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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:
    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 15, 2018

    By MedStar Health


    By John Irwin, MD, MedStar Harbor Pediatrics

    Every year, thousands of children and young adults are diagnosed with juvenile diabetes, also known as type 1 diabetes. Type 1 diabetes is an autoimmune disease that prevents the body from producing insulin, a hormone you need in order to survive.

    It’s important for parents to know the signs and symptoms associated with type 1 diabetes, and take their child to see a physician, if these conditions persist. Some of the most common early indicators include:

    John F. Irwin, MD
    • Increased thirst
    • Frequent urination
    • Extreme hunger
    • Unexplained or rapid weight loss
    • Fatigue
    • Irritability/mood swings
    • "Fruity" breath or odor
    • Blurred visition or inability to focus
    • Repeated yeast infections (girls)

    Learning that a child has diabetes can be devastating. However, know that the doctor will develop a comprehensive treatment plan that will emphasize health, wellness and the ability to selfmanage the condition, so your child can live a long, healthy life.

    If your child is diagnosed with type 1 diabetes, several medications may be prescribed to control and manage the condition.

    You will be taught how and when to measure blood glucose levels and urine ketones, how to document them, and what to do if your child has a low blood glucose reaction.

    Balanced, nutritious meals will become increasingly important in your household. And, most doctors will also suggest that you spend some time talking with your child about short and long-term goals. This is important, as it helps you understand what your child values most.

    Then you can determine what steps can be taken to assure your child can achieve those goals, despite the disease.

    We are happy to consult with you to answer any questions you may have, provide education and resources, and point you in the right direction, if your child needs specialty diabetic care and treatment.

    If you have concerns about childhood diabetes, or feel that your child may be at increased risk, take some time to talk with your existing pediatrician or call MedStar Harbor Pediatrics at 410-350-2253.

    Location Information

    For more information, please call



    MedStar Harbor Pediatrics
    Outpatient Center, Ste. 108
    3001 South Hanover St.
    Baltimore, MD 21225

  • January 15, 2018

    By MedStar Health


    MedStar Harbor Hospital's New President and Chief Medical Officer

    As a toddler, his favorite toy was a "Let's Play Doctor" medical kit. As he got older, the television show he looked forward to watching the most was "Emergency." Something about ambulances, sirens, and hospitals always appealed to Stuart Levine, MD, FACP.

    So it should shock no one that his career has evolved the way it has. Academic, clinical, and leadership experience all paved the way, leading Dr. Levine directly to the president and chief medical officer's seat at MedStar Harbor Hospital. It's a role for which he says he is extremely honored to have been selected. And, according to his colleagues, it's a role in which he already excels.

    Dr. Levine took some time to share his personal and professional experiences, his goals, and how he makes it a priority to ensure every single employee at his hospital feels valued and appreciated, while also ensuring that MedStar Harbor patients receive the highest quality care in a safe environment that meets their service expectations.

    What inspired your career path?
    I wanted to be a doctor at a very young age, which surprised a lot of people because I come from a family of accountants. I knew that if I went into medicine, I would have the opportunity to do good things, help people feel better, and make a positive difference. I have held a lot of different roles over the years, including the one I am in now. But I always have been, and always will be, a doctor first.

    Why did you join MedStar Health and has the organization been a good fit for you?
    I was working for an academic medical institution, but wanted to focus more on clinical care. I thought that I could achieve a good balance in a role that was centered on patient care, but also offered leadership opportunities and a chance to be involved in medical education programs.

    I found that balance at MedStar Health. I was here for just a short time when I was presented the chance to get involved in truly innovative work that could and would impact the entire MedStar system of care. The leadership team was receptive to my observations and encouraged me to bring new ideas and approaches to the table. They were confident in me, and that gave me confidence in myself.

    How did your career experiences prepare you for your new role?
    Every job I've had has helped me grow and prepare to lead MedStar Harbor. While each role has been different, all have carried a strong link to the things I am most passionate about: providing excellent patient care and taking every possible step to maximize patient experiences and outcomes; building relationships among the team, because everything is possible with strong collaboration and respect; and problem solving.

