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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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  • January 31, 2018

    By MedStar Health

    Researchers from the Firefighters’ Burn and Surgical Research Laboratory at MedStar Washington Hospital Center evaluated wound cleansers to limit the effects of two strains of antibiotic-resistant bacteria.

    Published in Advances in Skin and Wound Care, this study sought to identify the effectiveness of wound cleansers that may be used in both the setting of chronic wounds and in actue wounds such as burn injuries. The goal of “Disruption of Biofilms and Neutralization of Bacteria Using Hypochlorous Acid Solution: An In Vivo and In Vitro Evaluation” was to see which cleansers were most effective in stopping methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, two infections that can impact patient outcomes.

    The lead author on this was Anna Day. The study team included Abdulnaser Alkhalil, PharmD, Ph.D.; Bonnie C. Carney; Hilary N. Hoffman; Lauren T. Moffatt, Ph.D.; and Jeffrey W. Shupp, MD. The Burn Center at MedStar Washington Hospital Center is the only adult burn center in the region and the Burn Research Team here focuses on the study of surgical and chronic wounds and traumatic injuries, including wound healing, non-invasive imaging, and burn pathophysiology.

    This study utilized collagen films with active bacterial cultures, which were treated with the wound cleanser, Vashe Wound Solution (VWS), 1% and 10% povidone-iodine, 0.05% chlorhexidine wound solution (CWS), or normal saline.

    The films were then evaluated using multiple assays to assess bacterial cell death, and using traditional quantitative cultures. Each assay was performed in three times for each treatment group, and the experiment was done in duplicate for each bacterial strain. The cleanser was also tested for cytotoxicity in human skin cell cultures to evaluate for the potential cell toxicity to the host wound bed.

    The MRSA films treated with the VWS were found to have a similar amount of live bacteria cells as the CWS-treated films. Both of these films were found to have a higher number of dead cells than live cells and both showed more dead cells than those films treated with the saline.

    “These findings support the use of VWS in the treatment of wounds with biofilms,” the study concluded. “Ultimately, VWS had a similar effectiveness to CWS in eliminating bacteria but with lower cytotoxicity.”

    Advances in Skin & Wound Care, 2017. DOI: 10.1097/01.ASW.0000526607.80113.66

  • January 31, 2018

    By MedStar Health

    As part of the MedStar Health commitment to research across the system, we are proud to announce the launch of PowerTrials within our electronic health record (EHR).

    PowerTrials is a new module within MedConnect that integrates current research studies into clinical care through a unidirectional connection with OnCore, our clinical trial management system (CTMS). This connection allows for clinicians to access information about a patient’s participation in a MedStar Health or Georgetown clinical trial, as well as information about the study, in one location when in the EHR. The plans for this stage of integration was announced at the Fall 2017 MHRI Town Halls and has gone live as of February 1, 2018.

    Key functionalities of PowerTrials, which enhance patient safety, include:

    • Clinicians have awareness of their patient's research participation via an “on study” flag on the demographic Banner Bar
    • Clinicians can view the research study description and recruitment information in PowerChart at the point of care and can take the study information into consideration when caring for the patient; while most patient participation in research does not overlap with their routine clinical care, any questions during the course of the patient’s treatment may be directed to the point of contact listed in the research study information, located in the Clinical Research tab
    • Study contact information for the investigator and coordinator, which can be used in the Message Center, will enhance non-urgent communication between the clinical and research teams
    • Automated alerts will be sent to the research team’s Message Center when a research patient comes into the Emergency Department or inpatient admission
    • An auditor/monitor workflow is available to ensure HIPAA compliant access for study monitors and auditors

    Thank you to all who have been a part of launching these new systems to help support research at MedStar. For more information about PowerTrials, please contact research@medstar.net.

  • January 30, 2018

    By MedStar Health

    It can be a shock to look down at the toilet paper after going to the bathroom and seeing bright red blood—a classic symptom of hemorrhoids. But hemorrhoids are no big deal, right? Just wait a few days, maybe pick up some cream from the pharmacy, and life will go back to normal. Unfortunately, it’s not that simple.

    We are all born with small veins supplying the anus and rectum. However, over time, the tissue above the vein becomes weak and the veins enlarge and bulge. This is how a hemorrhoid develops. If something agitates them, they can cause symptoms such as rectal bleeding, soreness and itching. Hemorrhoid symptoms are similar to the symptoms of other conditions that are much more serious or can even endanger your life.

    About 75 percent of adults will have symptomatic hemorrhoids to some degree in their lifetimes. Of these, only about one-third will need medical attention to treat the problem. So how do you know when to get medical help?

