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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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  • July 23, 2020

    By Brian Lim Bello, MD

    Even though colorectal cancer is the second leading cause of death from cancer in men and women in this country, some people are still hesitant to get screened. Honestly, though, the screening test is a rare occurrence in a person’s life. For people at average risk, a colonoscopy could be just once every 10 years.

    The preparation is easy. The procedure is painless and safe. It reduces the risk of getting cancer and can save lives. It’s worth the time to get screened and go on with your life.

    Early Screening: The Best Protection

    It’s very important to get screened when you’re supposed to. We shouldn’t delay colon cancer screening because sometimes polyps can grow into cancer, and more advanced cancers are more difficult to treat.

    Also, the higher the stage of the cancer, the lower the survival rate. So, we always want to treat patients before they develop the disease, by identifying it with screening and removing polyps before they turn cancerous.

    @BLBello says we shouldn’t delay colon cancer screening because sometimes polyps can grow into cancer. via @MedStarWHC

    Click to Tweet

    Prep Tips

    There are many types of preparations (preps) out there. Your healthcare provider discusses the prep with you in detail. It’s very important to follow the directions closely. The most common preps start the day before your procedure, where you:

    • Drink laxatives and liquids
    • Avoid solid food

    Most preparations are split up: the first half is done the day before the scheduled colonoscopy and the second half is done later that day or the morning of the procedure. When we do that, the prep is more tolerable and can improve the view in the colon.

    If we perform a colonoscopy and there’s not a good view, sometimes patients have to repeat the procedure. You can save time and money by following the prep diet instructions.

    Best Age for Your First Screening

    Most physicians would agree that, at age 50, people who are at average risk should get screened for colon cancer. People should get colonoscopies earlier if they have a close relative with colorectal polyps or cancer. The American Cancer Society recently recommended that we start screening at age 45.

    If patients have any concerning symptoms like change in bowel habits, blood in stool, abdominal pain, or unexplained weight loss, they should get screened earlier.

    The right age for you to have your first screening test is a discussion best had with your doctor.

    African Americans at Higher Risk

    Most providers recommend that African Americans start their screening earlier, at age 45. It is unclear why African Americans are at higher risk, although it is likely a combination of factors like genetics and access to care.

    How Often Should You Be Screened?

    • For patients at average risk, colonoscopy can be done every 10 years
    • For patients who have a known risk factor like colon polyps or a family member with colon cancer, surveillance is every three to five years
    • For patients who opt to do one of the stool DNA tests or the stool blood tests, sometimes retesting can be done every one to three years

    The Gold Standard

    It’s been proven in many studies that colonoscopies have the highest detection rate for polyps, which are abnormal growths that can develop into cancer. Other tests, such as the stool blood test and stool DNA test, can be good alternatives, especially for patients at average risk. There are pluses and minuses to these alternative tests, but the gold standard is still a colonoscopy. Besides, the procedure is painless and safe, and patients can go back to their usual activities the next day.

    If you’re unsure about the right screening method for you, talk with your doctor. Keep in mind that the best test is a test that’s actually done.

    Early Symptoms

    Sometimes, patients have no symptoms. That’s why screening is critical. It’s important to let your doctor know if you have these symptoms:

    • Rectal bleeding
    • Abdominal pain or discomfort
    • Weight loss
    • Fatigue
    • New changes in your bowel movements
      – Constipation
      – Not emptying the bowels very well
      – Change in the caliber of your stool

    Family History and Lifestyle Risk Factors

    One of the biggest risks of colon cancer is if you have had polyps in the past. If so, you’re at higher risk than average to get colon cancer. If a member of your immediate family has colon cancer or colon polyps, you are also at higher risk.

    There are other genetic conditions that put people at higher risk of colon cancer, such as Lynch syndrome, familial adenomatous polyposis, and inflammatory bowel disease (ulcerative colitis and Crohn’s disease).

