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  • January 14, 2022

    By Allison Larson, MD

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

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

    1. Do: Wear sunscreen all year long.

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

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

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

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

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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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

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

    3. Do: Pay closer attention to thick skin.

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

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

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

    Related reading:  Follow these 5 Tips for Healthy Skin

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

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

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

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

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

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

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

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

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

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


    5. Don’t confuse skin conditions with dryness.

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

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

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

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


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

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • December 07, 2018

    By MedStar Health

    The holiday season is a time in which we often share the things we are thankful for with our families and friends. However, there are many benefits to be had by sharing our gratitude all year round.

    Regardless of what we might be going through, stopping to consider all the things you have to be grateful for can change your perspective on a scenario or change your whole mood. In fact, being thankful can help improve your:

    • Physical health, as people who are grateful report feeling healthier and have fewer aches and pains, according to a study published in Personality and Individual Differences.
    • Psychological health, as people saw improvements in depression and overall happiness after participating in an exercise that prompted them to think of three good moments or things that happened each day.
    • Relationships, as thanking new acquaintances makes you more likely to seek an ongoing relationship. Whether you give a coworker a thank-you note or thank them for holding the door, acknowledging their kindness can lead to new opportunities.
    • Sleep, as people who have more positive thoughts and less negative ones at bedtime fall asleep faster and have more restful sleep.
    Feeling #Grateful can improve your physical health, relationships, sleep, and more. Discover three tips to help you reap these benefits. via @MedStarHealth
    Click to Tweet

    How to Feel Grateful

    Feeling grateful can be challenging with life’s twists and turns, such as when you’re stuck in rush-hour traffic or facing tight deadlines at work. Through the years, I have found three techniques to be the most effective in remaining thankful.

    1. Reflect on Small Moments

    Throughout the day, make an effort to stop and feel grateful each time something positive happens to you. For example, after someone at work engaged with you to ask what the best part of your weekend was, take a moment afterward to appreciate their gesture.

    Taking moments to identify what makes you feel good also can generate more feelings of gratitude. Each time something makes you feel good, think about why. This allows you to appreciate it more the next time a similar event occurs.

    1. Make Sure Others Know You’re Grateful

    If the people around you don’t recognize your gratitude, how grateful can you really be? Make sure to let others know how thankful you are for their acts of kindness through sincere, verbal affirmations or small gifts. When we give thanks, it makes us feel better about ourselves.

    1. Write Down What You’re Thankful For

    Writing out the things you are thankful for can go a long way toward feeling grateful. A good time to do this is each morning before you leave for work or before bed. However, if you have trouble finding time, consider doing it at work when you have downtime. Additionally, writing thank-you cards to colleagues, family, and friends is a good way to practice gratefulness.

    1. Accept Gestures or Expressions of Gratitude

    Consider a gesture of gratitude as a gift and respond to it as such. I’ve found that responding positively to an expression of gratitude can positively impact a person’s experience. To accept gratitude, we can say “Thank you so much for saying that!” or “Thank you! That made my day,” as opposed to saying, “No problem” or “That’s okay. I was just doing my job.”

    How Your Gratitude Can Help Others

    I’ve heard or been a part of countless scenarios where someone is feeling down and someone else’s kindness picks them up. For example, when someone thanks their spouse for doing the dishes or picking up groceries after work, it can reduce any past resentment and make them feel appreciated. Expressing gratitude can also be beneficial in health care, helping to reduce burnout of a care provider, and overall, it can contribute to a more pleasant environment. Just think of all the people you can positively impact by simply making an effort to give thanks as often as possible.

    The next time someone does something nice for you, you may want to return the favor or do something else kind in return either because you feel obligated to do so or you feel there’s an imbalance in the relationship. It’s often why we write thank-you notes, give a gift, or offer a kind gesture in return. An expression of gratitude is the first step we can take to find that balance again. Most importantly, feeling grateful has numerous benefits to our health and well-being. Consider these tips to help positively impact the lives of both you and the people around you.

    Would you like to thank a MedStar Health associate for making a positive impact on your life or a loved one’s life? Express your gratitude by sharing your story on the MedStar Health Facebook page using the hashtag #GratitudeMatters.

    Share Your Story

    If you’d like to partner with our grateful patients, families, and friends who are committed to MedStar by making a gift online, visit this page.

