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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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  • March 18, 2021

    By Vadim V. Morozov, MD

    Having unusually intense pain with menstruation is a way of life for many women. They bear it stoically, perhaps because their mothers and sisters have always experienced the same issue or because they simply attribute it to “being a woman.”

    Some amount of cramping can be expected at the time of a woman’s period. But extreme pain during menstruation—or heavy bleeding and pain from intercourse, bowel movements, or urination—isn’t normal. It may be endometriosis.

    If you’re experiencing this pain, you’re not alone: endometriosis affects more than 6 million American women. In fact, it occurs in about one in 10 women of reproductive age, most commonly women in their 30s and 40s; however, it also has been found in young girls and postmenopausal women.

    What Is Endometriosis?

    When a woman becomes pregnant, the newly fertilized embryo becomes embedded in the endometrium, the lining of the uterus. One theory is that in some women, for reasons unknown, the endometrial tissue travels outside the uterus and begins to take hold and grow in other parts of the body. This displaced tissue remains sensitive to estrogen, the hormone that regulates the menstrual cycle, so it can literally cause symptoms of menstruation wherever it is growing, most typically severe pain and cramping at the time of a woman’s period.

    Other theories are that endometriosis develops as part of the autoimmune process, or as part of “misprogramming” during embryologic development before a woman is even born.

    Endometrial tissue can migrate literally anywhere in the body. Most typically, it appears in the pelvis, on the ovaries, fallopian tubes, bladder, or rectum.

    Endometriosis can add an element of risk to a woman’s pregnancy, although many women with the condition do successfully become pregnant and carry a healthy baby to term.

    Endometriosis affects more than 6 million American women, causing pain and potentially affecting pregnancy. But there is help for chronic symptoms. @VadimMorozovMD has the details. https://bit.ly/3t9qSjf via @MedStarWHC
    Click to Tweet

    Cause and Symptoms

    So, why do some women have endometriosis, but not others? Although the cause of the condition is unknown, it tends to run in families—if a woman has it, chances are, her daughters and granddaughters may develop it as well. And although endometriosis is not a cancerous condition, women with the disease may be at slightly higher risk of developing some cancers.

    For many women, the menstrual period is often marked by cramps and pain. For women with endometriosis, endometrial tissue that has migrated to or developed in other parts of the body will intensify that discomfort by causing additional inflammation, bleeding, cramping, and pain during menstruation. If endometrial tissue has attached to the bladder, for example, monthly period pain will include discomfort in the area of the bladder as well, causing bladder pain, an urge to urinate, and occasionally blood in the urine.

    Additional but less common endometriosis symptoms include GI symptoms such as constipation or diarrhea, bloating, and upset stomach. Pain caused by endometriosis can leave the patient in a painfully unpleasant state each month, unable to play sports, care for children, have intercourse, or perhaps even get out of bed.

    Symptoms typically begin in a girl’s teen years and get progressively worse until the disease is finally diagnosed years later. Some patients may experience no symptoms at all, yet the condition is discovered during an unrelated surgery.

    Planning a Family

    While this condition does not cause infertility per se, it may make it more difficult for a woman to get pregnant. In almost 40 percent of women who have trouble conceiving, we find that inflammation from endometriosis has damaged ovaries, eggs, fallopian tubes, or the uterus itself.

    When a woman with endometriosis wants to have a child, we recommend trying naturally for three to six months, depending on her age. If she does not conceive within that timeframe, we discuss short- and long-term goals. The gold standard of care is laparoscopy to remove ectopic endometrial and scar tissue which may be affecting pregnancy.

    Most women with endometriosis are likely to conceive. But it’s important that they consult with their Ob/Gyn to understand the potential risks. For a woman who does conceive, damage done by endometrial tissue may increase her risk of a painful pregnancy, premature labor, or Cesarean section. Happily, however, for reasons not fully understood, painful symptoms tend to improve a bit during pregnancy and breastfeeding, even while the underlying disease persists.