    And then there are the lifestyle risks. Although not as strongly linked as the other factors, people should still be aware of these risk factors:

    • Obesity
    • Diabetes
    • Diets high in red meat and low in fiber
    • Smoking

    An Inside Look at Reducing the Impact of Cancer

    Usually during the screening procedure, we’re able to remove polyps completely. If you have colon polyps and they are not removed, they can grow into colon cancer.

    Sometimes we perform a colonoscopy and find cancer. Usually the next step in that situation is a CT scan to ensure there is not spread of disease. Surgery is often performed for colon cancer. The survival rate and prognosis are very good for an early-stage colon cancer, usually 90% or higher five-year survival rate.

    Stages of Colon Cancer

    People should be aware of the stages of colon and rectal cancer:

    • Stage 1 is cancer in the first layers of the wall of the colon
    • Stage 2 is cancer into the deeper layers of the wall of the colon
    • Stage 3 is cancer into the lymph nodes that drain the colon
    • Stage 4 is when there is cancer outside of the colon and rectum

    Treating the Disease

    At MedStar Washington Hospital Center, we specialize in minimally invasive surgery and can treat the most complex conditions. We look at the whole patient and provide a multidisciplinary consensus plan for that person.

    We always present our cancer cases at a tumor board: a multidisciplinary meeting with representation from surgeons, medical oncologists, radiation oncologists, and pathologists, and we discuss the case and together develop a consensus plan. Stage 4 cancers can be very complex. We may either recommend surgery, chemotherapy or radiation, or a combination of these three treatments.

    Advantages of Minimally Invasive Approaches

    We often use minimally invasive approaches for colorectal surgeries. For patients, the benefits of this include:

    • Less pain
    • Smaller incisions
    • Faster recovery
    • Quicker discharge from the hospital
    • Faster return to eating meals
    • Quicker return to usual activities
    • Fewer complications

    Enjoy a Colon-Healthy Lifestyle

    We always recommend eating a heart-healthy, high-fiber diet. A high-fiber diet includes fruits and vegetables. We encourage people not to eat a lot of red meat or processed meat. We recommend quitting smoking and trying to exercise and stay fit.

    Happy Patients, Satisfying Outcomes

    It is very rewarding to be able to find and remove colon polyps before they turn into colon cancer.  Also, we like it when we are able to remove cancers through small incisions and patients are potentially cured of their disease.

    Get screened for colorectal cancer.

    Our specialists are here to help.

    Call 202-644-9526 or  Request an Appointment

  • July 22, 2020

    By Jasmeet Singh Bhogal, MD, MBA

    Whether you’re heading off to vacation or enjoying the long days of summer at home, the warm months are a great opportunity to get outside for some fun. The following summer safety tips can help ensure you spend most of your time outside rather than inside a hospital getting treated for an accidental summer injury.

    Headed for an adventure or enjoying the warm months at home? On the #LiveWellHealthy blog, read Dr. Bhogal’s summer safety tips to ensure you spend your time outside rather than bedside in a hospital:

    Click to Tweet

    Summer safety tips.

    1. Cover your skin in sunscreen and bug spray.

    Whether you’re swimming at the beach or hiking in the mountains, it’s important to protect your skin from harmful ultraviolet (UV) rays from the sun and bug bites. Too much sun exposure can lead to sunburn—or even skin cancer. Likewise, ticks can carry infection-causing bacteria, such as Lyme disease.

    To protect your skin in the sun, use a broad-spectrum sunscreen of 30 SPF or higher. Be sure to reapply frequently, especially if you’re sweating or in the water. Other sun precautions include wearing protective clothing, sunglasses, and a wide-brimmed hat—all of which can minimize your skin’s exposure to the sun.

    Before choosing a location for hiking or camping, do your research to make sure you’re avoiding tick-infected areas. While there, consider wearing long-sleeved shirts and pants and using an insect repellent containing DEET to minimize the likelihood of getting bitten. After your hike, a thorough bath is a great way to get rid of any ticks that may be lingering on your skin but haven’t latched on. You should also carefully check for ticks on your body and remove them promptly.

