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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

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  • June 11, 2018

    By MedStar Health

    According to the Centers for Disease Control and Prevention (CDC), obesity affects more than one-third of adults and one in five children in the U.S. This trend is associated with a combination of the amount of food we eat and a decline in physical activity—we gain weight when we eat more calories than we burn.

    A key contributor to this imbalance is oversized food portions. Over the past 20 years, U.S. food portions have doubled or tripled, making it easier than ever to overeat. When we order meals in restaurants, there's often enough food for two or even three people.

    It can be challenging to determine appropriate portion sizes when we’re used to seeing massive sandwiches and huge side dishes. This “portion distortion” affects what we think of as normal portion sizes when we cook at home, too.

    Although our food portions are much larger today than they used to be, it doesn’t mean we need to eat everything just because it’s in front of us. You can battle the tendency to overeat by working with a registered dietitian and by following three easy tactics to control your calorie intake and make healthier food choices.

    3 Strategies to Control What You Eat

    1. ChooseMyPlate

    The United States Department of Agriculture (USDA) offers the ChooseMyPlate website, which provides a visual example of what a healthy meal should include for most Americans. You can use the visual aid to plan meals, eat out, or cook at home.

    The plate is divided into the five healthy food groups—fruits, vegetables, grains, protein, and dairy. Ideally, half of the plate should be fruits and vegetables, one-quarter should be a lean protein, and the final quarter should be grains. Dairy is shown as a side cup or dish next to the plate. ChooseMyPlate also offers recommended daily amounts for each food group, all of which vary based on an individual’s unique nutrition needs and level of physical activity.

    Below are some guidelines to think about when you use ChooseMyPlate:

    • Vegetables: Any type of vegetable or 100 percent vegetable juice. Fresh vegetables—cooked or raw—are recommended, but canned, pureed and frozen are acceptable as well.
    • Fruits: Any fruit or 100 percent fruit juice. Like vegetables, fruits can be fresh, canned, pureed or frozen, and also can be dried.  
    • Proteins: Lean meat, lean poultry, seafood, beans and peas, eggs, processed soy products, nuts, and seeds. Red meat is recommended just every now and then.
    • Grains: Foods made from wheat, rice, oats, cornmeal, barley or other grains. Common foods in this group include bread, pasta, oatmeal, cereal, tortillas, and grits. At least half of the grains you eat should be whole grains.
    • Dairy: Milk and many foods made from dairy are considered part of this food group if they have calcium. Eligible foods include yogurt, cottage cheese, and calcium-fortified soymilk. Dairy products that don’t have calcium are not included in this group, such as cream, butter, and cream cheese.

     2. Measure With Your Hands

    A recommended serving size is the amount of each food you should eat during a meal or snack, while a portion is the amount of food that you actually eat. If you eat more than the recommended serving size, you likely will get too many calories or too much of a certain nutrient.

    An easy solution is to measure the food we eat. But how can you determine a proper serving without specific measuring tools? You can use your hand and fingers to measure appropriate food portions.

    Use this cheat sheet for estimating portions of specific foods:  

    • Your thumb is roughly equivalent to an ounce.
        • Cheese
        • Peanut butter
    • Your closed fist is about the size of one cup
        • Vegetables
        • Milk or yogurt
        • Cooked rice, pasta, or cereal
        • Fruit, raw or cooked
        • Fruit juice can be one-half cup, or half a fist
        • Leafy salad greens can be 2 cups, or the size of two fists
    • A handful is about an ounce
        • Nuts or dried fruits, such as raisins
        • Larger snacks, such as chips, pretzels, or popcorn can be about two handfuls
    • Your palm is roughly equivalent to 3 to 5 ounces
      • Meat, fish, and poultry

    While it’s not an exact science, this method can help you keep proper portion sizes in mind wherever you go. For example, if you get a piece of chicken at a restaurant that’s the size of both your palms, cut it in half and share it or save the other half for tomorrow’s lunch. You can train your brain to avoid portion distortion. Every now and then, measure your favorite foods on a food scale as well so you can have a visual of the appropriate portion size.

