MedStar Health Blog

The holidays offer us time with friends and family, and sometimes even vacations from work. But one thing we have noticed over the years is that the holidays and winter months also correspond with increased risk of heart disease, the leading cause of death in the U.S., according to a 2017 study released by the Centers for Disease Control and Prevention (CDC).

Cold weather can cause your blood vessels and arteries to shrink, restricting blood flow and reducing oxygen to the heart. As a result, your heart has to pump harder—which can cause your blood pressure and heart rate to increase. These factors can make individuals more vulnerable to heart disease and other heart conditions.

We see this firsthand at MedStar Heart & Vascular Institute, as we are much busier around the holidays. In fact, we see about 50 percent more heart attacks in the winter. And, alarmingly, more people die of heart related causes on Christmas and New Year's Day, than any day during the year. While these numbers aren’t meant to scare anyone, they serve as a good reminder for us to take time this winter to stay on top of our heart health.

Heart Conditions Associated with Winter Holidays

Holiday Heart Syndrome

Binge drinking during the holiday season creates increased heart risk known as holiday heart syndrome, in which patients develop atrial fibrillation (A-fib), an irregular rapid heart rate that has symptoms such as fatigue, shortness of breath, and lightheadedness. Alcohol causes A-fib, through triggers such as:

• High blood pressure
• Obesity, as alcohol has a lot of calories
• Sleep disorders, such as sleep apnea

When uncontrolled, A-fib can cause heart failure as the irregular fast heart rhythm can make it more difficult for the heart to pump blood throughout the body.

Studies show that moderate to high alcohol intake causes A-fib in people over 65 with existing cardiovascular disease or diabetes. And binge drinking increases the risk of A-fib  similar to habitual heavy drinking for those who consider themselves moderate drinkers.

Heart Failure

We also see more heart failure at MedStar Heart & Vascular Institute during the winter months. This matches the experience in other areas of the country. A study 20 years ago examined the number of visits for heart failure to 18 different emergency departments in New Jersey and New York from Dec. 1 to Jan. 31 each year.

Comparing the average daily visits during a two-week window between Christmas and New Year’s Day, there was about a 23 percent increase in daily visits from Dec. 25 to Jan. 7, about a 33 percent increase from Dec. 26 to Dec. 29, and a 30 percent increase from Jan. 2 to Jan. 5.

Tips for Good Heart Health This Winter

Some common tips we provide patients—especially around the winter holidays—to maintain a healthy heart include:

• Avoid binge drinking: Men should try drinking no more than two drinks a day, while women should drink no more than one to avoid any health implications.
• Avoid stress, if possible: Low stress levels promote good heart health. The holidays can overwhelm us with to-do lists: holiday parties, gift-giving, or making travel plans. Making plans in advance and getting seven to eight hours of sleep each night help control your stress levels. Make sure you seek medical attention if these simple tips aren’t helping.
• Don’t avoid care: People tend to be busier during the holidays. And from my experience, this can delay them from seeking medical attention. Although some clinics have limited hours during the holidays, your local emergency room, or prompt care, can help. MedStar Health has a large network of prompt care sites in Maryland and the District of Columbia.
• Follow a Mediterranean diet: This diet encourages healthy food choices including fruits, vegetables, beans, legumes, grains, poultry, and eggs. The Mediterranean diet provides the best-studied and most evidence-based diet to prevent heart disease.

Staying top of your heart health all year long included increased heart awareness during the winter months and around the holidays. I hope that these tips bring you heart health this holiday season and all year long!

In most women, the endometrium—the mucous membrane lining the uterus—grows inside the uterus and sheds during the monthly period. But in women with endometriosis, the endometrium starts to grow outside the uterus, on the surface of the bladder and intestines and all around the pelvic organs.

As a result, women with endometriosis experience symptoms that can range in severity from hardly noticeable to debilitating pain. Common symptoms include:

• Constant dull to severe pelvic pain from inflammation
• Cramping
• Digestive problems, such as diarrhea or nausea
• Heavy menstrual periods
• Pain during sex
• Painful urination
• Subfertility, or difficulty becoming pregnant

Fortunately, treatment is available to reduce these life-altering symptoms. Let’s discuss common questions women ask about endometriosis and how medical advances are changing the way we approach diagnosis.