    In a woman’s later years, estrogen production declines with the change of life that comes at menopause. Symptoms from endometriosis generally tend to improve then as well; however, endometriosis has been found and reported in postmenopausal women and symptoms may return if estrogen is brought back through estrogen replacement medications used to treat menopause symptoms. Again, discussion with an Ob/Gyn is an endometriosis patient’s best course of action.

    Diagnosing and Treating

    Symptoms of endometriosis may actually simulate other medical issues, such as pelvic inflammatory disease, ovarian cysts, chronic bladder infection, or irritable bowel syndrome. A definitive diagnosis is made via minimally invasive laparoscopy.

    Although endometriosis is a chronic, long-term condition with no current cure, medication and surgery can help to reduce symptoms and the risk of permanent damage to affected organs.

    Managing pain is the primary goal of medication. Over-the-counter anti-inflammatory drugs such as ibuprofen (Motrin®) and naproxen (Aleve®) are a first step. If these are ineffective, medications used to treat nerve pain, such as gabapentin and duloxetine, may be prescribed. Because of the risk of addiction, we avoid using narcotics.

    The production of abnormal tissue is fueled by estrogen, so medications that reduce estrogen production may also help—including hormonal birth control agents, a hormone antagonist, or an aromatase inhibitor.

    At MedStar Washington Hospital Center, we conduct a laparoscopy if symptoms are significant enough that we suspect endometriosis. With the patient under anesthesia, we insert a small camera into the abdomen, usually through a small incision in the navel, then add a few more tiny incisions that allow us to view the pelvis thoroughly.

    If abnormal tissue is found, we remove samples for testing. In many cases, we can entirely remove the abnormal tissue during the same procedure. Almost every patient goes home the same day and experiences little to no scarring. In more than 90 percent of cases, recovery time is one to two weeks.

    In some cases, when we find that significant damage to vital organs has occurred, more extensive surgery may be needed. For example, serious damage to the wall of the rectum would require a resection and possibly a temporary colostomy. In that case, we would schedule the patient with a colorectal surgeon, and recovery time would be longer.

    Improvements in Care

    At one time, surgical removal of the uterus and ovaries was considered the only way to improve endometriosis. Today, with laparoscopic detection and minimally invasive surgery, we can target specific problem spots and avoid many of the complications that come with removal of reproductive organs.

    We are getting closer to improved ways to diagnose this condition via a blood test or saliva smear. We are also looking for a genetic marker that may predict which women are at greatest risk for developing endometriosis.

    Here at the Hospital Center, our multidisciplinary team is always looking for ways to keep our patients on their feet and enjoying life. We consult with specialists from other disciplines whenever needed; for example, we would perhaps include physical therapy to also address a patient’s pelvic floor problems or behavioral health to help her cope with this chronic condition.

    We have the skills, drive, and resources needed to get endometriosis patients on the road to recovery as conveniently and safely as possible.

    A Final Word

    Despite the current pandemic, please address symptoms without delay. Every woman’s condition is unique, and much depends on how early we make a diagnosis. Endometriosis doesn’t go away, but the sooner it is correctly addressed, the sooner you can live a full life with less limitations.


    Abnormal menstrual pain?

    Our specialists can help.

    Call 202-788-5048 or Request an Appointment

  • March 16, 2021

    By MedStar Health

    Jo Ann Boyle’s family had experienced health scares before. As wife, mother, and grandmother, Jo Ann had stood faithfully and supportively by her family as her husband Garth successfully beat cancer and her son Brian emerged triumphantly from rehabilitation following a serious accident.

    Happily, Jo Ann herself had no apparent medical issues—until her routine physical in 2018, when her family doctor advised her to complete a colon screening. In her late 50s at the time, Jo Ann had never been screened. And she was well overdue according to 2018 guidelines that recommend patients get screened at age 45 instead of 50.

    Jo Ann had no symptoms and none of the typical risk factors for colorectal cancer—a family history of colon cancer, a previous diagnosis of colon cancer or precancerous polyps, or the presence of any type of colorectal disease. So, she was a good candidate for an at-home colon-screening test.

