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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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  • November 23, 2020

    By Shawn Tejiram, MD, Burn Surgeon

    Did you know that, when it comes to fires and burn injuries, cold-weather holidays—especially Thanksgiving—tend to be the most dangerous of all?

    Kitchen accidents cause at least half of all fires in the home, with over 2,000 occurring on Thanksgiving itself. This is higher than any other day of the year, exceeding even fireworks-related events on Independence Day. 

    Here are some tips that may help you prevent a kitchen burn, especially around the holidays:

    Take Care with the Turkey Fryer

    Kitchen burns are often not severe, but it can be an entirely different story when it comes to deep-frying the holiday turkey.

    Few kitchen burns are severe, but frying the turkey can cause serious, life-threatening injuries. Stay safe with tips from Dr. Shawn Tejiram. @MedStarWHC via https://bit.ly/3ltgyPq
    Click to Tweet

    Incorrect use of a turkey fryer can set your entire house on fire. According to the National Fire Protection Association, deep-frying fires cause an average of five deaths, 60 injuries and more than $15 million in property damage each year.

    A fried turkey gone wrong can cause severe injury requiring intensive care and surgery. As a burn surgeon, I recommend no deep frying at all; oil can stick to your skin and burn longer than water-based liquids. It’s safer to roast or use newer, oil-less frying technology.

    But, if you plan to fry in oil:

    • Do your homework on the proper procedure, or recruit help from someone more experienced.
    • Many frying accidents start with an over-filled fryer pot. When food goes in, oil spills out, right onto the ignition source. If the food item is the size of a turkey, it can easily cause a large, intense fireball. Be sure your fryer pot is large enough for both the oil and the bird. The day before you cook, stage a dress rehearsal with the turkey and cold water. Size the bird for the fryer. Check the specs of your fryer, but a safe guideline is to choose a bird 12 pounds or smaller.
    • Be sure your turkey is fully thawed and dry before frying. Water or ice can hide in the cavity or under the skin and then boil instantly in hot oil. The steam created can propel oil toward both the cook and the flame. For this same reason, don’t fry in rain or snow.
    • Place your fryer on a non-flammable surface. Think concrete, not wood decking.
    • Set up your fryer as far from any structure as possible, clear of any roof, overhang or doorway. Place the burner on a solid and level footing, to prevent tip-over.
    • Keep at least two feet of space between the propane tank and the fryer. Position the feed line so it’s not a tripping hazard.
    • Use a thermometer to monitor oil temperature, especially before the turkey goes in. Oil is most dangerous at its “smoke point,” hot enough to ignite. Oil at 325°F/163°C is plenty hot for frying; it should never exceed 350°F/177°C If the oil begins smoking, shut off the heat to let it cool before proceeding.
    • Shut off the flame when dropping the turkey into the fryer. If the oil spills, you’ll have removed one major potential fire source. Wait for the oil to settle down before relighting the burner.
    • Keep kids and pets far away from the fryer during heating, cooking and cooling. And after cooking as well: several gallons of oil can take many hours to cool enough for safe disposal.
    • The cook is responsible for wearing protective equipment: barbecue-rated mitts, goggles, long sleeves, long pants and sturdy shoes.

    Indoors Too, Safety Counts

    Indoors as well, cooks can be at risk for several potential hazards. Follow these common-sense guidelines to help keep your kitchen safe at the holidays and all year round:

    Know Your Limits: An online video can make complex recipes look easy. But the cook’s prior experience might not extend beyond heating ramen noodles. A recipe demanding advanced skills may tip the balance toward an accident. Be sure you’re up to the challenge. If in doubt, try something less complicated.

    Avoid a Scalding: Scalds are among the most common burns. Soups, stews, pasta water and hot sauces are easily sloshed, splashed and spilled—placing both cook and diner at risk. Be sure the pot is big enough for the load and don’t overfill it. Wear long sleeves and use oven mitts when handling hot liquids.

    Read the Instructions: If you’re using a piece of equipment for the first time or haven’t used it recently, review the manual or other instructions. Guessing can put you at risk. If you’ve lost the instructions, look online.

