Leading Medicine Winter 2024, Houston Methodist West Hospital edition

LEADING MEDICINE WINTER 2024

Understand What Makes Arthritis Flare Up

CARING FOR YOU:

Why Your PCP Is Pivotal to Your Health YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN KATY-WEST HOUSTON

Learn How to Detect Cancer Early

Know Your Risk for

Nonalcoholic Fatty Liver Disease Dr. Ihsan Al Bayati

Most people haven’t heard much about nonalcoholic fatty liver disease (NAFLD), but it can strike without warning or obvious symptoms and can lead to serious health consequences.

NAFLD causes too much fat stored in the liver of people who drink little or no alcohol.

It affects nearly 100 million people in the U.S.

RISKS AND SYMPTOMS OF NAFLD

“Scientists don’t know exactly what causes NAFLD, but it’s critical to understand your risk,” explained Dr. Ihsan Al Bayati, a gastroenterologist at Houston Methodist West Hospital. “While NAFLD is diagnosed at any age, it’s most common when you’re in your 40s and 50s and if you also have a high risk for heart disease because of factors like obesity and type 2 diabetes.”

NAFLD is also linked to metabolic syndrome, a cluster of abnormalities that includes: ■ Increased abdominal fat ■ Poor ability to use the hormone insulin ■ High blood pressure ■ High blood levels of triglycerides Other symptoms of NAFLD may include: ■ Enlarged liver ■ Fatigue ■ Upper right abdominal pain

WHY YOU SHOULD TAKE NAFLD SERIOUSLY

If you have even one of the risk factors, Al Bayati suggests talking to your doctor about NAFLD for these five reasons: 1. NAFLD can become liver cirrhosis.

Cirrhosis is scarring of the liver that can’t be reversed. Over time it can lead to serious liver dysfunction.

“Fatty liver disease is manageable,” Al Bayati explained, “but things get difficult if it becomes cirrhosis.”

2. NAFLD can lead to liver cancer.

About 25% of the time, NAFLD develops into nonalcoholic steatohepatitis (NASH), which can lead to liver cancer.

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3. Heart disease and NAFLD are linked.

“Fatty liver has been shown to be an independent predictor of heart disease because so many patients have both,” Al Bayati said.

4. People with diabetes can develop NAFLD. “The association between diabetes and NAFLD is bidirectional, which means that some patients with NAFLD will develop diabetes,” Al Bayati said. Those who have diabetes are at risk of developing NAFLD. An estimated 60% of people with type 2 diabetes have this chronic liver disease.

5. NAFLD is associated with chronic kidney disease.

While this link is not as strong as those between NAFLD and heart disease and diabetes, a risk remains.

NAFLD may be tied to metabolic syndrome, which involves plaque buildup in blood vessels throughout the body.

HOW TO REDUCE YOUR RISK OF DEVELOPING NAFLD

Al Bayati recommends these ways to reduce your risk: ■ Choose a healthy diet rich in fruits, vegetables, whole grains and healthy fats.

■ G et regular exercise.

■ Maintain a healthy weight.

“Symptoms of NAFLD may not be obvious or present at all,” Al Bayati said. “That’s why it can be important to talk with your doctor about regular screenings such as blood and liver enzyme and function tests. These can help detect NAFLD early when treatment is most effective.”

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A Specialist Is Here for You Worried you may be at risk? Schedule an appointment with a gastroenterologist in Katy-West Houston by visiting houstonmethodist.org/gi-west or calling 832.522.8560.

WHAT MAKES ARTHRITIS FLARE UP? Arthritis is a general term used to describe pain, tenderness or swelling in a particular joint (or joints). If you suffer from arthritis, you are likely to be looking for ways to alleviate symptoms.

Some common types of arthritis include: ■ Gout ■ Rheumatoid arthritis Dr. Dona Poulose ■ Osteoarthritis “It is important to see a doctor to diagnose the type of arthritis you may have,” explained Dr. Dona Poulose, a rheumatologist with Houston Methodist West Hospital. “You can then understand what is causing your pain and work with your doctor to understand how best to manage it.”

GOUT

Gout is a complex type of arthritis that can flare up suddenly and severely when high levels of uric acid cause sharp crystals to form and deposit in joints, creating inflammation, swelling and pain.

To avoid flare-ups, stay away from foods high in purine, a chemical that converts to uric acid during digestion, including: ■ Alcohol, particularly beer ■ Certain types of seafood, including tuna, scallops and trout ■ Fruit juices and other beverages that contain fructose ■ Organ meats such as liver ■ Red meat “Please see a rheumatologist if you think you may have gout,” Poulose said. “The attacks are typically treatable and preventable.”

