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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.
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    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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  • July 14, 2021

    By MedStar Team

    MedStar Heart & Vascular Institute has built a legacy of exceptional research, education, and patient care. Now, we are raising the bar in cardiac surgery, challenging ourselves to better serve our colleagues and our communities.

    Our cardiovascular specialists are internationally recognized for their vigor, fortitude, and expertise. We are leaders in research, clinical, and surgical innovations for even the most complex heart conditions.

    Still, there are ample opportunities to evolve our positioning and expand our reach within the communities we serve, nationally, and internationally.

    Along with maintaining our high standards of patient care, the cardiac surgery team has chosen and committed to four patient-centric goals this year:

    • Renewing our focus on multidisciplinary collaboration.
    • Embedding our surgeons in the communities we serve.
    • Amplifying patient and provider education.
    • Expanding clinical trial research opportunities.

    We have already begun moving forward with these projects, and in my first few months at MedStar Health, I am inspired by the inherent collaboration and enthusiasm of the cardiac surgery team to continually push the needle forward for our patients.

    1. Renewed focus on multidisciplinary collaboration.

    The most important factor we bring to the table is not a new cardiovascular tool or device. It is our way of using all our available resources in collaborative patient care.

    At MedStar Heart & Vascular Institute, every patient gets access to the full team’s expertise. Interventional cardiologists, cardiovascular imaging specialists, and cardiac surgeons review complex cases together. Our multidisciplinary approach helps us produce a personalized treatment plan for every patient.

    Our heart failure, valve, and structural heart disease specialists meet regularly because collaboration yields the safest procedures and best patient outcomes. As we always say, just because a patient is referred to a cardiac surgeon does not and should not mean surgery is the best next step.


    The MedStar Health #cardiacsurgery team has a legacy of excellence. Now, we’re kicking it up a notch. Explore 4 key #patientcare initiatives we’re excited to achieve under the leadership of Chief Cardiac Surgeon, @abeel_mangi: https://bit.ly/3r8V8e9.

    Click to Tweet


    2. Embedded surgeons in our communities.

    Healthcare knowledge belongs to the people who need it—and we aim to share our expertise far and wide. As such, we are embedding our cardiac surgeons in the communities in which we live and work through:

    1. Social media outreach.
    2. Same-day virtual clinics for referrals and consultations.
    3. Staffing MedStar Health heart surgeons at more community clinics.

    Social media platforms are a natural way to connect current and prospective patients with cardiovascular education. From self-care tips to identifying risks and recovering from surgery, our goal is to answer community members’ questions and reduce patients’ concerns about seeking care.

    Through our same-day virtual clinics, referring cardiologists from any healthcare center can call to talk with a dedicated, on-call cardiac surgeon. We launched these clinics to answer patient and provider questions, expedite decisions around referrals, and reduce unnecessary patient travel.

    In that same spirit, our cardiac surgeons will be staffing MedStar Health clinics closer to home for more patients. We are working to open a clinic in Reston, VA, another in Frederick, MD, and at least three more throughout the region. These clinics will deliver our top-tier surgical care to patients who wish to avoid traveling to Washington, D.C.,

    3. Amplified patient and provider education.

    As an academic medical center, MedStar Health is focused on educating not only our patients, but also our faculty and staff. The expertise of our providers is unmatched. However, we live for the challenge of “what’s next”: discovering, learning, and teaching the seemingly endless flow of cardiovascular advancements.

    We take a multi-pronged approach to covering all these bases outside our clinical duties. First and foremost, we play an instrumental role in educating the public on the dangers of heart disease. It is our duty to empower community members to recognize and seek care for heart conditions at the first sign of symptoms. The earlier heart disease is identified, the better the chances for positive outcomes.

    Secondly, we are kicking off a continuing medical education conference series this fall to give regional and national health care providers access to our surgeons’ expertise in four complex topics:

    Our goal is to encourage early identification of complex conditions, so community providers can refer patients to specialty cardiovascular care sooner in the disease process. Additionally, each of our surgeons leads an outreach program, delivering presentations to community providers on various areas of cardiovascular interest.