    Protect Yourself: When things go wrong, a cook will often instinctively grab a burning pot or pan to get it away from the heat, forgetting to use an oven mitt. Keep the mitts nearby and get into the habit of putting them on every time you grab a pan. You’ll be more likely to put them on in an emergency, too.

    Don’t cook barefoot or in sandals or slippers. Sturdy shoes, long sleeves and long trousers will protect you better. Avoid frilly or lacy garments that might easily catch fire. Tie back long hair.

    Keep an Eye on the Kids: Sometimes kids can get rowdy around the holidays. Set clear rules around the stove and oven. Turn pot handles inward, so little hands can’t reach them. And never leave hot food unattended. The best way to keep the kids safe is with responsible supervision.

    Be Careful about Cooking while Drinking: I am confident in saying that alcohol use while cooking can make things worse, slowing your response in an emergency. Go easy during meal prep.

    Have a Good Extinguisher: Every kitchen should have a grease-rated fire extinguisher, with the letter B in its rating. Keep it within reach, every time you cook. An extinguisher will knock down a small fire, preventing it from spreading and doing more damage. Read the extinguisher manual, too, so you’re prepared to use it if needed. Never throw water on a cooking fire; it can spread burning oil and grease.

    When to Call for Help: A small fire can be out of control in the blink of an eye. If fire threatens your home or your loved ones, get out and call for help. You may lose a few possessions, but it could save your life.

    If You Get Burned

    Burns are rated by degree or depth of injury.

    • First degree burns affect only the uppermost layer of skin. Sunburn is a good example, sometimes painful but improving in a day or so.
    • Second degree burns (partial thickness) cause blistering and typically call for medical attention. They may take as long as three weeks to heal.
    • Third degree burns affect the entire thickness of skin. Because they often damage nerve endings, there is often no pain, at least initially. This burn has a dry, leathery appearance and is considered a medical emergency.
    • Fourth degree burns go even deeper, to soft tissue, muscle and bone, and are medical emergencies.

    When you get burned, you may have been told to apply ice or cold water to stop the heat. This is no longer recommended: cold constricts blood vessels, and healing is dependent on blood flow. Keep room-temperature water flowing over the burn for 5–10 minutes. Clean with soap, especially if the burn came from hot grease or oil. Apply first aid burn cream or petroleum jelly, then bandage before having a doctor evaluate.

    Burns can sometimes worsen over time, so it’s always best to consult a doctor for any burn injury. According to the American Burn Association, these injuries should be seen at a burn center as quickly as possible:

    • Burns on the face, hands, feet, genitals or joints
    • Burns that wrap around the arms or legs
    • Deeper burns and burns covering more than 5% to 10% of the total skin area
    • Burns in people with underlying medical conditions, like diabetes

    Our Burn Center

    MedStar Washington Hospital Center is proud to provide the Washington, D.C., area with comprehensive burn treatment services at our Burn Center. We not only manage immediate effects of the burn and complete an evaluation, but we’re better equipped than most medical facilities to manage serious burn injuries that may require several weeks or months to heal. Our burn survivors have access to a multidisciplinary team of experienced physicians, advanced-practice nurses, therapists, dietitians, social workers and psychologists.

    The team works together closely, taking a holistic approach to prevent infection, speed healing and maintain normal function. Burns can scar and tighten tissue, so rehabilitation is key to keep the joints healthy and moving. And we work closely with cosmetic and reconstructive surgeons to remediate scarring. Survivors of serious burns can even receive special nutritional care to aid healing.

    The Burn Center team is also involved in both clinical and basic science research, so our patients can be assured that they’re getting the latest and greatest burn care.

    A final reminder: This holiday, be sure to cook safely!  Everyone here at the Burn Center wishes you and your loved ones a happy, healthy holiday season, burn-free!

    Burned while cooking?

    At the Burn Center, we’re ready to help.

    Call 202-788-5048 or Request an Appointment

  • November 23, 2020

    By Lauren Maragh, MD, Internal Medicine Physician, MedStar Medical Group

    The pandemic—and 2020 in general—has been stressful and isolating for many people, and this holiday season, it’s more important than ever to reconnect with loved ones, even if it looks different than tradition. That’s because connection helps you to decompress and destress, causing happy hormones to positively affect your immune system and keep you healthy.

