Leading Medicine Spring-Summer 2023, Houston Methodist West Hospital edition

LEADING MEDICINE

JOINT PAIN: Your Body’s Signals to Consider Surgery

Improving Quantity & Quality of Life with a New Heart Valve

Patients with aortic stenosis, a common and serious condition of the aortic valve of the heart, once faced only a few choices for treatment — and open-heart surgery isn’t a choice anyone wants to make. Today, we’re instead helping patients extend the quantity and quality of their lives with a minimally invasive procedure, to implant a new valve, from which they can recover in as little as one day.

As many as 300,000 people in the United States are diagnosed with severe aortic stenosis yearly. Among the most common and serious heart valve conditions, aortic stenosis usually develops because of aging, as calcium or damage from scarring damages the valve and disrupts proper blood flw. It is most common in patients over age 65 or those with congenital conditions.

“I like to use the analogy that it’s almost like rust on the door,” explained Dr. Tariq Dayah, an interventional cardiologist at Houston Methodist West Hospital. “With age or with other external conditions, sometimes the door just doesn’t open anymore.”

DON ’ T IGNORE THESE SYMPTOMS

It’s important to listen to your body and talk to a doctor if you experience any of the follow symptoms of aortic stenosis.

■ chest pain

■ fluttering heartbeat

■ dizziness

■ trouble breathing

■ swollen feet

■ reduced ability to do normal activities

Patients with aortic stenosis have a decrease in life expectancy. Once symptoms become severe, the chance of dying from the condition within two years is 50%.

“If a patient is suffering from severe aortic stenosis, there’s usually a need to replace the aortic valve,” said Dr. Javier Lafuente, a cardiovascular surgeon at Houston Methodist West Hospital. “Ths can be accomplished with open heart surgery or with a minimally invasive catheterbased procedure.”

Transcatheter aortic valve implantation (TAVI or TAVR) is a procedure in which doctors use one small incision, usually in the groin, to thread a small tube through a patient’s blood vessels. Though this tube, the surgeon will replace damaged heart valves with artifical valves. “We have performed more than 100 TAVI procedures at Houston Methodist West Hospital, all with excellent outcomes, and over 2,000 throughout the Houston Methodist system,” said Lafuente.

FROM FATIGUED TO FABULOUS

Aortic stenosis is most often diagnosed with an echocardiogram or an ultrasound of the heart. Patients are then referred to specialists to discuss their treatment options.

“Nobody wants to have open heart surgery and be facing weeks of recovery if they can avoid it,” said Dr. Dayah. “TAVI allows us to avoid that.”

Today, TAVI is the preferred choice of most patients, thanks to the benefits of minimally invasive surgery. “We carefully examine all patients with aortic stenosis to determine if they are good candidates for this surgery. With imaging technology like a CT scan, we examine the size of the arteries and the heart valves to ensure they are large enough for the catheter and instruments to pass through,” said Dayah.

Dr. Javier Lafuente

Dr. Tariq Dayah

A NEW LEASE ON LIFE

Most patients get almost immediate relief from this procedure, which is very gratifying for them and for their doctors. With an artifical valve in place, blood flw to the body is restored and patients often feel like their younger selves again.

Many patients with aortic stenosis have mistakenly assumed symptoms, such as fatigue and shortness of breath are the result of normal aging. Following TAVI, many patients say they feel 10 years younger.

“Patients undergoing TAVI have less pain and discomfort, faster recovery times and shorter stays at the hospital,” said Lafuente.

TAVI is a life-saving, life-lengthening, and life-improving procedure for most patients. “We’re proud of our strong record of helping our cardiac patients improve the quantity and quality of their lives,” said Dayah. •

JOINT REPLACEMENT: GettingYou Back to an Active Lifestyle

DNV Advanced

Orthopedic and Spine Center of Excellence

Houston Methodist Orthopedics & Sports Medicine at West Hospital and Houston Methodist Spine Center at West Hospital have been designated a DNV Advanced Orthopedic and Spine Center of Excellence. This designation affirms Houston Methodist est has achieved excellence in the provision of diagnostic services, surgical services, and therapies related to orthopedic, spine and neuro care.

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

“Joint replacement surgery may be the only option for long-term relief for patients with severe joint damage,” explained Dr. Zach Shirley, an orthopedic surgeon at Houston Methodist Orthopedics & Sports Medicine at West Hospital. “Conservative treatments, such as medication and physical therapy can provide temporary relief, but they may not be enough to address the underlying issue.”

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 why 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

“Joint replacement surgery can be a life-changing procedure, allowing you to regain mobility, and reduce pain,” said Dr. Christopher Smith, an orthopedic surgeon at Houston Methodist Orthopedics & Sports Medicine at West Hospital. “It’s natural to feel apprehensive about surgery, but it’s important for patients to remember that joint replacement is a safe and effective treatment option with a high success rate.”

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.

However, it is important to have realistic expectations about living with the updated joint. Shirley explained, “Your knee won’t be what it was 20 years ago. But if you are looking for a functional knee and less pain, you’re going to be happy with the results.”

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

1. Long-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.

“Following joint replacement surgery, patients can expect to experience improved mobility and function in the affected joint,” Smith said. “While it may take several weeks or months to recover fully, most patients can return to their normal daily activities, including exercise and recreational activities.”

