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  • January 14, 2022

    By Allison Larson, MD

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

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

    1. Do: Wear sunscreen all year long.

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

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

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

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

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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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

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

    3. Do: Pay closer attention to thick skin.

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

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

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

    Related reading:  Follow these 5 Tips for Healthy Skin

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

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

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

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

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

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

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

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

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

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


    5. Don’t confuse skin conditions with dryness.

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

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

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

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


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

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • January 04, 2018

    By MedStar Health

    By Anne Gunderson MS; Ed.D.

    Over a decade ago, our nation’s healthcare sector was in upheaval following the disclosure of the Institute of Medicines report on deaths due to medical errors (IOM, 2000).  In response, a Jedi warrior with a passion for patient safety education determined that someone needed to bring like-minded warriors together to discuss the plight of healthcare in America. Contemplating the vast need to join forces with other patient safety Jedi masters, the warrior identified and invited select masters to the table. In 2004, select Jedi made their way to a remote mountain in Colorado. Over five long days and nights, each member of the Jedi council shared their knowledge and experience at the Roundtable. As the council members engaged in open conversation and consensus building, the initial plans for the rebellion against medical error became a reality.  As each member shook hands and agreed to meet again the following year, the rebellion was born.

    In 2008, two medical students and two residents with strong interest in safety and quality were invited to the Jedi roundtable. The four Padawan learners added their voices to the discussions while learning from the Jedi masters.  The success of this model provided the inspiration for a new training academy for health science learners. The Council determined that a constantly expanding interdisciplinary educational program was needed to better prepare health sciences students and medical residents to understand, appreciate, demonstrate proficiency, and assume a leadership role in patient safety and quality outcomes initiatives. The learning opportunities would provide young Padawan’s with the knowledge and experiences that promote discipline competence and a sense of personal and societal responsibility for the delivery of safe, highly reliable patient care.

    Padawan to Jedi Warrior: A New Hope for Healthcare

    Despite our progress, we are facing a dark future unless we embrace the Force. By that, it means we must focus on what is happening around us, to be mindful, and commit fully to the rebellion on preventable medical error and or harm. Recent reports estimate deaths due to medical error are not improving, and in fact, are now thought to be four times the number revealed in the 2000 IOM report (James, 2013). Although we have trained almost 1,000 Padawan learners over the past 8 years, our Jedi army cannot withstand the siege. Patient safety practices’ resulting in quality outcomes is the number one requirement for the provision of safe patient care. To meet this requirement, education and training in safety and quality must be the very foundation of every training academy. Instead of teaching to the content of national examinations, academic institutions should focus on creating effective learning that meets the needs of the health care system and the patients that are dependent on their care.

    I wrote this reflection on my last run to the rebel base. As I sit in the back of the training room, wearing my Yoda shirt and observing the newest team of Jedi warriors, I have to believe that the Force is strong in them. A Jedi must have the deepest commitment. We have coached them to focus on the present, to fully embrace and commit completely to providing safe healthcare practice. They have learned, and they have been tested. They are aware of the dark side and have acknowledged that we must beat the enemy all around us; medical error. As Yoda said, “Try not. Do. Or do not. There is no try” (The Empire Strikes Back, 1980)

  • January 02, 2018

    By Evan H. Argintar, MD

    Joint pain from cartilage or tissue injury in the knee and shoulder can make it painful to run, play sports, walk or even stand. Although clinical exams and magnetic resonance imaging (MRI) play a large role in diagnosis, sometimes interpretation can be unclear or even wrong. Nothing is more accurate than direct visualization, particularly when we’re helping a patient determine if they need surgery.

    We use an advanced technique called in-office diagnostic arthroscopy to plan treatment for a variety of conditions, including:

    • Evaluating cartilage, ligament or tendon injury
    • Optimizing injection accuracy
    • In certain cases, helping the doctor determine an appropriate surgical solution

    I’ve been using in-office diagnostic arthroscopy since mid-2017. The procedure was formally approved for use at MedStar Washington Hospital Center when an MRI doesn’t tell us everything we need to know about a patient’s injury, and our program is among the pioneers of this technology in the D.C. metro area. The tool helps me show patients in real time what’s going on in their knee joint after an MRI scan. The quick, safe procedure helps us make more informed decisions about their next steps for treatment, save patients’ time, reduce the need for anesthesia and possibly avoid invasive procedures. Additionally, though the visualization of their own anatomy, I believe patients develop a better understanding of their condition.