    3. Read Your Food Labels

    Many of us grew up starting our mornings by pouring a heaping pile of cereal into a bowl. How much cereal we ate depended largely on the size of our bowl. However, many cereals suggest a serving size of less than a cup, and many of us eat much more than that in a sitting.

    We all need to understand food labels, not only to learn the recommended serving size, but also to use the nutrition information in the context of our entire day. The nutritional elements included in the label, such as total carbohydrates, sodium, or sugar are suggested amounts in the context of a serving size.

    If we have double the serving of cereal, for example, we’ll eat double the amount of sugar or sodium listed on the food label. Use these tips when reading food labels and incorporate the recommendations into your daily food intake:

    • Check the serving size. Sometimes more than one serving is listed.
    • Follow the USDA’s 2015-2020 Dietary Guidelines for Americans Unless otherwise directed by your doctor or dietitian, eat and drink:
      • Less than 10 percent of calories per day from added sugars.
      • Less than 10 percent of calories per day from saturated fats.
      • Less than 2,300 milligrams (mg) per day of sodium.
    • Pay attention to the order of food ingredients. They’re listed in order of quantity, from greatest to least. Keep in mind that just because something is far down the list doesn’t mean there’s just a little of it. For example, tomatoes may be the most prevalent item in salsa, but it might have a lot of sodium, even if salt is the last ingredient listed.
    • Check how many ingredients are in the food. A long list of ingredients may be a sign of artificial additives.
    • Understand the daily recommended amounts of ingredients. Using sodium as an example again, the recommended daily amount for adults without health complications is just 2,300 mg per day, or just a little more than one teaspoon. The percent of daily value number on the label is an easy way to see how much of a day’s worth of a certain nutrient is in the food you’re about to eat.
    • Eat foods that don’t have labels. In other words, opt for whole foods, such as fresh fruits and vegetables, more often than processed foods.

    Use these tips to beat portion distortion at home and while eating out. If you need a little extra help, consider working with a registered dietitian to get your nutrition on the right track. Before you know it, portioning, choosing healthy foods and reading food labels will become second nature.  

    Want to learn more about how we can help you live a healthy life? Click the button below to view the list of our services.

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  • June 06, 2018

    By I. David Shocket, MD

    The American Cancer Society has released new colonoscopy recommendations: Adults at average risk should start getting colonoscopies at 45 instead of 50. The update is due to an alarming trend that shows U.S. patients are developing colorectal cancer at younger ages.

    Colorectal cancer is the third most commonly diagnosed cancer in the U.S. and will be diagnosed in more than 101,000 people in 2019. Additionally, more than 44,000 will be diagnosed with rectal cancer. The two cancers are expected to kill more than 51,000 people during this year, and we’ve seen diagnoses in patients as young as their 30s.

    The updated recommendations are a smart move to save the lives of more patients. Colonoscopies serve a dual purpose: early detection of existing cancer and prevention of cancer before it has a chance to develop.

    Due for a colonoscopy? Call 202-877-3627 to schedule your cancer screening.

    Request an Appointment

    How colonoscopy can prevent colon cancer

    During a colonoscopy, we check for existing cancer. More often, we find polyps, which are growths that appear in the colon and throughout the gastrointestinal tract. Polyps can be smaller than a quarter of an inch to several inches in diameter, and they look like small bumps growing along the lining of the bowel.

    Many polyps are harmless, but they can turn into colorectal cancer without causing noticeable symptoms until the cancer has progressed. It’s impossible to know for sure which polyps become cancerous, but generally the bigger they are, the more likely they are to be or become cancerous.

    We routinely remove any polyps we find during the colonoscopy to prevent the development of colon cancer. The procedure is painless, and the entire visit usually takes less than 40 minutes. For most patients, the worst part is the preparation before the visit, which requires completely emptying the bowels so we have a clear view of the colon. Find tips to make colonoscopy prep more bearable.