    We will also invite outside speakers to MedStar Health to share their knowledge with our surgeons. When we pool our collective knowledge, we improve our chances to increase community awareness and reduce the burdens of cardiovascular disease, at home and abroad.

    4. Expanded research opportunities.

    Every study we join has the potential to bring a novel treatment or rehabilitation approach to life or reveal a new utility for a proven therapy. Some of our recent trials have focused on:

    • Advanced treatments to reduce kidney complications after heart surgery.
    • Gene therapy for patients who are not eligible for heart surgery.
    • New devices to potentially treat mitral stenosis and mitral regurgitation.
    • Valve implants that can be placed through minimally invasive surgery.

    In the future, we will develop specific channels of research within invasive heart surgery, including robotic surgery and further refinements to our exceptional heart transplant program and arrythmia surgery protocols.

    For example, we were the first heart center in the region to offer the Epi-Sense System Hybrid AF Therapy by ArtriCure, a novel ablation treatment for atrial fibrillation that requires deep collaboration between our heart surgery and electrophysiology teams.

    Our multidisciplinary mindset and focus on clinical research gives patients access to advanced treatments that are not yet widely available elsewhere. Explore current cardiac clinical trials.

    Our promise to patients and the community.

    We believe that each person should be treated with respect and dignity. We are thoughtful and deliberate about who we choose to operate on, always taking care to make sure that the benefits of heart operation far exceed its risks.

    We are equally deliberate about making sure that every alternative treatment strategy has been thoroughly explored before making the decision to operate on someone, in close consultation with our colleagues from cardiology and other disciplines.

    Ultimately, our goal is to ensure that each patient gets a therapy that is tailored to their own unique circumstances, and that they are intimately involved with that decision making process. That is how we accomplish the best cardiovascular outcomes for patients.


    Do you need specialized heart care?

    The cardiac surgeons at MedStar Health are here to help.

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

  • July 09, 2021

    Every year, hundreds of patients visit our otolaryngology (ear, nose, and throat) providers to find relief from disruptive chronic sinusitis symptoms, such as:

    • Facial pain and pressure
    • Postnasal drip
    • Recurrent sinus infections
    • Runny nose
    • Severe congestion
    • Snoring or sleep apnea

    For approximately 90% of patients, non-invasive treatments such as nasal sprays and medication provide substantial relief. However, for the remaining 10%, these frontline treatments might not be enough – and sinus surgery might be appropriate.

    Thankfully, antiquated practices such as open surgery and stripping the sinus lining are no longer the standard of care.

    Modern sinus surgeons know that extra sinus tissue typically is not the source of chronic sinus problems. Rather, the culprits often are inflammation, irritation, structural defects, or nasal polyps. These are grapelike growths that dangle inside the sinuses, obstructing normal air and mucus flow.

    When surgery is the best choice, innovations in imaging technology and surgical techniques help MedStar Health sinus surgeons provide precise procedures. With proper maintenance, minimally invasive sinus surgery can provide lasting results with less pain, scarring, and downtime for recovery.


    Approximately 10% of people with chronic sinus issues may benefit from sinus surgery. Find out who’s eligible and how today’s procedures reduce pain, complications, and recovery time: https://bit.ly/3wvMjfp.

    Click to Tweet

    Frontline medical treatments typically work well.

    MedStar Health sinus experts blend the benefits of medicine and surgical intervention. These frontline treatments, alone or in combination, provide adequate relief for most patients:

    • Antibiotics for sinus diseases: If bacteria are to blame for your chronic sinus woes, courses of antibiotics might help relieve the bulk of your congestion and pain.
    • Medicated sinus sprays: Medicated allergy sprays such as topical corticosteroids (i.e. Flonase, Nasonex) or antihistamines (i.e. Azelastine) are safe to use long-term. However, the medication only works on areas it can touch. If polyps or other obstructions are blocking your sinuses, you might not get the full benefit.
    • Oral or injectable medications: Steroid medications taken by mouth or injections can help reduce inflammation if other methods don’t work. Prednisone, for example, can help dissolve polyps and temporarily reduce sinus irritation. Long-term steroid use is not recommended due to side effects such as weakened bones or developing cataracts.
    • Nasal saline rinses: High volume saline irrigations (i.e. NeilMed Sinus Rinse, Navage, neti pot) can bathe” the sinuses, cleaning the sinuses and nasal passages out while keeping them moist, which helps to reduce inflammation. These systems also help clear particles such as pollen out of your nasal passages, reducing irritation.