    Hospitals face numerous challenges every day. Many of the initiatives I have worked on over the years have requires strong scientific and systematic thinking. As a doctor who has also working in various leadership roles, I've been able to offer a unique perspective and solutions for consideration.

    Stuart Levine, MD, FACP, consulting with medical team at MedStar Harbor Hospital.

    You have a lot of responsibilities. How do you remain focused on what matters most?
    In health care, it's essential to always be thinking about the future, and the steps our organization must take to reach our goals. But it's equally important to keep a good focus on where we are now. I'm a believer in the value of being present.

    Obviously, I can only be in one place at one time, yet it's key that my influence as president and chief medical officer is felt throughout the hospital, even at times when I am not physically here. I can do this by inspiring people and instilling confidence in them when they do see me. I'm an active player in resolving conflicts, and helping everyone on the team identify the best resources to get our jobs done productively and efficiently.

    I make it a priority to be out in the hospital meeting with people in various roles. I want them to know that I am on their team too. And along the way, I want to make sure everyone is having some fun. That's important!

    Why do you believe MedStar Harbor is a great place to receive care? 
    This is a very friendly place. Many employees here consider their colleagues family. Our people take personal responsibility for ensuring every encounter with a patient or family member is a positive one. That approach goes a long way in our ability to deliver an outstanding patient experience and achieve the best possible outcomes for every person who chooses to come here for care.

    Additionally, during the past 18 months, MedStar implemented an "interdisciplinary model of care," or IMOC, as we call it, that aims to improve our internal collaboration and communications, as well as the way we share information with patients and their families. IMOC has had a positive impact at all the MedStar hospitals. MedStar Harbor was one of the earliest adopters of the new model. Our team played an instrumental role in building it, and that speaks volumes about our commitment to providing great care.

    What are the biggest challenges you face, especially in light of the constantly changing and evolving healthcare landscape?
    Health care is complicated. Period. Our daily work, and one of our biggest challenges, is to try to set the complicated stuff aside and think about the core principals that guided why we went into healthcare careers in the first place. We need to understand the regulatory, political, and financial factors that impact our industry, but we can't allow these things to distract us from what we are here to do. And that is to provide outstanding patient-centered care in alignment with the needs of our community.

    We need to constantly evaluate the services we offer and are known for, such as women's care and behavioral health, and keep growing in those areas. We need to develop new expertise, and invest in skilled providers, new technology, and expanded facilities to deliver that expertise in the form of excellent patient care. As we successfully expand our service offerings, we become better equipped to provide a true continuum of care.

    What are the three most important things for people to know about MedStar Harbor?
    First, this is a hospital you can come to for world-class care, in a warm, friendly, and family-focused environment. Along with that, MedStar Harbor is a great place to turn for a wide range of healthcare services. If your medical needs are more complex, and require a level of care beyond our capabilities, we are still able to help manage your care through our specialty service line partnerships with the MedStar Health system, which offers regionally and nationally recognized clinical programs at MedStar hospitals across the Baltimore/Washington, D.C., corridor. And lastly, in Baltimore City we are a "marquee" healthcare provider. We are a safe place to turn. You have our commitment that we will do everything in our power to take good care of you.

    What do you like to do when you are not working?
    I love spending time with my family, especially my three daughters, who are ages 16, 13, and 9. I am passionate about music and enjoy playing the guitar. I also like getting outdoors as much as I can, whether it's to go for a run with the dog, or take a day or weekend trip with my family. We love to go skiing, and some of us are adventure enthusiasts. My oldest daughter and I love roller coasters and our personal favorite is the Griffon at Busch Gardens in Williamsburg, Virginia.

    Can you share a fact about yourself that isn't well known?
    I'm a naturalized U.S. citizen. I was born and raised in Montreal, Quebec, Canada.

    Anything else you'd like to share?
    I am incredibly humbled and proud to lead this hospital. I'm grateful for the people who choose to come here for care, and for the people who choose to work here, and make this hospital as great as it is. MedStar Harbor Hospital is truly a special place, and I want everyone around us to know it.


    Winter 2018

    Location Information

    For more information, please call


    MedStar Harbor Hospital
    3001 South Hanover St.
    Baltimore, MD 21225

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  • January 12, 2018

    By Laura S. Johnson, MD

    Burn injuries are one of the leading causes of accidental death and injury in the United States. And while nearly 97 percent of people who suffer burn injuries survive, many will sustain serious, lifelong physical disabilities.

