MedStar Health Blog

Burns can happen to anyone, but people with diabetes may be more susceptible than others. In fact, between 10 and 15 percent of patients admitted to our Burn Center have diabetes.

High or unstable blood sugar levels, the hallmark of diabetes, can damage your nerves and blood vessels. This can cause poor circulation, which can leave you feeling cold, particularly your feet.

We often see patients who were burned trying to warm their legs and feet using hot water and heating pads or by propping them up against heaters and radiators. In the summer, we see people who burn their feet walking barefoot on very hot concrete.

Damaged nerves cause you to lose feeling, so you may not be aware you're being burned. And it also leaves your body less able to fight infection and heal from a burn.

Even a small burn can quickly get out of control, and one in 10 patients  with diabetes who burn their feet requires amputation. But by following a few simple tips to prevent burns and seeking immediate treatment when one occurs, we can better thwart these types of outcomes.

Tips to prevent burns when you have diabetes

There are a few simple things you can do to avoid burn injuries:

• Set a timer when using a heating pad. This will ensure you don’t accidentally leave it on too long or fall asleep with it on. It’s also a good idea to put a piece of cloth/clothing between the pad and your skin.
• Avoid sitting too close to a warming device, such as a heater, radiator or fireplace. They can be hotter than you think and cause mild or severe burns.
• Check water temperature with a thermometer or your elbow or sensitive body part, such as the elbow. And don’t use Epsom salts to increase the boiling point of water and allow it to retain heat longer.
• Avoid walking barefoot, even in the house, and particularly in the kitchen.
• Inspect your feet regularly for burns and wounds.

Also, maintain proper glucose levels and practice good diabetic foot care. I can’t stress enough the importance of regular visits with your primary care doctor to manage your diabetes. This is also a key time to bring up any new symptoms, such as, “My feet are cold all the time now.” Your doctor also should inspect your feet during these visits and discuss foot care.

Unfortunately, I see many burn patients with diabetes who had no idea they should be doing anything special regarding their feet, such as inspecting them regularly, wearing sensible shoes or taking extra care when cutting their toenails. Diabetic foot education is incredibly important for all patients to avoid serious diabetes injury or illness.

Read more: Prevent diabetic foot problems with these easy care practices

If you discover a burn that is not healing, contact your doctor immediately and, if possible, go to a burn center for treatment.

Treating burns in people with diabetes

Burn patients with diabetes often seek treatment late—many people don’t even notice their burns right away because of lost nerve sensation in the affected area. We’ve seen patients come in anywhere from six hours later when they notice blisters forming to weeks later when they seek treatment for a seemingly unrelated problem caused by infections from the burn.

Early treatment for burns is important for anyone, but especially for people with diabetes due to their problems with healing. According to a 2015 study, patients with diabetes had to stay in the hospital on average 21 days for burns, compared with patients without diabetes who stayed an average of nine days. They also had more complications, including regrafting and amputation.

Because of this, it’s beneficial for these patients to seek care at a burn center. People often ask, “There’s a hospital or clinic down the street from me. Can’t I just go there for treatment?” But burn injuries are unique, and there are nuances to treating them that not every health facility is used to managing. Similarly, diabetic foot management requires specialized knowledge as well.

Read more: When to seek treatment at a burn center

Multiple teams coordinate on a diabetic patient’s burn care. Along with burn surgeons, physical therapists, dietitians and social workers, your team also may include endocrinologists to improve diabetes management and vascular specialists to evaluate and enhance blood flow in the area of the burn. Once the burn injury is stabilized and healing, you may be able to get follow-up care closer to home. But for that crucial initial treatment, a burn center will give you the best chance at optimal healing and preserving the limb.

If you’re due for a diabetes checkup or foot exam, request an appointment today. Be sure to ask your doctor what you can do at home to keep your feet warm, safe and burn-free.

In November 2017, martial arts expert and actor Chuck Norris filed a lawsuit in California alleging an ingredient in a contrast dye used in a specific type of magnetic resonance imaging (MRI) poisoned his wife, resulting in extreme illness and a mountain of healthcare bills.

