Leading Medicine Winter 2024, Houston Methodist Sugar Land Hospital edition

LEADING MEDICINE WINTER 2024

Let’s Talk About Lower Back Pain

CARING FOR YOU:

Why Your PCP Is Pivotal to Your Health YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN FORT BEND AND SURROUNDING COUNTIES

Is Caffeine Stealing Your Sleep?

3 SHOE TIPS to Start Your Run on the Right Foot Whether you’re running a marathon or just around the block, it’s important to have running shoes you can count on to get you to the finish line without pain.

“Having the right running shoe means the natural movement and biomechanics of your foot can take over,” said Dr. Alessandra Falk, a foot and ankle surgeon at Houston Methodist Orthopedics & Dr. Alessandra Falk Sports Medicine at Sugar Land. “The wrong shoe can affect the normal movement of your foot and increase your risk of injury.”

Shoes that are too tight cause blisters, toe bruises or numbness.

Shoes that are too big can make your feet slide back and forth, affecting how you run and placing unwanted stress on your foot.

“It’s very important to know your true shoe size,” Falk said, “but when it comes to training for and running long races, there’s more to it than just the right fit.”

1. MATCH YOUR SHOES TO YOUR FOOT TYPE

Finding a running shoe that can take you the distance means knowing your foot type, as this affects the way your foot contacts the ground.

To pick out the right running shoe for your foot type, look at the arch of your foot: ■ High arch: Look for a shoe with a lot of cushioning.

■ Low arch (flat feet): Find a shoe that’s meant for stability and motion control.

■ Normal arch: Gear your shoes for stability.

“A specialty running shoe store is a great place to determine your foot type,” Falk advised. “The sales staff are very knowledgeable about how your foot type, stride and mechanics impact your run — and they can help you find the right shoe for you.”

If you don’t have a store nearby, Falk recommends a DIY way to find your foot type.

“If you get your feet wet and stand on dry cement, your footprint can give you a sense of whether you have a normal, high or low arch,” she said.

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2. REPLACE YOUR OLD SHOES

Running shoes have a lifespan that’s measured in miles, not time.

“After about 300-400 miles, your running shoes will have worn out,” Falk said. “If you keep wearing those same shoes, you increase your chances of causing an injury.”

To give them the longest life, Falk recommends only wearing your running shoes when you’re training or participating in the race.

While you can wait for signals like lower leg or foot pain to tell you that your shoes are near the end, Falk recommends a more proactive approach.

“You can keep track of how many miles are on your shoes with a smartphone app,” Falk said. “Some will even send you alerts when it’s time to replace your shoes.”

3. BREAK IN NEW SHOES SLOWLY

Wearing old shoes can cause foot and leg pain, but so can a brand-new shoe that your foot’s not used to yet.

“Log between 50-100 miles in your new running shoes before you wear them for a race,” Falk advised. “This gives your feet time to adjust to the shoe without wearing through the cushioning.”

When it comes to buying new shoes, Falk recommends staying with what works.

“Stick with your favorite shoe once you find one that feels right and works with your foot and goals,” Falk said.

“If you can’t get that model anymore, the experts at the shoe store can help you find one that’s close.”

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Let’s Talk About Foot Pain Whether it’s your feet or knees, an orthopedic specialist can help ease your pain. Schedule an appointment by visiting houstonmethodist.org/ orthopedics-sl or by calling 281.201.0409.

4 THINGS TO

KNOW ABOUT WEIGHT LOSS SURGERY For the 42% of Americans who live with obesity, sometimes diet and exercise alone aren’t enough to reach a healthy weight.

If you’ve been trapped in a cycle of failed weight loss, or your health is compromised, weight loss surgery may be an option.

“It’s important to understand that obesity is a medical condition that can be managed,” explained Dr. Nabil Tariq, board-certified Dr. Nabil Tariq bariatric surgeon at Houston Methodist Center for Weight Loss & Bariatric Surgery at Sugar Land.

“Weight loss surgery is an option to consider for those who qualify, and it’s a big decision to make that comes with a lifelong commitment to a healthy lifestyle.”

Here are the things to keep in mind about weight loss surgery:

1. THERE ARE QUALIFICATIONS

Some basic guidelines apply to weight loss surgery: ■ Patients should be age 18 or older at Houston Methodist Sugar Land Hospital.