    You tell us: Do you think more patients will get colonoscopies now that the recommended age to start is 45, not 50?

    Tell us on Facebook or Twitter.

    How patients can protect their health

    Some patients worry about a colonoscopy or other screening technique being a hassle or discomforting, but I always encourage them by explaining how common it is and that it could be a life-saving procedure.

    I anticipate as people start getting colorectal cancer screenings at younger ages, we’ll remove more polyps sooner, decreasing the rates of colon cancer over time. Colon cancer typically develops slowly over the course of several years. The sooner we can remove polyps—and catch existing cancer at an early, manageable stage—the better chances we have to save more patients’ lives.

    It's important to note that, although the American Cancer Society now recommends starting screening at 45, the U.S. Preventive Services Task Force (USPSTF) hasn’t changed its recommendation that patients start at 50. This can impact whether your insurance will cover your screening because the Affordable Care Act (ACA) requires both private insurers and Medicare to cover the cost of colorectal cancer screening tests as long as they are recommended specifically by the USPSTF. Make sure to speak with your insurance company prior to scheduling your appointment.

    Get screened today for colorectal cancer.  Call 202-877-3627 or click below to make an appointment.

    Request an Appointment

  • June 06, 2018

    By MedStar Health

    Many of us are so busy that we don’t think about what to make for meals until it’s crunch time. We zip through the store on our lunch break or after work, before our son’s piano lesson and our daughter’s soccer game. Grabbing food that’s easy (but also usually lower in nutritional value and more expensive) and then race home to cook. But what if you could skip the worry and rush with just an hour of planning?

    As a dietitian, I always recommend that patients try meal planning. Cooking is an important way to pay attention to our diet and focus on our health. When you plan your meals ahead for a week at a time, you can save money and time, lower your stress levels and eat healthier.

    Imagine thinking, “What’s for dinner?” just once a week! #Mealplanning is good for your health, budget, and time. via @MedStarHealth
    Click to Tweet

    Tips for Easy Meal Planning

    It can sound like a daunting task to plan out a week's worth of meals at a time, but it's a lot easier than it looks! Streamline the process with these tips:

    Do’s

    • Double healthy recipes or make meals in bulk so they’ll stretch for more than one night or can be frozen for a future meal
    • Plan out two or three meals per week
    • Stick to a budget
    • Make a list

    Don’ts

    • Wander (or worse, race!) through the store aisles
    • Grab less healthy, more expensive choices
    • Overspend or overshop

    The same tips work for locally sourced shopping and farmers markets. It’s fun to wander around and learn what’s in season as you shop. Just make sure you buy what you like and what your family can eat or freeze before it spoils.

    Pick Your Day

    Schedule time to plan and cook. Do it all in one day, such as Saturday, or split it into two—whatever works for you. Set aside 20 minutes or so to think about a menu of two to three dinners for the week. I encourage planning two to three meals and planning to eat leftovers the rest of the week.

    I also recommend planning the week’s lunches, so you’re not tempted to “grab and go” with fast food. For lunches, I love to use my slow cooker to make healthy recipes, such as bean and vegetable chili or lemon chicken, and then portion them out into separate containers for the week’s lunches. Very little work or thinking for five days of healthy meals!

    Pick Your Recipes

    Meals don’t have to be gourmet or perfect every time. Pick recipes you like and are good at making while aiming to include all food groups. Repeat meals are fine—most of us have favorites we rotate over and over. At the same time, try to be open to new variations and recipe ideas. Creativity can make food planning and cooking much more fun and easy.

    Sometimes patients say, “I’m a lousy cook,” but I believe everyone can cook if they want to learn! I recommend starting with simple recipes using foods you love. When people start to get a little more confident at the cooking process and find meals they enjoy, they can start working on variations. For example, if you have Fajita Friday, you can use leftover salsa, avocado and shredded cheese for Salad Saturday. Other popular themes to try are Meatless Monday or Taco Tuesday.

