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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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  • May 21, 2020

    By Min Deng, MD

    Did you know that skin cancer is the most common type of cancer? And, even more concerning, it often goes unrecognized.

    Understanding signs and symptoms can help you determine whether that spot on your skin is normal—or something potentially more serious.

    What Are the Three Main Types of Skin Cancer?

    #1: Basal Cell Carcinoma

    Basal cell carcinoma is the most common. With an estimated 4.3 million cases diagnosed in the U.S. each year, this condition affects more people than lung cancer, breast cancer, and prostate cancer combined.

    Basal cell carcinoma is caused by an abnormal growth of basal cells, which originate from the base of the topmost layer of skin. This type of cancer appears most often on parts of the body frequently exposed to the sun, like the head and neck. It is often mistaken for a "pimple," except this "pimple" doesn't go away and will often bleed with minimal trauma. Surgery is the most common treatment. The prognosis for basal cell carcinoma is generally very positive when caught early, with most patients making a full recovery after treatment.

    #2: Squamous Cell Carcinoma

    Squamous call carcinoma is the second most common type, with an estimated 1 million cases diagnosed in the U.S. each year.

    Like basal cells, squamous cells originate from the epidermis, the top layer of the skin. Damage to these cells, caused by cumulative ultraviolet (UV) exposure, can lead to squamous cell carcinoma. These can look like red crusty lesions. While the majority of squamous cell carcinomas have a good prognosis, this condition should be caught early to avoid deeper invasion and spread.

    #3: Melanoma

    Melanoma, although less prevalent than basal cell carcinoma and squamous cell carcinoma, is typically more aggressive. In 2020, approximately 196,000 cases of melanoma are expected to be diagnosed in the U.S. Unlike non-melanoma skin cancers, melanoma can occur anywhere on the body, including areas not typically exposed to the sun. This type of cancer can spread beyond the skin to other parts of the body and therefore early detection and treatment is key to a good prognosis.

    Although melanomas can often be fully treated with surgery, they may require radiation, chemotherapy, and other drug treatments if they have spread beyond the skin. The prognosis for this condition depends on several factors, including the thickness of the melanoma and the extent of spread. The five-year survival rate for all people diagnosed with melanoma is 92%.

    LISTEN: Dr. Deng discusses skin cancer in the Medical Intel podcast.

    What Causes Skin Cancer?

    There are several significant risk factors, including:

    Sun Exposure: Sun exposure is cumulative. Each time a person gets a sunburn, their skin is damaged on a genetic level. The damage increases over the individual's lifetime and may eventually cause this condition.

    Use of Tanning Beds: Because indoor tanning beds emit more UV radiation than the sun, their use is directly tied to increased risk for this type of cancer.

    Genetics: Some people are more genetically predisposed to it than others. People with fair skin, and especially individuals with red hair, are at greater risk of developing both non-melanoma and melanoma skin cancers. Individuals with a family history also have a higher chance of developing one of these conditions.

    The A-B-C-D-Es of Skin Self-Exams

    Conducting regular skin self-exams can help you detect skin cancer early. I recommend checking your skin for any bleeding or changing lesions no more than once a month. If you check too frequently, you run the risk of not noticing that a spot has changed.

    When it comes to basal or squamous cell carcinoma, keep an eye out for any spot on your skin that keeps recurring. These spots can bleed, often with minimal rubbing, but don't usually hurt.

    Conducting regular skin self-exams can help you detect skin cancer early. bit.ly/2ZmxkYd via @MedStarWHC
    Click to Tweet

    When checking your skin for signs of melanoma, remember your A-B-Cs...and don't forget D and E! If you notice one or more of these indicators, schedule an appointment with a dermatologist:

    • Asymmetry: Regular moles are usually symmetric, while melanomas often lack symmetry.
    • Borders: Regular moles typically have smooth, round borders. If you have any spots with jagged or irregular edges, have them checked by a dermatologist.
    • Color: Regular moles tend to have one or two brown shades at most. A mole with multiple colors, such as grey, black, white, or pink, could be a melanoma.
    • Diameter: Any mole with a diameter larger than about 5 mm (around the size of a pencil eraser) should be checked by a doctor. However, keep in mind that melanomas can start out much smaller than this. Don’t wait for an irregular mole to grow larger before having it examined by a dermatologist.
    • Evolution: This is the most important sign! Any mole that is changing in appearance should be examined, even if you haven’t noticed any of the other four signs above.

