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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

All Blogs

  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

  • January 12, 2022

    By Walter Hembree, MD

    Your foot is composed of 26 bones, 30 joints, and more than one hundred ligaments, muscles, and tendons that work together to provide stability, balance, and support as you move. When any one of those become damaged, it's harder for the foot to function as it's designed. If you develop pain in your foot or ankle, you quickly realize the important role your feet play in enabling you to live an independent life doing the things you enjoy.


    Anyone can potentially experience foot or ankle pain in their lifetime, whether you're an adolescent athlete or an older adult. Sometimes pain is caused by an injury, like an ankle sprain, while other times repeated wear and tear over time causes painful conditions, like arthritis or tendonitis in the foot. Certain parts of the foot are at a greater risk of injury because of the amount of pressure they carry. Your Achilles tendon, for example, can hold up to 10x your bodyweight, making it more susceptible to damage.


    If you have intense pain in your feet or ankles, you don't have to live with it. There is a wide range of treatment options that can alleviate your pain and get you back to the activities you love, whether that's taking your dog for a walk or running 5 miles.


    Seek care if your pain is limiting your ability to participate in your daily activities.

    Foot or ankle pain can often be attributed to a broken bone (fracture), arthritis, tendinitis, or deformity. Everybody has a different pain tolerance, and sometimes pain in the foot may subside with rest and time. But when severe pain in your feet or ankles prevents you from doing the things you enjoy, you should talk to an orthopedist with specialized training in treating the feet and ankles. It's better to get your feet evaluated earlier before your pain worsens and causes further damage. A foot and ankle specialist can recommend a variety of non-invasive treatment options or determine if you may need surgery to relieve pain.

     

    A weight-bearing x-ray may help determine the cause of your pain.

     At your orthopedist's office, a foot and ankle expert will start your evaluation with an x-ray that can rule out certain conditions, like arthritis or stress fractures. The imaging can also determine if there is any misalignment in the bones of the foot which may contribute to discomfort. At MedStar Health, we also have access to advanced weight-bearing computed tomography (CT) technology, which produces an incredibly detailed image of your feet while you're standing. This kind of imaging technology isn't available everywhere, and we’re proud to be ahead of the current standard of care for our patients.


    While imaging helps us easily diagnose if you have a broken ankle or a fracture in your foot, sometimes we can't determine the exact cause of your foot and ankle pain with the x-ray alone. That's why we'll ask questions about your symptoms, the location and frequency of your pain, and the kind of pain you're feeling. For example, heel pain may indicate a different issue than a sharp pain near your big toe.

    Common causes of pain in the feet and ankles.

    Men and women of all ages are susceptible to unexpected foot and ankle injuries, like sprained ankles, torn ligaments, and foot fractures. Likewise, anyone can develop painful conditions in the feet caused by repetitive motion, such as plantar fasciitis or rheumatoid arthritis. Abnormal anatomy, like having flat feet, can also cause pain in the ankle joints, on the bottom of the feet, or on the inside of the foot, depending on the individual. Men tend to rupture their Achilles heel five to six times more than women. On the other hand, women may be at an increased risk for bunions or a pinched nerve on the ball of the foot or toes (called Morton's neuroma) which causes radiating pain between the third and fourth toes. Narrow shoes with tall heels can contribute to these conditions.


    In other cases, untreated ankle or foot injuries may lead to problems in the foot. For example, people may experience ankle instability if they had a sprained ankle in the past that didn't heal correctly. This can cause the ligaments to stretch out, which makes the ankle feel like it's "giving way", or loose. As a result, they are more likely to sprain it again or develop early arthritis, which may require more aggressive treatment.

    Work with your doctor to find out the best plan of action for you.

    During your visit with one of our fellowship-trained foot and ankle experts, we'll determine the best course of action for relieving your ankle or foot pain. Your treatment plan will be customized to your specific needs and goals, and we may need to attempt a few different things to see what works best. We try to alleviate your discomfort with nonsurgical options when possible, but other times, an operation may offer the most relief and prevent something from getting worse.


    We start with conservative treatment options, when possible.