    LISTEN: Dr. Patel discusses hemorrhoids in the Medical Intel podcast.

    Serious issues often mistaken for hemorrhoids

    Anytime there’s bleeding from the gastrointestinal (GI) tract, which includes the anus and rectum, that’s concerning to me as a gastroenterologist. If a patient comes in and reports this kind of bleeding, we have to think about the much more serious issues that also can cause bleeding in this area, such as:

    • Abnormal blood vessels in the colon. These are present from birth in most people who have them.
    • Anal fissures, which are small tears in the tissue of the anus that also can cause bleeding.
    • Colon polyps or even colorectal cancer. Bloody stools and constipation are a few of the symptoms associated with colorectal cancer, so they’re not signs we can afford to take lightly.
    • Diverticulosis, which causes areas of the colon’s lining to weaken and form small pouches. These pouches can erode over time and cause bleeding, which appears during bowel movements.

    Patients who come to see me for rectal bleeding or pain need a thorough examination, which includes us discussing how long their symptoms have been going on and whether additional concerns have developed. For example, long-term bleeding can cause anemia, a shortage of red blood cells. Our blood tests can tell us approximately how long this process has been going on, which often is longer than patients have noticed the symptoms. The length of time can give us a clue as to whether it’s a case of hemorrhoids or something potentially more serious, and it can let us know if we need to do more testing.

    Hemorrhoids treatment and reducing your risk

    The first step, however, is talking to your primary care or family doctor about these symptoms. Most of the time, they’re signs of hemorrhoids, which a primary care doctor usually can treat successfully. If you have hemorrhoids, you likely don’t need to see a specialist like me at first.

    The connective tissue that keeps hemorrhoids in their place can get thinned out for many reasons. Straining to have a bowel movement is a common cause. Constipation, which we define as having three or fewer bowel movements in a week, is another frequent trigger for hemorrhoids. The way toilets are built also can contribute to the problem. The bowl of a toilet doesn’t support your bottom the same way a chair does. When you sit on a toilet, the perineum—the area between the thighs where the anus and rectum connect—can drop an inch or two into the bowl area while you have a bowel movement. That strains the connective tissue and can lead to symptomatic hemorrhoids over time.

    Of course, diet also plays a role in developing the symptoms of hemorrhoids. Not getting enough fiber in your diet can make the stool in your colon bulkier and drier, which increases the chances of becoming constipated. If you’re not drinking enough water, your colon will pull more out of the food you eat, which leads to the same problem.

    Controlling your hemorrhoids symptoms usually focuses on addressing the causes of constipation. Your doctor likely will recommend that you increase the amount of fiber in your diet. Vegetables and fruits, particularly fruits with peels, are a great way to increase the amount of fiber you eat. Foods with bran and oats, such as bran cereal or oatmeal, also pack on the fiber. If dietary changes aren’t enough, or for people who aren’t ready to change their diets, over-the-counter fiber supplements like Benefiber or Metamucil can help.

    You’ll also need to make sure you’re getting enough fluid each day. Adults should drink 48 to 64 ounces of fluid per day. Among its many other benefits, getting enough fluid makes the stool softer and less painful to pass.

    Adding #fiber to your diet and drinking plenty of fluids can help relieve #hemorrhoids symptoms. via @MedStarWHC

    Click to Tweet


    And, of course, one of the best ways you can help your colon move waste out of the body is to exercise. The colon is a hollow tube of muscle, and it squeezes to push fecal matter along. Going for a walk or bike ride, taking an aerobics class or any other form of sustained exercise helps promote good colon health.

    If you try these measures for a few weeks with no improvement, or if your symptoms change suddenly, getting help from a gastroenterologist is the next step. But whatever you do, don’t just ignore these symptoms. Getting help early not only can improve your quality of life, but it also can help us catch potentially serious problems quickly and safely.

    To request an appointment with one of our gastroenterologists, call 202-877-3627 or click below to request an appointment.

    Request an Appointment

  • January 29, 2018

    By MedStar Health

    In 1988, MedStar Washington Hospital Center became one of the first four hospitals in the United States to implant a ventricular assist device, or VAD, in a patient with heart failure. Today, our Advanced Heart Failure Program uses left ventricular assist devices (LVADs) as a regular part of patients’ treatment plans. These amazing devices, implanted in the heart, can keep the heart pumping when medications are no longer enough.

    When LVADs were first invented, it felt very much like how the Wright brothers must have felt in 1903, trying to prove humans could use technology to fly. The LVAD technology wasn’t practical to use for most patients, and it didn’t allow people to do anything but lie in bed. It’s fascinating to see how far we’ve come. In just three decades, LVADs have blossomed from a seemingly impossible technology to become an advanced treatment option that’s given thousands of patients their lives back during heart failure treatment.