    During treatment, your doctor may conduct a CT scan to make sure we’re on the right path with your care plan. If you are feeling better but your CT scan still shows inflammation, surgery is likely not needed but reiterates the importance of continued use of the topical medication and rinses to prevent recurrence of your symptoms. However, if inflammation is too much for the medication alone to handle, surgery may ultimately be a good option.

    Please note: Surgery is not a cure-all. Even with even the most severe sinus problems, surgery is a complement to long-term maintenance with medical therapy.

    Who can benefit from sinus surgery?

    Patients who might benefit from surgery include those whose:

    • Symptoms continue to come back after adherence to nonsurgical treatments.
    • Nasal polyps don’t go away with medication.
    • Structural problems, such as a deviated septum, can’t be resolved with nonsurgical treatment.

    All patients who are considering surgery get a pre-operative CT scan. The sinuses in the front and back of the head are situated close to delicate structures such as the brain, nerves, blood vessels, and your eyes.

    CT imaging helps us create a precise, effective surgical plan that avoids those structures while adequately addressing your problem areas, creating more open sinus drainage passageways, and disturbing as little unaffected tissue as possible.

    Sinus surgery is like keeping house.

    If your home has multiple rooms with tight corners, walls, and doors, it can feel stuffy and difficult to move around. But if you have an open floor plan, it’s easier to move freely throughout the home. The same is true with your sinuses.

    With surgery, we open the sinuses by removing debris such as inflamed tissue or bits of bone that crowd the space. Advanced surgical tools such as the endoscope – a lighted tube with a camera in the tip – let us see deeper into the sinuses to explore exactly what is wrong and where. Using this tool, we can perform functional endoscopic sinus surgery (FESS) to target just the affected areas without opening or disturbing the rest of the sinuses.

    Freer sinuses allow better drainage and ventilation so medication can touch the places where relief is needed. And, just like your home, ongoing maintenance is required to keep your sinuses in top shape.

    During surgery, we use CT navigation software as a double-check tool to confirm that we are addressing all the affected cells in your sinuses. The navigation software shows us in real-time where our small tools are in your sinuses and it shows us the surrounding tissue. Paired with surgical and anatomical expertise, this technology helps validate our surgical plans, resulting in more precise, efficient, and safe surgeries.

    Post-surgery recovery and maintenance.

    While recovery is generally not painful, many patients will experience some uncomfortable congestion or sinus pressure for a few weeks after surgery. The tissues inside the sinuses will scab and crust over, just like any other surgical wound, which causes temporary stuffiness.

    Most patients can return to work and normal activities within a week. The major restriction is no heavy lifting, which can increase the risk of bleeding.

    All patients should follow these post-surgery guidelines, along with special instructions from your doctor:

    • Avoid smoking: Smoking stunts the body’s ability to clear particles and air from the sinuses. It also slows the healing process. You wouldn’t fill your home with smoke – your sinuses don’t want it there, either.
    • Use high-volume saline rinses: Keeping the sinuses moist is key. Dry sinuses means crustier scabbing, which can cause problems as you heal. We recommend most patients use a saline rinse four to five times daily during recovery to clear unwanted particles and moisturize the nose. Make sure you thoroughly clean these devices before and after each use to avoid introducing new bacteria to the sinuses.

    Properly maintaining the sinuses after surgery will better prepare you for your one-week post-op visit, during which we will do debridement, or clearing the sinuses of any residual gunk from surgery. Pulling off a moist scab is much more comfortable than removing a dry one.

    Sinus surgery can be life changing for patients with chronic sinusitis and nasal polyps. I’ve had a fair number of patients tell me it’s one of the best health decisions they’ve made. It helps control sinusitis and significantly reduces sinus pressure and pain, which leads to dramatic improvement in sleep and overall quality of life.


    Is sinus surgery right for you?

