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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.
    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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  • October 31, 2017

    By MedStar Health

    A MedStar study comparing the load-to-failure and stiffness associated with differing surgical techniques in the repair of elbow fractures was published in The Journal of Hand Surgery. In “Fixation of Regan-Morrey Type II Coronoid Fractures:  A Comparison of Screws and Suture Lasso Technique for Resistance to Displacement,” the authors compared the results between screw fixation and suture lasso fixation in cases of coronoid fractures.

    The research team at the Curtis National Hand Center at MedStar Union Memorial Hospital included Nicholas P. Iannuzzi, MD; Adrian G. Paez, BS; Brent G. Parks, MSc; and Michael S. Murphy, MD.

    Coronoid fractures most commonly occur in tandem with complex elbow dislocations. This type of fracture accounts for less than 2% of all elbow fractures but has been identified in 10% of elbow dislocations. In the Regan and Morrey classification system, based on the height of the coronoid fragment, Type II fractures are 50% or less.

    The study team performed a biomechanical study using 10 pairs of cadaveric elbows, which were randomized to receive either a screw fixation or suture lasso fixation. The load to failure and stiffness were then measured using a material testing machine.

    The authors found that screw fixation provided greater strength and stiffness than suture lasso fixation. They concluded that when feasible, screw fixation may provide greater resistance to displacement of the coronoid compared with the suture lasso technique.

    While this research was conducted with a small sample, it is clinically relevant, as other researchers have reported a higher rate of failure after screw fixation. For type II coronoid fractures, screw fixation may provide a stronger fixation construct for fractures of adequate size to support a screw. Future research may consider the use of multiple, smaller screws for fixation and the role that soft tissue structures, particularly the anterior capsule, have in imparting elbow stability after terrible triad injuries of the elbow. The authors wrote that “where feasible, the improved biomechanical stability imparted by screw fixation supports the use of screws in Regan-Morrey type II coronoid fractures in the setting of unstable fracture dislocations about the elbow.”  

    The Journal of Hand Surgery, 2017. DOI: 10.1016/j.jhsa.2016.11.003

  • October 31, 2017

    By MedStar Health

    Published research from MedStar investigators has found the potential for exenatide to possibly reduce the risk of heart attack and stroke in patients with type-1 diabetes in a small study. Exenatide is a glucagon-like peptide 1 analogue (GLP-1), a class of drugs that has been shown to favorably affect the risk for heart disease in patients with type 2 diabetes but its role in patients with type 1 diabetes is unknown. Led by Evgenia A. Gourgari, MD, the research team included Mihriye Mete, PhD; Maureen L. Sampson; Alan T. Remaley, MD, PhD; and Kristina I. Rother, MD, MHSc.

    The research published in Diabetes Care, “Exenatide Improves HDL Particle Counts and Size Distribution in Patients With Long-standing Type 1 Diabetes”, was an ancillary study of a previously published clinical trial. In the initial study, over 6 months, participants were randomized to receive medication (exenatide) to treat their type-1 diabetes in either alone or in tandem with other medications (daclizumab). Participants also received nutritional counseling.

    The 14 study participants were 50% female vs male, with an average age of 37, living with type-1 diabetes for more than 20 years. A total of 11 of 14 patients were on statin treatment. People who have naturally higher levels of HDL cholesterol are at lower risk of heart attacks and stroke.

    “Our study shows that exenatide treatment increased total fasting non-HDL cholesterol, fasting large HDL particles (HDLp), and postprandial large and medium HDLp. This finding is important given that large, lipid-enriched HDLp are associated with a decreased cardiovascular disease risk compared with small HDLp,” the authors found. They noted that while some of the decreased risk could have been associated with weight loss, other studies have shown that even a single dose of exenatide can improve postprandial lipids in patients with type 2 diabetes, regardless of weight loss.

    “Our preliminary results suggest that exenatide might improve cardiovascular outcomes in patients with type 1 diabetes by improving large HDLp,” the authors concluded. Future studies can seek to validate these results in a larger group and further examine the biological effects of exenatide on HDL function.

    Diabetes Care, 2017. DOI: 10.2337/dc16-2602

  • October 31, 2017

    By MedStar Health

    By Melanie Powell, MD, Fellow for Quality & Safety
    MedStar Institute for Quality & Safety

    Imagine starting a new job. You immediately feel slightly stressed, right? Regardless of how adequately you’ve researched the company, or whether you’ve worked at the company for 15 years and are simply starting a new position, there is a feeling of uncertainty associated with a job change. What will the challenges be? Will I get to do what I love? Will I have support when I feel like things aren’t going as planned?