    There are a variety of nonoperative things we can try to reduce your discomfort, depending on the source of your foot or ankle pain. For example, some people benefit from orthotic inserts that offer additional foot and ankle support. Orthotics can alleviate stress and pain in the foot, and you can get some customized to the unique shape of your foot for the most effectiveness. A foot or ankle brace may also help to prevent your pain from worsening.


    Concentrated injections of anti-inflammatory medication may be an effective way to manage any arthritic pain in the ankle. Over-the-counter anti-inflammatory medications may help to reduce swelling, tenderness, and pain. Voltaren™ topical gel is known to alleviate pain in and around the foot caused by arthritis or tendonitis. Physical therapy can also be helpful in improving things like your gait which may fix the root cause of your pain, depending on your condition.


    What to do when surgery is necessary.

    Sometimes it's obvious when surgery is necessary, like bad ankle fractures. Other times, a painful condition like flat foot doesn't require urgent surgery, but it may end up being the best option if conservative treatments don't help. In those instances, your decision to undergo elective surgery is a personal one that should consider the pros and the cons, and we can help you make that call. 


    Sometimes foot or #AnklePain resolves itself, but other times surgery may relieve pain when other treatments failed. On the #MedStarHealth blog, foot and ankle expert Dr. Walter Hembree explains your options: https://bit.ly/3GmzbPB.
    Click to Tweet

     

    Recovery time varies by individual and surgery type, but a successful outcome requires a commitment to following your doctor’s instructions. Some, but not all, procedures will require you to stay off your feet for the recommended period of time and not bear any weight on the leg you were operated on. You'll need to plan ahead for things like getting a ride (if you aren't able to walk, you can't drive), and navigating your home if you have stairs. But sacrificing your independence for a few weeks may ensure you're able to return to the activities you love without pain.

     

    You don’t have to live with foot or ankle pain.

    Talk to one of our highly specialized orthopedists today.

    Schedule an Appointment

  • January 07, 2022

    By Ellie Kelsey, RD, LD, CNSC

    Every January, our Nutrition team answers an influx of questions from patients resolving to improve their health and lose weight in the new year. Intermittent fasting—a dietary approach that cycles between periods of fasting and eatinghas become one of the most popular diet trends.

    While celebrities including Jimmy Kimmel and Jennifer Aniston have created a buzz about the weight loss benefits of intermittent fasting, people have fasted for religious reasons for centuries. 


    Clinical research on intermittent fasting is limited—and mixed. Some studies have shown that it can lead to improved health and mild or moderate weight loss. Others suggest that fasting has no significant long-term health benefits.


    If you’re considering intermittent fasting to improve your overall health or lose weight, it’s important to understand:

    • The plan’s basic principles  
    • How to find accurate information about intermittent fasting
    • That everyone responds differently to eating patterns

    Intermittent fasting is not a quick fix for weight loss (there’s no such thing) or a plan that “allows” you to eat large amounts of processed or fast foods within limited time frames. Knowing how to start fasting and what guidance to follow can be confusing; there’s no shortage of advice available from both medical professionals and non-experts.

    To help you learn how to incorporate it into your life safely, I’ve answered the five most common questions I get about intermittent fasting as a registered dietitian.

    Related reading: Mindful Eating for Healthy Weight Loss

    1. Is there a ‘right way’ to fast?

    Intermittent fasting is popular because it's less about what you eat and more about when. Most people in the U.S. eat during a 12-hour window each day: 8 a.m. to 8 p.m., for example. Intermittent fasting changes this pattern by limiting the eating window or restricting calories during certain days. 


    But there’s no “right” way to fast. People choose different patterns based on their lifestyle and preferences. Here are four methods to consider.