    2. Drink water…and then drink some more.

    Drinking lots of water is the best way to prevent heat-related illnesses because it helps your body stay hydrated and regulate its temperature. Heat-related illnesses can range from mild heat cramps to heat exhaustion and stroke, all of which can come on quickly after too much time in the sun.

    To avoid dehydration, take breaks when outside and carry water with you wherever you go. Minimize your sun exposure by seeking shade, when possible, and wearing appropriate clothing. If your clothes become soaked in sweat, be sure to change clothing because wet clothes will make it harder for your body to cool down. When hiking or participating in another outdoor activity with a group of people, make sure you know the signs of heat-related illnesses. If someone shows symptoms, everyone should stop the activity because chances are high that others have it, too.

    3. Keep a first aid kit nearby.

    On top of heat exhaustion, summer recreation can bring on unexpected injuries that range from cuts and scrapes on the skin to muscle-related accidents, like sprains and fractures. As an urgent care physician, I’ve seen my fair share of bike accident injuries and fishhooks lodged in fingers from boating trips.

    There are safety precautions you can take to minimize your risk of both of those things from happening. But if an accident occurs, it’s good to be prepared with a stocked first aid kit. A simple first aid kit should include:

    • 1 bottle of saline solution
    • 5 antibiotic ointment packets
    • 5 sterile gauze pads
    • 25 adhesive bandages, 1 roller bandage, 1 adhesive cloth tape
    • 5 antiseptic wipe packets
    • 2 adhesive compress dressings
    • Tweezers
    • 1 oral thermometer
    • 1 instant cold compress

    Learn more about common summer injuries and how to avoid them.

    4. Be proactive about water safety.

    Did you know drowning is one of the top causes of accidental deaths in the country? The good news is that drowning is almost always preventable with the proper precautions.

    Adults should practice water safety for themselves, and kids will follow their lead. If you’re in or around water, avoid using alcohol or illicit drugs, which can impair your judgment. If you’re on a boat, wear a lifejacket.

    Pools, lakes, and other large bodies of water aren’t the only places where kids can drown. Toilets and buckets with even just a few inches of water pose risks to babies and toddlers. That’s why children should always be actively monitored by an adult who is within an arm’s reach anytime they’re near water.

    The best way to minimize drowning accidents is to ensure that kids can’t access water without help. Pools should be protected with a proper fence on all four sides. Families with young children should make sure bathrooms are secured so little ones can’t accidentally access the tub or toilet.

    Learn more about preventing water injuries and drowning.

    5. Exercise caution around grills and campfires.

    From s’mores to barbecue, some of the best summertime food is tastiest when cooked over a fire. But, the dangers associated with grills and campfires aren’t to be taken lightly.

    Adults and children alike are at risk of severe burns caused by getting too close to a hot grill or fire. To minimize the risk of burns and other fire-related injuries, make sure kids are closely supervised at barbecues and around a campfire. And, never leave either unattended.

    In addition, both campfires and grills should be placed in an open area away from anything that could be flammable. All grill equipment should be properly inspected and maintained to prevent any malfunction, including the gas tank. Consider using fireproof mitts and long-handled utensils when cooking food over a fire to avoid skin exposure to flames. Wearing form-fitting clothing with short sleeves can also ensure you don’t accidentally catch your clothes on fire.

    Get the care you need, now.

    It’s important that you don’t delay your medical needs or ignore symptoms that would typically make you seek care. Early detection and treatment improve our ability to provide the most comprehensive and effective care.

    Since the COVID-19 pandemic reached our region, MedStar Health has made innovations to ensure we are still the best and safest place to receive care.

    We have worked hard to make sure we can provide the care you need in the most appropriate and safe setting. MedStar Health Video Visits are still options for a variety of appointment needs, but in some cases, an in-person visit may be best. We’re here to help you get the right care that reflects your needs and comfort level.

