Leading Medicine Winter 2016, Houston Methodist Baytown Hospital edition

LEADING MEDICINE W INT ER 016

WEIGHING THE RISKS HOW EXTRA POUNDS CAN AFFECT NEARLY EVERY PART OF THE BODY

DO YOU REALLY NEED A MAMMOGRAM?

ER 101:

THE SYMPTOMS THAT SPELL EMERGENCY YOUR LINK TO HEALTH INNOVATIONS, NEWS AND TIPS IN EAST HOUSTON/BAYTOWN

HEALTHY EATS

Slow-Cooker Turkey Chili Traditional chili gets healthier (and easier to make) with this perfect-for-winter recipe.

INGREDIENTS 1 Tbsp. vegetable oil 1 lb. ground turkey Cooking spray 2 cans (10 oz.) of low-sodium tomato soup 2 cans (15 oz.) of kidney beans, drained 1 can (15 oz.) of black beans, drained

1 small onion, chopped ½ green pepper, chopped 2 Tbsp. chili powder ½ tsp. cumin 1 tsp. red pepper flakes ½ tsp. black pepper

DIRECTIONS Heat oil in a skillet over medium heat. Cook the turkey until evenly browned, then drain. Lightly coat inside of slow cooker with cooking spray.

Add cooked turkey and all other ingredients. Stir and cover. Set slow cooker to high and simmer for 4 hours.

NUTRITIONAL INFORMATION Makes eight servings. Each serving contains: 245 calories, 8.6 g fat, 42 mg cholesterol.

IN THIS ISSUE WINTER 2016

Weighing the Risks How extra pounds can affect nearly every part of the body

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Emergency 101 Which symptoms should be considered an emergency and which can wait for your doctor?

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Great Expectations Why joint replacement patients are getting younger

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Vanquishing Veins With so many treatment options available, varicose veins don’t have to be a pain

Count on This We take a by-thenumbers look at colorectal cancer, a very treatable disease when detected early

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PHOTOS BY THINKSTOCK

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Don’t Wait Having a mammogram is the best way to detect breast cancer early

Don’t Wait Having a mammogram is the best way to detect breast cancer early Lately, figuring out the best way to detect breast cancer has gotten a little confusing. Maybe you’ve heard that breast self-exams aren’t necessary or Dr. Mary Goswitz that a recent study suggests mammograms don’t make a difference. Well, let’s be clear: Houston Methodist recommends that women get annual mammograms starting at age 40, or earlier if they are considered to be at high risk for breast cancer.

“Our recommendations have not changed,” said Dr. Mary Goswitz, a radiation oncologist with Houston Methodist San Jacinto’s Cancer Center.

“Though one study might question the efficacy of mammograms, there are still many studies that emphasize their importance.”

Many experts question the results of the study, noting that aspects like the quality of the mammograms may have affected the findings. The study also

included patients with more advanced stages of cancer, in which a lump could be felt. Mammograms are designed to detect the tiny lumps that can’t be found by touch.

“Early detection is unquestionably a key factor in the fight against breast cancer,” said Goswitz. “Mammograms are still the best way to find cancer in its early, more treatable stages.

Combine mammograms with physical exams and you have a very powerful screening tool.”

Most women should begin having mammograms at 40. Women with an increased risk, such as those with a family history of the disease, may start sooner. Remember to continue screenings as you get older.

“Risk increases with age,” said Goswitz. “One mammogram is not

THE WAY TO A BETTER MAMMOGRAM A void scheduling your mammogram during the week before your period.

Wear a separate top and bottom so that you’ll only need to take your top off during the exam.

The day of your screening, skip deodorant, lotion and perfume, which can cause shadows on the mammogram image.

enough, so it is imperative that women keep getting screened throughout their lives.”

A mammogram typically requires only 15 minutes. Your doctor will receive the results in two to three days and will call you.

“Since 1990, mammography has helped reduce breast cancer deaths by a third,” said Goswitz. n

Mammograms in 3-D

Houston Methodist San Jacinto Hospital now offers 3-D mammograms, which provide the clearest images at no additional radiation dose. Call 832.556.6300 or visit houstonmethodist.org/sanjacinto to schedule your mammogram today.