    LISTEN: Dr. Argintar discusses in-office diagnostic knee scoping further in the Medical Intel podcast.

    How does diagnostic arthroscopy work?

    A diagnostic arthroscopy is minimally invasive. There’s no general anesthesia, and the procedure takes about 10 minutes. Most patients can leave the office about five minutes after that.

    First, we apply a local anesthetic so you don’t feel pain, though you might feel mild discomfort that patients have described as feeling like a bee sting. Then, without an incision, we insert a tiny scope into your knee, hip or shoulder joint. The scope is a thin, flexible tube with a camera attached that shows images from inside your joint on a screen in the office.

    Prior to us using in-office diagnostic arthroscopy after MRI, a traditional diagnostic scope under general anesthesia sometimes was needed to find out what was wrong with the joint. In other words, some patients had to spend most of a day in the hospital, go under anesthesia and wait in recovery just to find out whether they needed surgery. Then they’d have to come back again for shoulder, hip or knee surgery.

    A supreme benefit of this diagnostic tool is this that we can find out right away if injury exists. This helps for better understanding and planning. And in situations where we don’t find anything, diagnostic surgeries can be skipped, avoiding unnecessary surgeries and exposures to anesthesia.

    Is it weird to see inside your own joint?

    While I wouldn’t expect most people to get excited about the idea of seeing the ingredients of their own joints, people don’t get grossed out by it, either. Most of my patients have been fascinated by what the inside of their joint looks like. Really seeing what’s going on can help them understand the severity of their injury, and it also can help them get proof that some injuries aren’t as bad as they thought. I find that information is useful because it reassures them that they can successfully proceed without surgery when an MRI or X-ray doesn’t give a clear enough picture.

    When we find during in-office arthroscopy that surgery is necessary, we can use the tool to make our surgical recommendations much more confidently. For example, we had a patient with a complex knee condition that, before, would have required two surgical procedures: a preliminary procedure to fix the immediate concern and potentially a full knee replacement to get to the root of the problem later in life. Using in-office arthroscopy, I was able to recommend an immediate partial knee replacement instead, avoiding the need for separate surgeries. This made the patient—and me—much more comfortable with the recommendation. Rather than basing our advice solely off of what has worked with similar patients in the past, we were able to tailor this patient’s procedure to their unique anatomical needs.

    Will in-office arthroscopy replace traditional knee scoping?

    In-office diagnostic arthroscopy is approved for use in combination with standard MRI or X-ray imaging and a physical exam. Its role is constantly changing and increasing. The tool helps me educate patients, which is why I find it very useful to show patients why I think nonsurgical therapy would be successful. It also can help me show patients in real life what’s torturing them, and that can help them understand why surgery might help.

    Some orthopaedic surgeons might question the worth of in-office arthroscopy if it points to problems that shouldn’t be corrected with surgery. But we understand why it’s worthwhile. In our practice, we recommend surgery only if physical therapy or other interventions alone won’t work. In fact, I spend more time in appointments explaining why a patient doesn’t need surgery than explaining procedures!

    One of the most important parts of my role is education and helping people become more informed about their bodies. When you can visualize what’s going on inside your joint and understand what you need to do to heal, it can become easier to stick to your treatment plan.

    If you’re experiencing pain, call 202-877-3627 or ask your doctor to connect you with a specialist in your area who uses this innovative tool.

    Request an Appointment

  • January 02, 2018

    By David Balto

    I am a Chaplain at MedStar Washington Hospital Center, the largest hospital in the nation's capital. It is my third year at the Hospital Center (where I did my Clinical Pastoral Education training) and I focus on several intensive care units and the cancer unit.

    I decided to work Christmas Eve and Christmas Day.  My goal was to bring comfort especially for families of patients in critical condition and patients without families and friends who might not be visited. I focused on the cancer unit and all the ICUs.

    Here are a few stories from those two days.

    Finding a Home for the Homeless

    One of the things I really wanted to do for Christmas was to serve food for those in need. Unfortunately,  all of the homeless shelters and the Archdiocese were already booked with volunteers.

    When I arrived at the Hospital Center in the morning I saw a short elderly woman leaning in a fragile status in a lonely hallway. She looked confused, her coat was worn and torn and she had two large bags with her meager belongings. I asked her who she was, and after a while she finally was able to tell me her name, and that she had come to D.C. looking for her family.

