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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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  • July 26, 2017

    By MedStar Health

    Some of my patients have come to me worried after seeing media coverage of a report about knee arthroscopy, a minimally invasive surgery used to diagnose and treat knee joint conditions. The report, which was published in May 2017 in the journal BMJ, compares the effectiveness of arthroscopic surgery for treating degenerative disease with conservative treatments, such as physical therapy and medication.  

    The authors reported that fewer than 15 percent of patients who had knee arthroscopy felt long-term improvement in pain or function. As such, they strongly recommend against the procedure for patients with degenerative knee problems. But I disagree with their conclusions.  

    I’m not trying to be a snake oil salesman. Knee arthroscopic surgery is one of the most common orthopaedic procedures, with more than 2 million performed around the world each year. I’ve performed about 5,000 knee arthroscopies during my career, and the vast majority of my patients see improvement afterward. Many doctors in the trenches would say the same.  

    While it’s true that not every patient with knee problems will benefit from arthroscopic surgery, the key is to look at each patient’s situation individually. Let me explain why I take issue with the report, how I treat patients with degenerative knee disease, and what you should consider before undergoing the procedure.

    Why I disagree with the report’s knee arthroscopy recommendations  

    Degenerative knee disease is an umbrella term for conditions in which the cartilage that covers the ends of the bones in the knee breaks down, causing pain, stiffness and limited mobility.  

    The authors of the BMJ report define degenerative knee disease as patients older than 35 who have knee pain with or without:

    • Imaging evidence of osteoarthritis, the most common degenerative knee condition
    • Tears in the meniscus, a type of knee cartilage  
    • Locking, clicking or other mechanical symptoms
    • Symptoms that occur suddenly or have been ongoing  

    The first issue with the report is that this is a huge category of people. The only patients they exclude are those whose symptoms appeared immediately after major knee trauma and have joint swelling.  

    This just doesn’t make sense to me. If I have a 36-year-old patient with a meniscus tear whose X-ray shows no sign of osteoarthritis, this article seems to indicate arthroscopic knee surgery would not help. The weight of medical evidence from my experience says differently. I know repairing or removing a part of a damaged meniscus can improve pain and function.  

    My second concern is how the studies were carried out. These were double blind studies, which are a high standard, but the treatments didn’t take into effect the specifics of each patient.  

    The study split people with a meniscus tear and no evidence of arthritis into two treatment groups: arthroscopy and physical therapy. People with osteoarthritis also were split into arthroscopy and physical therapy groups.  

    But we already know that patients who have osteoarthritis and no other conditions will not benefit from arthroscopy. However, the surgery can benefit patients with meniscus tears. The study is basically comparing apples to oranges.  

    Finally, the report recommends physical therapy and medication in lieu of arthroscopy – or in severe cases total knee replacement. But many of these patients have tried physical therapy and medication such as lubricant injections, with no relief from pain. And they may be too young or not quite ready for a knee replacement.  

    What are we supposed to offer these patients? They can’t do physical therapy and take anti-inflammatory medications forever. I’d hate to tell a 45-year-old patient with a meniscus tear and a little wear and tear on his knee cartilage that if physical therapy and medication doesn’t work, he must live with the pain until the day he absolutely needs a total knee replacement.

    I never blanketly refuse surgery to all who have some degeneration in the knee, or those older than 35 as the article suggests. If something has occurred to the knee that is new and causing pain and it is subject to arthroscopic repair, I will always offer this option to the patient.  

    We must offer these patients something, like arthroscopy, that may relieve some or all their pain. The trick is to examine each patient to determine what’s causing the problem, walk them through their options and have an honest discussion about how much pain each option may alleviate.  

    How we treat degenerative knee disease

    The only true cure for degenerative knee disease is knee replacement. I never treat degenerative knee disease with arthroscopy as the primary treatment, only if there is a new meniscus tear, or a tear of a degenerative meniscus that has become suddenly painful from a new tear-within-a-tear.  