  • December 07, 2018

    By MedStar Health

    During his training at The Johns Hopkins University School of Medicine in Baltimore, Anirudh Rao, MD, found the most meaningful cases to be those involving end-of-life issues, including those with difficult, often emotionally painful decisions for patients and family members.

    "The opportunity to do things that aligned care and treatment with a family’s goals was very fulfilling,” Dr. Rao says. “That’s when I decided to focus my career on palliative medicine.”

    Dr. Rao was 10 years old when his family moved from India to New York. A magna cum laude graduate of Cornell University, Dr. Rao came to Johns Hopkins for medical school, and stayed for a combined residency in Internal Medicine and Pediatrics, and a fellowship in Hospice and Palliative Medicine. He joined MedStar Washington Hospital Center’s Section of Palliative Care as an attending physician for the research and mentoring opportunities, and to help train fellow physicians in the discipline.

    “I also liked the fact that the patient population is similar to Baltimore’s,” Dr. Rao adds. “The diversity of backgrounds and cases is both familiar and challenging.”

    Addressing Misconceptions around Palliative Care

    In working with families, Dr. Rao sometimes has to address misperceptions about palliative medicine, particularly concerns that it heralds a significant transition in a patient’s care strategy.

    "I try to educate them that we can do palliative care in conjunction with other treatments, and that we can still treat the symptoms of an illness as well help alleviate their effects,” he explains.

    Establishing and maintaining dialogue with the family are likewise essential elements of palliative care.

    "Certainly end-of-life discussions are important, but we try to get involved well before it reaches that point,” Dr. Rao says.

    If a patient is scheduled to receive a heart-assist device, for example, Dr. Rao will work with the patient and family to clarify expectations and goals. “Building that kind of understanding and environment for decision-making is very good for the patient,” he adds.

    Keeping Up with Research

    Dr. Rao looks forward to continuing investigations on topics such as how advanced heart failure interventions and therapies affect patients and their quality of life, and how to improve the experience of patients whose treatment is no longer effective. He’s also interested in following up on patients who received palliative care as children, and how to improve the transition of care once they reach adulthood.

    With a caseload made up mainly of difficult, often emotionally-wrought end-of-life issues, Dr. Rao has to maintain his own balance of professional objectivity and personal empathy.

    “I’m there to provide patients and family members with good information, and support them emotionally,” he says. “If I’m able to come away with that, regardless of what they decide, and what happens, I’ve done my job.”

    Life Outside the Hospital

    Along with reading and regularly documenting his challenges for future reference, Dr. Rao stays active with tennis and racquetball. He also enjoys family time outdoors with his wife, who is an ob/gyn at a community hospital near Baltimore, their two-year-old daughter and their dog.

    “They’re the best coping mechanisms of all,” he says.

  • December 04, 2018

    By Matthew Schreiber, MD

    “You’re trying to steal me!”
    “Don’t put me in that oven!”

    These are actual comments we’ve heard in the intensive care unit (ICU) from patients who were admitted after an accident, stroke or other trauma. Their delusions stemmed from an acute condition called ICU delirium, which is a sudden, intense confusion that can include hallucinations, confusion, and paranoia.

    The list of causes for delirium is long. For example, we know that medications historically used in the ICU to treat patients can be associated with delirium. And the environment of the ICU itself can also lead to a patient being overwhelmed and confused, with lights beeping 24 hours a day and frequent changes of bandages or medical devices.

    Research suggests that ICU delirium can affect as many as 80 percent of patients in the ICU. Understanding the symptoms of the condition can go a long way in raising awareness and identifying treatments.

    LISTEN: Dr. Schreiber discusses ICU delirium in the Medical Intel podcast.

    How does ICU delirium develop?

    While we don’t have a model to say “A causes B,” ICU delirium is the brain failing in response to other things going on within the body. The same blood that cycles to the brain travels to all the other bodily systems as well. For example, the harmful by-products of an infection in one area of the body has the potential to be carried to the brain in some cases. Though delirium is a problem of the mind, its roots often are found in other parts of the body.

    We know delirium is associated with physical changes in the brain. A 2012 study looked at magnetic resonance imaging (MRI) data on patients who were diagnosed with delirium during an ICU stay. The study revealed that, after three months, the brain actually looked different when compared to ICU patients who did not have delirium. Clearly, there are long-term effects of this condition.

