Leading Medicine Fall 2016, Houston Methodist Baytown Hospital edition

LEADING MEDICINE FA LL 016

THE BEST WAYS TO PROTECT YOURSELF FROM

5

COMMON CANCERS

New Options for Breast Cancer Survivors Running on Empty: How Sleep Affects the Body

YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN EAST HOUSTON/BAYTOWN

HEALTHY EATS

Mustard-Glazed Roast Pork Tenderloin Pork tenderloin takes a delicious and low-fat turn in this recipe that’s ideal for a blustery fall day.

INGREDIENTS 1 pound pork tenderloin, trimmed of fat 1 large garlic clove, smashed 1 teaspoon olive oil 1 medium shallot, minced 2 tablespoons Dijon-style mustard ⁄2 teaspoon minced fresh thyme

1

⁄2 teaspoon salt, divided

1

⁄4 teaspoon pepper, divided

1

2 8-ounce sweet potatoes, peeled and cut in wedges 1 pound fresh asparagus, tough ends snapped off 2 teaspoon canola oil 4 fresh thyme sprigs

DIRECTIONS Rub pork with garlic; discard garlic. Heat olive oil in small skillet over medium heat. Add shallot and cook 1 to 2 minutes, or until tender.

Remove from heat. Stir in mustard, minced thyme, 1⁄4 teaspoon salt and 1 ⁄8 teaspoon pepper. Coat pork with mustard mixture; place in large roasting pan, tucking in tips. Arrange sweet potatoes and asparagus in pan around pork. Sprinkle vegetables with remaining salt and pepper.

Drizzle vegetables with canola oil. Scatter thyme sprigs over pork and vegetables. Roast in preheated, 400-degree oven for 25 minutes.

Remove from oven; turn pork and potatoes over; stir asparagus. Roast 15 to 20 more minutes, or until meat thermometer registers 160 degrees.

Remove from oven. Discard thyme. Let pork rest 5 minutes; thinly slice on the diagonal.

IN THIS ISSUE FALL 2016

F ive Common Cancers The best ways to protect yourself

L ifting Spirits Breast cancer survivors have options beyond implants What Your Joints Are Telling You Joint pain is common — but what’s causing it?

8 9 10

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Wounds That Won’t Heal Learn the warning signs and treatment options for a nonhealing wound unning on Empty R Why catching some ZZZs should be a priority for your entire body A Sporting Chance Get your student-athlete ready for success with a comprehensive physical

Makes four servings. Each serving (with vegetables) contains: 260 calories, 6 g total fat, 23 g protein, 25 g carbohydrates, 65 mg cholesterol, 486 mg sodium and 5 g dietary fiber.

10 TOP PHOTO BY THINKSTOCK, BOTTOM PHOTO BY ISTOCK

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R ushing to the Restroom?

Four telltale signs of an overactive bladder

NUTRITION INFORMATION PER SERVING

4 SIGNS of an

OVERACTIVE BLADDER Here’s how to spot telltale signs of an overactive bladder

I

f you find yourself rushing to the restroom multiple times per day, take note: It might not be the 64 ounces of water you’re guzzling. Overactive bladder (OAB) affects more than 13 million adults in the United States, and can be a frustrating, embarrassing issue to live with.

Many adults ignore the problem and try to manage it themselves, or confuse it for something else entirely, like a urinary tract infection.

“UTIs are acute, isolated incidences, while overactive bladder is chronic,” said Dr. Bayo Tojuola, a urologist with Houston Methodist San Jacinto Hospital.

But there’s no need to just deal with it — treatment is available. Read on to find out if you have an overactive bladder, and then talk to your doctor.

1

A SUDDEN URGE

One of the telltale signs of a bladder working too hard is that the need to go comes on fast and strong — so strong that sometimes you don’t make it to the bathroom in time. “While many people try to control this symptom, it isn’t controllable,” said Tojuola. “It can occur at any time, regardless of how much liquid you’ve consumed in recent hours.”