■ You have a body mass index (BMI) of 35 or higher if you have an obesity-related condition like diabetes, and 40 or higher without.

■ For insurance coverage, you may need a “letter of medical necessity.”

This is just a snapshot. It’s a good idea to talk with a bariatric surgeon about your unique situation and all the qualifications.

2. MINDFUL EATING STILL MATTERS

Remember that surgery is only one tool to help you on your weight loss journey — you’ll need to make lifestyle changes such as diet and exercise along the way.

As part of our program, you’ll receive nutritional guidance to create a plan that’s right for you. Guidelines are typically between 800-1,500 calories with 60-80 grams of protein a day, while avoiding too many carbohydrates such as bread, pasta and sugar.

Foods high in sugar and fat will be reserved for special occasions, and rarely eaten if you have gastric bypass surgery. Healthy vitamin- and protein-rich foods are also important.

3. TOTAL WEIGHT LOSS VARIES

“It’s hard to say exactly how much weight you might lose. There are a lot of factors, including the type of weight loss surgery and how closely you follow your new diet after the procedure,” Tariq explained.

Generally, about 30% of your body weight is lost. You’ll want to talk with your doctor about what expectations are right for you.

4. THERE ARE BENEFITS FOR PHYSICAL AND MENTAL HEALTH

Research shows successful surgery can help you live longer and reverse obesity-related conditions, such as high blood pressure, high cholesterol, sleep apnea and diabetes.

“Not only will your physical health likely improve,” Tariq said, “but as you start moving and feeling better, your mental health can improve as well. It’s a win for your overall well-being.”

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Get Help From the Experts Our surgeons and weight loss specialists are here to help you decide if bariatric surgery is right for you.

Visit houstonmethodist.org/weight-management or call 832.667.LOSE (5673) to learn more.

CHECK OUT OUR DIGITAL MAGAZINE AT HOUSTONMETHODIST.ORG/NEWSROOM/NEWSLETTERS

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High Time to Learn About

LOW BACK PAIN Throwing your back out — developing pain in the lumbar spine of your lower back — is a common experience. It may be temporary for you, but for others, it’s a constant battle. In fact, lumbar pain is something an estimated 619 million people live with worldwide, according to the World Health Organization.

Dr. Christopher Sy

LOOK FOR LUMBAR SYMPTOMS

Lower back pain can vary from person to person, but these common symptoms typically point to the lumbar spine as the culprit: ■ Dull ache in your hips and/or pelvis ■ Muscle spasms or tightness ■ Pain that’s noticeably worse in the morning ■ Pain that worsens with sitting and quickly improves while walking ■ Sharp, tingling pain that starts in your lower back and travels down one leg A combination of symptoms might come on suddenly or creep in slowly over time, depending on the cause. Dr. Christopher Sy, a neurosurgeon with Houston Methodist Department of Neurosurgery at Sugar Land, explained the reasons for the agonizing aches.

PAINFUL INJURIES

Sprained ligaments and strained muscles are common reasons for a twinge in your lower back. That’s because the lumbar spine is always working. It’s in charge of the muscles that move feet, legs, pelvis and hips, helping us twist and bend our way through the day. It’s also supporting our upper body weight at the same time.

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“It’s easy to pull a muscle or ligament in this busy part of the back,” Sy said. “Lifting a heavy item, playing a sport or taking a fall can all cause a painful injury. A lower back sprain or strain can also result from a long history of slouching posture or repetitive motions.”

Years of wear and tear make the lumbar spine an easy target for bothersome aches. If the stubborn ache comes and goes and gets worse over time, see your doctor right away. You may have a chronic issue.

CHRONIC PAIN

Unlike pain that starts suddenly and eventually goes away, chronic pain is months or years in the making and tends to stick around.

Conditions that can spark ongoing lower back pain include: ■ Accident-related trauma ■ Compression fracture (collapsed spinal bone) ■ Degenerative disk disease (natural wearing away of spinal disks) ■ Facet joint damage (breakdown of cartilage in spinal joints) ■ Herniated disk (disk slippage due to age or trauma) ■ Osteoarthritis (arthritis caused by joint wear) ■ Scoliosis (improper curvature of the spine) ■ Spinal stenosis (compression of nerve roots) ■ Spondylolisthesis (disk deterioration caused by bone slippage) “Chronic conditions of the lumbar spine can be nagging and negatively affect a person’s life,” Sy explained. “These issues could relate to disks, nerves or other parts of the spine and often require specialized care to get back to the most pain-free life possible.

