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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 12, 2020

    By Brian Barry, MD, Neurology

    Nearly a million Americans—about one in 300—have multiple sclerosis (MS), an autoimmune disease affecting the spine, brain and optic nerves. Its cause is uncertain, but we do know that—like in other autoimmune diseases—an unknown trigger turns the patient’s immune system against itself, causing inflammation of the brain and spinal cord. Plaques or lesions are left behind, a form of scarring known medically as sclerosis. MS causes many such scars, hence the name “multiple sclerosis.”

    Although there is no one definitive test for MS, this scarring appears as spots on an MRI in areas where myelin is damaged. Like insulation on an electrical wire, myelin is a coating that protects and isolates nerve tissue. Damage to myelin causes a wide range of symptoms in MS, the most common being fatigue, difficulty walking, numbness, tingling, weakness, dizziness, vision changes, mood changes and bladder problems.

    Just a few decades ago, medical science had no tools to treat MS. But that has changed dramatically. Today, we have over 20 different therapies, with new agents approved each year.

    Risk Factors

    MS is an autoimmune disease, like type 1 diabetes, psoriasis and rheumatoid arthritis. Although it is more common in certain populations, it can strike anyone.

    Some risk factors that may encourage the disease:

    • It is more prevalent among women, who are about three times more likely to be diagnosed than men. We don’t know exactly why, but hormonal differences may play a role.
    • Risk is higher for people who have an immediate family member with MS, making genetics a contributing factor.
    • MS is more prevalent farther from the equator. We know vitamin D deficiency is a risk factor, so it’s likely that the additional exposure to the sun at lower latitudes is protective, since sunlight stimulates vitamin D production in the body.
    • We suspect that childhood and adolescent obesity increases risk.
    • Smoking both increases the risk of developing MS and can significantly worsen the disease in people who have MS. I encourage all my MS patients to quit.

    There is some evidence that African Americans are likeliest to exhibit more severe symptoms once diagnosed, but MS affects all races and ethnicities.

    No Two Cases Are Alike

    MS symptom severity is highly variable. Some patients have frequent severe early relapses, but in others, symptom progression is slow, starting as early as the teen years. When symptoms eventually spur the patient to seek medical help, we often find that early symptoms were either overlooked or misdiagnosed.

    Diagnosis, which typically occurs between the ages of 20 and 50, can be challenging, as many of the signs of MS can be caused by other conditions. For example, carpal tunnel syndrome or a pinched nerve can cause numbness and tingling in the extremities. Transient neurological symptoms are unlikely to be due to MS, but it’s a red flag if symptoms last longer than 24 hours.

    Accurate diagnosis calls for detective work—careful consideration of the patient’s history, exam findings and tests including MRI imaging. Occasionally we find that an MS diagnosis is incorrect. Sometimes patients with migraine are misdiagnosed as having MS, as migraine can cause similar abnormalities on an MRI. Even experienced neurologists may have difficulty confirming a diagnosis and will refer the patient to a neurologist with a specialty in MS.

    Generally, we see patients in MS clinics who had a concerning MRI result and were referred by their internist or general neurologist. We conduct a detailed history and thorough neurologic examination. If we remain suspicious, we order an MRI of the brain and spinal cord.

    Sometimes diagnosis is immediate—confirming or excluding MS on the patient’s first visit. But in many cases, watchful waiting is the right course of action. We follow the patient closely to see how symptoms evolve over months and may need to repeat MRIs.

    Emotional Effects

    Because anxiety and depression are so common in MS patients, we now believe they are physiologically linked to the inflammation the disease causes, rather than an emotional by-product of it. MS neurologists are familiar with the treatment of these conditions, but we also work closely with our experts in psychiatry, psychology and social work to design a blend of counseling and medical therapy to improve mood symptoms.

    MS can likewise have a profound impact on family and caregivers. The disease often strikes those in the prime of life, active in careers and raising families, so it can be a jarring and confusing diagnosis when symptoms are subtle or not outwardly apparent.

    We provide counseling to help patients and families understand the disease and how best to manage its effect on their lives. This is especially important when there are invisible symptoms of MS, such as cognitive problems, bladder dysfunction or depression.

    The Therapy Era

    Broadly speaking, MS comes in two forms: relapsing and progressive. But because it can vary in how it presents, we see a lot of overlap.

    • With relapsing MS, episodes of worsening symptoms tend to occur over days or weeks, followed by eventual improvement.
    • With progressive MS, there is a slow worsening over time, even without relapses.
    • One form can evolve into the other—typically, the relapsing form changes over years to a progressive phase.