    But with COVID-19 cases spiking in some areas across the nation, you may be wondering how you can safely celebrate Thanksgiving and other holidays without increasing your risk of getting sick. Fortunately, with a little bit of planning and creativity, there are lots of ways to safely celebrate the holidays during COVID-19, whether you decide to gather with family or friends in person or virtually.

    It’s more important than ever to reconnect with loved ones over this holiday season. On the #LiveWellHealthy blog, Dr. Maragh and Dr. Mcdonald share 5 tips for celebrating the #Holidays safely during #COVID19: https://bit.ly/35WYRT6.

    Click to Tweet

    1. Weigh your risk for being exposed to or spreading COVID-19.

    The Centers for Disease Control and Prevention notes that small household gatherings contribute to the rise in COVID cases, which is why it’s important to be cautious about when, where, and with whom you decide to gather over the holidays.

    There are several factors that can determine your level of risk for either catching COVID-19 or unknowingly exposing someone else to the virus. When deciding how your family can safely celebrate the holidays during COVID-19, consider the following questions.

    What are the local rules and regulations?

    Many states have established quarantine guidelines for individuals visiting from out-of-state, which may make it difficult to visit family members who don’t live nearby. And, some places, like Maryland and Washington, D.C., are also enforcing laws to keep group sizes to less than ten people in order to limit the risk of infection and spread among their communities.

    What do you know about the people who will be in attendance?

    You have control over your own safety precautions, like wearing a face mask and frequently washing your hands, but do you know if other attendees are taking the same precautionary measures? If you’re gathering with one other family who you know is following the same safety recommendations, then your risk of exposure to COVID-19 is likely low. However, if you’ve been invited to a large gathering that includes people who you don’t know, you increase your risk of being exposed to the virus.

    What is your health status?

    If you’ve recently tested positive for COVID-19 or have been around someone who tested positive, you should definitely avoid gathering with others over the holidays so that you don’t spread the virus. And, if you have comorbidities that increase your risk of complications from the virus, it’s best to find an alternative way to celebrate the holidays without physically being around other people.

    If you have any of the following conditions, you should stay home to reduce your risk of severe illness:

    • Cancer
    • COPD
    • Coronary artery disease
    • Diabetes
    • History of smoking
    • Kidney disease
    • Obesity

    And, as a primary care doctor, I have to add that if you’re overdue on a preventative screening, see your doctor. You can’t afford to skip a screening that might save your life!

    Learn about our primary care and urgent care options:

    Find care now.

    2. Communicate expectations with your loved ones.

    While many of us may feel alone, we’re all in this together and we’ll get through it by supporting one another. If you’ve been invited to an in-person gathering, be honest about your expectations related to:

    • Number of attendees
    • How attendees will maintain social distancing
    • Mask-wearing
    • Duration of the gathering
    • Food preparation

    You have to determine for yourself what level of risk you’re willing to take to safely celebrate the holiday season. It’s important to be transparent about what that means for your family out of love and a desire to keep both you and those around you healthy. If it’s going to be too hard to stay six feet away from your favorite aunt who is at increased risk of severe illness from the virus, then it may be in your and her best interest to stay home. Likewise, if you decide it’s best for your immediate family to have your own intimate Thanksgiving to minimize your exposure in a group setting, most people will be understanding as long as you’re upfront about it.

    3. Take steps to mitigate risk when traveling or staying at overnight accommodations.

    If you decide to travel over the holidays, be sure to understand what the local rules and regulations are for quarantine and/or testing. You should also get your flu shot before traveling, because that’s one way you can reduce your risk of getting sick.

    If you have to stay in the same residence as another family over the holidays, it’s important to be cautious by:

    • Sleeping and bathing in a separate area of the home
    • Avoiding high traffic areas of the home
    • Following social distancing guidelines
    • Wearing a mask when you can’t maintain social distance
    • Frequently washing your hands and disinfecting surfaces

    If you start to experience symptoms of COVID-19 while traveling, you should shelter-in-place before returning home to minimize exposing someone else to the virus during your travels. You should also contact your doctor immediately. That way they can help you monitor your symptoms and determine if and where you should get tested.