    Talk with a sinus disease expert today.

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

  • July 05, 2021

    By MedStar Health

    The first virtual MedStar Health Teaching and Research Scholars Capstone program was held on Thursday, May 20th to celebrate education, innovation, and scholarship from our Teaching & Research Scholars. This event culminates the two years of research done by the scholars while in either program. It was also chance to view the works in progress of the scholars who have completed their 1st year.

    The evening started with an open poster session to view the research of our graduating Teaching and Research Scholars as well as those in their first year. Following this, the formal presentations began with opening remarks from our very own Dr. Stephen Evans, Executive Vice President and Chief Medical Officer.

    Next, we had our Teaching Scholars and Research Scholars presentations.

    Research Scholar, Heather Hartman-Hall, PhD, is a clinical psychologist on the MedStar Health Internal Medicine (MHIM) faculty as well as a behavioral health consultant in the Primary Care Center at MedStar Franklin Square Medical Center. As an assistant professor of Clinical Medicine in the Georgetown University School of Medicine, she teaches didactics and mentors research projects on well-being and behavioral health topics. Heather presented "We don’t really talk about it: Role Modeling and Coping with Patient Deaths in the ICU" (see poster). The purpose of this study is to better understand what attendings are intending to teach and what residents perceive they are learning about how to cope with death. The primary findings identified gaps in role modeling about coping with patient deaths in the intensive care unit, creating an informal curriculum that may leave residents unprepared to cope. Also, team briefings after a difficult patient death could bridge these gaps. Next steps include piloting team debriefings after patient deaths in the intensive care unit to clarify the best methods and address potential barriers.

    Teaching Scholar, Pashna N. Munshi, MD, is an Assistant Professor of Oncology at Georgetown University and is the associate director of the MedStar Georgetown Stem Cell Transplant and Cellular Immunotherapy Program at MedStar Georgetown University Hospital (MGUH). Her clinical and research interests focus on management of cellular immunotherapy toxicities focused in improvements in patient and caregiver health-related quality of life. Pashna presented, "We’re in This Together: Self-Preparedness, Caregiver Burden, and Patient-Reported Outcomes in Patient/Caregiver Dyads in the Hematopoietic Stem Cell Transplantation Setting" (see poster). The purpose of this study is to examine health-related quality of life trajectory in patient/primary caregiver to explore associations between patient and primary caregiver perceptions of preparedness and health-related quality of life domains (anxiety, depression, fatigue, sleep, physical functioning and pain) using validated tools. The primary findings indicate that poor caregiver preparedness post-transplant negatively affects patient and caregiver health related quality of life 3 months post-transplant. Also, high caregiver burden 3 months post-transplant negatively affects patient sleep and physical functioning at 3 months post-transplant. Next steps for further research are to identify interventions targeted towards improving health-related quality of life for patients/primary caregivers and decreasing primary caregiver burden.

    The evening concluded with closing remarks by Aviad Haramati, PhD, Professor of Integrative Physiology in the Departments of Biochemistry, Molecular & Cellular Biology and Medicine (Nephrology), Founding Director of the Center for Innovation and Leadership in Education (CENTILE), and co-director of the Integrative Medicine and Health Sciences Graduate Program at Georgetown University Medical Center.

    If you were unable to attend, you can view the capstone booklet here and the recording here.

    The scholars’ posters and alumni accomplishments can still be viewed our webpage.

    Congratulations to all of our Teaching and Research Scholars for their achievement!

  • July 05, 2021

    By MedStar Health

    Researchers from the Firefighters’ Burn and Surgical Research Laboratory at MedStar Washington Hospital Center examined the utility of an electrical injury treatment algorithm. This examination compared the incidence of testing done on a cohort of burn patients before and after implementation. Published in the Journal of Burn Care & Research, “Institutional Experience Using a Treatment Algorithm for Electrical Injury” sought to assess the utility of this electrical injury treatment algorithm in identifying patients at risk for complications while reducing unnecessary testing, monitoring, and admissions.

