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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 

    Follow these six tips to prevent and treat skin damage caused by winter dryness.

    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 

    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.

    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.

    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.

    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.

    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.

    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.

    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 

    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.

    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 

    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog:
    Click to Tweet


    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.

    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.


    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • February 03, 2021

    By Harjit K. Chahal, MD

    As a cardiologist, I know how important it is to eat healthy and exercise. And, up until COVID hit, I applied the same tips for a healthy heart that I recommend to my patients in my personal life. However, when the pandemic began affecting our communities, I quickly abandoned some of those habits without realizing it.

    I gained ten pounds, became less disciplined, and neglected exercise, which started a vicious cycle that many of my patients can relate to. I missed seeing my patients face-to-face, and I wasn’t able to see my friends and family, which felt isolating. Many of my patients needed a shoulder to cry on as they dealt with pain and loss from anxiety, stress, job loss, and more. And the truth is, I was going through the same emotional and mental turmoil that my patients were struggling with.

    It can be hard to establish healthy habits but it’s critical to preventing #HeartDisease. On the #LiveWellHealthy blog, learn 4 tips from cardiologist Dr. Chahal, who had to re-establish her own heart health during #COVID19:

    Click to Tweet


    Why it’s important to have a healthy heart.

    The heart is an incredible organ, beating several thousand times a day and pumping nutrients throughout the body. But, to do its job efficiently, it has to be healthy. Anything that puts stress on the heart muscle impacts the rest of our body. For example, we know that excess weight gain can lead to other health problems, like diabetes and high blood pressure. Those conditions can eventually lead to heart disease.

    In highly stressful situations, our body releases a hormone called cortisol. Cortisol is like your body’s “fight or flight” response to stress, shutting down other parts of the body while we respond to the stressor. Studies show that women are more prone to chronic stress, and long-term exposure to stressful situations positions you and your heart at high risk for cholesterol, diabetes, high blood pressure, and heart disease.

    Everything is connected in our body. That’s why it’s so important to be aware of our daily choices that impact our hearts, including:

    • What we eat
    • How much we exercise
    • How we handle stress

    This applies to cardiologists, too. Eventually, I realized that I needed to take back control of my heart health. Here’s how I did it.

    How I regained control of my heart health.

    When COVID-19 derailed my healthy habits, I decided to take small steps that were manageable and realistic. The first thing I did was sign up for an online yoga platform as a way to motivate myself to exercise in the absence of visiting the gym. I invited some friends to do it virtually with me throughout the week. And, we began getting together once a week outside in a socially distanced setting to do the class together while wearing masks.

    Within two weeks, I felt more energetic again and more empathetic with my patients, although I could only see them virtually. The more I did it, the better I felt, and the more motivated I was to make mindful choices throughout the day, including more nutritious food choices. I lost the weight I had gained and maybe even a few extra pounds without using any kind of fad diet.

    A cardiologist’s top tips for a healthy heart.

    Tip #1: Eat more whole foods and less processed foods.

    Whole foods encompass anything you can get from nature, including:

    • Fruits
    • Vegetables
    • Whole grains
    • Nuts
    • Beans

    Whole foods are nutrient-dense and don’t come from a box or factory. In contrast, processed foods typically have a long list of ingredients, many of which you cannot pronounce. They’re empty calories that take minimal effort to cook, and they contain chemicals to stay preserved over a long time. A potato, for example, is a whole food. Comparatively, potato chips are processed foods that are high in fat and sodium.

    It can be hard to break eating habits, especially when options abound at the grocery store. You don’t have to overhaul your whole pantry and life at once. Try taking one meal at a time, one snack at a time, one day at a time. A slow approach could follow the following steps week-by-week:

    • Learn what a whole food is
    • Distinguish between whole foods and processed foods at the store
    • Swap a few of your favorite processed breakfast foods for whole foods (e.g. eat oatmeal and fruit instead of sugary cereal for breakfast)
    • Start swapping ingredients for snacks and the rest of your meals

    Tip #2: Move every day.