LISTEN: Dr. Morozov discusses endometriosis treatment in the Medical Intel podcast.

How is endometriosis diagnosed?

We can make an initial diagnosis by listening to a patient describe her symptoms and by conducting a physical exam. But to be 100 percent sure, we must perform minimally invasive surgery and do a biopsy of any endometrial lesions, or tissues that have been damaged by the culprit disease.

The cause of endometriosis is unknown, but we know genetics can play a role. For example, if a woman’s mother, sister, or aunt had endometriosis, she is at a higher risk of developing it herself. Some studies also claim that environmental factors, such as organic pollutants in the atmosphere, also affect the development of endometriosis. However, we do not yet have conclusive results.

How is endometriosis treated?

Endometriosis is very unlikely to go away on its own. Thankfully, treatment can radically reduce symptoms for many patients. We typically start with medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or birth control pills that control hormonal fluctuations in the body. However, most patients don’t find enough relief with medication alone and eventually opt for minimally invasive surgery to remove the endometriosis. This procedure is performed through incisions in the belly that are less than an inch in length.

It’s important to seek treatment for endometriosis as soon as you notice symptoms. That way, we can work to control the endometriosis before it can spread to other organs in the pelvis and abdomen. Additionally, the symptom of pelvic inflammation has led researchers to speculate that there could be an association between endometriosis and endometrioid-type ovarian cancer, or when endometrioid tumors develop in the ovaries. There is no direct link, but some researchers are studying whether particular endometriomas— ovarian cysts containing thick, brown fluid—could lead to endometrioid-type cancer.

What is recovery like after endometriosis surgery?

Patients usually feel substantial symptom relief within six months after surgery. During the first six to eight weeks, patients might be sore from the procedure. Then, the endometriosis pain starts to dwindle. The severity of pain during recovery varies from patient to patient.

I have an honest discussion with my patients in anticipation of the treatment option she chooses. It’s important to note that the goal of surgery or medication can’t realistically be to make a woman 100 percent pain-free, but to control her symptoms so she can function normally with minimal pain.

What advancements can improve treatment in the future?

There are a couple exciting areas of research regarding endometriosis right now. One is the development of biological markers for the disease, which would allow doctors to diagnosis it without doing surgery. The markers are made by drawing patients’ blood or doing a saliva test. The tests would go to a laboratory and determine whether there’s a good chance someone has the disease. It’s still in the research phase, but the results so far are promising.

Other research includes the development of better visualization tools for surgery. We often go into laparoscopy with a small camera that’s placed in the abdomen and pelvis, and there is a risk that we might miss a lesion because our eyes alone can’t always recognize them in the pelvis. As a result, researchers are working on camera filters that allow for better visualization during laparoscopic surgery.

MedStar Washington Hospital Center is one of the largest and best equipped medical facilities on the east coast. Our group at the National Center for Advanced Pelvic Surgery has multiple urogynecologists and specifically-trained female urologists that specialize solely in endometriosis and chronic pelvic pain.

If you experience endometriosis symptoms, don’t wait to seek treatment. Our endometriosis specialists offer initial diagnosis, second opinions and ongoing care for chronic pelvic pain.

Diarrhea is a menace in the form of hard-to-control bowel movements and loose, watery stools three or more times per day—quite the hassle when you’re at work, traveling, or doing everyday activities. Other unpleasant diarrhea symptoms include:

• An urgent need to use the bathroom
• Inability to control bowel movements
• Nausea
• Stomach pain

But along with being annoying, severe diarrhea can dehydrate the body, leading to further health complications, such as low blood pressure or fainting. Diarrhea comes in two forms: acute and chronic. The conditions have similar symptoms, but much different implications for patients. Acute diarrhea lasts for less than two weeks and gets better on its own. It’s usually a sign of an infection, food poisoning, lactose intolerance, or gastroenteritis. Chronic diarrhea can last much longer and can be a symptom of a more serious condition, such as ulcerative colitis, Crohn's disease, celiac disease, or C. difficile infection. Most acute cases can be managed at home, but severe diarrhea warrants a visit with the doctor. Let’s discuss how to manage diarrhea and the tell-tale signs of when to go see your doctor.

