome will be sacrificed as a result of waiting. However, the decision to proceed with joint replacement — sooner than later — will eliminate the pain and suffering of a prolonged waiting period.

“I schedule a follow-up visit with every patient one year after joint replacement surgery, and during this visit, I commonly hear ‘I wish I had done this sooner.’”

Considering Joint Replacement Surgery?

To schedule an appointment with one of our joint specialists at Houston Methodist The Woodlands Hospital, visit houstonmethodist.org/jointpain or call 936.321.8000.

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HEPATITIS C What You Need to Know

D

id you know that if you’re one of the more than 76 million baby boomers born between 1945 and 1965, you are five times more likely to have hepatitis C than Dr. Shazia Gill other adults? Hepatitis C is a chronic disease that can lead to liver damage, cirrhosis, and in rare cases, liver cancer.

SYMPTOMS

Symptoms of hepatitis may include: Bruising and bleeding easily Dark-colored urine Fatigue Swelling in the legs Yellow discoloration of the skin and eyes (jaundice) However, most people with hepatitis C have moderate symptoms or no symptoms at all. “While hepatitis C is treatable, many people don’t know they’re infected,” said Dr. Shazia Gill, a specialist in infectious diseases at Houston Methodist The Woodlands Hospital. “Most people can live with hepatitis C for decades without feeling sick or presenting symptoms, which is why screening is so critical.”

RISK FACTORS

The only way to know for sure if you have hepatitis C is to get tested. Your primary care doctor can give you a simple blood test to tell if you are infected with the hepatitis C virus. If you do test positive for the virus, your doctor will refer you to an infectious diseases specialist for treatment.

The Centers for Disease Control and Prevention recommends that everyone born between 1945 and 1965 be tested.

Others who should be tested include those who have:

Injected illicit drugs Tested positive for HIV Had a piercing or tattoo before the use of disposable ink Received a blood transfusion or organ transplant before 1992 Received clotting factor concentrates before 1987 Received hemodialysis treatments for a long period of time A mother with a hepatitis C infection

TREATMENT OPTIONS

The good news is that hepatitis C is highly treatable. “I tell my patients that most people who receive treatment have a greater than 90 percent chance

Get Tested

of being cured,” Gill said. Treatment for hepatitis C includes an oral regimen of antiviral medications that work to clear the virus from your body. Treatment generally causes minimal side effects and can last eight to 24 weeks, depending on the individual. In severe cases, a partial or whole liver transplant may also be considered. This lifesaving option is available at Houston Methodist Hospital.

“Our goal is to treat the virus early to decrease the risk that a patient will experience symptoms or damage to their liver,” Gill explained. “The treatment is very well-tolerated by most people and is usually covered by insurance, but screening is critical.”

The infectious diseases specialists at Houston Methodist The Woodlands Hospital can test your blood to see whether or not you have hepatitis C. If you do, your doctor will discuss treatment options with you. For more information about our hepatitis C treatment options, call 936.270.3835.

6 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

STAYING HEALTHY

THIS SUMMER

S

ummer is the season for outdoor grilling, picnics, parades and pool parties. But before you soak up the sun and engage in your favorite activities, Dr. Jennifer it’s important to take Greenblatt precautions against illness and injury. Dr. Jennifer Greenblatt, a primary care doctor with Houston Methodist Primary Care Group in The Woodlands, offered these tips for staying safe as you enjoy the season of sun.

MIND THE HEAT AND SUN

“Be aware of heat-related illnesses, including heat stroke and dehydration,” Greenblatt said. “The young, the elderly and pets are particularly vulnerable groups.”

Follow these tips to prevent heat-related illnesses and to protect your skin.

Stay hydrated. Hydration should begin before any outdoor activity. If you’re taking in enough fluids, your urine should appear clear to pale yellow.

Take frequent breaks in the shade or in air conditioning to keep cool.

Protect children and pets. Never leave them unattended in a hot car.

Avoid strenuous activities during peak temperatures (between the hours of 10 a.m. and 4 p.m.).

L imit sun exposure. Ultraviolet rays can damage the skin in only 15 minutes.

Wear sunscreen with an SPF of 30 or higher, and reapply every two hours and after swimming or sweating.

Wear protective clothing, widebrimmed hats as well as UVA- and UVB-blocking sunglasses.

DEFEND AGAINST INJURY

“Staying active during the summer is important, however, certain activities, especially if you don’t engage in them often, such as swimming in the ocean, hiking or boating, can lead to injury,” Greenblatt said.

Wear appropriate protective gear, such as helmets and life vests.

Never leave children unattended near pools or bodies of water.

Swim in designated areas only and never swim alone.

When using fireworks, follow package instructions, position yourself in a wide-open space, use protective eyewear and keep away from children.

Schedule an Appointment

To schedule an appointment with a primary care doctor, visit houstonmethodist.org/pcg or call 713.394.6776.

Avoid alcohol and drugs, which can impair judgment, balance and coordination.

PREVENT BITES AND STINGS

Summer and bugs go hand in hand.

To protect against mosquito bites and mosquito-borne diseases, such as Zika, reduce exposure to mosquitoes. Wear EPA-registered repellent and destroy mosquito breeding grounds by emptying containers holding stagnant water. If you or your child gets stung or bitten, apply calamine lotion or hydrocortisone cream to prevent itching. Carry an emergency first-aid kit so you’re prepared in case of an allergic reaction. Include items such as an antihistamine like Benadryl, topical steroid cream, plus vinegar for jellyfish stings. To avoid attracting insects, steer clear of scented soaps and lotions.

WHEN TO VISIT THE ER If you experience severe symptoms, such as shortness of breath, difficulty breathing, sudden confusion or a deep wound, go to the nearest ER. Houston Methodist Emergency Care Center in The Woodlands, located at the intersection of FM 1488 and Kuykendahl Road, is open 24/7 to meet any emergency that may arise.

To learn more, visit houstonmethodist.org/er and remember to always call 911 in the case of heart attack or stroke.

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LIVE A LIFE WITHOUT

JOINT PAIN We can help you get there.

Conroe The Woodlands

If you’ve suffered from years of joint pain and struggled to find relief, we have the joint care expertise to get you back to your everyday life. With treatment plans customized for you, our specialists offer a full range of advanced nonsurgical and surgical techniques, including: • • • •

Innovative pain control methods Physical therapy to improve mobility and range of motion Latest technology, including minimally invasive surgical techniques Presurgical education programs for joint replacement

Willowbrook

Memorial City Bellaire

Katy

Baytown

Texas Medical Center Pearland Sugar Land

Clear Lake

Schedule an appointment to discuss your options with a joint specialist.

Houston Methodist Orthopedics & Sports Medicine Locations in The Woodlands and Conroe | 936.321.8000 houstonmethodist.org/jointpain

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