LEADING MEDICINE
PRIMARY CARE
What Are the First Signs of Multiple Sclerosis?
About 1 million people in the U.S. have multiple sclerosis (MS), a disease of the central nervous system. If you suffer from MS, it impacts the way you think, learn, move and feel.
The best treatment success comes when MS is found early, so it’s important to understand the first signs of the condition.
“Multiple sclerosis is considered an autoimmune inflammatory disease,” explained Dr. Abdul R. Alchaki, a neurologist and multiple sclerosis specialist at Houston Methodist Hospital. “The body’s immune system, specifically certain types of white blood cells, mistakenly attacks and damages the myelin sheath, the protective covering that surrounds nerve fibers in the central nervous system.”
Alchaki explained how symptoms can come and go or last a lifetime.
MS SYMPTOMS
“The scarring caused by MS is as distinct as a fingerprint, varying from one person to another,” Alchaki said. “This means the unique pattern of their lesions influences the symptoms each individual may encounter.”
MS symptoms occur in relation to the lesion location:
■ Optic nerve: Optic neuritis can cause pain and blurred vision in one eye.
■ Spinal cord: Symptoms can include weakness that causes difficulty walking, coordination problems and loss of sensation in the hands or feet. Bowel and bladder problems like constipation and a frequent urge to urinate are common.
■ Brain: Lesions in the brain can lead to problems with concentration, multitasking or memory. When the disease
impacts the part of the brain related to coordination, symptoms can include tremors or difficulty balancing.
Although symptoms are different for each person, blurry vision, numbness and fatigue are the most common.
VAGUE AT FIRST
In the first stages of MS, symptoms may be noticeable but might not immediately seem related to the condition.
“During this early stage, which can last from three to five years, symptoms aren’t typically specific and may manifest as changes in mood, such as depression, anxiety or fatigue,” Alchaki said. “These early signs might not prompt an immediate consultation with a neurologist or lead to a brain MRI.”
Most people with MS first notice symptoms in their 20s and 30s, but diagnosis is most common in the 30s to 40s. Often, targeted symptoms are treated without knowing the underlying cause.
“If you catch the disease early, and you start the right medication, a person can do very well for the rest of his or her life,” Alchaki added. “Caught later in life, there is not much that can be done to reverse the damage caused by the lesions.” •
Talk to a Specialist
If you see any signs of MS, it’s time to talk to a multiple sclerosis specialist. To learn more or to schedule an appointment, visit houstonmethodist. org/multiple-sclerosis or call 713.441.3780
Dr. Abdul R. Alchaki
HIGH TIME TO LEARN ABOUT Low Back Pain
Do you ever wonder why you’re experiencing lower back pain? The lower back, or lumbar spine, supports the weight of your upper body and is involved in everyday movements of your hips, pelvis and lower extremities — such as bending, twisting and coordinating muscles.
“Because of its important role in movement, the lumbar spine is prone to overuse. The bones, ligaments, muscles and disks are often under strain,” said Dr. Karim Shafi, an orthopedic surgeon at Houston Methodist Hospital. “Injury and deterioration over time can affect the lumbar spine and cause lower back pain.”
LOWER BACK PAIN CAUSES
A spinal compression fracture occurs when a vertebra in your lumbar spine essentially collapses in on itself. Often due to osteoporosis or trauma, it results in sudden pain and limited spinal mobility.
Lumbar spinal stenosis happens when the spinal canal in your lower back narrows, placing pressure on nearby nerve roots, causing pain, aching or cramping in the legs or buttocks. Causes may include bone spurs, ligament thickening and degeneration, or herniation of disks or joints.
Spondylolisthesis is when a lumbar vertebra slips forward, over the top of the vertebrae below, placing compressive force on the disk that separates the two vertebrae. If the lumbar disk flattens from this force, it can lead to nerve compression and sciatica.
A lower back strain can result from an acute injury — such as lifting something too heavy or playing sports — or develop over time due to repetitive movements or poor posture.
Treatment can involve anti-inflammatory medications, muscle relaxers, at-home therapy and rest until the pain subsides.
“Healing from a lower back injury can take a few days or a few months. If your pain continues or gets worse, however, there may be other factors at play,” Shafi explained.
The source of chronic lower back pain usually involves issues with the lumbar disks, nerves or joints.
A herniated disk can be acute or chronic and occurs when the inner gel of one of the five disks in your lumbar spine slips or squishes beyond the outer rind and presses on surrounding nerves, which then causes leg or low back pain.
Facet joint damage happens over time when the joint cartilage connecting the five lower back vertebrae breaks down from repetitive force and stress. Poor alignment or repeated overuse can result in inflammation, stiffness and muscle spasms.
According to Shafi, osteoarthritis and degenerative disk disease are very common causes of lower back, leg or buttock pain, but speaking to a doctor will help determine the root cause of your pain.