    • 5:2 diet: With this approach, you eat as you normally would for five days each week. For the two remaining days—which are typically non-consecutive—you consume between 500 and 600 calories. On these days, choose low-carb, high-fiber foods, such as vegetables; grilled or steamed fish; boiled eggs; natural yogurt; low-calorie soups; and black coffee or tea. This approach tends to help those who respond best to only having to follow the “rules” during these two days. 
    • Alternate-day fasting: A subset of the 5:2 diet, this plan alternates a “feast” day with a “fast” day every other day. Like the 5:2 plan, you consume 600 calories or less on fast days. 
    • Circadian fasting: This pattern aligns your eating schedule with your natural hormone cycles. Our circadian rhythm—the body’s 24-hour clock—controls our sleep, digestion, hormones, and stress levels. Time your meals for early in the day when your energy levels are likely to be higher. Fast when the sun goes down and your energy decreases and digestion slows.
    • 16:8 diet: This time-restricted approach is best for people who like routine. You choose an eight-hour eating window each day and consume most of your calories in the middle of the day. Some people skip breakfast, eat from noon to 8 p.m., and then fast until noon the next day. Others may eat from 10 a.m. until 6 p.m. Combined with regular exercise, this method has been linked to reduced fat mass and body weight and can be easier to follow consistently than more restrictive patterns.

    I recommend trying different patterns to see which one—if any—works best for your lifestyle.

    When combined with endurance exercise, most of these approaches can result in significant weight loss and help lower the risk of heart disease. They have also been linked to improved insulin sensitivity and blood pressure.

    Know the difference between 5:2 and 16:8 #IntermittentFasting? Get the answer to this common #fasting question, plus 4 more, in this blog from a registered dietician: https://bit.ly/3JIDabc.
    Click to Tweet

     

    2. Can I eat whatever I want on non-fasting days?

    Like any successful diet plan, no foods are off limits for intermittent fasters. But we always recommend that you eat more fruits and vegetables and fewer processed foods, whether or not you are trying to lose weight. 


    Eating more plant-based foods rich in nutrients, vitamins, and minerals helps keep your immune system healthy. It also reduces your risk of chronic inflammation, which is associated with diseases such as
    diabetes, heart disease, liver disease, and several types of cancer.

    While many people try fasting to improve their health, some try fasting to lose weight. We rarely recommend that weight loss be the primary goal of a diet plan, as studies show this approach typically does not result in long-term weight loss or improvements in health. In fact, it often negatively impacts mental health. But if you’re fasting to lose or maintain your weight, even if it’s not the primary goal, you should also be mindful of the amount of food you eat. 

    Some people who choose more restrictive patterns of intermittent fasting eat more than they normally would on non-fasting days in anticipation of—or to make up for—eating less on fasting days. Because they’re consuming the same number of calories overall, their weight stays the same. 

    Related reading: Fight Harmful Inflammation with These 10 Healthy Eating Tips

    3. What are the health benefits of intermittent fasting?

    When people fast, the body swaps its source of energy from glucose to ketones. This process, combined with exercise, is known as metabolic switching. Theoretically, it can change your body by flushing out damaged cells and replacing them with newer, healthier cells, making it possible to lose weight and reap long-lasting health benefits such as:

    Keep in mind that some people only experience one or two of these health benefits—or none at all. Everybody’s metabolism functions differently, and you might need to eat more often than someone else. 


    I know people who say fasting helps them feel more energetic and other people who tried fasting and said it made them feel anxious and jittery. If any diet plan makes you feel worse mentally or physically, it is not safe to continue.

    It usually takes two to four weeks for your body to become accustomed to new eating habits. Any side effects you may experience when you start fasting, such as headaches or irritability, usually disappear after a week or two. But if you’re miserable a week in, don’t force yourself to keep going. Accept that it’s simply not the right eating plan for you.

    4. Is intermittent fasting sustainable?

    The flexibility of intermittent fasting patterns makes it easier than other diet plans to stick to long term. If you’re eating a balanced diet, sleeping well, exercising, and in good health overall, it’s perfectly safe to fast long term, as long as you remain in good health, both physically and mentally. 


    There’s not a lot of long-term research or peer-reviewed studies about fasting. However, studies have shown that
    the 5:2 diet often results in short-term weight loss because people have a hard time sticking to it over time.

    The 16:8 method is often easier to maintain than the 5:2 plan because you’re eating every day. Yet even this approach can be difficult when you factor in weekends; some people fast only during the work week. The key is choosing a pattern that’s easily sustainable for your particular lifestyle.

