Leading Medicine Spring-Summer 2023, Houston Methodist Sugar Land Hospital edition

LEADING MEDICINE

JOINT PAIN: Your Body’s Signals to Consider Surgery

HAVING CHILDREN LATER IN LIFE IS THE NEW NORM How To Get Your Body Baby Ready

Women are choosing to delay childbirth more often. According to the Centers for Disease Control and Prevention (CDC), the birth rates for women over the age of 35 have increased every year since 2010. Pursuing a career, saving money and the availability of advanced fertility treatments are some reasons women choose to delay having children until an older age. But no matter your age, you should have a plan in place before getting pregnant.

“Planning for pregnancy must include making sure your body can support a healthy pregnancy,” said Dr. Katherine Diase, board-certified obstetrician-gynecologist with Houston Methodist Obstetrics and Gynecology Associates at Sugar Land. “This will not only benefit your first child, but also any subsequent babies.”

Here are some important decisions to make before becoming pregnant to ensure your body is baby ready.

STOP SMOKING

The single most important change a woman can make before becoming pregnant is to give up smoking. Smoking risks include low birth weight, premature birth and an increased chance of cesarean section. If smoking occurs in your home, your baby is at greater risk for asthma and ear infections.

BEGIN TAKING FOLIC ACID

Insufficient folic acid intake has been connected to spina bifida and other birth abnormalities, many of which occur before a woman realizes she’s pregnant. Before you even start trying to get pregnant, start taking folic acid to build up a reserve. Taking a prenatal vitamin ensures that you’re getting optimal nutrition and it will meet most women’s needs for folic acid. The recommended dosage is 0.4 mg of folic acid or 4 mg if you have a family history of spina bifida or other neural tube defects.

EXERCISE REGULARLY

Physical exercise is extremely important. “If you develop a regular exercise habit now, before becoming pregnant, you’re more likely to continue after you’re pregnant,” Diase noted. “Studies show that regular exercise during pregnancy promotes faster and less painful labor and may also decrease the risks of gestational diabetes and cesarean section.”

TAKE CONTROL OF ANY LONG TERM CONDITIONS

High blood pressure, diabetes, asthma and seizure disorders are just a few examples of chronic conditions that may impact your pregnancy.

“It’s a good idea to develop a plan with your doctor in a preconception appointment as some medications for chronic conditions can affect the fetus,” added Diase.

Your obstetrician-gynecologist can help you manage chronic diseases during pregnancy and lower your risk of birth defects.

MAKE HEALTHY LIFE CHOICES

“I advise women to consider their life choices carefully, including when and how they will have children,” said Diase. “After age 35, the risks of having difficulty conceiving, miscarriage and chromosomal abnormalities increase.”

Getting pregnant later in life can be more difficult as fertility decreases with age, for men and women. But making healthy choices now, before you’re pregnant, increases your chances of a healthy baby. •

EXPERT NICU CARE

Houston Methodist Childbirth Center at Sugar Land is the first neonaal intensive care unit in Fort Bend County to be designated at a NICU level III. This level III designation means the best quality of neonatal intensive care is available to meet the needs of moms and babies who have unique care journeys, including specially trained medical staff and personnel.

Houston Methodist Childbirth Center at Sugar Land also provides round-the-clock care for women and babies with dedicated board-certified obstetrician-gynecologists on-site 24/7 who can provide obstetric-designated emergency services for expecting moms who are 16 weeks or greater in their pregnancy. For more information about our Childbirth Center, visit houstonmethodist.org/childbirth-sl or call 281.274.7080.

Schedule A Visit

To schedule an appointment with Houston Methodist Obstetrics and Gynecology Associates at Sugar Land, visit houstonmethodist.org/obgyn-sl or call 346.456.5328

Dr. Katherine Diase

When Should I Worry About MUSCLE TWITCHING?

You’re just sitting at your desk and suddenly tic, tic, tic. Small muscles in your eyelids or legs start twitching, seemingly taking on a mind of their own.

The zings, fizzles nd ever-so-slight thumps of a twitching muscle feel weird and kind of unsettling. And if they happen to you frequently, you might worry whether they’re normal.

Muscle twitching is a very slight, involuntary, and often repetitive triggering of a muscle. They are extremely common.

“People typically experience muscle twitching in the lower eyelid and legs,” said Dr. Darine Kassar, board-certifid neurologist with Houston Methodist Neuroscience & Spine Center at Sugar Land. “However, muscles throughout your body, including the ones in your arms, feet and lower abdomen, can twitch as well.”