    But we almost always start with more conservative treatments, including:

    • Physical therapy
    • Anti-inflammatory medication such as ibuprofen
    • Injections that lubricate the joints
    • Corticosteroid injections for severe arthritis

    If these treatments do not provide relief, we may discuss arthroscopic surgery. Arthroscopy can, among other things:

    • Repair anterior or posterior cruciate ligaments (ACL and PCL)
    • Repair meniscus tears  
    • Remove pieces of torn cartilage that are loose in the joint
    • Adjust a kneecap that is out of position  

    I started performing knee arthroscopies in 1978, and I’ve learned who may benefit from the procedure and who won’t. I’ll be honest if I don’t think arthroscopy will help.  

    In fact, I had a patient several months ago come to me for a second opinion. Her doctor had recommended arthroscopy, but I told her that due to the amount of arthritis in her knee, arthroscopy would not help and she needed a total knee replacement. She decided to do the arthroscopy with her doctor, but ended up having a knee replacement when the arthroscopy didn’t relieve the pain.  

    As I said, arthroscopy will not cure or relieve pain from arthritis. However, we may recommend it to slow the arthritis down by removing loose fragments in the joint that can chip away at the cartilage.  

    Questions to ask your surgeon before undergoing knee arthroscopy

    We all need to be good healthcare consumers and do our due diligence when making medical decisions. Before you decide whether to have arthroscopic knee surgery, ask these questions:  

    • How many knee arthroscopies have you performed? A surgeon’s experience is crucial in knowing who may benefit and who won’t.  
    • What percent of pain will the procedure alleviate? If your doctor says you can expect 50 to 80 percent improvement in pain, you must decide whether that’s worth it. Some people say they’ll live with the pain, while others want to relieve at least some of the pain. Or your doctor may say the procedure can relieve pain for up to three years. For some people, that’s a long time to be free of knee pain. For others, it’s a sign to start considering total knee replacement.  
    • Are there alternative options? If you’re talking to a surgeon, you’ve likely already tried other conservative treatments, such as physical therapy, medications and injections. But it’s always worth asking if there’s anything else to try.  

    For arthritis, knee arthroscopy is more damage control than curative. But the majority of patients who get arthroscopy for the right reasons experience relief from knee pain.   Request an appointment with an orthopedic surgeon to discuss whether arthroscopic knee surgery can help alleviate your knee pain.  

     Request an appointment with an orthopedic surgeon to discuss whether knee surgery can help alleviate your knee pain.

    Request an Appointment

  • July 24, 2017

    By MedStar Health

    Job duties can pose various dangers to workers’ health: handling chemicals, operating heavy machinery, even sitting for hours on end in an office every day. But the schedule you work also can put you at greater risk for conditions such as heart disease, depression and cancer.  

    While the traditional 9-to-5 workday is not entirely a thing of the past, more Americans than ever – nearly 15 percent – work hours outside that schedule or work shifts that rotate between day and night. These employees keep the country moving 24 hours a day and include police officers, truck drivers, manufacturing workers and my colleagues here at the hospital.  

    These types of schedules, known as shift work, pose various challenges to daily life – but sleep often is the biggest one. The resulting difficulty sleeping or excessive fatigue even has a name: shift work disorder. It’s estimated that up to 10 percent of shift workers suffer from this condition.  

    An October 2016 study found that:

    • 30 percent of shift workers reported poor sleep quality
    • 61 percent of night shift workers reported short sleep duration, or sleep lasting less than seven hours
    • More than 40 percent required more than 30 minutes to fall asleep
    • 18 percent of night shift workers reported having insomnia  

    If you are one of the 20,000 shift workers in the United States, it’s important to understand the dangers sleep deprivation can pose to your health, how to improve your sleep and when to seek help.