    People tend to be black and white about what they will and will not eat. The idea of something like Meatless Monday helps us find an interesting balance and can encourage us try meals beyond our usual comfort foods. For example, Meatless Monday gives people who generally eat meat with every meal an opportunity to try foods they may not eat otherwise, such as legumes or tofu. And even better, it’s heart-healthy to go meatless once in a while to reduce the amount of cholesterol and saturated fat the family eats.

    Gaining in popularity the flexitarian lifestyle, which follows a primarily vegetarian diet with the occasional addition of meat or fish. It’s about flexibility, but also keeping your health in mind. You could try going meatless on Mondays, eat fish one day, and eat a different lean meat the other three days of the workweek.

    Try to plan for healthy recipes that overlap in ingredients to stay within your budget. For example, if I’m going to make a recipe with bell peppers, I’ll find another recipe or meal that also includes bell peppers but isn’t in the same genre. The key is to put together meals with the same ingredients without creating boredom. This is especially useful for herbs and spices that we generally don’t buy and that tend to be expensive, for example, fresh rosemary or basil.

    Prep It

    Break down the planning into four easy steps:

    1. Look at what’s in your fridge and pantry
    2. Find tasty and healthy recipes
    3. Make your grocery list
    4. Check your store’s flyers or clip coupons

    There are two schools of thought regarding store sales flyers and coupons. The first method is to check for specials after steps 1 and 2, so you’re not tempted to buy more than what you need. The second method, which works better for some budgets, is to find what’s on sale first and then plan your meals around those groceries.

    Take a Night Off

    It’s OK to eat out or order in every now and then. Remember that restaurant meals tend to be higher in calories, fat, and sodium and more expensive, with much larger portions than necessary. Planning meals in advance also allows you to look forward to a fun meal out with family or friends. Just make sure you dining out or ordering in doesn’t become a frequent, last-minute decision.  

    Meal Planning Tools

    Take advantage of digital tools, such as meal planning apps for Apple or Android devices and phones. Check out Choose MyPlate for an interactive weekly planning calendar you can type your menus on and sample two-week menus, both of which you can download and print.

    Meal planning is all about awareness, variety and efficiency. I encourage my patients to consider meal planning. When we plan and think about what we eat, we make healthier, more budget-friendly food choices. And let’s be honest—all of us could use a little more time efficiency in our lives!

    Meal Planning Tools

    Try these tasty recipes for a healthy, delicious dinner your family will enjoy:

    Want to learn more about how we can help you live a healthy life? Click the button below to view the list of our services.

    Learn More

  • June 05, 2018

    By MedStar Health

    Robotic surgery is one of the most effective and least invasive options we offer our hernia patients. In fact, we’re able to do even large hernia repairs with robotic techniques, which benefit patients with smaller “keyhole” incisions and less pain during recovery than traditional open surgery.

    A hernia occurs when an internal organ pushes through the muscle or tissue that holds it in place. Hernias can occur in the abdomen, groin, thigh, belly button, upper stomach or in previous surgical incision sites. When a hernia blocks off blood supply to an organ or interferes with its function, it can cause symptoms such as:

    • Fever, nausea or vomiting
    • Interference with daily activities or exercise
    • Pain at the site

    Most patients with hernias need regular monitoring to ensure they don’t get worse, and some need surgery to repair the weakened tissue. If you do need surgery, minimally invasive or robotic surgery is a safe, effective option for many patients. Still, it’s important to understand all your options before you and your doctor decide what type of hernia repair surgery is best for you.

    LISTEN: Dr. Zubowicz discusses traditional and minimally invasive hernia repair in this Medical Intel podcast.

    Types of hernia repair surgery

    Traditional open surgery

    This technique involves a large incision extending beyond the size of the hernia. Open surgery is required for very large hernias because we physically move the abdominal wall muscles to access the hernia, and then cover the gap with synthetic mesh to reinforce or strengthen that repair and the abdominal wall. Some patients with severe heart problems or who have a lot of scar tissue from multiple abdominal surgeries can only have open surgery and may not be candidates for minimally invasive options.

