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  • January 14, 2022

    By Allison Larson, MD

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

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

    1. Do: Wear sunscreen all year long.

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

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

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

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

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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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

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

    3. Do: Pay closer attention to thick skin.

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

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

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

    Related reading:  Follow these 5 Tips for Healthy Skin

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

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

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

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

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

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

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

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

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

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


    5. Don’t confuse skin conditions with dryness.

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

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

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

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


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

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • September 01, 2020

    By Brian Lim Bello, MD

    Colorectal cancer has traditionally been considered an older person’s disease. But according to the American Cancer Society, in 2020, 12% of colorectal cancer cases will be diagnosed in people under 50. From 2011 to 2016, colorectal cancer rates rose by 2.2% per year in people under age 50. Perhaps even more alarming, from 2008-2017, colorectal cancer death rates increased by 1.3% in that age group.

    This is disturbing on several levels. First, the reasons for these increases aren’t entirely clear to doctors or researchers. Second, this age group is younger than the recommended age to start regular colon cancer screening. But one fact is clear: Young adults and their doctors need to understand their risk for colorectal cancer, so we can detect the disease early and treat it successfully.

    LISTEN: Dr. Bello discusses colorectal cancer in young adults on the Medical Intel podcast.

    What risk factors should young adults consider?

    Research suggests that the increase might be caused by a combination of factors. A likely risk factor is unhealthy lifestyle choices. Young people today grew up eating more processed foods than generations past, and I see many patients who don’t get enough exercise.

    Unhealthy #diet and lack of #exercise likely contribute to the growing rate of #colorectalcancer among young adults. via @MedStarWHC

    Click to Tweet

    Genetics are a known factor in overall colorectal cancer risk, and researchers are studying whether this affects young adults at a great rate. While we continue to study this problem, there are steps you can take to lower your risk:

    • Avoid excess alcohol consumption.
    • Avoid fatty and fried foods.
    • Don’t smoke, or quit if you do. Our Section of Pulmonary Medicine offers services to help you quit.
    • Eat a high-fiber diet.

    Exercise for at least 20 minutes a day at least two to three days per week.

    When should young adults get tested for colorectal cancer?

    Even with colon cancer diagnoses trending younger, we don’t routinely test adults of all ages for colorectal cancer. We’ve found that routinely testing young adults can lead to more false positive results than true diagnoses, which leads to unnecessary testing and undue stress. The American Cancer Society recommends that people at average risk begin colorectal cancer screening tests once they turn 50. If you have a family history of colorectal cancer, particularly if a relative was diagnosed at 50 or younger, your doctor might recommend that you have a colonoscopy or alternative test earlier. Unfortunately, my research has shown that approximately 40 percent of patients here in Washington and across the U.S. don’t get appropriate colorectal cancer screenings. People give a variety of reasons for not getting screened:

    • Their doctors don’t talk to them about colonoscopy
    • They think it’s gross to talk about the colon
    • Colonoscopy seems scary
    • Preparing for a colonoscopy sounds unpleasant

    Related reading: Tips to make colonoscopy prep more bearable Young adults and their doctors should watch for potential warning signs of colorectal cancer. These include:

    • Chronic pain in the abdomen, or belly, that doesn’t go away
    • Rectal bleeding
    • Unexplained weight loss
    • Unexplained anemia, or a low volume of red blood cells

    If you notice any of these symptoms or if you’re concerned about your colorectal health, talk to your doctor about whether you should consider getting a colonoscopy.

    What happens if we find colorectal cancer?

    Our patients have a whole team of experts in their corner. We bring together surgeons, gastroenterologists, medical oncologists, pathologists, radiologists and other experts for every patient. Our colorectal cancer team reviews scans and biopsies at our regular tumor board meeting. The experts give treatment recommendations, and we work together to create a personalized care plan for each patient. This team-based approach benefits all patients, but it’s vital for unusual or complex cases. For example, we treated a patient in his 20s whose routine blood work showed he was anemic. His primary care doctor referred him to a gastroenterologist for a colonoscopy, which showed multiple large colon polyps. Biopsies on these polyps showed that the polyps were precancerous. Instead of simply removing them like routine polyps, the gastroenterologist referred the patient to me. I recommended that we remove part of his large intestine and the surrounding fatty tissue to prevent colorectal cancer from developing. He agreed, and I performed this procedure laparoscopically, which involved just a few small incisions. He was able to go home in just a few days. But had he not gotten his regular blood work, and had his doctors not worked as a team in his care, he might not be here today. Today’s young adults must be aware of their colorectal cancer risk. Pay attention to your body, and if something doesn’t seem right with your digestion or bowel movements, talk to your doctor. We’ve heard it all—we’ll never judge you, and our No. 1 goal is to protect your health. But if “toilet talk” makes you uncomfortable, remember this: It’s preferable to find and treat colorectal cancer early than to let it threaten your life.

