Leading Medicine Spring/Summer 2024, Houston Methodist Clear Lake edition

SLEEP APNEA TREATMENT: KNOW YOUR OPTIONS

Have you been told you snore loudly? Are you tired or sleepy during the day? With obstructive sleep apnea (OSA), the flow of air into the lungs is either partially or completely obstructed in the upper airway, causing at least 10 seconds of unconscious stoppage breathing. A narrow airway, large tongue or obesity are some of the risks for OSA.

If snoring keeps you up at night, maybe it’s time to act. Getting treatment for OSA can help ensure a better night’s rest and avoid serious health consequences, including high blood pressure, heart disease and heart attack, type 2 diabetes, stroke and more.

“Not only does OSA impact sleep, productivity and relationships, but also it’s considered one of the so-called silent killers,” said Dr. Stephanie Chen, a board-certified otolaryngologist (ENT) at Houston Methodist Clear Lake Hospital.

Depending on your condition, treatment can range from breathing machines to surgery. Your doctor can help you determine your best option.

Read below for the answers to common questions asked about sleep apnea treatment.

WHAT'S A CPAP MACHINE?

Many sleep apnea sufferers are prescribed a device called a continuous positive airway pressure (CPAP) machine. The CPAP machine delivers oxygen into your nose and mouth via a mask. This pressurized air keeps your airway open, preventing any breathing interruptions.

“Using a CPAP machine to treat sleep apnea can reduce your risk of chronic health disorders, improve sleep quality and reduce fatigue,” Chen said. “For the full benefit, you should use it every night, but some people find it too uncomfortable.”

DO I NEED SURGERY?

If you find a CPAP machine hard to tolerate, sleep surgery may be an option. There are various sleep apnea surgeries, depending on where your specific obstruction is located.

“To identify the areas of obstruction, your doctor will perform a drug-induced sleep endoscopy using a small camera to evaluate your throat and upper airway,” Chen explained. “Then, using this information, we will discuss possible surgical options.”

ARE THERE ANY NEW TREATMENT OPTIONS?

Treatment advances have resulted in new, less invasive techniques for treating moderate to severe sleep apnea. For example, hypoglossal nerve stimulation uses a device to stimulate your hypoglossal nerve, responsible for moving your tongue.

This device, implanted in the upper chest using two small incisions, is only turned on while you’re asleep. It works by detecting respiration and, each time you inhale, the device stimulates your hypoglossal nerve to push your tongue forward, opening your airway. “It’s like a pacemaker, except instead of helping your heart, it helps you breathe during sleep,” Chen added.

Hypoglossal nerve stimulation has been proven to work remarkably well, virtually eliminating the need for a CPAP machine. •

Rest Easier With Help

It’s time for you to get the restful night’s sleep you deserve. To speak to a specialist about sleep apnea, visit houstonmethodist.org/ENT-cl or call 832.783.1170

Dr. Stephanie Chen

What to Do About NEUROPATHIC PAIN

Neuropathy can result from physical injury, a metabolic condition, such as type 2 diabetes, or harsh medications, such as chemotherapy drugs. Muscle weakness, numbness and chronic pain are just a few neuropathy symptoms that can greatly affect your quality of life.

According to Dr. Heather Colmenter, a pain specialist at Houston Methodist Pain Management Associates at Clear Lake, neuropathic pain occurs when nerve damage causes the nervous system to malfunction. “It is often described as a burning, shooting, tingling or pins and needles sensation, triggered by something as simple as wearing socks or laying a sheet over your legs,” she added.

RELIEVE PAIN BY MANAGING THE CAUSE

“Treating the underlying condition is always our first objective,” Colmenter said. For example, if the pain is caused by diabetes, then improving blood glucose control can help prevent additional nerve damage.

Sometimes the root cause cannot be corrected, so the next course of action is practicing lifestyle measures to help relieve the pain.