    We’re open and prepared to safely offer the same high-quality care you expect from MedStar Health, when you are ready to see us.

    Find care now.
    Click below for more information on our services.

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  • July 21, 2020

    By The MWHC Blog Team

    If you have to go through a painful surgery and lengthy recovery to repair a knee injury, you want to do everything you can to make sure the surgery corrects the problem. The most important thing you can do is pick the right surgeon and the right hospital for the repair.

    That’s what led D.C. resident Daniel Kramer to MedStar Washington Hospital Center’s orthopaedic surgeon Evan Argintar, MD. When Mr. Kramer, 38, injured his knee while playing soccer, he knew he needed medical attention. The first doctor he saw diagnosed a tear in his anterior cruciate ligament (ACL), which stabilizes the knee.

    Torn ACLs are the most common knee injuries, caused by sports that involve sudden stops, jumps, or changes in direction. An estimated 200,000 ACL injuries occur nationwide each year, and about half require surgery.

    Mr. Kramer knew it was important to seek a second opinion. Fortunately, he also knew Dr. Argintar—they had been fraternity brothers and fellow lacrosse players at Tufts University near Boston. Dr. Argintar examined him, confirmed the diagnosis of a torn ACL, and also determined that he had a torn meniscus.

    “I don’t usually operate on friends,” Dr. Argintar says, “but I use a different technique than many other surgeons, and I thought this technique would help him recover faster and lead to a more predictable recovery than conventional surgery, so I made an exception.” The surgery was performed in November 2017.

    Dr. Argintar—along with MedStar Orthopaedic Institute surgeons Wiemi Douoguih, MD; William Postma, MD; and Daniel Hampton, MD—are among the few surgeons nationally who use this special technique to repair torn ACLs and other ligaments in the knee, shoulder, elbow, and ankle.

    When reconstructing the ACL, surgeons use a ligament from the patient’s own body or from a deceased donor to replace the damaged ACL.

    That repair can take up to a year to fully heal and become part of the body. It is most likely to fail at two to three months after surgery, when physical therapy often is most intense.

    Dr. Argintar adds a piece of polyethylene—it looks like a shoestring—alongside the new ligament to strengthen the repair. “It’s an internal brace that acts to stabilize the healing ligament during recovery,” he explains.

    Study Demonstrates the Technique’s Superiority

    Until recently, he had only anecdotal evidence that the internal brace made a difference to recovery. Then he conducted a study of 30 patients who had the internal brace compared to 30 patients who had the traditional surgery, two years after their surgery. Those who had the internal brace reported lower pain scores and faster recovery. A higher percentage returned to their pre-injury level faster, a key indicator of success to Dr. Argintar.

    His findings were published in the Journal of Arthroscopy’s July 2019 issue, the first study that demonstrates the superiority of this technique. “The internal brace is a small change that brings a big improvement,” he says. “More predictable, better outcomes lead to happier patients.”

    Mr. Kramer is very satisfied with his results. He continues to be athletic, and recently completed a 10-mile race. He is on his feet constantly, managing the four restaurants he owns: two Duke’s Grocery, Duke’s Counter and Gogi Yogi Korean Barbecue, all in Northwest D.C.

    “I’m grateful to be able to be all the way back on my feet,” Mr. Kramer concludes. “I’m grateful for the attention I received from Dr. Argintar and his team.”

    Sidelined by a sports injury?

    Connect with our specialists.

    Call 202-644-9526 or Request an Appointment

  • July 17, 2020

    By The MWHC Blog Team

    If you’re invited to have dinner with the family of Reena A. Garg, MD, be ready to talk medicine. Dr. Garg, an attending physician in Ophthalmology at MedStar Washington Hospital Center, is married to a pain management specialist. Her father is an allergist and her brother is an orthopedic surgeon.

    The Ellicott City, Md, native explains that she and her brother were fascinated with theirfather’s work, “and always asked about interesting cases he was handling. Her own career path within medicine was set after being paired with an ophthalmologist during a high-school mentoring program.