    5. Who should not try intermittent fasting? 

    While intermittent fasting can be tailored to individual lifestyles, it is not safe for certain populations, including:

    • Anyone under age 18. Their metabolism and hunger cues are not fully developed.
    • People who are prone to restrictive eating patterns or have a history of eating disorders. Fasting can lead to or exacerbate binging and starving, over-restricting food intake, or eating/food anxiety.
    • Those who need to take medication with food at specific times.
    • People who are pregnant or breastfeeding. Fasting can cause low blood sugar. Plus, growing and feeding a baby requires sufficient—not restricted—calorie intake.
    • Anyone who becomes irritable, shaky, or anxious when they don't eat for a certain amount of time. 
    • People prone to constipation. While some report improved digestion after intermittent fasting, others have experienced constipation.

    If you fall into one of these categories and want to change your diet, talk with your primary doctor or a registered dietitian about sustainable ways to do so safely. People with any type of health condition should not try intermittent fasting or any other diet plan without close monitoring by their doctor.


    Many “wellness experts” provide well-meaning advice about intermittent fasting that can be harmful. In addition to speaking with a professional, when seeking more information:

    • Ensure research you read is peer-reviewed from a trusted source (such as the National Institutes of Health or a peer-reviewed medical journal).
    • View online searches with skepticism. If an “expert” is only presenting the benefits of a diet plan and also selling that diet plan, the information should be taken with a grain of salt. Many websites want to sell you a diet they claim is easy and magical for weight loss. However, in most cases the only loss you’ll see is in your wallet.

    Bottom line: Intermittent fasting isn’t for everyone.

    It can be easy to get swept into someone else’s excitement about a diet that works for them. But don’t get discouraged if you don’t experience the same results or if you find it difficult to stick to full-time intermittent fasting.


    I’ve tried—and enjoyed—intermittent fasting in the past, but it wasn’t conducive to my lifestyle long term. When changing your eating habits for better health or weight loss, do what works best for you with the guidance of a credible medical professional who knows your medical history.


    Searching for a diet plan that will stick?

    Our nutrition experts can help.

    Call 202-877-DOCS (3627) or Request an Appointment

  • January 05, 2022

    By MedStar Team

    There is good news for those who have varicose veins or are worried about developing them in the future. Today’s treatments for removing these enlarged veins are much less invasive than in years past. And taking steps early on may even help you minimize or avoid them altogether.

    What causes enlarged veins in legs and feet?

    In most cases, weakened veins are to blame. Varicosities and their smaller cousin, spider veins, can occur anywhere in the body, but they are far more common in the lower extremities.

    That’s because gravity is a factor. Blood has a long uphill journey from the feet back to the heart. To keep it flowing upward, your leg veins—unlike those in your upper body—have valves along the way. These act like one-way doors, opening and closing as blood pushes upward with each muscle contraction. Healthy valves close tightly. But weakened ones let blood flow backward, putting extra pressure on the veins. That can create stretching and distortion, which leads to purple, cord-like veins bulging just beneath the skin’s surface.

    Varicose veins are extremely common, more so in women, and typically harmless. Common risks include having a family history of them, aging, pregnancy (especially more than one) excess weight and long periods of standing on a regular basis. A history of more serious clotting, known as deep vein thrombosis, can also increase your risk.

    In addition, some people are born with a condition called May-Thurner syndrome that can lead to varicosities, often in the left leg alone. This happens when an artery in your pelvis presses on an underlying vein carrying blood to your left leg. Although the condition is rare, it’s something we look for during the initial ultrasound when we evaluate each patient’s veins and valve function.

    Are they cause for concern?

    For many people, varicose veins are just an unattractive nuisance. But for others, they eventually cause bothersome symptoms, such as burning, bleeding, itching, aching pain and/or a feeling of heaviness in the legs and feet. Sometimes, minor blood clots develop, which can be treated with pain reliever and warm compresses until the body resorbs them. In severe cases, skin sores erupt.