WHEN TO SEE A SPECIALIST
“You should see a specialist if your lower back pain doesn’t resolve from at-home care,” Shafi said. “Your doctor will be able to help you find a diagnosis and provide treatment that helps you get back to the activities you love most.” •
We’ve Got Your Back
If you have recurring back pain, get help from one of our spine specialists. To learn more or to schedule an appointment, visit houstonmethodist. org/spine or call 713.790.3333
Dr. Karim Shafi
PRIMARY CARE Beyond the Annual Checkup
Your primary care provider (PCP) is a long-term partner to help in your quest for better health. With regular wellness exams and age-appropriate screenings, your PCP understands your needs and can help catch harmful health issues that don’t have obvious symptoms.
“I already know your medical history and can provide the best treatment advice,” said Dr. Priya Davar, a family medicine physician with Houston Methodist Primary Care Group. “That’s why continuing care with the same PCP is important.”
To help manage your overall health and well-being, your doctor is your best resource. Ask about a new health fad, immunizations, hurts, pains and even your worries. Your doctor is here to listen.
FOR QUESTIONS & IMMUNIZATIONS
When it comes to the latest diet trend or learning about immunizations, instead of asking Google for advice, start with your doctor. After all, he or she understands your health history and can guide you based on clinical evidence.
“There is a lot of misinformation online regarding medication side effects, fad diet plans and advertised supplements. I am here to advise and help you understand the latest clinical guidelines to make sure you are doing no harm to your health,” Davar said.
Everyone should get an annual flu shot, as well as a tetanus, diphtheria and pertussis (Tdap) or tetanus diphtheria (Td) booster every 10 years. Your doctor may also recommend vaccines depending on your age and health history, and if you have international travel plans.
Dr. Priya Davar
TO FIND A LURKING HEALTH ISSUE
There are things you can’t really miss — acid reflux, asthma, urinary tract infections.
Unfortunately, some chronic health conditions, such as high blood pressure, prediabetes and high cholesterol, can lurk quietly in the background. Having an annual wellness exam with your primary care doctor can help uncover these conditions.
Depending on your age and family health history, your PCP may recommend other health and wellness exams, such as prostate cancer screening for men or colorectal cancer screening.
“If a cancer screening comes back positive, then it’s my job to quickly coordinate with a specialist who manages that condition and make sure you’re seen by him or her in a timely manner,” Davar explained.
Navigating the health care system alone can be overwhelming. Your PCP can make it easier by briefing specialists such as cardiologists, neurologists or endocrinologists on your health challenges.
Afterward, your PCP can help with a continued care plan. “I review the specialist’s findings to have a better understanding of your condition and treatment plan,” Davar added. “Then I help navigate you through strategies and timely interventions.”
TO STAY MENTALLY WELL
Your PCP is the first person to evaluate your mental health. Health changes that can cause isolation from your daily activities as well as lead to anxiety and depression include:
■ Cancer
■ Childbirth
■ Diabetes
■ Heart attack
■ Hypertension
■ Stroke
“In primary care, we screen for those conditions and can also help with treatment — including treatment for your mental health,” Davar added. “Sometimes you are started on medications or therapy. If need be, your PCP can help find a psychiatrist or a therapist to continue the treatment plan.”
FOR OVERALL HEALTH NEEDS
Whether it’s an acute illness such as a bad cold or you’re just not feeling right, get comprehensive care from an established relationship with your PCP. “Preventive care goes beyond the wellness exam — I am here to support you throughout your life,” Davar noted. •
Find a Primary Care Provider
Houston Methodist Primary Care Group has more than 45 practices across the Greater Houston area. To find a doctor near you, visit houstonmethodist.org/pcg/central or call 713.441.7965.
SEE YOUR DOCTOR VIRTUALLY
Life can get busy, and making time for a doctor’s visit doesn’t always fit into your day. That’s where virtual visits come in — a perfect option for your health and lifestyle. Whether from your bed, couch, kitchen or hotel, your doctor can see you.
Follow-up care and many common health issues can be addressed via video visits, such as:
To get quick access to care, visit houstonmethodist.org/ pcg/central and schedule a virtual appointment with one of our primary care providers.
Protecting the Heart More Than a Cholesterol Check
Coronary artery disease (CAD) remains one of the leading causes of death globally, and its development is closely tied to cholesterol levels. While we’ve long understood that cholesterol plays a critical role in heart disease, new insights have revealed the importance of looking beyond simple cholesterol numbers to get a clearer picture of heart health.
PREVENTING CORONARY ARTERY DISEASE
While cholesterol is necessary for certain bodily functions, too much LDL, or “bad” cholesterol, can lead to dangerous plaque buildup in the arteries, which increases your risk of a heart attack and stroke.
“Cholesterol is like fuel,” explained Dr. Khurram Nasir, a cardiologist at Houston Methodist Hospital. “It moves through your bloodstream, but when levels are too high, it begins to deposit in your arteries. The real problem arises when these deposits inflame and rupture, potentially causing a heart attack.”
RETHINKING CHOLESTEROL
For many years, foods like eggs and butter were blamed for increasing the risk of heart disease. However, research has shown that dietary cholesterol has a much smaller impact on blood cholesterol than once thought. The real culprits are saturated fats, processed sugars and the liver’s ability to process cholesterol.