2

GOING ALL THE TIME

In a 24-hour period, you shouldn’t have to urinate more than eight times. If you find yourself going frequently, you may have an overactive bladder. And when you do go, it should be more than just a few drops. If you’re rushing to the bathroom for only a small amount, something may be off.

3

UP ALL NIGHT

PHOTO BY THINKSTOCK

Are your trips to the bathroom interrupting your shut-eye?

If you find yourself getting up more than twice a night to urinate, talk to your doctor. “This symptom is known as nocturia. It becomes more common as we age, but should be addressed because lack of sleep can harm your health,” said Tojuola.

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REARRANGING YOUR LIFE

If you find yourself making concessions to your urinary patterns, you may have an overactive bladder. People living with OAB often find themselves immediately searching out restrooms in public places and even avoiding social situations out of fear of having an accident. When left untreated, OAB can be a quality-of-life issue. n

Schedule a Consultation

Do you have the signs and symptoms of an overactive bladder? Schedule time with a Houston Methodist San Jacinto urologist today by requesting an appointment online at houstonmethodist.org/sanjacinto or by calling 281.428.2273.

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THE

BEST WAYS to protect yourself from

5

COMMON CANCERS

I

t seems every time you check your email there’s another story or news alert about some household item or behavior that causes cancer. “It’s hard to know where to start when it comes to protecting yourself,” said Dr. Mary Goswitz, a radiation oncologist with the Cancer Center at Houston Methodist San Jacinto Hospital. “But the worst thing you can do is not start at all.”

To help separate the signal from the noise, we’ve compiled the most important steps you should take to reduce your risk for developing the five most common types of cancer.

PHOTO BY ISTOCK

4 LEADING MEDICINE IN EAST HOUSTON/BAYTOWN

BREAST CANCER

LUNG CANCER

Lose weight Body weight plays a role in several types of cancer, including breast cancer. In fact, the World Cancer Research Fund estimates one in five cancer deaths is related to excess body weight. Being overweight doesn’t seem to affect breast cancer in premenopausal women, but it has been linked to an increased risk of breast cancer in women after menopause, according to the American Cancer Society.

Don’t smoke Almost everyone has heard a story of someone who has had lung cancer and never smoked.

But the reality is, 90 percent of lung cancers can be attributed to smoking, according to the Centers for Disease Control and Prevention. Smokers and former smokers are 15 to 30 times more likely to develop lung cancer than nonsmokers. “But it’s really never too late to cut your risk,” Goswitz said.

Talk to your doctor about effective ways to quit.

PROTECTION STRATEGY

OTHER IMPORTANT STEPS TO TAKE

PROTECTION STRATEGY

Houston Methodist recommends women get annual mammograms beginning at age 40. “If hormone therapy is necessary for treating symptoms of perimenopause, take the smallest dose for the shortest amount of time,” Goswitz said.

Not smoking isn’t always enough.

Secondhand smoke leads to nearly 3,000 lung cancer-related deaths per year, according to the National Cancer Institute. Also avoid carcinogens at work and test your home for radon.

PROSTATE CANCER

COLON CANCER

Eat a heart-healthy diet Although researchers don’t quite understand why, diet seems to play an important role in prostate cancer. Some experts have estimated that eating a healthy diet could reduce the risk of prostate cancer by up to 30 to 50 percent, according to AARP. Past studies have shown that certain foods such as cruciferous vegetables and tomatoes may offer some protection against prostate cancer, but the American Cancer Society simply recommends eating a low-fat diet similar to the DASH diet for heart health.

Get your colonoscopy Most colorectal cancers start out as polyps — small growths — inside the colon. During a colonoscopy, a screening test for colon cancer, doctors can actually remove polyps before they turn cancerous.

Today’s five-year colon cancer survival rate is 90 percent, and that’s largely

PROTECTION STRATEGY

OTHER IMPORTANT STEPS TO TAKE

“There is some evidence that too much calcium may play a role in prostate cancer,” Goswitz said. Men at average risk for prostate cancer should talk to their doctor at age 50 about screening.

