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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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  • August 28, 2018

    By MedStar Health

    Increasingly younger patients are seeking partial or total hip or knee joint replacement—people in their 40s, 50s and 60s who are working and active and who can’t afford to slow down. As such, researchers expect a 77 percent growth in joint replacements over the next decade. These patients may have a surgical option previous generations never had before: outpatient joint replacement surgery. These advanced procedures allow patients to go home in as little as 24 hours after surgery.

    Patients who are good candidates for outpatient joint replacement surgery are those who:

    • Are healthy and active
    • Are non-smokers
    • Have a low body mass index (BMI)
    • Have a good support system at home

    It’s crucial that patients who go home the same day as their joint replacement surgeries have a robust support system at home—a friend or family member who can care for them so patients can enjoy all the benefits of outpatient techniques.

    Many patients come to us who have been turned away from other centers. A lot of patients who come to us either have significant joint deformities or they’ve had several procedures that have been unsuccessful in the past. We evaluate them to provide a more stable functional prosthesis. We will frequently see those patients at our institutions because we use a personalized team approach that includes care at every step along the way—before, during and after their surgeries.

    LISTEN: Orthopedic surgeon Savyasachi Thakkar discusses same-day joint replacements in the Medical Intel podcast.

    What are the benefits of outpatient joint replacement?

    One of the biggest benefits for patients is to recover in the comfort of their own home. We make this possible by collaborating with social workers called the post-acute care (PAC) coordinators. These experts address all of a patient’s needs before, during and after surgery. This includes home-based physical therapy for two weeks after surgery, which has several benefits for patients:

    • Better pain levels without ongoing in-hospital vitals checks
    • Cleaner, better-controlled environment
    • Fewer falls after surgery
    • No need to arrange transportation to physical therapy

    For all of these reasons, outpatient joint replacement recovery often is healthier, quicker and much more effective than recovery after inpatient surgery.

    Recovery after same-day #jointreplacement often is healthier, quicker and much more effective than recovery after inpatient surgery. bit.ly/2Nqoekz via @MedStarWHC

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    We saw an energetic individual who clearly demonstrated a need and desire to get back to her active lifestyle. She needed a knee replacement surgery to do that. We brought her in for surgery and performed the operation without any complications. In fact, she was so ecstatic with her mobility and pain control that she was eager to leave the very same day.

    How do outpatient and traditional joint replacements compare?

    The actual surgical procedure is similar for both traditional and outpatient joint replacements. The main difference for patients who undergo traditional surgery is that rehabilitation occurs in the hospital, not at home. Inpatient rehab patients may experience:

    • Higher pain scores because they’re not in their normal home environment
    • Increased cost for the hospital stay
    • Longer rehabilitation times

    joint replacements make sense for some patients who are elderly and more fragile, who don’t have support systems at home and who are less active. But for more active, younger patients, we think that outpatient procedures are the way to go.

    Frequently asked questions about outpatient joint replacement

    How long is the recovery process?

    For a younger, more active individual, recovery could be as quick as three or four weeks. For an elderly patient, it could be about seven to eight weeks. Many patients who have had these outpatient procedures are raring to go back to work after six weeks. We are starting to see a larger proportion of patients who want to get away from the distraction of having surgery and reduce their pain by going back to work sooner.

    Is it possible to completely return to normal after surgery?

    Absolutely! Joint deterioration happens over a long time, though it might cause noticeable symptoms only for a few months or a few years. Joint deterioration is associated with several other problems, such as loss of muscle mass and inability to perform or enjoy daily living activities. Those things take about three or four months to get back to normal. Our team of specialists work together to minimize pain as much as possible, and for the most part, when patients are pain-free after surgery, they experience such relief that they are able to tackle life at a much faster pace.

    Related reading: Am I too young for knee or hip replacement?

    What are the advantages of a team-based approach?

