Leading Medicine Summer 2014, Houston Methodist Hospital edition

LEADING MEDICINE Your link to health innovations, news and tips FROM HOUSTON METHODIst

SUM M ER 2014

SMART women Take our quiz to learn more about your greatest health risks

Summer Sun Savvy

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Heads Up on Concussions

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Here Comes the Sun A few simple actions will help you protect against skin cancer this summer With more than 2 million people diagnosed every year, skin cancer is the most common cancer in the United States.

It’s one of the most treatable cancers when Dr. Daniel Lehane diagnosed early, but it’s also largely preventable if you avoid the sun’s harmful ultraviolet (UV) rays.

“These rays can cause damage in as little as 15 minutes, but a few simple actions can go a long way toward safeguarding ourselves,” said Dr. Daniel Lehane, chair of medical oncology at Houston Methodist Hospital.

Staying out of the sun is the first and foremost recommendation. But when you can’t avoid being exposed, the combination of sunscreen and protective clothing is your best bet.

“Sunscreen alone is helpful, but loose-fitting, long-sleeved shirts and

long pants made from tightly woven fabric offer the best protection,” said Lehane. “Obviously, we can’t completely cover ourselves in fabric, so sunscreen is good for those areas of the skin that remain exposed.”

A hat helps protect your scalp, face, ears and even your neck. Choose canvas over straw, which can let rays through its holes. Sunglasses not only protect the sensitive skin around your eyes, but they can also help prevent cataracts.

SUNSCREEN SAVVY

Be sure to apply sunscreen 30 minutes ahead of sun exposure and reapply every two hours and after swimming, sweating or toweling off. Water-resistant sunscreen still needs to be reapplied often. You can use a sunscreen with a minimum SPF (sun protection factor) of 15, but the higher the number, the better.

Don’t forget to check the expiration date on sunscreen. That bottle from

Sign Up for a Skin Screening

WARNING SIGNS

Check your skin at least once a month for warning signs of precancerous or cancerous moles or lesions, using these ABCDE guidelines: • Asymmetry: One half does not match the other half.

• Border: The border or edges are ragged, blurred or irregular.

• Color: The color varies throughout the spot or has shades of tan, brown, black, blue, white or red.

• Diameter: The diameter is larger than the eraser of a pencil.

• Evolution: There is a change in size, shape or color.

“If you find anything questionable, even outside the typical warning signs, be sure to ask your physician,” added Lehane. “Skin cancer can present itself in a multitude of ways, so it is better to get checked early when it is more easily treated than to wait until it grows.”

PHOTO BY THINKSTOCK

If you have a personal or family history of skin cancer, you should visit a dermatologist annually for a screening. To learn more, visit houstonmethodist.org/skin-cancer-screening or call 713.790.2700.

your cruise three years ago has most likely lost its effectiveness. If there is no expiration date, three years is considered the standard shelf life for sunscreen, but higher temperatures can shorten the lifespan.

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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 that a Dr. Luz Venta recent study suggests mammograms don’t make a difference.

Well, let’s be clear. Women need to 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. Luz Venta, director of the Houston Methodist Breast Care 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

Schedule Your Mammogram

To learn more about breast cancer screenings at Houston Methodist, visit houstonmethodist.org/breast-cancerscreening or call the Houston Methodist Breast Care Center at 713.441.PINK (7465).

cancer,” said Venta. “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 Venta.

“One mammogram is not 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 Venta.

So, don’t put it off any longer. Make your mammogram appointment, and remember these tips: • Avoid 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.

• If your previous mammograms were performed in a different location, ask for them to be sent to the new facility for comparison.

PHOTO BY THINKSTOCK

We’re Here to Help Welcome to the first issue of the new Leading Medicine publication,

brought to you by Houston Methodist Hospital. Three times a year, we’ll provide valuable information to help you make informed health care decisions. You can share our digital version with friends and loved ones through the QR code, or at houstonmethodist.org/publications.