    Electrical injury can be associated with high morbidity and mortality but due to its low incidence, evidence-based guidelines to triage and treat electrical injuries are lacking. Diagnostic tests such as electrocardiogram, serum troponin, and creatine kinase are used in the emergency room to determine the patient’s risk of negative cardiac outcomes. However, the predictive efficacy of these tests is not understood and there is high variability in diagnosis and management among clinicians.

    In July 2015, The Burn Center implemented a new algorithm for triage and management of electrical injury. This retrospective cohort study involves patients admitted to The Burn Center over a course of 5 years. The study team hypothesized that protocolized treatment for electrically injured patients will improve quality of care by reducing unnecessary tests, hospital admissions, and ultimately healthcare costs.

    Fifty-six patients with electrical injury were admitted to The Burn Center pre-algorithm implementation and 38 patients were admitted post-algorithm implementation. There were no significant differences between groups in terms of age, sex, race/ethnicity, proportion of work-related injuries, or voltage exposure. Furthermore, there were no significant differences between groups in presence or extent of cutaneous burn area, Glasgow coma scale on arrival to the hospital, or proportion of patients with loss of consciousness immediately after sustaining electric shock.

    The result show there was no difference in the proportion of patients who received electrocardiogram testing after implementing the algorithm. However, the proportion of patients who received testing in the pre-algorithm cohort was significantly higher for troponin (79% vs 34%), urinary myoglobin (80% vs 45%), and creatine kinase (82% vs 47%). Of 44 patients who had troponin levels tested in the pre-algorithm cohort, only 14% had abnormal results. The results also show there were more days of telemetry monitoring and greater intensive care unit length of stays, prior to algorithm implementation. There were no significant differences in total hospital lengths of stay, incidence of intensive care unit admissions, in-hospital mortality, or 30-day readmissions.

    The study team concluded that use of this algorithm allowed for reduction in testing and health care costs without increasing mortality or readmission rates. Further data collection, targeted quality improvement and the use of actual cost-differences vs cost-savings estimates would be considered for future research.

    The study team included Saira Nisar, MBBS, MS; John W. Keyloun, MD; Sindhura Kolachana, BS; Melissa M. McLawhorn, RN, BSN; Lauren T. Moffatt, PhD; Taryn E. Travis, MD; Jeffrey W. Shupp, MD; and Laura S. Johnson, MD.

    Journal of Burn Care & Research, DOI: 10.1093/jbcr/irab020
  • July 02, 2021

    By Elspeth Cameron Ritchie, MD

    After more than a year of COVID-19 social restrictions, the U.S. pivoted from “you’re safer at home” to “get vaccinated and get back in action!” within a matter of weeks.

    For some, the change was a major relief. But for many, the quick transition added fuel to a growing inferno of pandemic-related anxiety. Will I get sick if I return to the office? Is the vaccine safe? What if someone confronts me for wearing a mask?

    Whether you are an introvert, extrovert, or somewhere in the middle, feeling a little rational anxiety—fact-based concerns—about “returning to normal” is expected and reasonable. However, excessive rational or irrational anxiety—unfounded worry—can prevent people from smoothly resuming social and career encounters that benchmark a healthy, happy life.

    When I see patients for behavioral health care, I ask how the pandemic has affected them. Answers vary based on personal factors, such as whether they:

    • Caught the virus or witnessed a loved one get sick
    • Are suffering from long-term COVID-19 side effects, such as depression, memory loss, or “brain fog”
    • Worked from home or in person with the public
    • Lost their job
    • Had their children at home 24/7
    • Homeschooled their kids
    • Took care of aging parents
    • Were safe at home during lockdown

    Even people who weren’t overtly affected personally by COVID-19 may be “languishing”—struggling to feel “normal” again after months of societal turmoil. The truth is, life is unlikely to revert to the “normal” we were used to, and that’s not necessarily a bad thing.

    Despite the tragedies of the pandemic, some positive changes will hopefully continue, such as more choices for remote employment; increased telehealth options; and the precedence for staying home from work when we’re ill.

    Still, rational and irrational anxiety is causing roadblocks for many people who want and need to move on from the pandemic. The good news is that re-entry anxiety is manageable when you are ready to start healing. Let’s discuss the differences between rational and irrational anxiety and what support services are available.