    She had no idea where to go or how to get there.

    I got a wheelchair and took her to the cafeteria. I wheeled her through and she chose a complete Christmas dinner with turkey, stuffing, corn, sweet potatoes and pie. She obviously had not eaten for days. I kept her company while she ate. We talked about her life and she shared memories of Christmas as a child.

    I then went searching for a shelter. Two places were filled. One place could not accept an elderly person, another only had top bunks (and there was no way she was going to climb into a bunk).  Finally, I found a shelter in Northwest, not far from the hospital.

    I called an Uber, and after giving him extensive instructions to get her inside the shelter (and an additional tip), I sent my new friend off with blessings, wishes for a blessed holiday, and Psalm 121.

    I  lift up my eyes to the mountains——
         where does my help come from?

    2   My help comes from the Lord,
         the Maker of heaven and earth.

    3   He will not let your foot slip—
         he who watches over you will not slumber;

     indeed, he who watches over Israel
         will neither slumber nor sleep.

    5   The Lord watches over you—
         the Lord is your shade at your right hand;

    6   the sun will not harm you by day,
         nor the moon by night.

    7   The Lord will keep you from all harm—
         he will watch over your life;

     the Lord will watch over your coming and going
         both now and forevermore.

    I said to her that the Lord is always her companion and I prayed she would be safe and would be at home.

    Raising the Spirit with Song

    The ICU waiting rooms can be a lonely place especially on Christmas. Families muster their courage and hope as they grapple with the unknown, the fear.  It is a challenge to feel the holiday cheer when someone beloved is in such fragile health, perhaps close to death. And perhaps there is hope but the anxiety clouds the glimmers of hope.

    There are 10 ICU units at the Hospital Center. The waiting rooms are often dark, small and crowded. They are places where people often are overwhelmed, looking to the floor as if the fear closes them up.

    It’s Christmas Eve – a time of hope. I went from waiting room to waiting room with my best weapons against fear – an open heart and a buoyant spirit and song sheets. I went to each of the waiting rooms on Christmas Eve and led them in Christmas carols. (Yes, Jewish Chaplains know Christmas carols, especially when they grow up in Minnesota.) And perhaps, just perhaps, as they sang the carols, they would kindle fond memories that would strengthen their hope and their faith for a few moments. And perhaps the carols would also strengthen their spirits and dissipate their fear.

    Christmas through the Eyes of a Child and a Centenarian

    Third floor ICU at 9 pm. It’s quiet. There is a little boy sitting with his aunt in a waiting room. He looks tired and bored. He needs a good-night story.

    I told him a tale about a little boy who visits his grandmother and plays with animals – The Squeaky Door. We have to make the noises of the various animals in the story and we laugh together. People around the waiting room listen and watch us tell the story. He is ready for bed when we finish.

    I then asked the ICU nurses for patients who may not have family visitors. There is a woman over 100 years old who had not been visited during the day. I sit quietly in her room and read psalms as she receives treatment. It reminded me of a woman – a National Park Service guide – I met earlier this year in Selma, Alabama, who told me her mother died in the 1950s during childbirth because they could not get “Black blood” in time from Birmingham. I asked myself, “Was there a time earlier in the patient’s life that this woman once received “Black blood?”

    “Black blood?” What kind of a world was that? What kind of injustice had this woman faced in her life? And what kind of injustice – or justice – would the little boy face? I prayed that there would be justice for this child and others, and was reminded of what Dr. Martin Luther King said, “The arc of the moral universe is long, but it bends toward justice.”

    Finding the Hidden Birthdays

    Much of my time was spent focusing on patients who would not have visitors. The spirit of Christmas – the joy, family connection, laughter, cheer – was absent. Certainly the staff was welcoming and provided good wishes, but there are an overwhelming number of patients. For those without visitors, the rooms could be quiet and sullen and the spirit might be absent.

    So I went from room to room for those who would not receive visitors. Perhaps my simple words, a touch, a smile might lift their spirit. Help them feel a sense of this day of celebration.

    In one room in the cancer unit I spoke with a woman fighting a battle with a cruel disease. We held hands and shared prayer. I asked her about Christmas in her childhood. She shared precious memories of Christmas with her large family of siblings. She smiled.

    And then she told me, “Today is my birthday.” And her roommate said, “It’s mine, too!” I told them how incredibly special it was to be born on the day of Jesus’ birth.