    How far LVADs have come

    The first LVADs were huge, bulky contraptions. They had to be connected to pumps the size of a refrigerator to keep them running. The size of the internal components required lots of room under the belly muscles to squeeze blood through the body. That ruled LVADs out for just about any patient who wasn’t a man who weighed 200 pounds or more. Most women and smaller men just didn’t have the room in their bodies to accommodate the internal equipment. And to top it off, these machines were entirely hospital-based, so a patient with an LVAD couldn’t go home.

    Our problem then was that we were trying to copy the natural human heart—an incredible machine. It fills with blood and pumps it out about 2.5 billion times in an average lifetime. So, of course, the first LVADs took this as the inspiration. But any “improvements” to the pumps just made them bigger or more complicated. For example, when the early air-powered pumps were changed to electric, that meant they had to have motors.

    It’s no wonder we only were implanting about five LVADs per year before the mid-2000s. Most people chose hospice care instead or only used LVADs as a stopgap measure, hoping for a possible heart transplant.

    The breakthrough and where we are today

    By the late 1990s, we realized we had to get away from trying to mimic the filling/pumping action of the human heart. Enter continuous-flow technology. We found that a pump that constantly keeps blood flowing, rather than stopping and starting again and again, can be smaller and more efficient. Now, instead of a pump the size of a refrigerator, my colleagues and I were developing an LVAD called the HeartWare, which fits in the palm of a hand. For this device, only a cable, controller and small battery pack need to be outside the body.

    In 2005, we finally got funding for the device, and one of my colleagues and I performed the first human surgery with our device at the University of Vienna. The first U.S. patient received their LVAD here at MedStar Washington Hospital Center in 2008. Today, we’re putting in 90 LVADs per year, of which the HeartWare is the most-often used, and our Advanced Heart Failure Program has grown to become one of the top five programs of its kind in the country.

    One interesting note about continuous-flow LVADs: Patients who have one of these devices no longer have a pulse.

    Patients who have a continuous-flow #LVAD for #heartfailure no longer have a pulse. via @MedStarWHC
     

    Click to Tweet

    LVADs as an alternative to heart transplants

    LVADs were first developed as a way to keep patients alive until they could get heart transplants. Today’s LVADs allow patients to do a lot more than just lie in a hospital bed and wait for a donor heart to become available. That’s good, because the D.C. area is one of the toughest in which to get a donor heart for a transplant. The chance that one of my LVAD patients will have a heart transplant within a year of receiving their LVAD is less than 20 percent.

    In part, that’s because the number of available hearts for transplant has stayed virtually the same for the past decade, even as the number of people who need a heart has gone up. And even if a heart is available, that doesn’t mean it will be acceptable for a transplant. A 2015 study found that, out of more than 82,000 hearts available nationally, only 34 percent were accepted for use in transplantation surgeries.

    The fact of the matter is that, without a huge increase in the number of donor hearts, most people with heart failure who could benefit from a heart transplant won’t get one. The LVAD has become the long-term solution for these patients.

    The future of LVADs

    LVADs have changed patients’ lives for the better in the last decade, and we continue to pursue advancements in the therapy and devices. Our next big challenge is to overcome the need for a power source and controller outside the body, which can limit what patients are able to do in their everyday lives.

    We’re hard at work designing the next generation of LVAD technology. And we’re hopeful that the next LVADs can be completely implanted in a patient’s body with just a small scar on the chest as the only evidence of heart surgery. This future LVAD will work like an artificial heart, keeping blood flowing for hours off a single charge. Afterward, the patient would charge up the LVAD with a patch on their chest, like a wireless charging station can recharge the battery of a smartphone.

    We also hope to get the word out to more people about how LVAD technology can help them. Only about 8 percent of the people who would benefit from an LVAD actually have one, compared to the 70 percent of people who can benefit from a defibrillator and have one. Many doctors don’t understand the advances we’ve made in the last 10 to 15 years, and that means patients aren’t learning about their options either.

    LVADs started out almost as a curiosity rather than a practical treatment plan. Now, LVADs provide essential care for people worldwide with heart failure. Think about the advancements between the Wright brothers’ first flight and then, less than 70 years later, blasting a team of astronauts to the moon. I’m astonished at how far we’ve come in heart failure treatment in just three decades, and I can’t wait to see the new horizons in store for us and our patients.

  • January 26, 2018

    By MedStar Health

    As with any other workplace, MedStar Washington Hospital Center goes to great lengths to maintain a safe environment for physicians, staff and, of course, patients. Yet, even the most well-established and effective practices may have room for improvement. For example, refining procedures or layouts can cut treatment area risks even further, while addressing situational stressors can reduce the potential of miscommunication and mistakes.