    Potential dangers related to shift work sleep disorder

    Just like anyone who doesn’t get enough quality sleep, shift workers are at increased risk for accidents and work-related errors. It also can cause them to become irritable or depressed. But lack of sleep due to shift work also can affect your health.  

    Our circadian rhythm controls the production of hormones such as melatonin, which causes drowsiness, and growth hormones that help repair and restore body processes during deep sleep. While our circadian rhythm is partially driven by natural factors, it’s also influenced by our environment, especially light. When there is less light, like at night, our brain tells our circadian rhythm to make more melatonin so we fall asleep. During the day, we produce less melatonin, so we stay awake.  

    Although we don’t understand exactly how, researchers have found that disrupting the circadian rhythm can trigger changes in the body at a molecular level. In fact, the World Health Organization in 2007 deemed shift work a probable carcinogen due to a potential connection between cancer and night shifts.  

    In a 2015 study, researchers found that in nurses who worked rotating night shifts:

    • 11 percent had a shortened lifespan after at least six years.
    • The risk of death from cardiovascular disease increased by 23 percent after 15 years.
    • The risk of death from lung cancer increased by 25 percent after 15 years.  

    Sleep restores our bodies. Without it, you may become irritable or depressed, and your short-term memory may suffer. Poor sleep also can impair the immune system, which can mean you’re at increased risk of catching a cold or the flu.  

    Shift work doesn’t mean you’re doomed to poor health. There are steps you can take to improve your sleep, and if that doesn’t work, your doctor may be able to help.

    How to improve sleep when you work odd shifts

    Just like anyone else, shift workers need to make sleep a priority. And preparing your body for sleep starts before you even get home from work.

    • Wear sunglasses on your way home: This prevents the sunlight from confusing your body about what you want it to do.
    • Close the blinds when you get home: Darkness will tell your body it’s time to sleep. 
    • Tell friends and family when you will be sleeping: This hopefully will keep them from waking you with visits and phone calls.
    • Keep to your sleep schedule: Go to bed and wake up at the same time as often as you can – even on your days off.  

    If you practice good sleep habits and still struggle with your sleep schedule, see your doctor. They may recommend or prescribe a wake-promoting agent, which can make you less sleepy while you work, and a melatonin supplement or sleeping pill to help you get better rest.  

    When to seek help for shift work disorder

    Adjusting to a shift work schedule does require some patience. It can take months to adjust to a shift work sleep schedule. And if you go back to a “normal” schedule, it also may take time to readjust to sleeping during night hours.  

    But because sleep plays such an essential role in our health, it’s important to see your doctor when you’re not getting enough of it for a prolonged period of time.  

    Unfortunately, many people with shift work disorder never see a doctor – or wait until it’s causing serious problems. Some think that working night or rotating hours just means they have to deal with poor sleep. They don’t realize there are options to improve or treat it.  

    Request an appointment if you’re experiencing any of these symptoms:

    • Difficulty falling asleep  
    • Excessive sleepiness or falling asleep during work hours
    • Insomnia, or not getting an uninterrupted six to eight hours of sleep
    • Irritability or depression
    • Sleep that doesn’t feel refreshing  

    Request an Appointment


    Your doctor will ask about your health history and sleep habits. Consider keeping a sleep diary, which can help your doctor assess and monitor your sleep habits. Here’s what you should include:

    • The times you went to bed and woke up
    • How often you awoke up during the “night” and for how long
    • What you ate and drank before going to sleep
    • Whether you exercised and when  

    Your doctor also may recommend a sleep study, which we will perform during your normal sleep hours. This can help rule out other sleep disorders, such as sleep apnea. Once we determine a cause, we can recommend behavioral changes or medical treatment.  

    Poor sleep is not normal or something you just have to deal with – no matter your work schedule. There are things you and your doctor can do to help you get a good night’s rest.  

  • July 20, 2017

    By MedStar Health

    It’s the rare physician who elects to endure the rigors of residency a second time. Yet for Helena Pasieka, MD, something about dermatology got under her skin, figuratively speaking.  