    None of the staff knew. I told the staff and they returned and we sang them Happy Birthday.

    A Lonely Young Man

    In the cancer ward, I ask whom to visit. They sent me to visit a young man who kept pushing the nurses away. My heart tells me this is why I woke up this morning. I come in and he is lost in a video game dismissive, distant.

    I sit down preparing myself to stay for a while. I know God wants this young man to feel his presence, to know he is not alone, that he is cared for.

    We chat. He can tell that I have moved in, that I feel that I belong, that I cannot imagine any more precious way to spend my time than to listen to him. We talk about what interests him, makes him smile, makes him curious. We talk about his spirit, how he deals with an illness that brings him to the hospital every month.

    No, we did not talk about God and he did not sound like structured faith was part of his life. But for a few moments I hope he knew he was cared for and that he knew God was looking out for him.

    The Holiday Project and Serving Cookies

    The Holiday Project is a volunteer group that brings song to institutions like hospitals on holidays.

    As I journey between ICUs on Christmas Day, I hear the world burst into song as I encounter 20 people walking through the hospital singing.  It’s the Holiday Project.  Since I lack all humility about my voice, I readily join them.  And I grab a tin of cookies I brought (of course David’s Cookies) and pass them out to nourish the families listening as we journey from unit to unit.

    I then guide them to the ICUs and finally to our two birthday women in the cancer unit to give them a chorus of Happy Birthday and joyous Christmas carols.

    Jewish Study on Christmas Eve

    I do not want the Jewish patients to feel ignored. There is an older man who had worked in a school for most of his life. He has a warm countenance and smile. I have to give a sermon this Sabbath on the last chapters of Genesis – Jacob’s last message to his sons and his death. We reflect on what it means to make the most of one’s later years and what kind of message, legacy we want to leave for our families.

    We talk about the nature of God and God’s love for humanity. And we study the end of Genesis and discuss why Joseph’s brothers ask for forgiveness after they have already been forgiven. That leads to a more extensive discussion of the wonder that God created man as an imperfect creature who is able to repent and seek forgiveness.

    I learned a great deal from our meeting.

    The Blessings of Welcoming the Stranger

    When I think about my service on Christmas, I am reminded that the most important mitzvah (commandment) in the Old Testament is to welcome the stranger. Holidays help us feel community, family, and continuity. But for those alone, who are not visited, or for those in fragile health or trying to provide comfort for the sick, the holiday may heighten their sense of isolation, fear and estrangement.  Hopefully, my service helped some people feel God’s presence and comfort and gave them a sense of belonging and the wonder of the holiday.

    And helped them feel they are not strangers in the hospital.

  • December 29, 2017

    By Mark L. Gonzalez, MD

    As the Glaucoma Research Foundation notes, about three million Americans have glaucoma, but only about half of them know it. That’s because there may not be any symptoms to notice until the disease starts to cause noticeable vision loss. Glaucoma is caused by high eye pressure, so I’m always interested in ways to help patients lower this pressure and, therefore, lower their risk for the disease.

    As it turns out, exercise can lower eye pressure, particularly for patients at severe risk for glaucoma or who have already been diagnosed with the condition. But how you exercise is as important as whether you exercise when it comes to this risk, because some forms of exercise actually can increase your eye pressure.

    Exercises that can lower the risk of glaucoma

    We’ve known for years of exercise’s role in maintaining a healthy weight, lowering the risk of heart disease and many other aspects of a healthy life. As it turns out, certain forms of exercise actually can lower your risk of developing glaucoma as well.

    In particular, I’m talking about low-impact aerobic exercise. This kind of exercise involves moderately raising your heart rate for 20 to 30 minutes at a time. Aerobic exercise can lower your blood pressure, as well as eye pressure, in addition to increasing the blood flow to the eyes. All of these factors can lower your risk of glaucoma and lower the risk of vision loss in people who have glaucoma in the long run. 

    Aerobic #exercise can lower your risk of #glaucoma by lowering #bloodpressure as well as eye pressure. via @MedStarWHC

    Click to Tweet


    There are many forms of aerobic exercise. Just a few examples include:

    • Going for a walk
    • Jogging on a treadmill or outside
    • Riding a bike (stationary or outdoor)
    • Swimming
    • Taking a Zumba class
    • Using an elliptical machine

    The key is to find activities you enjoy and that you’ll stick with. This increases the likelihood that you’ll keep exercising over the long term and continue to get the benefits.

