Leading Medicine Winter 2018, Houston Methodist The Woodlands Hospital edition

LEADING MEDICINE W INT ER 2018

HELP FOR CHRONIC HEADACHES WHAT IS YOUR THYROID TELLING YOU?

WHY WOMEN SHOULD LISTEN TO THEIR HEARTS Symptoms can vary when compared to men

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

Preparing for a COLONOSCOPY WHAT TO EXPECT FROM THIS LIFESAVING TEST

No one wants to talk about getting a colonoscopy — but this important test could save your life! Dr. Apurv Varia, a gastroenterologist and member of Houston Methodist Physicians’ Alliance for Quality, urges patients to make time for a colonoscopy.

Dr. Apurv Varia “If you have any hesitation, your doctor will guide you through the experience and educate you on what to expect,” Varia said.

A colonoscopy is recommended at age 50 for people with average risk of developing colorectal cancer or earlier if you have a family history of colorectal cancer or other risk factors.

“A colonoscopy can detect colon cancer early, when it’s highly treatable, and even prevent cancer with the removal of polyps,” Varia added.

SCHEDULE YOUR EXAM

TIP Schedule your colonoscopy for a time when you can take the day off from work or other commitments.

Pick up your bowel preparation kit from your pharmacy a few days in advance as instructed by your doctor. Dietary changes or changes to your medications may be required a few days prior to a colonoscopy, so be sure to follow any special instructions from your doctor’s office.

PREP DAY

TIP Stay close to your bathroom during your prep time, since

you will have a frequent and urgent need to use the toilet.

The prep requires that you take a laxative and are on a clear liquid diet. “We advise you drink plenty of fluids and read the instructions carefully to guarantee you are prepared for the procedure,” Varia said. On the examination day, you will be asked to fast during the four to six hours prior to the procedure.

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EXAM DAY

TIP A colonoscopy typically takes about 30 minutes, but the total time of your visit will be longer.

You will be positioned on your side in the exam room and given medicine to help you relax. During the exam, a gastroenterologist or surgeon inserts a colonoscope, a long flexible tube, into your rectum and guides it into the colon. Air is used to inflate the colon for a better view of the colon wall. Using a tiny video camera, the doctor checks for any abnormalities, including polyps, and removes them. “Most patients sleep comfortably through the entire exam,” Varia noted.

AFTER CARE

TIP Due to the medication given during the procedure, you must have a responsible adult drive you home.

Following the procedure, you will be taken to a recovery area where a nurse will continue to check your vital signs. If you still feel bloated, passing gas will make you feel more comfortable.

Your doctor will review the findings of the colonoscopy with you. If no abnormalities are found, your next colonoscopy is usually recommended in 10 years. If polyps were removed, a more frequent screening schedule will be followed.

Set the Date for Your Colonoscopy

Don’t put off having this lifesaving test. Call your doctor to schedule a colonoscopy. If you do not already have a gastroenterologist, or if your managed care provider requires you to see a primary care physician first, call 936.270.3333 to find a doctor near you.

Help for Chronic

HEADACHES A ccording to the World Health Organization, up to 1 in 20 adults has a headache every day. Dr. Stacy V. Smith, neurologist at Houston Methodist The Woodlands Hospital, wants everyone to know that there is hope — and help — for headache sufferers. “Many people miss school, work or family and social activities Dr. Stacy V. due to headaches,” Smith said. “Helping Smith headache patients find an effective therapy plan substantially impacts all aspects of their lives.”

Smith sees another type of headache known as a medication overuse headache, also known as a rebound headache. “Many patients develop worsening headaches over time partially due to too frequent use of pain medications,” Smith added. “Almost any pain medication, whether prescription or over the counter, contributes to this phenomenon. We advise patients to limit acute headache therapies (“as needed” medications) to no more than two days per week on average. This can be difficult for patients with chronic headaches, so part of my job is to help patients manage their medications to avoid medication overuse,” Smith explained.