    We have several specialists devoted to patients who need joint replacements. The team treats about 1,000 patients each year at MedStar Washington Hospital Center, from simple hip and knee replacements to complex surgical revisions:

    • Dr. James Tozzi and Dr. Savyasachi Thakkar perform primary and revision hip and knee replacement surgeries
    • Dr. Wiemi Douoguih and Dr. David Johnson perform primary knee replacement surgeries
    • Physical therapists evaluate patients before surgery, immediately after surgery and then six to eight weeks after surgery on a continual basis
    • Social workers exclusively care for patients having knee and hip replacement surgeries who also have complex medical needs and complex social situations
    • Specialized nurses are devoted to patients on our orthopedic floors

    We are a tertiary care facility, which means our patients also have streamlined access to other specialists, such as neurosurgeons, cardiac surgeons and other various doctors and specialists, so that any potential complications can be addressed easily. Also, if a patient we initially planned on leaving the same day ends up needing to stay in the hospital for a night or two, it’s easier to transition the patient. This is in contrast to numerous surgery centers that are popping up across our communities, where they do not have such facilities or expertise.

    5 areas of upcoming research in total joint replacement

    Joint replacements have come a long way, especially during the last decade, but there’s still room to grow. We are focusing on several areas of research for joint replacement patients:

    • Improved patient outcomes through best practices and procedures that focus on safety and reduced readmissions.
    • Pain management research so we can deliver different kinds of therapies at the same time.
    • Pre- and postoperative nerve ablation, which is the blocking of pain signals from nerves using radiofrequency ablation to remove the skin nerves around the incision sites of the surgery, reducing pain.
    • Robotics or computer-assisted navigation to help us reduce operative time, blood loss and the need for blood transfusion. We’re calling this “bloodless surgery” because we can avoid significant blood loss, reduce the risk of blood clots and perform the procedures safely without the risks involved with blood transfusion.
    • Alternative bearing surfaces, in which we cap the bones with different materials that help form the new joint. Alternative bearing surfaces can give patients better pain control, better mobility and longer-lasting joint replacements.

    We think most patients are shocked at first by the notion of having a joint replacement surgery and leaving the hospital the same day. They are often nervous about the idea, but when they look at our pain control strategies and how we have organized treatment for them, most patients wake up after the surgery remarkably happy and satisfied. They go home feeling comfortable that they can call us anytime and someone will be available to answer their questions, ease their fears and help them transition back to a more active lifestyle.

     

    Thinking about a hip or knee replacement? Call 202-877-3627 or click below to make an appointment today.

    Request an Appointment

  • August 24, 2018

    By Christopher M. Gallagher, MD

    Triple-negative breast cancer is notoriously difficult to treat. It grows aggressively, and it lacks the three most common markers (estrogen and progesterone receptors and the HER2-neu protein) that we often target in our treatments. Some of our gold-standard treatments don’t work well enough against this type of cancer, and national survival rates are lower within five years of diagnosis compared to other forms of breast cancer.

    As such, we are continually researching better ways to screen for and prevent this type of breast cancer. So when an August 2018 study published in the Journal of the National Cancer Institute found that several previously unknown genetic mutations were associated with a higher lifetime risk of triple-negative breast cancer, we were eager for good news. Some popular media outlets suggested that genetic testing could help identify more at-risk women and lead to better prevention strategies.

    There’s no doubt that the discovery of these mutations is a potential breakthrough for triple-negative breast cancer prevention. But not every woman should rush to genetic testing to determine her risk. While there seems to be more benefits for women who previously have been diagnosed with triple-negative breast cancer, the results of genetic testing may not be as helpful for women who have never had the disease.