    4. If hosting, plan for extra safety precautions.

    If you’re hosting a small gathering for Thanksgiving or another upcoming holiday, it’s your responsibility to make sure you establish a safe place for celebrating. To minimize your risk and the risk of your attendees, consider the following:

    • Adhere to local regulations
    • Limit the number of attendees
    • Host outdoors, if possible, or open windows when indoors
    • Wear a face mask and ask attendees to do the same
    • Set-up your space with social distancing in mind
    • Establish hand-washing and sanitizing stations equipped with disinfecting wipes
    • Delegate only a few people to food prep so the kitchen remains uncrowded
    • Use one-use utensils and dishes

    Using a combination of safety precautions in your home can lower your risk of spreading COVID-19.

    5. Embrace the challenges of this holiday season, even if it looks different than usual.

    With family members geographically dispersed across states,one of the ways my extended family plans to celebrate Thanksgiving this year is to take a virtual cooking class from my mom, where we’ll watch her prepare a family recipe via video. We snagged the idea from the HBO Max series ‘Selena + Chef’, and we think it’ll be a unique and memorable way to celebrate the holidays this strange year.

    Here are a few other suggestions to creatively and safely celebrate the holidays during COVID-19:

    • Watch the Macy’s Day parade on TV
    • Compete in a virtual Turkey Trot 5K
    • Schedule a sporting event or holiday movie virtual watch party
    • Organize a virtual Secret Santa gift exchange

    This will be an unforgettable holiday season.

    We’re all yearning for a bit of normalcy, and that applies to the holidays, too. But, try to keep a positive perspective that recognizes this year as the anomaly that it is while holding onto hope for a more traditional holiday season in 2021. One day, we’ll be back to normal, but until then, let’s try to make the best of it.

    Regardless of what you plan, you will probably never forget “that year we celebrated Thanksgiving during a pandemic”. Let’s be thankful for what we do have and allow that to give us the strength to make it into the New Year!

    Want more information on COVID-19 or MedStar Health Primary Care and Urgent Care? 
    Click below to learn more.

    Primary Care and Urgent Care

    COVID-19 Information

  • November 20, 2020

    By MedStar Health

    It’s 3:00 a.m. and you suddenly hear a loud noise from just outside your door. As you investigate, you discover that your loved one has fallen on the way to the restroom and needs immediate help. What do you do?

    In a moment of panic such as this, it’s difficult to know exactly how to react. That’s why it’s important to anticipate the situations you may encounter as part of caring for an elderly or disabled relative or friend.

    Here are some suggestions to keep in mind when preparing for medical emergencies at home.

    1. Keep important information handy.

    Examples of important information to include:

    • Documents and records. Keep important documents, both personal and financial, in a waterproof portable container. This should include personal ID, insurance cards, your loved one’s MOLST (Medical Orders for Life-Sustaining Treatment), DNR form, and/or advance directives.
    • Medication list. Keep a current list of medication that your loved one is taking, pharmacy numbers, and doctors’ names and phone numbers.
    • Contact numbers list. Create and keep a current list of phone numbers of family members, physicians, and other personnel who are involved in the care of your loved one. Contact your local emergency medical services to ensure they have your correct address and your loved one’s medical condition on file to ensure a quicker response time.

    If you prefer your documents as physical copies instead of digital ones, keep one copy of each document in your vehicle and another copy in a place where you could quickly access it in the event of an emergency. If you prefer to manage health information digitally, you can use mobile applications. However, you should always have a paper copy handy for others in case you are not present.

    2. Have a hospital overnight bag packed.

    For your loved one, pack some nightclothes, toiletries, books, personal care supplies, and any other items to help them retain routine if they are required to spend the night in the hospital. It should have enough supplies to last two to three days. For yourself, pack some extra clothes, daily hygiene products, medications, snacks, and books to help you pass time while waiting in the hospital.

    In response to COVID-19, MedStar Health has updated our visitor policies to ensure the safety of our patients. Read more about our temporary visitor policies.

    Medical emergencies can happen at any time. If you’re caring for an elderly relative or friend, it’s important to be prepared to take care of your loved ones and yourself during unexpected moments. Read the #LiveWellHealthy blog for tips that can help: https://bit.ly/3kOSKEw.