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. Zach Shirley

Dr. Christopher Smith

5 WAYS YOU CAN Take Control of IBS

Do you have abdominal pain and diarrhea so unpredictable you’re afraid to stray too far from a restroom? How about abdominal pain and constipation that is resistant to every over the counter laxative and stool softener you’ve tried? Do you find that eating or not eating certain foods may help your symptoms one day but not the next? You may have a gastrointestinal disorder called irritable bowel syndrome (IBS).

IBS causes predominately abdominal pain with constipation, diarrhea or alternating constipation and diarrhea. Many IBS sufferers choose not to seek treatment because of embarrassment, but Dr. Adrianne Van Norman, a gastroenterologist at Houston Methodist West Hospital, has tips to help you manage your symptoms.

START BY GETTING TO THE ROOT OF THE PROBLEM

“IBS is a disorder of brain-gut interaction. Our central nervous system, which consists of our brain and spinal cord and our gut nervous system, also called our enteric nervous system, are intricately connected. So if we are feeling anxious, depressed, or undergoing stressful events, those feelings can result in altered bowel habits and abdominal pain. Similarly, if there is a disorder in the gut, that can affect our mental health,” explained Van Norman.

If you’ve ever had butterflies efore giving a speech or a bellyache during a heated argument, you can understand the brain and stomach connection.

There are many treatments for IBS aside from medications.

5 TIPS FOR REDUCING YOUR IBS SYMPTOMS

1. S ee your doctor as soon as symptoms appear. Your doctor will know what treatment course is best for you. According

to Van Norman, IBS may mimic serious disease symptoms, so your doctor must rule out any underlying disorder.

2. Prioritize lifestyle changes. Exercise, get plenty of sleep and do activities to reduce your stress levels.

3. C onsider dietary changes with the low-FODMAP diet. “ The low-FODMAP diet has been shown to reduce overall symptoms of IBS,” says Van Norman. It eliminates common food triggers of IBS symptoms and then reintroduces them slowly over time.

4. Try peppermint oil. “Peppermint oil has also been shown to reduce overall symptoms of IBS, but specifially it works as an antispasm medication to improve abdominal pain,” says Van Norman. You can also try over-the-counter peppermint oil capsules twice a day.

Do a mental health check. While your doctor can treat the “gut” portion of IBS, it is important to remember that taking care of your mental health plays an equally large role. Therapy, such as cognitive behavioral therapy (CBT) and hypnotherapy, have been shown to also improve overall IBS symptoms.

“It is important to remember that treatment of IBS is highly individualized and it may take several trials of different medications and approaches to determine what works best for each patient,” says Van Norman. •

If you are concerned you may have IBS, schedule an appointment with a primary care doctor. Visit houstonmethodist.org/pcg/west or call 713.394.6791.

Dr. Adrianne Van Norman

WHEN YOU SHOULD CONSIDER A VIRTUAL VISIT

Staying connected with your primary care provider is important to maintaining a healthy lifestyle. Studies show that people who prioritize primary care improve their overall health, lower their medical costs, and can identify future health needs.

Life can get busy, and making time for a doctor’s visit doesn’t always make the top of the priority list. That’s where virtual visits come in. “A virtual visit is the perfect option for both health and convenience,” said Dr. Jason Taffet, a primary care provider at Houston Methodist West Hospital. Taffet explains the benefits of virtual visits and when they are appropriate.

BENEFITS OF A VIRTUAL VISIT

There are a variety of advantages to a virtual visit, including:

■ Comfort and convenience. A virtual visit allows you to see the doctor from the comfort of your home — from your bed, couch or kitchen.

■ Control of infectious illness. A virtual visit can help prevent the spread of infectious diseases, such as COVID-19 or the flu while allowing you to visit and receive treatment from your doctor.

■ Reduced cost. Primary care is less expensive than specialty and urgent care, ER visits and hospitalizations.

■ Increased Accessibility. Virtual visits take the stress out of travel if you live in a remote area or have difficulty traveling to see a doctor in person.

■ Improved continuity of care. Virtual visits allow you to stay in regular contact with your doctor, which keeps you in better health.

WHEN TO SCHEDULE A VIRTUAL VISIT

1. Minor symptoms: If you are experiencing minor symptoms, such as a cold, cough or mild rash, a virtual visit will allow you to receive a diagnosis and treatment plan from home.

2 . L ack of availability of in-person appointments: If you cannot schedule an in-person appointment with your doctor due to a busy schedule or long wait times, a virtual visit is a good option.

3 . Travel restrictions: If you are traveling within Texas and need medical attention, a virtual visit is a convenient way to see your doctor without leaving your hotel room or fiding a local doctor.

4. Prescreening before an in-person visit: If you are experiencing symptoms and are not sure if you need to see a doctor, a virtual visit will help you determine if an in-person visit is necessary.

5. Follow-up visits: If you have already received care in person and need a follow-up visit, with a virtual visit you can see your doctor without having to leave your home.

“It is important to note that virtual visits are not appropriate for all medical conditions and may not be able to replace an in-person visit in all cases,” Taffet emphasized. “If you are experiencing a serious or life-threatening medical condition, you should seek medical attention in person.” •

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Dr. Jason Taffet