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Smart

Women

If you’re like most women, you’re in charge of your family’s health. Women make 80 percent of health care decisions for their families. But how much do you know about your own health? Take this quiz to see whether what you don’t know might be hurting you.

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Women and men don’t always experience the same heart attack symptoms. Name a symptom more common in women.

ANSWER: While men often experience crushing

chest pain during a heart attack, women tend to have more subtle symptoms such as pain in the abdomen, nausea or unexplained fatigue.

“Women’s symptoms are often misinterpreted as stress-related, or as some other condition,” said Dr. Karla Kurrelmeyer, a cardiologist at Houston Methodist Hospital. “By the time younger women are diagnosed with a heart attack, they often are outside the time window for lifesaving procedures such as percutaneous coronary angiography or clot-busting drugs.”

WHAT YOU CAN DO: “If you even remotely suspect you are experiencing symptoms of heart disease, be sure to take them seriously,” said Kurrelmeyer.

“Knowing your risk factors is also helpful in determining your susceptibility.” That’s especially important if you are diabetic, hypertensive or have high cholesterol levels.

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Think FAST — and spell out this acronym that identifies the sudden signs of stroke.

Answer: FAST stands for face

drooping, arm weakness, speech difficulty and time to call 911.

What you can do: With women accounting for 60 percent of stroke deaths, adopt heart-healthy strategies to reduce your risk. This year, the American Stroke Association issued its first guidelines for preventing stroke in women. The guidelines address stroke risk factors unique to women, such as preeclampsia and use of birth control pills.

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True or false: With the advent of human papillomavirus (HPV) testing, I only need a Pap test to check for cervical cancer every five years.

Answer: True, if you’re between 30 and

65. Women in this age group who are at average risk for cancer should have Pap and HPV tests every five years (or a Pap test alone every three years). Women ages 21 to 29 should have a Pap test every three years; those 65 and older who have a history of regular screening and normal results can stop Pap tests.

What you can do: “One way you can decrease your risk of contracting HPV is through vaccination,” said Dr. Eric Haufrect, an obstetrician-gynecologist at Houston Methodist Hospital. “Other ways to avoid it include limiting your number of sexual partners, always using condoms and maintaining an overall healthy lifestyle.”

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Rank in order the top cancer killers of women — breast, lung, colorectal.

Answer: Lung, breast, colorectal. Lung

cancer kills more women than breast and colorectal cancers combined.

What you can do: If you smoke, quit. The U.S. Preventive Services Task Force recently recommended annual lung cancer screening for smokers ages 55 to 80 who averaged a pack of cigarettes daily for 30 years and those who quit within the past 15 years.

The Houston Methodist Lung Cancer Screening Program offers low-cost scans for qualified patients. To learn if you are a candidate for a screening, call 713.441.5864.

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Choose the correct answer: A woman should have a mammogram annually/every other year beginning at age 40/50.

Answer: Houston Methodist, like

the American Cancer Society and the American College of Radiology, recommends that women begin annual mammograms at age 40. One in six cases of breast cancer occurs in women in their 40s. In addition to mammography, the Houston Methodist Breast Imaging Center offers breast MRI to clarify mammogram results and improve diagnosis.

What you can do: “Early detection greatly increases the chances for the successful treatment of breast cancer,” said Haufrect. “Annual mammograms, combined with clinical breast exams, are a powerful screening tool. Also, in between appointments, perform monthly breast self-exams about one week after the end of your period.”

Find Your Women’s Health Specialist

To learn more about how Houston Methodist can help keep you healthy, visit houstonmethodist.org/womens-health or call 713.790.3333 to find a women’s specialist near you.

Health Screenings at Every Age Great health is built on a foundation of smart choices.

“Many health screenings are available that can help identify problems at their earliest, most treatable stages,” said Dr. Linda Porter-Tucci, a Houston Methodist family practitioner.

“Take advantage of them. They can go a long way toward staying healthy for years to come.” Here’s a decade-by-decade look.