    Click to Tweet

    3. Educate yourself about emergency response.

    Take classes for first aid and CPR. Assemble and keep first aid kits handy at home and while you travel, such as inside the vehicle. Some essential items include bandages, scissors, tweezers, gloves, cotton swabs, thermometer, cold compress, hand sanitizer, and a blanket. Talk with your loved one and his or her healthcare provider to determine whether you should have specialty items on hand like a blood sugar monitor, blood pressure monitor, automated external defibrillator, etc.

    4. Discuss medical alert systems with your loved one.

    Medical alert systems offer your loved one a fast and easy way to seek help during an emergency, especially if you and your loved one do not share a household. They are usually wearable devices such as bracelets, watches, wristbands, or necklaces. If your loved one needs help, he or she can push the button on the device to be connected with a trained dispatcher who will contact emergency help or a loved one as needed. There are a variety of medical alert systems, ranging from in-home (using a landline) to mobile (using GPS technology) devices. Identify your loved one’s needs and habits to determine which device is the right fit.

    5. Plan to alternate caregiving responsibilities.

    While acting as a caregiver can be a fulfilling responsibility, it can also be personally taxing and time-consuming. Experiencing “caregiver stress”—feeling tired and overwhelmed—is common.

    Recharge yourself by alternating caregiving responsibilities with siblings, friends, and neighbors. Practice simple self-care techniques like breathing exercises and meditation to ease your mind from any stress or anxiety. In addition, try finding local or online caregiving support groups to cope with the demands and challenges of long-term care.

    Will you be ready?

    Medical emergencies can happen at any time. It’s important to be prepared to take care of your loved ones and yourself during these unexpected moments. Preparation is the best medicine in the event of medical emergencies.


    Want more information about caring for your loved ones?
    Click below to learn more, and see how MedStar Health can help.

    MedStar Health Home Care

  • November 18, 2020

    By John F. Lazar, MD

    Editor’s Note: The photo above was taken prior to the COVID-19 pandemic.

    In the U.S. and around the world, lung cancer is the leading cause of cancer deaths for both men and women, killing 1.7 million people each year. According to the American Lung Association, the five-year survival rate for lung cancer is lower than many other cancers, at just 18.6 percent. Over half of those diagnosed die within a year. (By comparison, the five-year survival rate for colorectal cancer is 64.5%; breast cancer, 89.6%; and prostate cancer, 98.2%.)

    Early detection is key. If this cancer is found while still localized within the lungs, the five-year survival rate jumps to 56%. Unfortunately, only 16% of lung cancers are discovered at that stage.

    But MedStar Washington Hospital Center now has the opportunity to improve these grim statistics and save lives by using the Auris MonarchTM Platform, a revolutionary robotic navigational bronchoscopy tool.

    Dr. John Lazar: Before robotics became more mainstream in thoracic surgery, we depended on CT-guided biopsy to help us analyze nodules—small, abnormal growths in the lung. The CT guides a radiologist to the target area for a needle biopsy, with the tissue then analyzed outside the body.

    Now, using this robotic navigation bronchoscopy technology, we’ve taken a big step toward enhanced accuracy, greater precision, increased safety and the ability to make definitive diagnoses. With the Monarch, CT scan data are loaded into the robot’s computer, giving us the equivalent of turn-by-turn GPS navigation deep into the lungs, where structures are very small and difficult to view via traditional methods. The robot lets us find lesions deeper into the bronchial tree and take tissue samples with unprecedented accuracy.

    When cancer is suspected, we are now able to target even tiny lung nodules with greater accuracy and less risk to the patient. Learn more from Drs. Lazar & Wang Memoli. @jflazar @MedStarWHC via https://bit.ly/38E700j.
    Click to Tweet

    Dr. Jessica Wang Memoli: It’s a great addition to our existing tool kit. Pulmonary nodules can be challenging. Early in the disease, they’re often too small to biopsy by traditional means, a lost opportunity for early diagnosis. With Monarch, we can go deeper to target and biopsy the tiniest nodules with a much greater degree of accuracy and less risk to the patient. That improved accuracy helps us better target potentially malignant growths for radiation oncology and other forms of treatment.

