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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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  • November 13, 2018

    By James E. Tozzi, MD

    Hip and knee replacements have played an important part in the treatment of arthritis and other painful joint conditions for decades. However, recovery from surgery and subsequent inflammation can be painful. Many patients had to rely on opioid medications, which can lead to stomach problems and sometimes addiction.

    Fortunately, today’s patients have another effective, safe option: multimodal pain control techniques. Multimodal pain control lets us tackle your pain before, during and after joint replacement surgery to significantly reduce pain, shorten recovery time and reduce the need for strong pain medication after surgery.

    LISTEN: Dr. Savyasachi C. Thakkar Discusses Multimodal Pain Control in the Medical Intel Podcast.

    Our Three-Pronged Recovery System

    The process of hip replacement or a knee replacement recovery is three-pronged:

    1. Having a post-anesthetic care coordinator, which is a program developed by the Chair at MedStar Washington Hospital Center for patients undergoing primary joint replacement and revision.
    2. An advanced recovery after surgery program, developed by the Chair of the Department of Orthopaedics, and Dr. Susan Dumsha Stasiewicz, anesthesiologist, at MedStar Washington Hospital Center.
    3. Multi-modal pain management, a primary and critical point in recovery for patients undergoing primary joint replacement and revision. This includes preoperative medications, an intraoperative cocktail or injection, and postoperative medications that have been fine-tuned by the arrival of fellowship-trained joint surgeon, Dr. Savyasachi Thakkar.

    This strategy often allows us to perform the joint replacement surgery using local anesthesia, rather than general anesthesia. In doing so, we can avoid complications in your heart or lungs and decrease the risk of nausea and low blood pressure after surgery.

    Most patients benefit from this approach, but others may need more aggressive pain management. Our joint surgeons, anesthesiologists and pain management experts collaborate to identify those at greater risk for severe pain after surgery, as well as what’s likely to trigger their pain. Together, we set realistic goals for pain management.

    Better Pain Control and Faster Recovery

    You’ll likely want your pain to be completely gone right after your surgery. Of course, we understand that—but it’s not feasible. You’ll likely experience some pain after surgery, and a multimodal approach can make it more tolerable with lower amounts of opioid medication. Studies have shown that people who take opioid pain medications for longer periods after joint replacement surgery do not see a reduction in their pain. In addition, we’re currently seeing the effects of the national opioid epidemic, in which tens of thousands of people die every year due to overdoses of these powerful drugs.

    Traditional pain management methods have focused only on the time after joint replacement surgery and only by prescribing powerful pain medications. By modifying our pain-control protocols, patients who have had joint replacement surgery see a number of benefits, such as:

    • Lower doses of opioid pain medications
    • Shorter duration of taking them
    • Reduced risk of dependence
    Modern #paincontrol techniques after #jointreplacement surgery mean patients need lower doses of #opioid pain medications for a shorter time. via @MedStarWHC

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    In addition, our advanced surgical techniques have made it possible for many patients to have joint replacement surgery on an outpatient basis, meaning they can go home the same day as their procedures. People often report lower pain scores when they are able to be at home, in their own beds, with their loved ones, rather than being in an unfamiliar hospital environment during their recovery periods.

    A Potential Breakthrough in Pain Control for Joint Replacement

    Multimodal pain management is a vast improvement over the traditional approach, but we’re not satisfied with the status quo. Our team has helped to pioneer further pain control advances for joint replacement patients, such as nerve ablation.

    In nerve ablation, pain management specialists use radiofrequency ablation, which involves high-energy radio waves, to reduce the sensitivity of the nerves around the site where we will make our surgical incisions. The ablation process “quiets” the nerves near the surgical site, which means those nerves report less pain to the brain and also decrease the amount of inflammation in those areas after surgery. The patient can use their new joint quicker and more effectively without the normal pain and inflammation. We repeat the process about six weeks after surgery to continue to relieve the patient’s pain. After that, the nerves will “wake up” again, and the patient’s skin and scar will have healed.