    We can turn these statistics around by following a few simple burn prevention tips and by knowing what to do if you or a loved one is burned. Unfortunately, we see a lot of mistakes because people simply didn’t know what to do in the situation or because they followed an old wives’ tale.

    Despite all the best prevention efforts, burns can happen. If you find yourself faced with a burn wound, whether it’s on you or a loved one, make sure you know what not to do. Let’s take a look at some of these more common mistakes, and talk about what should actually be done.

    Struggling with a burn wound? Request an appointment at our Burn Center.

    Request an Appointment

    5 mistakes people make when treating a burn wound

    1. Icing burn wounds

    Fight heat with cold, right? Wrong, at least when it comes to burns. Using cold water or ice on a burn is one of the biggest mistakes we see people make. I know it probably feels good at first, but it may end up doing more harm than good.

    Don’t forget that frostbite is as much a thermal injury as a burn caused by fire. They both damage tissue. You don’t want to add a cold injury on top of a heat injury. Also, you don’t want to lower your body temperature too much, as it can impair your physiologic response to stress. Instead, if it’s a small burn that doesn’t require immediate emergency care, run the wound under room-temperature tap water for 10 minutes. Then, apply a first aid burn cream or petroleum jelly and a bandage.

    2. Using home remedies

    Speaking of first aid burn cream, don’t try making your own. Mayonnaise, mustard, honey, butter—I’ve seen it all applied to burns. Toothpaste may have been my favorite because they smelled so minty fresh! While these products may not necessarily make a burn wound worse, they may impede healing by trapping the heat. And if they are contaminated in any way, they can lead to infection.

    So save the butter for your toast. Instead, use an over-the-counter, nonperfumed, antimicrobial moisturizing agent. You also can take an over-the-counter pain reliever, such as ibuprofen or acetaminophen for pain control.

    3. Popping burn blisters

    If your burns are severe enough to blister, you should probably be seen at a Burn Center. The providers can drain the blisters and provide dressings to protect the skin underneath.

    Related reading: When to seek treatment at a burn center

    4. Asking for antibiotics 

    “Is it infected? Do I need antibiotics?” This is a common question we get from burn patients. Antibiotics generally are not needed in the early management of burn wounds.

    There are a couple reasons for this. First, there’s no way to completely sterilize burn areas, since our normal, healthy skin has bacteria living on it on a day-to-day basis. Antibiotics prescribed to take by mouth will disrupt the normal balance of bacteria in our bodies.

    Second, as antibiotic resistance has grown over the years, we’ve become much more careful about how we administer antibiotics. The topical agents we put on burns are anti-microbial, which provide an antibiotic action, but it’s targeted to the specific area. This way, we can avoid impacting a person’s entire body.

    5. Underestimating burn wounds 

    Burns can be deceiving. Unless you see burns all the time, it can be easy to be fooled into thinking one isn’t as bad as it actually is. I would much rather you overestimate how bad a burn is and come in than wait too long and face long-term consequences, such as amputation or loss of function.

    If the burn is bigger than the palm of your hand or there is blistering, seek help. You also should seek medication attention if you have a persistent fever or redness that extends beyond the border of the burn injury, as these may indicate an infection.

    You also may want to consider seeking treatment at a specialized Burn Center like ours. The American Burn Association recommends you receive treatment from a burn center if you have:

    • Burns that involve the face, hands, feet, genitals or major joints
    • Third-degree burns, which can appear whitish, charred or translucent with no sensation in the burned area when pricked with a pin
    • Burns that cover more than 10 percent of total body surface area
    • A pre-existing medical condition that can complicate recovery, such as diabetes

    While it’s always good to know how to treat a burn wound, we hope you’ll never actually need to use that knowledge. You can reduce your burn risk by avoiding a few common mistakes.

    5 mistakes that can increase your burn risk

    1. Not wearing safety gear

    It’s not always appealing, but safety gear can save your life. This can include goggles, gloves and shoes. It may seem like common sense, but you’d be surprised by the number of people we treat who were burned because they weren’t wearing oven mitts to pick up a hot item in the kitchen.