    Protect Yourself

    Although skin cancer is the most common type of cancer, it’s also the most preventable. The best step you can take to reduce your risk is to protect yourself from the sun.

    When you spend time outside, be sure to wear sunscreen. The American Academy of Dermatology recommends SPF 30 sunscreen or higher. However, people often don’t apply enough sunscreen, so I recommend using SPF 50 to ensure your skin is protected. Try to choose a broad-spectrum sunscreen with zinc oxide and titanium dioxide for the best protection. And don’t forget to reapply your sunscreen every two hours, or every hour if you’re swimming.

    It’s also important to minimize your time spent in direct sunlight. Of course, there’s no need to stay indoors all the time, but be aware of the time you’re spending in the sun—particularly between 10 a.m. and 2 p.m. Wear protective clothing, including a hat, and stay in the shade as much as possible.

    If you notice any changes in your skin, schedule an appointment with a dermatologist. At MedStar Health, our team of board-certified dermatologists can conduct a head-to-toe skin check to help you examine any areas of concern.

    Spot on your skin?

    Our dermatologists can help.

    Call 202-644-9526 or Request an Appointment

  • May 20, 2020

    By MedStar Health

    In the U.S., skin cancer is by far the most commonly diagnosed cancer, according to the American Cancer Society. Since most skin cancers develop as a result of exposure to harmful ultraviolet (UV) rays, taking steps to protect your skin in the sun can help you reduce your risk of skin cancer.

    #SkinCancer is the most commonly diagnosed cancer in the United States. Minimize your risk by protecting your skin in the sun with these 7 tips from family medicine physician Dr. Bhogal: https://bit.ly/2XebRy5 #LiveWellHealthy.

    Click to Tweet

    It’s important to use sun protection while enjoying the benefits of getting outside.

    Our skin makes vitamin D naturally when it’s exposed to the sun, which can positively impact our body’s mental and physical function. In fact, vitamin D can help to boost your immune system and improve your mood by increasing serotonin levels in the body. Still, there are many dangers to the sun, which is why most doctors recommend getting vitamin D from what you eat or supplements.

    While there are many benefits to getting outside, the sun’s UV rays can be harmful if we don’t take precautions to protect our skin in the sun. The sun gives off two different types of UV rays, both of which can be dangerous:

    • UVA rays are responsible for sunburn, hyperpigmentation, and skin cancer.
    • UVB rays can contribute to skin aging and skin cancer.

    Although both types of UV rays can negatively affect the skin, UVB rays are more likely to cause skin cancer, including melanoma.

    Factors affecting UV exposure

    It’s important to protect your skin from both types of UV rays because neither one is safe. And, your environment can impact how strong they are. The following factors can impact how much your skin is exposed to UV rays:

    • The time of day: 10 am to 4 pm is when UV rays are strongest.
    • Distance from equator: The closer you are to the equator, the stronger the UV rays are.
    • Elevation: Higher elevation means more exposure.
    • Reflection off surfaces: Sand, snow, and water may reflect sunlight, increasing UV ray exposure.
    • Length of time: The longer your skin is exposed, the greater your risk.

    By taking the right steps to protect your skin in the sun, you can reduce your risk of getting skin cancer—and prevent premature skin aging, like wrinkles, dark spots, and leathery skin.

    How to protect your skin in the sun.

    Even if it’s not sunny, your skin is still exposed to harmful UV rays any time you’re outside. Here are seven simple ways you can limit your UV exposure and protect yourself in the sun.

    1. Choose the right type of sunscreen.

    Sunscreen is an effective way to minimize your risk of skin cancer and signs of early skin aging caused by the sun. Except for babies under the age of six months, everyone should wear sunscreen anytime they’re outdoors. When picking a sunscreen, it’s important to choose the right kind. The American Academy of Dermatology also recommends selecting a sunscreen that is:

    • A broad-spectrum option, offering protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
    • Sun protection factor (SPF) of 30 or higher.
    • “Water-resistant”.