    What we’ve seen so far indicates that patients who have nerve ablation before their surgeries have significantly better outcomes than those who don’t. We’re still studying the data from our research, but it would be exciting if this led to patients one day not needing to take any pain medication at all after joint replacement surgery.

    It’s critical for us to successfully manage your pain when you undergo total joint replacement. Keeping pain under control means you’re at much lower risk from long-term use of pain medications, and you can enjoy your new joint faster as part of an active, healthy lifestyle.


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

    Request an Appointment

  • November 09, 2018

    By Taryn E. Travis, MD

    When most people think of a burn center, they think of heat-related injuries. While we are the only adult burn treatment center in the Washington metropolitan area, we treat far more than just burns. Many patients benefit from our expertise in skin and wound care, whether we are helping them deal with issues such as smoke inhalation and scars or traumatic skin injuries.

    Apart from treating patients for burns, we provide expert care for a number of conditions you might not expect a burn center to specialize in—particularly the six I’ve outlined below.

    1. Frostbite

    In many ways, frostbite is similar to a burn in terms of skin damage. However, injuries from extreme cold can be more unpredictable than thermal injuries, or those caused by heat.

    Successful treatment of frostbite depends on getting expert care within 24 hours of the injury. During that time, blood vessels in the affected tissue start to become blocked, and the tissue receives less oxygenation from the bloodstream and begins to die. If we see patients within that 24-hour window, we may be able to use special chemicals or the expertise of our interventional radiology colleagues to reopen the blood vessels and restore normal blood flow. If patients don’t get help within 24 hours of a frostbite injury, much of our ability to save the injured tissue is gone. Amputations of fingers and toes may then become necessary to save hands, arms, feet, and legs.

    Get to an emergency department right away if you think you may have frostbite. One of the telltale symptoms is any sort of numbness or tingling in the affected area after being exposed to cold. Also, watch for gray- or blue-colored skin in the exposed area. Color changes are a very serious sign of frostbite, especially the farther they extend up the limb toward the body.

    Related reading: Pay attention to potential frostbite – early treatment can save fingers and toes

    2. Electrical injuries

    Injuries from electricity can be especially dangerous because skin changes seen at the surface might be only a fraction of the total damage underneath. Low-voltage electricity typically causes minor injuries, but can be especially dangerous for people who have an irregular heartbeat or heart disease.

    Contact with high-voltage electricity often involves the electrical current entering the body, traveling along a bone, and exiting the body at some other point. Along the way, the electricity can damage skin, nerves, muscle, and internal organs. We typically see high-voltage electrical injuries in two instances: lightning strikes and injuries at work.

    Electrical injuries usually happen to people who are in good health and who are working, so these injuries can be especially devastating for families. The patient might need to be in the hospital for a long time as they recover, which can lead to long periods without a steady paycheck. If the patient’s heart is badly injured by electrical current, these injuries can be fatal.

    A specialized burn and trauma center like ours is staffed by specialists from a number of fields, allowing us to provide whole-patient care. For example, we had a patient suffer spinal fractures and a laceration to the spleen after receiving an electrical shock and suffering a major fall. His successful care depended on a number of experts, including:

    • Burn care doctors and nurses
    • Cardiologists
    • Neurosurgeons
    • Trauma doctors

    3. Pressure injuries

    Pressure injuries happen when an area of skin is pressed against a surface for an extended period of time. These injuries behave like deep burns, resulting in a loss of blood flow and even death of the affected skin in some cases.

    We don’t see these develop in most people who sit or lie still for long periods because they subconsciously move or fidget to relieve the pressure. However, people who are unconscious, paralyzed, or otherwise injured might not be able to do that. For example, you might be familiar with bedsores, which can develop in people who are unable to walk and who aren’t moved regularly to relieve pressure on their skin.

    We have treated people who were found by loved ones or coworkers after they had been down and unmoving for long periods of time. One patient was pinned under a piece of heavy equipment at work. Another had suffered a stroke and had been lying immobile on the floor. In severe cases such as these, we might need to perform surgery to treat the pressure injury and allow the affected skin to heal properly.