    “I was struck by the difference he made in patients’ lives by restoring their vision, and wanted to have that same kind of impact,” she says.

    After graduating from a highly competitive six-year dual degree program at Drexel University School of Medicine, Dr. Gargcompleted her internship at the University of Maryland Medical Center. She then completed anophthalmology residency at Case Western Reserve University School of Medicine, where she served as Chief Resident. A highly intensive subspecialty fellowship in glaucoma at Columbia University brought her to New York CityThere, she also served as assistant professor at the New York Eye and Ear Infirmary of Mount Sinai, a role that included educatingresidents.

    After two years of private practice in Atlanta, Dr. Garg and her husband had started a family and were ready to move closer to her hometownEager to return to teaching, she found the perfect opportunity in the nation’s capital. Along with specializing in glaucoma and cataract treatments at the Washington Eye Institute, Dr. Garg also serves asprogram director for the joint Hospital Center/Georgetown University ophthalmology residency program.

    We’re making such a difference for a community that’s historically underserved,” Dr. Garg says, adding that advancements in treatment therapies can often give even the oldest patients the visual acuity of a 20-year-old. She hopes to make her own contribution through research focusing on screening and early detection of glaucoma. 

    “The sooner we can treat glaucoma, the less risk of a patient losing his or her vision,” she says. “We’re doing things like tele-glaucoma, where we can make a diagnosis remotely, and analyzing treatment outcomes that might allowproceduresto be performed sooner.”

    Helping Residents Transition to Practice

    Having experienced both sides of medical education, Dr. Garg enjoys helping residents navigate the challenging process of developing their clinical and surgical skills while also taking on greater responsibility. 

    “It’s a unique position to have your medical degree and be‘the doctor,’ knowing that you still have a lot to learn,” she says. “We’re here to support them and help them flourish in that role.” 

    Learning works both ways, Dr. Garg adds, as each new class of residents brings new ideas that can help make a good program better, includingways to efficientlytriage emergenciesand improve systems for surgical scheduling.

    Outside of Work

    Dr. Garg has also learned a few things about time management, balancing her responsibilities to patients and residents with family life that includes two sons, ages twoyears and eight weeks. She’s also an avid baker, though that hobby is on hold for awhile, she says, “at least until the younger one starts sleeping more regularly!

    Experiencing vision loss?

    Schedule an appointment with Dr. Garg

    Call 202-644-9526 or Request an Appointment

  • July 16, 2020

    By Ivanesa Pardo, MD

    Some people still think of bariatric surgery solely as weight-loss surgery. But the benefits extend far beyond a leaner body.

    For people with obesity-related diseases, like diabetes, for example, bariatric surgery can immediately eliminate or improve them. Bariatric surgery can dramatically reduce the risk of developing a life-threatening illness, such as cancer or heart disease. It can also extend people’s lifespans.

    Given the safety of today’s surgical techniques and the well-proven long-term health benefits to be gained, I tell patients who are considering it not to wait. Find out all you can. Today, there are a variety of options for you to consider and some additional options on the horizon. At MedStar Washington Hospital Center, these surgeries are done with minimally invasive techniques—meaning laparoscopically or robotically—to speed recovery and maximize safety for patients. And our team offers in-depth support before, during, and after surgery to help ensure that patients experience enduring health benefits.

    Gastric Sleeve (Sleeve Gastrectomy)

    Today, the gastric sleeve procedure is the most popular bariatric surgery technique nationwide and is selected by three out of four patients at MedStar Washington Hospital Center. It involves sectioning off about 80% of the stomach with a stapling device, removing it, and creating a smaller, vertical “sleeve” of stomach shaped like a banana. Not only does this reduce the amount of food you can ingest at any given time, it also decreases the level of hunger-signaling hormone that the stomach sends to the brain—so you have less of an appetite, amongst other metabolic changes. Patients often choose this surgical option, as it offers some metabolic improvements and sustained weight loss via a procedure that changes only the stomach.