    Among the First

    Dr. Lazar: MedStar Washington Hospital Center was among the first hospitals on the East Coast to acquire this technology. We’ve had the Monarch for over a year and have helped many patients in that time.

    Dr. Wang Memoli was doing a great job with traditional bronchoscopy and X-ray before Monarch, but developing our interventional thoracic program requires the most advanced technology. Working as a team to have this technology on-hand has strengthened the partnership between thoracic surgery and interventional pulmonology, benefiting patients who potentially face a lung cancer diagnosis.

    Dr. Wang Memoli: We’re doing things we couldn’t have done with traditional methods, like sampling multiple nodules, on both sides of the lung, in one session. This technology has significantly improved interventional pulmonology and our approach to lung nodules.

    Robotics for Greater Control

    Dr. Lazar: Monarch is an endoscopic robot. For nodules, we first do a high-definition CT scan, with very thin “slices” of the lungs. We load that into the robot’s computer, creating a 3D virtual map of the complete airway pathway. We bring the patient into the bronchoscopy suite and administer anesthesia to put the patient to sleep. We do a traditional bronchoscopy to look for anything larger than a nodule.

    Then, we register the patient’s unique anatomy to the robot. We operate the robot with a small console, very similar to a video game controller. We steer a thin tube with a tiny camera, light source and various instruments we use for biopsy directly to the site of the nodule.

    Dr. Wang Memoli: Controlling direction is the key. The structure of the lungs is like a tree, with a large trunk dividing into thinner and thinner branches. Monarch reaches into the thin twigs, deep into the airway while still maintaining direct visualization. With other systems, electromagnetic guidance is the only input guiding our pathway. With the new system, we have multiple technologies—from the electromagnetic inputs, to the view of the actual airways, to integrated CT imaging and directional cues—all displayed on the monitor. To have constant visual contact with the target is new and very exciting.

    Dr. Lazar: The reach is much broader, and the scope follows some amazing turns and bends to go where it needs to go. It’s real-time vision married to a sort of GPS algorithm.

    Dr. Wang Memoli: The other big advantage is stability. The structures we target are very small, only fractions of an inch. Before, we controlled everything manually; when we reached the nodule with traditional bronchoscopy, my assistant and I had to hold the scope steady, which is difficult to maintain in human hands. Meanwhile, the patient is breathing normally, so the lungs are in motion. If either doctor or patient makes the slightest movement, we might lose the target and need to relocate.

    But the robot knows where it is at all times. When it’s time to deploy an instrument for a tissue sample, we lock its position and it stays put, rock solid, while we biopsy the nodule.

    Reducing Wait Time for Patients

    Dr. Lazar: Monarch also supports our commitment to accelerate the whole process. Any potential cancer diagnosis creates a lot of anxiety and a sense of urgency for the patient and family. With traditional methods, we have a delay between biopsy and staging—determining how advanced the disease is. Monarch eliminates that delay: we can examine and stage in the same session. That goes a long way towards relieving the psychological burden on the patient when cancer is suspected.

    Dr. Wang Memoli: Plus, we really want to start treatment as soon as possible. Doing biopsy and staging at the same time can eliminate weeks of wait time.

    Dr. Lazar: That’s also a key motivation for the unique dynamic between interventional pulmonology and surgery at our hospital. Our collaborative, cooperative relationship also streamlines the process. We both get to know the patient early on and, with the relationship established, we can fast-track diagnosis and treatment as much as possible.

    Dr. Wang Memoli: The collaborative approach also improves diagnosis. The whole team works as a unit, gaining experience with each procedure and anticipating each other’s needs. It’s truly a multidisciplinary commitment—the doctors and bronchoscopy tech working together with nursing, anesthesia, radiology and pathology.

    Next Step: Treatment

    Dr. Lazar: The Holy Grail for cancer is combining diagnosis, staging and treatment. With the Monarch, the first two steps are in place, and we’re heading down the path toward the third. In the future, the Monarch will likely deliver some form of ablation—focused heat or microwave energy to destroy tumors.

    It will take some time, as any new procedure must be thoroughly vetted for safety, effectiveness and cost, compared to existing standards of surgery and radiation. But that day will come, maybe in just a few years. Imagine diagnosis, staging and treatment, all in half a day, on an outpatient basis.