    A generation ago, MS was a frightening and debilitating diagnosis. We could not prevent disability from MS, and we managed the symptoms as best we could. But now, this disease is highly manageable, thanks to dramatic advances in therapy. When caught early, we can treat MS before a patient experiences life-altering disability.

    Once a devastating disease, multiple sclerosis is manageable today, thanks to dozens of targeted therapies that dramatically improve quality of life. Dr. Brian Barry explains. @MedStarWHC via https://bit.ly/3e94kZs
    Click to Tweet

    About 30 years ago, injectable agents were introduced and administered under the skin similar to insulin for diabetics. In the 2000s, oral medications became available. Today’s patient may also receive infusion therapy at an infusion center every month, or every six months, depending on the medication. Medications have been documented as very effective, particularly against the relapsing form of the disease.

    Because MS looks and behaves differently in each patient, we tailor therapies to both the disease and any other underlying conditions. Our strategy can change as the disease evolves and more treatments become available, so it’s not unusual for the patient to take different medications over the course of their lifetime. Monitoring the drugs’ effect on the immune system is also important to avoid complications like infections. With proper monitoring, the drugs are well tolerated and safe, can slow or stop the progress and can give the brain a chance to heal to improve function.

    The MedStar Difference

    At MedStar Washington Hospital Center, we treat MS holistically, leveraging the expertise of a wide range of specialists to manage the disease and maintain the highest possible quality of life for each patient.

    MS patients are managed primarily by a neurologist. Neuro-radiologists help interpret MRI scans to monitor for changes. Physical therapists, occupational therapists and physiatrists are on board to help with maintaining and regaining physical function. We frequently also work with urologists who understand the potential bladder complications of MS. Mental health experts such as psychiatrists and counselors help manage anxiety and depression. The team also includes experts in our Neurosciences Center who work with insurance companies on any necessary medication approvals.

    And as a partner with the Multiple Sclerosis and Neuroimmunology Center at MedStar Georgetown University Hospital, our patients have access to ongoing clinical trials for investigational therapies.

    A Bright Future

    The most common misconception is that MS is difficult to treat. That reputation goes back to the days when no treatments were available. The landscape is much different now.

    With MS therapies, we treat the “future you.” Not every deficit can be reversed, but our game plan is always long term and almost all symptoms of MS can be improved with careful treatment. Our goal is to make this illness manageable and for our patients to live full and productive lives.

    As with many other diseases, early intervention provides the best chance at successful management. Your long-term health is at stake, so don’t ignore any chronic issues that could be symptoms of this disease.

    Today’s drugs target the inflammation MS causes. But medical research is also seeking to develop agents that target the disease itself, or a cure through prevention. When we’re able to positively identify the trigger that knocks the immune system off track, we will potentially be able to stop this disease before it starts. Future therapies could also reverse the damage it causes.

    I’m optimistic we’ll see such developments in our lifetime.


    Numbness, weakness or trouble walking?

    Talk to our neurology team.

    Call 202-788-5048 or Request an Appointment

  • November 11, 2020

    By Irina Veytsman, MD, Medical hematologist and oncologist at MedStar Washington Hospital Center

    Lung cancer is the deadliest form of cancer, as more people in the United States die from the disease than any other type of cancer. And, although survival rates are much higher than they were thirty years ago, the American Cancer Society estimates that over 135,000 people will have died from lung cancer in 2020.

    Unfortunately, many people die from lung cancer because they don’t get diagnosed until the disease has progressed to a later stage. In fact, 57% of people with lung cancer are diagnosed with an advanced stage of lung cancer called distant metastasis, which means cancer has spread to other organs in the body. Once that happens, lung cancer is much harder to treat.

    The good news is that advances in technology and medicine have made it possible to improve your chances of surviving lung cancer. Here’s how.

    Get screened for lung cancer before you experience symptoms.

    If you wait until lung cancer symptoms appear, you’ve already given the disease a chance to grow and spread. Instead, talk to your doctor about getting screened for lung cancer. During a lung cancer screening, an x-ray technician will use a low-dose computed tomography (CT) scan to take detailed pictures of your lungs. This allows your doctor to inspect the lungs for signs of cancer, even before any symptoms arise.

    Learn more about what to expect during a lung cancer screening.

    Less than six percent of patients with late-stage lung cancer live longer than five years after their diagnosis. But, the five-year survival rate for patients diagnosed with localized lung cancer tumors during early stages is 60%. Getting screened sooner than later can ensure you’re catching anything suspicious early while it’s most curable. An early lung cancer screening can even decrease your risk of dying from lung cancer by as much as 20%.

    Lung cancer screening eligibility.