    Our attitude about exercise needs to change. You don’t need to exercise for two hours every day in the gym. In fact, the best effects from exercise come from moderate to high-intensity exercise that lasts just 20 to 30 minutes. Even walking can help you to keep heart disease at bay.

    Aim to exercise at least 30 minutes every day. If you have a busy schedule, you don’t have to do it all at once. Consider breaking up your exercise time into chunks. For example, get up and walk three times a day for 10 minutes in between meetings.

    The benefits extend beyond looking and feeling good. Exercise can also help:

    • Tone your muscles
    • Strengthen your heart
    • Lower inflammation in your body
    • Fight disease

    Many forms of exercise don’t require a lot of equipment or expensive membership, such as yoga or hiking. Just do something to avoid being sedentary all day!

    Tip #3: Meditate.

    As I mentioned, everything in our body is connected, including things that create emotional calmness. That includes meditation and things like mindfulness which helps us to reduce our stress and thereby increases our ability to fight disease.

    Even ten minutes of meditation can produce the feel-good hormone serotonin that offers health benefits. Meditation can look different for everyone but may include:

    • Thinking about your day
    • Praying
    • Practicing slow-breathing

    Tip #4: Be kind and grateful.

    Your mental and emotional health impacts your overall well-being, including our heart health. Similar to meditation, showing kindness releases good hormones that can:

    • Lower stress
    • Reduce inflammation
    • Lower your blood pressure
    • Increase your body’s ability to fight disease
    • Lessen depression

    It’s easy to show kindness, whether it’s simply holding the door for someone else or reflecting on the things in your life that you appreciate.

    Watch our Facebook Live broadcast with Dr. Chahal to learn more about taking control of your heart health:

    Start taking steps toward a healthier heart today.

    There’s no quick fix to a healthy heart. But by taking small steps in the right direction, you can develop long-lasting habits that will benefit your heart and your entire body. If I can do it, you can, too.

    If you have been diagnosed with diabetes, high blood pressure, or heart disease, continue taking your medication and working with your doctor to make healthier choices. At MedStar Health, we’re here for you and are taking strict precautions to ensure our offices are safe and ready to care for you. Don’t delay care. In an emergency, it’s far better for you to be in the care of the experts rather than at home, even during the pandemic.

    Do you need support in taking steps towards a healthier heart?
    Schedule a visit with a MedStar Health primary care doctor today.

    Learn More

  • February 01, 2021

    By MedStar Health

    Monti Schmitt is one of those rare individuals whose idea of fun was riding off-road over rough terrain on a motorcycle at high speeds. For the former motocross race competitor, it was natural—and exhilarating. So were his “20-hour workdays” at his Fredericksburg, VA, motorsports business. He thought he was nearly indestructible, despite breaking multiple ribs twice in motorbike accidents. So, when the now 64-year-old had a pain in his chest during a walk, he thought little of it. But when the pain persisted for hours, Mr. Schmitt decided that his wife was right—a trip to the hospital was warranted.

    “It was late December 2018,” Mr. Schmitt says. “When I woke up, it was January. I was shocked out of my mind when the doctor told me I needed a left ventricular assist device [LVAD] because I was in heart failure.”

    Mr. Schmitt wanted a second opinion and did some research. That’s when he saw Mark Hofmeyer, MD, Director, Advanced Heart Failure Intermediate Care Unit at MedStar Washington Hospital Center. “He first tried some alternative treatment options. He took me off the drugs I had been put on at the other hospital and tried a defibrillator. But that wasn’t working.”

    When his legs became swollen, Mr. Schmitt sent Dr. Hofmeyer a photo. “He told me to come into the hospital right away.” Two weeks later in early May 2019, Mr. Schmitt was implanted with an LVAD and was put on the heart transplant list. While the LVAD relieved Mr. Schmitt’s symptoms, he knew it was a temporary solution for his failing heart.

