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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • September 18, 2018

    By Sarika N. Rao, DO

    Most patients respond well to standard therapies for thyroid cancer. The five-year survival rate is more than 98 percent, and thyroid cancer is responsible for less than 0.5 percent of all cancer-related deaths. Even in advanced stages, we have many effective weapons in the fight against thyroid cancer.

    Thyroid nodules are common and generally are detected during an imaging test performed for some other reason, such as a CT scan after a car accident or during a physical exam of the patient’s neck. Nodules will then be examined by ultrasound and subsequently biopsied depending on their appearance to determine whether the nodule is cancerous, and if so, what type of cancer it is.

    Determining a patient’s specific cancer type helps us plan the appropriate treatment. There are four main types of thyroid cancer:

    • Papillary thyroid cancer: 80 to 85 percent of cases (a differentiated thyroid cancer)
    • Follicular thyroid cancer (including Hurthle cell thyroid cancer): 10 to 15 percent of cases (a differentiated thyroid cancer)
    • Medullary thyroid cancer: 1 to 2 percent of cases
    • Anaplastic thyroid cancer: less than 2 percent of cases

    Every case is different, and we closely work with each patient and their entire care team to determine the most effective treatment options. I’ve outlined our general approach to thyroid cancer as well as more advanced treatment options below.

    LISTEN: Dr. Rao discusses treatments for standard and advanced thyroid cancer in the Medical Intel podcast.

    Treatment of differentiated thyroid cancers

    Thyroid surgery

    The type of thyroid surgery is based on the extent of the of thyroid cancer. For smaller, single-nodule thyroid cancers, often a lobectomy (removing only part of the thyroid gland) is sufficient, followed by close monitoring. However, a total thyroidectomy with or without lymph node dissection is recommended for larger, multi-foci thyroid cancers.

    Following surgery, we evaluate the full pathology report and determine the specific type of thyroid cancer, the extent of the disease (including sites of local invasion), and its stage. If we confirm a diagnosis of differentiated thyroid cancer (papillary, follicular, or Hurthle cell), then, based on the extent of disease, we could recommend radioiodine therapy.

    Radioiodine therapy 

    Radioiodine therapy, also known as RAI therapy, is an important treatment step in differentiated thyroid cancers. Because thyroid cells love iodine, the intent of using a radioactive form of iodine is to “kill” or “ablate” any remaining thyroid cells after surgery.

    In preparation for this treatment, a patient needs to refrain from consuming foods with iodine for a few weeks in an effort to “starve” the thyroid cells of iodine, so that they will be “hungry” when the treatment dose is delivered. Additionally, we also want the thyroid stimulating hormone (TSH) to rise, either naturally by withdrawing the thyroid hormone replacement or synthetically using a drug known as Thyrogen®. This will stimulate any remnant or recurrent thyroid cells.

    At the time of treatment, we begin with a low-dose of RAI and a diagnostic scan to help us identify the presence of thyroid cells that take up iodine. If the scan proves there is evidence of uptake, we proceed with the higher ablative dose of RAI. One week later, a post-treatment scan is obtained, and we often will use the results of this scan to further stage the cancer. This can show evidence of thyroid cells located outside the thyroid bed, indicating both regional and/or distant spread of the disease that hopefully will be treated with the ablation. The ablative effect on the thyroid cells may take up to six months to notice structural or biochemical changes. RAI after surgery has been shown to reduce tumor recurrence and improve patient outcomes compared with patients who don’t receive postoperative RAI treatment.

    #Radioactiveiodine therapy after #thyroidcancer surgery reduces tumor recurrence and improves patient outcomes. https://bit.ly/2xrXlWF via @MedStarWHC
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    Following ablative RAI therapy, the patient must take precautions for one week to protect others from radiation exposure, especially young children and household pets. We provide detailed instructions, which can include:

    • Arrange childcare for infants and young children
    • Avoid public transportation
    • Avoid sharing plates, cups or eating utensils
    • Refrain from kissing and physical contact

    After surgery and RAI therapy, we want to reduce the risk of recurrence by preventing any remaining thyroid cells from getting larger. Simultaneously, we need to replace the patient’s thyroid hormone following the removal of the thyroid gland. We accomplish both goals through thyroid-stimulating hormone (TSH) suppression therapy.