    While the condition isn’t generally harmful to your health, it can be uncomfortable and negatively impact your quality of life. With the minimally invasive treatments we offer today, there’s little risk in having them removed.


    Varicose veins can be uncomfortable and negatively impact your quality of life. But with minimally invasive treatment, there’s little risk in having them removed. Learn more from Dr. Krystal Maloni: https://bit.ly/32LGx0D.
    Click to Tweet


    How are they treated?

    The most common way we treat varicosities today is with radiofrequency ablation. This minimally invasive technique involves injecting the area with numbing medication, then using a tiny needle to gain access to the problematic vein. A very thin, flexible tube (catheter) is inserted into the vein, with ultrasound imaging used to guide it into place.


    As we slowly draw it backward, the catheter uses radiofrequency to send out heat, which seals off the vein as it goes. Any veins attached to the main branch that we treat also tend to regress over the next three months or so. Blood flow naturally reroutes to healthy veins, and the body eventually resorbs the treated veins over the next few months.

    Radiofrequency ablation takes less than 30 minutes, requires no anesthesia or downtime and is highly effective for removing symptomatic veins with little risk. Most patients don’t need any further procedures and are happy with the results long-term.

    This technique works for most patients, whose varicose veins tend to branch from the superficial leg veins known as the greater saphenous, small saphenous or anterior saphenous. These long, straight veins can easily accommodate the thin catheter.

    A newer procedure we offer for treating veins like these is called VenaSeal™. It works much like radiofrequency ablation but, instead of using heat inside the vein, VenaSeal involves injecting a medical-grade adhesive to close it. The benefit is that no local numbing medicine is needed along the vein, so there are fewer injections overall, which some patients prefer. Occasionally, patients have a skin reaction to the adhesive, but for the most part, studies show it works well.

    Radiofrequency ablation and VenaSeal™ aren’t for every vein problem. For much smaller varicose or spider veins, we offer sclerotherapy. This involves injecting a solution into the vein that causes it to collapse and fade away over a few weeks. Some centers treat these smaller veins with laser therapy. While the laser can be effective, it’s actually more painful than sclerotherapy injections. It also takes more time, which means you may need multiple visits for laser treatments.

    Extremely dilated veins, which look like thick grapevines under the skin, sometimes require more complex treatment. For these, we may recommend a surgical phlebectomy. This requires general anesthesia at the hospital and involves making small incisions over the affected veins and actually removing them one by one. While surgical phlebotomy is more complex and invasive, it’s also highly effective for advanced cases.


    Does health insurance cover treatment?

    Most insurance plans do not cover treatments that are purely cosmetic. But if your varicose veins are causing symptoms—such as the burning, itching, pain or heaviness mentioned earlier—insurance plans will usually cover the ultrasound evaluation and treatments if venous disease is confirmed.


    Can varicose veins be prevented?

    Compression stockings are the gold standard approach for minimizing varicose veins. I highly recommend them if you already have these veins or any risk for developing them, such as pregnancy or a job requiring lots of time on your feet. These tight-fitting knee-highs or thigh-highs keep blood moving instead of pooling or back flowing. In order for them to be effective, however, they must be worn consistently every day, putting them on in the morning when you get dressed and taking them off when you go to bed at night.


    Medical-grade compression stockings require a prescription and can be purchased online or at local medical supply stores. (Typically, a pressure of 20 to 30 mmHg is a good start.) If these are too uncomfortable, however, non-prescription varieties are less snug and cost less; you can often find these online. The key is to choose compression stockings that you will commit to wearing regularly.


    If you’re sitting for long periods, try to elevate your legs to 90 degrees when you can. Maintaining a healthy weight can also help to minimize pressure and swelling on your legs. Regular walking and other leg exercise are another plus, since the muscle stimulation helps keep blood flowing and veins healthy. I recommend avoiding herbs and supplements you see advertised, as there’s no good evidence that they can prevent or help varicosities.


    When in doubt, get them checked out.

    While medical treatment for varicose veins isn’t always a must, varicosities do tend to worsen over time for most people. Coming in early for an ultrasound evaluation and a conversation about prevention and treatment options is ideal.