    Concerned about colorectal cancer?

    Schedule a consultation with a specialist.

    Call 202-644-9526 or  Request an Appointment

  • August 27, 2020

    By Carlos A. Garcia

    Cardiac PET scan technology promises to elevate cardiovascular diagnoses to a completely new level. 

    Positron emission tomography (or PET) is traditionally associated with cancer care. Oncology, in fact, is where the technology developed and advanced. But today, this type of scan can be applied to other areas of the body—and it’s becoming a real game-changer in cardiac care. 

    Most other forms of imaging technology unveil physical or anatomical structures in the body. For example, a traditional X-ray can show broken bones, blockages in the sinuses or disease in the lungs. Mammography uncovers breast disease. CT scans offer detailed imaging in the form of virtual slices of organs that can illustrate abnormalities like tumors and clots. MRI delivers even deeper detail, especially within soft tissue. 

    But this scan is different. It uses molecular imaging to determine function at the cellular level. In other words, where other imaging methods see physiology, PET sees biology and function.

    Other imaging methods see physiology, PET sees biology—function at the cellular level. That’s bringing new accuracy to cardiac screening, says Dr. Carlos Garcia. via @MedStarWHC

    Click to Tweet

    How It Works

    Like all living things, cells need food. Most of our cells run on glucose, a type of sugar, and cardiac muscle cells run on fatty acids. In nuclear imaging, we take advantage of that fuel cycle and use these nutrients as a carrier for a radiopharmaceutical, an indicator made with radioactive isotopes. As the cells consume the food, they absorb the radiopharmaceutical, and the camera technology tracks it in real time.

    The level of radioactivity needed is relatively low, so the patient is exposed to minimal radiation. And as technology improves, dosages are decreasing. In fact, compared to other nuclear studies, the required dose may be up to two-thirds less. PET is safe and getting safer. 

    What It’s Best For

    When it comes to cardiac imaging, this type of scan is well suited to assess perfusionhow well the coronary arteries supply oxygen to the heart muscle. It can also measure viability, determining which heart muscle cells are healthy and living if a heart attack or other damage has killed cells and created scar tissue. And, lastly, we can use it to assess disease processes infiltrating the heart muscle, especially diseases that cause cardiomyopathy.

    Before this new technology was introduced, the gold standard for assessing blood flow was single-photon emission computerized tomography (SPECT). SPECT allows us to identify areas of the heart muscle that are not receiving an adequate blood supply. These will present as perfusion “defects” when the cells do not uptake the radiopharmaceutical. SPECT is still a very useful tool in the cardiologist’s toolbox. But PET does more.

    SPECT can deliver equivocal results at times. For example, breast tissue can reduce the amount of activity captured by the cameraIncreased body habitus or a buildup of fluid around the lungs, which often accompanies heart disease, can have a similar effect. PET, when combined with CT, can see through all those obstructions and gives the doctor more detailed data.

    Measuring Blood Flow

    Not only do the scans measure blood flow superior to SPECT, they can accurately measure coronary flow reserve, the body’s ability to maximize blood flow to the heart when oxygen demand rises, such as during exercise.

    Oxygen is so critical that the body will adapt to narrowed arteries, rerouting blood through other vessels and even growing new vessels to replace blocked ones. But even with that remarkable response, flow can still be reduced at the capillary levelthe tiniest blood vessels where oxygen molecules move from blood to cells. Other cardiac imaging studies cannot see that level of detail and may not show flow reduction at all. With PET, we can tell with great accuracy when cells are threatened by lack of oxygen.

