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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.
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    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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  • May 04, 2017

    By Savyasachi C. Thakkar, MD

    A 30-year-old man came to our emergency room with excruciating pain in both hips. He had been experiencing pain for several years, but it had become so bad he hadn’t been able to walk for a couple weeks. Imaging showed advanced bilateral hip arthritis—bone was rubbing on bone.

    After a total hip replacement and physical therapy, he’s back to work and tells me he has more mobility than he’s had in years. Thirty may seem young for a joint replacement, but a growing number of younger people are getting these procedures.

    Our team performs more than 400 joint replacements each year, and the average age of our patients is 60. But according to the American Academy of Orthopaedic Surgeons, the number of:

    • Total knee replacements increased by 120 percent from 2000 to 2009, and 188 percent for patients age 45 to 64.
    • Total hip replacements increased by 73 percent in that timeframe, and 123 percent for patients age 45 to 64.

    It’s a common misconception that knee replacements and hip replacements are just for the elderly. I’ve heard patients say, “Grandma didn’t get a knee replacement until she was 80. I figured I’d just have to deal with the pain until then.”

    If you’re unable to live the life you want due to pain, consider joint replacement surgery sooner than later.

    LISTEN: Dr. Thakkar discusses more myths about joint replacement surgery on the Medical Intel podcast.

    Why are younger people getting joint replacements?

    A couple decades ago, most hip and knee replacement patients were older than 70. That was largely due to the fact that our implants weren’t nearly as good as they are now. They only lasted about 10 years, so doing surgery wasn’t always worth it if you knew you were going to have to redo it two to three times during someone’s life.

    Our implants now are much better and last much longer. In fact, a 50-year-old who gets a knee replacement has a 70 percent chance of it lasting until they are 80. That’s 30 years of being able to work, run, bike or play golf pain-free. And current hip replacements are lasting up to 25-30 years.

    Osteoarthritis, which is a common reason for hip and knee replacements, is connected to wear and tear on the joints. It’s only natural that your risk of getting it increases as you age. But we’re also seeing it in more patients who are middle age or younger. This could be due to two factors:

    • Popularity of high-intensity sports: Repetitive actions and injuries, such as tears to the cartilage that cushions the joint, increase the risk of arthritis. More people are taking part in activities, such as running and biking. For example, according to Running USA, 17 million people finished a race in 2015, compared with less than 5 million in 1990. While healthy, these activities also can be hard on the joints.
    • Obesity: Carrying extra weight puts increased stress on the joints. Being 10 pounds overweight can put an extra 40 pounds of pressure on your knees. One study found that obesity was strongly associated with the need for knee or hip replacements, with 72 percent of the study group (age 18-59) classified as obese compared to 26 percent of the general population.
    “Being overweight puts increased stress on the joints. An extra 10 pounds adds 40 pounds of pressure to the knees.” via @MedStarWHC

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    When should I consider a knee or hip replacement?

    Don’t think about your age when considering joint replacement surgery. Instead, consider your pain and mobility. Do you struggle to walk a short distance or drive a car? Are you unable to perform work duties? Do you consistently take medication to control the pain?

    Conditions, such as arthritis, also can affect your general health. You may find yourself giving up activities one by one as they become too painful. Eventually, lack of exercise may cause weight gain and conditions that can accompany it, such as diabetes and high blood pressure.

    You may benefit from a knee or hip replacement when:

    • Pain and stiffness limits everyday activities or interrupts rest or sleep
    • It becomes necessary to use a cane or walker to remain mobile
    • Treatments, such as anti-inflammatory medication, cortisone injections, physical therapy or less-invasive procedures fail to relieve pain
    • An abnormality develops, such as bowing in or out of the knee

    Our bodies sometimes break down, affecting quality of life. Fortunately, in some cases we can replace the faulty parts and return mobility. While those new parts may wear down eventually, advancements in technology help us give younger people more years to do what they love—pain-free.

    Request an appointment to see if joint replacement surgery is right for you.

    Request an Appointment

  • May 01, 2017

    By MedStar Health

    According to data from the U.S. Department of Health and Human Services, nearly 25 percent of people between the ages of 65 and 74 have a hearing problem. And for people 75 and older, that number rises to nearly 50 percent.

    People often think of hearing loss as a fact of life—something that comes along with getting older. But hearing loss can affect anyone. More than 10 percent of U.S. adults between 20 and 64 have hearing loss caused by exposure to loud noise. In total, about 48 million Americans, or 20 percent of the country, have some amount of hearing loss.