    Benefits of genetic testing for triple-negative breast cancer survivors

    The current guidelines from the National Comprehensive Cancer Network (NCCN) state that women should be referred for genetic counseling if they:

    • Have been diagnosed with triple-negative breast cancer before age 60
    • Were diagnosed with any type of breast cancer at or before age 50
    • Have a close family member, such as a mother, grandmother, or sister, who has been diagnosed with breast cancer or ovarian cancer
    • Have been diagnosed with two separate breast cancers

    If a patient is referred for genetic counseling, the counselor will conduct a detailed review of her family history to determine whether she might benefit from genetic testing. We currently test for a number of known genetic mutations, including mutations to the BRCA1 and BRCA2 genes, which are known to greatly increase a woman’s risk for breast cancer. With the newly discovered mutations from the previously mentioned study, we potentially can add additional mutations to our routine screening and get a better idea of how likely a woman is to develop another triple-negative breast cancer. Patients who are found to be at high risk might benefit from more intensive screening with the addition of breast magnetic resonance imaging (breast MRI) tests to standard mammogram so we can find the disease earlier.

    New research indicates more women with triple-negative #breastcancer could benefit from #genetictesting. bit.ly/2wplHzN via @MedStarWHC

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    Women at high risk also might want to consider more aggressive treatments, such as prophylactic mastectomy (removal of one or both breasts) or oophorectomy (removal of the ovaries and fallopian tubes). Double mastectomy has been shown to reduce the risk of breast cancer by at least 95 percent in women with a genetic risk of breast cancer, and oophorectomy can reduce the risk of breast cancer by about 50 percent in these patients. But given the relatively small lifetime increase in breast cancer risk with these additional mutations, I would not advise prophylactic surgery in most cases.

    Genetic testing isn’t for women who haven’t had triple-negative breast cancer

    Genetic testing is a valuable resource, but not all women will benefit. The National Cancer Institute notes that 12.4 percent of women born in the U.S. will develop a form of breast cancer in their lifetimes. But triple-negative breast cancer accounts for only about 10 to 20 percent of all breast cancer cases. Think of it this way: If we took a random sample of 100 women, about 12 would be expected to develop breast cancer. Of these 12, only one or two might develop triple-negative breast cancer.

    Inherited genetic mutations play a small role in your total risk for developing breast cancer. Only 5 to 10 percent of breast cancer cases are caused by inherited mutations. That means 90 to 95 percent are caused by factors that genetic testing can’t detect.

    It’s also important to understand that not all genetic mutations are created equal. For example, most mutations are not as concerning as BRCA1 and BRCA2 mutations. Some of the mutations identified in the study might increase a woman’s risk by 2 to 3 percent, or a lifetime risk increase from 12 to 15 percent. In most cases, that wouldn’t be enough of an increase for me to recommend elective mastectomy or oophorectomy. The potential benefits of prophylactic surgeries may be outweighed by the potential side effects, such as:

    • Chronic chest wall pain
    • Early menopause
    • Pulmonary embolism, a blood clot that blocks the artery supplying blood to the lungs
    • Potential wound infections
    • Reduced quality of life

    In addition, genetic testing often identifies mutations called variants of unknown significance. This means we know there’s a change in a gene, but we don’t know if that change affects a patient’s cancer risk. That knowledge can make patients wonder, “Is this mutation harmful? What could it do to me?” Unfortunately, we can’t always provide these answers. In the same issue of the Journal of the National Cancer Institute in which the new study appears, an editorial was published stating that doctors must be careful about treating patients based only on risks we estimate from genetic testing. While genetic testing can help us gain insight into her risk for breast cancer, the results only show us a small part of that patient’s overall risk. There are risk factors that can be modified to reduce a woman’s risk of developing breast cancer. Regular exercise, maintaining a healthy body weight, and moderate alcohol consumption can all decrease breast cancer risk.

    The future of cancer genetic testing

    I think we are moving toward a time when women will be able to get tested for their lifetime genetic risk for breast cancer, ovarian cancer, and a number of other cancers—but gaps in the information we obtain from genetic testing show we aren’t there yet. The decision to undergo genetic counseling should start with a conversation with your primary care doctor, and decisions about genetic testing should be made after a conversation with a genetic counselor to determine whether testing will be beneficial.