Muscle twitching can be disruptive but is usually nothing to worry about. Rarely can they be a sign of an underlying health condition. However, it is important to know when to take them seriously.

WHAT CAUSES MUSCLE TWITCHING?

The peripheral nervous system helps control voluntary muscle movement. The motor nerves that trigger fie muscle movements are incredibly sensitive. And, sometimes, they misfie, causing it to twitch.

“Your brain needs to receive a specific mount of nerve impulses to enable your body to move,” Kassar explained. “Muscle twitching occurs when there is an imbalance.”

There are various reasons muscle twitching occurs. These

twitches can often be due to lifestyle-related causes, such as caffeine, stress or fatigue. More severe muscle twitching can be the result of an underlying health condition.

HOW TO STOP MUSCLE TWITCHING

Muscle twitching typically resolves on its own when it is lifestyle related.

“ Those who experience occasional muscle twitching can work on creating better habits, such as getting more sleep, reducing screen time and drinking more fluids,” Kassar suggested. Your provider may recommend muscle-relaxing medications if the twitching is severe enough and disrupts daily activities.

WHEN TO WORRY ABOUT MUSCLE TWITCHING

A twitching muscle can be annoying. Fortunately, it’s rarely serious. When twitching is accompanied by additional symptoms, such as weakness, loss of tone or shrinkage in muscle, then it becomes more concerning.

Follow up with your doctor if muscle twitching is new and you’re experiencing additional symptoms. •M

Talk to a Specialist

If you’re experiencing new muscle twitching and other issues of the muscle, visit houstonmethodist.org/neuro-sl or call 281.201.6052 to schedule an appointment.

Kassar

YOUR CANCER SCREENING CHECKLIST

Early detection is a powerful weapon in the fiht against cancer. Cancers may develop slowly or rapidly, and sometimes without any noticeable symptoms. Make sure to see your primary care provider (PCP) annually so you stay up to date on your screenings.

“When cancer is found early, the chance is better for effective treatment,” said Dr. Nabeel Shalan, board-certifid hematologistoncologist with Houston Methodist Neal Cancer Center at Sugar Land. “It is important to stay up to date with cancer screening tests.”

CERVICAL CANCER

To check for cervical cancer, a gynecologist will perform a pelvic exam, checking the vaginal and cervical walls for abnormalities. A sample of cells may be taken from the cervix area for a Pap test or lab culture. The uterus and ovaries are examined for enlargement or other abnormalities.

High-risk factors for cervical cancer include:

■ Human immunodeficiecy virus (HIV)

■ Human papillomavirus (HPV)

■ Immune deficiecy

■ Multiple sex partners

■ S exual activity before age 18

■ Smoking

According to Shalan, women age 21-29 should have a Pap test alone every three years. HPV testing alone can be considered for women who are 25-29, but Pap tests are preferred. Women age 30-65 have three options for testing — both a Pap test and HPV test every five years, a Pap test alone every three years or HPV testing alone ever y five years. “After 65, your doctor will decide how often these tests need to be taken,” he noted. “It may all depend on your history of abnormal results.”

COLON AND RECTAL CANCER

Doctors can perform at least three tests to check for colon and rectal cancers. A colonoscopy examines the inside of the colon and rectum for bleeding, polyps or cancer. A flexible sigmoidoscopy examines the inside of the rectum and part of the lower colon (sigmoid colon) for the same things. Both tests use a colonoscope (lighted camera tube) and a biopsy of an abnormality is collected for lab testing during the outpatient procedure. Also, fecal blood tests look for blood in samples of a patient’s stool.

T he high-risk factors for colon and rectal cancer include:

■ A frican American men and women

■ Family or personal history of polyps, colorectal or uterine cancers

■ Individuals 50 years and over

■ Obesity

■ Personal history of chronic inflammatory bowel disease

■ Smoking

For tho se with any high-risk factors, talk with your doctor about when to begin screening and how frequently. “Colorectal cancer rates are rising among younger adults,” said Shalan. “Routine screening should begin by age 45 and then in consultation with your doctor after age 75.”

R egardless of age, it is very important to see your doctor if you develop symptoms, such as abdominal pain, anemia, bowel habit changes, rectal bleeding or unintentional weight loss.

ORAL CANCER

Oral cancer can be found during an oral exam to identify mouth abnormalities. Chewing tobacco, drinking alcohol and smoking are all high-risk factors for oral cancer. Doctors recommend an annual oral exam by at least the age of 18 and once a year.