    Unfortunately, most people don’t get their hearing checked until they notice hearing loss or people around them complain. And that’s a problem, because it can make hearing loss more difficult to treat in the long run. Every adult should have regular hearing tests to monitor for hearing loss.

    Are you overdue for a hearing exam? Make an appointment today!

    Request an Appointment

    How often should you have a hearing test?

    All adults should have their hearing tested at least once every five years, according to the Office of Disease Prevention and Health Promotion (ODPHP).

    But 2012 ODPHP data show that only about 21 percent of adults between 20 and 69 had a hearing test in the previous five years. And just over 40 percent of adults 70 and older, who are much more likely to have a hearing problem, had a hearing test within the recommended time.

    As part of its Healthy People 2020 initiative, the ODPHP hopes to improve these numbers by the year 2020. The goal is a 10 percent improvement for all adults. But even that increase would mean most adults still wouldn’t receive regular screening. We clearly have a lot of work to do to get the word out about the importance of regular hearing tests.

    Why do you need regular hearing tests?

    Just like we do for blood pressure, it’s helpful for your doctor to have a regular reading of your hearing function. Regular hearing tests help us establish your baseline, or normal, hearing level. That way, if you notice a change in your ability to hear, or if we start to see a change from one test to the next, we can identify how abnormal your hearing function is and when the change likely happened.

    If you wait until there’s an issue to have a hearing test, it’s harder to determine the problem. The doctor will have just the current exam to work from. One test won’t help us determine just how much your hearing has changed and when. A problem you may think appeared out of nowhere might have been developing for many years before you noticed.

    Different types of hearing loss have very different management and treatment strategies. In some cases, we can correct hearing problems with surgery. In others, we can’t correct the disorder itself, but we can improve hearing ability with the use of hearing aids. The more time we lose trying to find the cause of hearing loss, the more hearing you could lose.

    Health effects of hearing loss

    Hearing loss is a major problem that is related to multiple health and emotional disorders. As a 2011 study noted, older adults with hearing loss are more likely to have difficulty with the normal activities of daily life than older adults without hearing loss. Hearing loss is associated with several problems in adults of all ages, including:

    • Dementia
    • Depression
    • Emotional difficulties
    • Feeling isolated from friends and family members
    • Lower workforce participation

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    In addition, many people are unaware of the link between hearing loss and diabetes. Over time, people with diabetes can develop a condition called diabetic neuropathy. This is a type of nerve damage that can cause pain, loss of function or other problems in different areas of the body.

    In some cases, hearing loss can be an early warning of diabetic neuropathy. That can be a warning sign for people to get their blood sugars under control. Hearing loss might even be a sign to diagnose diabetes in patients if they’re not already being treated for the disease.

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    Talk to your doctor about hearing tests

    Most primary care doctors don’t regularly test their patients’ hearing. Your primary care provider can refer you to an audiologist—a doctor who evaluates patients’ hearing and treats hearing disorders.

    Hearing tests are covered by most insurance plans with a doctor’s referral. The test takes about 30 minutes to an hour. Our Hearing and Speech team uses sounds with different tones, frequencies and intensities to measure your hearing threshold – the minimum level of sound a person can hear. During the test, the audiologist also will present a series of words to see what percentage you hear correctly and can repeat. The audiologist will plot your results on an audiogram, which is a visual readout of your hearing thresholds, and go over them with you after the test.

    Hearing loss can sneak up on us if we’re not careful. But it doesn’t have to. Regular hearing tests can give your doctor a head start toward keeping your hearing strong and healthy as you age.

  • April 27, 2017

    By MedStar Health

    If you Google “pregnancy apps,” there’s no shortage of articles with titles such as “10 best pregnancy apps” or “Must-have apps during pregnancy.” According to a 2015 study, 7 percent of the 165,000 available health-related apps were related to women’s health and pregnancy. That’s more than 11,000 apps!

    And we’re just seeing the tip of the iceberg in healthcare apps’ potential. As more healthcare providers begin to use apps in their practices, as we do in ours, women will begin to expect and demand them. As that happens, we’ll begin to see more high-quality apps that provide better, more accurate information.

    "We’re just seeing the tip of the iceberg in healthcare apps’ potential." #digitalhealth via @MedStarWHC

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    There’s no doubt about it: Pregnancy apps are here to stay. This means healthcare providers need to stay up-to-date on quality apps, and women need to talk with their doctors and be savvy about which apps provide accurate information and which are just for fun.