    Now imagine starting a job that’s never existed in your company. Would you feel something more than stress?

    While there exist other Fellows in Quality and Safety around the country (albeit a small number), there has never been an administrative Fellow in Quality and Safety at MedStar Health. It was the distinct vision of a select few at the MedStar Institute for Quality and Safety who created my position and continue to support my efforts and our collective vision.

    This distinction affords me two things:

    1. Freedom
    2. Pressure

    On any given day, I have the freedom to participate in activities that further my education, and to collaborate in real time with quality and safety leaders in the organization (at least once weekly I have one-on-one time with the Assistance Vice President of Quality and/or the Assistant Vice President of Safety at MedStar Health – invaluable mentorship that I cherish). This is important for several reasons: obviously the education, but also because safety events happen at 2am; event reviews are arranged within 48 hours of an event; disclosure happens within minutes; CANDOR and Patient Communication Consult training sessions and Clinical Quality and Safety meetings are scheduled throughout the week at widely varying times. There needs to be flexibility in the schedule of an administrative fellow.

    For instance, this month (all with minimal notice) I attended an event review for a serious safety event, volunteered to interview providers in operating rooms at two separate hospitals as part of a project to reduce the incidence of retained foreign objects, scheduled a lecture to educate residents about just culture and high reliability, rounded with surgical residents to observe safety events and unsafe conditions, attended a conference to improve the diagnostic process and reduce diagnostic error, became the team lead on a project to develop measures to reduce diagnostic error with the Institute for Healthcare Improvement, joined a committee to develop educational interventions to improve the diagnostic process with the Society to Improve Diagnosis in Medicine, and on and on and on…

    Now to the pressure. This particular fellowship is not accredited by the ACGME…yet. If I succeed in attaining my educational objectives it will further the case for ACGME accreditation; if not, we will have lost a huge opportunity to contribute to a formal Quality and Safety Curriculum in Graduate Medical Education. To maximize the likelihood of success, I spent a great deal of time researching other fellowships and looking at the credentials of leaders in quality and safety to create a robust list of goals and objectives. I will also complete a certificate program in Executive Leadership in Quality and Safety in the spring at Georgetown University, a passion project of quality, safety, and education leaders at the MedStar Institute for Quality and Safety. This Masters level certification will provide critical didactic knowledge to round out my practical experience.

    So, while I do feel stressed, I also feel incredibly privileged. Every day I get to do exactly what I love. I also have the privilege and the pressure (as Billie Jean King likes to say, pressure is a privilege) of setting the tone for all future fellows who work at the MedStar Institute for Quality and Safety. It’s a huge responsibility. I think to myself, in 15 years what will the fellow(s) be working on? Will there be a fellow in Resident Quality and Safety education? A Fellow in High Reliability? A Fellow in Practice Improvement? The possibilities are endless…if this experiment succeeds.

    What I do know is…when I go to residency programs and tell current trainees that they can complete a Fellowship in Quality and Safety, they sit up straighter and at least one set of eyes sparkles. I remember that feeling, and I know that any future Fellow in Quality and Safety at MedStar, because of the flexibility to seize all educational opportunities and develop projects with system-wide support, will make a huge difference at MedStar Health and beyond.

  • October 31, 2017

    By MedStar Health

    At the recent MedStar Health Research Institute (MHRI) Fall Town Halls, four associates and one team were awarded an MHRI HeRO Award. Presented by Joan K. Bardsley, MBA, RN, CDE, FAADE and Karen J. Wade, these awards were to recognize associates who routinely demonstrate an exemplary commitment to the goals set forth by MedStar Health as a high-reliability organization. Nominations for the five categories of HeRO awards were opened to all MHRI associates. Congratulations to all our recipients and thank you all for your commitment to patient safety and being a part of a high-reliability organization.

    HeRO Good Catch Award

    Ron M. Migues: HeRO Good Catch Award
    HeRO Good Catch Award: Ron M. Migues

    Awarded to Ron M. Migues, this award highlights a great catch that not only helped prevent patient harm but resulted in a lasting change that will improve patient safety for all future patients. Ron is the Scientific Center Administrative Director for MHRI at MedStar Washington Hospital Center. Ron was nominated for his commitment to HRO by verifying those who had access to our electronic medical records, thus ensuring that patient privacy was protected.