Don’t put off seeing a doctor to get a proper diagnosis and the right treatment.”

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SELF-CARE FOR SPRAINS AND STRAINS It’s important to visit your primary care provider anytime your lower back acts up. For minor injuries, your doctor will give you a few treatments to try at home. Depending on your overall health, common suggestions for temporary back sprains and strains include: • Heating pad to encourage healing • Ice packs to relieve inflammation • Over-the-counter anti-inflammatories or pain relievers If at-home self-care is not helping, there may be a deeper cause for your lumbar pain. Your doctor may recommend a specialist to help get to the bottom of it.

We Can Help If lower back pain is affecting your quality of life, a neurosurgeon with Houston Methodist Neuroscience & Spine Center at Sugar Land can help. Visit houstonmethodist.org/neuro-sl for more information or call 281.205.4662 to schedule an appointment.

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ESTABLISH CARE WITH AN ADVANCED PRACTICE PROVIDER Did you know your primary care office has multiple experts on the team? You may decide to choose an advanced practice provider (APP) as your PCP. An APP is a licensed nurse practitioner or physician assistant who is trained to provide the same type of care as a PCP, and who can also be your partner in optimizing your health. Just like a PCP, an APP can help you with: ■ Chronic conditions like diabetes or heart disease ■ Physicals ■ Prescriptions ■ Referrals to specialists ■ X-rays and tests In addition, an APP’s appointment schedule may have more openings so that you can get in sooner. To schedule an appointment with a provider near you, visit houstonmethodist.org/pcg/southwest.

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CARING FOR YOU: Why Primary Care Matters You’re unique. Your health care should be, too. That’s why choosing a primary care provider (PCP) matters when it comes to building your best overall health.

“Your PCP is a main point for care,” explained Dr. Giovanna Figueredo, a board-certified family medicine doctor at Houston Methodist Primary Care Group at Dr. Giovanna Brooks Street. “And because of this, we build Figueredo a relationship allowing for personalized and continuous support.”

Your PCP can help you manage: ■ Allergies and asthma ■ Diabetes ■ High blood pressure ■ High cholesterol ■ Men’s and women’s health ■ Physicals and health screenings ■ Thyroid concerns Below are a few of the many reasons why it’s important to visit a PCP.

PREVENT AND TREAT ILLNESS

“PCPs focus on disease prevention — we aim to help you stay healthy,” Figueredo explained. “Getting an annual physical helps you stay on top of routine screenings, immunizations and general well-being year after year.”

When illness happens, your PCP can help with that, too.

If something does come up, such as the flu or pink eye, your doctor knows your health history and can diagnose the issue, prescribe a medication and see you for follow-up as needed.

TACKLE HEALTH GOALS

With an established PCP relationship, you have a long-term partner to help you work through obstacles in your quest for better health. Whether you want to quit smoking, lose weight or break the family cycle of diabetes or heart disease, your PCP can help you achieve your goal.

“If possible, I like to start with lifestyle changes,” Figueredo said. “A simple plan such as adding a morning walk to your daily routine can lead you onto a healthier path.”

If you need a little more help beyond lifestyle changes, your doctor may recommend tests or screenings to create a long-term health plan.

CONNECT YOU WITH SPECIALISTS

Navigating the health care system alone can be overwhelming, especially when you are managing a chronic condition. Your PCP can make it easier by briefing specialists such as cardiologists, neurologists or endocrinologists on your health challenges.

“Knowing your health history helps to have better communication with specialists who are involved in your care,” Figueredo noted. “Think of your PCP as your advocate who can help ensure a treatment plan is right for you and your goals.”

Your specialist will help you manage your condition, but when you need to see the doctor for a screening or illness, your PCP is the best option.

PROVIDE SUPPORT FOR ALL YOUR HEALTH NEEDS When you find a PCP who understands your medical history and beliefs, you’ll form a provider-patient relationship that leads to more individualized and better care. This trusting partnership is built upon supporting your needs physically, spiritually and emotionally.

“We make sure you’re comprehensively cared for — from specialists to your everyday health care needs,” Figueredo said.