    Her doctor prescribed Cologuard®, an FDA-approved test that examines a person’s stool sample for abnormal DNA or traces of blood that may warn of precancerous polyps or colon cancer. The Cologuard test provides the patient with the tools to easily collect and ship a viable stool sample to a testing center. Jo Ann submitted her stool sample and awaited her test results.

    Why Testing Is Critical

    Those results came in a troubling phone call from her doctor. With concern in his voice, he informed Jo Ann that her at-home test was pointing to a potential abnormality in her colon. He recommended that she make plans immediately for a colonoscopy.

    A possible abnormality certainly calls for attention: In the U.S., colorectal cancer is the second most common cause of cancer deaths among men and women and is expected to take over 50,000 lives this year.

    Fortunately, the number of patients diagnosed with this cancer has declined since the 1980s, mainly thanks to a strong focus on early screenings, as well as patients’ greater awareness of lifestyle factors that may increase their risk. Early detection is critical for good long-term outcomes.

    At-home testing can be useful to flag the presence of polyps or suspicious symptoms within the colon. But colon cancer screening via a colonoscopy, performed onsite at a medical facility, is regarded as the gold standard, not just for locating and identifying growths but also for removing them when found.

    Jo Ann’s Journey

    Jo Ann, however, dreaded the thought of a colonoscopy. She feared the procedure itself, as well as a possible diagnosis of cancer.

    Although she realized the situation called for speedy attention, she delayed scheduling her colonoscopy. In fact, she put it off for over a year. She focused her energies instead on continued nurturing of her family, especially the granddaughter and brand-new grandson of whom she was so proud.

    But that didn’t mean that Jo Ann didn’t worry regularly about her Cologuard result. As she puts it, “Always, in the back of my head, I was thinking, ‘I’ve got to get this done. I’ve got to get this checked out.’”

    As several months passed and Jo Ann persisted in delaying her colonoscopy, a new concern emerged for everyone: the novel coronavirus began to spread across the U.S. Although hospitals immediately implemented safe, effective COVID-19 protocols, in Jo Ann’s mind, the virus represented another good reason not to enter a hospital for a procedure.

    At that point, Jo Ann began noticing some worrisome new symptoms. She felt an unfamiliar achy tenderness in her side when she picked up her grandkids. And she noticed that her stools were becoming long and skinny, an indicator of possible colon issues. (Other possible symptoms of colon issues are rectal bleeding, stools that may be darkened by the presence of blood, constipation or diarrhea lasting more than a few days, and fatigue brought on by iron-deficiency anemia.)

    “Suddenly, one day I read an article in a MedStar Health publication about how important colonoscopy is,” she comments. “And I noticed that it mentioned several of the symptoms I’d been having! That really got my attention.”

    Jo Ann decided it was time at last to reach out to MedStar Washington Hospital Center and schedule that crucial colonoscopy.

    “For your peace of mind and your family’s—and to protect your health—don’t delay care. If your doctor advises it, get the colonoscopy!” Read Jo Ann’s story. https://bit.ly/3takyaX via @MedStarWHC
    Click to Tweet

    Jo Ann’s Procedure

    “I was quite afraid to start the process,” said Jo Ann. “The prospect of possible cancer was terrifying. But I was at the point where it was better to get the information I needed and move ahead than to be paralyzed by anxiety.”

    Jo Ann’s first appointment was a telehealth visit with nurse practitioner Andrea Greetham. After Andrea assured Jo Ann that it’s common for some patients to be apprehensive about their colonoscopy, she walked her through colonoscopy prep as well as the colonoscopy procedure itself, and answered her questions. The two set a date for Jo Ann’s colonoscopy and discussed her check-in procedure.

    “Right away, I could feel my fear starting to fade,” said Jo Ann. “I even felt relaxed enough to ask if I could wear makeup during my procedure. Andrea admitted that she’d never been asked that one before! We had a good laugh.”