    Gastric Bypass

    This second most popular technique, also called Roux-en-Y (ROO-en-why) gastric bypass, involves changing both the stomach and the intestines. Those additional changes to the body can offer extra health benefits. With this technique, we use a stapling device to section off a small egg-size pouch of stomach; the rest of the stomach remains. Then, part of the small intestine is rerouted and connected to the stomach pouch. As a result, the food you eat goes into the small stomach pouch, then directly into the connected lower section of small intestine, bypassing most of your stomach and the top portion of the small intestine. This works like the gastric sleeve to reduce the amount of food you eat and the release of hormones that send hunger signals to your brain. In addition, the rerouted intestine limits the absorption of food nutrients and calories. It also causes an even more drastic metabolic impact on your body.

    Gastric bypass tends to be a little better than the sleeve procedure for creating more weight loss and resolving more weight-related health issues like diabetes, high blood pressure, and sleep apnea. It’s also a very good option for people with severe acid reflux as this procedure improves that condition. These healthy changes also tend to persist longer-term because the absorption in the intestine is changed. But on the flip side, patients have a slightly higher risk of malnutrition long-term. Typically, this can be managed with vitamins and supplements.

    Today, this is a relatively safe procedure. I tell patients the risks of this versus the gastric sleeve after surgery are about the same, and the potential for greater health benefits may be worth considering.

    Biliopancreatic Diversion with Duodenal Switch

    Like gastric bypass, this technique involves making the stomach smaller and rerouting the intestine to reduce food absorption. The difference is that the reduced-size stomach is more similar to the gastric sleeve; in other words, it is larger than the gastric bypass pouch and patients are able to eat a little more. In addition, much more of the intestine is bypassed, starting at the duodenum (hence the name). So absorption of food, especially fat, is reduced even further, by more than 70%. While the weight loss is highest and most long-lasting, and the metabolic benefits are more profound with duodenal switch, the long-term risk for malnutrition is especially high. Close monitoring for vitamin, mineral, and protein deficiencies is a must.

    Gastric Band

    Also known as the adjustable Lap Band, this was the most popular bariatric surgery option more than a decade ago. It involves placing a flexible silicone band around the top part of the stomach and tightening it to create a narrowed passageway. It’s meant to limit how much food you can eat at any given time.

    While it’s the least invasive approach, and completely reversible, it also doesn’t work very well for many people and has decreased in popularity. Patients tend to lose weight much more slowly and often regain it. And the gastric band doesn’t offer the metabolic health benefits that the other surgical options do. Also, more than 30% of people develop complications from the gastric band, such as heartburn or swallowing issues. While this option is still available, it’s not typically recommended, as newer techniques offer greater, more reliable health benefits.

    Other Options on the Horizon

    Several new alternatives are currently being evaluated. These include some endoscopic bariatric therapies, performed through a flexible tube inserted through a patient’s mouth rather than via abdominal incisions like traditional bariatric surgeries. Currently, the most well-known approach is the intragastric balloon, by which a fluid- or gas-filled balloon is placed in the stomach.  It makes you feel full faster and slows down stomach emptying so you may feel full longer.

    Some centers also offer endoscopic sleeve gastroplasty, which is similar in some ways to a gastric sleeve surgery. Part of the stomach is closed off with sutures, which are placed using the endoscopic tube inserted through the patient’s mouth and down into the stomach.

    Although there are no long-term data on their effects, these less-invasive approaches may be worthwhile for patients who are not safe candidates for traditional surgery.

    At this time, severely obese patients have excellent options to consider.

    Bariatric surgery isn’t just about losing weight. Dr. Ivanesa Pardo discusses the additional health benefits of this procedure. via @MedStarWHC
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    How To Choose the Option That’s Right for You

    If you’re considering surgery, sign up for an information session. These free sessions are typically offered online or in person, and they provide an excellent overview of the pros and cons of each surgical option the medical center offers. It’s a great opportunity to learn more and ask questions. From there, you can make an appointment with a bariatric surgeon to further discuss your options.