    TSH suppression after thyroid cancer surgery

    The dose of thyroid hormone replacement (T4) after surgery is weight based, however the calculated dose for a patient with benign disease is lower than those with thyroid cancer. The higher dose is prescribed to suppress the TSH, which is made in the pituitary, from stimulating any remnant thyroid cells after surgery and RAI therapy. Patients need regular blood tests to make sure their TSH levels are well-controlled.

    Concurrently, we also are measuring the protein known as thyroglobulin (which is normally made by the thyroid cells) and the thyroglobulin antibody. In the absence of the gland after surgery and RAI therapy, a patient’s level should be low to undetectable. Hence, we use the thyroglobulin as a tumor marker for differentiated thyroid cancer.

    Treatment options for recurrent thyroid cancer

    The following options often are necessary to treat recurrent differentiated, medullary, or anaplastic thyroid cancer. We also may need to use these tactics for patients whose papillary or follicular thyroid cancer recurs or doesn’t respond to RAI therapy. Our treatment options in these cases include:

    • Surgery: We may be able to resect medullary or anaplastic thyroid tumors or recurrent cancers that are localized in the neck, and this treatment offers the best survival.
    • Alcohol ablation: This percutaneous treatment can be used to treat localized differentiated thyroid cancer that has failed the standard therapies by focally ablating the patient’s nodule with an ethanol injection.
    • Radiation therapy: If the patient’s thyroid cancer metastasizes to bones, such as the spine or ribs, it can be difficult to resect the lesions surgically. Radiation therapy, though less commonly used, can target these sites.
    • Targeted therapies: For cases in which the patient’s thyroid cancer recurs after RAI ablation and are considered RAI-refractory disease (which means their disease no longer responds to RAI therapy) and for disease not surgically resectable, we may turn to tyrosine kinase inhibitors, such as lenvatinib (Lenvima®) or sorafenib (Nexavar®) where these agents have been approved for use in differentiated thyroid cancer. Additionally, vandetanib (Caprelsa®) and cabozantinib (Cometriq®) have been approved for use in advanced medullary thyroid cancers. These oral chemotherapy medications provide systemic therapy for patients with rapidly progressive or metastatic disease. Patients with resectable or non-resectable cancer or anaplastic thyroid cancer should also be considered for clinical trials.

    Active monitoring

    In cases of asymptomatic but persistent thyroid cancer, active surveillance is very important. Close monitoring can give the patient peace of mind and allow the doctor to quickly act if the cancer begins to grow or spread. However the decision to operate or initiate a more aggressive medication, such as those listed above, depends on several factors, including the patient’s symptoms, location of disease, and how fast the disease is growing. In many cases, especially if the patient is asymptomatic and their known sites of disease are remaining stable, it may be preferable to spare the patient the financial cost and stress of treatment for what may be little or no noticeable benefit.

    There are many effective methods available to treat patients with advanced thyroid cancer. Through a team-based decision-making process that includes the patient, their endocrinologist, surgeon, nuclear medicine specialist and potentially other providers, we can create a plan that addresses each patient’s unique concerns and provides the best chance for a successful outcome.

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  • September 12, 2018

    By MedStar Health

    Migraines are quite common, affecting 18 percent of women and 6 percent of men in the United States, according to the Migraine Research Foundation. It is a more severe type of headache with moderate to severe pain on one or both sides of the head and usually is accompanied by an upset stomach, sensitivity to light and sound, and in some cases, vomiting. Thankfully, there is a plethora of over-the-counter (OTC) and prescription medications available for treating it. But, what if you could lessen the pain ahead of time or at least prevent your migraine from interrupting your day and sending you to the nearest emergency room? Here’s everything you need to know about migraines and how to treat them.

    Migraines with aura vs. migraines without aura

    Migraines can be broken down into two broad categories, migraine with aura and migraine without aura. A migraine with aura is a migraine that comes after a brain symptom, and often, that symptom is a change in vision. For example, you may see a bright flashing spot that turns dark. The spot might move for a few minutes or grow to the point where it’s difficult to see through that spot, and the aura will resolve within sixty minutes from when it started. Usually, a migraine follows immediately after or within an hour after the aura resolves itself.

    While visual aura is the most common, there are other types of aura. Some examples include a sensation of numbness, tingling, or weakness on one side of the body, dizziness or a sense that the room is moving, or difficulty speaking. The initial episode of migraine with aura can be especially frightening because the symptoms are similar to that of a stroke. Symptoms lasting longer than one hour should be evaluated by a medical professional, and you should see your health care provider to discuss your symptoms if you have experienced what may be migraine with aura.

