Leading Medicine Spring-Summer 2021, Houston Methodist The Woodlands Hospital edition

LEADING MEDICINE SPRI N G/SUM M ER 2021

Lowering Blood Pressure Leads to Healthier Hearts

When to See a Doctor for

ORTHOPEDIC INJURIES Colon Cancer in Younger Adults: Know the Risks

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

Lowering Blood Pressure Leads to Healthier Hearts

H

ow’s your blood pressure?

Knowing your blood pressure is important not only because high blood pressure is a dangerous condition, Dr. Paul but because it can also Cunningham be a symptom of more serious heart disease.

If you haven’t been to the doctor recently, you might not know your blood pressure, and that concerns Dr. Paul Cunningham, interventional cardiologist at Houston Methodist DeBakey Heart & Vascular Center at The Woodlands. “While it’s important that we focus on the current health crisis,” Cunningham remarked, “conditions like high blood pressure and heart disease are no less dangerous than they were before the pandemic.”

UNDERSTAND YOUR NUMBERS

Blood pressure is written as two numbers.

The first number is the pressure when the heart beats and pumps blood. The second is when the heart is resting, between beats.

A normal blood pressure range for adults is lower than 120/80 mmHg and higher than 90/60 mmHg.

KNOW YOUR RISK FACTORS

There are several factors that put you at an increased risk for high blood pressure.

Risk factors you can’t change are your family history, race, age and gender.

However, you can make changes to the following risk factors to help manage or avoid high blood pressure: Lifestyle. Engaging in 30 minutes of activity on most days of the week helps to strengthen your heart, reduce stress and improve your overall health. If you smoke, get help to quit.

ADVANCED VALVE TREATMENTS AT THE WOODLANDS The heart has four valves that help to regulate the flow of blood to and from the heart. Over time, conditions like a heart murmur, high blood pressure, cholesterol, calcification and infections can cause the valves Dr. Lucas Duvall to work poorly or stop functioning.

“Heart valve procedures have advanced in recent years, allowing us to correct these structural heart issues without opening the chest,” said Dr. Devang Parikh, interventional cardiologist at Houston Methodist DeBakey Heart & Vascular Center at The Woodlands.

Transcatheter aortic valve replacement (TAVR) is a less invasive procedure for the replacement of damaged heart valves. “When severe aortic stenosis limits the heart’s ability to function as it should, TAVR provides an option for placing a new aortic valve using catheter-based Dr. Devang techniques instead of open heart surgery,” explained Dr. Lucas Duvall, a Parikh cardiothoracic surgeon at Houston Methodist DeBakey Heart & Vascular Center at The Woodlands. “The advantages of TAVR include faster recovery times, improved safety and shorter hospital stays.”

Advanced valve treatments can be lifesaving. The Valve Clinic at Houston Methodist DeBakey Heart & Vascular Center in The Woodlands makes it easier for patients to get the necessary imaging and meet with specialists in one convenient visit. If you or a loved one suffers from valve disease, visit houstonmethodist.org/valveclinic or call 936.290.8258 for more information.

Weight. Being overweight with a body mass index of 25 or greater puts a strain on your heart and circulation. Losing as little as 10 pounds can improve your heart health and lower blood pressure.

Diet. Eat a variety of fruits and vegetables, and limit your intake of salt, sugar and trans fats. If you drink alcohol, limit it to no more than one drink a day for women or two drinks a day for men.

BENEFIT FROM TEAM EXPERTISE AND EXPANDED SERVICES If you or a loved one needs specialized heart care, knowing where to go is key.

Take Control

“Delivering comprehensive heart care in a compassionate manner is important to us,” said Cunningham. “Our team includes experienced cardiologists, cardiovascular surgeons, cardiac imaging experts and nurses specializing in heart care who all work together to deliver the best possible care for every patient.”

In addition, the recent expansion of cardiovascular services at Houston Methodist DeBakey Heart & Vascular Center at The Woodlands includes increased diagnostic cardiology space and more prep/recovery rooms. Future expansion plans include two new cath labs, bringing the hospital’s total to six.

Team up with your health care provider to take control of your blood pressure. The team at Houston Methodist DeBakey Heart & Vascular Center at The Woodlands can help you manage high blood pressure and other heart conditions. Call 713.DEBAKEY or visit houstonmethodist.org/debakey/woodlands to schedule an appointment.

2 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

WHY AM I SHAKING? S haky hands or other involuntary movements can be upsetting.

You may wonder: “Could I have Parkinson’s disease?” The reality is that most involuntary shaking is not caused

by Parkinson’s, and only some shaking is caused by neurological disorders.

When you experience shaking or trembling Dr. Randall due to your muscles making uncontrolled Wright contractions, it’s known as a tremor. Most tremors happen in the hands, but they can occur in the arms, torso, legs, head and even vocal cords.