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Find a Primary Care Provider Who Is Right for You Houston Methodist Primary Care Group has more than 45 practices across the Greater Houston area. To find a provider near you, visit houstonmethodist.org/pcg/southwest or call 713.441.7965.

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8 THINGS TO KNOW ABOUT CERVICAL CANCER Cervical cancer is the most preventable gynecologic cancer. Understanding a few facts will help reduce your risk.

1. HPV IS THE MOST COMMON

CAUSE OF CERVICAL CANCER

Human papillomavirus, or HPV, is a common virus passed from person to person during sex.

Dr. Yihharn “More than 90% of cervical cancers are caused Hwang by some type of HPV,” said Dr. Yihharn Hwang, an OB-GYN with Houston Methodist Obstetrics and Gynecology Associates at Sugar Land. “But not all types of HPV are high-risk or cancer-causing.”

2. NEARLY 9 OUT OF 10 PEOPLE WILL GET HPV

HPV is the most common sexually transmitted infection (STI).

According to the CDC, more than 42 million Americans are infected with the virus at any given time, including teens. Typically showing no symptoms, most people won’t even know they are infected.

3. TEENS SHOULD VACCINATE AGAINST HPV

There is a vaccine to help protect both women and men against the types of HPV most likely to cause cancer. Most effective before exposure, the vaccine is recommended for girls and boys age 11 and 12, but older teens and younger adults can also benefit. Recent guidelines have increased the upper age limit to 45.

4. START SCREENING FOR CERVICAL CANCER AT AGE 21

Cervical cancer screening is part of a woman’s annual well-woman exam, which includes HPV testing and a Pap smear.

“A Pap test checks for suspicious changes to cells of the cervix,” Hwang said. “This test can identify precancerous cells that can be treated easily and effectively.”

It is crucial to follow cervical cancer screening recommendations, including periodic HPV testing, which can reveal a high-risk HPV capable of causing cancer.

5. SCREENING PREVENTS CERVICAL CANCER DEATHS

“If you look at all the women who follow the recommended screening guidelines, it is incredibly rare to find someone who died from cervical cancer,” Hwang stated.

With regular screening, an issue is either caught when it’s precancer or the cancer is found early, so it is treated and cured.

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6. HPV TESTING REDUCES UNNECESSARY PROCEDURES

Not every abnormal Pap test means cancer. Cervix cellular changes are also caused by inflammation related to a yeast infection or post-menopausal vaginal irritation.

“Instead of undergoing unnecessary diagnostic tests, we can follow up an atypical Pap smear with high-risk HPV testing,” Hwang said. “If that is positive, then we know abnormal cells are more than likely precancerous, and more testing is necessary.”

7. NEVER IGNORE CERVICAL CANCER SYMPTOMS

Cervical cancer symptoms include vaginal bleeding between menstrual cycles, after menopause or after sexual intercourse. Pelvic pain after intercourse is another sign.

8. ADVANCED CERVICAL CANCER IS VERY DIFFICULT TO TREAT

Unlike some other types of cancer, cervical cancer is best treated surgically. But the surgery is less effective when the cancer is large or has spread.

“To treat cervical cancer successfully, we must find it early,” Hwang noted. “The more advanced, the less chance of survival, so screening is crucial.”

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First Stop: Your OB-GYN When it comes to discussing cervical cancer prevention, your OB-GYN is a good place to start. Your doctor can help guide you to cancer screening tests appropriate for your age and risk level. To find an OB-GYN near you or schedule an appointment, visit houstonmethodist.org/ obgyn-sl or call 346.456.5328.

TIME TO SEE A SPECIALIST If you or a loved one has been diagnosed with cancer and would like to schedule an appointment, visit houstonmethodist.org/cancer-sl or call 281.201.6669 to find an oncologist with Houston Methodist Neal Cancer Center at Sugar Land.

Relief From

HERNIA PAIN The pain of a hernia is excruciating, but there is no reason to tough it out when help is available. Advanced surgical procedures can get you back to the quality of life you deserve.

Dr. Katherine Baxter “There are many advantages for patients when they undergo minimally invasive hernia repair,” said Dr. Katherine Baxter, a board-certified surgeon with Houston Methodist Department of Surgery at Sugar Land.

WHAT IS A HERNIA?