    A few years ago, we treated a number of patients injured in unexpected laboratory accidents. While they did suffer burns, the injuries could have been much worse had they not been wearing safety goggles.

    2. Not being aware of your environment

    Stop for a moment. Do you know where the nearest exits and fire extinguishers are? Along with preventing a fire in the first place, it’s important to think about protecting yourself and escaping from a fire as well. A little pre-planning can go a long way. Make sure everyone in your household knows how to escape various rooms in the house, and establish a plan for where to meet up at a safe distance.

    3. Not knowing how to put out a kitchen fire

    When a pot or pan catches fire in the kitchen, people tend to want to throw it in the sink or outside. This can lead to a burn while picking it up or to the fire spreading as it’s moved.

    Instead, if there’s a fire on the stovetop, cut off the oxygen that feeds it by covering the pot or pan with a lid. If this doesn’t work, pour baking soda on it or grab the fire extinguisher. Don’t try to smother the fire with a towel unless it’s soaking wet.

    If something catches fire in the oven, shut the oven off and back away. The fire should eventually die down on its own. Once it’s cooled, you can open the oven and clean things up.

    If a fire doesn’t die down within a few minutes or begins to spread, call the fire department immediately.

    Related reading: Tips to avoid burns in the kitchen

    4. Not using sunscreen or checking the temperature of bathwater

    These are two basic burn prevention methods that too many people don’t take seriously enough. A first-degree sunburn, while maybe not life-threatening, can be exceptionally painful. Use a sunscreen with an SPF of 30 or higher and reapply every two hours or after swimming or sweating.

    And while most people tend to think of checking the temperature of their child’s bath, they often forget when it comes to our elderly loved ones. Temperatures that healthy adults might be able to tolerate can be enough to cause burns on the fragile skin of the young and old.

    5. Not following instructions

    Before you throw a turkey into your new deep fryer, have you read the manufacturer’s instructions? Most appliances and electronics carry a risk of fire, especially if not used as directed. I’ve seen it all, including burns from e-cigarettes exploding .

    We often can prevent fires and burns by following a few simple tips, and we can keep burn injuries from becoming more serious by avoiding common mistakes. If you or a loved one suffers a burn injury, seek immediate treatment at a Burn Center. Even if you don’t think the burn is “that serious,” we can make sure you receive appropriate care to prevent infection, reduce scarring and lower the risk of long-term complications.

  • January 10, 2018

    By MedStar Health

    Top 5 Blog Posts of 2017

    From a solar eclipse with potential vision threats to a shift in long-standing heart health guidelines, 2017 was a remarkable year for health care. Through it all, we’ve provided breaking news and health tips on the Center View blog to keep the D.C. area informed.

    We reviewed our 137 healthcare news stories of 2017 (which were read by nearly 510,000 readers!) and selected the following as our top five healthcare news stories of the year. Best wishes for a healthy and happy 2018 from all of us at MedStar Washington Hospital Center!

    1. Tips to make colonoscopy prep more bearable

    Colonoscopy Prep liquids

    Patients often say the worst part of getting a colonoscopy is the prep before the screening. The liquid diet, the bowel-clearing fluids, the newfound relationship with the bathroom—unfortunate necessities for this lifesaving screening. Our readers submitted personal tips for making colonoscopy prep a little easier, and we compiled them in this March 2017 blog article. Learn more.

    2. Changing blood pressure targets frustrate patients – and doctors

    Doctor Measuring Patient's blood pressure

    Different health organizations have varying opinions on what constitutes high blood pressure. Then, in November 2017, new hypertension guidelines mean that nearly half of adults across the country are now considered to have high blood pressure. Dr. Allen J. Taylor discusses challenges with research and shares blood pressure management tips. Read more.

    3. Knee replacement alternative relieves pain, retains mobility

    Female medical provider examines athlete's injured knee

    If you’re facing knee replacement due to arthritis, you might feel like you’re caught between a rock and a hard place. Being active is painful, but being inactive while recovering or giving up high-impact activities like running, jumping and skiing sounds awful. Dr. Evan Argintar, an orthopaedic surgeon, discusses alternatives to knee replacement that can ease your pain and keep you active. Discover your options.