WAYS TO RELIEVE PAIN AT HOME

Your doctor may recommend a combination of methods for managing your neuropathic pain, including:

■ Eating a healthy diet that includes fruits and vegetables

■ Exercising multiple times a week

■ Getting a restful night’s sleep

■ Managing stress by practicing relaxation and mindfulness techniques

■ Taking over-the-counter pain relievers, such as ibuprofen and naproxen

■ Using topical pain medications, such as lidocaine ointment or patches

WHEN OTHER TREATMENT IS NECESSARY

Colmenter recommended consulting your doctor if neuropathic pain doesn’t respond to over-the-counter medications or persists despite lifestyle changes. “If the pain affects your ability to function, work or sleep, your doctor could also prescribe other medications, such as antiseizure medicine or antidepressants,” she added.

Additional options include transcutaneous electrical nerve stimulation (TENS) or an injection that helps block pain from specific nerves.

WHEN SURGERY MAY BE NEEDED

If physical therapy and medications aren’t enough to provide adequate relief, a surgical implant under the skin may help ease neuropathic pain. These are not first-line treatment options and are only used when neuropathic pain is severe.

“Neuromodulation devices, such as spinal cord stimulation (SCS), dorsal root ganglion stimulation (DRG) and peripheral nerve stimulation (PNS), use electrical stimulation to interrupt pain signals and change how you perceive pain,” Colmenter explained. These devices have a trial period to see whether they help relieve your pain before being permanently implanted under your skin. •

Find Relief From the Pain

If you’re suffering from neuropathy pain, it may be time to see a pain specialist. Visit houstonmethodist.org/ pain-mgmt-cl or call 713.363.9090.

TIPS FOR COPING WITH CHRONIC PAIN

Get some support. Consider talking with a physical or occupational therapist to develop strategies to cope with the pain.

Be open to trying various treatments. Exercising, stretching, alternative therapies or natural remedies may improve your pain or keep it from getting worse. Consult your doctor first.

Practice self-care. Develop a plan to take care of yourself, especially when the pain is most intense.

Adjust your expectations. Give yourself time to adjust to your new lifestyle. Your doctor can help with treatment options.

Don’t Take Osteoarthritis Sitting Down: STAYING ACTIVE TO HELP YOUR KNEE PA IN

Dr. Sawyer Croley

Osteoarthritis is often known as a wear-and-tear disease. Unfortunately, when osteoarthritis strikes the knees, you may decide to take it easy and opt out of the activities you once enjoyed.

Dr. Sawyer Croley, an orthopedic surgeon at Houston Methodist Orthopedic & Sports Medicine at Clear Lake, doesn’t want to see that happen. With osteoarthritis, you may experience knee pain during exercise, but physical activity is rarely the cause.

“The real cause of osteoarthritis is genetics or injury,” Croley said. If your parents both had knee replacements, chances are higher you’ll have a problem, too. Even though osteoarthritis is a wear-and-tear disease, living an active lifestyle can help manage the pain.

IS MY KNEE PAIN OSTEOARTHRITIS?

Osteoarthritis is the disease process of losing the cartilage in your knee — the tissue that cushions the ends of bones to decrease friction with joint movement. “This is different from rheumatoid arthritis, a condition in which the immune system attacks joints and their lining,” Croley said.

You should consult a doctor who can diagnose your knee pain as a symptom of osteoarthrosis or something else. Osteoarthritis has hallmark signs, which may include:

■ Inflammation and swelling

■ Joint tenderness or a feeling of the joint giving out

■ Pain described as deep and aching

■ Stiffness at times, though more common with rheumatoid arthritis

■ Varying amounts of discomfort during an activity or prolonged inactivity

“While pain often occurs while standing or walking, it can also occur after sitting for a long period of time. Symptoms are often most noticeable when using the stairs,” Croley explained.

CAN I PREVENT IT?

Family history, aging or injury are the common causes of osteoarthritis.