    This past April, during the worldwide coronavirus pandemic, Mr. Schmitt got the call. “I was told a heart was available,” he says. “I remember I didn’t quite understand and said ‘What?’ Then I put Dr. Hofmeyer on hold. I was hesitant because of COVID. But I spoke to my wife and son who told me this was my heart, and this was my time. I said ‘Let’s do it!’”

    “I know the hospital well and I knew that everyone would ensure my safety,” he says. “It was hard not to have my family there because of the no-visitors rule, but we got through it. Before I left, I had a lot of conversations with the team about post-procedure protocols for home. I had physical therapy at home, too. And in the time since, I’ve had lots of contact with the team—phone calls, video conferencing, especially with the Transplant Coordinator Kimberly Demirhan—she’s my gal!”

    Now with his new heart, Mr. Schmitt says, laughing, “I’m a new person, like a 19-year-old iron man!”

    Your heart deserves expert care.

    Contact our team today

    Call 202-788-5048 or Request an Appointment

  • January 29, 2021

    By MedStar Health

    As a longtime athlete, Kyle Reynolds, MD, knows that the course of a game can be altered in a heartbeat. The same holds true for his career, as the Queens, NY, native had his sights set on becoming a lawyer, until he was sidelined by a shoulder injury.

    “I was just fascinated by anatomy and biomechanics of how everything worked,” Dr. Reynolds recalls, “so the doctor suggested I become an orthopaedic surgeon.”

    A second career pivot occurred during his surgical rotation at New York Medical College. Unlike orthopaedic patients who tended to be younger and healthier, cardiovascular patients tended to be more diverse, and in greater need of help.

    “Many had symptoms that were written off as chronic, when there were reasonable treatment alternatives to help ease the impact on their daily life and could also prevent worsening complications,” Dr. Reynolds adds.

    After coming to MedStar Washington Hospital Center and MedStar Georgetown University Hospital for his residency, Dr. Reynolds knew he’d found a home.

    “The other residents, attendings, APPs—they were all like family, and I wanted to keep working with them,” he says.

    Now an attending vascular surgeon in MedStar Heart & Vascular Institute, Dr. Reynolds specializes in the treatment of aortic disease, including aneurysms and dissections, carotid artery disease, venous occlusive disease, deep vein thrombosis, and peripheral arterial disease, including claudication and critical limb ischemia. One of the most exciting treatment tools, he says, is transcarotid artery revascularization (TCAR), an advanced method for placing stents in blocked carotid arteries for patients who may face higher risks of stroke with conventional procedures.

    New treatment alternatives are also available for wound healing, which can be influenced by both peripheral arterial disease and deep venous disease.

    “Deep venous conditions were often treated medically, but it wasn’t enough to advance healing,” Dr. Reynolds says. “Now, we can treat some of these cases surgically, preventing complications and improving other aspects of the patient’s quality of life as well.”

    Currently resigned to spending most of his free time reading, Dr. Reynolds looks forward to getting back into team sports once pandemic-related health risks ease. He’s also working on becoming certified in scuba diving, which will open the door to travel opportunities.

    “I’ve heard of some great places to dive and can’t wait to get out there,” he says.

    Vascular issues?

    Schedule an appointment with Dr. Reynolds

    Call 202-788-5048 or Request an Appointment

  • January 29, 2021

    By Glenn W. Wortmann, MD

    As the COVID-19 vaccine becomes available across the nation, you may have some questions about whether or not you should get vaccinated. In part one of this series on frequently asked questions about the vaccine, I talked about side effects, safety, and importance of the vaccine, as well as other things that you should know.

    In part two, I’ll continue answering common questions about the COVID-19 vaccine regarding:

    Have questions about the #COVID19Vaccine? Infectious disease expert Dr. Wortmann answers more FAQs in part two of the COVID-19 vaccine series on the #LiveWellHealthy blog:

    Click to Tweet

    Who should get the vaccine?