    Because the incision is larger with open surgery than with minimally invasive surgery, the risk of infection is higher. Patients also will have a longer recovery and longer hospital stay after surgery.

    Laparoscopic surgery

    Instead of one large incision, laparoscopic, or minimally invasive hernia repair uses multiple keyhole incisions, which are tiny incisions around the hernia. The 5 mm to 8 mm incisions allow the surgeon to insert a small telescope attached to a camera, called a laparoscope, and miniaturized surgical instruments to repair the weakened tissue and insert the mesh reinforcement.

    Smaller incisions result in lower infection risk, fewer complications and less pain than traditional open surgery.

    Robotic laparoscopic surgery

    Robotic laparoscopic surgery is a minimally invasive technique in which the surgeon manipulates robotic arms with instruments at a console instead of manually inserting tiny instruments inside the body. The way the surgeon moves their hands indicates the way the robotic “hands” move, giving the surgeon greater precision and range of motion than during traditional or laparoscopic surgery. During laparoscopic or robotic repair, we use keyhole incisions around the hernia, and a mesh reinforcement patch is put in from behind the abdominal wall. In open surgery, the patch is placed over the hole outside the abdominal wall.

    Similar to laparoscopic surgery, robotic surgery has a lower infection risk, less pain and a shorter recovery time than traditional surgery. Patients often can leave the hospital the same day or the next day. In terms of getting back to exercise, we ask patients to hold off on weight training or extreme sports for up to six weeks to allow the repaired tissue to heal properly. But most patients can resume light aerobic activity such as walking within a week.

    A note about the mesh used in hernia repair

    There are scary commercials online and on TV stating that hernia repair mesh causes infections. It’s true that when a foreign substance such as mesh is placed in the body, the risk of infection increases. But for the vast majority of hernia repairs, the benefits of the mesh far outweigh the risk. And mesh repairs have a substantially lower risk for additional repair in the future than surgeries done without it.

    Robotic laparoscopic surgery is a minimally invasive option with faster recovery time and less pain, even for patients with large hernias. bit.ly/2LOcJSF via @MedStarWHC

    Click to Tweet

    If you need hernia surgery, choose a surgeon who is skilled in all of these techniques. Sometimes, due to a surgeon’s training limitations, patients are given an open repair when a minimally invasive approach could be just as effective. Be sure to ask questions and get a second opinion if a surgeon tells you minimally invasive or robotic surgery is not an option for you.

    Call 202-877-3627 or click below to make an appointment for hernia repair.

    Request an Appointment

  • June 04, 2018

    By MedStar Health

    A mere 24 hours after landing in Santa Monica, Marilyn Abrams knew the fun part of her two-month stay was over.

    The trip started off well enough for the Bethesda resident. After breakfast and a morning stroll, Marilyn decided to take a bike ride along the Pacific. But then things took a turn for the worse: She lost her balance, toppling to the ground. To her horror, she couldn’t get back up.

    Within minutes, Marilyn was in an ambulance; within hours, she was in an operating room as surgeons worked to put her badly broken left femur back together again. She ended up spending six of her eight vacation weeks either in the hospital or a rehabilitation facility.

    Once back home, however, Marilyn, then 72, noticed that her left hip was bothering her even more than before the fall. Between the growing pain and a leg that was a half-inch shorter than the other due to surgery, she also had a bad limp. “I started looking around for the best hip replacement surgeon I could find,” Marilyn said. “But because of my previous surgery, I was getting wildly conflicting opinions on everything…from when I could have the replacement to what my recuperation would be like. It was so frustrating!”

    To stave off her pain while she continued her quest, Marilyn did physical therapy. And that’s what led her to the doctor she needed: Brian Evans, MD, of MedStar Georgetown University Hospital. 