Men at increased risk should have this discussion sooner.

OTHER IMPORTANT STEPS TO TAKE

PROTECTION STRATEGY

because of early detection. If you’re 50 or older, talk to your doctor about getting screened.

OTHER IMPORTANT STEPS TO TAKE

Talk to your doctor about starting a low-dose aspirin regimen, which has been found to reduce the risk of colon cancer by up to 40 percent, according to the American Cancer Society. Limit alcohol use and avoid smoking.

SKIN CANCER

PROTECTION STRATEGY

Be sun safe Sun damage is the No. 1 cause of skin cancer, with about 90 percent of nonmelanoma skin cancers being attributed to ultraviolet radiation exposure, according to the Skin Cancer Foundation. Avoid the sun during peak hours of the day (between 10 a.m. and 4 p.m.) and wear protective clothing, including long-sleeve shirts, long pants, a wide-brimmed hat and sunglasses when outside. And don’t forget to apply sunscreen every day.

Daily use of SPF 15 or higher can reduce the risk of developing melanoma by as much as 50 percent.

OTHER IMPORTANT STEPS TO TAKE

Check your skin monthly for new or changing moles and have your doctor perform a skin check annually. “And of course, stay away from tanning beds,” Goswitz said. n

Prevention and Early Diagnosis Are Key When It Comes to Beating Cancer For screening, schedule an appointment with the Houston Methodist Primary Care Group online at houstonmethodist.org/sanjacinto or by calling 281.428.2273.

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LIFTING SPIRITS Breast cancer survivors have options beyond implants

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ollowing a cancer diagnosis, most patients search for any small nugget of positive news to buoy their spirits.

For some patients, that good news could come from an unlikely source: breast reconstructive surgery.

Patients who meet the requirements to undergo the deep inferior epigastric artery perforator (DIEP) flap breast reconstruction procedure may also reap the aesthetic benefits of a slimmerappearing waistline. The procedure involves a surgical technique in which tissue is taken from the abdomen in order to re-create a breast, making use of the excess skin and fat that exist along the lower abdomen in most people. This tissue is removed and transferred to the chest wall, where the blood vessels are reconnected under a microscope. The tissue is then shaped into a breast mound.

“It’s similar to having a tummy tuck because you’re removing the same tissue

that would be discarded, but instead using it to reconstruct the breast,” said Dr. Benjamin Albright, a boardcertified plastic and reconstructive surgeon at Houston Methodist San Jacinto Hospital.

Albright said the procedure is an evolution of a technique used in older reconstructive methods that removes muscle from the abdominal area, which could cause postsurgical complications such as weakening of the abdominal wall. But the DIEP flap technique minimizes these potential consequences by preserving the muscle and harvesting only the overlying fat and skin.

“Most people are carrying around excess fat in their central trunk. The abdomen is a good place to go to get enough fat volume and skin surface area to replace what’s missing from the breast,” Albright said. “The DIEP flap technique allows us to resurface and restore those parts of the breast that were taken in the mastectomy

For more information on breast reconstruction after cancer or other cosmetic surgical procedures at Houston Methodist San Jacinto, call 281.420.8658.

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The following are benefits of the DIEP flap procedure: Soft reconstruction Complete preservation of abdominal muscles Minimally invasive Potential for restoration of normal sensation

while decreasing recovery time and discomfort.”

Albright said that while use of the DIEP flap technique is becoming more common, prosthetic reconstruction using implants is still used in about 70 percent of breast reconstructive surgeries nationwide.

DIEP flap is considered an advanced microsurgical procedure that requires a longer recovery time — the average length of the hospital stay postsurgery is about seven days — than implant reconstruction, but the benefits include that it avoids implant-related issues and uses only the body’s own tissues.

The reconstructed breast can change with fluctuations in the patient’s weight and the aging process, much like a real breast would. n

PHOTO BY THINKSTOCK

Schedule a Consultation

KEY BENEFITS

What Your Joints Are Telling You Joint pain is common — but what’s causing it?