    Tips to choose pregnancy and fertility apps

    Simple pregnancy apps send you notifications about your baby’s growth week by week or help you choose a baby name. More complex apps offer help with listening to your baby’s heartbeat or timing your contractions. Before you download an app, ask yourself these three questions:

    1. Who developed the app?

    There are apps that let you listen to your baby’s heartbeat – if they’re used in conjunction with a home Doppler. But if the app claims that all you need to do is put your phone against your belly and listen, don’t believe it. If you put the phone on your desk, you’ll likely hear the same sound!

    This is why it’s important to look at who developed the app. Was a reputable healthcare source involved? For example, the American Congress of Obstetricians and Gynecologists (ACOG) launched an estimated due date calculator in January 2016. Unlike due date calculators from non-healthcare organizations, this one takes more into account than the first day of your last period.

    You wouldn’t go to someone other than your doctor or midwife for pregnancy treatment, so don’t rely on health advice from a non-medical group’s app. And if an app promises to do something that seems impossible, like letting you listen to your baby’s heartbeat, ask your doctor first!

    2. How accurate is the app?

    A study published in the July 2016 issue of Obstetrics & Gynecology looked at 33 fertility calculator apps and found that only three accurately predicted a woman’s “fertile window.”

    If you’re using one of these apps to help you conceive – or avoid getting pregnant – that’s a problem. Fertility is not as simple as these apps would lead you to believe. For one thing, not everyone’s menstrual cycle is the same, so you may not ovulate as consistently as the app’s algorithms would lead you to believe.

    Even apps that track babies’ benchmarks week by week may not be entirely accurate. Three apps could tell you three different things about how big your baby is and which organs are forming in a particular week. Was a healthcare professional involved in creating one of them? If so, that one is more likely to be accurate. But don’t forget that your baby may not follow those growth timelines exactly.

    3. What’s the privacy policy?

    You wouldn’t give out your personal health information to just anyone. But that’s what you may be doing when you download and use some pregnancy apps.

    Before you download a health app, read the disclaimer so you understand what it will do with your information, including whether it will be shared with third-party sites.

    "Before you download a health app, read the disclaimer so you know who will see your health information." via @MedStarWHC

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    Which pregnancy apps did you find reliable and useful during your pregnancy? Connect with us through Facebook and Twitter.

    The pregnancy app we use

    We use the Babyscripts app to help us monitor our low-risk pregnant patients between appointments.

    Women who participate receive a Bluetooth-enabled blood pressure cuff and weight scale. When they take their blood pressure and weigh in, the information is sent to their doctor or midwife. Abnormal results trigger an alert for the doctor, who can then request that you come in.

    Some MedStar practices have been using this app for about a year and a half, and we’re seeing good results. In fact, we had one patient whose high blood pressure reading led her doctor to ask her to come in. When she did, we discovered she had preeclampsia, a potentially dangerous complication. Had the app not alerted her doctor to the blood pressure reading, it’s possible the condition may not have been diagnosed until it was advanced.

    The other nice thing about this app is that it can be tailored to each practice. For example, if I recommend my patients not travel after 29 weeks, I can put it in the app. Women have told me that it makes them feel like they have a doctor in their pocket.

    Not all healthcare apps are the “digital snake oil” some have been made out to be. But we do need to proceed with caution. And the medical community is beginning to work more closely with patients to do that. For instance, the American Medical Association in November 2016 approved principles to promote the use of safe, effective healthcare apps.

    If you’re looking for a fun way to pick a name for your baby, go ahead and download that app. But if you’re looking for more in-depth pregnancy information or advice, talk to your doctor or midwife first. They may have their own app for that!

     

  • April 24, 2017

    By MedStar Health

    Some people with Type 2 diabetes can manage the disease with diet and exercise alone. Others need medication, in addition to lifestyle management, to reach their target blood sugar levels, and many will eventually need two or more medications.

    Studies have demonstrated how these medications perform over a short period of time. But we currently don’t know which of these drug combinations works best long-term.

    An ongoing study, following participants for up to seven years, is looking to change that, and District of Columbia and Baltimore-area residents are helping in the effort. The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) study aims to enroll 5,000 participants at 45 sites across the country. Along with helping advance our understanding of how best to treat this disease, participants also receive medication and supplies, clinic visits, lab tests and education during the trial.

    As of March 1, 2017, nearly 4,400 people were enrolled in the study, and about 200 are from the D.C. and Baltimore area, ensuring that the study’s findings will be representative of our surrounding community. To help reach the 5,000-participant goal, we are recruiting more people in the area with type 2 diabetes to join.