    On the day of her colonoscopy, due to COVID-19 protocols, Jo Ann was required to enter the hospital alone—at a time, of course, when she most wanted family members with her. “I was very nervous,” she acknowledges. “But I was immediately met by my Hospital Center team. They brought me in, got me comfortable, and prepped me for my procedure. They explained each step they were taking” she notes, “to help manage any anxiety I had and help me feel ready for my procedure. Even surrounded by staff members who were masked and fully outfitted for COVID-19 safety, I felt calm and cared for.”

    Just before she was anesthetized, Jo Ann still fondly recalls a team member telling her, “I just want to let you know, you remind me of my mama. And I love my mama. I’m going to treat you the way I’d want her to be treated, ok?”

    Jo Ann’s colonoscopy, performed by colon and rectal surgeon Dr. Brian Bello, took just 40 minutes. During the procedure, a flexible, lighted tool called a colonoscope is used within the colon to view its entire length and allow the surgeon to spot, identify, and remove any precancerous polyps or malignant growths.

    In Jo Ann’s case, Dr. Bello discovered and removed a pair of colon polyps to be biopsied. Jo Ann was released from the hospital and reunited with her family shortly after.

    A few days later, Dr. Bello contacted JoAnn with the reassuring result of her biopsy. After more than a year of stress and uncertainty, her polyps were found to be benign!

    Don’t Wait, Take Action

    Jo Ann Boyle has some advice for anyone who is overdue for their colonoscopy or feeling discomfort and noticing other symptoms:

    “I wish I hadn’t waited so long to reach out to speak to a doctor and schedule my procedure. For your peace of mind and your family’s—and to protect your health—please don’t delay care. See your doctor and get your colonoscopy!”

    Remember: Early detection of precancerous growths helps prevent the spread of potentially deadly cancer. A colonoscopy is an easy, outpatient procedure that can identify and remove those growths before they become cancerous.

    If you’re over 45 and have not yet scheduled yourself for a baseline colonoscopy, ask yourself: “What am I waiting for?”


    Blood in your stool?

    Our specialists are here to help.

    Call 202-788-5048 or Request an Appointment

  • March 12, 2021

    By Ebony R. Hoskins, MD

    The COVID-19 pandemic has presented us with some unique challenges, especially when it comes to caring for cancer patients with compromised immune systems. It probably won’t surprise you that the arrival of the vaccine was one of the most uplifting days for me and my colleagues.

    I remember when I first heard the news… it was like Christmas came early! The decision to get the vaccine was an easy one for me. Working at a hospital, I have seen firsthand how devastating this disease can be. Some of my patients became infected with the disease and it delayed their cancer treatment. Others were so sick that it inhibited their daily activities beyond the time of their initial diagnosis.

    I knew the vaccine was the best chance I had to protect myself, my family and my patients. I honestly couldn’t get vaccinated fast enough.

    This isn’t just about me, though.

    We have had to adopt a very strict visitor policy at the hospital in our efforts to help slow the spread of COVID-19. This means that many people were not able to see their families or friends while hospitalized. While we provide medical treatment, the presence of family and friends is a key component in the healing process.

    This became very evident to me when I was caring for a patient this summer who was admitted to the hospital for four weeks. She was having a tough time—in lots of pain and unable to eat and drink. She couldn’t have the support of her loved ones in person because of the pandemic. Our doctors, nurses, and support staff tried to fill that void, but it just wasn’t the same. I often wonder if she would have had a speedier recovery if she had been able to hug a family member or watch TV with a friend while she was in the hospital.

    Family and friends can help our patients during a hospital stay, but the only way we can get back to allowing visitors on a more regular basis is by getting the pandemic under control. The vaccine is our best chance to do that!

    I strongly encourage you to get vaccinated as soon as you have the chance to do so. Trust the science. These vaccines are extremely effective at preventing the spread of COVID-19. The sooner everyone gets vaccinated, the sooner we can start returning to a sense of normalcy. Do it for yourselves. Do it for your family and your community.

