Picture this: you’re out on a run or playing in the yard with your kids and suddenly, you’re wheezing. You’re having trouble breathing. Talking is becoming difficult. It’s an asthma attack. What do you do? When seconds count, an asthma action plan can help you stay in control.
An asthma action plan follows a basic framework of green, yellow and red zones. Each zone provides clear instructions of how to handle your symptoms as well as the steps to take to get back to green (safe zone). It also includes a list of your unique triggers and prescription medications.
Dr. Charanjeev Mann
“Asthma attacks can turn dangerous quickly,” explained Dr. Charanjeev Mann, board-certified internal medicine specialist at Houston Methodist Primary Care Group in Pasadena. “An asthma action plan is an easy way to get ahead of your symptoms and prevent attacks from escalating.”
Whether it’s a smartphone asthma diary app or a piece of paper on your refrigerator, the goal of an asthma action plan is the same — to outline how you will manage your condition to reduce your risk and what do when your symptoms start.
Having an organized plan can help prevent flare-ups and provide clear directions on what to do during an attack. This is especially helpful if someone else needs to get medicine for you. “If you know you need an oral steroid, but can’t tell someone what kind it is, having that information written down can make a big difference in getting the attack under control,” Mann said.
To get started, download an asthma action plan template at nhlbi.nih.gov and review it with your doctor at your next appointment. Action plans should be customized to fit your symptoms and the prescription medication you have available.
Here is an example of an asthma action plan. Your plan will vary depending on your symptoms, medications and your baseline peak flow. Work with your doctor to identify what green, yellow and red looks like for you, and the steps you should take at each level.
All of the following are true:
✓ I am not coughing or wheezing.
✓ I can do all normal activities.
✓ My peak flow is 80% or more of my best peak flow.
Whether your asthma diagnosis is new, or you need a refresher, understanding these important terms are key to writing your asthma action plan:
■ Controller medications or control drugs help manage asthma symptoms and prevent attacks. They require daily use to work well.
■ Corticosteroid drugs are inhaled to decrease airway inflammation and prevent flare-ups. They should be used daily as a control medication, even if you don’t have symptoms. For severe asthma attacks, IV or oral use may be required.
■ Long-acting beta-agonist (LABA) medicine relaxes your airway muscles. It should be used on a regular basis to control symptoms. It is almost always prescribed in combination with corticosteroids.
■ Peak flow measures how well you can blow air out of your lungs. To test it, you blow air through a mouthpiece connected to a peak flow meter.
■ Quick-relief medicine or rescue medicine is a fast-acting drug that provides short-term relief during an asthma attack or if symptoms worsen.
■ Spacer/holding chambers are inhaler attachments that help medicine reach your lungs. Without these devices, it’s possible that inhaler medicines can hit your mouth or throat.
Dos age and medication effectiveness can change over time. If your medication is not controlling your asthma symptoms or you have questions about how to use them, make sure to see your doctor right away.
Action plan: I’ll take my controller medication twice a day. Once in the morning and once in the evening. Exercise triggers my asthma, so I’ll take two puffs of my quick-relief medicine 15 minutes before I hit the gym.
One of the following is true:
■ I’m coughing, wheezing or having difficulty breathing.
■ I feel tightness in my chest.
■ It’s hard to exercise.
■ Frequent coughing wakes me up at night.
■ My peak flow is 50% to 79% of my best peak flow.
Action plan: I’ll take my controller medication twice a day, but I’ll also take two puffs of my quick-relief medicine. If I still have symptoms after 20 minutes, I’ll take another two puffs. If things don’t improve after an hour, I’ll take my oral corticosteroid and call my doctor.
One of the following is true:
■ It’s very hard to breathe.
■ Walking or talking is difficult.
■ My medicine isn’t helping my symptoms.
■ My lips or fingernails turn gray or blue.
■ My peak flow is less than half of my best peak flow.
Action plan: If any of these are true, I’ll immediately take two puffs of my quick-relief medicine and go to the emergency room or call 911.
It’s very important that you share your asthma action plan with others, especially if you’re concerned about being in the yellow or red zone often. “Having someone nearby to help during a red zone event or asthma attack can help get you the right medical attention,” Mann noted. •
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Hearing the news that you or a family member have cancer can take your breath away. Your thoughts and emotions start to race. Deciding what to do next feels impossible.
Finding the right provider and treatment plan is a highly personal decision for you and your family. Many people feel an urgency to get started with treatment right away. However, experts say it’s a good idea to take a couple days to understand your diagnosis before making any decisions. But where do you start?