    Are you eligible? To learn whether you qualify to join the GRADE study at MedStar Health Research Institute, call 301-560-2915, email grade@medstar.net, or take our survey here.

    Who is a candidate for the study, and what benefits may they see?

    GRADE study participants represent patients with type 2 diabetes who have had diabetes for less than 10 years and are currently managed on metformin. The GRADE study is making a focused effort to enroll participants from a wide range of ages, race and ethnicities, and across a broad geography.

    Volunteers may be eligible to participate in GRADE if they meet the following criteria:

    • Have had type 2 diabetes for fewer than 10 years
    •  Are older than 30 years of age, or 20 if American Indian
    • Only take metformin (Glucophage) for your diabetes
    • Are willing to take a second diabetes medication
    • Are willing to make four office visits per year for the next four to five years

    In the GRADE study, as with other studies conducted here, the care provided in the study does not replace the usual care participants receive from their doctor, but rather complements it. In the study, participants have their glucose control checked (through a blood test called the HbA1c) every three months. During the visits, the study teams works very closely with the participants to help reach good diabetes control.

    Current Type 2 diabetes medications

    When patients need help beyond diet and exercise to manage their Type 2 diabetes, the medication metformin is usually the first-line choice of treatment. Metformin helps the body respond to insulin more effectively, reduce glucose production in the liver, and decrease the amount of glucose absorbed in the body.

    Metformin has been used in the U.S. since the mid-1990s, and among drugs used to treat diabetes, it has the most evidence to date in terms of long-term safety and benefits. Nonetheless, diabetes is a progressive disease. Beta cell function, or pancreatic function, tends to deteriorate over time in diabetes, so many patients eventually will need to add a second medication to help control glucose levels. It is important to maintain good glucose control to minimize long-term complications related to diabetes, such as nerve, eye and kidney damage.

    It can be a challenge to determine which of the current available medications is the best choice to give patients along with metformin. There are a limited number of studies that have been able to compare the many choices we have available.

    When additional medications need to be added to control blood sugars, a number of factors are considered, including the medication’s:

    • Cost.
    • Safety profile. For example, does this medication increase the risk of having a low blood sugar reaction, or hypoglycemia?
    • Effectiveness. How effective is this medication in controlling blood sugars, and depending on where the patient’s levels of glucose control is, what is the likelihood of the medication getting them to their goal?
    • Complexity of treatment.
    • Likelihood of adherence.

    We hope that the GRADE study will help us say with more certainty which treatment works best and for whom.

    GRADE first long-term study of medication combinations

    Previous studies have looked at the short-term effect of using different drugs along with metformin. The studies typically analyzed how effective drug combinations were in lowering A1C levels. A1C tests are used to understand how well-controlled diabetes is by measuring average blood sugar levels over several months.

    Lowering a patient’s A1C is important, but the GRADE study takes it a step further. It is not only looking at A1C lowering but also determining which combination of drugs is most effective at achieving and maintaining diabetes treatment goals over the long term. Specifically, the goal of the GRADE study is to determine which combination of two diabetes medications is best for achieving good glycemic control, has the fewest side effects, and is the most beneficial for overall health in long-term treatment for people with type 2 diabetes. These types of questions cannot be answered in short-term studies, but require longer-term evaluation such as what is being done in GRADE.

    Funded by the National Institutes of Health, the GRADE study will follow patients who take metformin along with one of four commonly used glucose-lowering medications: glimepiride, sitagliptin, liraglutide and basal insulin glargine. Each has a different mechanism of action and a different effectiveness and safety profile, and the GRADE study is the first study to directly compare all four treatment choices for this patient population.

    This head-to-head comparison of commonly used diabetes medications will examine the effects on glucose levels, durability of maintaining treatment goals, and a number of other areas of interest, including effects on pancreatic beta cell function and quality of life. The study also is unique in that we’ll be able to look at how different groups of people react to the different combinations, which will ultimately help us better personalize treatment for each patient.

    Nearly 1.4 million Americans are diagnosed with diabetes every year. With your help, this study will help current and future with type 2 diabetes in our community better manage their disease and stay healthy longer.

  • April 21, 2017

    By MedStar Health

    If you’ve been told you need a knee replacement due to arthritis, it can feel like you’re caught between a rock and a hard place. On one hand, walking around and being active is painful. But while a total or partial knee replacement can relieve the pain and return your mobility, it also means you may no longer be able to participate in high-impact activities like running, jumping and skiing.  