    “My physical therapist, who wasn’t even affiliated with MedStar, told me Dr. Evans gets all the really difficult cases,” Marilyn recalled. “I made an appointment immediately, and it made all the difference in the world.” 

    Chief of the Adult Reconstructive Surgery Service at the Hospital and a hip and knee specialist with the MedStar Orthopaedic Institute, Dr. Evans is known throughout the region for his success with the most complex cases, including surgical revisions to correct failed or painful total joint replacements.

    With arthritis, a leg length discrepancy, and a titanium rod and screws holding her thigh bone together, Marilyn fit the profile. 

    “First, we had to remove all the hardware from Marilyn’s leg, which was overgrown in spots by bone tissue,” Dr. Evans explained. “With empty holes where the screws once were, Marilyn’s femur was now even more fragile. Her reconstruction would have to accommodate the weakened bone to prevent refracture and allow weight bearing.” 

    Marilyn walking on a treadmill
    Regular exercise helps Marilyn stay in top shape after her successful hip replacement.

    Complicating matters further, Marilyn’s leg had rotated during healing, leaving a slight deformity.

    “It all adds up to a more difficult procedure,” said Dr. Evans, who estimates that up to half of his patients are referred from other orthopaedic surgeons. “You have to consider so many things that are simply not an issue with a straightforward replacement.”

    Despite its complexity, Marilyn’s operation took Dr. Evans only about 90 minutes to complete, including restoring her leg length. Just like any other hip replacement patient, Marilyn was up and walking the day
    after surgery. The next day, she was home.

    Only 10 weeks after her replacement, she was traveling again and thrilled to discover she could dash through the airport to catch a connecting flight.

    “Dr. Evans gave me my balance and my abilities back,” Marilyn said. “I feel absolutely renewed, and can’t say enough good things about Dr. Evans and MedStar Georgetown.”

    Request an Appointment

    MedStarGeorgetown.org/HipReplacement or call 202-295-0549 to make an appointment.

  • June 04, 2018

    By David Mayer, MD

    In today’s data-driven world, there’s more incentive than ever to be the best. Health care is no exception. But here’s the challenge: Who’s determining what it means to be the “best”?

    Many organizations provide hospital rankings. Some are part of government databases or consumer rankings. Not all of the organizations are focused on the same aspects of the hospital experience, and they use different methodologies to come up with their rankings. Some organizations charge hospitals a fee to use their rankings as part of a marketing strategy. The end result is an inconsistent mess of ranking systems in which very few hospitals are ranked at the same level in multiple systems—and no hospital is ranked the same in every system.

    But there is hope for healthcare consumers to make some sense of these mixed ratings. It just takes some extra effort to understand what’s being measured, what types of hospitals are being compared, and what exactly is being compared.

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    What data are being measured?

    Various ratings organizations examine different metrics, or key measurements, using healthcare rankings systems to compare hospitals. For example, the Centers for Medicare and Medicaid Services (CMS) uses a system called Hospital Compare to measure data obtained from hospitals based on seven key criteria:

    • Mortality, or the death rate for patients who have specific conditions or treatments
    • Safety of care
    • Readmission, or how often patients have to be admitted again to the hospital on an unplanned basis
    • Patient experience, or how satisfied patients were with various aspects of their care
    • Effectiveness of care
    • Timeliness of care, or how quickly patients with key conditions were seen
    • Efficient use of medical imaging

    That’s a comprehensive look at what a hospital is doing well and where it can improve. But then you look at other hospital-rating organizations that also measure safety, and they’re not looking at the same data as CMS. Of course, these other organizations want to stand apart from CMS—otherwise, we’d all just use the CMS ratings. This leads to ranking organizations that can’t agree on what makes a hospital the “best” in a given area.

    #Hospital ratings are confusing because organizations use different criteria to draw conclusions. bit.ly/2kMRpBs via @MedStarWHC
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    It’s also important to look at the time period from which a rating system is getting its data. Some use information from two to three years ago. That’s a long time in terms of policies and procedures in large academic medical centers like ours across the country. You may be looking at data that don’t reflect the hospital’s current operations.