    Post-pandemic #anxiety is a real and common problem. But help is available to manage the rational and irrational stressors of re-entering society. Elspeth C. Ritchie, MD, MPH, discusses tips to reclaim your quality of life: https://bit.ly/2UlFyQ9.

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    Rational vs. irrational anxiety.

    Rational anxiety is rooted in truth. For example, at the time of this writing, the U.S. is widely lifting domestic travel restrictions. Simultaneously, new virus variants are emerging and we’re hearing news of catastrophic viral spread in Brazil and India. It’s natural to worry whether our country is on the right track.

    Other rational pandemic-related fears may include:

    • Going in public after having COVID-19: If you or a loved one were affected by the virus, it’s rational that you might be more concerned about spreading the virus or catching it again.
    • Traveling by mass transit: Close proximity with others in an enclosed space can be a recipe for illness—a fact-based concern, regardless of the pandemic.

    Irrational anxiety is characterized by unsubstantiated worry or fear when there is clear evidence to the contrary. In daily life, this may include hesitance to enter a tall building or feeling terrified by an innocuous sight or sound.

    Irrational pandemic-related anxiety may include conspiracy theories, such as:

    • Obsessive worry that Americans are being microchipped through the vaccine: More than 80% of U.S. adults use smartphones, which already enable geolocation. The idea of going to such great lengths for tracking is as unreasonable as it is unlikely.
    • Fear of developing COVID-19 from the vaccine: This is scientifically impossible, since there is no actual virus, alive or dead, in any of the approved vaccines.

    Both rational and irrational anxiety can absorb one’s thoughts, making it tough to focus, perform daily tasks, or even leave home. However, both can be treated with a thoughtful approach to how we perceive and react to pandemic-related stressors.

    Related reading: How to spot depression and anxiety in teens.

    8 anxiety management strategies.

    Some patients with newly diagnosed or existing-but-worsened anxiety may benefit from medication. However, symptoms often can improve significantly with supportive, guided behavioral changes to help you regain control of anxious feelings.

    1. Control the controllables.

    A proven technique for managing anxiety is to focus on what you can control and minimizing what you can’t. Throughout the pandemic, many patients had trouble sleeping due to racing thoughts, such as an overwhelming fear that we were all going to die. I’ll admit, this worry crossed my mind at the beginning of the pandemic.

    Yes, all of us will die someday. That is not something we can control. But what we can control is how we handle the present. I typically recommend that patients work through an internal dialogue about what they can and can’t control. This can help you find positives on which to focus your thoughts.

    For me, my “controllable” was getting up, getting ready for work, and presenting my best self for my patients. What might “controllables” look like in your situation?

    2. Practice deep breathing.

    Take deep breaths through your nose and exhale out of your mouth. Repeat this 10 times. Focusing on manual breathing subconsciously refocuses your mind away from whatever was bothering you, if even for a moment. Deep breathing is a form of mindfulness, which is key to more sophisticated awareness practices, such as meditation.

    3. Set healthy boundaries.

    Several friends invited me to dinner a few weeks back. We’d all been vaccinated, but I requested that we all sit outside where it’s well-ventilated. I still preferred to wear my mask, and I decided in advance that I would leave early to avoid excessive hugging, handshakes, and crowds. What I told all my friends was that I had to be home at a certain time, and no one gave me a hard time about leaving before they did.

    It’s up to you what you are comfortable with. Conversely, we owe it to each other to be kind if someone isn’t as ready as you to unmask or hang out at an event or in a restaurant.

    Related reading: 6 signs you should be concerned about your mental health.

    4. Exercise outdoors.

    Moving and getting a change of scenery can help reset the mind and body. I enjoy walking around the koi ponds and flowers at MedStar Washington Hospital Center when I have a few moments between appointments.

    If you live in Southern Maryland, you may have easy access to enjoy outdoor activities such as fishing, crabbing, canoeing, and boating. In Baltimore, you might catch a baseball game. Find an activity you enjoy and take your mind off worrying for a while.

    5. Give back.

    It can be tough to make yourself participate when you have anxiety. However, volunteering can temporarily replace racing thoughts by helping you focus on something positive. Animal lover? Volunteer at a pet shelter. Enjoy reading? Offer to read to kids at your local library. Worried about the homeless? Help out at a food bank. There’s always work to be done, and plenty of opportunities to help in your passion area.