“Often, people will experience tremors mildly at first,” said Dr. Randall Wright, neurologist at Houston Methodist The Woodlands Hospital. “Some tremors are temporary and pass on their own, and some may progressively worsen over time. Because shaking can be associated with many different conditions, if a tremor doesn’t go away on its own, it’s best to get it checked out.”

NOT-SO NEUROLOGICAL CAUSES OF TREMORS

The causes of a tremor can range from the benign to the serious.

Some tremors are caused by circumstances or behaviors, including: Medication side effects: Some medications list tremor as a potential side effect. These include certain medications used to treat asthma, cancer, depression, epilepsy and high blood pressure.

Excessive caffeine: In general, ingesting up to 400 mg of caffeine in a day is considered safe for most adults. While some people can tolerate even higher intake, others risk a caffeine overdose that can cause a wide range of symptoms.

These can include diarrhea, insomnia, anxiousness, headache, fever and uncontrollable muscle movements. It’s wise to limit your intake of caffeinated beverages, as the average cup of coffee can have up to 100 mg of caffeine, while an energy drink can reach 250 mg of caffeine.

Anxiety: Anxiety is characterized by excessive, persistent worry and fear. Physically, it can also lead to sweating, a fast heart rate, rapid breathing and shaking.

L ow blood sugar: When your blood has low levels of sugar, or glucose, it’s called hypoglycemia. It’s often a sign of poorly managed diabetes, but can have other causes. Examples include excessive alcohol consumption, a hormone deficiency or an eating disorder like anorexia nervosa. In addition to a tremor, other symptoms of mild hypoglycemia can include hunger, sweating, dizziness and blurred vision.

Overactive thyroid: If your thyroid gland produces too much thyroid hormone, you can experience wide-ranging symptoms, which can include shakiness. Other possible symptoms to watch for include swelling in the neck, mood swings, fatigue, muscle weakness, an increased appetite, sudden weight changes and a fast heart rate.

Calm Your Fears

If you’re experiencing unexplained shaking or trembling, make an appointment with your primary care provider. They can help identify potential causes and provide a referral to a neurologist at Houston Methodist The Woodlands Hospital, if necessary. To schedule an appointment, visit houstonmethodist.org/pcg/north or call 713.394.6791.

AT REST AND ACTIVE TREMORS

“Tremors that persist over time, or progressively get worse, we can classify into two categories: resting and active,” said Wright.

Resting tremors occur when muscles are relaxed, such as when your hands are resting on your lap. Action tremors happen when you are using your muscles, such as when you are writing, reaching for a glass or making a fist. “When trying to diagnose the cause of a tremor, it’s one of the first things we determine,” explained Wright. “Generally speaking, active tremors are not Parkinson’s related, whereas tremors that occur at rest may be.”

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When to See a Doctor for

ORTHOPEDIC INJURIES

W

hen you have an injury, you may wonder what to do next. Should you just walk it off, hope to get an appointment with a doctor the next day, go to an urgent care clinic the same day or head to the ER immediately? Every year, millions of people, who end up in the emergency room or doctor’s office with orthopedic injuries, have the Dr. Leonardo same debate.

Taarea Injuries are bound to happen whether you’re competing in sports, exercising, moving furniture or simply stepping down from a curb. “It’s not always clear what to do and where to go for medical care following an injury,” said Dr. Leonardo Taarea, a primary care sports medicine physician with Houston Methodist Orthopedics & Sports Medicine at The Woodlands.

Protect your injury by wearing a cast or brace, or using crutches, if needed.

HOW SERIOUS IS IT?

How do you know if you have a minor injury that will heal on its own, or if you need further treatment from a doctor? Minor injuries can often be treated at home, but there are times when you should see a doctor to ensure proper healing.

Your ability to bear weight on the joint is key. “Being unable to bear weight on your knee or ankle is a sign that you should see a physician for an evaluation and possibly X-rays,” Taarea said. “In those cases, you should use crutches and visit our same-day injury clinic or see a doctor promptly.” Any injury that triggers swelling in the ankle or knee should also be evaluated. The majority of these injuries don’t need to be evaluated in the hospital, but should be evaluated soon in a doctor’s office.

The question is whether it should be evaluated right away, or if you should wait. Warning signs that you should seek medical help right away for more serious injuries include the following: Any deformity of the limb Inability to bear weight Persistent joint pain Significant swelling with inability to move fingers or toes Swelling of a joint that comes on rapidly Weakness when moving a limb or muscle

WHAT TO DO AFTER AN INJURY

Whether you get hurt at home or while you’re out and about, deciding what to do after an injury can be stressful. You may feel compelled to push through the pain, but continuing to move the injured area could lead to further damage and a longer recovery time.

“The pain you experience postinjury is your body’s way of letting you know that you need to slow down and rest,” said Taarea. He advises the following after an injury: Rest the injured area to avoid further injury.