UNDERSTANDING YOUR HEADACHE

SPECIALIZED TREATMENT FOR BETTER RESULTS

People can be affected by different types of headaches, such as migraines, tension headaches and cluster headaches.

Migraines often

Tension headaches typically

Cluster headaches typically

ffect one A side of the head

Wrap around the head

Affect one side of the head

Create throbbing and pounding pain

ause pressure C or tightness (nonthrobbing pain)

Cause sharp, stabbing pain over the temple or behind the eyes

Are associated with light or sound sensitivity

end to come T on later in the day

ome in a C cluster, often several times a day, for a period of time and then disappear

ause nausea C or vomiting

Are not associated with nausea or vomiting

May cause nasal congestion, watery eyes and flushing of the forehead and face on the same side as the headache

reate visual C auras, such as kaleidoscope vision

May be associated with stress and fatigue

Cause sudden onset of pain that may awaken you from sleep

When it comes to headaches, finding the right treatment for your unique symptoms is vital. A neurologist is trained to identify your headache and offer treatments for your specific needs.

Treatment options are diverse and include over-the-counter and prescription medications, dietary supplements, noninvasive medical devices, cranial nerve blocks, BOTOX® injections, infusions, psychological techniques and physical therapies.

“With BOTOX treatment, a tiny dose is injected in specific areas of the head and neck to prevent chronic migraine headaches,” Smith said.

WHAT TRIGGERS YOUR PAIN? Find out by keeping a headache diary. Jot down answers to these questions each time you get a headache in the next month.

1. Did you eat anything shortly before the headache’s onset?

2. Did any symptoms precede the headache?

3. Where did the pain begin?

4. Did the pain come on slowly or suddenly?

5. Describe the pain. Is it throbbing?

6. Are you experiencing nausea or vomiting?

7. W ere you under any special stress before the headache occurred?

8. At what time of day did the headache begin?

Take your headache diary to your healthcare provider. It may offer important clues to what may be triggering your headaches — a major step in preventing the pain.

Get Relief

If you’re suffering from headaches, we can help. To schedule an appointment with a neurologist at Houston Methodist The Woodlands Hospital, call 936.270.3333.

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WHY WOMEN SHOULD LISTEN TO THEIR HEARTS Symptoms can vary when compared to men

4  LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

D

espite the perception that heart disease is a man’s disease, it’s the No. 1 killer of women, according to the American Heart Association. Millions Dr. Margit of women die of heart Nemeth disease every year, yet many are unaware of their risk for the condition. Women often put off taking care of their health — and this inaction can put an extra burden on their hearts.

One form of heart disease, a heart attack, can strike suddenly and with no advance warning. Just like men, women often experience the crushing chest pain and discomfort typically associated with a heart attack. But, women are somewhat more likely than men to experience other common heart attack symptoms and often ignore them.

“A misunderstanding of gender-related heart attack symptoms could cause women to delay getting care because they aren’t sure if they’re having a heart attack, panic attack or indigestion,” said Dr. Margit Nemeth, medical director for non-invasive cardiology at Houston Methodist The Woodlands Hospital.

“It’s key to learn and watch for signs that something may be wrong — and if you’re ever in doubt, don’t hesitate to seek prompt medical care.”

Use these heart health facts for women to bolster your prevention and treatment efforts:

HOW A WOMAN’S HEART ATTACK MAY FEEL

You may already be familiar with classic heart attack symptoms for men, such as crushing chest pain that radiates down the left arm associated with sweatiness, paleness and shortness of breath. “Women are more likely than men to describe chest pain that is burning and sharp, as well as experience extreme fatigue, pain in the neck, jaw, throat, abdomen or back,” Nemeth said.

RISK FACTORS OFFER CLUES

Managing your risk factors for cardiovascular disease is only possible if you know what they are, and routine screening tests can reveal the answers.

At your next checkup, ask your doctor to assess your weight and BMI (body mass index), waist circumference, blood pressure, cholesterol and fasting blood glucose level. “These tests offer important clues to cardiovascular health as well as your overall health,” Nemeth said.