    Migraine without aura, is more common, and occurs when there is no associated aura prior to the migraine. People experience head pain with nausea or vomiting and light and sound sensitivity. The pain is often one-sided, throbbing or pulsing in nature, and can worsen with physical activity. That said, people who have migraines without aura may also experience migraines with aura on occasion.

    Do you suffer from frequent migraines? Request an appointment today with a specialist in St. Mary's County.

    Request an Appointment

    Can certain things trigger a migraine?

    Migraine is a genetic disease that can be impacted by the environment. Often, migraine is the result of having a certain genetic makeup, through which you inherit a brain that is more sensitive, and changes in your behavior, habits, or the environment around you can cause a migraine cycle to occur.

    There are several environmental changes that can trigger migraines. Most often, these factors include:

    • Changes in the weather (i.e. before or after it rains or snows)
    • Dehydration
    • Hormonal changes, for women (before or during menstrual period, during early phase of menopause)
    • Lack of sleep
    • Overuse of OTC medications
    • Stress

    In addition, many people consider food as a trigger for migraines, but currently, there is no substantial evidence to support this. It’s hard to say that particular foods always correlate with migraine attacks because symptoms and triggers can vary from person to person. It’s actually rare that migraines are caused by one particular thing. Usually, certain factors layer and feed off of each other, and when combined, they can trigger a migraine. For example, if you’re working long hours and under a lot of stress, have irregular sleep patterns, don’t exercise regularly, and don’t eat nutritious meals, then together these factors could trigger a migraine.

    What do you recommend for pain relief?

    Depending on the severity of your migraine and how fast it starts, some relief methods will be more effective than others. Since migraine headaches can last for up to three days, it’s important to treat them as soon as they begin and get your symptoms under control. If your migraine starts with moderate pain that builds gradually, consider taking an OTC medicine that includes one of the following ingredients:

    • Acetaminophen
    • Aspirin
    • Ibuprofen
    • Naproxen
    • Salicylic acid

    Before taking a medication, it is important to always consult with your primary care provider about treatment options, especially if you’re already using prescription drugs for a different condition. When using any type of medicine, you should follow the directions stated on its label. You can also treat your symptoms using holistic and topical methods like taking deep breaths, sleeping, or applying an ice pack, heat pack, or mentholated cream to your head.

    For those who are still unable to relieve the migraine using these methods, I recommend speaking with your provider about prescription options or a more targeted treatment with a neurologist. Ask your doctor or neurologist about a preventive method to decrease the frequency of the headaches so they don’t negatively impact your life.

    Does gender play a role in causing migraines?

    Due to hormonal changes, migraines tend to be more common in women in comparison to men. What’s interesting, though, is that during childhood, migraines occur more frequently in boys than in girls, but as they reach puberty, the reverse happens. As boys age, their frequency of migraines tends to decrease over time, and when girls begin their menstrual cycle, the possibility and frequency of migraines can increase as they get older. It’s possible that the frequency may be affected by the increase of testosterone in young men and the lack thereof in young women during puberty. While more research needs to be done on the effects of testosterone, some medical experts say it could reduce inflammation, and as a result, reduce the pain and other side effects of migraine attacks. However, at this time, there is no substantial proof to support that theory.

    Is it possible that migraines can be a sign of something more serious?

    If you’re concerned that you may have a more severe, underlying condition, a neurological exam can determine if anything else is going on in addition to your migraine. For adults over age 50 who have new onset headaches, unlike anything they’ve experienced before, that could be a sign of something more serious. If you already have a history of migraines, but there’s a change in the pattern or frequency or they’re accompanied with fever, weight loss, or confusion, that’s also a concerning sign. If you have a preexisting condition, that can compromise your immune system, your doctor may further investigate if anything else is causing the acute headaches. In any of these scenarios, I recommend that you get a neurological exam and seek specialized care from a physician.

    Now that you have a better understanding of migraines, their unique characteristics, and treatment options, I hope you feel empowered to take control of your symptoms and tackle your migraines head on. For those with acute cases of migraine attacks, pain relief is attainable with the help of your primary care doctor or neurologist. With more knowledge and resources in tow, you have the advantage over your headaches and can maintain a great quality of life.

    Do you suffer from frequent migraines? Request an appointment today with a specialist in St. Mary's County.