    With that level of detail, the technology can deliver a number of miraculous advances. One of the most impactful: the potential for early detection of coronary artery disease, even when no symptoms may be present.

    Fighting Cardiomyopathy

    This new scanning technology is also proving to be a powerful weapon against infiltrative cardiomyopathy, when foreign cells invade cardiac muscle tissue.

    One cause of this cell invasion is sarcoidosis, a challenging autoimmune disease that can affect any organ in the body. Sarcoidosis is a hyper-immune response to inflammation that causes the body to over-produce immune cells. They clump together to form granulomas. In the heart and blood vessels, sarcoidosis can mimic traditional coronary artery diseaseand do just as much damage. Once in the heart muscle, sarcoidosis can stiffen the tissue, making it less elastic and reducing pumping efficiency, called cardiomyopathy.

    Over time, the invading cells displace healthy cardiac muscle and the heart has a harder time doing its job. This condition can look like full-blown congestive heart failure, with fatigue, shortness of breath, swelling of the extremities and fluid buildup.

    Because PET shows what’s happening at the cellular level, we can use it to assess these disorders very accurately and determine treatment and management. As such, it is difficult for any study to be more accurate in identifying these kinds of problems.

    What to Expect From a Scan

    Every patient is unique and is asked to do some dietary preparation, depending on the study. Generally, this involves fastingto make your cells hungry for glucoseor going on a low-carb/high-protein diet to keep the cells sensitive to fatty acids. The prep is very simple, and our staff calls every patient to review the instructions and answer questions.

    When you arrive, we’ll start an IV to administer the radiotracer. You’ll have no dietary or exercise restrictions when you go home, but we will ask you to drink extra fluids to flush the tracer out of your system. An average stay is around two hours, including prep, the study and discharge.

    Looking Ahead

    PET will become even better over time.

    The perfusion radiopharmaceuticals we use today are very short-lived, lasting only about 75 seconds. So we cannot, for example, run a scan while the patient is on a treadmill, as we do in a traditional stress test. However, Fluorine-18 Flurpiridaz, a new agent that will likely gain FDA approval next year, will make scanning even more versatile, as it will last up to two hours in the body and enable stress testing. It also binds to mitochondriathe batteries that power every cellwhich will help increase the accuracy of the tests. And it will likely cost less than the agents in use today.

    The MedStar Washington Hospital Center Difference

    At the Hospital Center, our patients have access to state-of-the-art nuclear and molecular technology like cardiac PETnot every medical center offers this technology. Our team of full-time nuclear medicine experts are at the leading edge of this specialty and fully dedicated to it.

    We focus on our patients’ peace of mind. We know that being placed inside a large, unfamiliar machine can cause apprehension, and we work hard to make the experience as comfortable as possible.

    Our team members take pride in treating every patient like a member of their own family. When you come to the Hospital Center for a nuclear medicine study, you’re not a stranger. We are friendly, welcoming, accessible and reassuring, helping to put every patient at ease.

    This is possible thanks to our truly collaborative culture. Each member of our team is like a member of an orchestra. We play our hearts out, doing our absolute best to make the music that will create the wonderful symphony that will be your experience.

    And our patients respond well to that.

    Concerns of the heart?

    Learn more about PET scans from our experts.

    Call 202-644-9526 or  Request an Appointment

  • August 26, 2020

    By Katherine Byrd, MD, Emergency Medicine Physician and Department Chair, MedStar Montgomery Medical Center

    When it comes to seeking care in the emergency room (ER), it’s often best to get there sooner rather than later. For many illnesses and injuries, there are more options—and better outcomes—the earlier you receive treatment.

    This is especially true if you experience chest pain, shortness of breath, or signs of a stroke—all of which are medical emergencies. If you or a loved one shows signs of stroke, you should call 911 immediately.

    Every second counts when you’re having a stroke.

    A stroke, or “brain attack”, occurs when a clot or burst blood vessel blocks blood flow to the brain. When brain tissue doesn’t receive proper blood flow, millions of brain cells begin to die quickly. These brain cells are responsible for movement, speech, and thinking, which means every minute that passes increases your risk of permanent damage to your brain, or even death. That’s why many healthcare providers say “time is brain”.

