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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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  • March 12, 2019

    By MedStar Team

    Ulcerative colitis (UC) is an inflammatory bowel disease that causes long-term inflammation and ulcers in the digestive tract, particularly in the innermost lining of your colon and rectum. This is one of the most common conditions I treat—nearly 700,000 people in the United States are affected by it.

    Symptoms of UC can be isolated to gastrointestinal only or with other unrelated symptoms because the inflammation can affect any part of your body. Symptoms might include:

    • Bloody stools
    • Diarrhea
    • Fatigue
    • Nocturnal diarrhea, or waking at night due to bowel movements
    • Severe arthritis, or joint inflammation
    • Skin rashes
    • Tenesmus, or severe urgency with feelings of incomplete evacuation
    • Uveitis or episcleritis, or eye inflammation
    • Weight loss

    Ulcerative colitis is an auto-inflammatory condition in individuals with a genetic predisposition, meaning they have an increased likelihood of developing a particular disease based on their individual genetic makeup. The inflammation also can be triggered by external factors, such as antibiotics, food additives and preservatives, and infection.

    There’s no known cure for UC yet. However, the right balance of medications, and sometimes surgery if needed, can significantly reduce symptoms and even provide long-term remission for patients.

     

    What Ulcerative Colitis Treatments are Available?

    If a patient is diagnosed with UC, medication is the most common treatment method we recommend. There are several effective medications, to help relieve symptoms and even bring about remission. Every patient’s severity of symptoms and the way they react to medications is different. A discussion with a doctor will help determine which treatment option is best.

    There's no cure for #ulcerativecolitis. Thankfully, symptoms can be well managed with the right balance of medications or surgery. https://bit.ly/2HtMSR4 via @MedStarWHC

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    4 Types of Medication for Ulcerative Colitis

    1. Mesalamine: Mesalamine diminishes inflammation by blocking the production of substances that cause inflammation (cyclooxygenase and prostaglandin). This is a time-tested drug that we use as a first-line therapy for mild to moderate disease.

    2. Immunomodulators: These include azathioprine or mercaptopurine (6-MP), which inhibit purine synthesis. Purines are building blocks for DNA and RNA. By inhibiting purine synthesis, less DNA and RNA are produced for the synthesis of white blood cells, thus causing immunosuppression. Decreasing the immune system causes decreased inflammation over time. We are starting to steer away from using these as first-line medications, as better and improved drugs—such as biologics—become available on the market.

    3. Biologics: There are currently multiple biologics in the market that which belong to three different class of drugs, meaning two different mechanisms of action. Infliximab, adalimumab, and golimumab belong to the anti-TNF-α class of action and have been on the market the longest. These medications reduce inflammation quickly and effectively and help heal the lining of the colon. Since we started using them roughly 18 years ago, fewer patients now require surgery for UC. Vedolizumab, which belongs to anti-integrin class was approved in 2014 and has continued to show excellent results in addition to improved safety profile.

    4. Small molecules: Tofacitinib, which is an oral medication, was approved by the FDA in May 2018 for the treatment of UC. This is the next step in effective therapies with improved ease of taking the medication. The oral pill is taken twice daily. Tofacitinib is a JAK-inhibitor, which targets and blocks a signaling pathway in the inflammation. Being that it is a relatively new medication, the long-term effects are uncertain.

    Surgery

    Removing the colon, or total-proctocolectomy, is an effective treatment, usually reserved for patients who do not respond to medications or have rapidly progressive disease. But it can have complications. One issue patients can still have after surgery is primary sclerosing cholangitis (PSC), or inflammation of the bile ducts. This can occur as a complication of ulcerative colitis, even years after the colon is removed. So, it’s important for patients to follow up with their doctor at least once a year to be under surveillance for this.

    Patients can experience symptoms of the disease in one of the following ways:

    • Mild, which may only involve part of their colon or the entire colon.
    • Mild, but at some point—gradually or sometimes suddenly—worsens to severe disease.
    • Severe, or even what we call fulminant disease, where they need immediate hospitalization, aggressive therapy, and sometimes even surgery.

    When to See a Doctor

    If left untreated, ulcerative colitis can cause debilitating short-term and long-term symptoms that could affect not only a person’s work performance and attendance, but also their social and family life. Severe cases in the short-term have led to patients needing emergency surgery and hospitalization because of a toxic megacolon, in which the colon is infected and swells up. Sometimes patients can have refractory bleeding, in which the patient might experience massive blood loss from the colon requiring urgent surgery.