CHECK OUT OUR DIGITAL MAGAZINE AT HOUSTONMETHODIST.ORG/NEWSROOM/NEWSLETTERS 3

Weighing the

How extra pounds can affect nearly every part of the body

Risks

T

he lives of millions of Americans are at risk every day. Why? More than 72 million adults are obese — and obesity is a gateway condition to a host of health problems that affect the heart, joints, internal organs and more. “Obesity affects the entire body, from head to toe,” said Dr. G. Storm Walmsley, a family medicine physician at Houston Methodist San Jacinto Hospital.

Most dangerous is “central obesity” in the midsection. “As we gain belly fat, we increase our insulin resistance,” Walmsley said.

“We increase our risk of high blood pressure and cholesterol.

Central obesity is a direct marker for fat depositing in our organs.”

Not all obesity is equal: Overweight patients with a normal waist size and blood pressure and cholesterol levels are at far lower risk than those with central fat. People who carry extra weight in their bellies are at higher risk for diabetes, heart disease and stroke.

How do you know where you stand? Know these two numbers: your waist size and your body mass index (BMI), a measure of body fat based on height and weight. Talk to your doctor about what your results mean for your health and the screenings you need to make sure you’re not in danger.

“You have the power to effect change,” said Walmsley, who recommends avoiding liquid calories like soda and following a Mediterranean diet heavy in fresh produce, healthy fats such as olive oil, and proteins like fish. Following a low-carbohydrate diet and doing exercise to build lean muscle, like resistance training, will help reduce belly fat.

Just how much damage can obesity do? We take a look at the body’s obesity burden.

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NUMBERS CAN LIE Even if your body mass index (BMI) number falls within the healthy range, that may not mean you’re in the clear — or that you have license to eat junk food at will. It’s possible to be unhealthy even if the scale says otherwise.

Some people call it “skinny fat.” It’s the idea that you can look perfectly healthy while being at risk for chronic conditions because of diet, lack of exercise and genetics.

“High blood pressure and high cholesterol are called silent killers for a reason,” said Dr. G. Storm Walmsley, a family medicine physician at Houston Methodist San Jacinto Hospital.

“Everyone, no matter your size or weight, needs an annual visit with their doctor.”

THE DANGER ZONE Women

WAIST > 35 in.

BMI > 25

Men

WAIST > 40 in.

BMI > 25

HOW EXTRA POUNDS AFFECT THE ENTIRE BODY Throat

Brain

As BMI increases, so does the risk of stroke. Obesity can be tied to depression and anxiety.

Lungs

Sleep apnea, which can be due to an airway narrowed by neck fat, causes you to stop breathing multiple times during the night.

The possibility of developing asthma increases.

Heart

The long list of risks includes heart disease, heart attack, high cholesterol, high blood pressure and heart failure.

Esophagus

Gastroesophageal reflux disease (GERD) and esophageal cancer are sometimes linked to carrying extra weight.

Pancreas

Your body can lose the ability to properly use insulin, leading to diabetes.

Liver

Fatty liver disease and cirrhosis are risks.

Back

Being heavier means having a higher chance of back pain.

Gallbladder

You are at increased risk of gallstones and an enlarged gallbladder.

Reproductive Organs

Kidneys

ILLUSTRATION BY TRACI DEBARKO

Diabetes and high blood pressure due to obesity can lead to kidney disease and kidney failure.

Women can face abnormal periods and infertility.

Men may struggle with erectile dysfunction.

Colon

Obesity has been linked to colon cancer.

Knees

Extra weight can wear down the joints, leading to osteoarthritis.

COMPLETE YOUR HEALTH CHECKLIST

Houston Methodist San Jacinto Hospital is here to keep you and your family healthy.

Visit houstonmethodist.org/sanjacinto or call 281.420.8600 to schedule an appointment with one of our physicians.

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Emergency

101

Which symptoms should be considered an emergency and which can wait for your doctor?

I

n movies, it’s easy to identify emergencies. They come in the form of horrendous car wrecks, dramatic heart attacks and suspenseful near-drownings.

While these scenarios do occur in real life, most situations that require medical care are less black and white. Do you know what to do in an emergency?

Take this quiz to learn which symptoms warrant a trip to the emergency department or a Houston Methodist Emergency Care Center — and which can wait for a visit to your primary care provider.

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TRUE OR FALSE: UNEXPLAINED CHEST PAIN IS ALWAYS AN EMERGENCY.