    Identifying ICU delirium

    People with delirium often:

    • Have waxing and waning levels of sedation and/or agitation
    • Are confused by their surroundings (this may not be obvious to an observer)
    • Can’t maintain focus or pay attention
    • Don’t think clearly or have disorganized thinking
    • Sometimes see or hear things that aren’t there

    However, diagnosing ICU delirium involves more than watching for the telltale symptoms. Unlike other psychological disorders, ICU delirium can come and go. Mental fluctuations are a key component to identifying the disorder.

    Any of the following could be a risk factor and must be considered for every patient.

    • The older a person is
    • The use of medications such as sedatives or steroids in their treatment
    • The more ill a person is
    • Patients who have a history of dependencies on different chemical substances, such as alcohol, illicit drugs and prescription medications
    • Patients who are on ventilator machines. As many as 80 percent of people who end up on a breathing machine will have delirium at some point during their hospital stay

    You can’t tell if someone is delirious by looking at them, and often you can’t tell just by talking to them. There is a standardized, objective test we use to diagnose delirium. First, we look to see if they have had a change in their state of being calm, agitated, or sedated. Next, we determine whether a patient is attentive. We test patients’ ability to focus by seeing whether they can perform a simple task 10 times. Then, we measure disorganized thinking by gauging the ease with which patients can answer questions with obvious answers, such as:

    • Can you hit a nail with a hammer?
    • Is a mouse bigger than a giraffe?
    • Is ice cream cold?

    We try to reduce a patient’s risk by providing whiteboards in rooms showing the day’s date, nurse and information, as well as TVs to keep them up on the news and help keep their mind sharp.

    Quick treatment of ICU delirium is imperative. But, as with all conditions, prevention is the ultimate goal. We have implemented the ABCDEF bundle with ICU patients to potentially avoid long-term complications with ICU delirium.

    Preventing ICU delirium with the ABCDEF bundle

    Assess and address pain

    When a patient is agitated, it might be because they’re in pain. If we can control their pain and use relaxation techniques instead of a sedative or antipsychotic medication, we might be able to reduce their risk of developing delirium and help manage their pain at the same time.

    Both a spontaneous breathing and spontaneous awakening trial

    We check every day whether patients who are on breathing machines for life support can breathe on their own. If they can, we might take them off the machine or reduce its intensity because patients develop ICU delirium much more often when on a breathing machine—likely because of the inflammation it creates throughout the body. Also, for patients on a continuous IV infusion of sedatives, we check every day to see if the patient “needs” these medications or if they can be administered in an “as needed” regimen.

    Choice of medications

    Medicines in the family of benzodiazepines, such as Xanax, have shown a strong link to the risk of ICU delirium. Sometimes these medications are needed, but we try to avoid them when we can. We often can use an alternative medication that’s safer for our patients. For example, Propofol has been shown to have less association with delirium than benzodiazepines and can be just as effective in achieving sedation when it’s required.

    Delirium: Check for it

    We monitor for the warning signs of ICU delirium with the Confusion Assessment Method for Intensive Care Unit, or CAM-ICU test. Research has shown it to be an excellent tool in diagnosing the condition among patients in the ICU.

    Early mobilization activity

    It’s important that patients are up and moving around during their stay in the ICU, if possible. Activity can reduce the risk for delirium and could include participating in physical therapy or doing simple movements around their room with assistance from their nurse.

    Family engagement and involvement

    Since it’s affecting their own brain, a patient usually isn’t aware of their symptoms. Family members often notice, however. They may wonder, “Why is my loved one not themselves?” or “Why did they act like they didn’t know who I am?” If loved ones bring these concerns to us, we check right away for delirium. Family support also can decrease a patient’s risk for delirium.

    One study found that teaching family members to recognize delirium symptoms and keeping familiar objects around, such as pictures of loved ones, cut the number of ICU delirium cases in half. Our ICU allows visiting hours around the clock to be sure our patients get the support they need.

    #Physicaltherapy and other structured movement can help reduce #ICU patients’ risk of #ICUdelirium.  via @MedStarWHC

    Click to Tweet

    Life after ICU delirium

    As patients recover from the condition that put them in the ICU, their delirium may start to improve. However, having delirium during the hospital stay has been shown to increase the risk of death six months after diagnosis, which is why it’s so important to prevent it. Over time, patients also tend to have more cognitive and functional issues, such as short- and long-term memory loss.

    I recommend as a great resource for patients, practicing clinicians, and family members to see testimonials from patients, caregivers, and hospital professionals regarding the long-term outcomes of this condition.