    Meet the Physician

    A graduate of the University of Washington School of Medicine, Dr. Pasieka had completed a residency in Internal Medicine at the University of Michigan and had stayed on as an internal medicine hospitalist. Along with handling critically ill patients, she also admitted patients to the inpatient dermatology service. Her up-close look at dermatology cases was, to say the least, eye-opening.

    “I was completely fascinated by the different types of cases and how they were being managed,” she recalls.

    Dr. Pasieka initially balked at a mentor’s suggestion that she pursue a residency in dermatology. A few years later, however, an opening at the Johns Hopkins Dermatology Residency Program in Baltimore coincided with her husband eyeing a job opportunity at the National Institutes of Health in Bethesda.

    “The stars just seemed to align,” Dr. Pasieka says with a laugh, “and I’m glad they did.”

    Dr. Pasieka's Work Today

    Splitting her time as director of Inpatient and Consultative Dermatology at both MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Dr. Pasieka works with conditions ranging from cellulitis and infections, to diseases associated with HIV/AIDS and immunological issues. Because skin ailments are often a visible manifestation of an underlying condition, Dr. Pasieka often encounters a higher degree of anxiety among her patients.

    “And it’s understandable, because this is something they can see, as opposed to, say, a cholesterol test result,” Dr. Pasieka says. “An important part of my work is to help alleviate their concerns, as I guide them through the diagnosis and treatment.”

    Dr. Pasieka is involved in a variety of research programs, including one exploring Stevens-Johnson Syndrome, a rare disorder that can result in significant skin loss, unless treated immediately. She’s also focused on raising dermatology’s profile in public health, as access to specialized expertise is often limited by patient resources or location, even in urban areas.

    “If a primary physician doesn’t have access to a dermatology consult, how does it translate to costs and outcomes,” she says. “Are there higher risks of a misdiagnosis or improper prescriptions?” She adds that while technology such as telemedicine may help with educating both patients and providers, “we first need to fully understand the extent and implication of accessibility issues.” 

  • July 19, 2017

    By MedStar Health

    Gone are the days when you’d stand at a window and gaze at 15 babies lined up in bassinets in a hospital nursery. Nurseries for healthy babies are disappearing from hospitals across the country, including ours.  

    Instead, moms and babies now stay together in the same room 24/7. The main driver behind this trend is the Baby-Friendly Hospital Initiative (BFHI). There are plenty of benefits to this program, but the main one is that it promotes breastfeeding.  

    We were proud to receive this prestigious designation in June 2017 after spending the past couple years implementing new policies, curriculum, action plans and training, as well as completing a rigorous on-site assessment.

    In fact, Baby-Friendly designation is more than a 'seal of approval.' It requires extensive engagement and education of the staff. We had more than 200 nurses in our Labor and Delivery, Mother/Baby and Infants’ Services units who received extensive additional lactation training.

    What’s a Baby-Friendly hospital?

    The World Health Organization and United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative in 1991 to encourage hospitals to create environments that promote mother/baby bonding and support women who choose to breastfeed.  

    Facilities that achieve the Baby-Friendly designation have successfully implemented the 10 steps to successful breastfeeding, which include:

    • Have a written breastfeeding policy that is routinely communicated to all health care staff.
    • Inform all pregnant women about the benefits and management of breastfeeding.
    • Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
    • Practice rooming in – allow mothers and infants to remain together 24 hours a day.
    • Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.  

    Many healthcare organizations have endorsed these steps, including the American College of Obstetricians and Gynecologists, American Academy of Pediatrics and U.S. Preventive Services Task Force. Over the past two years, this philosophy has become a part of our culture and what we do. 

    “Promoting mother/baby bonding and breastfeeding is part of our culture.” via @MedStarWHC

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    What we did to become a Baby-Friendly hospital

    As we examined our longstanding policies and procedures over the past few years, we identified three areas in particular that we could adjust to better encourage successful breastfeeding: nursery, formula and pacifiers.