A hernia occurs when tissue pushes through an opening in the abdominal wall muscles (ventral hernia) or groin area (inguinal hernia). Common hernia symptoms can include: ■ A bulge or lump in the abdomen or groin ■ Difficulty having a bowel movement or passing gas ■ Heaviness, weakness or dull pain in the groin or abdomen ■ Nausea, vomiting or both ■ Pain in the abdomen when coughing, bending, twisting or lifting objects Both men and women can develop

hernias. The causes vary, including a birth defect, age, chronic coughing, damage from injury or surgery, or lifting heavy objects.

Pregnant women are susceptible to hernias because of muscles stretching, thinning and weakening during pregnancy.

While hernias don’t go away on their own, lifestyle changes such as maintaining a healthy weight, managing your diet, exercising and avoiding constipation can help. Ultimately, symptoms may worsen and many hernias need surgery.

ENHANCED SURGICAL PROCEDURES

Surgeons can repair hernias with traditional, open surgical techniques using long incisions. Increasingly, however, they’re opting for laparoscopic surgery, a minimally invasive technique using much smaller incisions in the skin.

In laparoscopic surgery, the surgeon inserts and manipulates long-handled

surgical tools and a camera called a laparoscope through these incisions to guide the procedure.

“The result is an increased degree of surgical precision because I am able to make agile and effective motions inside the body with small instruments,” Baxter said.

For patients, laparoscopic procedures may offer many benefits, such as: ■ Fewer wound complications and lower risk of infection ■ Less postsurgical pain ■ Less scarring due to smaller incisions ■ Reduced loss of blood On average, patients who undergo laparoscopic surgery for hernia repair return to their normal activities about eight days sooner than those who have traditional repair.

Hernias are very painful, but help is available. Don’t suffer needlessly.

Talk with your doctor about treatment options.

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Ease the Pain Hernia repair is a low-risk procedure that can relieve your pain so that you can get back to your normal activities. To make an appointment with a general surgeon at Houston Methodist Department of Surgery at Sugar Land, visit houstonmethodist.org/spg/surgery or call 281.763.2502.

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IS AFTERNOON CAFFEINE

KEEPING YOU UP AT NIGHT? We’ve all been there: tossing, turning, counting sheep and the hours of sleep we’re not getting while we lay awake at night. Could caffeine in that after-lunch latte be to blame?

“Quality and quantity of sleep are both important for your health,” explained Dr. Gulnur Kul Ormanoglu, board-certified primary care physician at Houston Methodist Dr. Gulnur Kul Primary Care Group at Sweetwater. “Sometimes Ormanoglu our habits can get in the way of good sleep, and caffeinated drinks are a major culprit.”

When it comes time for that afternoon pick-me-up, how late is too late to drink coffee, soda or tea without keeping you awake at night?

HOW DOES CAFFEINE KEEP YOU AWAKE?

Caffeine is quickly absorbed and distributed throughout the body after you drink it. In the brain, caffeine produces its most classic effect, keeping you awake and alert.

“The parts of your brain that promote sleep are called adenosine receptors,” Kul said. “Caffeine looks very similar to adenosine, so it blocks the receptors instead.”

One of adenosine’s many roles is helping regulate cycles of sleep and wakefulness. Its levels change in your brain, starting out low in the morning and building up throughout the day until you start to feel sleepy.

That is unless the adenosine receptors are blocked by caffeine.

When this happens, your sleep-promoting pathways aren’t activated, which can cause you to toss and turn at bedtime.

HOW LONG DOES CAFFEINE LAST?

According to the U.S. Food and Drug Administration, caffeine sticks around in your body for a while. In fact, after 4-6 hours, about half of the caffeine you consumed is still active.

“Caffeine doesn’t stay in your body forever,” Kul said. “But the timing of when it’s no longer effective can be important if it overlaps with planned sleep.”

“Getting enough sleep is very important for your health,” she continued. “Over time, too little good sleep can influence many different health issues, from high blood pressure to obesity. It’s important to ensure you’re getting a good night’s rest.”

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HOW LATE IS TOO LATE FOR CAFFEINE?

The answer to when you should stop drinking caffeine each day to get good sleep depends on several factors, including your personal tolerance.

“Some people are more sensitive to caffeine, others are less so,” Kul explained. “And not everyone has the same work or sleep schedule.”