5 ways to overcome diarrhea

1. Stay hydrated

There are over-the-counter oral rehydration solutions sold in pharmacies, but I always suggest to patients an easy way to make it at home. Mix six teaspoons of sugar, one-half teaspoon of salt, and a half-gallon of water in a container and drink it throughout the day. The sugar and salt help your body absorb water better, which keeps you better hydrated.

2. Consider taking zinc supplements

Zinc been shown to reduce the severity and duration of diarrhea, especially in children. This is used more commonly in developing countries, but something to keep in mind if you’re having ongoing acute diarrhea.

3. Eat a healthy diet

I advise my patients to eat a healthy, nutritious diet full of plant-based protein, increased yogurt intake, and additional prebiotic foods. These nutrients can restore the beneficial bacteria that diarrhea causes your body to flush out.

4. Avoid antibiotics

Antibiotics could be used to treat diarrhea, but most times they can do more harm than good. Antibiotics can disrupt the microbiome, or the trillions of bacteria, viruses, and fungi found primarily in a person's gut, and can cause more long-term symptoms. Plus, they can cause antibiotic-associated diarrhea from irritation or changes to the colon bacteria and even cause an infection with C. difficile. I reserve antibiotic treatment for those patients for whom it’s the only feasible treatment, such as for a proven, serious infection.

5. Consider taking probiotics

If I do prescribe an antibiotic, I typically recommend eating yogurt, which includes Lactobacillus, a natural probiotic that reduces the severity and duration of antibiotic-associated diarrhea. Keep in mind, most probiotic supplements are not FDA regulated, so buying a probiotic and expecting big results could be a shot in the dark. Fermented foods are an excellent source of prebiotics as well and a great addition to your daily food intake. Examples of such foods are sauerkraut, kombucha tea, tempeh (made from fermented soy beans), and miso (a Japanese seasoning made from soybeans fermented with koji, which is a natural fungus. Prebiotics are foods that feed the good bacteria in our gut. You can find prebiotics in plant-based foods such as dandelion greens, onion, garlic, leeks, and common foods like asparagus, green unripe bananas, oats, and barley.

When to seek treatment

Even when taking preventative measures, there are times, what I call “red flag symptoms,” when a person should visit their doctor, such as when there are:

• Nocturnal stools or waking up in the middle of the night to have a bowel movement
• Signs of blood in the stool
• Symptoms of weight loss, fevers, or night sweats
• Times when diarrhea occurs even without eating, or on an empty stomach

I remember treating a young woman who had been on antibiotics many times for sinusitis and urinary tract infections, and she was suffering with chronic diarrhea. After tests from her primary care provider showed no obvious conditions, we gave her a breath test and discovered she was suffering from small bowel bacterial overgrowth. After initially treating her with a non-absorbable antibiotic (we had to in order to get rid the overgrowth), we helped the patient improve her diet with more plant-based foods, adding prebiotic foods, and probiotics. Her condition vastly improved in the following months. For most patients, the first step in diagnosing the cause of chronic diarrhea is a stool study to uncover undiagnosed infections or diseases. The doctor also might conduct lab work to identify any conditions, such as anemia or abnormal liver numbers. If your doctor identifies any underlying conditions, you might need further testing. For example, an endoscopy may be necessary so we can take biopsies of the small bowel. Sometimes, a colonoscopy may be necessary if there’s blood in the stool or ongoing nocturnal stools, as it could show inflammatory bowel disease or microscopic colitis. Diarrhea can make everyday activities a hassle, but it also can signify a more serious condition. If you’re suffering from severe or chronic diarrhea, see your doctor for help right away.