Apply ice or compression to reduce swelling.

Elevate the injured area.

“If you’re unsure about how to handle an injury, play it safe and get checked out by an orthopedic specialist or sports medicine doctor,” Taarea said.

SAME-DAY ORTHOPEDIC INJURY CLINICS The next time an injury slows you down, come in for quick and convenient same-day care at Houston Methodist Orthopedic Injury Clinics. Simply drop in for evaluation and treatment of your injury. Most major insurance plans are accepted.

The clinic provides treatment for: Acute orthopedic injuries Fractures and broken bones Injured tendons Minor dislocations

Painful or swollen joints Sports injuries Sprains and strains Torn ligaments Visit houstonmethodist.org/osm-injury-tw or call 936.321.8000 to get started.

Chronic conditions, spine injuries, motor vehicle accidents and workers’ compensation injuries are not treated at the injury clinic.

Please call 936.321.8000 to schedule an appointment with the appropriate physician for those conditions.

4 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

HOW LONG WILL IT TAKE TO HEAL? Some injuries take longer to heal compared to others, and this may depend on the location and severity of the injury, your age, overall health and other factors. In addition to home treatment with RICE (rest, ice, compression and elevation), a doctor may recommend anti-inflammatory medication, cortisone injections or surgery to repair torn muscles or ligaments. For injuries that don’t heal quickly on their own, physical therapy can be a key part of the recovery process.

The following is a range of recovery times for common orthopedic injuries.

AVERAGE RECOVERY TIMES HAMSTRING STRAIN

a few days

A few days for a mild strain; up to 3 months for a partial or complete muscle tear.

ANKLE SPRAIN

1-3 weeks

1-3 weeks for a mild sprain; up to several months for a severe sprain.

TENNIS ELBOW

4-6 weeks

Most people improve in 4-6 weeks.

SHIN SPLINTS

3-6 months

Up to 3-6 months.

ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR

4-6 months

4-6 months for recovery from knee surgery.

ROTATOR CUFF INJURY

4-6 months for recovery from rotator cuff repair surgery.

HOUSTONMETHODIST.ORG/THEWOODLANDS 5

Colon Cancer in Younger Adults:

KNOW THE RISKS I

Dr. Mohammed Khalil

Dr. Priya Ramshesh

t may be hard to believe that colon cancer could develop in your 20s, 30s or 40s — but the risks are real. In 2020, the death of actor Chadwick Boseman at age 43 from colon cancer underscored the threat of colon cancer to younger adults.

“Colon cancer rates are declining among older adults, but we’re seeing colon cancer rates rising every year among adults younger than 50,” said Dr. Priya Ramshesh, a medical oncologist and medical director of the Infusion Center at Houston Methodist The Woodlands Hospital. “Although lifestyle factors, such as having a poor diet and being overweight, may be part of the problem, it’s scary because we don’t really know what is behind this increase.”

“With colon cancer increasing in younger adults, it’s important to raise awareness about the risks and be proactive about prevention and early detection,” said Dr. Mohammed Khalil, a medical oncologist with the Cancer Center at The Woodlands.

COLORECTAL CANCER SCREENING

Early screenings and detection of colorectal cancer make it possible to find the disease early when it’s more treatable.

The American Cancer Society recommends colorectal cancer screening starting at age 45 for people with an average risk of colon cancer. “If you have an increased risk for colorectal cancer, you should talk to your doctor about screening before age 45,” Ramshesh said.

You may be at increased or high risk for colon cancer if you have: A strong family history of colon cancer A personal history of colorectal polyps Inflammatory bowel disease, including ulcerative colitis or Crohn’s disease A hereditary syndrome that increases your risk Radiation to your abdomen or pelvic area to treat a prior cancer

Connect With Your Doctor

If you have concerns about your risk for colon cancer, you should talk to your doctor about a colorectal cancer screening. To find a Houston Methodist primary care doctor, visit houstonmethodist.org/pcg/north or call 713.394.6791.

6 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

How do you know if you have a strong family history of colon cancer? Having a first-degree relative (parent, sibling or child) diagnosed with colorectal cancer increases your risk. “The risk goes up if your relative was diagnosed before age 50 or more than one relative was diagnosed,” Ramshesh added.

REDUCE YOUR RISKS

Some of the factors that increase your risk for colon cancer are beyond your control. However, you have the power to make healthy lifestyle choices to help reduce your risk: Eat a healthy diet. A healthy diet with plenty of fruits, vegetables and whole grains may help prevent colon cancer.

Avoid highly processed foods. Lunch meats and foods containing added chemicals and preservatives may increase colon cancer risk.

Exercise regularly. Having a sedentary lifestyle has been linked to colon cancer.

Lose weight. Being overweight or obese can also increase the risk of colon cancer.