    If a patient is in the ICU, we want to help give them every opportunity to get back to being themselves. The last thing we want is patients going home and living with undiagnosed delirium. Make sure to alert your or a loved one’s doctor if you suspect the condition during or after a stay at the hospital.

    Call 202-877-3627 or click below to make an appointment with a doctor.

    Request an Appointment

  • November 29, 2018

    By MedStar Health Research Institute

    Bridging Clinical Research & Clinical Health Care Collaborative— March 4-5, 2019

    This March, health care professionals, patients, physicians, academics, clinical researchers, service and technology providers, and regulators will join and work together to advance clinical research and its link with health care.

    The 2019 Bridging Clinical Research & Clinical Health Care Collaborative program will focus on providing collaboration opportunities to transform the health care system and accelerate learning cycles. The goal is to build bridges to close the gap that separates clinical research and health care so that the lessons learned from patients in research and health care settings reach and benefit other physicians and patients in a timely manner.

    Keynote speakers include John Barry, MBA, COO of Pharm-Olam and patient advocate, and Michelle Keefe, President of Commercial Solutions, Syneos Health. Additional speakers and panelists will hold sessions on Integration of Research and Health Care, Addressing Global Challenges and New Innovations to increase opportunities for collaboration.

    Review the full agenda or meet the speakers. To learn more, please visit

    Bridging Clinical Research & Clinical Health Care Collaborative
    March 4-5, 2019
    National Academy of Sciences
    Washington, D.C.,

  • November 29, 2018

    By MedStar Health

    November Peer-Reviewed Publications from MedStar Health

    Congratulations to all MedStar researchers who had articles published in November 2018. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on here.

    Selected research:

    1. Prevalence and Location of Obstetric Lacerations in Adolescent Mothers.
      Journal of Pediatric and Adolescent Gynecology, November 2018. DOI: 10.1016/j.jpag.2018.11.004
      Shveiky D, Patchen L, Chill HH, Pehlivanova M, Landy HJ.
    1. Neurologic Events in Continuous-Flow Left Ventricular Assist Devices
      Cardiology Clinics, November 2018. DOI: 10.1016/j.ccl.2018.06.007
      Kadakkal A, Najjar SS.
    1. Physician Choice of Hypothyroidism Therapy: Influence of Patient Characteristics
      Thyroid, November 2018. DOI: 10.1089/thy.2018.0325
      Jonklaas J, Tefera E, Shara N.
    1. Ambiguity in End-of-Life Care Terminology-What Do We Mean by "Comfort Care?"
      JAMA Intern Med., November 2018. DOI: 10.1001/jamainternmed.2018.4291
      Kelemen AM, Groninger H.
    1. Need for a Global Definition of Normative Echo Values-Rationale and Design of the World Alliance of Societies of Echocardiography Normal Values Study (WASE).
      Journal of the American Society of Echocardiography, November 2018. DOI: 10.1016/j.echo.2018.10.006
      Asch FM, Banchs J, Price R, Rigolin V, Thomas JD, Weissman NJ, Lang RM.
  • November 29, 2018

    By MedStar Health

    MCCRC Recognized a Clinical Research Site of Excellence by MAGI

    MedStar Community Clinical Research Center (MCCRC) has been designated a MAGI Blue Ribbon Site for excellence as a clinical research site.

    The main focus of MCCRC is on the conduct of diabetes-related clinical trials, including diabetes prevention, treatment, and management of diabetes-related complications. MCCRC employs a team approach to the conduct of federal grant, commercially-sponsored, and investigator-initiated clinical trials. MCCRC is well known for its proven ability to recruit and retain underrepresented research participants while strongly contributing to racial and ethnic diversity throughout our clinical research program.

    Launched in 2017, MAGI’s Blue Ribbon Site program seeks to promote a culture of excellence in the clinical research site community. The program publishes a directory of sites that are considered excellent. It also seeks to facilitate collaboration and communication between these sites while encouraging other sites to meet the standards of excellence as set forth by the program.

    “MCCRC takes pride in our track record of robust recruitment and retention, which is a core element of MAGI’s determination that we are a site of excellence,” said Becky Montalvo, Executive Director of the MedStar Community Clinical Research Center. “It is a privilege to offer clinical trial participation to as many patients as possible and continue advancing health through research.”

    Model Agreements & Guidelines International (MAGI) is streamlining clinical research by standardizing best practices for clinical operations, business, and regulatory compliance. With more than 10,000 members, all sides of the clinical research industry are represented. Learn more about the Blue Ribbon program here.