    Over the long term, untreated ulcerative colitis can increase the risk of colon cancer by almost eight-fold. Furthermore, patients with UC are at increased risk of developing primary sclerosing cholangitis (PSC), or the inflammation and scarring of the bile ducts, which puts patients at risk for bile duct cancer (cholangiocarcinoma) and gallbladder cancer.

    Another reason to see a doctor is the risk of having concurrent infections such as clostridium difficile (C. diff), a dangerous bacterium that’s increasing in the community. A patient’s risk of developing C. diff increases significantly when they have UC. Moreover, the presence of C. diff makes UC more difficult to treat and increases the risk of hospitalization and needing an emergency colectomy.

    It’s important that patients experiencing symptoms of ulcerative colitis schedule an appointment with a doctor. The doctor will find the best treatment option personalized for each patient and ensure any underlying diseases are managed as well.

    To request an appointment with a gastroenterologist, 202-877-3627 or click below.

    Request an Appointment

  • March 08, 2019

    By MedStar Health

    Understanding ways to prevent heart disease, the leading cause of death for both men and women in the U.S., is essential to living a long, healthy life. And this goes for people of all ages, as heart disease can begin early on in life and continue to progress as we get older.

    The primary cause of heart disease is coronary artery disease, or when plaque builds up in the coronary arteries, which supply blood to the heart and throughout the body. Over time, plaque buildup causes the arteries to narrow over time, a process called atherosclerosis.

    While genetics can play a role in your heart disease risk, many risk factors, such as high blood pressure and cholesterol can be controlled through a healthy lifestyle. Here are some key ways you can begin boosting your heart health.

    Heart Disease Prevention Strategies

    1. Exercise

    Regularly exercising is good for the heart, as it helps you maintain a healthy weight and keep your blood pressure under control. In fact, being physically inactive increases your heart disease and stroke risk by 50 percent. Moreover, exercising is good for many other parts of your life, such as coping with mild depression and anxiety. We recommend exercising at least 30 minutes a day, four days a week. If you feel as though you don’t have time, try using a step counter and aim to take around 10,000 steps per day.

    #Exercise is good for the #heart, as it helps you maintain a healthy weight and keep your high #BloodPressure under control, via @MedStarHealth. Learn more https://bit.ly/2TB2CbC

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    2. Don't Smoke

    Smoking is a primary heart disease risk factor, as it causes about one of every four deaths from cardiovascular disease. When you smoke, it can cause damage over time to the lining of the blood vessels around the heart, which can lead to plaque buildup and, in many cases, heart attacks and strokes. This applies not only to cigarettes but also vaping, as the juice used in these devices often contains chemicals that also can increase your heart disease risk.

    Quitting smoking can be difficult. Make sure to speak with your doctor if you’ve previously struggled to quit, as there are certain services, such as smoking cessation programs, that can help.

    3. Eat a Healthy Diet

    Eating a healthy diet can help people keep their high blood pressure and cholesterol levels in check, which reduces heart disease risk. We typically recommend that patients follow the Mediterranean diet, which avoids processed foods and prioritizes:

    • Fish
    • Fruits
    • Legumes, such as beans, chickpeas, lentils, and peas
    • Nuts
    • Poultry
    • Vegetables
    • Whole grains

    Type 2 diabetes increases your risk of heart disease because, when your body has trouble handling sugars, it inflames your blood vessels and then leads to problems with the kidneys, triggering a cascade of vascular issues. Eating a healthy diet that’s low in sugar significantly reduces your risk of developing type 2 diabetes.

    4. Regular Checkups With a Doctor

    Your age, existing conditions, and risk factors help dictate how often you should see your primary care doctor. For someone who’s young and healthy, checking in once a year probably is sufficient. However, if you have high blood pressure, bad cholesterol levels, or past heart conditions, checking in two times or more a year likely is necessary. Visits with your doctor help you stay on top of your risk factors and ensures you are continuously receiving feedback on your overall health.

    It’s important to remember that the information above is general and may not apply to everyone. Make sure to speak to your doctor about what works best for you. Depending on your specific situation, you may need to make more or different lifestyle changes than the ones we’ve discussed here.

    Want to learn more about heart disease prevention? Click below to find out about services at MedStar Heart & Vascular Institute or watch this video.