    Find an information session here.

    You should also choose an experienced hospital and medical team. At MedStar Washington Hospital Center, our program has been recognized as an American Society for Metabolic and Bariatric Surgery Center of Excellence and is fully accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

    Our board-certified and fellowship-trained surgeons utilize the most current minimally invasive techniques, which can offer shorter hospital stays, less pain, and faster recovery. In addition, our surgeons are supported by a complete care team, including a gastroenterologist, nurse coordinator, psychologist, dietitian, and exercise physiologist to help ensure your needs are met and you are set up for long-term success. As a team, we also collaborate with your primary care physician. We typically start by evaluating your medical and weight history, diet and exercise habits, and the stomach itself. Then, we explain your options in detail and share the latest research findings to help you decide what’s right for you. Each patient ultimately chooses what they’re comfortable with, and we support them every step of the way.

    As I mentioned earlier, I urge people who’ve thought about bariatric surgery not to put off learning more about it. Don’t wait until obesity makes you sick if you aren’t already. In many cases, the earlier this surgery is done, the better the outcomes in terms of your health, your productivity, and your overall length and quality of life in the years ahead.

    It’s never too early for that.

    Explore your options.

    Connect with our bariatric surgery team.

    Call 202-644-9526 or  Request an Appointment

  • July 15, 2020

    By Dr. Dionne Hawkins, MPT, Clinic Director at MedStar Health Physical Therapy at Leisure World

    Social restrictions caused by COVID-19 continue to affect us all, and the senior community is no exception. With a higher risk for infection, our senior population is taking extra precautions to stay home, self isolate, and avoid exposure to the virus.

    Keeping your mind and body active is so important while you’re staying home, and we’re here to help with these simple tips and exercises.

    With a higher risk for infection, our senior population is taking extra precautions to stay home and avoid exposure to #COVID19. Read the #LiveWellHealthy blog for tips on how seniors can keep their mind and body active while at home:

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    General tips for staying active.

    • Get up and move at least once every 30 to 60 minutes. Set a timer if you need to!
    • Drink plenty of water to stay well hydrated.
    • Try to do a little exercise every day. A total of at least 30 minutes a day is a good goal.
    • Stretching is just as important as strengthening. Do both!

    6 strengthening exercises you can do at home.

    Keeping your body active is not only beneficial for your physical and overall health, but it is also a great way to occupy your time if you’re feeling bored or restless in the house. These exercises are simple, and only require three things so they can easily be done at home.

    Here’s what you’ll need:

    • Sturdy chair
    • Clear kitchen counter space
    • Clear wall space

    Each exercise should be done at least 10 times.

    1. Chair sit-stand.

    Purpose: strengthens hip and thigh muscles.

    • Scoot to the edge of a sturdy chair (kitchen or dining room chair).
    • Make sure feet are flat on the floor and spread hip-width apart.
    • Lean forward (“get your nose over your toes”).
    • Squeeze buttocks to help you stand.

    2. Wall push-ups.

    Purpose: strengthens chest and arms.

    • Stand facing a clear wall space.
    • Place your palms flat against the wall.
    • Bend your elbows to bring your face as close to the wall as you can without losing your balance.
    • Straighten your elbows to return to standing position.

    3. Standing marches.

    Purpose: strengthens hips and is good for general hip mobility.

    • Hold on to a sturdy chair or the kitchen counter.
    • Raise your knee up towards your chest, then put your foot back down.
    • Repeat, raising the opposite knee.
    • Continue to march in place, lifting the knee as high as you can.

    4. Standing heel-toe raises.

    Purpose: strengthens the calf muscles and helps reduce leg swelling.

    • Hold on to a sturdy chair or the kitchen counter.
    • Raise your heels off the floor as high as you can, standing on tiptoes and then return to starting position.
    • Now lift your toes off the floor and then return to starting position.

    5. Standing hamstring curls.

    Purpose: strengthens thigh muscles and is good for general knee mobility.