    4. Five tips to protect your eyes during the solar eclipse

    solar eclipse resize thumbnail

    The first coast-to-coast solar eclipse since 1979 crossed the skies on Aug. 21, 2017. People in the Washington, D.C., metropolitan area were treated to about 80 percent coverage of the sun that afternoon. Solar eclipse frenzy gripped the U.S., with people traveling hours to catch a glimpse. However, even a small amount of direct sunlight can damage the sensitive tissues of the eyes. We shared an article by Dr. Namratha Turlapati, an ophthalmologist, on how to enjoy the solar eclipse without damaging the eyes. Relive the solar eclipse excitement.

    5. How do colorectal cancer screenings measure up?

    Colorectal screening sign

    The gold standard for colorectal cancer screening is colonoscopy. It’s an accurate, effective test that may reduce the average person’s risk for getting colorectal cancer by 40 percent. But preparing for a colonoscopy can be a hassle, and some patients would rather have an alternative to this test. Dr. James F. FitzGerald discusses alternative colon cancer screenings and whether they’re as effective as colonoscopy. Learn more.

    Click the image to see the full-sized infographic.

    Top 2017 Blog Posts

  • January 09, 2018

    By Jack Sava, MD

    Imagine you’re walking to the bus or train when you spot a person lying on the ground, blood pooling under their leg. What do you do?

    The first instinct for many people is to freeze. Unfortunately, that response leads to avoidable deaths. Massive blood loss (hemorrhage) is the cause of death for more than 40 percent of people who die within 24 hours of sustaining a traumatic injury. Even when a person has the presence of mind to call 911, the victim could bleed to death by the time emergency responders can get them to our Level I Trauma Center. The luckier victims who make it to the hospital often are unconscious and need emergency surgery within minutes of arrival.

    While our trauma team is specially trained for these emergency situations, bystander intervention can help us save many more lives. In other words, it’s just as important for regular people in our community to learn how to stop a stranger’s blood loss as it is to learn CPR. And that’s why my team and I are actively involved in the Stop the Bleed campaign, a national movement to teach bystanders how to help people with bleeding wounds.

    LISTEN: Dr. Sava discusses how bystanders can stop blood loss in this Medical Intel podcast.

    What is the Stop the Bleed campaign?

    The Stop the Bleed campaign was started in response to mass shootings in the U.S. The general premise is that first responders, specifically police officers, should be able to stop bleeding with direct pressure, appropriate dressings and tourniquets. But we realized quickly that this doesn’t just apply to police officers and mass shootings—it applies to all our lives.

    An adult can die in less than five minutes from a bleeding wound in a critical area. Some areas, such as the neck or groin, can be very hard to control, even by expert medics. Other smaller wounds may stop on their own without much help. Stop the Bleed focuses on the broader middle ground—people who have severe bleeding and who need quick action by others within the hour after injury to save their lives.

    I’ve seen footage of crowds of people standing around a person on the ground, watching them bleed to death. They’re frozen, not sure what to do or scared to act. As a trauma surgeon, it’s torture to watch people who are well-intentioned but don’t have the training and preparation to do a couple simple things to save a life. Bleeding control, in many cases, can be easier—and more successful—than CPR.

    A person can bleed out in < 5 minutes from a bad wound. Don’t hesitate—apply pressure and call 9-1-1. via @MedStarWHC
    Click to Tweet

    What to do if you see someone bleeding

    If you find the victim by yourself, your primary objective is to put pressure on the wound, then call 9-1-1 when you can. If another person is with you, one of you should call 9-1-1 while the other person puts pressure on the victim’s wound.

    To apply pressure and stop the bleed, you first must find the actual wound. This sounds obvious, but if a person’s entire pant leg or shirt sleeve is covered in blood, the source might not be easy to identify. You might have to roll up, tear away or cut off the person’s clothing to find the wound.

    The next step is to press on the wound—hard. This may cause the person more pain, but applying hard, continuous pressure is the only thing that will stop the bleed. Protect yourself with gloves when you can. It’s OK to use a shirt or bandage when you apply pressure, but it’s not critical. In fact, using too much cloth or gauze actually can spread out the pressure, making your efforts less effective. Use your hands or kneel directly on the wound, as military medics are trained to do in the field. Don’t worry if your hands or shoes are dirty—the risk of getting germs in the wound is meaningless if the person bleeds to death.