This allegation is striking fear in individuals who need MRIs for ongoing care or diagnosis. There are a few key facts to address upfront:

• Millions of people have received gadolinium-based contrast agents, or GBCAs, for several decades without harm
• Older versions of gadolinium-containing dyes, called linear agents, are less often used today in favor of lower-dose, safer versions called macrocyclic agents
• The individuals who do get gadolinium-based MRI contrast dye need it, as the dye is extremely effective for detecting cancerous masses that can be hidden without the contrast dye

Let’s walk through each of these facts to clarify the safety and effectiveness of gadolinium, who needs it and what precautions we take to ensure patients’ safety when receiving MRIs.

Related reading: Dr. Jelinek discusses gadolinium risks and clinical uses in a WTOP Radio news article.

Gadolinium has a long track record of safety

After gadolinium is administered, the body removes it through the kidneys, as it does most other medications. Recent studies in people and animals have confirmed that, even in individuals with normal kidney function, small amounts of gadolinium can still remain in the brain and body long-term. However, a small amount of gadolinium doesn’t put patients at risk.

Gadolinium is extremely safe, with serious adverse reactions occurring in roughly 0.03 percent of all doses. As researchers noted in studies from 2008 and 2015 of patients exposed to gadolinium over time, those who were neither pregnant nor in kidney failure have rarely experienced side effects. In fact, fewer than 50 patients in the 30-year, 30 million-dose history complained of long-lasting side effects (such as headaches, brain fog and skin plaques).

It is also important to note that, for privacy, these patients’ records did not reveal the reasons for their MRIs, so a definitive link to gadolinium for these effects was never established. Still, in this large population pool, fewer than 50 patients out of 30 million doses is a staggeringly low number—roughly on par with the 1-in-700,000 chance any random American has of getting struck by lightning in a given year.

According to the Food and Drug Administration (FDA), the only scientifically established adverse health effect related to gadolinium is a rare condition called nephrogenic systemic fibrosis, or NSF, a painful disease of the skin. NSF can occur in a small subgroup of patients with pre-existing kidney failure. These patients, especially in the early 1980s and ’90s, received high doses of the earliest linear gadolinium.

A typical dose today is about 7 to 15 cc (cubic centimeters), which is less than a shot glass. But, 25 to 30 years ago, a typical dose was five or six times that amount, and the agent was less safe than it is today. For patients who were on dialysis or required a kidney transplant due to kidney failure, this was too much for their damaged kidneys to filter out. About a thousand patients worldwide developed NSF. A small portion of these patients died, and because of this, there were some changes made in the protocols used for gadolinium administration.

Newer forms of GBCAs are much safer

The first protocol set in place to protect patients from further developing NSF was highly effective. Patients with kidney failure were no longer given GBCAs unless it was medically unavoidable. All patients set to receive an MRI first were screened for kidney function. Those with kidney disease, even if found to be mild cases, were not given gadolinium.

Following the adoption of these guidelines in 2007, a study was conducted to search electronic medical records based on the criteria set forth to establish a trend in new NSF cases. In the three years following the restrictive GBCA guidelines adoption, no new cases of NSF were identified in a pool of nearly 53,000 contrast-enhanced MRIs, 36 of which were performed in patients considered to have kidney disease.

Another important feature of the gadolinium used today lies in its molecular structure. Many of the patients who developed NSF in the ’80s and ’90s likely were given higher doses of gadolinium, as mentioned, but it was also a less-stable, linear-structured agent. Linear GBCAs stay in the body longer than low-dose macrocyclic GBCAs that are used today, and the body can get rid of macrocyclic GBCAs more easily than the linear dyes.

Only people who really need gadolinium-based MRI contrast receive it

These MRI scans find things that we would not be able to detect otherwise. They are used to detect flares of multiple sclerosis (MS) in the brain, subtle brain tumors, cancer that has spread and other conditions that don’t show up on normal MRI scans. We really can’t do a breast MRI for early breast cancer without the contrast dye. If it were my wife or child having an MRI, I wouldn’t for a millisecond want them to go without gadolinium-based contrast dye, if I thought it would help their doctor detect cancer sooner.

It’s natural to have concerns about any medication your doctor prescribes, especially after it shows up in the news. Make sure you ask about any test your doctor recommends or performs, including any risks it may have and why you need it. We’ll take time to answer your questions and address any concerns you may have ahead of time.