    This has been a tough year for all of us. But there is light at the end of the tunnel. Once enough people get vaccinated, we will be able to do the things that we may have taken for granted before: hug a friend, go to a concert, or visit a family member in the hospital. Please, get vaccinated as soon as it’s your turn.


    For more information on the COVID-19 vaccine and how you can make an appointment, please visit medstarhealth.org/vaccine

  • March 11, 2021

    By Judith H. Veis, MD, Nephrology

    The kidneys are complex organs, functioning together as traffic cop, filtration plant, and biochemical factory. They keep us healthy by removing waste produced by cells. They also clear the body of medications, balance fluid levels and blood pressure, orchestrate red blood cell production, and even produce the active form of vitamin D for strong bones.

    The entire body depends on the kidneys to get through the day.

    Our two kidneys, each about the size of a fist, are situated in the lower back, at either side of the spine. Together, they’re a powerful metabolic engine, filtering blood via millions of microscopic blood vessels, at the rate of a gallon-and-a-half per hour. These tiny filters process blood plasma at the molecular level, extracting waste that then exits the body as urine.

    Because this essential work stream depends entirely on blood flow, any disease that affects the blood vessels will also affect the kidneys—making high blood pressure a major cause of kidney damage. Kidneys can also be damaged by diabetes, injury, or infection. And some people are born with urinary system malformations that may affect their kidney function.

    Kidney disease affects at least 37 million Americans. Men are at higher risk than women, and African Americans and Latinos have a higher risk than whites. We’re also learning more about the role that family history may play.

    When Damage Occurs

    The kidneys are so dependable that they continue to work even after disease sets in.

    When a filter within a kidney becomes damaged, other filters must work harder to compensate, and as these filters become more stressed, a chain reaction of damage can begin. But because each kidney has millions of such filters, it may take a long time for enough filters to become damaged and for symptoms to finally become apparent.

    So early-stage kidney disease is often without symptoms—as many as 90 percent of patients with the disease are not aware they have it. This is why we depend on laboratory blood and urine testing to monitor kidney function, particularly in early stages of the disease.

    When kidney function drops below 15 percent, a patient may experience chronic kidney disease symptoms such as loss of appetite, nausea, restless legs, daytime drowsiness, and anemia, even though their volume of urine output may be surprisingly close to normal. Fluid buildup can also occur within the body, causing shortness of breath and swollen ankles. At this stage, the patient’s condition is considered a medical emergency.

    Living with Kidney Disease

    When kidney disease has been diagnosed, proper medication and diet can help slow its progress. In treatment and management of chronic kidney disease, we focus on managing blood pressure and diabetes, to protect the blood vessels and prevent additional damage to the kidneys.

    We can prescribe a number of effective medications to help control both conditions. Some newer agents have secondary benefits that can protect the kidney as well. With successful maintenance, we may even see limited recovery of scarred kidney tissue, depending on severity.

    We also restrict certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Motrin®, Advil®). We may also restrict certain proton pump inhibitors for gastrointestinal disease, like omeprazole (Prilosec OTC®) and lansoprazole (Prevacid®) if alternatives are available. Acetaminophen (Tylenol®) is recommended to treat pain or fever. Check with your doctor before taking other over-the-counter drugs or herbal supplements.

    Nutritional management of chronic kidney disease includes the critical step of reducing sodium. And for diabetics, regulating carbohydrate consumption helps keep blood sugar even, preventing the dangerous highs and lows that can spur blood vessel damage.

    I recommend the Mediterranean diet or the DASH (Dietary Approaches to Stop Hypertension) diet. Both include lots of fruits, vegetables, whole grains, fiber, and other healthy foods, and exclude overly salty or processed foods. I follow these dietary approaches myself and can confirm that, when you give yourself time to adjust to it, food tastes fine with less salt. Choose high-quality, flavorful foods to satisfy your taste buds.

    We find that kidney disease patients who have the greatest success at managing their diet have the support of their family members. If the patient craves pizza, Chinese food, or another high-salt meal, it can be easier to resist if the family helps steer them to healthier options.