    If you or someone you love are experiencing stroke symptoms, don’t brush them off or wait for them to pass. Call 911 right away, as it could save your life.

    You only have a few hours to receive life-saving stroke treatment.

    The more time that passes without treatment, the more brain cells that will die, which means a greater risk of long-term disabilities. By acting quickly and calling 911 at the earliest signs of stroke, you can get to the hospital in time to receive treatment that clears the blockage and restores blood flow to your brain. This treatment can only be administered within 3-4.5 hours from the moment your first symptom appears. And, treatment is safer and more effective the earlier it’s used.

    Don’t try to drive yourself to the ER. Call 911 as soon as possible.

    You can’t afford to waste any time—or brain cells—when you suspect a stroke. But, don’t try to drive your car or let someone else drive you, as your symptoms could worsen on the way. The fastest way to seek treatment is to call 911. Emergency medical responders move quickly and communicate with the emergency room staff so they’re prepared to administer treatment as soon as you arrive at the ER. This can save precious brain cells that could mean the difference between your ability to talk and walk independently or live with permanent disabilities.

    Even if you think the symptoms are minor or could suggest a mini-stroke, known as a transient ischemic attack (TIA), don’t hesitate to call 911. A TIA could be an early sign that a larger stroke looms ahead.

    Don’t let the fear of overreacting prevent you from acting. It’s better to go to the hospital quickly and have the ER providers rule out a stroke than wait it out at home and risk your life. If you get to the ER and it’s not a stroke—celebrate! We’ll be glad you acted quickly and came to the ER to protect your life.

    When you suspect a #Stroke, call 911 immediately. On the #LiveWellHealthy blog, two ER and stroke experts share why you can’t afford to waste any time:

    Click to Tweet

    B.E. F.A.S.T.: How to identify early signs of a stroke.

    The acronym B.E. F.A.S.T. can help you notice early signs of a stroke, whether you’re experiencing them firsthand or witnessing them happening to someone around you.

    If you or someone else shows even one sign of the following stroke symptoms, call 911.

    • Balance: Do you feel a loss of balance or coordination? Are you having trouble staying upright or steady while walking?
    • Eyes: Are you having sudden vision problems or trouble seeing in one or both eyes? Do things look blurry or doubled in either eye?
    • Face: Do you feel numb on one side of your face? Or, is one side of your face drooping?
    • Arm: Does one arm feel numb or weak?
    • Speech: Are you slurring your speech, struggling to find commonly used words, or having other difficulties talking?
    • Time to call 911: If any of these stroke symptoms arise, don’t delay to see if it will go away. Call 911 immediately.

    Other signs of stroke may include sudden symptoms of:

    • Numbness on one side of the body
    • Confusion
    • Severe headache

    What to expect when you get to the ER.

    When you get to the ER via ambulance, a trained medical team will be waiting to diagnose and treat you immediately. At MedStar Montgomery Medical Center, our ER staff will work together to quickly determine whether or not you had or are having a stroke using blood work and diagnostic tests, such as a CAT scan or EKG.

    Once you’ve been diagnosed, we’ll act fast to remove the blockage and re-establish blood flow to the brain. We’ll also investigate what caused the stroke in the first place so we can help establish a plan to prevent it from happening again.

    Symptoms and severity of effects after a stroke vary from person to person. Some people make a full recovery, while others experience devastating losses in function, speech, or cognition. If you need rehabilitation services, we’ll help you get the care you need from a team of neurologists, physical therapists, occupational therapists, and speech therapists who can help you regain independence.

    Get the fast care you need in a safe environment.

    Patient safety has always been our number one priority at MedStar Montgomery Medical Center, and we are taking extra precautions to ensure our ER facility is safe, clean, and secure.

    If you spot early signs of stroke, don’t wait another minute. Call 911 immediately. It just might save your life.

    Want to find out more about MedStar Montgomery’s emergency services?
    Click below.

    Learn More

  • August 25, 2020

    By Stanley J. Pietrak, MD

    “What does it mean if I have a chronically noisy stomach?”

    This is something patients ask me all the time. Yet all of us have that noisy abdomen on occasion. And everyone’s baseline is a bit different: one person’s very noisy abdomen is another person’s normal belly sound.