As a rule of thumb, she recommends that people who work a 9-to-5 job and go to sleep at an average bedtime stop intake of caffeine around 2 or 3 p.m.

“There is limited research on the exact timing of caffeine’s impact on sleep,” she said. “But one small study showed it can affect sleep as early as six hours before bedtime. When it comes to quality sleep, it’s better to be safe than sorry.”

Ultimately, there isn’t a one-size-fits-all rule for how late in the day is too late to consume caffeine. The length of time the drug can impact your body can vary depending upon: ■ The caffeine content of the drink.

■ How much caffeine is already in your system.

■ How effectively your body metabolizes caffeine.

If you find yourself suffering through sleepless nights, consider stopping your caffeine intake earlier in the day or switching to a beverage with less caffeine per serving. These changes can help you start enjoying the benefits of a sound night’s sleep.

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Start Getting Better Rest Whether you need tips for getting more rest or are due for your annual physical, Houston Methodist Primary Care Group provides care that's personalized for you and your unique needs. To make an appointment, visit houstonmethodist.org/pcg/southwest or call 832.416.1678.

Reasons to See a RHEUMATOLOGIST If you have pain in your joints that is accompanied by other symptoms, such as swelling, stiffness and fatigue, your primary care provider (PCP) may recommend you see Dr. Quratul Raja a rheumatologist — a specialist who diagnoses and treats arthritis and other immune-related diseases and conditions.

The most common reasons to see a rheumatologist include: ■ R heumatoid arthritis ■ Psoriatic arthritis ■ Lupus ■ Sjögren's syndrome ■ Vasculitis ■ G out ■ Fibromyalgia ■ Osteoarthritis “It’s important to talk to your doctor about your symptoms,” explained Dr. Quratul Raja, board-certified rheumatologist with Houston Methodist Rheumatology Associates at Sugar Land.

“If your PCP suspects you have a systemic, autoimmune condition, he or she will refer you to a rheumatologist.”

Raja helps explain everything you need to know about seeing a rheumatologist.

CONDITIONS FOR TREATMENT

As the name implies, systemic autoimmune conditions can affect organs and areas throughout your body, leading to a variety of symptoms.

“These encompass a broad spectrum of conditions that can affect different organ systems, including your musculoskeletal system, skin, kidneys, lungs, nervous system and more — with the joints being the most commonly affected,” Raja said. “Wherever the immune system is attacking, specifically, is where you will notice the symptoms.”

The common symptoms of systemic autoimmune conditions include: ■ Fatigue ■ G eneralized weakness ■ Hair loss ■ Pain, stiffness or swelling in joints ■ Skin rashes or lesions If you notice any of these symptoms, start by talking to your PCP. Your doctor will more than likely order a basic panel of blood tests that look for markers of inflammation. “This will help distinguish if your symptoms are caused by osteoarthritis or by another inflammatory, autoimmune condition,” Raja said.

From there, your PCP will determine whether you need to see a rheumatologist for further evaluation.

HOW A SPECIALIST CAN HELP If you’re diagnosed with a rheumatic condition, your doctor will help to modify your immune system activity to reduce the inflammation it’s causing.

“Immunomodulatory medications and steroids help manage these conditions,” Raja said. “We will also add in symptomatic treatment with over-the-counter anti-inflammatory medications, such as acetaminophens and topical analgesics.”

“Your immune system plays other important roles, such as preventing infection — so we don’t suppress it unless your condition warrants it,” Raja noted.

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CAUSES FOR RHEUMATOID ARTHRITIS Rheumatoid arthritis is the autoimmune condition most frequently treated by a rheumatologist. It occurs when the immune system attacks joints, causing irreversible damage that leads to swelling, stiffness and pain.

Low-level inflammation is likely always present for people with rheumatoid arthritis, but it can also flare up in response to: • Dietary triggers • Non-adherence to treatment • Progression of disease • Recent infection • Recent surgery • Stress, which makes it more difficult for your body to regulate inflammation • Weather, specifically rain, due to changes in air pressure that affect joints

Get Help for Symptoms Talk to a rheumatologist about how to identify and manage your symptoms. Schedule an appointment with Houston Methodist Rheumatology Associates at Sugar Land by visiting houstonmethodist.org/rheumatology or by calling 281.201.5938.

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