    Patient Safety in the Age of COVID-19

    Dr. Wang Memoli: Cancer doesn’t wait, so we never stopped using the Monarch during the pandemic. Of course, patient safety is the top priority. We take every precaution to protect both patients and team members from infection of any kind, with masks, temperature checks and COVID-19 testing before a procedure.

    Dr. Lazar: We’re committed to safety and giving our clinicians access to the best, most advanced tools possible. That’s why MedStar Health is often at the front of the line for new technology—this commitment is organization-wide.

    Expanding the Footprint

    Dr. Lazar: Although we’re using Monarch only for bronchoscopy, I firmly believe it will become a very valuable tool for other specialty areas, like gastroenterology, and it could possibly be used as an operating room assistant. I see enormous potential for this technology.

    But, as important as the new tools are, success also depends on the people performing the procedures. Our team members are exceptionally talented and care deeply about their patients. And they are willing to collaborate at every opportunity for success.


    Dr. Lazar and Dr. Wang Memoli discuss lung cancer on Facebook Live.


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  • November 13, 2020

    By Gillian Louise Adams, MD

    Distance learning can be hard for any student, but kids with attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) face additional challenges that can make virtual school frustrating and discouraging.

    Students with ADHD and ADD generally thrive in environments where they can move around, access one-on-one support, and observe the social cues of students around them. Unfortunately, watching their teacher on a computer screen at home requires them to maintain focus using self-regulation, which is especially difficult for younger students with ADHD in elementary school.

    While teachers are doing their very best to create an engaging learning environment remotely, many parents feel pressure to take on the role of educator at home. If that’s you, here are a few things you should know about kids who think and learn differently.

    Distance learning can be hard for any student, but kids with #ADHD or #ADD face extra challenges. On the #LiveWellHealthy blog, Dr. Adams shares four tips you can try at home to help your child succeed: https://bit.ly/3eUwjN3.

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    ADHD is a medical disorder, not a sign of “laziness or stupidity”.

    Both ADHD and ADD are medical disorders that result from a chemical imbalance in the brain. This is important because an accurate diagnosis offers a clear explanation for why your child may be struggling in school more than their peers. The title of a self-help book for adults with ADD titled “You Mean I’m Not Lazy, Stupid or Crazy?” by Kate Kelly and Peggy Ramundo says it best. Kids with ADHD and ADD aren’t choosing to fight an uphill battle with school. They’re just responding to the natural way their brain is wired.

    Signs of ADHD/ADD in kids.

    While similar, there are a few distinctions between both disorders. ADHD, for example, typically presents itself as excessive fidgeting, a constant need for redirection, and an inability to sit calmly or participate in learning activities. Kids with ADD, on the other hand, may not struggle with hyperactivity. Instead, they have a harder time concentrating and staying focused, especially when surrounded by distractions. All of these symptoms are exacerbated when students are logging onto school from a screen at home amidst everything else going on in their house.

    Strategies to help kids with ADHD succeed in distance learning.

    For kids who are under the age of seven, sometimes it’s hard to determine if their behavior is typical or reflecting symptoms of ADHD/ADD. After all, many first graders struggle to sit still and maintain their attention span for a long period of time. One of the best ways to understand whether or not your child is just being a kid or exhibiting a learning disability is to ask the teacher if your student is struggling more than most. From there, your primary care doctor can offer recommendations for next steps.

    If your child is diagnosed with ADHD or ADD, here are a few ways you can equip them with the tools and structure they need to help them self-regulate while learning.

    Clarify realistic expectations with their teacher.

    It’s important to understand exactly what your child’s teacher expects of them in terms of what they should be doing and for how long. Maintaining clear communication can help you be clear on what the minimum requirements are for your child’s success in school. A teacher who knows your child can also help to offer additional resources and tools that help your child transfer classroom support to the home.

    Create a quiet learning environment with minimal distractions.

    Although many kids with ADHD follow the social cues of their peers to help them stay on task at school, there could be an advantage to having them working independently at home. With no students around to distract them, kids with ADHD/ADD may feel like they have more control over their attention.