RHEUMATOID ARTHRITIS

Rheumatoid arthritis occurs when the immune system attacks joints, causing irreversible damage that leads to swelling, stiffness and pain.

Inflammation is likely present for people with active, untreated rheumatoid arthritis. It can also flare up in response to:

■ S tress: which makes it more difficult for your body to regulate inflammation.

■ Infection: If you have pain in a new joint or a severe flare-up, call your doctor to check for an infection.

OSTEOARTHRITIS

Osteoarthritis is common. It is degenerative arthritis that affects the cartilage in joints and frequently occurs as we age.

The cause of a flare-up isn’t totally clear, but joint overuse is likely to play a key role. Take care to avoid overworking an affected joint.

Try a warming pad or warm compress, over-the-counter pain relievers, or simply rest the joint if you have a flare-up.

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Talk With a Rheumatologist If you need help identifying and managing your arthritis symptoms, a rheumatologist at Houston Methodist can help. Call 832.522.0360 to make an appointment with a doctor in Katy-West Houston.

PREVENTION IS KEY If you experience joint pain from time to time, it’s a good idea to consult your primary care physician. This way, your doctor can help determine if arthritis is the root of the problem and the type you may have. From there, you’ll learn the best types of treatment and may be able to stop additional joint damage. You may want to consider drugstore supplements, but it’s important to remember that over-the-counter remedies aren’t medical treatments — a doctor’s advice about your unique condition is best.

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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/west.

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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.

“A PCP helps you stay healthy,” explained Dr. Knic Rabara, a family medicine doctor at Houston Methodist Primary Care Group in West Houston. “We build a long-term relationship, so I understand your health history Dr. Knic Rabara to give you personalized and continuous care.”

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 — they aim to help you stay healthy. Getting an annual physical helps you stay on top of routine screenings, immunizations and general well-being year after year.

“It helps to think of your body like a car,” Rabara elaborated. “Just as you regularly take your car for oil changes and maintenance to keep it running smoothly and avoid breakdowns, it’s important to do the same for your body. Routine care helps prevent future health issues, and you should prioritize looking after yourself as well as you do your car.”

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

“When you do get sick, and it’s not an emergency, I am the first person you can turn to for care,” Rabara explained. “Since your PCP knows your current health and medical history, we can quickly 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.

“For preventive care, your doctor may suggest screening tests to detect problems before you notice them,” Rabara said. “Sometimes it’s

a holistic approach such as creating a plan to limit your stress. Little changes 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.

“Think of your PCP as the quarterback for your health,” said Rabara. “He or she will coordinate your care and can send you to other specialists if needed. If there’s a problem with your heart, you might see a cardiologist. If it’s about your muscles or joints, they might send you to an orthopedist or a physical therapist. Your PCP serves as your initial point of contact in the health care system, ready to connect you with specialized care when the need arises.”

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. Together, they are your health care team.

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 — not just from a medication standpoint, but from a physical and emotional view as well,” Rabara 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/west or call 713.441.7965.

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SWELLING IN YOUR

LOWER LEGS The puffy, tight, shiny skin on your swollen feet and ankles is both noticeable and uncomfortable. And may be a cause for concern.

“This swelling, or edema, can occur for Dr. Tam Huynh various reasons,” said Dr. Tam T. Huynh, a vascular surgeon with Houston Methodist Cardiovascular Surgery Associates. “In some cases, it can point to an underlying health condition.”

Lymphedema, on the other hand, causes chronic swelling that persists throughout the day. It can affect just one foot or one leg.

Heart failure causes swelling in both legs as blood begins to back up. Though the swelling can come on suddenly, it primarily occurs in people with known heart issues.

“Kidney failure can also lead to sudden swelling as excess fluid collects any place it can,” Huynh said. “This swelling isn’t isolated to just the legs, but also can accumulate in your hands and face.”

CAUSES OF SWOLLEN FEET AND ANKLES

ARE SWOLLEN FEET DANGEROUS?

Swelling in the lower legs occurs when fluid accumulates for one reason or another.

A salty meal, pregnancy, physical injury or standing or sitting for long stretches can all cause this condition.

“If the swelling comes and goes, it may not be cause for concern,” Huynh noted. “But persistent lower-leg swelling can be serious, pointing to issues within the circulatory system, heart or kidneys.”

Serious underlying health conditions such as venous insufficiency, lymphedema, heart failure and kidney disease can cause lower-leg swelling.