    Bothered by varicose veins?

    Schedule an appointment with one of our specialists today.

    Request an Appointment

  • December 31, 2021

    By Anteneh Tesfaye, MD

    People generally don’t think about their digestive system—until it stops working properly. Then its impacts on daily life quickly become evident.


    Any type of digestive malfunction can be distressing, so I understand why patients are often concerned after a gastrointestinal (GI) cancer diagnosis. However, misinformation about what caused their cancer and what treatment will be like can add unnecessary stress to the emotional burden they already carry.


    GI cancer includes several types of cancer that develop in organs throughout the digestive system, such as the:


    • Colon
    • Esophagus 
    • Liver
    • Pancreas
    • Stomach

    These cancers comprise 26% of cancer cases worldwide and 35% of all cancer-related deaths. Symptoms for each type of GI cancer vary but typically include indigestion, weight loss, abdominal pain, nausea, and changes in bowel movements.  


    Treatment usually requires surgery and sometimes chemotherapy or radiation. Though the experience is not easy or comfortable, advanced treatment gives many patients longer, healthier, and higher-quality lives. 

    Knowing the truth about GI cancer diagnosis, treatment, and survivorship can help families spend less time worrying and focus more energy on healing. Here are five common myths—debunked—about GI cancer.


    Myths about #GastrointestinalCancer can add unnecessary stress to a patient’s cancer diagnosis. In this blog, Anteneh Tesfaye, MD, debunks 5 common myths so patients can focus on facts—and feeling better: https://bit.ly/3Jv4FVC.
    Click to Tweet
     

    1. Myth: Certain foods can cause GI cancer.

    The truth: The common saying that “you are what you eat” is well-intentioned, but it has led many to believe that a patient’s diet can directly cause cancer; however, no direct cause-and-effect relationship has been discovered.


    While the Western diet, which contains large amounts of processed products and foods with high levels of sugar, salt, and fat, has been linked to higher rates of colorectal cancer, a direct connection is still unknown. Plant-based diets such as veganism or the Mediterranean diet are often recommended instead. But GI cancer develops in people who eat these diets as well. 

     

    It has been shown that certain foods can help decrease the risk of getting cancer, and MedStar Health oncologists and nutritionists frequently collaborate to help patients looking for guidance on changing their diet before or after a cancer diagnosis. 


    If you’ve heard that sugar (glucose) “feeds” cancer cells, that’s also not true. All cells get their energy from glucose, whether they’re cancerous or not. If you cut glucose from your diet, your body will make it naturally to fuel your cells. And even if less glucose is available, cancer cells will use another source to get energy.


    The bottom line is that food can contribute to a patient’s cancer risk, but a patient’s diet is not a sole cause for a GI cancer diagnosis.

     

    2. Myth: Certain foods can cure GI cancer.

    The truth: No miraculous diet or pill can cure cancer.


    Unfortunately, many have tried to profit from patients’ devastation after a cancer diagnosis by claiming that certain foods or alternative pills can replace medical treatment. 


    I understand the appeal of these claims when a doctor has delivered bad news. But working with your provider to develop a treatment plan as soon as possible is your best hope for beating cancer. Delaying care or drastically changing your diet might cause further damage to your body.


    Alternative treatments (also known as herbal, botanical, or other “natural” products) may help in managing symptoms of cancer and cancer treatment. But using them instead of modern cancer treatment has been shown to be harmful.


    3. Myth: Having GI cancer surgery can further spread cancer.

    The truth: Though we might find more cancer cells after surgery, they likely existed before surgery.


    No matter how advanced our technology is, cancer cells that spread through the body can be too small to show up on the scans and tests we conduct before surgery. When we find them later, it might seem like the cancer spread after surgery, but it was already there; we just couldn’t see it.


    Deciding to have surgery for GI cancer is a significant decision for a patient to make. Even though surgery can be a difficult experience, it can help cure life-threatening cancers for many patients.


    Recovery can be long and uncomfortable—not because the cancer has spread but because the body requires time to heal from an invasive procedure involving this vital organ system that needs to function smoothly for comfortable everyday existence.