Once you know the type of cancer you have and the stage, you can begin your search for a care team. Referrals from your primary care physician, family or friends are often good places to begin. For many people, online research is helpful.
Dr. Jitesh Joshi, a board-certified hematologist-oncologist at Houston Methodist Neal Cancer Center at Clear Lake, offers advice for people just starting on their cancer journey. Here are just a few things to look for when choosing a cancer team.
When it comes to medical care, we all want to be treated like an individual, not a condition or disease. In cancer care, this is especially important. “At Houston Methodist, we believe cancer treatment should be patient-centered and holistic,” Joshi said. “That means we look beyond your diagnosis and medical history and consider you as a whole person to design a treatment plan that’s as unique as you are.”
Cancer treatment takes a team of experts working together, including hematologist-oncologists, radiation oncologists, surgeons, nurses and many other specialists. “Having an entire team of specialists working together creates a comprehensive approach to care, which ensures every detail of patient care is considered,” Joshi said.
Certain health conditions can be affected by cancer treatment, such as arthritis, neuropathy (nerve damage or dysfunction), diabetes or some cardiac conditions. For example, someone who is on blood thinners may be unable to have cancer surgery. “When these complex health conditions are present, it’s important to have specialists available onsite to join the cancer team when needed to ensure the patient’s safety,” Joshi explained.
Your cancer team may include additional services to address other needs that arise during treatment. Look for a provider that offers these support services to complement your cancer care:
■ Nurse navigators
■ Physical, occupational or speech therapy
■ Registered dietitians
■ Financial navigators and social work
■ Acupuncture and massage therapy
■ Fertility preservation
People with the same kind of cancer may respond differently to the same treatment. That’s because every cancer has its own unique fingerprint, which influences how it grows and spreads. “At Houston Methodist, we look at the individual and their cancer type first,” Joshi explained. “Tissue typing, molecular therapy and other advanced technology allow us to create highly targeted treatment plans created especially for each patient.”
If surgery is part of your treatment plan, look for a surgeon and hospital that offer minimally invasive surgical techniques to reduce complications and speed recovery. Image-guided therapy uses 3D (or higher) imaging that allows surgeons to plan the best surgical approach in virtual reality before or during surgery.
There are many different treatment options for people with cancer, including chemotherapy, radiation therapy, immunotherapy and advanced surgical procedures. “These gold-standard treatments are very well established, but patients often want to explore alternatives,” Joshi explained. “This is where clinical trials come in.”
Clinical trials allow researchers to develop new approaches to treating cancer, which means more options for you to consider. Houston Methodist is the only health system offering FDAapproved clinical trials at multiple locations across the Greater Houston area.
Most importantly, experts say you should trust your cancer team and feel like an equal partner in all the decisions about your care. And don’t hesitate to get a second opinion, especially if you are contemplating which treatment path to take. •
Dr. Jitesh JoshiVisit houstonmethodist.org/ cancer to learn more about Houston Methodist Neal Cancer Center and our approach to cancer treatment. With seven locations throughout the Greater Houston area, you don’t have to travel far for exceptional care.
An important part of your cancer team, oncology nurse navigators are registered nurses who specialize in cancer care. They support you at every step of your cancer journey, providing a seamless navigation process from diagnosis to survivorship.
Cancer care means you will have many appointments with your team. Nurse navigators can help coordinate your appointments so you can
schedule multiple services on the same day at the same location. This can help you maximize your time away from work or family.
Nurse navigators can also:
• Answer general questions about your treatment options.
• Coordinate communication with your health care team.
• Direct you to health care services for further diagnosis and treatment.
• Direct you to local resources and support.
• Provide family support.
Visit houstonmethodist.org/oncology-nurse-navigator to learn more.
Cassandra Green, MSN, RN Oncology Nurse Navigator
Stress, worry and anxiety can take a toll on your stomach: Just think back to how you felt the last time you went on a job interview, got pulled over for speeding or had to perform or make a public speech. Those nervous butterflies in your belly were hard to ignore.
“The enteric nervous system, a collection of neurons in the gastrointestinal tract, makes up your gut’s brain,” said Dr. Muhammad Talha Farooqui, fellowship-trained gastroenterologist with Houston Methodist Gastroenterology Associates at Clear Lake. “The entire system is very sensitive to moods — and stress can be a major contributor to many digestive problems.”
While not all gastrointestinal conditions are caused by stress, it can worsen your symptoms. Here’s a look at common conditions and how they’re affected by stress:
■ Irritable bowel syndrome (IBS) is an intestinal disorder that’s often marked by cramping, gas, bloating, diarrhea or constipation. Some IBS sufferers find that stress causes flare-ups.