    Nursing HeRO Award

    Jean Flack, BSN, OCN, CCRC
    Nursing HeRO Award: Jean Flack, BSN, OCN, CCRC

    Jean Flack, BSN, OCN, CCRC, was awarded the Nursing HeRO Award, which recognizes an MHRI nurse whose invaluable efforts advance high reliability and ensure we deliver the highest levels of quality care and safety to our patients. Jean is the manager for oncology research at the Weinberg Cancer Institute at Franklin Square. She was nominated for her consistency in leading fellow associates in HRO principals and consistently reporting observations and safety catches.

    Safety Coach HeRO Award

    Rachel Campbell, RN
    Safety Coach HeRO Award: Rachel Campbell, RN

    Rachel Campbell, RN, was the recipient of the Safety Coach HeRO Award. Rachel is a Cardiology Research Nurse Coordinator at MedStar Union Memorial Hospital. This award honors associates who take on and embrace the safety coach role. Rachel was nominated for her commitment to this important role by presenting specific safety catches when asked, ensuring that all members of a care team are aware of safety implications, and being willing to speak up.  

    HeRO Non-clinical Award

    Sarah Wright-Gaul was awarded the HeRO Non-Clinical Award. One of the most common misconceptions about high reliability is that it only involves clinicians. Sarah is the Senior Proposal Development Specialist in the Office of Research Development, Planning and Communications. High-reliability affects every MedStar associate in every role and entity across the system. Sarah was nominated for her commitment to validating and verifying information before submitting proposals on behalf of the Research Institute.

    Team HeRO Good Catch Award

    Team HeRO Good Catch Award was awarded to the Office of Research Development, Planning, and Communications
    Team HeRO Good Catch Award: Office of Research Development, Planning, and Communications

    The Team HeRO Good Catch Award was awarded to the Office of Research Development, Planning, and Communications. This award celebrates the efforts of associates who collaborate with one another to achieve better patient outcomes. Through collective mindfulness, the team achieves improved patient safety and care. The team, under the leadership of Katie Carlin, MBA, was nominated for its consistent use of STAR and the application of HRO principals. The team includes Michele Lee Clements, Allison Selman-Lovell, Eva Hochberger and Sarah Wright-Gaul. The team is committed to detail, validating and verifying, and speaking up for research.

  • October 31, 2017

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in October 2017. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

    Selected research:

    1. Design and Evaluation of a Low-Cost Speculum Examination Training Model.
      Simulation in Healthcare Journal, October 2017. DOI: 1097/SIH.0000000000000252
      Benson JE, Hillebrand AM, Auguste T
    2. Outcomes After Operative and Nonoperative Treatment of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis.
      American Journal of Sports Medicine, October 2017. DOI: 1177/0363546517732526
      Bodendorfer BM, Curley AJ, Kotler JA, Ryan JM, Jejurikar NS, Kumar A, Postma WF
    3. Assessing the National Cancer Institute's SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial.
      Journal of Medical Internet Research, October 2017. DOI: 2196/jmir.8411
      Abroms LC, Chiang S, Macherelli L, Leavitt L, Montgomery M
    4. Transgender Youth Fertility Attitudes Questionnaire: Measure Development in Nonautistic and Autistic Transgender Youth and Their Parents.
      Journal of Adolescent Health, October 2017. DOI: 1016/j.jadohealth.2017.07.022
      Strang JF, Jarin J, Call D, Clark B, Wallace GL, Anthony LG, Kenworthy L, Gomez-Lobo V
    5. Analysis of factor XIa, factor IXa and tissue factor activity in burn patients.
      Burns, October 2017. DOI: 1016/j.burns.2017.08.003
      Shupp JW, Prior SM, Jo DY, Moffatt LT, Mann KG, Butenas S
    6. Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia.
      PLoS One, October 2017. DOI: 10.1371/journal.pone.0186060
      Wood SF, Podrasky J, McMonagle MA, Raveendran J, Bysshe T, Hogenmiller A, Fugh-Berman A
  • October 24, 2017

    By Karen Johnson, MD

    More than 16 million — or nearly 7 percent — of American adults experience at least one major depressive episode in a given year. And numerous studies have shown that the rates of depression among hospital patients are higher than the non-patient population.

    As a psychiatrist at MedStar Washington Hospital Center, I encounter depression in patients from two sides:

    • Patients who have depression already and develop a medical condition that requires hospitalization. In some severe cases, a suicide attempt may be the reason for hospitalization.
    • Patients who develop a depressive disorder during the course of diagnosis, treatment and recovery from a medical condition.