    Someone who has a #stroke and lies immobile on a hard surface for just 30 minutes might be at risk for a #pressure injury, which behaves like a deep #burn and can cause serious #skin damage. via @MedStarWHC

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    4. Skin diseases

    We often partner with our dermatology colleagues to care for patients who have rare skin diseases that cause them to shed their top layer of skin, much like what happens in a burn injury. Some of these include:

    • Bullous pemphigoid, which causes large fluid-filled blisters to develop on the skin
    • Stevens-Johnson syndrome, which involves a painful, blistering rash
    • Toxic epidermal necrolysis, a more severe form of Stevens-Johnson syndrome

    Patients with these diseases who are treated in our Burn Center have access to specialized nurses, rehabilitation therapy, a pharmacist, and a dietitian. These providers understand patients’ unique needs as they recover from injuries that cover large areas of their bodies.

    5. Chemical exposure

    Certain chemicals can cause injuries that penetrate deeper into a patient’s skin than a heat injury would. Most chemical burns happen at work for people whose jobs involve manufacturing or exposure to dangerous substances, but we do see patients who came into contact with common household products, such as cleaning supplies. Some of the many substances that can cause chemical burns include:

    • Ammonia
    • Battery acid, such as from a car battery
    • Bleach, including drain cleaners
    • Chlorine and other chemicals used in household swimming pools

    The severity of a chemical burn depends on several factors, including the strength of the chemical and the amount of time the skin was exposed to it. Be sure to thoroughly rinse the skin with water if you come into contact with a chemical, and get medical help if the burned area is:

    • Blackened, reddened, or blistered
    • Deep or larger than an inch in diameter
    • In a sensitive location of the body, such as the eyes, face, hands, feet, genitals, buttocks, or any major joint
    • Painful or numb

    6. Diabetic wounds

    We often see patients with diabetes who have been referred to us with wounds they have had for a long time that aren’t healing and might put them at risk for amputation. Our vast experience with skin injuries often means we can preserve their fingers, toes, hands, or feet.

    People with diabetes also have special needs when it comes to burns because of a nerve condition called diabetic neuropathy that leads to a decreased feeling and temperature sensitivity in the hands, legs, and feet. We often see patients with diabetic neuropathy who burn themselves in the bathtub or shower because they can’t feel how hot the water is. These patients may suffer more severe burns than they otherwise would, and typically have delayed wound healing.

    Related reading: Saving limbs and improving lives: The Center for Limb Salvage

    Treating the unpredictable
    One thing these very different types of injuries have in common is their unpredictability. Patients with these conditions can experience significant symptom changes in 24, 48, or even 72 hours. The advantage of a specialty burn center like ours is that we see non-heat “burns” of every severity all day, every day. When time is short, and a life is on the line, the specialists at our Burn Center can have the resources to save limbs and lives.

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

    Request an Appointment

  • November 07, 2018

    By MedStar Health

    Hormonal changes and the social and academic demands are constant pressures for teens. However, kids with attention-deficit/hyperactivity disorder (ADHD) can be impacted by this dynamic more severely than their peers.

    According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a national ADHD resource, the disorder affects 8.4 percent of Americans ages 2 to 18 and 12 percent of teens ages 12 to 17. ADHD is marked by an ongoing pattern of inattention and hyperactivity, often interfering with functionality or development. Common scenarios include frequently forgetting to turn in homework assignments and experiencing an inability to absorb information in class, often resulting in poor exam grades.

    Common symptoms of ADHD include the inability to:

    • Concentrate
    • Organize
    • Retain information
    • Sit still

    Generally, symptoms arise prior to a child’s 17th birthday. But parents often don’t realize the cause of these behaviors, resulting in many kids not receiving treatment through their teenage years. Being aware of symptoms so you can address them with a doctor, however, can result in a proper diagnosis and treatment that can manage your child’s symptoms.

    Difficulty concentrating, organizing, and retaining information are common symptoms of #ADHD, which affects about 8 percent of kids. Learn how symptoms are treated. via @MedStarHealth

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    How ADHD is diagnosed

    People are born with ADHD and oftentimes it runs in the family. Many teens outgrow ADHD (about four percent of adults have ADHD), although the hyperactivity, fidgetiness, and distractibility can persist.