    Additional steps may require some simple equipment. If any emergency responder arrives, or if you have access to a Stop The Bleed kit, you will be able to use hemostatic dressings, or a tourniquet. Hemostatic dressing is a type of gauze that is coated with special substances that help stop bleeding. The hemostatic dressing is placed directly on the wound and have continuous pressure applied until the bleeding stops.

    The tourniquet is an ancient tool that has recently become very popular, especially with the new, easy-t0-use designs. A tourniquet is a device that’s similar to a belt—you can place it around a wounded limb and tighten it to stop blood loss. These devices have been around for a long time, and one of the goals of Stop the Bleed is to make them readily available, just like defibrillators are available in public places for cardiac resuscitation.

    The key thing about a tourniquet is that it must be placed above the wound—upstream of the blood flow, if you will—rather than directly on the wound or below it. So, if you find a person with a bleeding wound right above their knee, you should place the tourniquet around the thigh (above the knee) and pull it tight to block blood flow to the wound and stop the bleed. A tourniquet can be left on for a few hours if necessary while awaiting medical care before the risk of permanent tissue damage from lack of blood flow would become a concern. Tourniquets can be highly effective for traumatic injuries to the legs or arms. However, if the wound is in the groin, armpit or another area of the torso, direct pressure is a more effective method to stop blood loss.

    Over the past decade, we’ve seen more emergency responders putting on tourniquets in the field, and citizens commonly use them as well. We’ve seen patients in our trauma center who suffered a workplace accident and someone applied a tourniquet. Often, these individuals arrive awake and alert when, without the tourniquet, they likely would have arrived soaked in blood and perhaps near death.

    How to get Stop the Bleed training

    The Stop the Bleed campaign team has developed course materials with simple messaging around the importance of bystander intervention, bleeding wound management and more. We use a simulation mannequin leg to teach pressure application skills during our one- to two-hour education sessions at local organizations.

    We’ve started to present Stop the Bleed sessions in middle schools, which have raised an interesting discussion nationally: What’s the appropriate age for kids to learn about bystander intervention for bleeding wounds? Across the country, middle and elementary school students learn basic first aid skills and CPR. However, many people consider bleed management to be too scary to teach to children. I disagree—I’ve been educating my kids about it from the time they were 4 or 5. If I got a minor cut on my finger while working around the house, I’d call the kids to me and show them how to stop the bleed.

    If you’re interested in a Stop the Bleed course for your family or your community organization, visit to find courses online or contact our Level I Trauma Center or a trauma center local to you. There are many certified trauma providers in our community who want to help equip you with the skills to potentially save a life one day. While bleeding wounds might be scary, safe blood loss management is vital for all of us to learn to keep each other safe.

    infographic for first aid bleeding treatment

  • January 08, 2018

    By Kenneth D. Burman, MD

    In May 2017, the U.S. Preventive Services Task Force (USPSTF) recommended that doctors not screen routinely for thyroid cancer in patients who don’t show symptoms of the disease. This recommendation came after the task force conducted a review of evidence relating to the diagnosis and treatment of patients with thyroid cancer.

    I think the USPSTF did an excellent job with this process. And, for the most part, I agree with the task force’s recommendation. But it does raise some questions:

    • Why don’t we just test everyone?
    • What do other organizations think?
    • When should we consider screening for thyroid cancer?

    Let’s go through each of these questions individually, along with what I think is the best approach for thyroid cancer screening.

    Why don’t we just test everyone for thyroid cancer?

    The problem with testing everyone for thyroid cancer is that doctors likely would over-diagnose the disease, which already may be a problem. The rate of people being diagnosed with thyroid cancer has gone up dramatically in the past few decades. In 1975, 4.85 out of every 100,000 people were diagnosed with thyroid cancer, as shown by data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. In 2013, that number had skyrocketed to 15.31 out of every 100,000 people—an increase of more than 215 percent in less than 40 years.