    We recommend lung cancer screening for men and women who meet all of the following criteria:

    • Are between the ages of 55-80
    • Have no signs or symptoms of lung cancer
    • Have a 30 pack-year smoking history (e.g. you have a history of smoking a pack of cigarettes a day for 30 years or 2 packs of cigarettes a day for 15 years) AND
    • Currently smoke or quit within the past 15 years or less

    Are you eligible for a screening?

    It’s important to note that while the majority of lung cancer patients smoke or have a history of smoking, it’s still possible for non-smokers to develop lung cancer. Although the screening guideline currently doesn’t include indicators for non-smokers, talk to your doctor if you are concerned about any environmental factors or genetic mutations that may affect your chances of lung cancer. They can recommend the best course of action to ensure you’re evaluated early if you’re at risk.

    #LungCancer is the deadliest type of cancer, but there’s still hope. On the #LiveWellHealthy blog, Dr. Veytsman shares 4 ways you can improve your chances of survival: https://bit.ly/3nfHOS5.

    Click to Tweet

    See a doctor as soon as you notice signs of lung cancer.

    Getting a lung cancer screening is the best way to catch lung cancer early and increase your survival rate. However, if you haven’t reached the age minimum for screenings, or you’ve delayed a lung cancer screening for whatever reason, seek a doctor immediately if you start to experience lung cancer symptoms.

    Lung cancer symptoms typically persist and worsen over a long period of time. Signs of lung cancer may include:

    Sometimes, smokers get used to a “smokers cough” and chalk it up as normal. It may not be. Don’t ignore signs of lung cancer. If you’re experiencing symptoms, lung cancer may already be spreading, making it much harder to treat. Delaying care only gives the disease more time to progress and worsen, so getting to the doctor sooner rather than later can make a difference between life and death.

    If you do have lung cancer, then getting to the doctor as soon as you notice symptoms may give you the opportunity to begin treatment before it worsens. And, a doctor can help to rule out lung cancer if your symptoms are related to something else.

    Quit smoking to improve effectiveness of treatment.

    Even if you’ve been smoking for decades, it’s never too late to quit smoking. Smoking cessation can reduce your chances of dying from the disease. Lung cancer thrives off of the carcinogens found in cigarettes and other types of smoking. So, if you quit, you “starve” the tumor of what it needs to grow, reducing the chances that it will increase in size.

    Additionally, many treatments don’t work well when combined with smoking. By quitting, you can increase the effectiveness of your lung cancer treatments.

    Talk to your doctor about which smoking cessation resources may help you stop smoking for good. From prescription drugs to virtual counseling classes, we can help you take the next step to increase your chance of survival.

    Prepare for a lifelong battle.

    Fighting lung cancer is a long and arduous journey. And for many, it’s an ongoing battle. Early-stage lung cancers have the greatest chance of survival. However, you will always need to be on the lookout for recurrence, as once you have it, it might return.

    If you have an advanced stage of lung cancer, there is little chance of a cure. The good news is that there are so many advances in medicine that can help to increase your survival rate. Molecular profiling helps doctors better understand your specific case, and there are many treatment options today, like targeted therapy and immunotherapy, that were unavailable thirty years ago. It may feel scary and daunting, but keep seeking treatment from doctors who are committed to helping you live a quality life for as long as possible.

    Remain hopeful, establish a strong support network, and don’t give up!


    Want to know if you’re eligible for a lung cancer screening?
    Take a quick quiz to find out.

    Lung cancer screening eligibility quiz

  • November 10, 2020

    By Vadim V. Morozov, MD

    Estimated reading time: 4 minutes

    Have you heard about nerve-sparing surgery?

    Although not a new concept, it was a little-known approach until recently. And as surgeons become increasingly skillful at preserving critical nerves during gynecologic and pelvic procedures, patients are realizing long-term benefits to their health and lifestyle.

    For the past five years, my colleagues and I have taught the latest in nerve-sparing laparoscopic techniques. Our goal is to help our doctors understand the extensive network of tiny-but-critical nerves surrounding the tissue they are excising. We educate both fellows and residents on newer techniques in preserving these nerves, an approach that can benefit the patient in several ways.

    The pelvic area is comprised of not one but a plexus of nerves. A successful nerve-sparing procedure is only possible when the surgeon is aware and knowledgeable not just of anatomy and of organ functions, but of how they interconnect.

    Our goal is to bridge the gap between the basics that doctors learn in medical school or early residency and the finely tuned skills they can apply in the operating room today. And we work to help our patients understand the importance of this expertise as well.

    Long-Term Effects of Conventional Approaches

    Early in the 21st century, doctors grew more and more skilled at laparoscopic procedures for hysterectomy and for excision of endometriosis. But at that time, the profession was focused mainly on the mechanics of performing these procedures and performing them well. In the course of surgery, doctors routinely dissected many tiny hair-like pelvic nerves, without realizing the potentially adverse, long-term effect on the patient.