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We’ve made great progress in recent years when it comes to lung cancer. As noted in trends data from the Centers for Disease Control and Prevention, the percentages of people diagnosed with or dying from lung cancer has decreased significantly from 2003 to 2012. But more people still die from lung cancer in this country than any other cancer. Here in Washington, D.C., our rates for people diagnosed with and dying from the disease are lower than the national average, but we still have a long way to go.

Constant vigilance is key to catching lung cancer early, when we have the best chance at successful treatment. We follow lung cancer screening guidelines established by the American Cancer Society (ACS) for screening patients who are considered at higher risk for developing lung cancer than the average person. These guidelines help us minimize unnecessary screening in patients at lower risk while increasing our chances of finding cancer early in patients who are at high risk.

Who benefits from lung cancer screening?

We perform lung cancer screening using low-dose computed tomography (CT) scans. Because CT scans do involve exposure to radiation, we don’t recommend screening everyone for lung cancer. These tests also can cause unnecessary stress and expenses for people who might not benefit from testing. That’s why the ACS guidelines recommend testing only those patients who are considered at higher than average risk for lung cancer. The following factors can increase a patient’s risk, even if they don’t show any symptoms of the disease:

• Age between 55 and 74
• Currently smoking or having quit smoking less than 15 years ago
• Smoking history equivalent to smoking a pack of cigarettes per day for 30 years (for example, smoking half a pack per day for 60 years or smoking two packs per day for 15 years)

Other factors, such as a family history of lung cancer or significant exposure to asbestos or secondhand smoke, also can increase a patient’s risk.

What are we looking for during lung cancer screening?

One of the main things we look for in our low-dose CT scans are suspicious nodules in a patient’s lung. A lung nodule is a growth or lesion inside the lung. Benign, or noncancerous, nodules can form from inflammation after lung infections or diseases. But we’re looking for abnormal, cancerous nodules. Some of the telltale signs we watch for are:

• Nodules that are tethered to the chest wall
• Nodules located in the center of the lung
• Nodules with a ground-glass appearance or those with solid component

What we find on the CT determines the next step for the patient. Sometimes it’s best to monitor a suspicious nodule regularly to see if it changes. Sometimes we find something that’s potentially more serious and need more information right away. So those patients are followed up with a positron emission tomography/computed tomography scan, or PET-CT scan. This test involves injecting the patient with a small amount of radioactive sugar. For the most part, tumor cells are more active than normal cells, and they need sugar to grow, so they’ll absorb this injected sugar and light up on the scan. Therefore, PET-CT scans can tell us the size and location of suspicious lung cancer tumor cells as well as demonstrate if a patient has metastases (where the tumor spreads to another organ).

If a PET-CT scan identifies a suspicious cancerous growth, the next step is to perform a biopsy. This involves taking a small sample of the growth and having the specimen be examined under microscopy by a trained pathologist to determine if it’s cancer. Interventional radiologists can take this biopsy through the chest with a long needle. If the nodule is not peripheral and is very centrally located, an interventional pulmonologist or a trained surgeon can perform what’s called an endobronchial biopsy or transbronchial biopsy. This involves using a long, flexible tool called a superD navigational bronchoscopy to go down the windpipe and into the lung to take the sample directly.

If the pathologist identifies the sample as cancerous, the next step is to decide if the patient is a candidate for surgery to remove the tumor. If the cancer is detected early and hasn’t spread outside the lung, we can remove the cancerous tissue and give chemotherapy or radiation to destroy any cancer cells that may remain depending on the final pathology. If the cancer, however, is more advanced and has spread to lymph nodes or other organs, we have to rely on chemotherapy or radiation plus or minus surgery to treat the disease.

Early detection of lung cancer is key to getting treatment when cancers are easier to treat. That’s why it’s critical for those who are most at risk to get screened according to the national guidelines.

Request an appointment for more information about your lung cancer risk or to get screened.

The holidays often involve lots of time in the kitchen preparing grand feasts for family and friends. With extra people in the kitchen and so much food going into the oven and simmering on the stovetop, accidents can happen.

According to the National Fire Protection Association, Thanksgiving is the peak day for home cooking fires, followed by Christmas and Christmas Eve. Some of the most common culprits are scalding burns from spilling or being splashed by grease or boiling liquids.