    4. Myth: People who have GI cancer surgery need a permanent colostomy bag.

    The truth: The majority of patients who have colon cancer do not need a colostomy bag after surgical treatment. If they do, most will be temporary.


    The first thing many people think of when they hear “colon cancer” is the colostomy bag that patients have after a colon surgery. During this surgery, a hole is created in the abdominal wall and one end of the colon is pulled through the opening, where waste is then collected in an external bag. Colostomy bags may be permanent in some cases but are temporary for most patients. 


    Surgical treatment for colon cancer continues to advance, and a colostomy is not the only or even the most common surgery patients receive. Less than 35% of colon cancer survivors had a colostomy to treat their cancer. And it’s permanent in less than 10% of these patients. 


    I also want to note that life with a permanent colostomy bag can be just as fulfilling as life without one. It certainly requires more adaptability, but modern bags are designed for convenience so that patients can have near-normal life.


    5. Myth: Long-term quality of life after GI cancer will significantly decrease.

    The truth: Life will be different—but a support system can help patients manage the changes and keep enjoying life.


    Following GI cancer treatment, many patients experience changes in their quality of life. That's not a reflection of anyone’s personal strength; it’s just a natural progression after a major disruption to the digestive system.


    Recovery is slow; I encourage patients to take it one day at a time. Depending on the treatment, appetite loss, diarrhea, fatigue, nausea, and vomiting may continue a year or more after treatment. Experiencing ongoing physical difficulties can lead to depression and anxiety as well.


    MedStar Health specialists—from nutritionists to gastroenterologists to psychologists—are dedicated to helping patients cope with these changes and have a rewarding life. Several innovative, effective treatment options are available to give patients the chance to return to work, enjoy hobbies, and spend time with loved ones. It’s not easy, but it is possible.


    When in doubt, ask your doctor.

    When it comes to cancer, your health care provider is your best source of information.


    Early detection increases the likelihood of successful recovery from GI cancer treatment. By paying more attention to your body’s regular digestive process, you can more easily recognize when you don’t feel right. Be sure to see your doctor immediately if something seems off.


    Learn the facts about gastrointestinal cancer.

    Request an appointment with a gastroenterologist to discuss your risk factors and a personalized prevention or treatment plan.

    Call 202-877-DOCS (3627) or Request an Appointment

  • December 29, 2021

    By Clayton Dean, MD

    Historically, patients who needed spine surgery could expect a long recovery process, often with a week-long hospital stay. Today, Enhanced Recovery After Surgery (ERAS) protocols are helping patients return to work and life faster and with better outcomes. For patients who are healthy and motivated to take an active role in their care, ERAS protocols offer many advantages over traditional spine surgery recovery, including:

    • Fewer complications
    • Shorter hospital stays (and sometimes no hospital stay)
    • Less pain during and after surgery
    • More positive patient experiences
    • Better long-term results

    ERAS protocols are evidence-based, meaning they've been peer-reviewed and proven successful in real-life surgeries. While the "fast-track" recovery strategies aren't new to orthopedic surgery, they've only recently been applied to spinal surgery under the care of experienced teams trained to implement modern ERAS principles. Teamwork is critical to expedited recovery, requiring collaboration between the patient and specialists across different disciplines before, during, and after the procedure.

     

    Patients play a critical role in enhancing spine surgery recovery.

    Under ERAS protocols for spine surgery, your recovery plan begins before you even step foot in the operating room. At MedStar Orthopaedic Institute in Baltimore, we provide every patient with preoperative education and counseling designed to educate the patient on what to expect. Many patients share that going through the program helps them to feel equipped to be active participants in the healing process.


    Patients are also asked to participate in pre-surgery rehabilitation, or prehab. The prehab program improves the body's overall strength and function before surgery, allowing you to return to resume activity faster and more easily afterward. Every patient also benefits from a virtual consultation with our acute pain service. During the telemedicine visit, patients are asked about any current medications as well as their pain tolerance and goals. This information helps your care team anticipate your needs on the day of and the weeks after surgery.