ANSWER: True. Chest pain is the most common heart attack symptom for both men and women. Unless you’re certain the pressure is heartburn, go to the hospital right away. Other symptoms may include shortness of breath, lightheadedness, fatigue, anxiety, sweating, nausea, vomiting, or pain in the back, neck, shoulders, arms, teeth or jaw. Women are more likely than

ANSWER: C. Compound fracture.

A broken bone can be treated at an urgent care facility, but compound fractures — in which the bone protrudes through the skin — require immediate emergency treatment. Mild concussions do not call for a trip to the ER (although a follow-up visit to your doctor is recommended). But serious concussions, on the other hand, should be treated right away. Symptoms of serious concussions include lasting confusion, seizure, unusual eye movement, unequal pupil sizes, repeated vomiting, balance problems or loss of consciousness for more than a few seconds.

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TRUE OR FALSE: A FEVER OF 100 DEGREES OR MORE WARRANTS EMERGENCY TREATMENT.

ANSWER: False. For otherwise healthy adults, elevated body temperature isn’t considered a fever until the temperature reaches 100.4 degrees.

Go to the emergency department for a fever of 104 degrees or higher, if you’re undergoing chemotherapy, or if you also have trouble breathing, changes in behavior or neck stiffness. Fevers in babies younger than 3 months and the elderly should also be treated sooner than later.

PHOTO BY THINKSTOCK

men to experience these symptoms in addition to or in the absence of chest pain. Many women report just feeling tired leading up to a heart attack. Be vigilant about seeking care when you feel something is off with your health.

2

WHICH SPORTS INJURY REQUIRES EMERGENCY CARE?

a. Mild concussion b. Sprained ankle c. Compound fracture d. All of the above

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TRUE OR FALSE: IT’S OK TO DRIVE YOURSELF OR A LOVED ONE TO THE HOSPITAL DURING A POTENTIAL STROKE.

ANSWER: False. If you think you or someone you know is having a stroke, call 911. You may think driving to the hospital will be faster than waiting for an ambulance, but it’s not. Every minute counts when a stroke occurs, and when you call 911, medical care begins as soon as first responders arrive. On the way to the hospital, they perform vital tasks and alert the hospital to ensure that a stroke team is ready to treat you.

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WHICH WINTERTIME AFFLICTION SHOULD HAVE YOU HEADED TO THE EMERGENCY DEPARTMENT? a. The flu b. Lower back strain after shoveling snow c. A cough that lasts 10 days d. Hypothermia

ANSWER: D. Hypothermia. The other ailments can be treated at home or by your primary care physician. Unless you have severe back pain that isn’t improving, your best bet is to apply heat (or ice) and take over-the-counter pain relievers. If you have the flu, rest and drink plenty of fluids. And know that coughs can last up to two weeks.

Hypothermia, on the other hand, calls for emergency medical attention.

It occurs when your body temperature goes too low, and symptoms include shivering, confusion, slurred speech and drowsiness. If hypothermia is suspected, take the person’s temperature — anything below 95 degrees is an emergency. n

We’re Here for You

For all your nonemergency needs, Houston Methodist Primary Care Group provides patientcentered, compassionate care to the Baytown community.

Our board-certified health care providers enjoy getting to know their patients so they can develop personalized health plans. Call 713.394.6724 to schedule an appointment today.

HOUSTONMETHODIST.ORG/SANJACINTO 7

GREAT

EXPECTATIONS Why joint replacement patients are getting younger

O

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PHOTO BY THINKSTOCK

nce upon a time, a total joint replacement patient was an older person who was suffering from severe arthritis pain and in search of a solution that could offer a better quality of life. Opting for this surgery late in life tended to reduce the likelihood of having to perform a repair or a second replacement.

But today, the number of younger patients choosing to have total joint replacement has sharply increased. Hip replacement statistics from the American Academy of Orthopaedic Surgeons provide a clear picture: In 1998, patients 45 to 64 years old made up just 27 percent of the total number of hip replacements performed. But by 2008, this number had risen to 40 percent.

Orthopedic surgeons at Houston Methodist have seen this shift firsthand. There are several reasons why.

HOW TO KEEP YOUR JOINTS HEALTHY INCREASED ACTIVITY LEVELS

One factor is that today’s younger joint replacement patients are simply more active than those of years past — and they’re less likely to be satisfied with a lifestyle of significantly reduced physical ability.

Faced with significant pain from a damaged or deteriorated joint, many of these younger, active patients are investigating joint replacement as an option — seeing it as a way to continue with the physical activities that are an important part of their lifestyles.