    In most cases, odd noises from your stomach are simply part of your normal digestive process. For example, if you’re in a fasting state and you’re hungry, something as simple as seeing images of food or smelling food may signal the stomach to start contracting in anticipation of eating.

    Also, your body has a process called the migrating motor complex that occurs every hour or so. It basically sends a shockwave down the digestive tract to keep digested material moving along, and this can likewise create unusual noises.

    What’s making your stomach rumble?

    Typically, it’s food moving through a “choke point” or sphincter. For example, noises you hear may be caused by food traveling from the stomach through the pylorus, the opening into the small intestine. Or they may be caused by contents moving from your small intestine through the valve that separates it from the large intestine (the colon).

    As these muscles contract, they push food products or liquids through your digestive tract, producing small whooshing or gurgling sounds. Most of the time, this is totally normal, provided there are no associated symptoms, like significant abdominal pain, nausea, or vomiting. In those cases, further investigation is warranted.

    Why the abdomen may be bloated or distended

    Several factors can lead to abdominal bloat. For many people, an overproduction of gas can be created by gut microbia breaking down the food we eat. However, bloating and distension could also be caused by an obstruction, or by a region of your digestive tract where contents pass through more slowly and may begin to back up.

    In addition, some people suffer from irritable bowel disease, which is hypothesized to be caused by low levels of inflammation in the digestive tract or by gut hypersensitivity. Here, the amount of gas or distension may spur symptoms of severe pain in the affected person. This type of hypersensitivity is the result of many factors occurring in the peripheral or central nervous system and can also be a factor in the development of a spastic colon, also a possible cause of irritable bowel syndrome (IBS).

    Leaky gut syndrome: real or myth?

    Leaky gut, or increased intestinal permeability, is a digestive condition in which toxins and bacteria may start to seep—or “leak”—through the intestinal wall. Although not historically considered a true condition, there is much conversation in the medical community concerning leaky gut.  Is it just one of several types of inflammatory conditions? Does it occur when intestinal inflammation interrupts normal cell function there? Is it caused by a restricted blood supply, or ischemia? Is it genetic? Is it related to diet?

    One thing we know for certain: diet plays a role in cancers of the gastrointestinal (GI) tract. Certain foods lead to chronic inflammation in various parts of the GI tract and, over time, can lead to cancer formation. We’re also beginning to see that genetics has a more significant impact on the disease process than previously thought. But eating a diet of fresh fruits and vegetables and high fiber and increasing hydration—rather than smoking and consuming processed foods, red meat and alcohol—may help prevent a leaky gut, or at least encourage a less inflamed one.

    Certain foods can lead to chronic inflammation in various parts of the GI tract which, over time, can cause more serious issues, says Dr. Stanley Pietrak. via @MedStarWHC

    Click to Tweet

    When it’s time to seek attention via telehealth

    If you’ve had an upset stomach for three or four days, you may have picked up a bug. But symptoms lasting for weeks or months might signify something more serious. A recurring or long-term issue calls for a deeper look by a gastroenterologist.

    In most cases, it’s something relatively common and treatable, such as a functional GI disorder or IBS. Also, certain medications can provoke GI issues—for example, iron supplements or non-steroidal anti-inflammatory drugs like naproxen and ibuprofen. So be prepared to discuss not just your symptoms but your medications with your specialist.

    At MedStar Washington Hospital Center, you can consult a gastroenterologist quickly and easily via a telehealth visit. In an effective video call, we can tell a lot by how someone looks, their skin color and their movements. The patient’s responses to our questions often enable us to begin determining the severity of their condition.

    Video is also useful to help the patient identify where pain is located. For example, if you indicate the upper right quadrant of your abdomen, we know that’s where the liver, gallbladder and bile ducts are. That could be a starting point to determining next steps in testing or treatment.

    Another example is appendicitis. Initially, the pain is mid-abdomen, near the belly button. As the infection worsens, pain shifts to the lower right quadrant. Understanding how the pain is migrating can often help us deliver a diagnosis quickly.