    The Federal Drug Administration has recommended that the only individuals who should not get the vaccine are those who are allergic to any of the ingredients in the vaccine. If you have a complicated medical condition and are unsure about whether or not you should get the vaccine, please talk to your healthcare provider and they can recommend the best course of action for your unique situation.

    If I’ve already gotten COVID-19, should I still get the vaccine?

    After having coronavirus, your body is protected against the virus for an estimated six months. However, there is no long term protection. As a result, you should still get vaccinated to keep you healthy long-term, even if you’ve had the virus.

    Is the vaccine recommended for pregnant women?

    Yes, the American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women get the COVID-19 vaccine. My advice would be to talk to your obstetrician or primary care provider about your particular situation and when would be the best time to get vaccinated.

    If you’re having major surgery, would you recommend getting the vaccine?

    If you are scheduled for surgery, talk to your doctor about when you’re eligible for the vaccine and when it makes the most sense to get it. Since COVID is so wide-spread right now, it would be best to get the vaccine now, if it’s available to you. However, if you don’t qualify for the vaccine at this time, then you can get the vaccine after the surgery.

    I’ve had serious side effects from other vaccines. Should I get the COVID-19 vaccine?

    This is a personal decision, but it’s important to remember that unfortunate events happen whether or not people receive the vaccine. Just because someone died or had any other serious event doesn’t mean it was associated with the vaccine. From the information we have, serious safety events did not happen any more frequently in people who received the vaccine as compared with people who received the placebo.

    If you are allergic to the flu vaccine, is it safe to get the COVID-19 vaccine?

    The components of the COVID-19 vaccine are different from those included in the flu vaccine, so as long as you aren’t allergic to the components of the COVID-19 vaccine, it should be safe for you to get it. If you are unsure, your primary care provider can help you determine what ingredients are included in the vaccine for coronavirus and whether or not you are allergic. You can also view what’s in the vaccine through the following links to the Centers for Disease Control and Prevention’s (CDC) website:

    Timing of the vaccine.

    Vaccine distribution varies by state. If you live in Maryland or Washington, D.C., visit MedStar Health’s website to learn when you are eligible to receive the COVID-19 vaccine

    Can I get coronavirus in between receiving the first and second doses of the vaccine?

    Because COVID-19 continues to spread rapidly across the country, it’s possible to contract the virus after your first dose of the shot but before your second dose when you’re 95 percent protected. If that happens, you’ll need to follow the recommendations established by the Centers for Disease Control and Prevention and quarantine for ten days. Once you’ve been cleared, you can come back for the second dose of the vaccine. Don’t stress if you aren’t cleared by the time you’re due for the second dose. Even if you get the second shot a few days late, it will still be effective.

    How long is the vaccine effective? Will I need to get vaccinated every year?

    We don’t know yet how long the vaccine will be effective. Studies are ongoing, and people participating in the studies will be followed for one to two years. Data from those studies will provide information on how long the vaccine works.

    If I take a blood thinner, do I need to stop the blood thinner before vaccination?

    If you are on blood thinners, you should still get the vaccine. Be sure to tell the person administering your vaccine as they’ll likely apply pressure a little longer after the shot.

    I’m due for another vaccine in between my COVID-19 vaccine doses. Can I still get it?

    You should avoid getting any other vaccine for 14 days before, in-between, or after getting the COVID-19 vaccine.

    Reactions to the vaccine.

    Why is this vaccine more likely to give you adverse side effects than the flu shot? What does this mean for the more vulnerable populations?

    The adverse effects seen with the messenger RNA (mRNA) vaccines are thought to come from the lipid nanoparticles which are wrapped around the mRNA. These nanoparticles prevent the mRNA from getting destroyed by our body before they enter into our cells and do their work. Studies show that older patients have fewer side effects than younger patients, so it’s likely that the more vulnerable populations will tolerate the vaccine well.

    Learn more about possible side effects of the vaccine in part one of this series.

    Is an agency keeping track of the adverse side effects in individuals as more people get the vaccine?