    Keep in mind that while sunscreen can be “water-resistant”, it is not waterproof or sweatproof. As a result, it’s important to reapply frequently, especially if you are swimming or sweating.

    2. Apply and reapply sunscreen regularly.

    The way you apply sunscreen impacts how effectively it protects your skin. The best way to apply sunscreen is to lather it on 15 to 30 minutes before you expose your skin to the sun. That’s about how much time it takes for your skin to absorb it. After you apply, wait 10 to 20 minutes to avoid accidentally rubbing off the sunscreen. You can reduce your risk of sunburn by reapplying every two hours—or sooner if you're swimming.

    How much sunscreen do I need to apply?

    Following the "teaspoon rule" is a great way to ensure you’ve used enough sunscreen to protect uncovered skin. The “teaspoon rule” suggests applying a teaspoon-sized amount of sunscreen according to these guidelines:

    • One teaspoon on your face and neck.
    • One teaspoon on each arm.
    • Two teaspoons on your front torso.
    • Two teaspoons on your back.
    • Two teaspoons on each leg.

    3. Wear protective clothing.

    Covering up in clothing is a great way to minimize your exposure to UV rays, but different types of clothing offer varying levels of protection. The following types of clothing offer the most protection:

    • Thicker fabrics (e.g. denim) compared to thin fabrics (e.g. cotton)
    • Darker colors
    • Dry fabrics

    Many clothing brands also make comfortable, lightweight tops and bottoms that can offer protection from the sun’s UV rays. Look for garments that are labeled with a UV protection factor (UPF). A higher number means more protection from UV rays.

    4. Cover your head with a wide-brimmed hat.

    Hats with brims at least three inches in diameter are an effective way to limit your face’s exposure to UV rays. Baseball caps or other hats with a narrower brim may not protect all of the areas on your face that may be exposed to the sun, like your ears, nose, and neck.

    5. Protect your eyes with sunglasses.

    Sunglasses are important for protecting your eyes and the skin around your eyes from the sun. It's hard to judge how well a pair of sunglasses can protect you from the sun just by looking at the color of the lenses. Instead, look for sunglasses that say they block 99% or 100% of UVA and UVB rays.

    6. Avoid the sun during peak hours.

    The sun’s UV rays are strongest between the hours of 10 am and 4 pm. Try to stay in the shade if you must be outside during that time of day—or avoid it altogether, if you can.

    7. Seek shade wherever you can.

    Staying under shade can be a great way to get outside while limiting your UV exposure. Whether you seek shelter under a tree or set up a tent on the beach, it’s important to find shade, especially during the sun’s strongest hours. This is especially true for babies who should avoid any unnecessary sun exposure. Babies younger than six months should always be protected from the sun with strollers, hats, and umbrellas.

    What to do if you get a bad sunburn.

    Most cases of sunburn are mild to moderate, which can be uncomfortable. Ibuprofen, aloe vera gel, or cold compresses can help to minimize swelling and pain while it heals. If you have any blisters, avoid picking them open. If they do rupture, clean them with soap and water and cover with a wet dressing to avoid any infection.

    In more severe cases that result in vomiting, fever, or disorientation, you may need to seek medical attention from an urgent care center.

    You don’t have to stay indoors altogether, but being cautious can help you protect your skin and minimize your risk of skin cancer. Limit unnecessary sun exposure by correctly applying sunscreen, covering up with clothes, hats, and sunglasses, and staying in the shade.

    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 the buttons below for more information on our services.

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  • May 19, 2020

    By Hayder Hashim, MD

    Feeling stress or strain on your heart these days? Here’s a sobering fact: Anxiety about the novel coronavirus is causing people in our community to avoid seeking medical help for their heart issues.

    So-called “COVID phobia” is delaying treatment and causing needless suffering. Since the pandemic began, the number of patients going to emergency rooms for heart attack and stroke has plummeted.

    If you have chest discomfort or other warning signs of a heart attack, don’t delay! Come to the ER. At MedStar Washington Hospital Center, we’re well equipped both to safeguard you from the virus and to give you cardiac care that could save your life or protect you from long-term injury.