    Nursery

    In the past, when mom wasn’t feeding her baby, the baby was in the nursery. This proved to be a barrier to breastfeeding.

    We used to encourage feeding every three to four hours. Now, we promote breastfeeding on cue. In general, moms are feeding their newborns eight to nine times a day. Having the baby in the room with you 24/7 facilitates easier breastfeeding and helps mothers learn their baby’s feeding cues. If separated, mothers have a harder time learning to identify the early signs the baby is ready to nurse.

    “Rooming in helps moms learn their baby’s feeding cues and make it easier to breastfeed.” via @MedStarWHC

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    Some women ask us, “I have two toddlers at home and I just want to get some sleep before I go home. Can the baby go to the nursery?” In these cases, we gently tell mom that we can’t take the baby to the nursery. We explain the benefits of sleeping when the baby sleeps. We also recommend asking a family member to stay and help so mom can get some sleep.  

    We make sure to talk to our moms before they have their babies about what to expect and explain why we do what we do.  

    We haven’t gotten rid of the nursery altogether. Some newborns need additional monitoring, but not the advanced care given in the neonatal intensive care unit (NICU). In those cases, they may spend time in the nursery. We also may do some exams or minor procedures in the nursery, but many exams are done right in the room so we don’t have to separate mom and baby.  

    Formula

    It used to be routine for a nurse to say, “Mom is sleeping and I don’t want to wake her, so I’ll give her baby a bottle.” We don’t do that anymore.  

    We don’t use formula unless mom requests it or there is an issue with the baby’s or mom’s health. If you don’t want to breastfeed, we may ask you why to address any concerns you may have. We want you to understand your options and the benefits of breastfeeding. However, if you choose not to breastfeed, we will respect your decision.  

    Pacifiers

    Artificial nipples such as pacifiers can interfere with breastfeeding, so we no longer use them in the hospital. Latching and sucking on a pacifier is different than sucking on a breast. We don’t want to confuse baby in the first few days of learning to breastfeed.  

    You tell us: What Baby-Friendly elements did you enjoy at your hospital, or what would you like to see in the future? Connect with us through Facebook and Twitter.  

    The benefits of breastfeeding

    We made these changes because we know that breastfeeding has great benefits for the health of baby and mom.  

    Research has shown that breastmilk:

    • Provides an optimal mix of nutrients
    • Contains antibodies that protect newborns from certain illnesses
    • Is easier to digest than formula
    • Lowers the risk of sudden infant death syndrome (SIDS)

    Breastfeeding also makes it easier for mom to lose the weight gained during pregnancy and may reduce her risk of breast cancer and ovarian cancer.

    Learn about what to expect when breastfeeding, common problems and concerns, tips for successful breastfeeding and how to avoid sore nipples by registering for one of our breastfeeding classes.  

    Breastfeeding is not always easy. But by providing an environment that facilitates and supports breastfeeding immediately after birth, we hope to help you achieve your goal.   

  • July 17, 2017

    By MedStar Health

    A little leg pain or soreness with exercise usually is normal. But severe pain, especially pain that appears when you’re only walking a short distance, may be a sign of a condition called peripheral artery disease. This condition, also known as peripheral vascular disease, can make even simple actions like walking across the room a challenge. As the Centers for Disease Control and Prevention reports, about 8.5 million Americans have peripheral artery disease, including 12 to 20 percent of people older than 60.  

    Peripheral artery disease doesn’t have to slow you down. Our diagnostic tools and treatment options let us identify and address the causes of your leg pain to get you back on your feet.  

    The warning signs of peripheral artery disease

    Peripheral artery disease involves the narrowing or blockage of blood vessels. The main cause of the disease is a process called atherosclerosis, in which fatty deposits build up in the blood vessels. Peripheral artery disease can occur in any of the body’s blood vessels, but it’s more common in the legs than the arms.  