    Over time, it was found that some patients gradually had trouble with bladder or bowel control (loss of urine, difficulty voiding or constipation), or perhaps a gradual decline in overall sensitivity during sexual function. Such dysfunctions were often simply attributed to the natural aging process, rather than that earlier surgery where certain essential nerves were cut.

    Hypogastric nerves, very inconspicuous, were frequently severed; today, we better comprehend how they innervate central pelvic organs—such as the bladder and rectum—and can also affect sexual sensitivity. We realize how crucial it is to avoid damaging adjoining nerves during hysterectomy procedures, or during vaginal-wall or bladder prolapse rectifications (a procedure in which the urogynecologist suspends the top of the vagina or the bladder so it doesn’t drop).

    Today’s Advances

    Here at MedStar Washington Hospital Center, we’re focused on minimally invasive laparoscopies that reduce the possibility of long-term side effects for the patient. We’re adept at protecting the large collection of pelvic nerves present in every patient, particularly during procedures where a good deal of dissection may be needed.

    Our techniques, instrumentation, cameras and screens have evolved significantly in recent years. Armed with high-definition laparoscopic screens during surgery, we have an excellent view of tiny capillaries, even the red blood cells running through them, giving us the visibility needed to preserve them.

    We concentrate not just on the procedure itself, but on precisely where to cut to spare these nerves. Perhaps this calls for a change in navigation during surgery: maybe we’ll choose a slightly different angle to achieve a better, safer level of dissection. And in a procedure like endometrial surgery, we can spare essential nerves even while completely excising areas of deep infiltration.

    Nerve-sparing techniques deliver excellent long-term results for pelvic laparoscopy patients. Dr. Vadim Morozov explains. @MedStarWHC. https://bit.ly/3e3bsXu
    Click to Tweet

    Tiny Incisions, Faster Recovery

    Years ago, pelvic surgeries routinely required a large incision. Today, all the work is completed via tiny incisions, using a set of laparoscopic instruments.

    In a nerve-sparing laparoscopic procedure, the surgeon inserts the camera into a small incision located within, or just adjacent to, the navel, depending on the patient’s anatomy and the surgical objective. The laparoscopic instruments are then inserted into two or three accessory 5-millimeter incisions, situated along the bikini line.

    The camera gives us a clear view of the area to be treated and lets us place and manipulate the instruments to dissect the necessary tissue and control any bleeding at the surgical site.

    Because nerve-sparing surgery calls for greater care and precision, it takes up to 15 minutes longer to perform than conventional surgery did. But those extra few minutes are time well spent when we consider the long-term wellness benefits to the bladder, bowel and sexual function.

    After Surgery

    For most of our patients, nerve-sparing laparoscopy is an outpatient surgery. If our patient is fully functional and can visit the bathroom, walk outside and climb stairs, we send her home the same day. The patient can then typically return to work and other normal activities in 7–14 days. Full healing occurs over about six weeks—much quicker than recovery from open surgery, which can take three months.

    We perform 15–20 nerve-sparing procedures a month at the Hospital Center, and I’ve noticed that women’s long-term outcomes have been much better with this type of surgery. Five or six years after their procedure, they’re very happy, with no sign of that gradual decline in bowel or bladder function.

    Our team is well equipped to review, recommend, and provide treatment for even complex cases. Patients can count on our expertise as one of the leading teams for nerve-sparing surgery in the mid-Atlantic region.


    Considering nerve-sparing surgery?

    Consult with our specialists.

    Call 202-788-5048 or Request an Appointment

  • November 05, 2020

    By John F. Lazar, MD

    When Dana Reeve—wife of disabled actor Christopher Reeve and a well-known activist for disabled persons’ rights—succumbed to lung cancer at age 44, her death raised a lot of eyebrows—and a lot of awareness. Why? Because Reeve was a healthy, committed non-smoker.

    Lung cancer is the number one cause of death in America—and it often surprises people to learn that it’s not just the second most common cancer in women, but also the deadliest.  Although it has traditionally occurred in men more than women, women are closing the gap, now accounting for 47% of all diagnoses.

    Most patients diagnosed with this cancer today—whether male or female—are not active smokers; rather, they tend to be former or never-smokers. Alarmingly, the incidence in these non-smokers is increasing. And a higher percentage of women with cancer of the lung have never smoked; in fact, about 20% of female deaths from lung cancer occur in non-smokers, compared to about 8% of men.

    Researchers are seeking to understand the rapid rise of lung cancer in women (particularly younger females), including looking into ways that genetic and hormonal influences may play a role. But the answers are not yet there.