    We constantly work to improve how our hospitals provide care. One great example of this is from 2014, when our internal records showed that the orthopedic surgeons’ patients at MedStar Union Memorial Hospital in Baltimore had no infections after 1,600 knee-replacement surgeries in the prior two years. That’s the best rate in the state of Maryland and one of the best in the country. So my team studied what the doctors and their teams were doing and applied that standard of care to all the hospitals throughout the MedStar Health system. We also share our findings with other hospital systems, and we apply what we learn from them to improve our care.


    What hospitals are being compared?

    It’s also important to consider that comparing the ratings of all hospitals within a certain geographical area may not be giving you the full story of how well those hospitals take care of their patients. It’s really hard to do an apples-to-apples comparison of smaller community hospitals to larger academic medical centers because of the different types of care they provide.

    Smaller hospitals may not be equipped to care for some complex medical problems such as strokes, which have a high risk of negative patient outcomes or even death. More complex cases often involve higher numbers of hospital readmissions, which can influence the scores of the larger centers that are equipped to care for these conditions despite their patients receiving the best care.

    Related reading: The need for fast stroke care–and why some patients don’t get it

    Another potential source of confusion about hospitals’ rankings is that many of the metrics the ranking systems use are based on financial and claims information, rather than true healthcare outcomes. There have been many instances in which a hospital system, having changed nothing about its medical care, improves its rankings significantly just by getting new claims coding and documentation software. That doesn’t mean it’s now a great hospital—that means it always was. The staff members simply didn’t have the tools needed to show it before, and some smaller hospitals may not be able to afford such tools.

    How do you know what to compare?

    So do data and rankings mean nothing? Should you just pick the closest hospital from Google Maps and hope for the best? Certainly not. Good healthcare data help people become better healthcare consumers. But finding this information is just the first step for an informed healthcare consumer.

    Good #healthcare data helps people become better healthcare consumers. bit.ly/2kMRpBs via @MedStarWHC
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    Start by comparing the hospitals you’re considering on the CMS Hospital Compare search page. This tool gives patients and family members good basic information as they begin their research. Next, dig a little deeper into the hospitals’ rankings for the specific specialty you or your loved one needs. For example, the Society of Thoracic Surgeons (STS) does a fantastic job of rating hospitals by outcomes in heart surgery. Recently, STS awarded MedStar Heart & Vascular Institute at MedStar Washington Hospital Center its highest rating, three stars, in all three ranked heart procedures. You can access that database at its public reporting page. Databases have been established for other medical specialties as well.

    When you’ve narrowed down your choices, schedule a consultation with a specialist at a hospital you’re considering. Ask them about their experience, including:

    • How many of these surgeries have you done?
    • How long do your patients usually stay after this surgery?
    • What’s your infection rate?
    • What types of complications are possible after this surgery, and how often do your patients have them?
    • How often do patients need to be readmitted after this surgery?

    Good hospitals want to share these data with potential patients and their families. If the data are good, they’ll showcase the hospital’s expertise. As a transparent organization, MedStar Health audits every specialty to share this information with our patients, so they can feel confident in their healthcare choices. If a provider tells you they don’t have that information, you should be cautious about trusting them with your care or that of your loved one.

    Of course, today’s connected world means word of mouth is a more powerful tool than ever for making important decisions like where to go for health care. Talk to your friends and family members about whether they recommend the hospital you’re considering. Ask your neighbors or co-workers if they’ve had good experiences. Ask your primary care doctor if they would send their patients or loved ones there.

    We all wish comparing the ratings of healthcare systems were as easy as grades on a test or report card. But useful comparisons of such complicated measurements often aren’t that easy. They require research on your part to become an informed consumer and patient.

    You are the most important part of your healthcare team. Make sure you choose a team you trust, be active in your care, and keep asking questions until you get the answers you need to make an informed decision.

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