    6. Laugh a little!

    At the start of the pandemic, I began carrying a stuffed lemur in the pocket of my hospital coat. Patients and colleagues would walk by, give me an odd look, then burst out laughing. Every time, I would beam ear-to-ear behind my mask. Laughing feels good, and it feels even better to make others laugh!

    7. Prepare for naysayers.

    There will always be a few people who feel it is their right to ridicule others for wearing or not wearing a mask as restrictions are lifted. At work, ideally you could turn to your boss or human resources professional to proactively manage or mitigate these situations. However, that’s not always possible.

    If you feel comfortable speaking your mind, remain polite but firmly state, “I respect your decision. Please respect mine.” Sometimes it helps to plan out what you will say or do in certain situations. Role playing with your therapist or a friend can help build your confidence.

    8. Take your time.

    Whether you are anxious about returning to work or taking your first post-pandemic vacation, incremental steps are key. In our practice, we often recommend “extinction” or “exposure therapy,” which incorporates visualization to manage stressors.

    For example, if a patient is afraid of crossing bridges, they’ll start with visualizing themselves crossing the bridge. Once they’ve mastered that, we arrange for them to cross a bridge with a loved one. Over time, they can work up to crossing solo. Some patients never cross alone, and that may be sufficient for them. The point is to set realistic, personally achievable goals you can stick to and go from there.

    As we all adjust to our post-pandemic society, remember: Everyone’s timeline will be a little different based on their mental health and their experiences over the past tumultuous year. If anxiety is interfering with your life, don’t hesitate to seek help. We’ve been here for you, and we will be here—no matter what curveballs the next year throws our way.


    Struggling with post-pandemic anxiety?
    The mental health team at MedStar Health is here to help. Call 202-877-3627 or click below.

    Request an Appointment

  • June 30, 2021

    By Oliver Tannous, MD

    The human spine is a miraculous, elegantly balanced system, the foundational support of the entire body. Gently curved in an S-shape, the spine balances the neck, chest, lower back, and pelvis to keep the  head, trunk, and legs in alignment.

    It provides a protective sheath for the spinal cord—the main conduit of the nervous system—and for some internal organs as well. It provides us with the support structure to maintain an upright posture. And it flexes to allow freedom of movement; in fact, every movement we make engages the spine.

    What Causes Back or Neck Pain?

    The spine is a stack of 33 vertebrae connected and cushioned by cartilage and connective tissue. These vertebrae are linked by facet joints that, like other joints in the body, can experience inflammation, degradation, and pain. Pain in the back or neck can occur when vertebrae, facet joints, or other spinal components feel the long-term impact of injury, poor posture, inactivity, too much sitting, or certain diseases.

    Over time, just about everyone will develop a spinal issue. By age 25, one in four people show some level of degeneration within the discs, pads of cartilage that separate the vertebrae and act as shock absorbers. Two-thirds of adults age 40 show disc deterioration; by age 60, 90 percent are affected.

    This progression is a normal side effect of aging and gravity over the years. And, although most adults are affected, not everyone shows symptoms of this degeneration. Often, it only becomes painful once it reaches a severe stage.

    But if you’ve ever experienced back or neck pain in any form, or know someone who has, you’ve seen its potential impact on quality of life. With even mild or moderate pain in the back or neck, an individual may have to forgo certain activities, can become increasingly sedentary, or might even have difficulty doing their job. At its most severe, spinal pain may even require a visit to the emergency room. And long-term pain can also spur depression, downheartedness, and other forms of psychological distress.

    Most typically, back and neck aches result from muscle strain, weakness, and lack of tone and conditioning due to inactivity, or from the opposite extreme—over-use or over-exertion. Fortunately, when it comes to addressing these more common complaints, a patient can frequently improve back or neck pain by following a simple program of targeted therapy.

    Targeted Therapy

    Although physical activity and exercise generally benefit good health, most of these activities do not specifically work to strengthen and condition the back. For patients who have sustained a neck or back injury, or who regularly feel some degree of pain and discomfort after certain activities, the best approach to improving their back health is a regular course of physical therapy.