    Request an Appointment

  • September 05, 2018

    By MedStar Health

    Running is a great way to lose weight and de-stress. However, a benefit that is often overlooked is that running can help treat or prevent certain heart conditions, high blood sugar, and symptoms of depression.

    While medications and regimens might be necessary to help manage symptoms and improve quality of life, running is free! Moreover, I’ve found that people who run often do so in social communities. There are many clubs and groups you can join to socialize and make new friends while improving your health.

    You tell us: Have you been a part of any fun running clubs or groups in your community? Tell us Twitter with @MedStarHealth and #LiveWellHealthy.

    How running can help with four health conditions

    1. High blood pressure (hypertension)

    Exercise, such as running, can help lower your blood pressure. Regular physical exercise can make your heart stronger, and a stronger heart can pump blood more easily, lowering your blood pressure. Furthermore, regular exercise can prevent your blood pressure from rising as you age and help keep your weight under control–another important way to avoid hypertension. With these benefits in mind, remember that exercise must be a done consistently to positively impact your blood pressure long term.

    One form of natural medicine that is easy but often forgotten is running, says Dr. Matthew Sedgley. Discover what benefits it can bring to your health via @MedStarHealth

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    2. High cholesterol

    Exercise can help raise good cholesterol, or high-density lipoprotein (HDL). Studies have shown that physically active people have higher levels of HDL cholesterol than those who are sedentary. Additionally, when combined with a healthy diet, exercise can help lower your total cholesterol numbers.

    3. Type 2 diabetes

    Exercise is an important part of the treatment plan for individuals with type 2 diabetes. Staying fit and active throughout life can help people control their diabetes and keep their blood glucose (blood sugar) levels in a healthy range, which is essential to preventing long-term complications,  such as kidney disease and nerve pain.

    Exercise can even help prevent blood glucose from rising to begin with. Exercise causes the muscles to contract, and it also increases insulin sensitivity–both of which help your cells use glucose for energy, rather than continuing to store it in the blood.

    4. Depression symptoms

    "Runner’s high” is a term that refers to the mental benefits of running. When you run, the brain releases endorphins, or chemicals that make you happy. This is a much better energy spike than consuming high-sugar products.

    Running or brisk walking can help reduce some symptoms of clinical depression, according to studies. This benefit is likely due to the body releasing endorphins along with other factors, such as:

    • Occupying your mind elsewhere
    • Raising self-confidence
    • Getting more social interaction

    It’s important to remember that running isn’t a replacement for medical care. But it’s a good way to compliment what you’re already doing to manage ongoing health conditions while actively reducing the risk for others.

    Running doesn’t require a lot of material commitment–just a good pair of shoes. Running can be an effective form of medicine and a fun, easy way to improve your health. Some people are a bit intimidated by running, especially in a group setting. My advice is to focus on finishing your goal, whether it’s running for half a mile or three miles. Don’t worry about how long it takes you or what people think, just relax and focus on your health.

     

    Looking for a great place to run? MedStar Sports Medicine is a proud partner of several races in your community.

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  • September 04, 2018

    By Ross Krasnow ,MD

    "You want to put your finger where? Why? Do you really need to do that?” I’ve heard many men say this or something similar after I recommend a digital rectal exam, also known as a DRE.

    I understand where they’re coming from. The test can be a little uncomfortable. But the value of DREs in detecting prostate cancer and other urological problems far outweighs a little awkwardness. That’s especially important for patients in Washington, D.C., We have the second-highest incidence rate of prostate cancer in the country and the highest number of people who die from the disease.

    A DRE actually is the second of two tests I use when screening patients for prostate cancer. The first test is a blood test for prostate-specific antigen, or PSA. Let’s go over how the two tests work together and what you can expect from a prostate cancer screening.

    LISTEN: Dr. Krasnow discusses the effectiveness of digital rectal exams in the Medical Intel podcast.

    Better together: A PSA test and digital rectal exam

    PSA is a protein that’s created by the prostate and present in semen. Small amounts of PSA naturally leak out into the bloodstream, but a higher-than-normal amount of PSA in the blood can indicate that a man may have prostate cancer. An elevated PSA level also can be sign of prostatitis (infection or inflammation of the prostate) or an enlarged prostate (also known as benign prostatic hyperplasia).

    When one of my patients has a high level of PSA in his blood, a DRE helps me understand and interpret what’s really going on inside the prostate. By feeling for any lumps or signs of cancer in the prostate, the rectum or nearby organs, I can get a better idea of whether my patient has prostate cancer, an enlarged prostate, or another condition. The combination screenings of PSA and DRE can tell us whether we need to move forward with more-invasive testing, such as a prostate biopsy.