    Modifying lifestyle habits before spine surgery can also lead to an expedited recovery, and patients are encouraged to:

    • Optimize their nutrition
    • Achieve a healthy body mass index (BMI)
    • Minimize or eliminate opioid, alcohol, and nicotine use

    Patients don't have to make these changes alone, as each patient is matched to a care coordinator who will help you navigate your surgical preparation and recovery. Our care coordinators are specially-trained healthcare professionals who work closely with your physician and care team to help you return to your active life as seamlessly as possible. Together, you'll develop a plan for rehabilitation that will help you reach your goals after surgery. 

     

    During surgery, your multidisciplinary team proactively manages pain and the risk of complications.

    A lot has changed when it comes to back surgery. Traditionally, patients were required to fast before undergoing an operation on the spine. Now, evidence proves that food and drink help to prevent your gastrointestinal system from shutting down during a procedure. Your care team will give you instructions for when you should stop eating and drinking before arriving at pre-op. In general, most patients are able to drink clear liquids up to two hours before surgery and solids up to six hours beforehand. Some patients benefit from a carb-loaded drink given once they arrive for surgery.


    There will be a team of medical professionals invested in your surgery, including your surgeon, an anesthesiologist, nurses, physical and occupational therapists, and counselors. When you arrive for your procedure, you'll meet with an anesthesiologist or nurse who will give you analgesics to help manage your pain and your body's stress response before you go into surgery. Whether you're having spinal fusion surgery or another type, back or neck surgery is major surgery that puts stress on the body. By using a combination of oral pain medication like Tylenol, non-steroidal anti-inflammatory drugs, and Gabapentin before the procedure begins, you're less likely to need opioid medications after surgery.

    During surgery, your surgeon and anesthesiologist work together to minimize blood loss that could lead to anemia. You'll also receive a regional or local anesthetic (pain medication injections) directly to the surgical site, which helps to control pain during the procedure. This multimodal approach to pain control results in earlier mobility, less pain, and minimized need for narcotics to manage pain following surgery. And, unlike other surgical procedures, most patients don't need a catheter, eliminating your risk of developing a urinary tract infection (UTI).

     

    Contemporary strategies for post-operative care significantly reduce nausea and vomiting, thereby speeding up recovery.

    In the past, patients weren't allowed to eat or drink until a day after surgery which meant that their gastrointestinal function was at risk for a partial or complete shutdown. As a result, nearly 50 percent of patients experienced nausea and vomiting that led to a prolonged hospital stay and recovery.


    ERAS principles after surgery encourage patients to eat and drink early, which helps to expedite the return of gastrointestinal function. In combination with other strategies, this helps to minimize nausea and vomiting and speeds up recovery because you can regain strength more quickly with good nutrition. Your anesthesiologist will continue to help control your pain using the same multimodal approach applied during surgery. Research suggests that patients who participated in ERAS protocols were dramatically less likely to need pain medicine one month after surgery.


    #SpineSurgery patients who participate in advanced recovery protocols are dramatically less likely to need pain meds one month after surgery. Spine surgeon Dr. Clayton Dean shares why: https://bit.ly/3qBkd1o.
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    You can also expect to get moving around as early as possible with the help of a physical therapist. Early mobilization helps to minimize muscle weakness and increase circulation in the legs, lowering your risk of blood clots following surgery. We know that most patients actually recover better at home, and you can expect a shorter hospital stay—or even no hospital stay, in some instances.

     

    Expedited recovery is well-suited for healthy people planning elective back surgery.

    Patients who are healthy, have a strong support system, and are willing to engage in the educational program and preparation beforehand are great candidates for an expedited recovery following spine surgery. Most often, ERAS principles are applied to elective surgeries, such as treating a herniated disc. Not all surgeons and surgical centers are well-versed in implementing ERAS protocols, so it's important to ask your care provider. At MedStar Orthopaedic Institute, our team is at the forefront of advanced protocols, technology, and that help you safely get back in action faster and with less pain.


    When it comes to spine surgery, experience matters.

    To meet with Dr. Dean, call 410-877-8172 or click below.

    Request an Appointment