    The number of people diagnosed with #thyroidcancer has increased more than 215% in less than 40 years. via @MedStarWHC

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    Much of this increase in the number of diagnoses is thought to be due to better methods of detecting thyroid cancer growths, also known as nodules, with imaging technologies such as thyroid ultrasound. The idea is that we’re diagnosing more people because we can see more thyroid nodules than we could before, especially those that are smaller and earlier in the disease process.

    But better testing may contribute to over-diagnosis of thyroid cancer. The USPSTF stated that there hasn’t been an increase in the number of people dying from thyroid cancer despite the rise in the number of people who have been diagnosed with the disease. This could mean that doctors are diagnosing thyroid cancer in people who might not need treatment.

    Like any medical treatment, treating thyroid disease does come with some risk. Depending on how large a person’s thyroid nodule is, treatment may involve the surgical removal of either part of the thyroid (called a lobectomy) or the entire thyroid (called a thyroidectomy). Patients may have hoarseness of the voice or low calcium levels as a result of these treatments. The risks are lower with surgeons who have more experience with the procedure, but the risks do exist and are factored into the USPSTF’s recommendation against routine screening.

    Related reading:  Why I usually recommend surgery to treat low-risk thyroid cancer

    What do other organizations think about this recommendation?

    Much of the USPSTF’s recommendation against routine screening for thyroid cancer rests on the idea that doctors are over-diagnosing the disease. But a response to the USPSTF’s recommendation by a team of researchers suggests that there has been an increase in both the rate of people being diagnosed with thyroid cancer and the rate of people dying from the disease—not just an increase in the diagnosis rate, as the USPSTF noted.

    The team’s response indicates that more research needs to be done to explain these increases, rather than attributing them only to over-diagnosis. Factors such as increasing rates of obesity could play a role in more people having thyroid cancer. In particular, changes in patients’ genes suggest that exposure to certain chemicals could account for some of the new cases of thyroid cancer we’ve seen in recent years.

    I believe there’s truth in both of these opinions. I think there has been some over-diagnosis of thyroid cancer in the past few decades. But I also think there are factors that could indicate potential increases in the number of people with this disease. So the best approach, in my view, is to use common sense to decide when we should screen patients for thyroid cancer.

    When should doctors perform thyroid cancer screenings?

    The USPSTF’s recommendations only apply to patients with a low risk of thyroid cancer. Screening still is a good idea for anyone with increased risk factors for thyroid cancer. People who have been exposed to radiation, especially radiation to the head or neck area during childhood, should be screened for the disease. The term “screening” as used by the USPSTF generally means trying to identify thyroid nodules and cancer in an asymptomatic general population. However, this is different than trying to identify thyroid nodules and cancer in a specific population, for example, patients who have a family history of thyroid cancer or who have had a thyroid nodule identified for another reason.

    As noted previously, chemical exposure may play a role in a person’s risk for thyroid cancer. Flame-retardant chemicals may increase a person’s risk, as can biocides, which are found in sanitizers, disinfectants and other cleaning products. This association is interesting, but a causal role has not yet been proven.

    I also recommend screening patients for thyroid cancer if they have a first-degree relative who has been diagnosed with the disease. Examples of first-degree relatives include:

    • Children
    • Parents
    • Siblings

    And, of course, we should test patients who are showing symptoms of thyroid nodules. Most nodules don’t cause symptoms, but patients with large nodules may experience:

    • Hoarseness or voice changes
    • Neck pain
    • Trouble breathing or swallowing

    I do agree that we shouldn’t perform thyroid ultrasounds on every patient who comes into the doctor’s office. While we could potentially locate thyroid nodules that way, screening every patient would lead to a high risk of over-diagnosis. For example, we might find in a 75-year-old patient a small nodule that would never grow large enough to cause any problems. Doing surgery to remove this sort of nodule may not be necessary.

    The truth of most debates rarely lies at one or extreme or the other, and screening for thyroid cancer likely is no exception. No one wants to put patients through unnecessary treatment, but we also don’t want to miss diagnose cancer that we could have treated successfully. Striking a balance by following common-sense guidelines for screening is the best option that lets us do the most good for people with thyroid cancer.

    Request an appointment with one of our endocrinologists if you think you may be at risk for thyroid cancer.

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