20s: Your whole life is ahead of you. Start it right. At age 20, begin cholesterol and blood pressure testing. At age 21, start Pap tests.

30s: Between careers, kids and relationships, 30-somethings are used to juggling. Add one more task to your to-do list: thyroid-stimulating hormone screening beginning at age 35.

40s: Parenting teenagers and experiencing hormonal changes make life wildly interesting. Don’t forget to begin mammography at age 40 and blood glucose testing at age 45.

50s: By midlife, you’ve learned to master your fears. Hit colonoscopy head-on starting at age 50.

60s: Bone up on your golden years with a bone density scan at age 65 and annual vision screening starting at 65.

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Heads Up With summer activities underway, be sure to recognize the symptoms of concussion Summer means heading outdoors to enjoy fun activities like bicycling, skateboarding or playing baseball. But don’t forget that participating in these activiKenneth Podell, ties can increase your PhD risk of head injury.

Be sure to take safety measures, like wearing a helmet, and remember the symptoms of concussion: • Headache • Mental fogginess • Sensitivity to light or sound • Memory problems • Dizziness/balance problems

COUNTERING CONCUSSION MYTHS

Learn more about concussion diagnosis and care at the Houston Methodist Concussion Center by calling 713.441.8277 or visiting houstonmethodist.org/ concussion.

• Severe neck pain and stiffness Podell advises patients to get mental and physical rest after a concussion and to treat headache with acetaminophen only within the first 48 hours. Aspirin or nonsteroidal anti-inflammatory drugs can increase the risk of bleeding.

“Younger kids take about two weeks or longer to recover fully, while adults usually recover more quickly, within a couple of days to two weeks,” he said.

“Once patients stabilize after a couple of hours, it’s also OK to let them sleep through the night rather than waking them every hour or so. When in doubt about concussion symptoms, it’s always a good idea to consult your family doctor first.”

PHOTO BY THINKSTOCK

Many misconceptions about concussions exist, said Kenneth Podell, PhD, clinical neuropsychologist and co-director of the Houston Methodist Concussion Center.

“Loss of consciousness is rare in concussions,” he said. “Therefore, if you have any of the common symptoms,

but don’t lose consciousness, you may still have a concussion.”

Podell says symptoms of concussion are most likely to occur within the first few hours of an incident. But in some individuals, symptoms may be delayed for as long as 24 hours after the injury.

“While symptoms are the same in children and adults, a younger child will describe them differently,” he said. “A 6-year-old will not say they are mentally foggy or drowsy, so pay close attention to their words. A child might say the lights are too bright, their eyes hurt or that they don’t feel good.”

Someone who bumped his or her head rarely thinks of going to the emergency room, Podell said. But it’s important to monitor symptoms over time and understand which ones warrant a hospital visit, including the following: • Difficulty paying attention • Erratic behavior • Bleeding from the ears, nose or mouth or at the site of head injury • Numbness or tingling on one side of the body • Repeated vomiting (three times or more)

Care for Concussions

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Worth Its Weight Bariatric surgery is a viable option for patients with type 2 diabetes If you’re carrying extra pounds, a serious health condition may be gaining ground on you. Type 2 diabetes is a chronic disease that occurs when Dr. Vadim the body struggles Sherman to produce or use insulin, a hormone that regulates the metabolism of carbohydrates and fat.

More than 85 percent of people with type 2 diabetes are overweight or obese.

The basis of treatment is a weight loss plan that includes a healthy diet and increased exercise. Without weight loss, patients often must turn to medications that regulate blood sugar levels. Although medication can help control the disease, it rarely can reverse it. Over time, the pancreas may become damaged and produce less insulin, requiring the patient to begin insulin injections.

A recent study published in the journal Diabetes Care found that early, intensive treatment of diabetes with insulin and medication helps the body continue to produce insulin — which slows progression of the disease. Unfortunately, many diabetic medications, including insulin, can lead to weight gain.