MORE WEAR AND TEAR

Many other younger patients have cumulative damage from a lifetime of sports and exercise.

Today, people are generally more active, plus high school and college sports have become much more prominent than they were one or two generations ago.

Among the reasons relatively young patients are discussing joint replacement options with their surgeons are overuse injuries from running and racket sports; arthritis secondary to past surgical repairs to ligaments in the knee; and complications from incomplete healing of old injuries on the playing field or the ski slopes.

BETTER APPLIANCES

The improving quality of the prosthetic joints themselves is another reason for the increased number of joint replacements in younger patients. Simply put, the joints are less likely to need early repair or replacement — even when the initial surgery is performed on a relatively young patient.

A particular advancement has come in the plastics used on the weightbearing surfaces of prosthetic joints.

Today’s standard is a very dense high-molecular-weight cross-linked polyethylene — strengthened during manufacturing through the application of focused doses of radiation.

SURGICAL IMPROVEMENTS

Joint replacement surgery was once a highly invasive process. Improvements in surgical methods and tools, however, have made it more of a minimally invasive procedure than conventional surgery.

Another important development — and one that has helped to make joint replacement surgery more acceptable to many patients — is better pain management.

These improvements in surgery have translated into speedier recoveries as well. n

Are You in Pain?

You might need a joint replacement. Visit houstonmethodist.org/orthopedics to learn more or to schedule an appointment with a specialist.

When we’re young, we take our joints for granted — running, jumping, reaching and climbing with wild abandon. It’s not until we’re older or face an injury that we realize what our joints do for us, and why protecting them matters. Here’s how you can take care of yours.

What can I do to protect my joints?

Keep them moving. Because being immobile can lead to stiffness even in normal joints, exercise is key. Aerobic activity such as brisk walking helps with weight loss, which lessens stress on your joints.

When should I seek help for joint pain versus treating myself?

If your joint hasn’t experienced trauma or a severe injury, mild to moderate aches and pains can be managed through the tried-and-true RICE method: rest, ice, compression and elevation. This regimen can be accompanied by over-thecounter anti-inflammatory and pain medications as well.

How do I know if joint surgery makes sense for me?

If conservative approaches such as weight loss, physical therapy or medications have failed to provide relief and keep you mobile, you may want to think about surgical options, including joint replacement. But do your homework: Research the procedure you’re considering and ask your doctor questions.

HOUSTONMETHODIST.ORG/SANJACINTO 9

Vanquishing

Veins

With so many treatment options available, varicose veins don’t have to be a pain Varicose veins aren’t only unsightly. For some patients, they can cause persistent, aching pain and discomfort. Dark blue and near or above the surface of the skin, Dr. Jacobo Nurko they often appear on the back of the calf or inside of the leg but can form anywhere from the groin to the ankle.

If you have varicose veins — like 25 percent of American women and 15 percent of men — know that you don’t have to suffer. Dr. Jacobo Nurko, a board-certified vascular surgeon at Houston Methodist San Jacinto Hospital, understands the pain and other health problems varicose veins can cause.

Patients seeking relief from throbbing or cramping in the legs,

disrupted sleep due to leg pain or discolored skin should contact him for a consultation.

TREATMENT OPTIONS

For small varicose veins and spider veins, which are smaller and more common, Houston Methodist San Jacinto offers the following: SCLEROTHERAPY: A procedure in which the veins are injected with a solution that closes them, allowing veins to fade.

For larger varicose veins, we offer these treatments: VENOUS ABLATION: A minimally invasive treatment in which the vein is collapsed by light or radiofrequency instead of traditional vein stripping.

MICROPHLEBECTOMY: A procedure in which small incisions are used to remove bulging veins.

Learn More About Treatment Options

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There are many risk factors that increase your chances of developing varicose veins: YOUR JOB. An occupation that requires standing for long periods may put you at risk.

OBESITY. Extra weight puts more pressure on your veins.

AGE. The normal process of aging causes wear and tear on the valves in your veins that regulate blood flow.

GENDER. Because of hormonal changes, varicose veins affect approximately 25 percent of women and 15 percent of men.

GENETICS. Check to see whether your family members have varicose veins; heredity plays a significant role.

Other factors that can contribute to varicose vein development include pregnancy and trauma.