During the flurry of holiday activity, you may be tempted to rush or cut corners. But by following a few simple steps and knowing what to do if accidents happen, you’ll be able to focus on family—and food!—without the need for a trip to the hospital.

Tips to Avoid Burns in the Kitchen

While some of these tips may seem like common sense, we all could use a reminder from time to time.

Watch out for children

Be mindful of where they are, and keep them out of the kitchen if they’re too young to understand the dangers. Don’t try to prepare or handle hot food while holding a child, and make sure hot items and pot handles are well out of their reach.

Wear proper clothing

Before you start making that delicious meal you have planned, look at what you’re wearing.

Do you have shoes on? If you spill something hot or grease begins spattering, you’ll want your feet protected.

Are you in short sleeves? Long sleeves will protect your skin from grease spattering. However, don’t wear baggy or loose shirts, as they can catch fire when reaching over the stove or into the oven.

Do you have oven mitts handy? This may surprise you, but we often see people who were burned by grabbing a hot item with bare hands without thinking. Mitten types are best for taking things out of the oven because they also protect the back of your hands.

Use your kitchen equipment properly

Before you use any new kitchen gadgets, read the instructions so you know how to use them correctly.

When putting a pot or pan on the stovetop, make sure the handles are turned inward and not hanging over the edge of the stove. This will keep you and others from bumping into it and sending a pan full of hot food flying. And don’t underestimate the danger of steam. Stand back from a hot pot when you remove the lid, and be careful when you pour hot liquids into a bowl or colander.

Keep hot pads, oven mitts or towels near your stove, but make sure you don’t set them on or near a burner where they can catch fire.

Do you have a fire extinguisher in or near the kitchen? Make sure it’s in working order and that you know how to use it. And don’t forget to change the batteries in your smoke detectors.

Be careful with that turkey

Just about any way you prepare a turkey comes with a risk of burn injuries.

Deep frying turkeys has become popular, but it can be dangerous. Before starting, read the safety instructions that came with your fryer. Set the fryer on a level spot a safe distance from your home and trees. Make sure the turkey is thawed because dropping a frozen turkey into the vat of hot oil can cause a flare-up and make the oil boil over. After the turkey is cooked, let the oil cool overnight before disposing of it.

Another common burn culprit is greasy turkey drippings. The drippings pan will be heavy, and if it’s not solidly supported underneath, it can fold and spill everywhere when you pick it up.

There also are occasional reports of turkeys catching fire in the oven, which is why it’s important to know what to do in the event of a kitchen fire.

How to Put out a Kitchen Fire

First, let’s discuss what you absolutely should not do with a kitchen fire:

• Do not open the oven if there is a fire inside.
• Do not throw water on it.
• Do not try to put a burning pot or pan in the sink or take it outside.

If something catches fire in the oven, shut the oven off and back away. Fire needs oxygen, and you’ll only fan the flames if you open the door. The fire should eventually die down on its own. Once it’s cooled, you can open the oven and clean things up.

If there’s a fire on the stovetop, you want to cut off its oxygen. You can do this by covering the pot or pan with a lid. If this doesn’t work, pour baking soda on it or grab the fire extinguisher. Don’t try to smother the fire with a towel unless it’s soaking wet.

If an oven or stove fire doesn’t die down within a few minutes or it begins to spread, call the fire department immediately.

What to Do If You Get a Burn

Hopefully, you’ll never need to treat a burn. But accidents happen, so it’s best to be prepared.

The biggest mistake I see people make is using cold water or ice on a burn. Instead, run the wound under room-temperature tap water for 10 minutes. Then apply a first aid burn cream or petroleum jelly and a bandage.

If your clothing catches fire, don’t forget the old saying: Stop, drop and roll.

Some burns may require medical treatment. If the burn is bigger than the palm of your hand or there is blistering, seek help. You also may want to consider seeking treatment at a specialized Burn Center like ours.

The American Burn Association recommends you receive treatment from a burn center if you have:

• Burns that involve the face, hands, feet, genitals or major joints
• Third-degree burns, which can appear whitish, charred or translucent with no sensation in the burned area when pricked with a pin
• Burns that cover more than 10 percent of total body surface area
• A pre-existing medical condition that can complicate recovery, such as diabetes

Read more: When to seek treatment at a burn center

You can always call your local emergency department or urgent care center, if you’re unsure whether you should seek medical treatment.