    Managing blood pressure and diabetes protects blood vessels, which in turn protects the kidneys. Learn more about living with kidney disease from Dr. Judith Veis. https://bit.ly/308KlUz via @MedStarWHC.
    Click to Tweet

    Help from Dialysis

    When kidney function dips to 10 percent or lower, we turn to dialysis for help. Although most kidney patients will not need it, a small percentage will.

    The patient’s healthcare provider recommends a type of dialysis based on the patient’s physical condition, access to transportation, and home environment. There are two types of dialysis:

    • With hemodialysis, the blood is circulated through an artificial kidney that removes waste products. Before the process begins, the surgeon performs a minor procedure on the patient’s arm or leg to allow access to the bloodstream. Hemodialysis is done at an outpatient dialysis center and generally requires three sessions per week, about four hours a session. Patients can also have training to do hemodialysis at home.

    Peritoneal dialysis is performed within the abdominal cavity. Before the procedure, the cavity is slowly filled with a special fluid that draws waste from the blood directly through the network of blood vessels that line the abdomen. Both fluid and waste products can then be removed.

    Peritoneal dialysis can be performed by the patient at home. It can even be done overnight so it doesn’t affect the patient’s normal daytime routine. Patients are required to visit their specialist about twice a month to check lab results and review their treatment.

    Of course, with kidney disease, a patient may experience occasional days of not feeling well, especially if anemia—lack of iron in the blood—creates fatigue. Dialysis and medication for the anemia help us stay ahead of the anemia and make our patients feel more like themselves.

    Dialysis represents a big life change. But, although it can cause some temporary minor discomfort, most patients do very well with it. I have seen patients who resisted it at first, then helped those around them adjust to kidney failure when they realized how many opportunities dialysis gave them to enjoy everyday life again.

    Transplantation

    In the rare event that kidneys shut down completely, transplantation is the remaining option.

    As a national leader in transplant surgery, MedStar Health has a large, highly skilled surgical and nephrology team to support transplantation, with the full assistance of dozens of specialists and other experts in both clinical and support roles.

    We take a very holistic, teamwork approach and have treated many kidney patients, so we are capable of managing even the most difficult cases.

    COVID-19 and Kidney Disease

    Kidney disease is not thought to increase the risk of contracting COVID-19, but having kidney disease as a preexisting condition can definitely make the virus worse.

    And the virus itself can stress your kidney function, particularly for patients on a ventilator. The coronavirus can also infect the kidney directly.

    During the pandemic, it’s critical that kidney disease patients stay in touch with their specialist and take all advised precautions to prevent infection. Don’t delay scheduled lab work for your kidneys—that information is critical to your health, and having blood drawn is very safe with all the COVID-19 protocols we have in place. Our robust telehealth system is another great way to stay in touch with your doctor as needed, in between on-site visits.

    Living Well

    If you have kidney disease, it doesn’t have to interfere with living your life. With the right care and vigilance, patients with kidney disease can most certainly live their best lives and enjoy family, work, and play almost as well as those without kidney issues.

    We encourage you to do your part: eat healthy, exercise, and stay connected with your doctor to keep blood pressure and blood sugar under control.

    Your kidneys will thank you.


    Know your risk for kidney disease.

    Our specialists can help.

    Call 202-788-5048 or Request an Appointment

  • March 09, 2021

    By Meeta Sharma, MD, Endocrinology

    When medical professionals use the word syndrome, we are generally describing a group of interrelated problems. In the case of metabolic syndrome (MetS), we’re referring to a cluster of different disease processes that, together, make people sick and increase their long-term risk of serious illness.

    Risk factors associated with metabolic syndrome are excess belly fat, high triglycerides, a low level of “good” HDL cholesterol, and insulin resistance. (Insulin resistance is synonymous with pre-diabetes, when the pancreas is producing adequate insulin but the body is becoming resistant to it, leading to excess sugar in the bloodstream.)