    The therapist initially works with the patient to strengthen, stretch, and relax the area and relieve any discomfort from injury or overuse as quickly as possible. Then the patient is counseled on how to continue the regimen at home to keep the back in good condition.

    Recommended exercises and other physical movements are simple and constructive, typically requiring only a good exercise mat and a few resistance bands. For regular exercisers and the serious athlete, we may advise an additional level of targeted exercise, to protect and strengthen the neck and back for more specific activities.

    Most patients with neck and back pain do not need surgery: targeted therapy can improve their condition. 10 tips for a healthy spine from orthopedic spine surgeon Oliver Tannous, MD. https://bit.ly/3x5SzM9 via @MedStarWHC
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    10 Tips for Maintaining a Healthy Spine

    1. Stretch and strengthen the back

    Motivated patients often maintain a steady regimen of targeted stretching and strengthening, which is key to long-term success in managing and controlling spine pain.

    2. Maintain a healthy weight

    Excessive weight can place undue physical stress on the spine. Also, excess weight can often result in additional diseases or physical conditions that may further impair the spine or intensify existing issues.

    3. Don’t Smoke

    Nicotine is a vasoconstrictor—it tightens blood vessels, reducing blood flow and limiting oxygen and nutrition to the spine. Vasoconstriction can accelerate inflammation and degradation within the spine and throughout the body.

    4. Reduce or eliminate inflammatory foods

    Avoid a diet of inflammation-causing dairy, red meats, refined sugar, and other processed foods. Opt instead for healthy anti-inflammatory food choices, such as plant-based foods that are also naturally low in calories and help to discourage excessive weight gain.

    5. Take care with heavy lifting

    The act of bending to lift a heavy load places a large strain on the spine. Use correct technique when lifting: Keep the back straight, bend the knees, and recruit the power of the legs to complete the lift.

    6. Stay in motion

    Remaining in one position for an extended time is hard on the spine. Keep the spine activated—for example, if you must sit for long periods at work, take frequent breaks. Move around, walk, and occasionally exercise or stretch to keep your back flexible and limber.

    7. Stand whenever possible

    Constant sitting makes it nearly impossible to maintain neutral spine alignment—and that can contribute to spinal stress. Standing is frequently the better option. Many of my patients appreciate their stand-up desks. Another alternative: sitting on a large workout ball rather than an office chair, to engage the core and encourage the back to remain erect.

    8. Try yoga

    Yoga is a highly beneficial activity that can both strengthen and stretch muscles. Beginners should start slow to avoid aggravating any possible existing conditions with the back or neck. The yoga instructor can recommend any necessary modifications that will protect your spine while helping you get the most from each pose.

    9. Get into the water

    Water therapy can play a very helpful role in alleviating back issues, especially for older patients or those who experience severe discomfort with a land-based approach. Water exercise can be an effective way to build strength and confidence, and pave the way for eventual land therapy.

    10. Seek a doctor’s advice

    It makes sense to seek medical attention when neck or back pain is persistent—if it flares regularly or never fully dissipates. Your primary care provider will check for numbness, tingling, sciatica, or any other indicators of nerve involvement.

    Be assured, in most instances, back or neck pain will not require surgery. Your doctor may refer you to an orthopedic surgeon for further examination, or to a physiatrist, a doctor specializing in pain management.

    Comprehensive Care for Your Spine

    MedStar Washington Hospital Center features a superb, integrated program for spine health. Our specially trained providers focus primarily on non-surgical approaches to treating and managing back and neck pain.

    Our affiliation with the MedStar National Rehabilitation Network gives us access to some of the best physical therapists in the region. For most patients, we can tailor a program of physical therapy that works quickly to improve their condition.

    If you’re experiencing persistent neck and back pain, keep in mind that it typically won’t go away on its own. Follow our tips and remember: targeted therapy remains the most effective way to prevent and relieve most neck and back pain and to start you on the path to more pain-free living.


    Persistent back or neck pain?

    Trust our specialists to help.

    Call 202-788-0402 or Request an Appointment