“Venous insufficiency occurs when the valves inside the veins in the legs allow reflux of blood down the lower legs and ankles,” Huynh explained. “Commonly, swelling occurs in the feet and ankles, worsens throughout the day with gravity, but improves at night when the legs are elevated.”

If foot and ankle swelling is frequent, painful or persists over several weeks, it’s time to consult your primary care provider (PCP).

“If an underlying condition causes the swelling, the sooner you know, the better,” Huynh stated. “Lab work can evaluate your heart and kidney function and treatment options are available to help reduce your symptoms.”

SWELLING RELIEF

There are several home remedies to alleviate swollen feet and ankles. Elevation and compression, including compression socks, redistribute blood or fluid. Movement and avoiding sitting or standing for long periods of time are also helpful (see sidebar).

Though these simple solutions may give you temporary relief, Huynh stressed the importance of talking to your PCP if issues persist.

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HOW TO SIT LESS AT HOME At the end of a long day, it's hard to resist cozying up on the couch and binge-watching your new favorite show. To help reduce lower leg swelling, use these tips to move more and sit less while at home: Go for a walk. Plan to walk in the morning, afternoon or evening.

Get moving between episodes.

Stand up to walk in place or stretch.

Try active sitting. Balance on an exercise ball or rock in a rocking chair.

Find an active hobby.

Try cooking, tinkering in the garage or home improvement projects.

Getting to the Heart of the Matter

To find a Houston Methodist DeBakey Heart & Vascular specialist in Katy or West Houston visit houstonmethodist.org/ heart or call 713.790.3333.

Detect Cancer Early With

ROUTINE SCREENINGS Dr. Issam Alawin

Finding cancer as early as possible is key to fighting the disease. That’s why it’s important to keep up with routine cancer screenings.

“Life can get busy and we can sometimes forget regular screenings,” said Dr. Issam Alawin, medical oncologist at Houston Methodist West Hospital. “But cancers can grow silently. When caught in the early stages, the better the treatment outcome and chance of survival.”

See below for recommended screening guidelines:

BREAST

Doctors review your mammogram history and track results over time — detecting changes earlier. That’s why scheduling your mammogram starting at age 40 — or younger if you have a family history — is important.

Dr. Gerard Chaaya Depending on family history or other risk factors, such as having dense breasts, your doctor may also recommend an MRI. “Screenings should continue if you are in good health and expected to live at least 10 more years,” Alawin said.

CERVICAL

At age 25, women may want to start screening for cervical cancer.

Because human papillomavirus (HPV) is tied to cervical cancer, women should get a primary HPV test or HPV test with a Pap smear every five years or a Pap smear alone every three years, from ages 25-65. “If precancer is detected, regular testing should continue for at least 25 years after diagnosis. Your doctor is one of your best partners. He or she can explain your risks and what you need to do to stay cancer-free,” said Dr. Gerard Chaaya, hematologist-medical oncologist at Houston Methodist West Hospital.

COLORECTAL

Everyone at age 45 should talk to their doctor about a colonoscopy or a stool-based test. If you opt for stool-based, any abnormal finding will need a colonoscopy, so you might want to do the colonoscopy to save a step. But getting any screening is the most

important step. Continue screenings through age 75, and then talk to your provider about continuation.

ENDOMETRIAL

All menopausal women should ask their doctor about signs of endometrial cancer, such as bleeding or discharge, and call right away if they have any concerns. Depending on risk factors, a yearly endometrial biopsy may be needed.

LUNG

Everyone age 50-80 who smokes or who quit smoking in the past 15 years and has at least a 20-pack-year history should have annual lung cancer screenings. If you’re a current or past smoker, talk with your doctor about screening for lung cancer.

PROSTATE

Men, start talking to your doctor about prostate screenings when you turn 50. Start these conversations at 45 if you have a father or brother who had prostate cancer before age 65 or if you are African American, and at age 40 if you have multiple brothers or a father diagnosed at a young age. “After this discussion you should get the prostate-specific antigen blood test. You may also have the digital rectal exam as a part of the screening,” said Chaaya.

IF CANCER IS FOUND

Start by talking with your doctor about recommendations.

Generally, look for cancer centers with services such as: ■ Access to clinical trials, if needed ■ Comprehensive care teams ■ Cutting-edge technologies and treatments ■ Emotional and nutritional support

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Take Care of You Life gets busy, so make time for your health by seeing your doctor and getting the appropriate health screenings annually. To find a Houston Methodist doctor near you, visit houstonmethodist.org/west or call 832.522.5522.

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