    I believe this study into the genetic risks of triple-negative breast cancer will help us identify more women at risk for this dangerous disease. The study will help us develop better screening strategies for higher-risk women. It may also help to identify higher-risk women who may have not qualified to undergo genetic testing based on previous guidelines because of a smaller family tree (fewer sisters and aunts) diagnosed with breast cancer. However, genetic testing isn’t a one-size-fits-all solution. We still have more work to do before it becomes a routine part of the medical examination process.

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

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  • August 22, 2018

    By MedStar Health

    There’s an old expression that age doesn’t make you forgetful, it’s the amount of things you have to remember. But when it comes to dementia, which affects 5.7 million Americans, memory loss can be prevented or at least reduced as we grow older.

    Dementia is an umbrella diagnosis that describes a group of diseases, including Alzheimer’s, that might cause the brain to fail. Dementia becomes increasingly higher after age 60. While 7 percent of adults 60 and older have dementia, nearly 30 percent of those 85 and older do. All types of dementia lead to a continued loss of brain tissue, which can affect:

    • Behavior
    • Emotions
    • Memory
    • Perceptions
    • Thinking

    Some forgetfulness is to be expected as we age, but these six tips can help slow down memory loss as we age—or stop it in its tracks.

    Dementia affects 5.7 million Americans, impacting memory, behavior, emotions, and more. Dr. Constantino has 6 tips to help people reduce their risk of developing dementia, via @MedStarHealth

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    Poor sleep is a risk factor for cognitive decline and Alzheimer’s disease. As a medical school professor, I’ve witnessed the short-term memory effects in my students. Those who don’t sleep well for a few days tend to forget more facts and do poorly on tests. Imagine the effect this can have on people over a long period of time! Sleep apnea can also contribute to memory problems.

    2. Eat a healthy diet

    A healthy diet benefits your brain as much as your waistline. You’ll see people in their 90s who have a good memory, and oftentimes their diets are healthy—full of fruits and vegetables, and hardly any processed foods. A poor diet can lead to nutritional disorders, which is another reason people experience memory loss. Having a healthy diet can help people avoid vitamin B1 and B12 deficiency, as well as thyroid conditions.

    3. Exercise regularly

    Exercise can help preserve brain health as we age. However, the National Academies of Sciences reports that, despite advances in understanding dementia risk factors, the idea that exercise might delay or slow age-related memory loss has not yet been proven.

    Unfortunately, some adults shun exercise and many children watch TV and play video games more than they play sports or spend time outside. Taking the time to exercise at least 30 minutes per day can go a long way in preserving brain health.

    4. Stimulate your mind

    Evidence suggests that doing activities that require high levels of mental stimulation and education helps reduce cognitive decline. This can help people who are beginning to develop dementia function normally for longer.

    I encourage people to spend their days doing what they enjoy. If working with computers makes you happy, then try to have a job that includes tinkering with computers or do so in your free time. If you like cars, make time for driving and working on them.

    5. Prioritize your social life

    Make time to have fun with friends and family—it’s good for the soul and the brain. In fact, one study found that being highly social later in life can decrease dementia risk by 70 percent. Regularly socializing with family and friends doesn’t mean you have to go to parties. Talk with friends and loved ones on the phone and consider volunteering. Helping others benefits you cognitively because you’re creatively using your brain by conversing and problem solving for others.

    6. Manage your stress and anxiety

    Chronic depression and anxiety might lead to an increased risk for developing dementia, studies suggest. We all deal with some level of stress and anxiety, but it’s important we always try to keep it under control. My best advice is to ask your primary care doctor for help managing your depression and anxiety, especially if it is chronic.

    A majority of dementia cases are caused by lifestyle factors, not genetics. It’s up to us to take the necessary steps to reduce our risk and protect our memories for years to come.

    Want to learn more about our memory disorder services? Click the button below.

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  • August 21, 2018

    By Matthew L. Pierce, MD

    Most of the time, people don’t notice their salivary glands. They are located in the mouth and throat, and they produce saliva. We start to notice these glands if a stone or tumor develops and blocks the flow of saliva. When that happens, they can become swollen and painful and can interfere with hydration, digestion and dental hygiene.