    Yes, unexpected or serious adverse reactions are entered into the Vaccine Adverse Event Reporting System as they are reported. In addition, you should enroll in the CDC’s ‘VSafe’ program provided to you when you receive the vaccine. This allows you to report your symptoms to the CDC on your phone, which helps them collect data on vaccine side effects.

    What else should I do to stay healthy after getting the vaccine?

    After you get the COVID-19 vaccine, you’ll want to continue wearing face masks in public and maintaining a physical distance of six feet from others outside of your household.

    What should I do if I’m vaccinated but others in my household are not?

    It will take time for the vaccine to become available to everyone. But the good news is that every time someone if your house gets vaccinated, that’s one less person at risk for getting the virus. And, it decreases the risk of someone bringing it into your house. Eventually, we’ll all have the opportunity to get vaccinated.

    Are monthly B12 injections considered a vaccination?

    No, B12 injections are not considered to be a vaccination. They are a supplement to replace a deficiency in the amount of B12 in your body.

    Are there any long-term negative effects of the vaccine?

    A significant percentage of people who were infected with COVID have developed long-term complications. Right now, we don’t know if those will eventually get better or be permanent. However, there is no reason to believe that receiving the COVID-19 vaccine will cause later problems.

    For more information from MedStar Health experts on the COVID-19 vaccine, watch our Facebook Live broadcast:

    Stay up-to-date with information on the COVID-19 vaccine.
    Click the link below.

    MedStar Health COVID-19 vaccine information

  • January 28, 2021

    By Lambros Stamatakis, MD

    Did you know that bladder cancer is the fourth most common non-skin cancer in the U.S.?

    Unlike prostate cancer, for which there is a standard screening, bladder cancer can frequently fall under the radar. Yet anyone between the ages of 20 and 90 may be affected by it—in particular, Caucasian males 60–70 years of age. So you should never delay a hospital visit if you’re experiencing issues.

    Here at MedStar Washington Hospital Center, we use an advanced technology, blue light cystoscopy, both to detect this cancer and help minimize the risk of its return. Although this technology is in use in other regions globally, the Hospital Center is one of the few medical facilities in this region utilizing the blue light technology. We perform 5 to 10 such procedures a month—more than any other medical center in the District of Columbia.

    But before we understand the benefits that blue light cystoscopy brings, let’s first understand what can cause bladder cancer and how it’s typically managed.

    Risk Factors

    Instances of bladder cancer may be localized and confined within the organ itself, or may potentially spread elsewhere. Multiple risk factors can encourage bladder tumors to appear and grow:

    • Cigarette smoking: This is the primary offender. Carcinogens inhaled by the smoker travel through the bloodstream to the kidneys, which try to eliminate the poisons via the urine. This interaction between the bladder lining and carcinogens in the urine is thought to lead to malignancies in the bladder.
    • Toxic chemicals: Chemicals such as aniline dyes (used in hair dyes or automotive paint), or those used in certain professions (some benzenes or aromatic amines), may also put exposed persons at higher risk.
    • Chronic bladder infections: Recurring urinary tract infections or the chronic use of tubes within the urinary tract can lead to inflammation, which can lead to bladder cancer over time.
    • Radiation: When used to treat cancers in the pelvis, radiation may spur a secondary malignancy in the bladder.
    • Genetic susceptibility: Hereditary conditions, such as Lynch syndrome, when combined with some of the factors listed above, can increase a patient’s risk as well.
    Did you know that cigarette smoking is a major cause of bladder cancer? Other risk factors include toxic chemicals, chronic bladder infections and genetics. @UroOncDC @MedStarWHC via
    Click to Tweet

    If a patient is diagnosed with this cancer, his or her survival rate can depend largely on the stage at which the cancer is detected, and whether it is muscle-invasive or non–muscle-invasive.