    A #digitalrectalexam can help doctors diagnose #prostatecancer or other #prostate conditions. 
    https://bit.ly/2LVu4c4 via @MedStarWHC

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    Who needs a digital rectal exam?

    Your doctor’s recommendation will depend on your individual risk for prostate cancer. Certain factors can increase your risk, such as being of African-American descent or having a father, son or brother (a first-degree relative) who was diagnosed with prostate cancer when he was younger than 65.

    The American Cancer Society recommends that doctors and patients discuss screening based on unique risk factors and following these general age guidelines:

    • Age 50 if a man is at average risk
    • Age 45 if a man is at high risk (African-Americans or one first-degree relative diagnosed with prostate cancer at an early age)
    • Age 40 if a man is at highest risk (two or more first-degree relatives diagnosed with prostate cancer at an early age)

    If your PSA test is normal, you probably only need to have PSA tests and DREs every two years. An elevated PSA test might mean you need yearly screenings to make sure we don’t see evidence of prostate cancer.

    Men who are older than 70 usually don’t need a DRE or other prostate cancer screening. We also usually recommend against screening in men who aren’t expected to live at least 10 more years, as they’re less likely to benefit from treatment if we were to find prostate cancer because of the slow-growing nature of the disease. Of course, this is a decision only you and your doctor can make together.

    What to expect during your digital rectal exam

    I typically use a mannequin to show my patients the area I’ll examine during their DRE. The prostate is a walnut-sized organ that sits right in front of the rectum, directly under the bladder. We can’t feel the prostate from outside the body, so the rectum is our best and easiest way to access it.

    During the exam, your doctor will wear a glove. They’ll lubricate their finger so the test is a little more comfortable. You’ll be undressed below the waist, either bending over the exam table or lying on the table on your side. The doctor will insert a finger and feel for any lumps or hardened areas on the prostate. The test takes just a few seconds to complete. You may feel like you have to urinate during the test, and there may be some discomfort. However, it usually isn’t painful.

    Though a digital rectal exam may be a little awkward, it plays an important part in the early diagnosis of prostate disorders and cancer. Ask your doctor about your risk for prostate cancer and whether you need to schedule this quick, potentially lifesaving procedure.

    Call 202-877-3627 or click below to make an appointment for a prostate cancer screening.

    Request an Appointment

  • August 31, 2018

    By David Balto

    “When we bless life, we restore the world.” ~ Rabbi Marcia Falk

    I am a Chaplain in a 912-bed inner-city hospital in Washington, D.C., who loves to bless and recognize blessings. Once a year, we visit all the patient units in the hospital and bless the hands of scores of nurses. Blessings are the substance of my spiritual day.

    But as I walk through the hospital, I often see other employees (we call them associates) who probably need to feel blessed and receive a “thank you.” What happens to the woman who cleans the bathrooms, the man who washes the dishes, the associates who cook and prepare the food, and those who remove the trash? How about the associates who run the infrastructure, make sure the hospital is clean, keep the machines operational? Do they know we are grateful for their efforts? Do they feel blessed?

    In the hospital, I reflect as I pass the associates transporting patients, the clean-up crews, the trash collectors: Do I notice them? Do I fully recognize their work? Have I expressed my gratitude?

    So, one day I decided to try to do just that.

    100 Blessings a Day

    There is a Jewish tradition of saying 100 blessings a day. Jews have blessings for practically everything, from lifting sleep from one's eyes, to seeing beautiful objects, to the blessings of nature and for the simplest bodily functions.

    In that spirit, I offered 100 blessings throughout the hospital one day in a different way. Rather than saying the traditional 100 blessings in our liturgy, I prepared 100 blessing cards to hand out to whoever agreed to receive a blessing. I set out to find 100 associates who do not normally deal with the public to bless them.

    The hospital is a huge campus with thousands of support staff. I walked all over the hospital, finding the places in the deep infrastructure unknown to the public. I blessed associates who sweep floors, wash dishes, empty bedpans, move equipment, gather trash, answer phones, fix computers, and transport patients. They keep our hospital running, but they probably don’t hear words of gratitude as often as they should.

    I asked them their name, how they were. I asked them if they wanted a blessing, and if they said “yes,” I gave them a blessing card, took them by the hands, and blessed them.