■ Heartburn causes burning or pain behind your breastbone. It occurs when the muscle between your esophagus and stomach opens up, allowing stomach acid into your esophagus. “Stress can slow down digestion, keeping food in your stomach longer, which can be a trigger for heartburn,” Farooqui said.
■ Indigestion — or feelings of bloating or nausea, belching, gas and diarrhea — is often caused by eating too much or eating too fast, consuming high-fat foods or eating during stressful situations. It can also be a sign of gastroesophageal reflux disease (GERD) or ulcers. “Indigestion can come and go depending on your stress level,” Farooqui said.
Everyone has occasional stomach issues, but experts say it’s important not to overlook lingering or recurring digestive problems. If you’ve been experiencing any of these symptoms more than two or three times a week, it may be time to schedule an appoint with a gastroenterologist. •
You can’t always avoid stress, but you can manage it and help ease your stomach woes. Some key strategies include:
■ Exercise. Regular activity helps reduce stress, control weight, regulate bowel function, and improve your overall well-being. Just make sure to exercise before eating or wait at least one hour after a meal.
■ Relaxation and breathing techniques. Try yoga or meditation, taking slow, rhythmic breaths to lessen stress and, in turn, cramps and pain.
■ Biofeedback. This mind-over-matter technique helps you learn to control over certain body functions, including gastrointestinal functions, and bring them back to normal. Biofeedback also helps reduce muscle tension and slow heart rate, promoting a relaxed state.
Want to get to the bottom of your tummy troubles? Let the experts at Houston Methodist Gastroenterology Associates at Clear Lake help diagnose your concerns. With years of experience and access to the most advanced testing options, we can design a personalized treatment plan just for you. To schedule an appointment, call 281.523.3320.
Talha FarooquiEvery day, your good health depends on your heart valves opening and closing successfully about 100,000 times. Your heart’s four valves work together to ensure adequate blood flow through the heart and throughout the body.
A narrowing or stiffening of a heart valve can make it harder for a heart to pump blood. Having a leaky valve that doesn’t close properly can cause a backward flow of blood called regurgitation. As these problems worsen, the heart may have to work harder to make up for the reduced forward blood flow through the valve. For many people, valve repair or valve replacement surgery is needed to restore function.
Dr. Ahmed Elsherbiny“Valve disease can be caused by infections, heart attacks, abnormal structure of the valve or most commonly, because of the wear and tear of those hard-working valves,” explained Dr. Ahmed Elsherbiny, fellowship-trained cardiologist at Houston Methodist DeBakey Cardiology Associates at Clear Lake.
Valve disease can increase your risk of heart failure, abnormal heart rhythm and sudden cardiac death. Fortunately, working closely with your doctor to manage valve disease can help you feel better and reduce the risks to your heart. Here are some key steps to take:
■ Prevent infection. Preventing infection is essential, especially for patients who have had valve replacement. Tell your doctor and dentist that you have valve disease, and take antibiotics before any dental procedures, surgeries or invasive tests if it’s recommended by your physician. Also, be vigilant about taking care of your teeth and gums to prevent infection.
The interventional cardiologists at Houston Methodist DeBakey Cardiology Associates at Clear Lake can help treat and manage your valve disease. Together you can review the actions you can take to reduce complications and live your best life. Call 281.523.3240 to schedule an appointment with a cardiologist today.
■ Watch for signs of infection. See your doctor if you have any signs or symptoms of an infection, especially if you have a fever, increased heart rate, fatigue, body aches, or a persistent cough, or swelling in the feet, legs or abdomen.
■ Take your medications as directed. Your doctor may prescribe medication to treat your valve disease or manage symptoms.
■ Consider having surgery or catheter-guided valve procedures. Your doctor may recommend surgery to fix a valve problem. Surgical options may include:
Annuloplasty – surgical placement of a ring around the valve to make it close tight Balloon valvuloplasty – widening the opening of the valve using a balloon through a catheter
Transcatheter aortic valve replacement (TAVR) –replacement of a narrowed or damaged aortic valve
Heart valve disease is something you may have to manage for the rest of your life, even after having surgery for valve repair or replacement. “It’s important to have a doctor monitor the progress of your valve disease,” Elsherbiny said. “Be sure to keep up with your follow-up visits as scheduled.”
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At Houston Methodist Breast Care Center at Clear Lake, our specialists review your mammogram history and track results over time — detecting changes earlier. That’s why getting your mammogram starting at age 40 — or earlier, if you have a family history — is so important. Breast Care Center offers: The latest 3D mammogram Board-certified of most major health and safety are our priority. are every to