The Benefits of Bariatric Surgery

A recent study points to bariatric surgery as a viable option for patients with type 2 diabetes. The surgery is not only more effective than medicine alone, but it also can reverse type 2 diabetes and allow most patients to stop using insulin and other medications.

Dr. Vadim Sherman, medical director of bariatric and metabolic surgery at Houston Methodist Hospital, said, “The study confirms that, along with weight loss resulting from gastric bypass surgery, rerouting of the intestine causes a direct change in the patient’s metabolic hormones.

Find a Way to Lose Weight

PHOTO BY THINKSTOCK

If you have diabetes, weight loss can dramatically improve your health. Learn more about options at the Houston Methodist Weight Management Center by calling 832.667.LOSE (5673) or visiting houstonmethodist.org/ weight-loss.

“Weight loss is achieved by several mechanisms,” he continued. “One, patients have a small stomach pouch, limiting the amount of food they can eat. Second, since food enters the rerouted intestine sooner, hormones for digesting the meal are released earlier, which leads to metabolic changes that further help with hunger and weight loss.”

Sherman said patients with early onset diabetes have a more than 90 percent chance of eliminating diabetes medications following gastric bypass. Although the procedure is safe and requires a relatively short recovery, he warns that weight loss surgery shouldn’t be viewed as a magic bullet.

“An effective weight loss plan always involves a permanent lifestyle modification, which includes small portions, a healthy diet and an active lifestyle,” Sherman said. “Surgery is the strongest tool available that can help individuals achieve this lifestyle modification and their long-term weight loss goals.”

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LEADING MEDICINE IN GREATER HOUSTON 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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HOSPITALS EMERGENCY CARE CENTERS IMAGING CENTERS

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For more information about Houston Methodist or for a physician referral, please call 713.790.3333 or visit houstonmethodist.org.

HOUSTONMETHODIST.ORG

1 HOUSTON METHODIST HOSPITAL (Texas Medical Center) 6565 Fannin St. Houston, Texas 77030

6 HOUSTON METHODIST WEST HOSPITAL (I-10 at Barker Cypress) 18500 Katy Frwy.

Houston, Texas 77094

2 HOUSTON METHODIST SAN JACINTO HOSPITAL (Garth Rd. exit off I-10) 4401 Garth Rd. Baytown, Texas 77521

7 HOUSTON METHODIST WILLOWBROOK HOSPITAL (Hwy. 249 and FM 1960) 18220 State Hwy. 249 Houston, Texas 77070

3 HOUSTON METHODIST ST. CATHERINE HOSPITAL (Katy - West Houston) 701 S. Fry Rd. Katy, Texas 77450

Emergency Care Centers 713.441.ER24 (3724)

4 HOUSTON METHODIST ST. JOHN HOSPITAL (Clear Lake Area) 18300 St. John Dr. Nassau Bay, Texas 77058

8 HOUSTON METHODIST EMERGENCY CARE CENTER – KIRBY 2615 Southwest Fwy., Suite 140 Houston, Texas 77090

5 HOUSTON METHODIST SUGAR LAND HOSPITAL (U.S. 59 and Sweetwater) 16655 Southwest Frwy.

Sugar Land, Texas 77479

9 HOUSTON METHODIST EMERGENCY CARE CENTER – PEARLAND 11525 Broadway St. Pearland, Texas 77584

10 HOUSTON METHODIST EMERGENCY CARE CENTER – SIENNA PLANTATION 8200 Hwy. 6 Missouri City, Texas 77454 Opening July 15 11 HOUSTON METHODIST EMERGENCY CARE CENTER – VOSS 1635 S. Voss Rd. Houston, Texas 77057

Methodist Imaging Centers 8 HOUSTON METHODIST BREAST IMAGING CENTER 2615 Southwest Frwy., Suite 104 Houston, Texas 77090 713.441.7765 12 HOUSTON METHODIST IMAGING CENTER 83333 Katy Frwy.

Houston, Texas 77024 713.797.XRAY (9729)

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