    Coronavirus vs. Chronic Medical Conditions

    During the pandemic, as always, it’s critical not to dismiss warning signs of a potential medical issue—like the crushing pain of a heart attack. Your condition may become even worse if you don’t get appropriate medical care when needed or neglect your planned therapy, preventative treatment, or screenings.

    At the Hospital Center, we are, of course, trying to prevent patients of all types from exposure to this new virus. But at the same time, our mission is to avoid a potential increase in deaths from other serious or chronic conditions.

    Feeling the warning signs of a #heartattack? Don’t avoid the hospital because you fear #COVID19. Head for the ER, says @HashimHayder bit.ly/3bIZqzm @MedStarWHC #COVIDPhobia
    Click to Tweet

    Listen to Your Body’s Warning Signs

    My patients often describe their heart attack pain as an elephant sitting on their chest. Pain might also travel down the left arm, or up to your neck or jaw. Other symptoms include:

    • Shortness of breath
    • A sense of impending doom
    • Vomiting
    • Sweating profusely even if not exerting physically

    Women may experience different and more vague symptoms:

    • Pain in the upper part of the abdomen right below the ribs
    • Indigestion

    And studies show that the novel coronavirus itself can impact the heart. It can imitate certain heart attack symptoms, such as difficulty breathing, shortness of breath, abnormal EKGs, and severe inflammation of the heart muscle (myocarditis) among others.

    Only a proper medical examination can determine whether you’re experiencing a heart attack, virus symptoms, or some other issue.

    When the Pain Goes Away

    For some patients, that characteristic crushing pain may very well subside. But this doesn’t mean you tackled death and won. This is just the body saying, “I tried everything I could to alarm you. I gave you pain, nausea, shortness of breath. I give up.”

    The damage remains, and most likely you will eventually suffer from a chronic, hard-to-treat illness. Ignoring symptoms of heart disease can lead to death of the heart muscle.

    Complications of Delayed Treatment

    Traditionally, our patients arrive from Maryland, Washington, D.C., and Virginia by ambulance or helicopter. The emergency medical service crew sends the EKG ahead, so we’re ready to work on patients as soon as they arrive. Because we can treat them within 50–60 minutes of onset, many heart attack victims are able to sit up shortly after treatment. They text, they call their family—even though they just suffered a heart attack!

    Unfortunately, these days many heart attack victims are staying home, wary of COVID-19. They opt to treat themselves with aspirin and wait for the pain to go away. After 24 hours, they don't feel pain anymore, but they will grow sicker over time.

    For example, before this new virus, we saw maybe one or two cases a year of ventricular septal defect (VSD), a hole between the chambers of the heart typically caused by delayed treatment. But in the last three weeks alone, we’ve already treated three patients with VSD.

    How Sick Is Too Sick?

    Some patients who are chronically ill with heart disease also try to stay home and self-treat. Unfortunately, without regular medical attention, their illness can progress to the point where it's too late to help them.

    Here’s an analogy: When 80% of your house is on fire, the house is already beyond help, even though 50 fire trucks might arrive to put out the flames. The minute you see the fire is the time to summon help, and extinguish it while damage is still minimal.

    In the same way, ignoring warning signs because of virus phobia can eventually make a weakened heart muscle difficult to salvage. Even if we can help you, you could be permanently injured or ill for the rest of your life. That’s what we want to prevent.

    Time is of the essence. As we cardiologists say, time is muscle. Make the phone call. Come to the ER if you have symptoms. Don’t wait for symptoms to improve—call 911 or have a telehealth visit with your doctor. Describe what you’re experiencing and get their advice.

    Equipped to Protect You

    Throughout MedStar Washington Hospital Center, we have developed new pathways and protocols to create a safe environment for you during this pandemic.

    We have the right personal protective equipment to keep you safe while we treat you. The minute you enter the Hospital Center, you will wear a mask. If you don't have one, we'll give you one.

    We take your temperature. If no fever is recorded, you will be guided to admissions or registration. Seating in our waiting areas is separated by six feet or more. There is enough staff to receive you and work to treat you quickly.

    If you’re going to the cardiac catheterization lab, a concierge associate will escort you. They’ll operate the elevator and help you arrive at the lab without contacting quarantined areas or hallways.