    • Hold on to a sturdy chair or the kitchen counter.
    • Lift your foot off the ground backwards, towards your buttocks.
    • Alternate and lift the other foot off the ground towards your buttocks.

    6. Bicep curls.

    Purpose: strengthens arms.

    • Sit in sturdy chair.
    • With a small weight in the hand, bend your elbow
      to raise your hand towards your face.
    • Relax and straighten your elbow to bring the weight back down.

    Tip: If you don’t have dumbbells, you can use a bag of rice or a small can of soup for a weight.

    5 stretching exercises.

    Stretching your muscles is also key when it comes to your physical health. If you are doing strengthening exercises, you should be making sure to stretch as well. And even if you aren’t, stretching is still beneficial to your health, and can be a great way to start your morning. Here are a few you can start out with.

    All stretches should be held for no less than 30 seconds and done twice. Remember, you should only feel a stretch in the muscle, not pain. Ease up if you feel any pain.

    1. Calf stretch.

    • Stand against a clear wall space.
    • Place your palms flat against the wall.
    • Place one foot in front of the other.
    • Lean against the wall, bending the front knee, but keeping the back knee straight.
    • Keep heels on the ground.
    • Stretch should be felt in the back of your leg.
    • Switch legs and repeat.

    2. Hamstring stretch.

    • Sit on the edge of a sturdy chair.
    • Straighten one leg out in front of you, keep the other knee bent.
    • Lean forward from your hips; keep your chest up tall.
    • Stretch should be felt in the back of your thigh.
    • Switch legs and repeat.

    3. Low back stretch #1.

    • Sit in a sturdy chair.
    • Slowly bend forward, reaching to the floor between your knees.
    • Slowly return from bent position to sitting upright.
    • Stretch should be felt across both sides of the low back.

    4. Low back stretch #2.

    • Sit in a sturdy chair.
    • Raise one arm over your head.
    • Bend to the opposite side of the arm that’s raised.
    • Stretch should be felt on one side of your low back.
    • Switch arms and repeat.

    5. Neck stretch.

    • Sit in a sturdy chair.
    • Tip your head to the side, leaning your ear over your shoulder.
    • Stretch should be felt along the side of your neck.

    Exercises for your mind.

    Keeping up with your mental health is just as important as keeping up with your physical health. Being stuck at home with social restrictions due to COVID-19 can be tough on your mental health, but there are plenty of ways to help it. Here are a few activities that can help occupy your time and keep your mind active.

    Go for a walk.

    It’s ok to leave the house and walk outside. Sunshine and fresh air are necessary for general health, boosting your mood, and overall well-being. Be sure to maintain proper physical distancing (six feet) and wear a mask. Make a date to meet your friend or neighbor and take a walk at the same time from opposite sides of the street.

    Stay connected with family and friends.

    Schedule a regular weekly or daily call. This will give you something positive to look forward to and stay connected. If you live nearby, invite them for a visit. Sit on the porch or in front of your house, while they visit from the driveway or sidewalk. If you live further away and everyone has access to a computer or smartphone, schedule virtual meetups using platforms like Facetime, Skype, Google Hangouts, or Zoom.

    Keep your mind sharp.

    Puzzles are a great way to keep your mind active and keep you occupied during the day. If you want to include your family and friends in on the fun, you can even do a puzzle exchange with them. Crossword puzzles and word searches are also great for your mind. There are plenty of word and number puzzles available on your smartphone or computer, as well as in magazines and newspapers. You can also try reading a new book or listening to an audio book instead of watching television.

    Listen to your body.

    Always pay attention to how your body is feeling when doing any sort of physical activity. Be mindful of any aches and pains you may feel, and remember to ease up or stop if you feel any pain. If you experience soreness or pain lasting longer than a few days after activity, you may benefit from physical therapy. Ask your physician if physical therapy is right for you.

    Want to learn more about physical therapy services with MedStar Health?
    Click the button below.

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