    The Stages of Bladder Cancer

    Tumors of the bladder are assigned very specific stages, based on these conditions:

    • Stage 0: In this beginning stage, abnormal cells are discovered in the tissue that lines the interior of the bladder. Stage 0a—sometimes referred to as noninvasive papillary carcinoma—can resemble long, thin growths, while Stage 0is (carcinoma in situ) presents as a flat tumor.
    • Stage I: Cancer has formed and spread to connective tissue adjacent to the bladder’s lining.
    • Stage II: Cancer has spread to include layers of the bladder’s muscle tissue.
    • Stage III: In Stage IIIA, cancer has spread to the fat layer surrounding the bladder and potentially to reproductive organs, but not to lymph nodes, or it has spread to a single lymph node in the pelvis not near its major arteries. In Stage IIIB, cancer has spread to multiple lymph nodes in the pelvis, or to at least one near a main artery.
    • Stage IV: In Stage IVA, cancer has spread from the bladder to the abdominal or pelvic wall, or to lymph nodes above the main pelvic arteries. In Stage IVB, cancer has metastasized to parts of the body, such as the liver, lungs or bones.

    How Is Bladder Cancer Diagnosed?

    There is no standardized screening for this cancer. A tumor of the bladder may cause no pain or other symptoms and may even be randomly discovered during an unrelated imaging test. More commonly, a patient’s first clue that there is an issue comes when they spot blood in their urine (hematuria), prompting medical attention.

    For women, although bladder cancer presents less frequently than it does in men, it tends to be caught at more advanced stages of the disease. This situation may occur because blood in a woman’s urine can be mistakenly connected with menstruation or a urinary tract infection.

    Any patient who discovers blood in their urine should consult their healthcare practitioner, who may recommend a hematuria workup.

    Or, if symptoms from conditions such as overactive bladder don’t improve with traditional therapies, it could also be a signal to discuss possible other causes with your practitioner.

    In these situations, your doctor might refer you to a urologist, who may recommend a comprehensive workup, including a CT scan and cystoscopy.

    In bladder cancer’s earliest stages, when it remains localized within the bladder, patients require close surveillance and sometimes local therapies within the bladder. But they generally do well under treatment, and their bladder can often be preserved.

    Blue Light Cystoscopy

    The conventional first-line treatment for the removal of bladder cancer is via transurethral removal of bladder tumor, or TURBT for short. TURBT is used for surveillance and treatment of non-invasive bladder cancer, or if there are multiple sites to check for cancer cells and growth. It’s also a critical aid for identifying recurrences early on, and potentially preventing progression of the disease.

    The “incision-less” TURBT process, usually performed as an outpatient procedure, involves resection of one or more tumors—that is, cutting out the diseased tissue—performed with the patient under anesthesia. Using a specialized endoscope inserted into the bladder, we scrape the tumor off the bladder’s inner lining. This allows us to not just eliminate the diseased area but also to diagnostically examine if it is invasive or non-invasive and whether it has spread.

    Blue light cystoscopy is the newest tool in our TURBT toolbox, a unique technology for pinpointing tumors of the bladder. It allows us to locate problem areas more easily than standard white light cystoscopy, which can miss very small tumors or lesions.

    An hour or so before TURBT, with the patient in pre-op, we first inject an imaging dye known as Cysview® through the urethra and into the bladder, giving it time to interact with the bladder lining and accumulate within abnormal tissue, such as cancerous cells. The dye is absorbed quickly by the rapidly dividing cancer cells. A compound within this dye—hexaminolevulinic acid—is photo-luminescent; exposed to blue light, it causes abnormal cells to glow pink (“fluorescence”).

    TURBT surgery generally takes about an hour. We use a thin, lighted, tube-like cystoscope to inspect the bladder. While typical cystoscopes use just white light, the blue light instruments allow the surgeon to switch between white light and blue light.

    Under this blue light, cancerous cells—which have absorbed the Cysview dye—glow a fluorescent pink, drawing the attention of the surgeon to the abnormal tissue. Thanks to this fluorescence, the surgeon can more readily note the edges of the bladder tumor, and remove even tiny lesions more quickly and thoroughly.