SKIN CANCER

The U.S. Preventive Services Task Force and American Cancer Society (ACS) no longer recommend regular skin examinations unless you have a history of skin cancer.

High-risk factors for skin cancer include:

■ Fair skin, particularly those with red or blonde hair

■ Family or personal history of melanoma

■ Unprotected or excessive UV light exposure (sunlight/tanning booths)

The signs and symptoms of skin cancer include:

■ A change in a skin spot, mole or growth, such as size, color, darkening or bleeding

■ Increased sensation, itchiness, tenderness or pain

■ New spots or growths that change and grow over time

The American Cancer Society recommends lowering your skin cancer risk by following the motto: SLIP! SLOP! SLAP! AND WRAP!*

■ Slip on a shirt. Cover up with protective clothing.

■ Slop on sunscreen. Use a sun protection factor of 30+ at least 30 minutes before exposure and every two hours during outdoor activities.

■ Slap on a hat. Cover your head and neck with a widebrimmed hat.

■ Wrap on sunglasses. Use eyewear with 100% UVA and UVB absorption. •

*Source: American Cancer Society, U.S. Preventive Services Task Force.

Dr. Nabeel Shalan

JOINT REPLACEMENT: GettingYou Back to an Active Lifestyle

Severe joint pain can keep you from enjoying life to the fullest. But thanks to advances in less invasive joint replacement surgery, you can get back to an active lifestyle with less downtime than you might think.

“Advancements in materials, surgical techniques and implant design have revolutionized joint replacement surgery,” explained Dr. Matthew Pearl, an orthopedic surgeon, who focuses on hip and knee replacement at Houston Methodist Orthopedics & Sports Medicine at Sugar Land. “ These are highly successful procedures that can provide patients a new lease on life.”

Joints are the parts of the body where two bones meet, enabling movement and stability. If a joint is damaged, it can cause signifiant pain and limited mobility that can negatively impact the quality of life. Hip and knee replacements are the most commonly performed joint replacements, but replacement surgery can be performed on other joints as well, such as the ankle, wrist, shoulder and elbow.

Common reasons joint pain develops include:

1. Arthritis

2. Overweight or obesity

3. Past injury

Without treatment, joint pain gets worse over time. Having surgery can seem daunting, but the results can be life-changing. Advancements in technology and techniques have made joint replacement procedures much safer and more effective, with quicker recovery times.

WHY SURGERY COULD BE YOUR NEXT STEP

“Patients typically say they wish that they had not put off urgery for so long,” Pearl said. “Sometimes they hear it’s going to be too painful or recovery is too hard.”

Essentially, joint replacement is more like joint resurfacing. When a joint becomes worn out, the nerve endings in the bones become exposed, causing pain. The surgeon places a new surface on the end of the bones, like a cap, that is designed to cover up and protect the nerve endings.

“We are not removing your joint or a large section of it, but only what we need to and technology has allowed us to disrupt less soft tissue to perform joint replacement,” said Pearl. “Ths less invasive process reduces your pain during recovery.”

There are several reasons to consider joint replacement surgery, including:

1. L ong-lasting results. In many cases, people can enjoy improved joint function and relief for upwards of 20 years. Over 80% of patients who have undergone surgery are very happy with their knee replacement and would do it again.

2. Minimal recovery time. Advances in surgical techniques have led to the development of less invasive joint surgery

options that offer quicker recovery times and reduced risk of complications compared to traditional surgery.

3. Increased activity. New technology and approaches make joint replacement outcomes feel more natural. Most patients who have joint replacement surgery can get back to low-impact activities, such as swimming or walking within four to six weeks.

Houston Methodist developed a Rapid Recovery Program to streamline healing after joint replacement surgery. Patients who are relatively healthy and have good family support are eligible to go home on the same day as the surgery. With telemedicine connectivity, patients can attend follow-up visits with their care team from the comfort of home.

For inpatient procedures, many patients are up and walking within hours after surgery. Whether you recover in the hospital or at home, your care team is dedicated to your success.

“ The components of a modern joint prosthesis are designed to mimic the shape and function of a natural joint, allowing for smooth movement and weight-bearing,” Pearl said. “However, it is important to have realistic expectations of what the procedure can achieve and to work closely with your health care team to achieve the best possible outcome.”