    Specifically, metabolic syndrome is diagnosed when a patient displays three or more of these five metabolic syndrome risk factors:

    • A waist circumference greater than 40 inches/102 cm in men or 35 inches/89 cm in women
    • Blood pressure exceeding 130/85
    • A fasting triglyceride level over 150
    • A fasting HDL cholesterol at less than 40 in men or 50 in women
    • Fasting blood sugar over 100 milligrams per deciliter of blood (after an eight-hour fast)

    These conditions are interrelated and, in combination, grow even more serious and complex. Because they contribute significantly to the risk of coronary artery disease, they increase the potential for heart attack and stroke, particularly when there is a family history of heart disease.

    Metabolic syndrome is a combination of risk factors that can cause stroke, heart attack, or other serious conditions. But with the right treatment, it can be controlled, even reversed. More from Dr. Meeta Sharma. https://bit.ly/3bhN9VU via @MedStarWHC
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    Risk Factors

    Numbers only tell part of the story. Even without most of the risk factors above, a patient may present with metabolic syndrome, depending on build, ethnicity, and family history. For example, a slightly built male of southern Asian heritage may have this disorder despite a waistline of less than 40 inches.

    It’s important to consult a medical professional if blood pressure and routine blood work fall outside recommended ranges. And, although the classic definition of metabolic syndrome specifies three or more warning signs, I tend to be more preemptive. If I see a patient with two indicators, I begin the process of education and intervention, since it’s likely he or she will develop a third or fourth factor over time if action isn’t taken.

    Besides increasing the patient’s risk of heart attack and stroke, additional imbalances significantly increase their odds of type 2 diabetes and fatty liver disease—disease conditions that are far better to prevent than to treat.

    So, whenever we notice a patient’s risk factors increasing, we act quickly and proactively.

    Lifestyle Influences

    Among the most significant risk factors for metabolic syndrome is age—risk is 40 percent higher after age 65 than it is in younger patients. African Americans are also at higher risk, as are Latina women. Diabetes during pregnancy can also increase a patient’s risk.

    I consider acanthosis nigricans a signal of metabolic syndrome—it causes dark velvety lesions in skin folds, such as at the neck, armpits, or groin.

    But these examples represent only a small percentage of causes. Most instances of MetS are the result of unhealthy lifestyle: excess weight, lack of exercise, and eating poorly. Our Western lifestyle tends to be more sedentary. We work and play at the computer, watch more TV, and eat more processed foods with more fat, sugar, and salt than our parents and grandparents ever did. It’s not surprising that as many as one-third of Americans have metabolic syndrome.

    And as obesity and Western habits have spread globally, so have type 2 diabetes and metabolic syndrome. They are both on the rise in Europe, Asia, and the Middle East, with Africa expected to “catch up” quickly. Without intervention, MetS has the potential to be a global epidemic.

    Taking Control

    We all have risk factors, such as family history, that we cannot change. But most of us can work to control weight, diet, and exercise. It’s not necessarily easy, but it is possible—and potentially life-saving.

    At MedStar Washington Hospital Center, we are always on the lookout for early-warning signs of metabolic syndrome in our patients. In the clinic, we begin with a thorough family history and physical exam. The potential for metabolic syndrome often becomes clear when we uncover heart disease, diabetes, obesity, or even gout, another potential predictor, in the family history. All my medical students carry a measuring tape to measure waist size, a primary indicator.

    When we suspect MetS, we prescribe blood work and a urine test to provide confirmation. Then, our first step is patient education. Because many of my metabolic syndrome patients feel fine and are living their lives without symptoms or problems, it can be difficult for them to accept that they’re potentially in medical trouble. But most of them have moderate or high risk.

    We have tools on hand to help, such as a cardiovascular disease risk calculator that can predict the risk of atherosclerosis and heart disease within the next 10 years. This can be quite an eye-opener for the patient.