    Salivary stones and tumors can range in size from smaller than a marble to larger than a golf ball! While the vast majority of salivary gland tumors are not cancerous, some continue to enlarge and can develop into cancer if left untreated. We treat a range of salivary gland conditions, including:

    • Chronic inflammation or infection, called sialadenitis
    • Parotid gland and submandibular gland tumors, either cancerous or benign
    • Salivary gland stones, called sialolithiasis
    • Salivary tumors

    Let’s take a look at the risk factors and symptoms of salivary gland diseases and how we treat them.

    LISTEN: Dr. Pierce discusses salivary gland diseases in the Medical Intel podcast.

    Risk factors and behavior of salivary gland disorders

    We don’t know why some people develop salivary stones or tumors. However, we know some behaviors are associated with them:

    • Not drinking enough fluid
    • High calcium levels
    • Smoking
    • Previous radiation or radioactive iodine treatment for thyroid cancer

    Salivary gland tumors can occur in young people, but they are found most commonly in patients in their 40s and older. Often, the condition is discovered when the patient is getting imaging such as an X-ray for an unrelated reason. If the tumors are not treated early, they can continue to enlarge over time and can potentially lead to cancer.

    Salivary stones and tumors can be smaller than a marble or larger than a golf ball! Most aren’t cancerous, but if left untreated, they can develop into cancer. bit.ly/2N6qmxL via @MedStarWHC

    Click to Tweet

    Salivary gland conditions behave differently from patient to patient. A stone or tumor:

    • May appear and get better—even go away—then come back
    • May cause no noticeable symptoms
    • May be quite painful

    Because we don't know exactly why stones develop in salivary glands, our best recommendation to prevent them is to stay well-hydrated. We can provide mouthwashes and medications to patients who have dry mouth to help improve saliva production before or after treatment for a salivary gland disease.

    Treatment for salivary gland diseases

    Patients used to undergo invasive surgeries to remove salivary stones, or even the glands themselves. Today, we have a minimally invasive procedure called sialendoscopy, in which we use scopes with miniaturized instruments that can fit into the larger salivary glands. We use these tools to look for narrowing (stricture) of the ducts, as well as stones and other abnormalities. Then we use the tools to remove small stones from inside the salivary glands.

    Sialendoscopy is a relatively straightforward and low-risk procedure, typically done with the patient asleep for comfort but sometimes can be done with the patient awake. Patients who have the procedure for a stricture or stone usually can go home the same day, whereas a hospital stay is usually required if the gland is removed for a tumor or other reason via an open procedure. However, sometimes a patient may be able to go home sooner than expected. For example, I had a patient who had a tumor of his parotid gland, and he elected to undergo surgery to remove the gland. He was able to go home the first day after surgery, and he is extremely happy with his result.

    While we use minimally invasive techniques whenever possible, removal of some larger salivary gland stones usually is performed with open surgery under general anesthesia, which requires a small, discrete incision in the neck or right in front of the ear. Patients who have salivary gland cancers sometimes require further treatments in addition to surgery, including radiation and/or chemotherapy.

    Salivary gland disease treatment has come a long way. Advanced treatments allow us to care for a wide range of patients with more minimally invasive options than ever before. The key, as in many conditions, is early diagnosis and treatment. The earlier we can intervene, the faster a patient can experience a better quality of life.

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

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  • August 15, 2018

    By MedStar Health

    It’s summertime—everyone is out and about and having fun. But with the extra time outside comes increased susceptibility to ticks. Tick bites are known for spreading Lyme disease, a bacterial infection that affects about 300,000 Americans each year. Maryland and Virginia are among 14 states that account for about 95 percent of all cases, so it’s important that we understand ways to avoid ticks and identify and prevent the Lyme disease.

    Lyme disease usually results in symptoms within the first 30 days of a tick bite. Symptoms can include:

    • Bullseye rashes
    • Chills
    • Fatigue
    • Fever
    • Muscle aches

    Severe cases can result in long-term conditions, including:

    • Bell’s palsy
    • Diffuse joint pain
    • Heart palpitations
    • Meningitis
    • Nerve pain

    Fortunately, in most cases ticks must be attached to humans for more than 24 hours to spread Lyme disease. Let’s discuss five ways to avoid tick bites and Lyme disease, and what to do if you’re bitten.