    Exercises that can raise the risk of glaucoma

    Not every form of exercise is good for the eyes, however. Exercise that involves straining or bearing down (anaerobic exercise) has the exact opposite effect. People who engage in anaerobic exercise may hold their breath temporarily while they’re straining, and this too can raise eye pressure and further increase the risk of developing glaucoma or worsening vision loss in people who have the disease.

    Examples of anaerobic exercise can include:

    • Situps and pullups
    • Sprinting while running, biking or swimming
    • Weightlifting, particularly powerlifting and bench presses

    Other types of exercise can raise the pressure inside the eyes as well, including inverted situps, crunches and squats. Many of these are done on an inversion table, which rotates the legs above the head, increasing eye pressure. Several yoga poses also incorporate inversion, such as:

    • Dolphin pose
    • Downward-facing dog pose
    • Forearm balance
    • Handstands, headstands and shoulderstands
    • Wall T-stands

    Tips for reducing your eye pressure and glaucoma risk

    For someone with only mild risk of glaucoma, a round of situps or the occasional yoga inversion isn’t something to be terribly concerned about. But for someone at higher risk or who’s been diagnosed with glaucoma, it’s worth taking some steps to reduce eye pressure and avoid unnecessary risks.

    There are plenty of exercises available in many disciplines that avoid this increased risk. Particularly for those in yoga classes, I encourage people who have glaucoma to ask their instructors or fitness professionals about possible alternatives to inverted exercises.

    Exercise is important across the board for developing and maintaining a healthy lifestyle. And while it might not be obvious, the eyes benefit from regular exercise just like every other part of the body. If you’re at risk for glaucoma, the right kind of exercise can be an important part of managing that risk over the long term.

    Request an appointment with one of our ophthalmologists to evaluate your risk for glaucoma.

    Request an Appointment

  • December 28, 2017

    By MedStar Health

    In December 1967, a South African surgeon made history when he successfully transplanted the heart of a woman who died in a motor vehicle accident victim into a heart failure patient.

    Flash forward 50 years to December 2017. Heart transplantation has made vast strides today. While the wait for a heart still can be long and tenuous, we now have the ability to transfer donor hearts cross-country in a matter of hours, and anti-infection protocols are much more stringent.

    In honor of the 50th anniversary of heart transplantation—and my 30th year performing heart transplants—let’s take a look at how far we’ve come giving people their lives back after heart failure.

    LVAD: Better quality of life pre-transplant can mean trickier procedures

    The basics of heart transplantation haven’t changed much in the past 50 years. We still open the chest, saw through the sternum, and remove the failing heart to replace it with a donor heart. The tricky part today is that in the Mid-Atlantic region, roughly 80 percent of patients who undergo transplantation are currently living with left ventricular assist devices (LVADs), which leads to more complicated transplantation procedures.

    LVADs help patients’ hearts pump blood more effectively and allow heart failure patients to have social lives, play sports and go to work instead of lingering for months on the transplant list. There are many delicate, implanted components of the devices that we must work around. Then, we must remove the LVAD before we remove the failing heart and implant the donor heart. From there, the procedure is similar to how we’ve always done it. We sew in the healthy donor heart, close up the chest, and begin the recovery process and advanced medication therapy.

    Improvements in anti-rejection

    A heart transplant recipient in the 1960s wasn’t expected to live long after surgery. In fact, the first heart transplant patient in South Africa died of an infection within a few weeks of surgery. Cardiologists then simply didn’t have the knowledge of anti-infection and anti-rejection drugs we have today. They’d use massive amounts of drugs which caused toxic effects.

    Immunosuppressive drugs are much more advanced and our understanding of organ rejection is much more robust than it was 50 years ago. Today’s drugs help us achieve the fine balance between prevention of rejection and infection more often.

    Patient outcomes and heart availability

    In the 1980s, donor hearts were more widely available. Fewer people needed them, and fewer people who were eligible for transplantation chose to undergo the procedure. Transplantation had developed a bad rap because so many people died soon after surgery. As we gained more pharmacologic knowledge throughout the ‘90s, we peaked in efficiency and donor heart availability. Then came the downhill slide we’re faced with now: fewer available donor hearts because of increased acceptance of the procedure and a tidal wave of people facing heart failure.