    When it’s time to seek attention on-site

    For serious symptoms, we recommend you call the Hospital Center and let us determine if you should seek immediate medical attention on-site here. These symptoms might include severe pain that impacts your day, persistent diarrhea or constipation, blood in your stools, vomiting blood, significant weight loss, or marked loss of appetite. All these indicators call for quick attention and a deeper dive into their cause.

    Patients with conditions of the digestive tract often endure them for years before their conditions are accurately identified. At the Hospital Center, our nationally recognized gastroenterologists can diagnose your condition, provide effective treatments and therapies, and help to restore your gut health, which has a positive effect on your overall health as well. Whether your concern is large or small, we are happy to provide a consultation.

    Concerned about stomach pain?

    Trust your gut to our specialists.

    Call 202-644-9526 or  Request an Appointment

  • August 21, 2020

    By Carissa Colangelo, MS, ATC/LAT, PTA, CSCS, MedStar Sports Medicine

    In a world where it seems everything in our normal daily life has changed in a very short period, it can feel like we are out of control. It is important at times like this that we stop and be mindful of creating or maintaining healthy habits with focus on controlling those things that we can. Here are a few tips to consider.

    It’s important in times like these that we be mindful about creating or maintaining healthy habits in our daily lives. Carissa Colangelo, MS, gives tips on how to do this during #COVID19 on the #LiveWellHealthy blog:

    Click to Tweet


    Have a good sleep schedule.

    Maintaining a regular sleep schedule, particularly during times of high stress, is vital to our physical and mental health. Sleep helps boost your immune function, improve focus, control your mood, and increase resistance to stress. If you don’t usually get 7-8 hours of sleep, now is a great time to start making it a habit!

    Maintain healthy eating habits and stay hydrated.

    Having healthy eating habits is crucial, but can be especially difficult when the refrigerator is only a few steps away. Try to stay on a normal eating schedule and avoid unnecessary snacking. You might be someone that is used to constantly being on the go, so now is a great time to slow down, try that new recipe, and get creative. Don’t forget about getting adequate hydration throughout the day.

    Create boundaries for yourself.

    Many of us are in situations where you find your work life and home life have morphed into one. It’s important to create or continue work life balance and create boundaries. This includes both physical and mental boundaries. Your workspace should not be in the same place you sleep. You should try to adhere to clear set start and stop work times (as much as you can control) to allow yourself time to refresh, reboot and separate yourself from your work day.

    Keep a daily routine.

    Your normal daily routine may look completely different from your current one. Regardless, having a schedule and routine is great for creating better focus on tasks and allowing for better management of your time. It also helps maintain self-discipline, and creates self-accountability.


    It’s common to feel isolated during these times. That’s why now more than ever, it’s important to continue communication with friends and family. There are several different virtual options to accomplish this. You can schedule daily or weekly phone calls, or if you have access to a smartphone or computer, use video chat services like FaceTime, Zoom, Google Hangouts, or Skype. Maintaining your normal social infrastructure and staying connected with friends and family is vital to your mental health.

    Take time for positive reflection.

    Honest reflection is important in times like this. When things feel heavy it is important to focus on continued successes, find things that bring you joy and reward yourself. Remember, sometimes success is in the small things in life!

    Manage stress and anxiety.

    It’s important to allow yourself time to recognize these feelings and deal with them in a healthy manner. If you are feeling stressed or have anxiety about what is going on around you, take time for yourself to calm those feelings. Suggestions for managing stress include practicing progressive relaxation techniques, meditation, and deep breathing.

    Stay physically active.

    Physical activity may take some creativity as your usual team sports and gym routines are put on pause. Look to replace them with a body weight or exercise band strengthening program you can do at home. Remember, it is still okay to get outside and get some fresh air during a run, walk, or hike if social distancing is maintained.

    If you already follow these recommendations, keep up the good work and stay focused! But if not, try starting with one of these simple suggestions, and make healthy habits part of your new normal.

    Click below for more information from MedStar Health on COVID-19.

    COVID-19 Information

  • August 20, 2020

    By Ebony R. Hoskins, MD

    If you’re a woman over 50, you’re probably familiar with the signs of menopause and perimenopause. You know that menopause is a natural part of aging—but do you know what’s normal and what might signal a problem in this stage of life? 