    As we adapt to life with the coronavirus, I am conducting more telehealth visits. I sit with my patients virtually, face-to-face, review their symptoms, discuss their medications, review their chart, and discuss their treatment plan. They don’t have to worry about the new virus. And if we determine they do need medical attention right away, they know what to expect when they get here.

    Avoid the Virus…But Take Care of Yourself!

    If you’re nervous about coming in to the hospital, but have some health concerns, speak with a medical professional. Schedule a telehealth visit. Mammograms, colonoscopies, and screening for cancer are still essential to detect life-threatening conditions. Maintaining your health to avoid future medical issues is as essential as getting your groceries or prescription medications.

    COVID-19 is just one illness that we face today. But other illnesses still require our attention. It’s worth repeating: if you think you’re having a heart attack, stroke, or other medical emergency, call 911 and come to the ER. For less urgent matters, schedule an appointment with your doctor.

    Let us give you the treatment you need when you need it.

    Your Heart Deserves Expert Care.

    Our specialists are here to help.

    Call 202-644-9526 or Request an Appointment

  • May 15, 2020

    By MedStar Health

    Experiencing bladder leakage is common, and it can negatively impact quality of life. Thankfully, there are many treatment options available.

    Urinary incontinence is the involuntary loss of urine. It affects about one in three women at some point in their lives, and becomes more likely with age. The three main types of urinary incontinence for women are:

    • Urge incontinence (overactive bladder): When you experience a loss of urine with a sudden strong desire to urinate immediately.
    • Stress incontinence: When you experience a loss of urine while performing activities that increase pressure in your abdomen, such as laughing, sneezing, or exercising.
    • Mixed incontinence: Leakage that includes symptoms of both urge and stress incontinence.

    In most cases, urinary incontinence can be treated successfully. I can’t tell you how many times I’ve heard patients say, “I wish I would have seen a doctor sooner,” following their treatment. Read on to learn about common treatment options.

    Urinary incontinence treatments.

    There are many different treatments for urinary incontinence. This gives you the freedom to work with your doctor to determine the best option for you. In most cases, we start with conservative measures like lifestyle changes and bladder training. If they don’t alleviate your symptoms, we move on to other options, such as medications, office procedures, or surgical procedures.

    First-Line Treatments

    First-line treatment for all types of urinary incontinence typically involves:

    • Physical therapy.Certain exercises strengthen the muscles in and around your pelvic floor, which can help prevent leakage and calm down your urge to use the bathroom.
    • Avoiding certain foods and drinks. Beverages high in caffeine, such as coffee and energy drinks, as well as acidic and spicy foods, are known to irritate the bladder and contribute to urinary incontinence.
    • Using a pessary. You sometimes can help prevent leakage by using a pessary, a vaginal support device made of silicone.
    #PhysicalTherapy can treat urinary incontinence by strengthening muscles in and around your pelvic floor. Learn about other common treatment options, via @MedStarHealth: https://bit.ly/2zLLzen.

    Click to Tweet


    Make sure to speak to your doctor if you’re interested in any of these first-line treatments. To use a pessary, you’ll need to visit your doctor for a fitting and to learn how to insert, remove, and clean it. Your doctor can teach you physical therapy exercises or refer you to an expert physical therapist.

    Medications

    Daily medications are often a great treatment option for our patients, especially those with urge incontinence. Some of the most common medications include:

    • Anticholinergics. These help relax your bladder and reduce your leakage and urge to use the bathroom.
    • Mirabegron (Myrbetriq). This helps relax your bladder, increase the amount of urine your bladder can hold, and increase the amount of urine you’re able to urinate at one time.

    Office and surgical procedures.

    Surgical and nonsurgical procedures are common urinary incontinence treatments, especially for women who don’t wish to take medication. They are also the next options for women who haven’t seen the results they want with medication therapy.

    Office Procedures

    Common nonsurgical treatments we perform for people with urge incontinence include bladder Botox injections and nerve stimulation. Bladder Botox injections block the ability of some nerves to communicate with the bladder, reducing your leakage. Nerve stimulation is similar to acupuncture. It involves your doctor inserting thin needles into the skin to stimulate specific body points to reduce your urge incontinence.