The sooner you talk to an orthopedic specialist about your persistent joint pain, the quicker you’ll be back to enjoying life to the fullest. •

Dr. Matthew Pearl

MORE THAN MEDICINE: Lifestyle Changes Can Lessen Stroke Chances

Making small daily lifestyle changes, such as adding in a daily walk around your neighborhood, or big lifestyle changes, such as limiting your alcohol intake, will help reduce your stroke risk, which is the leading cause of disabilities in the U.S. A stroke is an attack on the brain and occurs when the blood supply to part of the brain fails. Ths causes brain cells to die from the lack of oxygen and nutrients. When brain cells die, you begin to lose brain function, which affects your ability to move, speak, eat and perform other cognitive functions.

KNOW YOUR RISKS

High cholesterol – Individuals with high cholesterol are twice as likely to develop heart disease as those with lower cholesterol levels. Too much cholesterol buildup in the walls of blood vessels can cause blood clots — leading to a stroke. Regular screenings can help detect high cholesterol, which often goes otherwise undetected as it typically presents no symptoms.

High blood pressure – One-third of U.S. adults have high blood pressure, a condition that can have potentially life-threatening consequences. It is the leading cause of stroke and the most signifiant controllable risk factor. “Know your numbers and keep them low,” said Dr. Tram Tran, board-certifid family medicine physician with Houston Methodist Primary Care Group in Aliana.

Atrial fibrillation (AFib) – AFib is one of the most common heart arrhythmias — a heart rhythm disorder. An AFib clot can travel to the brain and cause a stroke and heart failure. People with AFib are five times more likely to have a stroke than those without heart disease.

“Strokes are dangerous and can be deadly,” Tran said. “But that doesn’t mean you can’t do anything about them. There are several ways to control and treat certain risk factors.”

REDUCING YOUR RISKS

While these health risk factors must be taken seriously, effective treatment options exist for all of them. In addition to medical treatment options, changes to your lifestyle can help increase your odds of stroke prevention.

■ Maintain a healthy weight

■ Exercise regularly

■ Don’t smoke

■ Limit alcohol consumption

■ Treat other health conditions

“Up to 80% of strokes can be prevented through healthy lifestyle changes,” Tran stated. “Knowing and controlling your risk factors early is key to prevention.” •

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Preventive Care is Key

The Ins and Outs of GUT HEALTH

Gastrointestinal (GI) problems often strike when you’re least expecting them — and at the worst possible time. You might have a gas attack at the movies, indigestion at a dinner party or diarrhea while on vacation.

Occasional GI problems are normal. If it becomes an everyday concern, or you experience a sudden increase in symptoms, there could be something more going on.

WHAT’S CAUSING YOUR SYMPTOMS?

One explanation may be that you have irritable bowel syndrome (IBS). However, the symptoms may also be a sign of something more serious, such a s co lorectal cancer. But how can you tell the difference?

IBS is a chronic GI disorder that affects the large intestine, known as the colon. Symptoms of IBS are typically triggered by food allergies, intolerances or sometimes stress. Symptoms of IBS include:

■ Abdominal pain

■ Bloating

■ Changes in bowel habits

■ Cramping

■ Constipation

■ Diarrhea

■ Difficulty controlling bowel movement urges

■ Difficulty swallowing

■ Nausea

IBS and colorectal cancer share similar symptoms, but there are distinctions to watch out for. These additional red flags can look like:

■ Fatigue and weakness

■ Heartburn

■ Loss of appetite

■ Rectal bleeding or blood in the stool

■ Stools thinner than usual

■ Unexplained weight loss

■ Vomiting

“Many concerning symptoms don’t necessarily mean you have cancer,” said Dr. Max E. Quintana, board-certifid family medicine physician with Houston Methodist Primary Care Group in Rosenberg. “But they could be more than IBS. You should schedule an appointment with your doctor immediately if symptoms came on suddenly and last more than two weeks.”

TRUST YOUR GUT — AND TALK TO YOUR DOCTOR

You know your digestive system better than anyone, and you may have the best insight (or at least a gut feeling) about what’s happening. Use this knowledge to your advantage by keeping a journal of your digestive episodes. Record the time of day and frequency of symptoms, such as frequent or loose bowel movements, constipation, cramps or heartburn. Also, note any food or other triggers that might be related.

At your appointment, your primary care provider, or PCP, will review your symptoms, ask about your health history and perform any necessary exams. Depending on the severity of your symptoms, your PCP may refer you to a gastroenterologist.

“Don’t ignore the warning signs,” Quintana emphasized. “ The earlier colorectal cancer is caught, the better the outcome.” •

Talk to a Primary Care Provider

If you have a gut feeling that something may be wrong with your digestive system, don’t delay. Houston Methodist Primary Care Group is here to help. Visit houstonmethodist.org/pcg/southwest or call 832.416.1678 to schedule your in-person or virtual visit.