    For both genders, of course, smoking is certainly a primary risk factor for diseases of the lung—and, as a thoracic surgeon who treats illnesses of the chest and lungs, I’m a big supporter of the risk-lowering benefits of quitting smoking. But unfortunately, avoiding smoking doesn’t guarantee that you’ll avoid contracting the disease. 

    Let’s look at some other potential risk factors that may increase a patient’s vulnerability to this cancer.

    Risk Factors Beyond Smoking

    One big risk factor is secondhand smoke. For non-smokers regularly exposed to another smoker’s habit, whether in the workplace or at home, the risk of lung cancer increases by 20–30%. Sadly, in the U.S., secondhand smoke kills more than 7,300 non-smokers annually, and has caused the deaths of 2.5 million adults since the Surgeon General first noted this hazard in 1964.

    Another risk factor: proximity to carcinogens. The earth naturally emits certain carcinogens, such as radon, a colorless, odorless gas. High levels of radon exist northward in Maryland and Pennsylvania and westward in West Virginia. In areas with high radon, people who spend a lot of time in basements and other spaces below ground over the long term may develop an increased risk for lung or other types of cancer.

    Boilers, furnaces, and heating and air conditioning units can also produce carcinogens, especially causing technicians who work with them to have a higher likelihood of developing cancer of the lung (although these workers don’t tend to be women). Risk of this cancer can also come from occupational or other environmental exposures to materials such as asbestos or to carbons like lead or diesel emissions.

    Lung Cancer and Women

    Lung cancer in young adults is increasing, and it is impacting many more young women than young men. Plus, these women tend to be diagnosed at an average age two years younger than men.

    Researchers suggest that estrogen, plentiful in young women, may promote cancerous growths in the lungs, but there is still much research to be done. Women are also more likely than men to experience genetic changes related to this cancer; again, research is underway.

    Although cancer of the lung tends to present similarly in women and men, women are more likely to contract lung adenocarcinoma (a non-small cell lung cancer), while men tend toward squamous cell carcinoma of the lungs and small cell lung cancer.

    Symptoms and Screening

    How do we typically discover a tumor in a patient’s lung?

    At the Hospital Center, our lung cancer screening program includes patients that we already know may be at high risk: individuals over 55 who have smoked a pack of cigarettes a day for over 30 years and don’t currently exhibit symptoms.

    But it’s the people who don’t meet the typical high-risk profile that we worry about the most. Ideally, we want to catch any malignancy on a chest X-ray or CT scan at early onset, when it’s easiest to manage.

    Unfortunately, in most patients, lung cancer is silent until it’s advanced. These people don’t realize they have a problem until they feel troublesome symptoms, at which point their cancer has likely progressed significantly.

    We encourage patients to speak with their healthcare professional if they experience unexplained and prolonged fatigue, cough up blood, or have a cough that has lasted 2–4 weeks (even in flu season). A family history of lung cancer is also an indicator that the individual should receive regular screenings.

    In general, although the most effective way to screen patients for lung cancer is a CT scan, it isn’t optimal to screen everyone for a disease that may occur in 1% of the population. But newer approaches in blood screening and breathalyzer analysis may become increasingly helpful to detect disorders within the lungs.

    Women are more likely to survive this cancer than men. But any patient whose cancer spreads from the lung to the brain, liver or bone has a less than 20% survival rate over 5 years.

    So it’s our mission to detect and treat early.

    It’s Lung Cancer Awareness Month: Even non-smokers get lung cancer. Learn more about the risks. @jflazar @MedStarWHC https://bit.ly/34tMXzc.
    Click to Tweet

    Removing the Cancer

    If the cancer is small and the patient is a viable candidate, we consider surgery—anatomical resection (lobectomy) of the lung—to be the gold standard for removal of lung tumors.  Lobectomy removes the diseased lobe (artery, vein and airway) from the lung. If the diseased area is found and excised early enough, the patient may not even require additional therapy.

    In a more advanced cancer—one that has spread from the lungs to lymph nodes or other organs—we may turn to chemotherapy, to which women tend to respond quite well.

    Patients for whom surgery is not optimum can receive stereotactic radiation, delivered in four or five daily sessions with radiation finely tuned to the specific area where it’s needed. Or we may recommend proton therapy, delivering doses of protons to the precise location of the lung cancer to combat it.

    The future is hopeful for fighting this cancer, as the U.S. government, American Lung Association and National Cancer Institute work toward improved identification and treatment. Areas of promise include:

    • Immunotherapy: A game-changing approach that we’re very excited about. Even patients at an advanced stage of the disease may be treated with new drugs that will allow them to be more active and give them a much better quality of life than previously possible.
    • Pharmacogenetics: A field of study enabling a patient’s genes to be analyzed and medicines tailored specifically to their genetic makeup. Because a lung tumor reflects a patient’s unique genetic code, this very personalized approach may hold great potential.