    For stress incontinence, a urethral bulking agent—which a doctor injects around the walls of your urethra using a thin needle and camera— is a great way to reduce or eliminate stress incontinence. In fact, I had one patient in her 70s who had stress incontinence that was affecting her ability to travel, as she constantly had to carry around pads to deal with her leakage. After receiving a urethral bulking agent, she reported that she no longer needs pads and can finally enjoy her vacations again.

    Surgical Procedures

    Urethral support surgeries are more definitive treatments for urinary incontinence. Urethral sling surgery, for example, is highly effective in treating stress incontinence. A sling acts as a hammock under the urethra to support it, and can be made of tissue from your body or a synthetic material. Make sure to speak to your doctor to learn more about surgeries that may treat your urinary incontinence.

    Don’t delay care.

    Urinary incontinence is a common condition, and you don’t have to manage it alone. If you’re experiencing symptoms of urinary incontinence, please reach out for help right away. If you have concerns about potential exposure to coronavirus (COVID-19) and are staying home, you can access 24/7 on-demand video access through MedStar eVisit.

    Want to learn more about MedStar Health eVisit? Click below for more information.

    Learn More

  • May 14, 2020

    By MedStar Health

    In this country and around the world, we are seeing a variety of abnormal skin conditions in patients infected with Coronavirus Disease 2019 (COVID-19). It’s too early to determine if these skin issues are hallmarks of the virus or simply a result of the body’s immune response in fighting off the infection. Medications used to treat the disease may also play a role.

    In the U.S., up to 20 percent of those infected have experienced some type of skin issue, much higher than the rate reported in China and Europe. We don’t yet know if the U.S. rate is truly higher or simply the result of better monitoring and reporting.

    The good news: most of the conditions are not serious and will go away as the infection clears. Some, however, may require testing and monitoring.

    Much of what dermatologists are seeing is anecdotal, meaning not yet proven or tested in a rigorous, scientific way. Since the pathogen is so new, we do not yet have enough data. But we are collecting it so we will be better able to quantify trends and causes in the future.

    Here’s what we know about certain skin conditions so far:

    COVID-19 may be causing some unique skin problems. Dr. Petronic-Rosic explains what is known so far. https://bit.ly/2zw6KRO via @MedStarWHC
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    COVID Toes

    COVID toes present as small red, purple or bluish patches on the toes. Occasionally, a blister may form, which can break and weep. It may be mildly uncomfortable and prickly or can sting or burn. It generally goes away after a few weeks with no repercussions.

    The lesions resemble chilblains, a kind of pre-frostbite that occurs when skin remains cold and wet for long periods. COVID toes can also be referred to as pseudo frostbite—or false frostbite—since those affected are actually not being exposed to cold or wet conditions. Unlike true frostbite, it heals with no permanent damage.

    Like so many aspects of this virus, it’s somewhat unusual. It seems to affect young people, including young adults and teenagers, some of whom have tested negative for the virus. They generally have no other symptoms and feel fine. This may be the reason it’s getting so much attention in the media, as patients and their parents share their stories.

    Most of the reported cases come from people who have been directly or indirectly exposed to the virus. Since we know that some can carry the virus and yet have no other symptoms, we treat those with affected feet as potentially positive, encouraging virus testing and limited exposure to others. As more data comes in, this foot problem might turn out to be an early warning, unlike other skin conditions that generally appear later when the illness has taken hold.

    Rash

    The most common skin issue associated with this virus is a red rash, appearing most often on the torso and less so on the extremities. It is mildly itchy, lasts a few days, and disappears as the virus runs its course and the condition improves.

    Pocks or Spots

    More recently, we have seen other rashes emerge, including one that appears as small blisters or red, crusty spots very similar to chickenpox. With coronavirus, though, these spots rarely appear on the face—unlike true chickenpox, which often affects the face. And because it has affected people who’ve already had chickenpox or the vaccine, and test negative for the chickenpox virus, we are confident it comes from a different source.

    Hives

    Hives are not unusual in the aftermath of viral infections. They are generally caused by an immune system thrown off-balance by the disease. Hives are generally mildly itchy and last a few days with no significant after-effects.

    Bruise-Like Lesions

    Spots that resemble bruises or pressure sores are being seen in the sickest patients, those on ventilators to support their breathing. They appear on areas of the body where pressure is not an issue, one reason we suspect they may be unique to the virus.