While some studies indicate supplements such as glucosamine

can help, there are actions you can take to reduce pain, including:

■ Building strength, especially in the quadriceps (muscles that control the knee) and hips

■ Managing weight to decrease stress on the joints

■ Quitting smoking, because it lowers blood supply and delays healing

“Strength building and exercise are good, but maintaining a healthy weight is critical,” Croley said. “The mechanical forces across the knee joint are unique. One pound on your body is anywhere between four and nine pounds on your knee. If you’re overweight, any amount of weight loss could make a big difference.”

HOW DO I TAKE CONTROL?

If your symptoms lead you to decreased physical activity, you may inadvertently add to the problem.

The good news? Your doctor can help you manage osteoarthritis pain by ensuring that your fitness routine builds muscles around the knees. With regular check-ins, your doctor will monitor your symptoms and, if needed, adjust your plan.

When medical care is needed, it often starts with these steps:

1. Topical ointments are available over the counter and deliver skin irritants that stimulate blood flow to decrease pain.

2. Oral medications, such as an over-the-counter acetaminophen or a prescribed anti-inflammatory can help with pain and swelling, but require close monitoring of your kidney function by your doctor.

3. Injection therapies are administered by your doctor in the office. He or she will recommend corticosteroids, hyaluronic acid or platelet-rich plasma (PRP) injections, depending on your need. There is no one-size-fits-all approach. Your doctor will help determine the best course of action for your knees. •

Take Control Over Knee Pain

If you are ready to take control of your osteoarthritis or get back in the game of life, we can help. To find support for your chronic knee pain, visit houstonmethodist. org/jointpain or call 713.363.9090

YOU CAN FIND KNEE PAIN RELIEF

If osteoarthritis knee pain is coming between you and your fitness routine, consult your doctor. He or she may recommend exercise modifications to help build strength, manage weight and decrease pain symptoms, such as:

Joining a water aerobics class

Riding a bike on an even terrain

Starting a swim routine

Strength training with a professional trainer

Trying light elliptical or stationary bike exercises

Walking or hiking on a trail with soft ground

When these exercises no longer offer you relief, it’s time to talk to your doctor about injections or surgery.

GUARD YOUR HEART: Tips on Maintaining Heart Health

Your heart is the engine that keeps your body going. Keeping it healthy is critical for living a long, active life. Heart disease is the leading cause of death for people in the U.S. Prevention reduces your risk of future heart issues.

“Because of family history, many of my patients are fearful they will experience a heart attack like their parents did,” said Dr. Luna Liu, a preventive cardiologist with Houston Methodist DeBakey Cardiology Associates at Clear Lake. “Following a heart-heathy lifestyle is an excellent strategy for preventing future heart problems.”

You can prevent heart disease by following these four essential habits:

1. Stop smoking. Smoking is a proven risk factor for heart attack, stroke and high blood pressure. Quitting smoking can significantly reduce your risk of developing heart disease.

2. Adopt a heart-healthy diet. Making nutritious foods a part of your diet can go a long way when it comes to preventing heart disease and managing cholesterol levels. Fill your plate with fruits, vegetables, whole grains, fish, lean proteins and healthy fats.

3. Get active. Exercise can improve blood flow, help maintain healthy blood pressure and reduce stress. Aim for at least 30 minutes of exercise five days a week.

4. Manage conditions. Monitoring your blood pressure and cholesterol levels to ensure they are within a healthy range is crucial. There is also a strong correlation between cardiovascular disease and diabetes.

WHAT TO LOOK FOR

Some signs and symptoms are more serious and may require the expertise of a cardiologist, such as a doctor who specializes in diseases of the heart. “A cardiologist can administer and evaluate

tests,” Liu noted, “as well as manage risk factors and determine the best course of action for treatment and prevention.”

Signs and symptoms that may indicate it’s time for you to see a cardiologist include:

■ Abnormally fast or slow heart rate

■ Chest pain

■ High blood pressure

■ Shortness of breath, dizziness or fainting

■ Swelling in your legs

MANAGE

YOUR RISK

Family history, age, chronic kidney disease and modifiable risk factors, such as high alcohol consumption or obesity, can also impact your risk level for heart disease. “Be open with your doctor about your concerns or symptoms so he or she can help you create the most effective treatment plan to meet your health needs,” Liu added.