    The classic and most common symptom of peripheral artery disease is leg pain. This may appear as pain in a specific area of the leg, such as in the calf or thigh—anywhere from the buttock and hip down to the foot. Weakness and leg cramps often go along with the pain.  

    You may especially notice these problems when you walk, though they can appear while resting as well. Everyone’s experience is different. I’ve had patients who could walk for a mile or so before they had to rest, while others experienced intense leg pain and cramps just walking to the mailbox. The pain, weakness and cramping are signs of poor circulation in the legs. Resting can improve circulation temporarily and relieve these symptoms.  

    Other common peripheral artery disease symptoms can include:

    • Changes in the color or temperature of the legs
    • Numbness or tingling in the legs
    • Toenails that become thick or opaque (unable to be seen through)  

    It’s possible for people with peripheral artery disease to develop ulcers in the toes or feet. This is because the narrowed blood vessels in the legs restrict blood flow to the feet, which makes it harder for the body to heal cuts, sores and other minor injuries.  

    As peripheral artery disease progresses, the symptoms get worse. Without treatment, peripheral artery disease can lead to serious consequences, including gangrene or even amputation of a leg. Peripheral artery disease also can increase your risk for having a heart attack or stroke without proper care. 

    #Peripheralarterydisease can lead to serious consequences, including #gangrene or even #amputation of a leg. via @MedStarWHC

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    What to do if you have these symptoms

    One of the big problems with peripheral artery disease is that people often don’t get help for it. They think it’s just a part of getting older, or maybe it’s their arthritis acting up. People with diabetes can mistake the pain of peripheral artery disease with diabetic neuropathy, a burning or painful feeling in the legs.  

    Don’t ignore these symptoms. Request an appointment with one of our doctors if you have leg pain while walking.

    Request an Appointment

    How we treat peripheral artery disease

    If we catch peripheral artery disease early enough, it’s often possible to treat it through changes in your lifestyle. This can include creating a plan for healthy eating and exercise, both of which can improve poor circulation and slow blockages from forming in the arteries.  

    One major lifestyle factor we recommend is to quit smoking if you smoke. We offer smoking cessation services through our Pulmonary Services team if you need help to quit smoking.  

    These lifestyle changes are important. But they may not be enough to treat advanced cases of peripheral artery disease. In these cases, we may have to take action to restore the blood flow to the legs. We usually can do this through endovascular surgery, which involves minimally invasive procedures.  

    We treat peripheral artery disease with the following procedures:

    • Angioplasty: We insert a thin, flexible tube called a catheter and thread it to the blocked artery. Then we inflate a special balloon inside the artery that pushes the blockage aside and restores proper blood flow. We also may implant a stent, a device to help keep the artery open, during this procedure.
    • Atherectomy: Similar to an angioplasty, this also involves using a catheter. We use catheters with special cutting tools to cut blockages out of arteries. Wealso may implant a stent during this procedure.
    • Bypass graft: If we can’t remove a blockage, we may be able to go around it. A bypass graft involves using either a blood vessel from elsewhere in your body or a synthetic vessel to go around, or bypass, the blocked artery.  

    Related reading: Debilitating Leg Pain Gone After Minimally Invasive Peripheral Vascular Surgery

    Leg pain isn’t just a part of getting older. It can be a sign of serious, potentially life-threatening problems. But with the right diagnosis and treatment, leg pain can be something you look back on—not something you just have to live with. 

  • July 13, 2017

    By Jeffrey Dubin, MD, Chief Medical Officer

    We’re no strangers to hot summer days in the District of Columbia. But when the thermometer inches toward and above 100 degrees Fahrenheit, we could all use a reminder about the dangers of heat illnesses.

    Heat can be lethal. We see a few patients in the emergency room every summer who are experiencing the full spectrum of heat illness symptoms. Some just feel muscle cramps or are nauseated while others have may have collapsed while running and are suffering from exertional heat stroke, which can be deadly.