    After the Procedure

    Most patients do quite well immediately following this procedure, apart from some temporary irritation, frequent urination for a short time or residual bleeding in the urine. Generally, patients may return home immediately after surgery, with their urinary health back to normal in a week or two. Sometimes, the patient will go home with a catheter in their bladder for several days to facilitate bladder healing.

    Post-recovery, patients will return to the Hospital Center to discuss next steps in the management of their bladder cancer. We’ll meet with patients every three to four months to assure there has been no recurrence of the tumor. In many cases where we’d like to continue surveillance on a patient, we’re able to perform blue light cystoscopy as an outpatient service in an office setting, thanks to the flexibility, speed and ease of the procedure.

    If we find no issues after a period of observation, the patient’s check-ups can be spaced out over time.

    The good news: Multiple studies in the U.S. and Europe show that the recurrence rate of non-invasive bladder cancer is lower for patients who undergo resection using blue light cystoscopy, compared with patients under white light. Depending on the tumor type, performing a TURBT with blue light has been shown to prevent recurrences by 12–43%.

    Reducing Your Risk

    So, what measures can the average individual take to protect themselves against bladder cancer? Here are some recommendations:

    • If you smoke, take measures to quit. And if you don’t smoke, don’t start.
    • Blood in your urine can be a signal. Talk to your healthcare provider and ensure that you receive the appropriate tests. Together, determine a necessary treatment path.

    Lastly, don’t let COVID-19 cause you to delay care. We’re available to you, ready to answer your questions and help you consider options. Even in the midst of the pandemic, cystoscopy, CT scans and other screenings can be done safely and efficiently on-site here, without exposure to other patients.

    Blood in your urine?

    Request a check-up with a specialist.

    Call 202-788-5048 or Request an Appointment

  • January 26, 2021

    By Taryn E. Travis, MD

    Whatever the cause—burns, trauma or surgery—scars can have a negative impact on a patient’s quality of life. In decades past, treatment of symptomatic scarring (scars that result in discomfort, itch, pain or reduced range of motion) was limited and often complicated.

    That has changed dramatically. Today, high-powered lasers shrink and relax symptomatic scar tissue, giving it flexibility closer to that of uninjured skin. Measurable improvements are possible in just a few months’ time, helping patients resume a happier, more normal lifestyle.

    Why Lasers Help

    Scarring is the body’s natural way to repair damaged tissue. But all scars are not alike. Depending on the individual and extent of the injury, some scars can critically limit the patient’s functional capability.

    For example, consider a burn survivor with scarring near a joint. Scar tissue is naturally tighter, denser and stiffer than uninjured skin, and scars around elbows, shoulders, hips, knees or fingers might significantly limit that patient’s functionality and range of motion in that portion of their body. Laser treatment gradually makes such problematic scars thinner and suppler, so they behave more like normal tissue, improving movement. The treatment can also improve scars that feel continuously itchy, painful or “foreign” to the body.

    In some cases, tight scars around a wound may prevent it from fully closing. But laser treatment can loosen these scars so they’re less of an obstacle to healing.

    And while no scar can be 100 percent removed, laser scar revision can reduce thickness and improve discoloration. The lasers we use at MedStar Washington Hospital Center are powerful and effective against thicker, stiffer scar tissue.

    When scars cause trouble, laser treatment can bring dramatic improvement in just a few months’ time. More from @TTravisMD. @MedStarWHC via
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    How Scars Form

    When the body is injure, it repairs itself by laying down collagen, the protein that makes up connective tissue. But the process isn’t necessarily neat—the collagen can be deposited in random layers and bundles, which is why scars tend to look, feel and behave differently than the damaged tissue they replace.

    Severe injuries generally produce severe scars. But everyone scars differently, for reasons we don’t completely understand—an injury in one person might result in completely different scarring characteristics than in another person. We do know that people with darker skin, particularly those with African American and East Asian lineage, are more at risk of severe scarring.