    Summertime bugs are never fun, especially ticks that can carry Lyme disease. Discover common symptoms, prevention techniques, and how Lyme disease is treated, via @MedStarHealth
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    Avoid tick bites with these 5 tips

    Preventing Lyme disease starts with being mindful when you’re out and about. If you’re going camping or hiking in grassy or wooded areas, follow these five tips:

    1. Wear long clothing: Even in the summer, choose long-sleeved shirts and pants to prevent ticks from latching on to your skin.
    2. Check your body for ticks: Ticks prefer warm, moist areas of the body, such as the armpits, groin, and hair. Remember to check your children, too!
    3. Heat your clothes in the dryer: As soon as you come inside, put your clothes in the dryer for at least 10 minutes to kill ticks on your clothes.
    4. Use insect repellents that contain DEET: This strong bug repellent is a common active ingredient in the most popular spray products.
    5. Treat clothes with pyrethrin: This synthetic insecticide helps keep ticks and other bugs away.

    Related reading: 2017’s growing tick problem: How to protect yourself

    What to do if you’re bitten

    Most tick bites will not result in Lyme disease. If you see a tick on your skin, remove it as quickly and as completely as possible with fine-tipped tweezers. Clean the area with soap and water or rubbing alcohol.

    If a red rash or other symptoms mentioned start to arise, call your doctor. Be sure to indicate when you might have been exposed to ticks and when you first noticed the symptoms. The doctor will give you a physical exam and possibly a blood test to check you for Lyme disease. If the test is positive, the typical treatment is a course of antibiotics.

    Avoiding Lyme disease starts with awareness and taking simple steps to avoid tick bites. Be sure to protect your family this summer and fall when you’re enjoying the great outdoors.

    In need of urgent care after a tick bite? If you need a Lyme Disease test or help removing a tick, visit us at MedStar Health Urgent Care.

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  • August 14, 2018

    By MedStar Health

    Does this sound like a typical day? Maybe you take an antacid with your morning coffee, a Zantac with lunch or a Nexium with dinner—perhaps a combination of tactics to keep heartburn at bay. If this sounds familiar, you’ve got a lot of company. It’s estimated that about 20 percent of American adults have heartburn symptoms at least once a week.

    Over the long term, heartburn can increase your risk for serious health conditions, including cancer. That’s why it’s important to see a gastroenterologist and get frequent heartburn under control.

    LISTEN: Dr. Patel discusses frequent heartburn in the Medical Intel podcast.

    What is heartburn?

    Heartburn happens in the esophagus, which is the tube food passes through as it goes from the mouth to the stomach. The esophagus has a sensitive lining that works much like the skin. As food reaches the stomach, it’s broken down into smaller particles by stomach acid so the body can absorb the nutrients. If some stomach acid splashes back into the esophagus, it can burn the lining there.

    This splash-back process is called acid reflux. It can happen because the esophagus opens and closes with a ring of muscle that we can’t control called the lower esophageal sphincter, or LES. As you eat and swallow, you naturally swallow some air, and the LES relaxes five or six times an hour. People who have acid reflux on a daily basis may have many more of these relaxations—up to 20 in an hour. The more the LES is relaxed, the easier it is for stomach acid to get into the esophagus and cause the burning sensation of heartburn.

    Acid reflux diet infographic

    Dietary Do's and Don'ts - Click to enlarge.

    Heartburn often can be triggered by a specific type of food, such as:

    • Caffeine
    • Chocolate
    • Citrus fruits, such as grapefruits and oranges, which contain citric acid
    • Spicy meals
    • Tomatoes, including tomato juice and sauces

    But for some patients, everything they eat causes heartburn. Being overweight or obese, especially if you carry extra weight in the upper torso, also can increase the risk of having heartburn. Chronic dry mouth—a common complaint of smokers—also contributes to the frequency and severity of heartburn, because saliva produced in the mouth naturally can shield the esophagus from some of the effects of stomach acid.