    These start as retiform purpura, a lacy bruise-like rash, when small blood vessels become inflamed and tiny clots develop within them. Retiform purpura can signal tissue damage that might eventually evolve to gangrene as the disrupted blood supply results in the cell death.

    Skin disorders can occur in ventilated patients, often resulting from low blood pressure, a side effect of ventilation. However, the lacy, bruise-like lesions seen in COVID-19 patients are different and may be unique to the virus. Progression to gangrene generally appears only in the most gravely ill patients. It has resulted in some amputations.

    Treatment

    In healthy people who do not have a severe response to the infection, most lesions will go away on their own with no damage left behind. When itching or discomfort become issues, we treat them symptomatically with antihistamines or topical steroids.

    In the case of hives, because they can put the patient at risk of a larger allergic reaction, we tend to be more aggressive with treatment to head off complications. We also know that NSAID medications, like aspirin and ibuprofen, can make hives worse, so we take steps to ensure the patient avoids NSAIDs until the hives clear.

    If You Experience a Skin Issue

    A simple way to get any skin condition evaluated is through a MedStar Health Video Visit with a dermatologist. During this pandemic, we are seeing most of our patients remotely—as many as 60–70 per day, compared to only two or three urgent patients in person.

    The video technology is very easy to use, accessible, and best of all it can help put your mind at ease. We use it to make an examination and assess history and condition. We are also training our patients to take high-quality still photographs of the affected area, a powerful complement to the video visit.

    During the session, we can look for warning signs of something serious, ask the right questions to gauge symptoms and severity, and instruct the patient to perform simple tasks that help inform our decision-making.

    What’s Going On?

    We don’t know all the mechanisms behind the skin problems, so it’s too early to speculate.

    However, we know that certain hallmarks of the disease can cause skin problems. One big suspect is microthrombi, or tiny blood clots widely reported in patients around the world.

    These clots are unlike those experienced in everyday life due to age, cardiac disease or poor circulation. Rather, they can occur in almost any part of the body and are a known contributor to death from the virus because they interfere with the healthy function of vital organs.

    Viral infections also stimulate the release of cytokines, proteins that play an important role in regulating the life process. They tell cells what to do and when to do it. At the extreme end of the immune response, a sudden, systemic cytokine release—the cytokine storm—can quickly overwhelm the body, potentially triggering high fever, bleeding, low blood cell counts, and multiple organ failure.

    But even a mild immune response can affect normal cytokine levels, which may lead to some of the skin lesions we are seeing. A link is yet to be proven.

    Data for Knowledge

    As we learn more and collect more data, some of these skin effects may be added to the list of other known coronavirus symptoms, like fever, cough, shortness of breath, and loss of taste or smell.

    The professional dermatology community is working hard to speed that process. For example, the American Academy of Dermatology has launched a registry, collecting details about skin conditions potentially associated with the novel virus. It is tracking thousands of cases and related details.

    We are also seeing unprecedented speed in information sharing. As in many other medical specialties, our journals are fast-tracking papers and articles related to the novel virus, giving physicians swift access to new trends and information.

    SARS-CoV-2, the virus that causes COVID-19, is dramatically different from most pathogens we have seen before—so, it makes sense that some of its symptoms are different, too. These unusual skin conditions certainly qualify.

    This pandemic evolved lightning-quick—only four months ago, there were no reported cases in the U.S. The situation has advanced and changed rapidly. Fortunately, the science is also developing very quickly.

    The answers we don’t have today, we may have tomorrow.

    Need to see a dermatologist?

    Connect with us from home with a video visit.

    Call 202-644-9526 or Request an Appointment

  • May 13, 2020

    By MedStar Health

    Many people unfortunately wait until they’re sick to find a doctor. Delaying preventative care or avoiding the doctor’s office altogether; however, may set you up for some unexpected health complications in the future.

    That’s why it’s important to have a primary care provider (PCP). A primary care provider can be a doctor or a nurse practitioner who specializes in family medicine or internal medicine. I’m a family medicine physician practicing at MedStar Medical Group at Navy Yard. My goal is to help you stay healthy from childhood through the rest of your life.