    ADHD, unfortunately, is underdiagnosed and undertreated, especially in girls. Symptoms of ADHD in girls are often less obvious, as girls who are dealing with these symptoms both inside and outside of the classroom tend to still receive good grades.

    To diagnose ADHD, doctors first evaluate a teen’s symptoms by asking the teen, parents, and teacher to rank common symptoms from non-severe to severe using the Conners rating scale, a behavior rating scale used to better understand certain behavioral, social, and academic issues in children ages 6 to 18 years old. If a follow-up test shows symptoms are consistent six or more months later, the doctor may diagnose ADHD. Doctors will sometimes perform additional testing to identify any underlying conditions with similar symptoms, such as learning disabilities, sleep disorders, or metabolic disorders.

    ADHD treatment options

    Behavioral therapy

    ADHD treatment usually starts with cognitive behavior therapy, which treats problems and boosts happiness by modifying dysfunctional emotions, thoughts, and behaviors. We often focus on solutions to teens’ symptoms by encouraging them to learn coping skills—which can include getting enough sleep, mentally accepting the diagnosis, controlling impulses, and seeking support from teachers, family, and friends when it’s needed. Your family practice doctor typically will refer your child to a therapist for this type of treatment.

    Medication

    Numerous medications effectively treat ADHD and have no known long-term side effects, if cognitive behavior therapy isn’t effective. These medications aim to improve chemical imbalances in our body that influence mental health, including neurotransmitters, serotonin, norepinephrine, and dopamine.

    Many of my teen patients who went through counseling and received medication come back for follow-up appointments exclaiming how much they enjoy school now and how much better they feel about themselves. These kids see the world brighter and live a more fulfilled life. However, just because teens take medication today doesn’t mean they have to for the rest of their lives. In fact, I find that about 50 percent of people who receive treatment that eliminates all symptoms for six months to one year never need medicine again.

    ADHD can severely affect a kid’s ability to learn, do well in school, and socialize. If your teen is experiencing symptoms, don’t hesitate to speak with them about it and seek medical care when necessary.

    Want to find out more on dealing with developmental issues in teens and young adults? Click below to learn more about our services.

    Learn More

  • November 06, 2018

    By Richard T. Benson, MD

    High blood pressure is a major risk factor for heart disease. But many patients don’t realize that high blood pressure (hypertension) also can increase the risk of ischemic strokes. This type of stroke is caused by blood clots that form in the arteries leading to the brain, blocking blood flow. Ischemic strokes account for approximately 87 percent of strokes.

    Your blood pressure is measured by the pressure within your vascular system when the heart is contracting or relaxing. I like to think of a closed loop system with a pump. The heart is the pump, and when it contracts, it creates the maximum pressure within that system. When the heart relaxes, the pressure decreases. All the organs receive blood from the heart before it goes back to the lungs, then back to the heart again, closing the loop. When this delicate cycle is disrupted, the risk for stroke increases.

    Having high blood pressure puts extra strain on the heart, brain, and kidney. The brain is most sensitive to this pressure. A stroke can occur when the high blood pressure affects the brain’s arteries causing problems, such as:

    • Changes to the walls of the lining of the arteries of the brain
    • Hemorrhages, or when blood leaks from a ruptured blood vessel
    • Narrowing of the arteries in the brain

    LISTEN: Dr. Benson, Md, discusses how high blood pressure can affect stroke risk in the Medical Intel Podcast.

    Americans with high blood pressure (almost one in every two adults) have many steps they can take to control their blood pressure, and in return reduce the risk of stroke. The first is finding out whether you have or are at risk for hypertension.

    Can You Tell If Your Blood Pressure Is High?

    Most people can’t tell if their blood pressure is high or not without measuring it. However, if people do experience symptoms, they can include blurred vision, headaches, and nosebleeds.

    Since symptoms are rare, it’s important that patients and doctors take the time to check the blood pressure regularly at home and at check-ups. There are even phone apps patients can use to log their blood pressures, or they can simply jot them down in a journal. Studies have shown that people who check their blood pressure at home with a monitor for just three months increase their chance of reducing their high blood pressure.