    Menopause is associated with a significant shift in estrogen and progesterone levels. Though these hormonal changes are normal, extreme fluctuations can sometimes lead to abnormal symptoms, such as vaginal bleeding.    

    Although most likely not a serious situation, post-menopausal bleeding can sometimes be warning sign of cancer or a pre-cancerous condition. If you have entered menopause, it is important to tell your doctor about any vaginal bleeding. Together, you can choose the best way to identify and treat the cause.  

    Menopause vs. Perimenopause

    Many people associate menopause with hormonal side effects like hot flashes, irregular periods, and mood swings. However, these are actually symptoms of perimenopause: the transition period between a woman’s normal reproductive years and menopause. Some women experience perimenopause for months, others for yearsevery individual is different.  

    During perimenopause, you will likely experience irregular menstrual periods. When you have gone 12 months without menstruating, you have officially entered menopause.  

    Vaginal Bleeding After Menopause

    Once menopause begins, vaginal bleeding—whether occasional spotting or more significant in volume—is considered abnormal 

    To identify the cause of the bleeding, your doctor will likely perform a speculum exam and a pelvic ultrasound. Because most causes of postmenopausal bleeding are identified via tissue, he or she will take a small sample from the affected area.  

    What causes abnormal vaginal bleeding? There are many potential reasons for post-menopausal vaginal bleeding, including these common causes: 

    Endometrial Atrophy: Menopause naturally causes a decrease in estrogen and progesterone levels. This drop leads to a thinning (or atrophy) of the endometrium. While this thinning is normal, it can sometimes become too severe, which results in vaginal bleeding. 

    Bleeding caused by endometrial atrophy is often treated with estrogen. For women already on hormone replacement therapy (HRT)a simple adjustment in dose may prevent further issues. 

    Benign Cervical or Uterine PolypsBenign polyps can grow in the uterus or cervix at any time, but due to the changes in estrogen levels that occur during perimenopause and early menopause, these polyps are more common for women in their 40s and 50s 

    Polyps are usually identified using a surgical procedure called a hysteroscopy D&Ccamera is inserted into the uterus via the cervix, and tissue is removed from the uterine lining. This tissue is then tested in a lab to rule out cancer. If the growths are identified as benign, they can be removed using the same procedure.

    Vaginal bleeding after menopause? @drebonyhoskins recommends consulting with your gynecologist as soon as possible. via @MedStarWHC
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    Atypical Endometrial Hyperplasia: While decreased estrogen and progesterone levels can cause excessive thinning of the endometrium, increased levels of these hormones may cause the endometrium to thicken.  

    When this occurs, abnormal cells can become overcrowded. This results in a pre-cancerous condition called atypical endometrial hyperplasia, which can cause abnormal vaginal bleeding. If left untreated, usually with surgery, this condition can lead to uterine cancer in some women. If you are diagnosed with atypical endometrial hyperplasia, your doctor will refer you to a gynecologic oncologist for treatment. 

    Uterine Cancer: This cancer is also associated with hormonal changes caused by menopauseThe average age at diagnosis is 60, while women under 45 are less likely to be diagnosed with the condition 

    There are two types of uterine cancer: endometrial cancer and uterine sarcoma. Endometrial cancer is far more common, accounting for over 90% of cases, and is closely associated with vaginal bleeding.  

    Women with endometrial cancer often undergo surgery as part of their treatment. For postmenopausal women, this may include a radical hysterectomy (removal of the uterus, cervix, upper vagina, and nearby tissues) and a bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).  

    Although age is a significant risk factor for this cancer, most women over 50 with vaginal bleeding do not have this condition. Still, vaginal bleeding in post-menopausal women should always be taken seriously as a potential symptom 

    Your Gynecologic Care at MedStar Washington Hospital Center

    If you have been diagnosed with endometrial hyperplasia or cancer, the team at MedStar Washington Hospital Center is here for you 

    Our multidisciplinary team includes radiologists, radiation oncologists, and gynecologic oncologists. We work closely with each patient to determine the treatment path that’s best for their specific needs.   

    LISTEN: Dr. Hoskins discusses post-menopausal bleeding in the Medical Intel podcast.

    Complications from bleeding?

    Reach out to our specialists.

    Call 202-644-9526 or  Request an Appointment