    How the Laser Works

    Our lasers are able to target this scar collagen very accurately. The laser creates scores of small, barely visible holes in the scar tissue, making incremental improvements by releasing tension in the tissue. Over time and subsequent treatments, more tension is released as we slowly and carefully destroy the thickest collagen bundles. This stimulates a sort of remodeling, as the flexibility of the scar improves with each treatment.

    The most fascinating aspect of this process is that we know that it is successful—but we’re not sure exactly why it works at the cellular level. Existing research is largely incomplete. We are working diligently to fill the gaps via multiple studies, including some with patients who volunteer to participate here at the Hospital Center. With time, we will unlock the secrets of the laser’s efficacy.

    Impressive Results

    Laser techniques have replaced many types of scar revision surgery, which were often uncomfortable and psychologically disheartening, as patients with large scars often had to start over with scar excision and the need for repeat skin grafting.

    Today’s laser scar revision is very gratifying because we can deliver dramatic improvements to the patient with no significant side effects or down time. After just one session, 96.5 percent of patients treated at the Burn Center report improvement in their scarring in the form of increased range of motion or reduction of pain, itch or other discomfort.

    On average, problem scarring can reduce range of motion to as little as 70 percent of normal. After one or two treatments, we can see that number improve to 76 percent. After the third treatment, patients may approach as much as 90 percent of normal capacity. Such improvement frequently enables patients whose scarring had rendered them unable to work to return to their jobs.

    Getting Started

    Most patients with thick and problematic scarring are great candidates for laser treatment.

    The patient meets with our burn rehabilitation therapists, who take photographs and careful measurements to assess range of motion, functionality and other symptoms. The next meeting is with the surgeon, who determines with the patient the best course of action and duration of treatment.

    Before treatment, we submit a report to the patient’s insurance company, detailing how laser treatment will help the patient’s specific symptoms. Getting each protocol preapproved paves the way for a treatment schedule without interruptions that can slow progress.

    Most patients with serious scars benefit from an average of six treatments, each four weeks apart. If we delay longer between treatments, we sometimes see symptoms return, so an interval of about a month is optimum.

    Laser treatment at the Hospital Center is a same-day procedure that takes 45 minutes or less. Patients are sedated during the procedure; general anesthesia is usually not needed unless we are treating very large areas or the neck or face.

    After the procedure, patients may experience a feeling like sunburn, easily managed with over-the-counter ibuprofen (Motrin®/Advil®) or acetaminophen (Tylenol®). Most patients can return to bathing, wearing regular clothing and the normal activities of work and school the following day.

    Why MedStar Washington Hospital Center

    The Hospital Center is the only adult medical facility in the Washington, D.C., area to own and operate this particular specialized laser equipment. We generally perform around 200 treatment sessions each year.

    And while the laser is a superb tool for the treatment of serious scars, it’s not the only one in the Hospital Center tool kit. The Burn Center is at the leading edge of treating scars from injury or surgical incision with a wide array of other treatment options such as compression garments, massage and topical silicone. While the days of being limited to large-scar revision surgery are happily behind us, we often perform smaller, less traumatic surgical procedures that will help improve effectiveness of the laser and other strategies.

    Careful rehabilitation also contributes to a patient’s good results. Experienced in scar management, our rehabilitation therapists carefully assess and evaluate patients’ functionality and help them take full advantage of the new flexibility delivered by the laser. Their work is further supported by our excellent team of advanced practice providers, social workers, psychologists and other specialists.

    In years past, physicians waited at least a year before surgical scar revision. Today, we know that laser care can begin as soon as the patient’s injury heals. It can even improve and relieve older scarring that has been problematic for decades. And during COVID-19, we are following all virus guidelines carefully and consistently, with treatments that are quick and minimally invasive.

    If scars are making life difficult for you or a loved one, we encourage you to reach out to the Burn Center team to discuss your needs with our specialists. Laser revision can help improve your quality of life significantly.

    Click here to learn more about our laser scar revision program.

    Troublesome scarring?

    Our specialists are here to help

    Call 202-719-0795 or Request a Consultation