    For Kathryn M. Kellogg, MD, MPH, there’s no better place to put these best practices to the test than the Hospital Center’s Emergency Department, where she serves as an attending physician.

    Unique research insights

    “My clinical work feeds my research and administrative work,” explains Dr. Kellogg, who relishes emergency medicine’s rarity of routine days. “Along with being alert to how well our practices work across a wide variety of situations and patient presentations, I also get ideas for things to research, or barriers to effectiveness that need to be addressed.”

    Dr. Kellogg’s interest in emergency medicine and human factors safety engineering was cultivated in medical school at the University of Rochester, under the guidance of her mentor, Rollin J. “Terry” Fairbanks, MD, MS, who later founded MedStar Health’s National Center for Human Factors in Healthcare, a safety engineering research center, and now serves as MedStar’s assistant vice president, Ambulatory Quality and Safety. The opportunity to again collaborate with Dr. Fairbanks brought Dr. Kellogg to the nation’s capital, after her residency in emergency medicine at Vanderbilt University Medical Center.

    Since then, Dr. Kellogg’s work on patient safety, emergency care and avoidance of adverse events has been published in multiple peer-reviewed journals. Since starting at MedStar, Dr. Kellogg has been awarded more than $2 million in grants and contracts, to pursue her safety research. Her current research efforts include developing and testing a task management tool, to help emergency physicians reduce and mitigate interruptions during the course of treating patients.

    “There’s a lot we can learn from other industries with similar stressors, including understanding their causes, and how we can better train staff to handle them,” she says.

    A multi-faceted team member

    Dr. Kellogg also works with other MedStar entities on improving safety and eliminating potential problems. In a new role as Associate Medical Director, Quality and Safety, she joins multi-disciplinary teams to investigate safety events, focusing on identifying and rectifying the root causes rather than simply how individuals responded, providing another parallel to her Emergency Department work.

    “Effectively treating emergency patients on what is likely the worst day of their lives requires quickly gaining their trust and confidence,” Dr. Kellogg explains. “The same holds true when we’re talking with associates who may understandably feel anxious after being involved in a safety incident. It’s the only way we’ll get a full understanding of what happened and why, in order to make changes that will minimize the risk of it happening again.”

    Outside the hospital

    Appropriately for someone seemingly always on the go, Dr. Kellogg is an avid runner and plans to take part in the Rock n’ Roll Half Marathon this spring. She and her husband have three children, and true to her investigative nature, discovery is often on the fun time agenda.

    “We love to travel, taking our kids to new places and helping them explore new things,” she says.

  • January 26, 2018

    By Rocco A. Armonda, MD

    When a patient has a stroke, seconds and minutes can make the difference between life or death. Similar to someone who has had a gunshot wound or a serious car accident, a patient who’s had a stroke needs emergency care to save their life or prevent permanent, life-altering disabilities, such as paralysis or speech difficulties.

    Unfortunately, many factors can come together to slow down access to emergency care. Two of the factors I see most often that slow down patients’ access to stroke care are loved ones not recognizing the signs of a stroke and delays in getting patients to the right type of facility.

    How do you know if your loved one has had a stroke?

    Family members play a vital role in getting their loved ones stroke care as quickly as possible. But time after time, I see patients who have been delayed in getting care because their loved ones didn’t know the person was having a stroke.

    This isn’t to place blame—compared to medical events like heart attacks, strokes can be hard to notice for someone who isn’t actively looking for symptoms. During heart attacks, people are in obvious pain and often can tell you they need help. That’s not the case for people who are having strokes. Family members may notice something different about their loved ones but just wait too long before getting help. They may falsely believe the situation will improve without emergency care, unknowingly delaying treatment that could save their loved ones’ lives or function.
    #Stroke can be harder for loved ones to notice than #heartattack due to a lack of complaints of pain & obvious symptoms. via @MedStarWHC
    Click to Tweet

    It’s also possible for family members to simply not see that anything’s wrong. Stroke symptoms involve a decrease in the level of function or in the ability to communicate. If that happens to your loved one in the middle of a conversation, you’re more likely to tell. But I’ve seen cases in which the patient has a stroke while sitting quietly in a chair, and the family just thinks their loved one is sleeping.