Varicose veins may also indicate that an individual is at a higher risk of other disorders of the circulatory system. Talk to your doctor. n

PHOTO BY THINKSTCOK

Houston Methodist San Jacinto Hospital offers comprehensive treatment options for common vein conditions, including varicose veins, spider veins and deep vein thrombosis. For more information, visit houstonmethodist.org/sanjacinto or call 281.420.8600.

RISK FACTORS

BY THE NUMBERS

Count on This Colorectal cancer is the third most common cancer diagnosed in men and women in the United States, but it’s also very treatable when detected early. Here’s what you need to know, by the numbers.

50

Doctors recommend everyone begin screening for colorectal cancer at 50 years old, or earlier if you have any risk factors.

FOUR

There are four common screening tests. Ask your doctor which is right for you: • FECAL OCCULT BLOOD TEST (FOBT).

Sometimes cancers or polyps bleed, and the FOBT can detect small amounts of blood in the stool. Your doctor will give you this simple, noninvasive test to take home; don’t forget to send it back to the lab. The American Cancer Society (ACS) guidelines recommend it be performed annually if used instead of colonoscopy.

• D IGITAL RECTAL EXAM. A rectal exam is often part of a routine physical exam.

• S IGMOIDOSCOPY. Your doctor checks for and removes polyps inside your rectum and lower colon with a flexible tube that has a camera. The ACS recommends it be performed every five years if used instead of colonoscopy.

•C OLONOSCOPY. Your doctor looks for and removes polyps inside the rectum and the entire colon using a tube that has a camera. The ACS recommends it be performed every 10 years.

50,000

Colorectal cancer is the secondleading cause of cancer-related deaths in the United States, leading to about 50,000 deaths last year. Men and women are affected in almost equal numbers.

MORE THAN

90% The five-year survival rate for people whose colorectal cancer is treated at an early stage, before it has spread, is greater than 90 percent.

5

That’s the average length, in feet, of your colon. Just thought you’d want to know.

EIGHT

Studies have found eight risk factors: 1. Older than 50. More than 90 percent of cases are diagnosed after 50. The average age at diagnosis is 72.

2. The presence of polyps.

Colorectal polyps are growths on the inner wall of the colon or rectum. Most polyps are not cancer, but some can become cancerous.

3. Family history of colorectal cancer.

4. Changes in certain genes.

5. Personal history of cancer.

6. Ulcerative colitis or Crohn’s disease.

7. Diet high in fat (especially animal fat) and low in calcium, folate and fiber.

8. Cigarette smoking.

Schedule Your Screening

If you’re 50 or older and at average risk for colon cancer, plan to have a colonoscopy every 10 years or another colon cancer screening more often. Learn more and get a referral at houstonmethodist.org or by calling 281.428.2273.

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HOSPITALS

Just around the corner Houston Methodist has locations throughout the Greater Houston area to best serve you near your home or workplace. Our locations include hospitals, and emergency care and imaging centers.

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2. Houston Methodist San Jacinto Hospital

6. Houston Methodist Willowbrook Hospital

3. Houston Methodist St. John Hospital

7. Houston Methodist The Woodlands Hospital Opening in 2017

SPECIALTY HOSPITAL 8. Houston Methodist St. Catherine Hospital

SPECIALTY HOSPITALS EMERGENCY CARE CENTERS

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5. Houston Methodist West Hospital

4. Houston Methodist Sugar Land Hospital

HOSPITALS

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1. Houston Methodist Hospital

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EMERGENCY CARE CENTERS 713.441.ER24 (3724)

. Houston Methodist Kirby Emergency Care Center 10. Houston Methodist Pearland Emergency Care Center

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11. Houston Methodist Sienna Plantation Emergency Care Center 12. Houston Methodist Voss Emergency Care Center

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13. Houston Methodist Cinco Ranch Emergency Care Center NOW OPEN! 14. Houston Methodist Cypress Emergency Care Center NOW OPEN! 15. Houston Methodist Spring Emergency Care Center Opening April 2016

IMAGING CENTERS 7. Houston Methodist Breast Care Center at The Woodlands Opening March 2016

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Staying healthy begins with knowing your risk.

Protect yourself from heart disease with a preventive heart screening.

Heart disease is the leading cause of death for both men and women in the United States, with it being the culprit behind one in four deaths. Join us for a free heart seminar and screening event to learn your 10-year risk for heart disease.

For more information or to register for the heart seminar and/or screening, visit houstonmethodist.org/events or call 281.428.2273.

. Houston Methodist Breast Care Center 16. Houston Methodist Imaging Center

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

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