    I see many patients with knee problems who don’t want to give up these activities. Though they have painful, degenerative conditions that gradually wear down parts of the knee, they don’t want to transition to a more sedentary lifestyle. They want an alternative to total knee replacement that will let them enjoy being active without pain or discomfort.  

    Thanks to a number of medical advancements, we now have an alternative option to treat arthritic knees: cartilage restoration. 

    How we treat arthritis with knee replacement surgery

    To understand whether you may be a candidate for a knee replacement alternative such as cartilage restoration, it’s good to know a bit about arthritis and how we treat it with standard knee replacement surgery.  

    The knee joint connects your femur (thighbone) to your tibia (shinbone). Cartilage covers the areas where these bones come together, allowing them to move against each other as you bend and straighten your leg without too much friction.    

    Unlike bones, cartilage does not receive blood flow, so it doesn’t heal as easily. As we grow older, cartilage tends to wear down, causing inflammation and pain as bones rub against each other without the protective padding of cartilage. This “wear and tear” is called osteoarthritis, and it’s most common among people older than 50.  

    Osteoarthritis is often treated with knee replacement surgery — also known as knee arthroplasty. In this procedure, a surgeon replaces arthritic parts of the knee with prosthetic parts. With total knee replacement, a surgeon basically installs an entire artificial knee, removing arthritis in the process.  

    We perform hundreds of knee replacements each year, and the demand for this surgery is growing. A 2007 study found that U.S. surgeons performed about 700,000 knee replacements every year, but that’s expected to rise to nearly 3.5 million procedures by 2030!

    Unfortunately, most people with osteoarthritis will eventually need a total knee replacement. So here’s the million-dollar-question for orthopedic surgeons: How long is it worth it to maintain a patient’s knee function with partial replacement, given that they’ll likely need total knee replacement in the future?
    Until recently, that was a hard question to answer. But for people with certain kinds of arthritis, we now have an alternative to total knee replacement that makes a temporary fix more worthwhile. By combining aspects of sports medicine with partial knee replacement procedures, we hope to give these patients as many active years as possible.

    How cartilage restoration relieves pain and retains mobility

    Ligaments connect bones together in a joint. A standard knee replacement removes two ligaments: the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Losing these ligaments means your body loses its ability to know exactly where the knee joint is in relation to its other parts – a sort of “sixth sense” known as proprioception. Proprioception is key to movement. It lets you perform motor tasks like walking without having to think about them. Removing the ligaments in your knee throws that sense out of whack.

    In cartilage restoration, we replace arthritic knee cartilage with cartilage from a healthy part of the joint or with a synthetic cartilage-like substance. This way we can patch problematic areas without removing the ligaments. It’s like fixing a pothole on your knee. This procedure, called an autograft arthroplasty or an osteochondral autograft transplant, allows people with arthritis in a certain part of their knee to remain active without the mobility restrictions of a full knee replacement.

    Surgeons can even reconstruct ligaments that have been damaged by trauma alongside cartilage restoration, giving people with torn ligaments–a common sports injury–new hope of being active again.

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    Who is a candidate for cartilage restoration?

    Whether someone is a good fit for cartilage restoration depends on the extent of their arthritis and how well they’ve responded to previous treatment.  

    If multiple parts of the knee are arthritic, as is often the case with osteoarthritis, cartilage restoration isn’t likely to help for very long. These patients would only have a brief period of reduced pain and improved mobility before needing another surgery. Instead, we would recommend a total knee replacement.  

    For someone to be a good candidate for cartilage restoration, they should only have arthritis in one area of the knee, making it easier to replace and more likely to succeed.  

    We prefer to treat knee problems with noninvasive methods before recommending surgery. This can include:  

    • Braces: These supportive wraps take weight off arthritic areas
    • Orthotics: Changes how you distribute weight or the alignment of your foot to reduce stress on your knee
    • Physical therapy: Strengthens muscles and helps mitigate further damage by increasing the knee’s flexibility  
    • Steroid injections/medication: Medications taken orally or by injection can reduce inflammation in the knee joint, relieving pain  

    Not everyone will benefit from cartilage restoration. Some people have arthritis so severe that it can only be successfully treated with a total replacement. But if you’re young (or young at heart), eligible for a replacement alternative and want to run, ski or play sports for years to come, this kind of procedure can help you live an active life without an arthritic knee getting in the way.   