Sudden symptoms, such as chest discomfort, shortness of breath, discomfort or pain in the arm, shoulder, jaw, neck or back, require immediate medical attention, as these are the common heart attack warning signs. Call 911 immediately to seek medical care.

Getting ahead of some of these signs and symptoms through preventive measures will give you the best chance of living a long and healthy life. •

Houston Methodist DeBakey Cardiology Associates at Clear Lake has cardiovascular experts who can help prevent, diagnose, manage and treat an array of heart diseases. Visit houstonmethodist.org/heartvascular-cl or call 281.523.3240.

BEYOND THE MAMMOGRAM: Breast Cancer Prevention

Staying up to date on your mammogram is essential to the early detection of breast cancer, but in addition to that appointment, there is more you can do to stop breast cancer before it starts.

“The small choices we make every day add up to a big choice when it comes to breast cancer prevention,” said Dr. Michelino Scarlata, breast surgical oncologist with Houston Methodist Clear Lake Hospital.

Emerging research indicates breast cancer may be more preventable than experts originally thought. While you can’t control your genes or age, there are plenty of other known risk factors that you can control.

Below, Scarlata shared ways that women can reduce their breast cancer risk and — in some cases — increase their chances of survival should it develop.

TURN UP PHYSICAL ACTIVITY

Studies indicate that even moderate exercise can lower your risk of breast cancer, and that intense exercise lowers it even more. This could be due to an exercise-estrogen link.

“The more exposure to estrogen over your lifetime, the greater your risk of breast cancer,” Scarlata said. “Exercise suppresses estrogen production by promoting lean muscle mass.”

RETHINK ROUTINE DRINKING

Compared with nondrinkers, women who consume two to five alcoholic drinks a day have about 1.5 times the risk of developing breast cancer.

While it’s best to limit alcohol to three or fewer drinks per week, Scarlata recommends women who don’t abstain consider taking a daily multivitamin with folate (folic acid), as research has linked low folate levels to breast cancer risk, particularly in those who have a high level of alcohol consumption.

BREASTFEED, IF POSSIBLE

Evidence suggests breastfeeding reduces a woman’s risk of developing breast cancer, and the protective benefits seem to increase the longer it continues.

“One theory is that women who breastfeed have fewer menstrual cycles throughout their lives, and thus less exposure to estrogen,” Scarlata said.

COMMIT TO WEIGHT MANAGEMENT

Extra pounds equal extra estrogen-producing fat cells and often higher insulin levels — both of which are linked to an increased breast cancer risk.

If you’re struggling, Scarlata recommends reaching out to your primary care provider to help you identify realistic goals, develop a personalized plan or connect with additional resources. •

Houston Methodist Clear Lake Hospital offers advanced 3D mammography technology to help detect breast cancer in its earliest stage when treatment is most effective. To schedule your mammogram, visit houstonmethodist.org/ breast-care or call 281.333.8858 .

HIT BACK AT HIGH RISK

While some breast cancer risk factors are beyond your control, such as family history, previous diagnosis or a period that began at a young age, it’s still important to talk to your doctor to see how you can mitigate those risks. Your options might include:

■ Genetic testing

■ Preventive medications

■ More frequent mammograms

■ Scheduling your first mammogram at an early age

“It’s not a one-size-fits-all approach, so the best starting point is an open, honest discussion with your physician,” Scarlata added. “In certain cases, women may decide to have preventive intervention, such as a risk-reducing mastectomy. Our job is to provide the information and specialized skills to ensure the best outcomes possible.”

Dr. Michelino Scarlata

At Houston Methodist Orthopedics & Sports Medicine, we know that joint pain affects every part of your life. With treatment plans customized for you, our specialists in Clear Lake offer a full range of advanced nonsurgical and surgical techniques. Our expert joint care includes:

• Innovative pain control methods

• Physical therapy to improve mobility and range of motion

• The latest technology, including minimally invasive surgical techniques that help reduce recovery time