    Why long-term self-treatment–or no treatment–is risky

    There are many over-the-counter treatments available for heartburn. However, when patients tell me they’ve been treating heartburn on their own with antacids for many years, that’s a big red flag that something more serious might be going on.

    Acid reflux and gastroesophageal reflux disease, or GERD (a chronic heartburn disease) do more than just cause heartburn, even though that’s all you may feel. The lining in your esophagus is delicate, and with repeated injury from acid reflux, the cells in that lining can transform into cells that are more like those in your stomach or intestines. This change is known as Barrett’s esophagus, and it can increase the risk for developing a dangerous form of esophageal cancer called esophageal adenocarcinoma.

    Long-term self-treatment for #heartburn may be a sign of serious complications, including #esophagealcancer. bit.ly/2nCdxjy via @MedStarWHC

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    We’re seeing more cases of Barrett’s esophagus and esophageal adenocarcinoma, and we’re seeing more people dying from this form of cancer as well. That’s why it’s so important to see a specialist like me for help with long-term heartburn.

    Some of the common over-the-counter drugs patients often use for years before visiting a specialist include:

    • Antacids, which include calcium carbonate, a substance that reacts with stomach acid to form water and carbon dioxide.
    • Histamine H2 receptor blockers, such as Pepcid and Zantac, which reduce the amount of acid the stomach makes.
    • Proton pump inhibitors, or PPIs, which block the enzymes that produce stomach acid. We use PPIs to diagnose GERD. The patient takes a PPI 30 to 60 minutes before their first meal of the day for two weeks, and if their heartburn symptoms stop during that time, that’s a pretty clear indication the patient has GERD.

    When PPIs came on the market in the 1980s, they were considered wonder drugs. They quickly were classified as over-the-counter medications, available like aspirin or ibuprofen without a prescription. But we’ve started to see study results that show potential links between these medications and an increased risk for complications in certain populations, including:

    • Decreased bone density
    • Decreased magnesium levels
    • Dementia in older adults
    • Infections, such as pneumonia or a bacterial infection of the colon called clostridium difficile
    • Kidney damage

    Researchers are trying to determine whether PPIs actually cause some of these complications or if the link is coincidental. Because of the potential risks of these conditions, doctors have to think about how to get their patients off of PPIs over time if possible.

    Managing heartburn and reducing your risk

    Your doctor may recommend one or more diagnostic tests if you’ve had heartburn symptoms for a long time. A test called an esophagogastroduodenoscopy, or an upper endoscopy, can let us know whether your esophagus is damaged and, if so, how much damage it’s sustained. That can help us decide the best treatment options.

    I work with my patients to make better lifestyle choices and avoid complications from acid reflux or GERD. Two of the most important approaches I recommend for my patients with heartburn are to maintain a healthy weight and, if they smoke, to quit. It’s often helpful for patients to keep a food diary for a period of time, so we can track what foods are more likely to cause their symptoms. Once we know the triggers, patients can avoid those foods. We’ll also track the severity of their symptoms:

    • Are they coughing or having a lot of throat irritation?
    • Is heartburn waking them up at night?
    • Is stomach acid wearing the enamel off their teeth?

    Patients who have severe, chronic GERD symptoms may be good candidates for surgical treatment. The most common surgical procedure to treat GERD is called fundoplication. In this procedure, the surgeon uses a thin, flexible tube called a laparoscope to sew part of the top of the stomach around the lower part of the esophagus. This makes it less likely that acid will back up into the esophagus.

    With time and collaboration with your gastroenterologist, it’s possible to reduce or even eliminate the burning and discomfort of heartburn and reduce your risk for the dangerous complications it can cause.

    Do you need help for persistent or long-term heartburn? Call 202-877-3627 or click below to make an appointment with a gastroenterologist.

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