HEART ATTACK NOT SOLE SETBACK

With all the focus on heart attacks, some aren’t aware that cardiovascular disease can take many forms. Other heart problems include heart failure, in which the heart isn’t pumping as efficiently as it should; arrhythmia, a too-slow or too-fast heartbeat that can affect its ability to meet the body’s needs; and heart valve problems, which can impede proper blood flow through the heart.

“Nearly all of these conditions are easily detectable with routine medical checkups,” Nemeth said. “It’s yet another reason why establishing an ongoing relationship with a primary care physician is so critical to your heart health.”

MENOPAUSE TOO LATE TO PREPARE Women with heart disease risk factors, such as high blood pressure, high cholesterol and a family history, shouldn’t wait until menopause to start a dialogue with their primary care physician about a prevention regimen to keep them healthy.

A recent survey published in the Journal of the American College of Cardiology found that 74 percent of women in the United States had at least one heart disease risk factor, but only 16 percent told their doctor about it.

“Women have such a low prevalence of heart disease until menopause that often times, the topic is ignored until women are well into their 50s and 60s,” Nemeth said.

“But those with risk factors need to be 10 years ahead of the game when it comes to prevention. Unfortunately, too many women already have heart disease by the time they’re tested.”

New High Blood Pressure Guidelines

Are you at risk?

The American College of Cardiology and American Heart Association released new scientific guidelines on what’s considered high blood pressure, lowering the threshold from 140/90 mmHg to 130/80 mmHg. Recommendations focus on making healthy lifestyle changes to lower blood pressure, including quitting smoking, managing weight, being active and eating a heart-healthy diet. Some patients may also need medication.

The new blood pressure categories consider both systolic (top number) and diastolic (bottom number) pressure.

Normal: Less than 120/80 mmHg E levated: Systolic between 120–129 and diastolic less than 80 mmHg H igh Stage 1: Systolic between 130–139 or diastolic between 80–89 mmHg H igh Stage 2: Systolic at least 140 or diastolic at least 90 mmHg Talk to your doctor to learn if you’re at risk and how you can protect your heart.

Heart Health Screenings

Tuesday, Feb. 13, 6–8 p.m.

Houston Methodist The Woodlands Hospital, 3rd Floor Conference Center Schedule an appointment to learn your 10-year risk for heart disease and receive cholesterol and blood pressure screenings.

Registration required. Visit us online at houstonmethodist.org/events to register.

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EASE CARPAL TUNNEL WITH THE RIGHT MOVES

C

arpal tunnel syndrome can strike anyone who uses their hands vigorously or repetitively — from office workers and truck drivers to musicians and gardeners.

“In the early stages of carpal tunnel syndrome, you may notice tingling or numbness in your fingers or hand that wakes you up during the night,” said Dr. Steven Gordon, a plastic and hand surgeon at Houston Methodist The Woodlands Hospital.

“Over time, symptoms become more painful and noticeable during the day. In severe cases, you may experience weakness in your hands and loss of dexterity or fine motor skills.”

The following steps may help relieve symptoms of carpal tunnel syndrome and prevent further progression: Take frequent breaks and alternate activities to give your hands a rest If you work at a computer, set up your desk and keyboard so that your wrists are in a neutral or more bent-up position If you use tools on the job, make sure they fit your hand correctly and use anti-vibration tool wraps and gloves, as needed Stretch your hands and wrists several times a day to give yourself a break (for example, make a fist and release it) Wear a wrist brace at night if recommended by your doctor

GET RELIEF FROM PAINFUL SYMPTOMS

If left untreated, carpal tunnel syndrome may lead to permanent nerve damage, and the longer you wait, the worse it can get.

“If finger numbness or hand pain interferes with your normal activities or bothers you at night, it’s time to see a doctor,” Gordon said. “At Houston Methodist, we can do a nerve conduction study to find out if your carpal tunnel is mild, moderate or severe, which helps determine the right treatment plan. In some cases, anti-inflammatory medicines or steroid injections may be used to ease symptoms.”