    A Few Things to Remember

    • Regardless of your gender, take the steps you need to stop smoking. Avoid situations where you are impacted by secondhand smoke as well.
    • Be aware of other possible carcinogens in your workplace or home environment, and take measures to diminish your exposure.
    • Stay aware and report symptoms such as extreme fatigue and bloody or persistent coughs to your physician. A simple chest X-ray may save your life.
    • Discuss any family history of lung cancer with your doctor, to determine if regular screenings make sense for you.

    At MedStar Washington Hospital Center, our multi-disciplinary team of physicians provides individualized, compassionate care for patients diagnosed with lung cancer.

    For those who qualify for the Hospital Center’s unique screening program, our nurse navigator guides patients through the screening process and, if cancer is found, through the additional steps we’ll take with you to treat and manage it. Also, our smoking cessation program delivers outstanding outcomes in helping many patients quit smoking before their surgery.

    Patients who are cured become part of our long-term surveillance group, and we see them every 6 to 12 months to keep them in the healthiest shape possible going forward.

    We understand that a diagnosis of lung cancer can be an alarming and life-changing experience. We’re here to help you through it.

    LISTEN: Dr. Lazar discusses lung cancer in women in the Medical Intel podcast.


    Over 55 and a long-time smoker?

    Get more information on our screening program.

    Call 202-788-5048 or Request an Appointment

  • November 04, 2020

    By David E. Stein, MD, Colorectal Surgeon and Regional Chief of Surgery in the Baltimore region at MedStar Health

    No one wants to have to run to the bathroom as soon as they arrive at a new place, but for some people, that’s reality. Everyone who has Inflammatory Bowel Disease (IBD) is different, and so are the tips and treatments that will help them to manage and treat symptoms.

    IBD is an umbrella term for ulcerative colitis and Crohn’s disease.

    There’s no single known cause of IBD, but genetics, environmental factors, and diet may all contribute to IBD. IBD encompasses two separate auto-immune diseases that result in inflammation in the digestive tract.

    Ulcerative colitis involves the colon and rectum and develops over time. It can be life-threatening and significantly increases your risk of colon cancer. Most frequently, ulcerative colitis is characterized by abdominal pain and bloody diarrhea.

    Crohn’s disease affects the small intestine, resulting in nausea and vomiting, among other uncomfortable symptoms. Similar to ulcerative colitis, people with Crohn’s disease may also experience pain in the abdomen and blood mixed with diarrhea.

    Other common symptoms of IBD include:

    • Bloating
    • Chronic diarrhea
    • Cramping
    • Fever
    • Urgency to go the bathroom

    Both types of IBD can be debilitating and serious, as frequent bowel movements can result in dehydration, anemia, and unintentional weight loss. Although there is no medical cure, there are things you can do to reduce inflammation and manage your symptoms.

    There’s no cure for #IBD, but there are steps you can take to manage your symptoms with less worry about where the nearest bathroom is. On the #LiveWellHealthy blog, Dr. Stein shares all about managing and treating IBD: https://bit.ly/2TSIGiR.

    Click to Tweet

    How IBD is diagnosed.

    Often, IBD symptoms come and go, which can cause people to delay seeking medical attention. After all, no one really wants to talk about their bowel movements. Certain things can trigger a flare-up, like a cold, and other times symptoms can come out of nowhere. You may want to consider keeping a journal of your symptoms, as that can help your doctor identify any patterns. And, it’s important to know your family history, as those with parents who have IBD are more likely to have IBD themselves. Other questions your doctor may ask include:

    • When did you first notice symptoms?
    • Are your symptoms continuous or intermittent?
    • How would you describe the severity of your symptoms?
    • Do you wake up in the middle of the night because of diarrhea?
    • Have you unintentionally lost weight?
    • Do your symptoms affect your ability to participate in everyday activities?
    • Is there anything that seems to worsen your symptoms?
    • Are you currently taking any medication?

    Because many IBD symptoms can be confused with other serious conditions, it can take up to two years for a doctor to confirm an IBD diagnosis. The lengthy diagnosis process is thorough and involves seeking help from a gastroenterologist. To rule out other possible causes of your symptoms, your doctor may use a variety of tests, including:

    • Blood tests to check for infection
    • A fecal occult blood test involving a stool sample
    • Colonoscopy during which your doctor can use a thin, flexible tube connected to a camera to view the inside of your colon
    • Imaging, including X-rays, CT scans, and MRIs to help evaluate possible involved organs

    Managing IBD symptoms.