“It’s not just about how much cholesterol you consume,” Nasir said. “It’s about how your body manages it, especially in terms of plaque buildup in your arteries.”
WHAT NUMBERS MATTER MOST?
LDL, the “bad” cholesterol, has long been the primary focus of cholesterol management, while HDL, the “good” cholesterol, was believed to help clear LDL from the bloodstream. Nasir noted that the role of HDL may not be as protective as once thought, particularly when HDL levels are unusually high.
“What’s important isn’t just the cholesterol number itself but how your body handles it,” Nasir said. “Are you at risk of plaque buildup in your arteries? That’s what matters most.”
UNDERSTANDING CORONARY ARTERY CALCIUM SCANS
The Coronary Artery Calcium (CAC) scan is a critical tool for assessing heart health. Unlike traditional cholesterol tests that estimate risk based on numbers alone, the CAC scan provides a direct look at plaque burden, allowing for a more precise assessment of heart disease risk.
“It’s a simple test that can change the course of treatment, especially for those unsure about their risk,” Nasir explained. “If the scan shows no significant plaque, you may avoid lifelong medications, but if the scan reveals plaque buildup, we can take proactive steps to prevent heart attack or stroke.”
TAKING CONTROL
“Cutting cholesterol isn’t the only goal,” Nasir noted. “You need to reduce refined sugars and processed foods, maintain a healthy weight, and stay active to lower your cardiovascular risk.”
Lifestyle changes can reduce cholesterol by about 10-15%, but some people may still need medications.
Take control of your heart health early by knowing your cholesterol numbers and, more importantly, understanding your overall risk.
“If you’re unsure, a coronary artery calcium scan is a fantastic tool to help guide decisions about medications and lifestyle changes,” Nasir added. •
Smart Hearts Get Heart Scans
Protect yourself from heart disease with heart-smart behaviors and annual heart screenings. To learn more about heart scans, visit houstonmethodist.org/ schedule-heart-scan or call 346.356.3044
Dr. Khurram
Nasir
FIND CANCER EARLY: 6 Cancer Screenings to Know
Cancer treatment is most effective when the disease is spotted early. That’s why it’s so important to know and keep up with routine cancer screenings.
“It’s easy to forget regular screenings when you’re busy,” said Dr. Akshjot Puri, oncologist at Houston Methodist Neal Cancer Center. “But cancer can grow without symptoms, and early detection gives the best chance of a positive treatment outcome, and survival.”
Consider these recommended screening guidelines:
BREAST
To detect changes in your breast tissue early, doctors review your mammogram history and track the results over time. That’s why it’s important to start getting annual mammograms on time — by age 40, or younger if you have a family history of breast cancer. Depending on your risk factors, including the density of your breast tissue, your doctor might recommend an MRI too.
“You should continue to get screened if you’re in good health and expect to live at least 10 more years,” Puri said.
CERVICAL
Screening for cervical cancer should begin around age 25 and continue until age 65. Human papillomavirus (HPV) is related to cervical cancer, so you should get a primary HPV test or HPV test with a Pap smear every five years, or a Pap smear alone every three years.
“Your doctor is your best partner in cancer prevention,” Puri said. “He or she can explain your risks and how to stay cancer-free.”
COLORECTAL
Everyone who turns 45 should talk with his or her doctor about a colonoscopy or stool-based test. If a stool-based test comes up abnormal, you will still need a colonoscopy. The most important thing is to get screened until you’re age 75. After that, talk with your doctor about continuing.
ENDOMETRIAL
If you’re menopausal, you should talk with your doctor about signs of endometrial cancer, including bleeding or discharge. If you have any concerns, call right away. Depending upon your risk factors, a biopsy may be needed every year.
LUNG
If you’re between the ages of 50 and 80, you smoke or you quit within the past 15 years, and you have a 20-pack-year history, you should get screened for lung cancer every year. If you smoke or used to smoke, talk with your doctor about screening for lung cancer.
PROSTATE
Men should start getting screened for prostate cancer at age 50. Start talking with your doctor by age 45 if you have a father or brother who had prostate cancer before age 65 or if you’re African American. Start at age 40 if you had multiple relatives diagnosed at an early age.
“After this conversation, you’ll want to get a prostate-specific antigen (PSA) blood test, and your doctor may also recommend additional testing including imaging,” added Dr. Eleni Efstathiou, oncologist at Houston Methodist Neal Cancer Center. •
IF CANCER IS DETECTED
Your doctor can help you find the best care team. In general, look for cancer centers with:
■ Access to clinical trials
■ Comprehensive care teams
■ Leading technologies and advanced treatments
■ Support for comprehensive well-being
Connect With Your Doctor
Houston Methodist provides personalized care to ensure you stay on top of your health. To schedule an appointment or find a primary care provider, visit houstonmethodist.org/ pcg/central or call 713.441.7965
Dr. Akshjot Puri
Dr. Eleni Efstathiou
HOUSTON METHODIST LEADING CARE