    Once you and your doctor determine your blood pressure and risk, it’s important to maintain a healthy blood pressure by actively pursuing a healthy lifestyle. There are many relatively easy changes patients can make at home that don’t cost anything and don’t require extra doctor visits.

    3 Ways to Maintain a Healthy Blood Pressure at Home

    1. Exercise

    One of the major reasons for high blood pressure is the obesity epidemic in America. Unfortunately, we're even seeing high obesity rates in young kids. We need to change this trend, and one way we can do so is by exercising more as a family.

    The Northern Manhattan Stroke Study, which is the first stroke study that looked at a tri-ethnic community—African-Americans, Hispanics, and whites— found that people who exercise 20 to 30 minutes a day, three times a week, have a lower rate of stroke compared to those that don’t exercise at all. My advice? Do 30 minutes three days a week, minimum.

    It doesn’t have to be a long run or heavy weightlifting session. Gather your family, friends, or neighbors and take a walk together, or even march in place in the living room to your favorite TV show or movie. Every bit of activity is beneficial to your health.

    2. Eat a low-sodium diet

    Let’s not sugar-coat it: Americans eat too much salt and fast-food, which hurts blood pressure because it’s less nutritious and high in sodium. The American Heart Association (AHA) suggests choosing foods with less sodium and preparing foods with little or no added salt. Aim to eat no more than 1,500 milligrams a day.

    An easy way to achieve this is to follow the tasty and heart-healthy Mediterranean diet. This plan reduces processed foods and red meats in favor of fruits, vegetables, whole grains, olive-oil, beans and legumes, and lean meats, such as fish.

    Related reading: 29 Things You Should Do for a Healthy Heart

    3. Manage stress

    Stress can exacerbate high blood pressure, and while we can’t take stress out of our lives completely, we can change how we respond to it. Consider these tips to relieve stress in a healthy way:

    • Exercise
    • Get enough sleep
    • Surround yourself with a good social support network of people who care about you
    • Meditate or pray if you are religious or spiritual

    If lifestyle changes aren’t enough to reduce your stroke risk, it’s important to take blood pressure medication. The AHA has an algorithm that suggests which medication to start with based on differences in patient demographics, such as gender and ethnicity. This can include an ace inhibitor, which allows your blood vessels to relax and widen, making it easier for blood to flow through. Another option is a diuretic, which removes excess salt and water from the body. Another option is a beta blocker, which helps your heart beat more slowly and with less force. It’s important to discuss the suggestions with your doctor because each person reacts differently to medications.

    Having #highbloodpressure can increase your #stroke risk. Dr. Richard T. Benson says lifestyle changes such as exercising, eating well, and managing stress, along with medication, can reduce stroke risk. https://bit.ly/2AOWzG9 via @MedStarWHC

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    How Doctors Can Help Patients

    Uncontrolled blood pressure is also a doctor problem, and there are provider-level interventions that doctors should use to improve their patients’ blood pressure. Doctors should adhere to an agreed-upon protocol or algorithm to know when they should change a medication and when to refer a patient to a hypertension specialist.

    Another method we use is an incentive program called Target BP, which is promoted by the AHA. The program encourages doctors to check their patients’ blood pressure control rates and provide non-patient-specific data to the AHA.

    The AHA then gives providers national recognition if they show that 70 percent or more of their patients’ blood pressures are below target. This type of incentive is a win-win for patients and providers. It encourages more doctors to take an active role in their patients’ blood pressure management, which results in better patient care.

    Education is another important role of doctors in reducing stroke risk. Beyond discussing the link between blood pressure and stroke, all patients should know the signs of a stroke and what to do if they or a loved one show symptoms. To detect the immediate signs of a stroke, a patient or doctor can use the FAST acronym:

    • F: face or facial weakness
    • A: arm weakness
    • S: speech problems
    • T: time, meaning call 911 immediately

    Seek Treatment at the First Sign of a Stroke

    As many as 70 percent of all strokes have at least one FAST symptom. Unfortunately, too many patients try to wait to see if some of the symptoms of a stroke go away, or to save themselves from paying a hospital bill, so they choose to wait. But we know that time is brain. The longer a patient waits, the longer it takes to get treatment that could restore blood flow to the brain, which increases the risk of long-term brain damage and death.