    Try to set-up a schoolwork area away from the normal hustle and bustle of the home to continue minimizing distractions. Avoid rooms where people are running in and out, like the kitchen where someone could be cooking. Instead, establish a dedicated area for learning activities that makes it easier for them to focus. And, consider giving your student something to purposely distract them from their surroundings while encouraging them to complete a task. Like turning on a white noise machine to drown out excess noise in the home, or a handheld fidgeter that can keep their fingers busy.

    Establish a structured routine for the day that involves breaks.

    Kids feel less pressure and stress when they know what to expect and when. Consider creating a structure for the day that starts with a consistent wake-up time and weaves in meal times, time for play, learning sessions, and time to relax. You don’t have to be firm on the times for each block, as a firm schedule can add additional pressure. But, organizing the day with activities that follow a certain order can help your student be successful.

    Foster a love of learning.

    The most important thing is to remember that we’re all in the same boat trying to navigate non-traditional schooling. There’s no doubt that it’s hard and many of us are making it up as we go. But the truth is, this will pass. Your kids will eventually go back to school where they will continue to learn and grow into fully functioning adults who will eventually pursue college or a career.

    In the meantime, the best thing you can do at home is to help them to love learning by keeping the atmosphere at home positive and encouraging. Take off the pressure of expecting them to achieve a certain threshold of success, whether it’s a specific letter grade or keeping up with other kids. Instead, make learning enjoyable by helping them to learn at their own pace and model a love of learning yourself. Your child will learn no matter what, even if it’s not in the way you expect!


    Concerned about signs of ADHD in your child?
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  • November 13, 2020

    By MedStar Health

    As a computer engineering and computer science undergraduate at the University of South Florida in Tampa, Shawn Tejiram, MD, seemed well on his way to a career in information technology. But volunteer opportunities at the nearby H. Lee Moffitt Cancer Center and Shriners Hospitals for Children motivated him to reprogram his future.

    “I liked the interaction physicians had with their patients and families and was inspired by the work they did,” he explains. “So, I added biomedical sciences to my major and decided to pursue medicine.”

    Burn Care and Treatment

    After graduation, the Tampa native stayed close to home by attending USF’s Morsani College of Medicine. He then came to MedStar Georgetown University Hospital/MedStar Washington Hospital Center for his general surgery residency. A research fellowship in the Firefighters’ Burn and Surgical Research Laboratory at MedStar Washington Hospital Center focused Dr. Tejiram’s interest in burn injuries and related care.

    “It was fascinating to see how acute care management for burn patients differs from other types of injuries, plus involves other specialties, such as dieticians, rehabilitation specialists, and outpatient treatment for scar care,” he says. “The opportunity to work with some amazing physicians also made a huge impression on me.”

    The experience led to additional fellowships in burn surgery, trauma surgery, and surgical critical care, at the University of California Davis Medical Center and Shriners Hospitals for Children—Northern California. The opportunity to return to the Hospital Center as an attending surgeon in The Burn Center, and at Children’s National Hospital, reunited Dr. Tejiram with colleagues and mentors, and allowed him to assist burn patients with both the physical and emotional aspects of their injuries.

    “A burn can be a very traumatic experience, but we have extensive experience managing all types of cases to achieve better outcomes,” he says. “We’re also at the forefront of utilizing some highly innovative treatment methods, such as using a patient’s skin cells to produce a solution that is sprayed over the wound during the surgical procedure. This helps speed the process of regenerating natural skin.”

    Research Focus

    Dr. Tejiram’s own research has focused on blood clot formation in burn patients, and the role it can play in optimizing acute burn patient care. These and other research projects have resulted in an extensive list of published papers and presentations. He also enjoys sharing his knowledge and experiences with Hospital Center burn care and surgical residents.

    “It wasn’t that long ago when I was in their position, with the same questions they’re now asking me,” Dr. Tejiram says. “I really enjoy the chance to help them become better physicians.”

    Outside of Work

    Still the enthusiastic volunteer, Dr. Tejiram and his wife work with several area animal rescue groups, inspired in part by their own rescue dog, Chestnut. “We’re also big hikers,” he adds, “and have explored Great Falls and other area trails. It’s great that we’re close to so many fun and scenic places.”


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