    In the past two years or so, the donor base has expanded for an unfortunate reason— the overwhelming number of opioid overdoses. When I share this, it often shocks people. How can a substance abuse patient’s heart be safe for donation? When a person overdoses, the brain often suffers the greatest damage. If we can get an overdose victim to the hospital in time, we try to save their life by keeping the brain alive. If the brain dies, we try to keep the heart pumping and healthy enough to transplant (if the individual was a registered an organ donor).

    Life expectancy after heart transplant plateaued in the 1990s at an average of 12 years post-surgery. Today, between LVADs and heart transplantation, we can add many quality years to the lives of heart failure patients, even in older adults. For example, baseball hall-of-famer Rod Carew received a heart transplant at age 71 in December 2016. The heart was donated by 29-year-old Konrad Reuland, a Baltimore Ravens player who died from a brain aneurysm.

    Now, the first instinct might be to assume Carew got a heart because of his celebrity or wealth. But to get a heart at an advanced age, patients must go through more rigorous screening than a person age 50 or younger. And it’s important to realize that, while aging causes many health problems, one remarkable change that can work in our favor is lowered immune response. The bodies of older patients don’t react as intensely to the transplant procedure, so their pain responses and rejection rates are lower than, say, patients in their 20s or 30s.

    As such, older patients tend to have better post-surgical outcomes than younger patients. One of my patients is in her 80s and she had no pain following transplantation. She bopped into my office like a rock star for every post-transplant visit. But most of my younger patients have discomfort for two to three weeks and rely on pain medication to get through recovery.

    What’s the future of heart transplantation?

    I foresee a time, likely within 25 years of this writing, in which patients will not have to wait for a donor heart from a deceased person. Rather, patients of the future will apply for a heart to be grown specifically for them. Doctors will strip the cells from within pig hearts, which are anatomically similar to human hearts, and repopulate them with patients’ own stem cells.

    If this sounds ludicrous, remember that 15 years ago, smartphones weren’t a thing. Self-driving vehicles didn’t exist, and we certainly couldn’t shop online for groceries. Today, we take these technological advances for granted. Through that lens, farm-to-operating-table hearts don’t seem so far-fetched!

    At the end of the day, heart failure is the No. 1 killer of women and men in the U.S. End-stage heart failure has a higher mortality rate than nearly every cancer. The more we can improve patient care pre-transplant and continue to advance technologies to improve transplantation processes, the more quality years we can add to the lives of people with heart failure.

  • December 28, 2017

    By MedStar Health

    by Armando Nahum, Director, MIQS Center for Engaging Patients as Partners

    It’s 2006 and another Labor Day Weekend is upon us. As preparations are under way for a gathering of family and friends, the phone rings…

    Our son Joshua, an avid skydiver instructor living in Colorado, has just had an accident. A cold air density pushed his parachute inward and threw him to the ground at 60 miles per hour. Joshua is being taken to the Emergency Department and I’m scrambling for any airline to get me on the next flight to Denver. I manage to find a ticket, and arrive Denver in the early evening hours. Joshua is in ICU with a broken left femur and a contusion on the back of his head. I immediately saw a tube on the top of his head and asked what it was. They told me they had to perform a ventriculostomy, a temporary drainage to reduce the swelling in Joshua’s brain.

    I sat there and watched my son go in and out of sleep, a result of the heavy sedation medication he had been given. I noticed the room was dark, no windows and bits and pieces of paper on the floor. I didn’t think much of it back then…I just wanted my son out of ICU. My understanding of hospitals at that time was quite limited: you go through the ED after an accident, then they move you to the ICU and if you get better you go to a “regular” room that means you get to go home soon.

    But that was not the case with Joshua. He spent six weeks in ICU, battled two cases of MRSA and delirium, and finally he seemed to be on a good road to recovery. His neurosurgeon told us Joshua was “good to go”. They found a Rehab Facility a couple of miles down the road where Joshua had some work left to do. I was so happy to hear that, finally, our nightmare would end.

    Six days into Joshua’s rehab, I received a call at 11:30pm from his neurosurgeon. He said that Joshua spiked a fever of 103F, his brain was swelling and he coded. He said he performed a lumbar puncture to determine if an infection was present. Little did he know that in doing so, he would end up “sucking” part of Joshua’s brain into his spinal column, damaging C1 to C3 leaving him unable to breathe on his own. He was on a ventilator to breathe for him while the neurosurgeon figured out the extent of this new insult to his spine–not from crashing 60mph into the ground, but sustained during care by his doctor. I was in shock by the news, a phone call that reported the opposite of what we had last been told, deflating our expectations of recovery. I also remember so many of the details the neurosurgeon shared meant absolutely nothing to me at the time. I only had one question for him: “Are you confident you can handle my son?” And he answered: “Absolutely!”