    MedStar Washington Hospital Center is a Comprehensive Stroke Center, which means we provide advanced techniques to treat patients with even the most complex strokes. Among the latest techniques is embolectomy, which is an incredibly effective intervention for clot-related strokes. For example, embolectomy, or mechanical thrombectomy, is a clot-retrieval procedure that can restore blood flow to the brains of patients who suffer in strokes, even up to 24 hours after the stroke began.

    If you or your doctor is concerned about your blood pressure, seek the care of a hypertension specialist. You can get coordinated care from all different specialties here at the Comprehensive Stroke Center, rather than just from cardiovascular specialists. When you come here, you have the best experts in all types of care at your fingertips.

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

    Request an Appointment

  • November 05, 2018

    By Susan O’Mara, MD

    Feeling dizzy can be scary—and rightfully so. We see many patients in the emergency department or urgent care seeking medical attention to determine the cause and the cure for their dizziness.

    Dizziness comes in two forms:

    1. Lightheadedness, which can lead to fainting
    2. Vertigo, when patients feel a disturbing sense of motion or that the room is spinning

    Both types are alarming to experience, and both can be either relatively harmless or a symptom of a more serious condition.

    #Dizziness can range from feeling like you might faint to the sensation that a room is spinning. Discover what causes dizziness and when to see a doctor. @MedStarWHC
    Click to Tweet

    Lightheadedness

    Lightheadedness, or the feeling you are going to faint, is caused by lack of blood flow to the brain—even momentary—for a variety of reasons. A common cause is the vasovagal response . That’s when your body responds to a scary, painful, or emotional situation by dropping your heart rate and blood pressure. We see this when a patient gets lightheaded while having blood drawn or faints when they see their loved one in the intensive care unit.

    A more concerning reason for lightheadedness is low blood pressure caused by anemia (low blood count) or dehydration (from vomiting, diarrhea, or fever). This is most noticeable to the patient when he or she moves from lying or sitting to a standing position and feels lightheaded—with the gravity challenge of standing up, it takes a few extra seconds to get enough blood flow to the brain and fainting or near-fainting can be the result. The other serious but rare cause of lightheadedness is abnormal heart rhythm. If the heart rate (pulse) is way too fast or way too slow, it can’t generate enough blood pressure to get good blood flow to the brain.

    What to do if you feel lightheaded

    If you feel like you might faint (lightheaded, flushed, nauseated, or like you “need some air”), you very well might faint if you don’t get more blood flow to the brain immediately. To achieve that, lie down with your head even with your heart. Always be cautious—it’s better to see the doctor than to risk an injury from falling.

    When to see the doctor about fainting or lightheadedness

    If you actually faint, if the lightheadedness persists more than a few minutes, or if you have any chronic medical problems (especially any history of heart trouble), you should see a doctor immediately. If you are a young, healthy person and you experience momentary lightheadedness that goes away immediately, you are probably OK to be checked out soon at your doctor’s office.

    The doctor can determine whether there is a concerning cause of your symptoms by asking about your symptoms in detail and examining you. The doctor can check your heart with an ECG and perform lab work or imaging if necessary. Depending on the doctor’s assessment, you could need a variety of interventions, from simple reassurance to IV fluids, blood transfusion, and/or admission to the hospital for further evaluation.

    Vertigo

    Vertigo is a less common type of dizziness, but we see it frequently in the emergency department and urgent care settings because it is often very disturbing to patients, and it usually starts without warning. Vertigo is the sensation of movement when there is no movement. It can range from mild seasickness to a feeling that the room is spinning to loss of balance. It can come from either the inner ear (peripheral vertigo) or the brain (central vertigo). Because the two types can feel the same, and because central vertigo can have a serious cause, vertigo warrants a doctor’s visit.