    Schedule an appointment online or call 202-719-0839 to see if you could be a candidate for cartilage restoration or another alternative to knee replacement.

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  • April 18, 2017

    By MedStar Health

    Tune in to the full podcast with Dr. Susan O’Donoghue.

    A relatively new sub-specialty of cardiology is helping people with a family history of certain serious heart problems understand their risk of developing the same conditions and how to prevent them.  Called cardiogenetics, the service is usually only available at advanced heart centers like MedStar Washington Hospital Center, which opened the first program in the Washington metropolitan area. But during the field’s short history, cardiogenetics has already demonstrated its value in identifying some inherited heart syndromes and improving, even saving, the lives of individuals with genetic-based heart disease.  

    That’s because some very specific and dangerous heart problems are known to have strong genetic components. Yet until now, we’ve had to rely on clinical findings, EKGs and imaging to diagnose and treat such conditions—most often, after symptoms have surfaced and the damage has already begun. In contrast, cardiogenetics gives us a new type of tool that can actually help predict the likelihood of developing the disease, allowing us to make pre-emptive strikes before problems arise.  

    Cardiogenetic Testing—When and Why  

    Despite the prevalence of cardiovascular disease in the United States, cardiogenetic testing is only used for a subset of conditions. Testing is most often recommended because of a suspicious finding on a patient’s EKG or other test, his or her symptoms, or personal or family history. Red flags include fainting or palpitations during exercise, a diagnosis of heart failure at age 40 or younger, multiple family members with the same heart condition, or an incidence of sudden, unexpected death in the family.  

    To date, the conditions most suitable for cardiogenetic testing are a few specific structural and electrical abnormalities that can produce fatal irregularities in the heart’s rhythm, including hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS). Anyone with an inherited heart disease like HCM or LQTS may face a 50/50 chance of passing this genetic error on to their children.  

    Hypertrophic cardiomyopathy, an abnormal thickening in the walls of the heart muscle that restricts blood flow and weakens the heart, may result in ventricular fibrillation, a fatal arrhythmia. Quite common, HCM occurs in roughly 1 out of every 500 people and is the leading cause of sudden cardiac death in people 30 and younger, in which the heart suddenly stops beating, without warning.  

    If an individual is found to have a defective HCM gene, we can then screen family members to determine who, if anyone, is at increased risk for the condition and needs close follow-up for early identification of disease and intervention. If the genetic error is discovered in a child, for instance, precautions might include frequent monitoring, an echocardiogram every few years and other safety measures, such as avoiding competitive sports. Conversely, a negative finding frees parents and kids from increased vigilance, life-style restrictions, and worry…at least for HCM.  

    How it Works

    Cardiogenetic testing is extremely simple for the patient, as it only involves collection of blood or saliva samples. Then the tricky part begins, as specialists work to find potential molecular changes that indicate—or, more often, suggest—the presence of the genetic material responsible for the disease.  

    There are three possible outcomes:

    • Positive: a genetic error is causing the patient’s disease or symptoms.
    • Negative: there is no evidence of a genetic mutation.    
    • Inconclusive: something genetically unusual is discovered, but science does not yet understand the relationship between the mutation and the disease; i.e., the genetic variation could be harmless or harmful.

    If tests identify a genetic disorder, recommendations range from avoiding certain things (like some common medications, strenuous exercise or excessive alcohol consumption) to watchful waiting to the prompt initiation of medical, electrophysiological or surgical treatment.

    Fortunately, we have the full array of proven and promising treatments available, multiple experts in every aspect of cardiac care and a certified genetic counselor in cardiology who can help guide patients and families in their decisions.

    Knowledge is Power

    As scientists continue to learn more about the genetic basis for heart disease, the field of cardiogenetic testing will evolve as well. Until then, interpretation is often as much art as science.

    Because of the field’s newness and complexity, current consensus guidelines advise that cardiogenetic testing only be carried out by dedicated centers, like ours, that offer genetic counseling before and after testing. That assures that patients and family members understand the various implications of results and options so they can make fully informed decisions.    

    Meanwhile, a patient’s best bet to defeat or minimize hereditary disease, of any type, is to be aware of his or her family’s medical history. In the presence of arrhythmias, congestive heart failure or cardiac arrest, ask your physician whether cardiogenetics testing might be appropriate for you. Results can help you eliminate, postpone or reduce the effects of genetic conditions or, if negative, reassure you that you’re not following in your family’s footsteps. Either way, knowledge is power!

    Listen to Dr. O’Donoghue’s podcast interview about cardiogenetics.