    Considering you’ll probably see your primary care provider more than any other type of doctor, establishing this relationship early is critical. Medical studies show that people who have a primary care physician experience better health outcomes and a longer life span.1

    Do you have a primary care provider? If you do, studies show you are more likely to live a longer, healthier life. Family medicine physician Dr. Rochon shares four reasons why on @MedStarHealth's #LiveWellHealthy blog: https://bit.ly/3ctXhZJ.

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    Here are four reasons why you should have a primary care provider.

    1. Your primary care provider knows you better than any other doctor.

    There are very few healthcare providers who know you as well as your primary care provider. Hopefully, your primary care provider is someone you see consistently every year, which means they know your:

    • Health goals
    • Lifestyle habits
    • Medical history
    • Medications
    • Family health history
    • Personality
    • Preferences

    Because they know so many details about your personal life, your PCP is equipped to help you prevent disease through proactive health screenings and lifestyle modifications. And, when something is wrong, they are more likely to catch it early because they are actively monitoring your health.

    2. They can care for you throughout your entire life.

    Your primary care provider is with you through it all, from your high school sports physicals and flu shots to your first cancer screening and beyond. Whether you’re a teenager, in your mid-30’s, or an aging adult, your PCP is trained to care for your health over time.

    That means they can help you:

    • Stay up to date on routine screenings (e.g. colonoscopies)
    • Manage your risks of developing a chronic disease
    • Catch health issues early before they progress into something more serious
    • Make lifestyle changes (e.g. stopping smoking)
    • Address any side effects to medications you’re taking

    Whether you’re due for a routine screening or you’re experiencing acute symptoms related to a disease, your PCP can observe changes from appointment to appointment which means...

    3. They can help you prevent disease.

    Primary care providers are experts in a broad range of conditions, especially when it comes to chronic disease, including:

    • Cancer
    • Diabetes
    • Heart disease
    • High blood pressure
    • High cholesterol

    People don’t always experience symptoms during the early stages of chronic disease, but your doctor or nurse practitioner knows exactly what to look for. Since they know the results of your routine check-ups and your risk of any hereditary diseases, they are already actively looking for early signs that may indicate a problem.

    As a result, PCPs can help you reduce your risk of developing a chronic condition. They also assist in mitigating potential disease complications by:

    Managing your chronic conditions. Your primary care doctor won’t leave you to manage your diabetes—or any other chronic condition—on your own. Rather, they’ll work with you to develop a treatment plan that considers your preferences, lifestyle, and condition. From support managing side effects from medication to regular follow-up, your PCP will help you prevent your condition from worsening.

    Supporting your lifestyle changes. When you have a chronic disease that can be improved through diet, exercise, and other healthy habits, your primary care provider can help you to take small steps towards better health.

    Related: Read 4 Lifestyle Changes to Prevent Heart Disease

    Referring you to a specialist. When something comes up that requires a more specialized approach, your primary care doctor can reach out to their network of specialists for a referral. For example, if your annual mammogram comes back abnormal, they can connect you with a breast health specialist or oncologist who can do further advanced testing.

    4. They can keep you out of the hospital.

    By catching signs of disease early, your PCP can ensure you receive treatment before it turns into something more serious. People who don’t have a primary care provider are more likely to end up in the emergency room, which can be expensive and time-consuming.

    How to find the right primary care provider.

    There are lots of reasons why you should have a primary care provider. But how do you choose a doctor or nurse practitioner?

    Most employers allow you to pick or change a primary care provider within your health insurance during what’s called “open enrollment”. Typically, this occurs when you are first hired and again at the end of the calendar year.

    The internet is a great place to research PCPs in your network because you can read reviews and ratings about other people’s experiences. Many MedStar Health providers even have their ratings included on their online profile pages found at MedStarHealth.org/FindADoc.

    Researching your primary care provider options allows you to think carefully about the qualities that are important to you. You may want to consider looking for comments or ratings related to values that include:

    • Good listening
    • Communication (Clear and easy to understand)
    • Team-oriented
    • Personable

    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 the buttons below for more information on our services.

    Primary Care

    MedStar Health Video Visits

    Footnotes

    1. Stanford University School of Medicine and Harvard Medical School