    Learn More

     

     
  • March 07, 2019

    By Susan O’Mara, MD

    We have all heard of people who faint when getting their blood drawn or when they are nervous. In fact, millions of people faint each year—and the most common reason is vasovagal syncope. People with this condition tend to faint, feel nauseous, or become dizzy as a reaction to certain triggers, such as the sight of blood or locking the knees while standing.

    We know that symptoms arise upon activation of a person’s vagus nerve in the neck, which helps control their blood pressure and heart rate. When the nerve is triggered, it causes the heart rate to slow and the blood vessels in the body to dilate, pooling the blood in the legs and depriving the brain of the blood it needs to stay alert. Some people have a more sensitive vagus nerve than others and tend to faint more often. The phenomenon occurs most often in teens and young adults, although it can occur in older people. While vasovagal syncope can be mistaken for epilepsy or heart arrhythmia, it’s usually harmless unless a person injures themselves when they fall down due to fainting. It is characterized by a prodrome – a period that usually lasts several seconds to a minute during which a person feels the fainting spell coming on. The person might experience lightheadedness, nausea, a flushed feeling, or that feeling that they “just need to get some air.” More sinister forms of fainting don’t characteristically have this prodrome phenomenon.

    Vasovagal syncope, a common condition that can cause people to faint, can happen to anyone, says Dr. Susan O’Mara (@SOMaraEM). via @MedStarWHC
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    Should I See a Doctor for Fainting Spells?

    Anyone who is worried about fainting spells should see a doctor. It’s better to get to the root cause, such as underlying conditions or identifiable triggers, to prevent fall injuries and identify significant medical issues.

    We particularly recommend seeing a doctor for a first-time fainting spell or for frequently recurring episodes, or if you have a medical condition such as pregnancy, heart disease, high blood pressure, high cholesterol, or diabetes. Furthermore, people should always be evaluated for an underlying heart condition if they experience fainting or dizziness during sports. An episode of vasovagal syncope doesn’t mean a person is more likely to suffer from serious heart conditions down the road. It’s a one-time event that we must be aware of and manage properly in order to avoid injury.

    Vasovagal syncope is not life threatening, but it can be difficult to tell if an episode of fainting is simple and harmless or caused by an underlying problem. After taking initial steps to manage the situation, it’s always best to have a medical evaluation.

    What to do If You Might Faint

    While fainting can’t always be prevented, there are certain things people can do to decrease the likelihood of it happening. Some of the most effective strategies include:

    • Lie down when a dizzy spell is coming on, with the head level with the heart to ensure adequate blood flow to the brain and maintain consciousness. Act immediately, because fainting happens fast! The best position is lying down next to a wall with your legs up on the wall to get blood flowing to the brain quickly.
    • Anticipate situations that trigger symptoms and, when able, lie down to do them. For example, if having your blood drawn is a known fainting trigger, make sure you tell the phlebotomist and lie down to have the procedure.
    • Keep moving when you have to stand for long periods of time. Frequently flex your knees and shift your weight if you are standing still, such as in a line or at a choir concert, to avoid having blood pool in your lower legs.
    • Stay hydrated, which won’t prevent the vagus nerve from responding altogether, but can help the brain be less sensitive to a lower blood pressure, reducing the risk of fainting.

    Though it might be a little embarrassing to acknowledge a trigger or lie down in public, it’s preferable to falling and injuring oneself or someone else. Having a reactive vagus nerve is not a testament to one’s character, sensitivity, or toughness. It’s a common, natural body reaction, and taking cautionary steps can promote safety during occasional episodes of fainting or dizziness.

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  • March 05, 2019

    By Ali Rahnama, DPM

    Millions of people—from athletes to people who walk to work—experience a sprained ankle each year. In fact, we typically see four to five a week at MedStar Washington Hospital Center. Sprained ankles often leave patients with:

    • Bruising
    • Inability to bear weight
    • Swelling

    In some cases, people experience several or more ankle sprains in the same foot over a span of years, resulting in a condition called chronic ankle pain or spraining. If individuals with chronic ankle pain visit a doctor, they can receive treatment to help them avoid much larger procedures when they are older, such as an ankle fusion or replacement.

    LISTEN: Dr. Rahnama discusses chronic ankle pain in the Medical Intel podcast.

    Caring for Sprained Ankles

    Once we determine someone has an ankle sprain through an overview of their symptoms and an X-ray to ensure they don’t have a fracture in the ankle, we typically divide first-line treatment into three categories:

    • Rest and protect the ankle with a brace, boot, and sometimes a splint
    • Begin working on range of motion, strength, and stability exercises
    • Begin exercises that gradually get people back to intense physical activity

    A mild to moderate ankle sprain typically heals in two to four weeks, depending on the person and what ligaments are affected. Severe ankle sprains, meanwhile, normally take up to six to 12 weeks to heal.