Surgery is another option for moderate to severe cases, and for those who do not respond to conservative measures. “Carpal tunnel release is a simple procedure that can relieve pressure on the median nerve,” Gordon said. “While historically large incisions were used across the palm and wrist, I perform either a mini-open procedure with a small incision on the palm or an endoscopic release with a small incision at the wrist. Patients can typically get back to doing everyday activities quicker with an endoscopic approach, and the procedure can be done on both hands at the same time if indicated.”

6 LEADING MEDICINE FROM HOUSTON METHODIST THE WOODLANDS HOSPITAL

NEW HAND SURGEON Meet Dr. Steven Gordon, a fellowshiptrained plastic and hand surgeon with Houston Methodist The Woodlands Hospital specializing in carpal tunnel Dr. Steven and cubital tunnel syndrome, hand Gordon and forearm trauma, tendinitis and arthritis in the hand and wrist, as well as plastic and reconstructive surgery.

Schedule an Appointment

We can help determine the cause of your pain and recommend treatment options for a fast recovery. To schedule an appointment with a hand and wrist specialist at Houston Methodist The Woodlands, call 936.270.3680.

What Is Your

THYROID Telling You?

A

re you gaining or losing weight without explanation?

Do you seem to be more sensitive to cold or hot weather? Having digestive problems Dr. Shivani or trouble sleeping?

Toma According to Dr. Shivani Toma, endocrinologist at Houston Methodist The Woodlands Hospital, these and other symptoms may indicate a problem with your thyroid, the small gland located in the lower front of the neck, just above your collarbone.

“The thyroid gland produces hormones that regulate our metabolism, which includes bodily processes, such as body temperature, heartbeat, digestion and more,” Toma explained. “It can affect so many systems in our bodies, including development and growth in children, energy, mood and cardiovascular and gastrointestinal systems. It also helps regulate women’s menstrual cycles and can affect ovulation and fertility.”

WHAT’S HYPOTHYROIDISM?

Hypothyroidism is when the thyroid makes too little thyroid hormone.

“Common symptoms are related to a slowing of metabolism and include fatigue, weight gain, dry puffy skin, cold intolerance, constipation and brittle hair and nails,” Toma said.

Your doctor will run a blood test to measure the levels of your thyroid hormones if hypothyroidism is suspected.

“Treatment of hypothyroidism is lifelong

and involves taking a daily thyroid hormone to restore adequate hormone levels,” Toma explained. “Levels are checked periodically, and doses adjusted based on levels and symptoms.”

WHAT’S HYPERTHYROIDISM?

Hyperthyroidism is when your thyroid is overactive and produces too many hormones. “When thyroid levels are too high, we see signs of an overactive metabolism, such as palpitations (heart racing or skipping a beat), weight loss, excessive sweating or heat intolerance, diarrhea, anxiety and insomnia. It can also cause significant fatigue and brittle hair and nails, like we see in hypothyroidism,” Toma added.

If your symptoms point to hyperthyroidism, your doctor will confirm the diagnosis with a blood test.

“Hyperthyroidism can be treated with radioactive iodine therapy to shrink the thyroid and reduce hormone levels.

Alternatively, drugs can be used to block hormone production or a part of the thyroid can be surgically removed,” Toma said.

NOT FEELING YOURSELF?

A thyroid problem can affect almost every facet of your health. “If you’re not feeling well, I would recommend getting thyroid levels checked. Many of the symptoms related to thyroid disease are nonspecific, so it is good to screen for thyroid conditions and also look for other conditions that may mimic thyroid disease,” Toma explained.

Questions About Thyroid Screening?

Sometimes a simple test, such as a thyroid screening, can uncover a problem so you can get back to feeling better. Call 936.270.3333 to make an appointment with an endocrinologist at Houston Methodist The Woodlands.

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