    The most common cause of vertigo by far is benign peripheral vertigo (BPV), which is a malfunction of the balance mechanism inside the ear. It causes problems when you move your head quickly, sending a nerve signal to your brain that your head is moving or spinning when it is not. This can be nauseating and can even cause vomiting.

    BPV can happen to people of all ages and has no known risk factors—frankly, most cases are just bad luck. The inner ear balance mechanism can be damaged by longstanding diabetes or by a chronic degenerative condition called Meniere's disease. But usually, the dizziness in those cases arises more gradually over time. Dizziness from BPV is harmless, and episodes pass quickly as long as you keep your head steady for a minute or so when symptoms arise. Overall, the symptoms can last from as short as one to three days or as long as up to two weeks.

    Central vertigo is much less common than peripheral, and it is much more serious. It is called central because it arises from the brain, which is part of the central nervous system. Central vertigo produces the same sensation as BPV, but it is usually more severe, is not brought on by moving your head, does not go away when you keep your head still, and often affects balance to the point where it is difficult to walk. Unlike BPV, central vertigo can have sinister causes, such as stroke, brain tumor, or bleeding in the brain. Risk factors include older age, high blood pressure, high cholesterol, diabetes, and taking blood thinners.

    What to do if you experience vertigo

    Keep your head as still as possible to reduce the abnormal messages from your ear. Closing your eyes also might help.

    When to see the doctor about vertigo

    If the dizziness persists for more than 10 minutes, get to a doctor right away. Call 911 if you are elderly, have a severe headache, or have risk factors for stroke such as high blood pressure, history of stroke, or heart problems. Any vertigo requires a medical assessment because it can be difficult for the patient to determine peripheral from central vertigo.

    The doctor will ask key questions and do a thorough physical exam to determine whether you are having peripheral or central vertigo. People who are diagnosed with BPV might be prescribed meclizine, a mild medication that alleviates symptoms by essentially hiding vertigo from the part of the brain that is experiencing it. Additionally, there is a technique called the Epley maneuver, in which a doctor moves a patient’s head in a series of positions in an attempt to reset the inner ear balance mechanism and restore functionality. If patients have persistent vertigo, we can refer them to an otolaryngologist (ear, nose, and throat doctor) for additional testing.

    If the diagnosis is possible central vertigo, patients who see us have access to doctors and nurses who participate in the National Institutes of Health (NIH) stroke program, which provides oversight for clinical trials to develop treatments for neurological disorders and stroke. These clinicians are experts in diagnosing central causes of vertigo and have rapid access to any testing or treatment that might be needed.

    Dizziness isn’t something to take lightly, especially if it is recurrent or accompanied by severe symptoms. Particularly in older patients, dizziness could be a red flag for a more serious condition.

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

    Request an Appointment

  • November 01, 2018

    By MedStar Health Research Institute

    Please mark your calendars for Thursday, May 30, 2019, to attend the 8th Annual MedStar Health Research Symposium, at the Bethesda North Marriott & Conference Center.

    Each year, we look forward to bringing together investigators, executive leaders, associates, and collaborative partners from across our system to share the clinical research they are conducting. The Symposium features large-scale research abstract display of more than 300 peer-reviewed projects. We are pleased to welcome all residents and fellows to attend and present their research for the third year. This year we will increase our collaboration with Georgetown University Medical Center, our academic partners.

    The day will begin with professional development and advancement sessions, followed by resident oral presentations, abstract presentations and moderated poster sessions, and the keynote address.

    Details on abstract submission deadlines and registration coming soon. To learn more about the event, visit MedStarHealth.org/Symposium.

    Thursday, May 30, 2019
    Bethesda North Marriott & Conference Center
    5701 Marinelli Rd.
    North Bethesda, MD 20852

    Schedule

    1:30 pm — Professional Development and Advancement Sessions
    3:00 pm — Resident Oral Presentations, Exhibit Hall, Scientific Poster Presentations and Keynote Presentation
    6:30 pm — Post-Symposium Receptions

    We hope that you will be able to attend this year’s event and thank you for supporting our mission to advance health through research, education, and innovation.