I

PHOTO BY ISTOCK

f your joints could talk, you’d get an earful.

Instead they pop, they creak, they crackle. They just plain ache.

And you could use a translator.

With hundreds of joints in the human body, deciphering their messages can be challenging, said Dr. Mark Franklin, an orthopedic surgeon with Houston Methodist San Jacinto Hospital.

“Unlocking the mystery is worth the effort, though,” Franklin said.

“Early diagnosis and treatment can help prevent, minimize or delay joint damage and pain and enhance quality of life.”

More than 63 million adults, or 26.3 percent of the population, suffer from chronic joint pain, according to a 2014 report from the U.S. Bone and Joint Initiative.

Knee pain is the most common, at 16.7 percent, followed by pain in the shoulders (7.8 percent) and hips (6.4 percent). Fingers, ankles, wrists, elbows and toes are other typical targets.

Here’s a guide to common ailments for which joint pain can be a symptom.

ARTHRITIS

For pain in the hands, knees, hips and spine, osteoarthritis is a possible culprit. Weight-bearing joints are

most commonly affected by this wearand-tear arthritis, but others can fall prey, too. You might hear creaking or grinding, experience worse pain in the morning and notice stiffness or swelling in the affected joint.

Also consider autoimmune diseases: Rheumatoid arthritis affects multiple joints, usually the same ones on both sides of the body and usually in the hands, wrists, feet, ankles and knees.

Psoriatic arthritis is characterized by joint pain, stiffness and swelling in the fingertips, spine and elsewhere.

Lupus is known as “the great imitator” because symptoms often resemble those of rheumatoid arthritis, fibromyalgia, Lyme disease and other conditions. Signs include pain, stiffness and swelling in foot, leg and hand joints.

BURSITIS

Pain in the shoulder, elbow, hip or other joints that perform repetitive motions may point to bursitis. Knees and toes also are targets.

FIBROMYALGIA

This can be tough to identify because it’s characterized by generalized, widespread, sometimes intermittent body pain, especially in the arms and

legs. Pain occurs on both sides of the body, above and below the waist.

Temporomandibular joint disorders, which cause pain in joints and muscles controlling jaw movement, sometimes accompany fibromyalgia. The jaw’s temporomandibular joints work together and are humans’ most used joints.

GOUT

If pain in your big toe wakes you, gout is a likely suspect. The joint may be so hot and swollen that it feels on fire.

Pseudogout, however, usually causes painful swelling in the knee or other joints. It’s a form of arthritis.

LYME DISEASE

Severe pain and swelling in the knees or other joints may be your first hints of this disease. It’s transmitted through the bite of an infected blacklegged tick.

Pain can shift, and other symptoms may include fever, headache, fatigue and skin rash. n

Schedule Now

To make an appointment with one of the Houston Methodist San Jacinto board-certified orthopedic doctors, Dr. Mark Franklin or Dr. James Pyle, please call 281.427.7400.

HOUSTONMETHODIST.ORG/SANJACINTO 7

TAKE CARE

Wounds

That Won’t Heal

For people with diabetes, managing wounds to prevent complications requires care and diligence. Here are some suggestions: Inspect and wash feet daily and clean minor injuries immediately.

Keep wounds covered and moist to reduce risk of infection.

Trim toenails straight across with clippers. Smooth corns and calluses by gently rubbing in one direction.

Wear proper fitting shoes and socks at all times.

Control your blood pressure and cholesterol to maintain proper blood circulation.

Learn the warning signs and treatment options for a nonhealing wound

F

San Jacinto, said understanding your diabetes risk and knowing the symptoms of diabetes is the first step toward preventing complications triggered by the disease.

“I encourage everyone to become aware of their family history of diabetes and to get checked for it on a regular basis,” said Kibbe.

The most common symptoms of diabetes are frequent urination, extreme fatigue, blurry vision, unexplained weight loss, and cuts and bruises that are slow to heal. Warning signs of a chronic, nonhealing wound include persistent pain in the area around the wound, discoloration of the wound’s edges, increased drainage from the wound site, and redness or swelling around or spreading away from the wound.