    Our bodies cool themselves by sweating. But when the heat and humidity combine to make it feel like 100 degrees or more, sweating may not be enough and our body temperatures can rise to dangerous levels. Our bodies just are not meant to spend long periods of time in extreme heat and humidity, particularly if we are exerting a lot of energy.

    While we weather this latest heat wave, let’s talk about symptoms of heat-related illness to watch out for and tips to stay safe when the temperature soars.

    Types and symptoms of heat-related illness

    There are two main types of heat illness: heat exhaustion and heat stroke.

    Heat exhaustion

    Heat exhaustion occurs when the body overheats due to exposure to high temperatures. It can appear suddenly or over time, particularly if you’re engaging in physical activity.

    Heat exhaustion symptoms include:

    • Dizziness or lightheadedness
    • Fatigue
    • Headache
    • Heavy sweating
    • Muscle cramps
    • Nausea or vomiting
    • Pale or cold skin
    • Weak, rapid pulse

    If you experience any of these symptoms, get out of the heat and into a cool place to rest. Drink water and take off any tight or extra clothing. You also can lower your body temperature with an ice pack or cool bath.

    If your body doesn’t cool down, heat exhaustion can turn into heat stroke, a more dangerous condition.

    Heat stroke

    Once the body temperature reaches 104 degrees Fahrenheit and there are signs of neurologic dysfunction such as confusion, agitation ,slurred speech or coma, you’re considered to have heat stroke. This serious condition requires emergency treatment. Left untreated, it can cause shock, organ failure and death.

    If you or a loved one have heat stroke symptoms, call 911 immediately. While waiting for emergency personnel, move to a cool location and remove excess clothing. Try to cool off further with a tub of cool water, a fan or ice packs.

    While anyone can suffer from a heat-related illness, there are a few factors that can put people at increased risk:

    • Age: The ability to regulate body temperature isn’t fully developed in young children, and the elderly’s may have reduced temperature control because of health conditions or medications.
    • Obesity: Extra weight can cause the body to retain more heat as well as affect the ability to regulate temperature.
    • Health conditions and medications: Some chronic illnesses such as heart or lung disease may increase your risk of heat-related illness. Certain medications also may affect the ability to stay hydrated and regulate body temperature, including some beta blockers, diuretics, antihistamines and antipsychotics.

    How to prevent heat exhaustion and heat stroke

    Heat exhaustion and heat stroke are preventable. The best ways are to avoid being outside in the heat and avoid overexerting yourself when you are. However, we know this isn’t always possible, so listen to your body. If you’re outside and starting to feel hot or dizzy or you’re experiencing muscle cramps, take a break to go inside and cool off. Avoid going back outside until you’re feeling normal again.

    You can seek relief from the heat in public facilities such as recreation centers, public libraries or senior centers. When the temperature or heat index reaches 95 degrees, the District of Columbia also activates cooling centers. Find a cooling center near you.

    A few more tips to stay safe in the heat include:

    • Stay hydrated: Drink fluids such as water or low- or no-sugar sports drinks every 15 to 20 minutes, even if you don’t feel thirsty. Avoid caffeine and alcohol.
    • Wear loose, lightweight, light-colored clothing: People who live in very hot areas of the Earth wear long, loose-fitting clothing. They know what they’re doing!
    • Take breaks: Try not to push yourself too much with exercise or work too hard. Go inside to cool down as often as possible.
    • Check on your neighbors: We’re all in this together. If you aren’t sure if your neighbors have air conditioning, stop by and see how they’re doing. This is particularly important if they are elderly or live alone.

    Finally, heat-related illnesses aren’t the only dangers we face during the hot summer months. We also want to avoid skin cancer from sun exposure. So don’t forget sunscreen and a hat when you’re heading outdoors.

    The temperature eventually will drop to a more normal summer range, but until then, stay safe out there.