    People with severe ankle sprains initially should elevate and ice their ankle, as well as use crutches to get around. Then, it is crucial for them to begin physical therapy, where they will perform exercises to strengthen their tendons and muscles in and around the foot and ankle. These exercises will help individuals avoid similar injuries in the future.

    We typically consider minimally invasive surgery when sprained ankles have not healed after seven to 12 weeks, or when people experience frequent recurrences of ankle sprains.

    When a #sprainedankle hasn’t healed after seven to 12 weeks, minimally invasive surgery might be the best solution to treat it, says Dr. Ali Rahnama. https://bit.ly/2SKyNkq via @MedStarWHC

    Click to Tweet

    How Surgery Works

    Minimally invasive surgery for chronic ankle pain consists of:

    • Making a small incision
    • Entering the joint
    • Identifying and removing any type of pre-arthritic or inflammatory tissue that does not belong in the joint with a tiny shaver instrument and camera and repairing the damaged ligaments or tendons

    During this time, we can also perform a lateral ankle repair if a patient’s ligaments are damaged. Surgery allows people with chronic ankle pain to get back to pain-free physical activity much faster than rest and strength training.

    Following surgery, patients typically have to stay off of the operated ankle for two to three weeks before they undergo resistance and strength exercises to strengthen the muscles and tissues around the foot and ankle.

    Conditions Sometimes Mistaken for Sprained Ankles

    We sometimes see patients who visit us with different conditions that have symptoms similar to chronic ankle pain. Some of the most common include:

    • Osteochondral defects: These are areas of damage to the surface of bones in the ankle that cause pain, especially if there are loose pieces of cartilage from the injury that now are in the joint.
    • Tendon injuries: A tendon tear or rupture sometimes is mistaken for a chronic ankle sprain.
    • Fractures: We sometimes see patients who were referred to us that did not have X-rays, so the patient visits us thinking they have a sprain until an X-ray shows a fracture.

    Patients should make sure they see a doctor to ensure they receive an accurate diagnosis for their pain, so they can receive the best treatment possible.

    How to Avoid Sprained Ankles

    To avoid ankle sprains, people should ensure their shoes are tied nice and snug to provide optimal ankle support and be aware of the type of activities they engage in. For example, runners should avoid running in the rain, snow, and dark to avoid landing on their feet irregularly or slipping. Moreover, when running trails or in a park, it is important that they know the course so they do not turn into any surprises, such as a ditch or hole.

    Ankle sprains can cause a lot of pain, especially when they occur frequently. Make sure to visit a doctor to treat chronic ankle pain and avoid further damage down the road.

    To request an appointment with a foot and ankle doctor, 202-877-3627 or click below.

    Request an Appointment

  • March 01, 2019

    By MedStar Health

    It’s a rare moment when Thomas J. Cusack, MD, MS, is not actively engaged in some activity. When he’s not on call as a neurointensivist in MedStar Washington Hospital Center’s Critical Care department, he may be found running or pedaling his stationary bike, playing with his 8-month-old daughter, or reading the latest addition to his voluminous personal library, which accompanied the New Jersey native across the country and back during his medical training.

    Biggest Challenge

    Indeed Dr. Cusack’s biggest challenge came when he couldn’t move at all. While cycling during an extended break between undergraduate and medical school, he was hit by a car, and seriously injured.

    "I faced a lot of questions—from how would I get through the day, to whether I’d be able to use my left arm again,” he recalls. “That really piqued my interest in learning how patients and their families deal with similar challenges, particularly end-of-life situations, and how it influences their treatment strategy.”

    Dr. Cusack’s yearlong recovery was aided by the loving support of his girlfriend, now wife, Lauren Drake, MD, who is now a primary care physician at MedStar Franklin Square Medical Center in Baltimore. Even with his many interests, Dr. Cusack says he never really considered another career path.

    “I come from a long line of pharmacists and nurses,” he says with a laugh, “but I’m the first physician in the family.”

    Love of Medicine

    While at what is now Rutgers New Jersey Medical School, Dr. Cusack was active in the All E.A.R.S. program, which encourages medical students to provide social support to terminally ill patients who may face their hardships alone. After an internship at Johns Hopkins Hospital, he spent his residency at the Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center in Phoenix. There, he studied under experts such as Abraham Lieberman, MD, the neurologist who helped treat Muhammad Ali for Parkinson’s disease.