    There’s no cure for IBD. However, there are steps you can take to treat IBD by reducing inflammation that triggers your symptoms.

    Build a relationship with a team of providers. Once you’ve been diagnosed with IBD, you’ll want a team of healthcare providers on your side. Gastroenterologists, nutritionists, nurses, and colorectal surgeons can work together to help you take a holistic approach to managing your symptoms.

    Try anti-inflammatory medication. As the first line of therapy for treating IBD, your doctor may suggest medication to reduce inflammation in your gut with minimal side effects. The medication you take will vary based on what part of your colon is affected.

    Consider immunomodulators. Immune system suppressors are innovative drugs that suppress the body’s natural immune response. Because IBD is an auto-immune disease that causes the body to attack its own immune system, immunomodulators may prevent an attack.

    Modify your diet. There’s no one diet that can help you to prevent IBD symptoms. But in some cases, your doctor can help you identify a diet strategy to pinpoint certain foods that may worsen symptoms. Otherwise, continue to eat a well-balanced diet full of nutritional food. Eating smaller meals more frequently throughout the day may help you to ensure you’re receiving adequate nutrition.

    Establish a support network. If you have IBD, you may be navigating symptom management for the rest of your life. It can be helpful to meet others who are experiencing the same thing and can offer support and advice. The Crohn’s & Colitis Foundation offers local chapters throughout the United States and can serve as a helpful resource for getting connected.

    When surgery is necessary.

    When medication doesn’t help relieve IBD symptoms caused by ulcerative colitis, or if the side effects affect your quality of life, surgery may be your best treatment option for IBD. Unfortunately, surgery cannot cure Crohn’s disease, but it can eliminate ulcerative colitis.

    During surgery, a colorectal surgeon will likely remove your entire colon and rectum. The surgeon will use your small intestine to construct a pouch for waste, allowing you to go to the bathroom. In other cases, a surgeon may need to create a permanent opening in your abdomen to collect stool in an attached bag.

    The Surgical Pavilion at MedStar Franklin Square Medical Center.

    If symptom management isn’t providing relief, talk to your gastroenterologist about your other options. At MedStar Health’s new Surgical Pavilion in Baltimore, you’ll find state-of-the-art care matched with the latest in advanced technology, thoughtful comforts, and spacious suites. Our large operating rooms come equipped with the latest industry tools and technologies that ensure your care team can work closely together and help you achieve your best outcome, should you need surgery.

    You don’t have to let IBD symptoms keep you from living a full life. Find a gastroenterologist who can help you manage IBD and start feeling like yourself.


    Want to learn more about how the new Surgical Pavilion at MedStar Franklin Square Medical Center can help with IBD?
    Click below.

    Learn More

  • November 03, 2020

    By Oliver Tannous, MD

    MedStar Orthopaedic Institute has a uniquely qualified team dedicated to spine surgery. The spine specialists here are specially trained and experienced in caring for the entire spine, from the base of the skull to the tail bone. 

    We specialize in the entire gamut of spine care for disorders of the cervical, thoracic, and lumbar spine. We treat conditions like spinal stenosis and sciatica, where pinched nerves may cause pain, tingling, numbness, or weakness in the arms and legs. We have a specific focus on treating deformities, such as scoliosis, as well as infections, tumors and traumatic injuries of the spine.  

    We treat these conditions using a tailored approach for each patient. Our procedures range from microscopic and endoscopic decompression to complex multi-level reconstructions. Our motion-preservation procedures are directed at avoiding fusions and enhancing motion; this includes cervical and lumbar disc replacements and minimally invasive decompressions. On the other hand, we have a focused multi-disciplinary approach for performing complex revision, reconstruction and deformity surgery.  

    My colleagues and I are supported by a team of excellent specialists, including resident physicians from two of the most prestigious orthopedic programs in the region as well as highly specialized physician assistants and nurses who specialize in spine care.

    Our imaging specialists, physical therapists, nutritionists, and other support staff all bring a unique and valuable skill set as well. Our team culture empowers each of us to be our best, every day. After all, each of our patients is a cherished family membersomebody’s mom, dad, sister, brother. 

    The Challenge

    The spine is complexcomposed of many joints, stacked one atop the otherIt’s one continuous and fluid unitand is classified into three sectionsthe cervical, or neck; the thoracic, or upper back; and the lumbar, or lower back.

    Its main components are: 

    • Vertebraethe bones of the spine 
    • Discspads of cartilage between each vertebra that cushion and insulate them, keeping the vertebra separate and flexible 
    • Nerves that pass through the bones and cartilagevirtually every nerve in the body can be traced back to a branch of the spinal column, like branches on a tree trace back to its trunk 

    This intricate and complicated system of moving parts can be affected by wear and tear, injury, disease, and deformities. When those kinds of problems affect the nerves, spine surgery can help.