The program’s wound care medicine-certified physicians and nurses work with patients and their primary care team to monitor, manage and treat wounds with the most advanced treatments available, including compression wraps, antimicrobial dressings, bioengineered skin substitutes and hyperbaric oxygen therapy (HBOT).

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“Hyperbaric therapy supplies oxygen under pressure that supersaturates the red blood cells and plasma with oxygen, so when blood is supplied to the area of the wound, these supercharged blood cells help repair the wound and kill the infection, leading to generation of new blood vessels and tissue growth,” said Kibbe.

Houston Methodist San Jacinto’s Wound Care and Hyperbaric Medicine Program is one of just two such programs in the Houston area certified by the Undersea & Hyperbaric Medical Society. n

Healing Help

Houston Methodist San Jacinto Hospital’s Wound Care and Hyperbaric Medicine Program offers the most advanced wound care treatment options, including hyperbaric oxygen therapy. For more information, call 281.425.2160.

PHOTO BY ISTOCK

or the estimated 29 million Americans living with diabetes, there’s no such thing as an “insignificant” cut or wound.

Even the smallest scrape can lead to potentially dangerous circumstances.

According to the Centers for Disease Control and Prevention (CDC), diabetes accounts for about 60 percent of noninjury-related lower limb amputations in adults, clearly illustrating the importance for diabetes patients to closely monitor their health and take quick action to provide the proper care to even the smallest wound, particularly in the feet.

In diabetes patients, high blood sugar can damage nerves, which may cause numbness in the feet and legs, and lead to a narrowing and hardening of blood vessels, which can result in less oxygen being circulated throughout the body to aid in healing. Houston Methodist San Jacinto Hospital’s Wound Care and Hyperbaric Medicine Program employs a multidisciplinary approach to treating wounds that won’t heal.

Nancy Kibbe, clinical nurse manager of the Wound Care and Hyperbaric Medicine and Diabetes Self-Management programs at Houston Methodist

RUNNING ON EMPTY You already know lack of sleep can make you a morning grump — but did you know it could seriously harm your health? Read on to find out why catching some ZZZs should be a priority.

YOUR HEART

If you’re skimping on sleep, you could be raising your risk for heart disease. “People who don’t sleep enough are at a higher risk for cardiovascular disease — regardless of age, weight, smoking and exercise habits,” said Dr. Ruby Parveen, a sleep medicine specialist at Houston Methodist San Jacinto Hospital. One study found that people who slept less than six hours per night were twice as likely to have a stroke or heart attack than their betterrested counterparts.

YOUR BRAIN

Trying to keep your memory sharp for years to come?

Try getting plenty of sleep. Researchers found that brain events called sharp wave ripples, which happen mostly during our deepest sleep, are responsible for consolidating memory. In addition to forgetfulness, lack of sleep can also contribute to depression. “Insomnia and depression feed on each other: Sleep loss can worsen symptoms of depression and depression can make it tougher to fall asleep,” said Parveen.

“When you don’t get enough sleep, your body releases cortisol, also known as the stress hormone,” said Parveen.

“In excess, cortisol can cause the elasticity in your skin to break down.”

YOUR WAISTLINE

If you’re waking up in the wee hours just to get in an extra hour of exercise, you may be fighting an uphill battle. Lack of sleep appears to be related to an increase in hunger and appetite, and possibly to obesity. Studies have shown that people who sleep less than six hours a day were almost 30 percent more likely to become obese than those who slept seven to nine hours.

And being exhausted all day doesn’t just make you hungry; it makes you crave high-fat, high-carbohydrate foods — the ones that make it even easier to pack on the pounds. n

YOUR SKIN

We’re all familiar with the puffy eyes and sallow skin that come after pulling an all-nighter. While these symptoms dissipate after a good night’s rest, chronic sleep loss can actually lead to lackluster skin and fine lines, giving new meaning to the term “beauty sleep.”