    Fortunately, most patients know that controlling blood pressure, sugar, and weight benefit their health and understand the need to improve their situation. We typically start with lifestyle changes, like these, that help reduce cholesterol and blood pressure:

    • Increase physical activity. I recommend 30 to 60 minutes of aerobic exercise five days per week. On the other two days, practice some form of resistance exercise.
    • To normalize blood sugar, adopt a carbohydrate-consistent meal plan, high in whole grains, greens, salads, and legumes.
    • To help with weight loss and reduced cholesterol, carbohydrates should make up less than 50 percent of everything you eat and drink. Total fat should be less than 30 percent of the diet; saturated fats from meat, cheese, butter, and other animal products, less than 7 percent.
    • Reduce salt intake, which is critical for those with high blood pressure.
    • Quit smoking, which also contributes to cardiovascular disease.

    Diet and exercise can bring dramatic improvement in MetS—even moderate weight loss can go a long way. Losing just 7 to 10 percent of body weight in the first year has a huge impact on a patient’s total risk.

    For patients who are unable to make enough difference via lifestyle changes, we consider medications, both for blood pressure and cholesterol. We carefully assess risk for each individual and introduce medication prudently, depending on the results of the patient’s other efforts.

    How MedStar Washington Hospital Center Can Help

    Our Endocrinology department is well equipped to help patients get metabolic syndrome under control.

    Our doctors are among the best in the country. Each patient has access to an entire multi-disciplinary team of doctors, diabetes educators, and nurse practitioners, all working to educate, support, and motivate. And, because metabolic syndrome can lead to other issues, we collaborate with other specialists, such as cardiologists, to keep the heart and arteries healthy. We also have superb specialists in surgical intervention for weight loss, if that measure is called for.

    Care During COVID-19

    For some time, we’ve suspected that the presence of metabolic syndrome may increase the severity of COVID-19. Research data have confirmed those suspicions: the factors that contribute to metabolic syndrome are also COVID-19 risks.

    Having the disorder doesn’t necessarily make you more likely to contract the coronavirus, but it can make the virus significantly worse once infection sets in. Studies show that metabolic syndrome patients are at higher risk for hospitalization, ICU admission, intubation, and death from COVID. This brings even greater urgency to get MetS under control.

    Unfortunately, the current pandemic has made it easier for all of us to fall back into old habits and let our diet and exercise regimens slip. Many people find that they’re not as active and have increased their snacking. Many have delayed visits to their physician.

    But remember, the threat of metabolic syndrome can double your risk of cardiovascular disease. Diabetes increases your risk five-fold.

    It’s critical to stay vigilant, stay on your diet, stay active, and stay in touch with your doctor.


    At risk for metabolic syndrome?

    Our endocrinology team can help.

    Call 202-788-5048 or Request an Appointment

  • March 07, 2021

    By MedStar Team

    Congratulations to all MedStar researchers who had articles published in February 2021. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

    Selected research:

    1. "Innovations in Infection Prevention and Treatment"
      Surgical Infections, 2021. DOI: 10.1089/sur.2020.202
      Tejiram S, Shupp JW.

       

    2. "Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments"
      Hand Clinics. 2021.DOI: 10.1016/j.hcl.2020.09.011
      Means KR Jr, Saunders RJ.
    3. "Negative pressure wound therapy system in extremely obese women after cesarean delivery compared with standard dressing"
      The Journal of Maternal-Fetal & Neonatal Medicine, 2021. DOI: 10.1080/14767058.2019.1611774
      Kawakita T, Iqbal SN, Overcash RT. 

       

    4. "The STRIATE-G Technique for COVID-19 ST-Segment Elevation Myocardial Infarction"
      JACC Cardiovascular Interventions, 2021. DOI: 10.1016/j.jcin.2020.09.045
      Yerasi C, Khalid N, Khan JM, Hashim H, Waksman R, Bernardo N.

       

    5. Early mortality benefit with COVID-19 convalescent plasma: a matched control study"
      British Journal for Haematology, 2021. DOI: 10.1111/bjh.17272
      Shenoy AG, Hettinger AZ, Fernandez SJ, Blumenthal J, Baez V.