    I took the next flight to Denver and upon arriving there I found that Joshua had been transported to another hospital. His neurosurgeon was no longer available. He decided to “wash his hands” as Pontius Pilate did, Joshua no longer his concern. Within a few days the damage caused to Joshua’s spinal column became clear: my son was now a ventilator-dependent quadriplegic with a gram-negative bacteria in his cerebral spinal fluid baffling everyone at that hospital. The bacteria that had been cultured were still unable to be stopped by any antibiotic available anywhere in the world. Joshua died a few days later, but not from his original injuries. My son ultimately died unnecessarily from an infection he caught during his hospital stay.

    Joshua acquired his infection from the first hospital that cared for him, and 11 years later they still hide. They still deny and “fudged” his death certificate to where Reuters decided to investigate and discovered lies from various hospitals. Article cited here:

    And so, after the death of my son, my personal search to find out how this could happen transformed me into a man on fire; a man with a mission and an unquenchable passion to discover how to stop these largely preventable infections from happening to anyone else ever again. As irony would have it, or maybe because I was now awake and looking, we soon discovered that a total of 3 members of our family had been impacted with hospital Infections in 3 different hospitals, in 3 different states in only 10 months’ time…

    Someone once said that, in life, even more than education, experience is sometimes the best teacher. I can tell you with all certainty, that there no one has been taught more or has been more profoundly affected by the personal devastation and particular loss caused by hospital acquired infections than my own family.

    With the help of the CDC, my wife Victoria and I decided to establish an organization dedicated on Infection Prevention (Safe Care Campaign) and arranged to meet with hospitals throughout United States and Canada; to tell our story and empower the caregivers to do the “right thing” for every single patient. The CDC taught us that the component of most importance to prevent infection during the delivery of care was something so simple: Hand Hygiene.

    We soon realized that it would take us many years to visit thousands and thousands of hospitals, and fortunately, a new “movement” was starting. A movement that would allow the Patient and Family Members’ voices to be heard. We jumped at the very first opportunity and created a new organization that, if done right, would have our voices heard throughout the world. The Healthcare and Patient Partnership Institute ( emerged from a partnership with two of the most renowned Patient Engagement experts: Marty Hatlie, JD and Tim McDonald, MD, JD.

    Together, we built a “model” of partnership between Patients and Family Members and hospital staff that was based on Quality and Safety initiatives. We wanted to make sure it would be patient harm that would be our focus, not just patient experience—the paint color of walls, the noise level in patient rooms or parking efficiencies. We wanted to help health systems with quality and safety initiatives, like reducing hospital-acquired conditions (HACs), reducing hospital readmissions and supporting these aims across the continuum of care.

    Our first client was MedStar Health, the largest not-for-profit healthcare system in the mid-Atlantic region. In just 2 short years, we established Patient and Family Advisory Councils for Quality and Safety (PFACQS®) in all of their 10 Hospitals. Today, MedStar Health, with the leadership of Dr. David Mayer, Vice President of Quality and Safety, is a leader in Patient and Family Engagement throughout the country. Since then we have worked diligently with Vizient Inc. (formerly VHA) in developing many Advisory Councils throughout the USA.

    With the recent launch of MedStar Institute for Quality and Safety (MIQS), my unexpected journey has recently provided me with yet another opportunity. As the Director of Center for Engaging Patients as Partners at MIQS, I am honored to be part of an innovative, state of the art and forward-thinking Institution with an impeccable team devoted to supporting the MedStar Health Quality and Safety mission.

    The Institute is home to the Center for Open, Honest Communication, the International Training Center for Bloodless Medicine and Surgery, the Center for Engaging Patients as Partners, the Academy for Emerging Leaders in Patient Safety, and an ever-evolving array of quality and safety research, education and training programs and clinical improvement programs. The MIQS Mission is shaped by the Quadruple Aim — Better Care, Better Health in Communities, Lower Costs, and Healthcare Workforce Support. Click here, to find out more about the work we are doing through MIQS.