Quit tobacco and limit alcohol. Both are linked to many cancers, including colon cancer.

COMPREHENSIVE CANCER CARE

“Getting checked out if you have concerns is important,” Khalil said, “and recent expansions in the Cancer Center at The Woodlands, as well as in other areas of the hospital, support the enhancement of comprehensive cancer care available to our patients. For example, as part of the $250 million phase II expansion, we will offer expanded services, including endoscopy and additional operating rooms in a new patient care tower, opening in early 2022.”

DEALING WITH

PANDEMIC DEPRESSION

E Dr. Maritza Figueroa

verybody feels occasionally sad and tired when times are normal. And right now, many of us are feeling especially down due to the coronavirus pandemic. We’re all more isolated and stressed than usual, and many of us are dealing with added pressures due to financial strain, family responsibilities, health concerns and job losses. So, it’s only natural to be down in the dumps. But at what point does feeling down become full-fledged depression?

DEPRESSION: A NEW PANDEMIC?

COVID-19 might not be the only pandemic we should be concerned about. Depression has become significantly more common in the wake of the coronavirus. The Centers for Disease Control and Prevention found that the prevalence of depressive disorder in U.S. adults was nearly four times higher in June 2020 compared to the second quarter of 2019. This means nearly a quarter of all U.S. adults reported symptoms matching depressive disorder. And Texas is no exception.

A recent CDC survey estimated that 31.8% of Texans had recently experienced symptoms of depression.

“Since COVID-19, I’ve seen a substantial increase in people with depression and other mental health conditions,” said Dr. Maritza Figueroa, a fellowship-trained neuropsychologist at Houston Methodist The Woodlands Hospital. “Depression isn’t just harmful for the mind, but it can harm a person’s physical health, too. It can produce muscle tension, aches and pains.

Also, restlessness, an inability to concentrate, poor sleep, chronic fatigue and weight changes.”

SYMPTOMS OF DEPRESSION

Keep an eye out for depression by learning the symptoms. Talk to your doctor if you experience some of these symptoms most of the day, nearly every day, for at least two weeks: Persistent sad, anxious or empty mood Hopelessness or pessimism Irritability Feeling guilty or worthless Loss of interest or pleasure in hobbies and activities Decreased energy Moving or talking more slowly Feeling restless or having trouble sitting still Difficulty concentrating, remembering or making decisions Problems with sleeping Appetite and/or weight changes

Thoughts of death or suicide Aches, pains, cramps or digestive problems without a clear physical cause

WHAT TO DO ABOUT DEPRESSION

The most effective treatments for depression are psychotherapy, medications or a combination of the two. But there are steps you can take to help prevent and lessen depression: Distract yourself. Depression can encourage a loop of negative thoughts in your mind. Focusing on something else can bring you out of your head and add a new level of meaning and purpose to life. Try learning a musical instrument, writing a novel or growing a garden.

Have a routine. Staying up late, skipping meals and generally avoiding self-care only gives your mind more reasons to feel down. Having a more structured day that includes time for self-care can help reduce stress and benefit your physical health.

Be grateful. Even when there are plenty of reasons to be depressed, there are still reasons to be grateful if you look.

It can be as simple as a beautiful sunset or a roof over your head. Or maybe it’s a TV show that makes you laugh or an outfit that makes you look really good. Maintaining a gratitude journal has been found to help people sleep better, lower stress and improve relationships.

Get moving. Exercise can help improve physical and mental health. While depression can make it hard to get started, all you need is five minutes of activity here and there. Ideally, you should aim for 150 minutes of moderate-intensity exercise each week.

Visit Houston Methodist’s On Health blog at houstonmethodist.org/blog to find additional tips for handling your mental health.

Offering Professional Help At Houston Methodist The Woodlands, our medical team helps diagnose and treat mental health disorders.

If you’re concerned about potential depression, visit houstonmethodist.org/find-a-doctor or call 713.790.3333.

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WE STAND BEHIND THE VACCINE Here’s why our experts support the COVID-19 vaccine:

TESTED

TRUSTED

EFFECTIVE

There has been thorough testing and rigorous external review. Previous research and new technology allowed the vaccine to be developed faster, yet still follow the standard FDA process for emergency review before approval.

Most side effects are minimal, like other vaccines — including sore arms, muscle aches and fever. These flu-like symptoms indicate that the vaccine is doing its job — helping your body develop immunity to the virus. Other side effects are rare.

Current evidence indicates the vaccine is safe and up to 95% effective. COVID-19 can be fatal or debilitating. The risks of experiencing serious symptoms or being hospitalized from the disease are far greater than the risks associated with getting the vaccine.

We encourage you to get the first vaccine available to you.

Visit houstonmethodist.org/texas-vaccine-hub to sign up for the COVID-19 vaccine now. #ProtectedTogether

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