Dr. Max E. Quintana

HEART VALVE SURGERY — YOUR QUESTIONS

You may feel overwhelmed if you or a loved one needs heart valve surgery. To put you at ease, Dr. Donnell K. Bowen, board-certifid cardiothoracic surgeon at Houston Methodist DeBakey Heart & Vascular Center at Sugar Land, answered frequently asked questions about the procedure and recovery.

Q: WHAT DO THE VALVES IN THE HEART DO?

A: The heart has four valves responsible for keeping blood moving in a circular pattern through the organ. The aortic and mitral valves are located on the left sid, the pulmonary and tricuspid valves on the right. Each valve has “flaps” that work like a gate that closes before the blood can flw backward from where it came.

Q: WHY IS SURGERY SOMETIMES NEEDED TO REPAIR OR REPLACE HEART VALVES?

A: “A valve can weaken and harden over time or due to certain conditions,” said Bowen. “Ths prevents blood from circulating properly.” Regurgitation is when the valve flaps don’t seal properly, causing blood to flw in the wrong direction. If the valve is only slightly damaged, a surgeon can repair it by removing the worn tissue and inserting a “ring” to keep the valve in shape. If the condition worsens, patients may require medication and/or surgery.

Q: ARE THERE DIFFERENT TYPES OF HEART VALVE SURGERY?

A: With open-heart surgery, the surgeon makes an incision to open the chest and repairs the damaged valve or replaces it with a new valve. In contrast, minimally invasive valve surgery is done through much smaller cuts or through a catheter inserted through the skin. Your doctor will determine which type of surgery is necessary.

Q: HOW LONG IS THE RECOVERY FROM HEART VALVE SURGERY?

A: Most people spend three to seven days in the hospital following surgery. “Once home, it will take at least four to six weeks to heal completely,” Bowen added. During this time, you may have some chest pain, and feel itchy, numb or tingly near your incision. For a while, you may have a poor appetite, mood swings, lack of energy and even some shortness of breath.

Q: WHAT ACTIVITIES CAN I DO AFTER SURGERY?

A: Plan to have someone in your home to help you for at least the first week. Try to stay active during your recovery, but remember to start slowly and increase your activity little by little. Moving, walking, carefully climbing stairs and light household chores are encouraged as long as you take each activity slowly. “It’s important to eat a heart-healthy diet and, during your recovery, avoid any exercise that pulls across your chest,” noted Bowen. •

Dr. Donnell K. Bowen

BUZZ, CLICK, HISS, RING, ROAR! Sound Familiar?

There’s a name for those strange sounds you’ve been hearing: tinnitus. Whether it’s a dull roar, faint hiss, unending ringing or periodic clicks or swooshes, tinnitus is real.

WHAT’S ALL THAT NOISE?

Tinnitus itself isn’t a disease, but a symptom of something affecting the auditory system. Tinnitus is exceedingly common — about 10% of American adults have experienced tinnitus lasting at least five minutes within the last year, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). It’s common to experience tinnitus for short periods of time, such as after a loud concert, or it can also be a constant problem.

“Those most at risk of developing tinnitus are people who work in a noisy environment, aging adults, smokers and those with conditions affecting blood flw,” said Dr. Bailey LeConte, an otolaryngologist (ear, nose and throat specialist) with Houston Methodist ENT Specialists at Sugar Land. “The cause of tinnitus can vary from earwax buildup to noise-induced hearing loss, certain medications, cardiovascular problems or even brain tumors.”

Tinnitus can be annoying, but it’s rarely an indication of a serious condition. But you should see a doctor if it becomes a chronic problem, occurs suddenly without cause, or you’re experiencing hearing loss or dizziness.

During an exam, your doctor will determine if you have subjective tinnitus, which is sound only you can hear, or objective tinnitus, which is sound your doctor can also hear. “Objective tinnitus is rare,” noted LeConte. “It’s usually caused by a blood vessel problem, muscle contractions or a middle ear bone condition.”

FINDING A FIX

No cure currently exists for tinnitus, but you may be able to reduce symptoms by treating the underlying cause.

“We offer a range of treatments depending on the underlying problem,” LeConte explained. “Sometimes simply removing impacted earwax can alleviate discomfort. Others may need a change in their current medications.”

If treating the underlying cause doesn’t help, you may fid relief through hearing aids, white noise machines or wearable masking devices. •

We ’ re Here to Help

Dr. Bailey LeConte