    Distinguishing Back Pain from Nerve Issues

    It’s important to make the distinction between pain and nerve problems. Back and neck pain can have many causes. Most frequently, pain is a result of muscle strain and inflammation, often associated with arthritis. Surgery doesnt fix that kind of back and neck pain, and I recommend it for only a small portion of the patients I see.  

    If there is no evidence of significant nerve involvement, non-surgical treatment is patient’s better option, including anti-inflammatory medications and physical therapy to improve conditioning, strength, and flexibility.  

    We don’t dismiss pain, of course, since it can have such a negative impact on quality of life. So even if a patient is not a candidate for surgery, we connect them with the help they need, such as a physical therapy team and other non-surgical resources. 

    For nerve problems, however, surgery can prove very effective in a variety of situations. For example, a patient’s arthritic spine can develop bone spurs that pinch nerves. Or when a patient’s disc slips out of place, it can put pressure on the nerve. When nerves become pinched by stenosis, the space they occupy shrinks and narrows, which can lead to painful arm and leg symptomsSurgery can relieve many of these issues 

    Spine surgery can also successfully treat deformities such as scoliosis, tumors, infection, and traumatic injury. MedStar Washington Hospital Center is the region’s busiest Level I Trauma Center, so our team is routinely tasked with treating complex and challenging injuries, like those caused by motor vehicle accidents.  

    Tracking the Source of Pain

    When the spine is injured, the patient generally experiences the resulting nerve symptoms in other parts of the body; classic examples are pain, tingling, weakness or numbness in the legs and arms. Besides conducting a patient medical history and physical exam, we explore what’s happening via X-ray, CT scan, and MRI, and can order tests to gauge nerve function. 

    The body is remarkably resilient. When we relieve pressure on the nerves, the system starts working again and we see real improvement. In many cases, we witness dramatic transformation after surgeryIt’s very gratifying to hear reports of patients dancing at a wedding who, previous to surgery, could barely stand or walk.

    Nerve problems in the spine can cause pain, tingling, weakness or numbness in the arms and legs. Dr. Oliver Tannous explains when surgery can make a difference. https://bit.ly/3mHs61K via @MedStarWHC
    Click to Tweet

    Advanced Techniques

    We can do more today than in years past, and much less invasivelywith less bone removal and fewer incisions. In some cases, we can preserve motion after surgery, with disc replacementan artificial implant replaces herniated disc and reduces strain on the joints above and below, potentially preventing future complications. 

    Plates, braces, and other structural elements needed to strengthen and stabilize the spine are smaller and lighter than those used in the past. We operate under the microscope and use tiny cameras to better visualize the areas that need attention. 

    Not every surgery can be done with minimally invasive techniques. But, for the right candidate, it can mean less postoperative pain, reduced infection riskand faster recovery.  

    The team is also highly skilled in revisionor correctivesurgery for any new issues that develop after an initial surgical procedureMany spine problems spring from degenerative diseases like arthritisas that degeneration continues after surgery, it may cause additional problemsSometimes things don’t heal properly the first time around. Or an injury or break in one joint can weaken those above and below it, spurring issues five or ten years down the road. 

    Revision procedures are challenging and put the team to the test. Because each case is unique, we take the time to consider all possible options and make the best possible decisionsThis careful consideration is important because the more successful the procedure, the more we can improve a patient’s quality of lifeand that is our primary goal. 

    Engaging the Family

    Everything before and after surgery matters. If your health is poor before surgery, you may have more difficulty healing after surgery. We work to get your nutrition right, or to get your diabetes under control orbecause nicotine slows bone healing, to help curb your smoking habit. 

    Making these changes can seem daunting, and it can be a great help when the entire family is involved. Including the family engages the patient. When the family is “all in, they suddenly become critical members of the healthcare team, helping you make the required lifestyle changes 

    The Road to Success

    Nothing is left to chance. We get the patient in good health before surgery. We get both patient and family invested. We apply our best possible skills in the operating room. We follow up with appropriate and effective pain managementAnd whave the patient up and out of bed as soon as possible, which is proven to speed recovery.  

    Then, after a period of healing, we provide access to rehabilitation and physical therapy experts with specialized experience in orthopedics. Our entire team pulls together to get the patient healthy and active. 

    At MedStar Orthopaedic Institute, we are proud to be a true leader in spine surgeryOur large and complex volume of cases keeps our skills well-honed 

    Restoring spine surgery patients to active living is exciting. And it’s what we strive for. 


    Experiencing back pain?

    Talk to a spine specialist.

    Call 202-788-5048 or  Request an Appointment