    May these hands be blessed for the loving care they give.

    May these hands be blessed for the kindness they show.

    May these hands be blessed for the great mitzvot (good deeds) they perform.

    May there be a great blessing on these hands.

    I was touched by so many of the encounters. In the kitchen, associates grabbed me and said, “You must bless my colleague.” Some staff told me about their fears and concerns and asked for prayer. Associates told me of relatives and friends who also needed a blessing. I found people who rarely see another person whose spirits were lifted just by a visit and by the words of blessing. And I gave some people the chance to pause and recognize the blessings of their work, how what they do affects the lives of everyone in the hospital – patients, staff and the public.

    One encounter that touched me was with an Environmental Services associate who had just cleaned the room where a patient died. He told me how he worked so hard to make the place completely spotless, how he felt it was sacred space because a person had died there, and how he wanted to make the space immaculate for the next patient. I blessed his strong and kind spirit.

    4 Lessons Learned

    I learned four invaluable lessons from giving these blessings.

    We typically do not see or acknowledge the tremendous efforts of all the dedicated associates who make the hospital work. Just as we say in Psalms that a human being is “wondrously made,” a hospital functions because of the efforts of thousands of wondrous people focused on a wide variety of tasks, many of which require tremendous effort.

    Second, taking the time to acknowledge, speak with, greet, thank and bless another helps support-team members recognize their own humanness and the vital nature of their tasks. There is a hidden seed of wholeness in each person; acknowledging and blessing the person helps that seed blossom. It reminds the person that they are performing a holy task in serving others.

    Third, blessings take us out of the world of the ordinary, of taking things for granted and bring us to a world of radical amazement. When we bless we see the wonder around us and see how each person is making a unique contribution. Blessings help us to feel and perceive the unique humanness of each person and how we are all connected.

    Finally, the one who offers a blessing is blessed as well. When we bless, we recognize the blessings we have received. As Rabbi Marcia Falk observes, “When we bless others, we free the goodness in them and in ourselves. When we bless life, we restore the world.”

    I felt I received the greatest blessing by giving blessings that day. It expanded my heart and helped me see God in so many faces. Perhaps some days the greatest blessing we can give is to those who work in humble silence to get the job done.

    Meister Eckhart said it best: “If the only prayer you ever say in your entire life is thank you, it will be enough.”

  • August 30, 2018

    By MedStar Health Research Institute

    Research Grand Rounds are sponsored by MedStar Health Research Institute and Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) and bring together the MedStar Health community for a learning experience focusing on a different topic each month.

    The Hispanic Community Health Study/Study of Latinos: Building the project, baseline findings, and future research opportunities
    Presented by M. Larissa Aviles-Santa, MD MPH
    Medical Officer at the National Heart, Lung, and Blood Institute at the National Institute of Health

    Following training in endocrinology and a junior faculty position at UT Southwestern, Dr. Avilés- Santa joined the National Heart, Lung, and Blood Institute (NHLBI) in 2006 to  direct the Hispanic Community Health Study - Study of Latinos (HCHS-SOL), assessing risks and protective factors for chronic (particularly cardiovascular and pulmonary) diseases, and their morbid outcomes in diverse Hispanic/Latino populations. She is an expert on the study and prevention of diabetes and cardiovascular disease in underserved populations, particularly among Hispanic communities. HCHS-SOL has enrolled over 16,000 adults of Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds, into a rigorous and comprehensive longitudinal study, spanning sites in Chicago, Miami, San Diego, and New York (the Bronx), creating a unique multidisciplinary and multi-institutional research team to address important health disparities impacting understudied and heretofore under-characterized populations. Her presentation will provide an overview of the HCHS-SOL, its rationale and design; discuss some of the key early findings; its current status, and potential opportunities for collaboration.

    September 7, 2018
    12 Noon to 1 PM – Presentation
    1 PM to 1:30 PM – Lunch
    MedStar Washington Hospital Center, 6th Floor, CTEC Theater
    110 Irving Street, NW, Washington, D.C., 20010

    Live-Stream Link: http://georgetownu.adobeconnect.com/mhri

    Research Grand Rounds are open to all members of the research team, from principal investigators to clinical and research coordinators and trainees. Topics covered in the Research Grand Rounds range from community-focused research to best practices and are intended to increase collaboration within the research community in and outside of MedStar Health. For more information, please contact Research@medstar.net or visit http://www.georgetownhowardctsa.org/.