    That’s why you need to be on the lookout for stroke symptoms, especially if your loved one is at risk for the condition. Strokes are more likely in people who:
    • Are overweight or obese
    • Don’t get enough exercise
    • Have a cardiac rhythm disturbance such as atrial fibrillation
    • Have a family history of strokes
    • Have diabetes
    • Have high blood pressure (hypertension)
    If your loved one has one or more of these risk factors, and you suspect they’re having a stroke, it’s time to think FAST:
    • Face: Ask the person to smile. If they can’t, or if only one side of their face moves, it could be a sign of a stroke.
    • Arms: Ask the person to raise their arms. A stroke can cause muscle weakness or paralysis, particularly on one side of the body.
    • Speech: Ask the person to repeat a sentence. If they slur their words or have trouble speaking, they may be having a stroke.
    • Time: Call 911 immediately. Don’t wait to see if the person gets better, and don’t try to take the person to the hospital yourself.
    #ThinkFAST if you think a loved one is having a #stroke: face, arms, speech, time. via @MedStarWHC
    Click to Tweet

    Where should your loved one go for stroke care?

    Dr. Armonda Army PhotoDuring my time in the Army, I was on battlefield deployment in Iraq. I was one of just two Army neurosurgeons, and there were a lot of soldiers who needed our help. We worked out of a centralized location in the middle of the country, and all severely brain injured soldiers were brought to us. Centralizing the neurosurgical care for these patients saved time and lives by preventing delays.

    Large vessel strokes should be treated with the same urgency and centralization as combat casualties are in war. Unfortunately, that’s not always the case. In our area, unnecessary delays have occurred when emergency medical services (EMS) personnel take patients having large vessel strokes to the nearest hospital that may lack the ability to perform lifesaving thrombectomies (catheter-based clot removals). Then, depending on that hospital’s affiliations or expertise, those patients end up getting transferred to facilities in Baltimore, or doctors rush from Baltimore to the patients. This wastes time that the patient may not have, and it just doesn’t make sense to me. In many cases, our Comprehensive Stroke Center and our sister hospital, MedStar Georgetown University Hospital, also a Comprehensive Stroke Center, are much closer than Baltimore to patients in Bethesda, Silver Spring, Rockville and many other communities.

    While it may be tempting to rush a patient to a hospital that’s two miles from their house, it may not actually save the patient time in the long run. Our Comprehensive Stroke Center or MedStar Georgetown University Hospital may be 10 or 20 miles from the patient’s home, but the time saved in the initial decision of where to bring them can translate to saved brain function.

    Especially for patients who need care for large-vessel occlusions, which are blockages in one of the large blood vessels bringing blood to the brain, treatment at a smaller hospital or one that doesn’t specialize in stroke care might not be enough. These patients may need a procedure called mechanical thrombectomy, a procedure to remove a stroke-causing blood clot that’s available only at specialized hospitals like ours.

    Related reading: How mechanical thrombectomy is revolutionizing stroke care

    How we streamline stroke care for our patients, and the vital role of EMS

    We treat patients who are having a stroke with the same sort of urgency as patients who have had a traumatic injury. For patients who come directly to us, we mobilize the team immediately, so we can assess the patient and complete imaging studies within about 15 minutes, with treatment underway in less than an hour.

    We’ve been working to bring our collaborative expertise from MedStar Washington Hospital Center and MedStar Georgetown University Hospital to hospitals that don’t specialize in endovascular stroke care through our regional telestroke program. When we identify a patient at one of these distant hospitals who needs emergency endovascular stroke care, we can help coordinate care there or bring the patient to us with emergency ground or air transportation. But that still can take precious minutes—time that might be saved if the patient were to get to us sooner.

    I have talked to doctors and EMS personnel alike, so they know patients can get the advanced stroke care they need with us. Ultimately, though, it’s up to the EMS operators and fire stations in the district, as well as in the Maryland and northern Virginia counties in our area, to change the decision-making process for their services. Some states have avoided unnecessary delays by mandating that EMS bring these patients directly to centers with full-time and experienced neuroendovascular capabilities. EMS providers can access a process developed by the American Heart Association (AHA) and American Stroke Association (ASA) to determine what type of stroke a patient is having and which stroke center can best treat it. The process is available online as a PDF for EMS providers.

    Ultimately, I’d like to see the AHA/ASA protocol become required at all levels—local, regional, state and national. Right now, there are no consequences for when the procedure isn’t followed, and families are left to pick up the pieces when their loved ones die or have their quality of life forever lowered because of strokes.

    Having the most advanced tools and technology to treat strokes is a commitment we take seriously. Stroke care starts with the loved ones and first responders who have to make swift decisions about the patient’s care. It’s a lot of responsibility, but I’m hopeful that more patients can get timely emergency stroke care as more people learn what to do in this kind of emergency.

    Learn more about thinking FAST if you think your loved one may be having a stroke.