PHOTO BY ISTOCK

Sleep Evaluation

The Sleep Center at Houston Methodist San Jacinto Hospital is accredited by the American Academy of Sleep Medicine and conducts thorough sleep studies. Call certified sleep medicine specialist Dr. Ruby Parveen at 281.420.8500 to schedule an evaluation.

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A SPORTING

CHANCE Get your student-athlete ready for success with a comprehensive physical

M

ost students may never reach professional athlete status, but they deserve all-star treatment nonetheless.

This starts with paying attention to youth athletes’ health even before their first team practice.

A two-part, preparticipation process — completing a medical history and undergoing a physical exam — can identify potential health issues, point to simple adjustments and, of course, make mom and dad rest a bit easier.

“Don’t dismiss the medical history as another annoying form to fill out,” said Dr. Mark Franklin, an orthopedic surgeon with Houston Methodist San Jacinto Hospital, which offers student physicals for middle school and high school athletes. “Instead, think of it as one more way to protect your kids, just like you did when they were little and you buckled them into their car seat.”

In Texas, the University Inter­ scholastic League requires an annual medical history and physical exam before student-athletes can participate in sports.

Students and parents fill out the medical history together. This is information doctors don’t want to get wrong. They use the history in concert with the physical exam to assess a potential team member’s risk of having a heart condition, for example, or to note medications used for allergies.

“The health history can help us diagnose many medical or musculoskeletal problems that, if not spotted and managed, could compromise a student’s well-being on the field or on the court,” Franklin said.

Houston Methodist San Jacinto’s physical exams include checks of students’ height, weight, vision, blood pressure, pulse, ears, nose, throat, heart, lungs, abdomen, spine and all joints in the upper and lower body.

During the exams, medical professionals might ask how a student deals with her or his asthma and offer suggestions for better management of the condition while playing sports.

They could spot a curvature of the

Houston Methodist Sports Injury Clinics

spine or elevated blood pressure or even suggest that a student with mild knee pain wear more supportive running shoes.

As needed, the medical team consults with parents and refers students to specialists.

Every Saturday, Houston Methodist San Jacinto Hospital opens its convenient sports injury clinics for student-athletes. We offer the same level of care we provide to Houston’s professional sports teams and performing artists. Student-athletes can be evaluated by a doctor and have X-rays or other imaging as needed — all designed to get them back in action. For more information and to find a clinic near you, visit houstonmethodist.org/athlete or call 281.428.2273.

10 LEADING MEDICINE IN EAST HOUSTON/BAYTOWN

PHOTO BY ISTOCK

Still, injuries are inevitable. In a 2009 report, the Agency for Healthcare Research and Quality said that among kids ages 5 to 17, sports activity caused 22 percent of injury-related visits to hospital emergency departments.

More than 98 percent were superficial “treat-and-release” injuries, the agency found. The remainder ranged from fractures to traumatic brain injuries.

But with proper attention, most student-athletes will find that benefits derived from sports — from lower rates of obesity and diabetes to better academic and career performance — outweigh the risks, Franklin said. n

MORE QUESTIONS? Female athletes will hear a few more questions than their male counterparts when they receive a student physical.

The questions are prompted by growing awareness of a syndrome known as the female athlete triad, any of three harmful effects women athletes may encounter when they train or diet too zealously. The triad’s conditions are: Disordered eating. Low calorie intake, gimmicky diets or excessive exercise deprive the body of needed nutrients.

Amenorrhea (menstrual dysfunction). Too much exercise and not enough nutritious food may lower levels of the hormones that regulate periods.

O steoporosis (weakened bones). Disrupted periods and poor nutrition interfere with the body’s bone-building processes.

Source: American Academy of Orthopaedic Surgeons

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Houston Methodist San Jacinto Hospital 4401 Garth Rd. Baytown, Texas 77521-2122 houstonmethodist.org/sanjacinto

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For more information about Houston Methodist or for a physician referral, please visit houstonmethodist.org or call 281.428.2273.

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