Slow down—the family will wait for the food. Don't spoil the meal and the day by not paying attention, hurting yourself or others, or starting a fire. By following these simple safety tips and remaining mindful in the kitchen, you’ll be able to spend your holidays at home enjoying all that wonderful food you made, not at a burn center.

Despite recent progress in lung cancer research, the survival rate for lung cancer patients remains poor. Only about 18 percent of patients survive five years after being diagnosed with lung cancer. That’s due in part to many patients not being diagnosed with the disease until it’s progressed to later stages, which are much harder to treat. Patients may think the symptoms are signs of less serious conditions, and the symptoms can be misdiagnosed early on by primary care doctors.

Fortunately, if lung cancer is diagnosed at an early stage, it can be treatable. In fact, there are more than 430,000 people living in the United States today who have been diagnosed with lung cancer at some point. But finding and treating lung cancer early depends on getting regular care and knowing the symptoms—and acting on them quickly if they appear.

Early signs and risk factors of lung cancer

Early lung cancer may cause what are called constitutional symptoms. These are symptoms that can affect many of the body’s systems, and include:

• Chills
• Fatigue
• Fever
• Loss of appetite
• Unintended weight loss

A cough usually is a sign of a cold or sinus infection. But if that cold doesn’t go away after a few weeks or a month, especially after getting treated by a doctor, that often is a sign that something more serious is going on. Chronic bronchitis or repeated episodes of pneumonia also are causes of concern, as are flu-like symptoms that don’t get better after multiple courses of medication. Coughing up blood, known as hemoptysis, is a red flag that something may be seriously wrong.

Other potential signs are more subtle. Shortness of breath or wheezing, especially with physical activity, are signs of decreased lung function, which can be caused by a number of conditions. Patients with these symptoms often are diagnosed with adult-onset asthma, but if asthma medications don’t improve these symptoms, it’s time to look for other possible causes.

There are a few clues that help point us in the right direction when it comes to lung cancer besides symptoms. A patient’s history plays a key role in determining who may need further testing. For example, a patient’s history of smoking is a key risk factor. Though up to 20 percent of people who develop lung cancer have never smoked, 80 to 90 percent of lung cancer cases still are caused by cigarette smoking.

Of nonsmokers who develop lung cancer, several factors may be involved, such as air pollution, secondhand smoke, radon gas—things we’re all exposed to throughout our lives that can cause lung cancer. Genetic factors inherited from our parents also may increase the risk. Some people inherit genes that reduce their ability to get rid of cancer-causing chemicals in the body or faulty mechanisms for repairing potentially harmful DNA mutations. And often, we as doctors can’t figure out why a patient develops a certain type of cancer, even in the setting of no risk factors.

Taking action and working with your doctor

Any symptoms that don’t go away after a few weeks to a month, especially those involving the lungs, can be enough to justify talking to your doctor about whether you should be screened for lung cancer. In the best-case scenario, the patient’s doctor would realize something’s wrong and order more testing when the patient doesn’t get better despite medical treatment. Unfortunately, however, I’ve occasionally had patients who have been sick for weeks and months, even after treatment with antibiotics, but no one thought to get a chest X-ray to see if something else was going on.

When we do a chest X-ray on a patient like this, we may see a lung mass that has been there for a while. It may have been there a few months or a year ago, when they first got sick. Or maybe the patient’s primary care doctor did order a chest X-ray, but the patient never followed up. Or perhaps the chest X-ray just didn’t show the mass and the patient needed a CT scan.

In an ideal world, primary care doctors should send such patients to pulmonologists or specialists like me if they aren’t getting better after repeated treatments. But the responsibility doesn’t lie solely with doctors. Patients need to feel comfortable advocating for their own care as well. Maybe their doctor is swamped with too many patients and not enough time in the day, or maybe the doctor just hasn’t had enough experience with lung cancer to realize what these symptoms could mean. Patients should feel empowered to push for more testing or a referral to a specialist for advanced care.

These may be uncomfortable conversations to have, but the discomfort is a lot better than avoiding the conversation, continuing to feel sick and potentially risking your life to lung cancer. If you don’t feel right, and you’re not getting better, say something. You owe it to yourself and your loved ones to take the next step.

Request an appointment if you’re concerned about your lung cancer risk and need to see a specialist.