    Deciding he was “an East Coast guy,” Dr. Cusack returned to Johns Hopkins Hospital for his fellowship in neurocritical care. Along the way, he took time out to participate in the Himalayan Health Exchange, working in an underserved part of northern India.

    The timing was good, he says, as public health conflicts in the U.S. had left him somewhat disillusioned.

    “It’s just you and the patient—everything else is stripped away,” Dr. Cusack says of the experience, which also “helped rekindle my love of medicine, and see poverty in a new light.”

    Teamwork and Collaboration

    As part of the Hospital Center’s Surgical Critical Care team, Dr. Cusack applies his skills to all types of cases, and be a resource on neurological issues. It’s the best of all worlds, he says—a highly diverse patient population, an academic connection with Georgetown University’s medical school, and an experienced, collaborative team of physicians, nurses and support staff.

    "Playing rugby and working part-time in restaurants taught me a lot about teamwork, which is important in medicine,” he says.

    Having also learned the value of strong interpersonal connections, Dr. Cusack regularly dips into his extensive collection of cookbooks to prepare feasts for his family and friends.

    “There’s something about almost dying that makes doing things important, even if they’re just everyday tasks,” Dr. Cusack. “I’ve seen some unbelievable acts of endurance and resilience in the face of critical challenge. Yet those patients are often most focused on the practical needs—avoiding pain or maintaining their dignity. Those are lessons I try to apply to my treatment approaches, and to my own life as well.”

  • March 01, 2019

    By MedStar Health

    Recent collaborative research sought to develop and pilot a digital interactive tool to evaluate social support and diabetes self-management among Black patients with Type 2 Diabetes. Social support can be defined as supportive actions of others that promote coping or protect against stressors.

    The research team was led by Deliya Wesley, PhD, MPH, with funding from the MedStar Diabetes Research Grant. “Is social support always supportive? A Qualitative Approach to Characterizing Diabetes Self Management Among Black Patients” sought to gain experience in applying a psychosocial assessment tool, known as a Colored-Eco Genetic Relationship Map (CEGRM) to assess social support. This tool is commonly used for cancer patients but was adapted to evaluate self-management for Black patients with Type 2 Diabetes.

    The research collaborators were Ashley Pantaleao, MA; Allan Fong, MS; Stephen Fernandez, MPH; and Mihriye Mete, PhD. These researchers from MedStar Health Research Institute, MedStar National Center for Human Factors in Healthcare, and the University of Maryland College Park found that despite having large social networks or high scores on social support measures, most participants indicated they keep their diabetes “to themselves” or don’t rely on their network for help with diabetes self-management.

    The study included 35 adults that identify as Black or African American with Type 2 Diabetes located at MedStar Union Memorial Hospital and Shepherd’s Clinic in Baltimore. For the first phase of the study, 5 Diabetes Colored-Eco Genetic Relationship Maps (D-CEGRMs) were conducted using the traditional paper method and to test a new digital prototype using a tablet-based method. The second phase of the study used digital D-CERGMs using the tablet-based prototype along with standard structured surveys. By using color-coded symbols, the research team was able to identify the representation of both positive and negative social support that could relate to a patient’s diabetes self-management.

    The analysis concluded that the D-CERGMs provided more descriptive outputs than the structured surveys. Participants found value in the D-CERGRM activity itself but some older patients were not as technologically adept and preferred something tangible vs. the tablet-based prototype. A majority of patients identified having fairly large social networks but most stated they do not share their health condition with their sources of support. Also, when it comes to diabetes self-management, participants shared different cultural and environmental barriers along with medical barriers such as issues with their glucose monitor and side effects of medication.

    While a digital prototype was successfully developed for the D-CEGRM tool, significant modifications and adjustments are still needed. The study concluded that complex family structures led to complex interactions for this patient population and further analysis would need to be explored. Some of the emergent themes from the qualitative analysis included stigma and shame issues, caregiver burden, spirituality, and cultural factors. Findings further suggest that for Black patients with Type 2 Diabetes, social support may not always confer the same level of health-promoting benefits conducive to positive self-management behaviors. Patients overwhelmingly reported finding value in the process, reflection, and visualization of the dynamics of social support in their networks using the D-CEGRM.

    This research was presented as part of the MedStar Health Teaching and Research Scholars Capstone event, which culminates both the two-year programs.