    Depression can cause people to pay less attention to their health, leading to a higher risk of chronic illnesses, such as high blood pressure, diabetes or heart disease. If depression develops after a diagnosis, it can reduce their ability to manage the condition, such as not taking medications as directed or missing doctor’s appointments.

    It’s essential that we recognize and treat depression as soon as possible. Let’s take a look at what depression is, how we treat it, and what you can do if a loved one is exhibiting signs of depression.

    LISTEN: Dr. Karen Johnson further discusses depression in hospital patients on this Medical Intel podcast.

    What are the signs of depression?

    Depression is as much a disease as diabetes or cancer. And while the terms sadness, stress and depression often used interchangeably, there’s a difference.

    Sadness is something we all encounter periodically during our lives. It’s a normal reaction to loss, unhappiness or struggle. Stress is an emotion we experience in response to adverse or demanding circumstances.

    Depression is more serious and long-lasting than sadness or stress. And it’s something people have no control over. A depressive episode is characterized by feeling sad and down most of the day, almost every day for a minimum of 12 to 15 days.

    Depression symptoms can include:

    • Persistent sad or anxious mood
    • Feelings of hopelessness, helplessness or worthlessness
    • Loss of interest in hobbies or activities
    • Decreased energy
    • Difficulty concentrating or making decisions
    • Changes in sleep pattern, such as sleeping too much or experiencing insomnia
    • Appetite or weight changes
    • Pain, headaches or digestive problems without a clear cause
    • Thoughts of suicide

    It can be difficult to recognize depression in patients because some medical conditions or medications can cause some of these same physical symptoms. But it’s important to be aware of these signs of depression so you or your loved one can begin treatment as soon as possible.

    Why some people develop depression in the hospital

    Let’s say you’ve had diabetes for 10 to 15 years. The disease has progressed to end-stage renal disease, meaning your kidneys no longer function as they should. Your doctor recommends beginning dialysis, which can have a significant impact on your life. Initially, you may be shocked or saddened by the thought of being on dialysis. But over time, you may develop a major depressive disorder.

    Unfortunately, this story is fairly common. Depression often accompanies illness. You may need to grieve a diagnosis or adjust your expectations for your future. It also can strain your relationships and finances. And depression won’t necessarily disappear after recovery, as you may continue to deal with lingering side effects or a fear of relapse.

    The good news is that depression is treatable. But it’s not something you can do alone, so it’s important to get help.

    How we treat patients experiencing depression in the hospital

    Our consult-liaison team diagnoses and treats depressive disorders whether they are the primary reason for hospitalization or a co-existing condition. The first thing we try to do is connect with our hospitalized patient, so they feel comfortable talking with us, all while being considerate of the fact that they’re very sick.

    As with anything in medicine, the first step is to identify what is wrong. Many patients are not even aware of their depression because they’re more concerned with the pressing medical emergency. But when we start talking to them, they begin telling us not just about what’s happening to them in that moment, but also about past life events that may be impacting what’s going on.

    In diagnosing depression, we’ll also talk to the patient and their doctors about conditions or medications that may be causing the depression. For example, depression may be a side effect of some steroids or medications to treat high blood pressure, and some thyroid conditions can cause depressive symptoms.

    Depression often is treated with a combination of medication and psychotherapy, also known as therapy or counseling.

    By starting a patient on an antidepressant while they’re in the hospital, we can monitor them closely for their response to it. We’ll work with their doctor to find an antidepressant that won’t aggravate the patient’s medical condition or interact with other drugs they’re taking.

    Psychotherapy works to help you learn constructive ways to deal with problems or issues in your life. You can learn to recognize when your medical condition or other external factors can impact your mood and develop coping skills around it.

    Some patients tell me they’re not interested in psychotherapy because they’ve tried it before and it didn’t work. I’ll often respond that I understand, but ask them to consider it with a more focused approach. Perhaps they take three things they’ve identified as needing to be addressed and deal with just those in therapy.

    There also are a few other lifestyle changes and interventions that may help patients deal with depression, including:

    • Taking part in regular exercise
    • Spending time with family and friends
    • Getting enough sleep
    • Keeping a journal
    • Setting realistic goals and not expecting your mood to improve overnight

    When a patient is about to be discharged with the hospital, we want to make sure they’re linked to the services they’ll need. This could be an outpatient behavioral health program, support group or perhaps even a workshop designed to help adults living with chronic conditions take charge of their health — physical and emotional.

    How to help a loved one with depression

    Often, it’s not the patient who first recognizes a depressive disorder, it’s those around them. Identifying symptoms of depression early can lead to your loved one receiving treatment before the disease progresses to a point where they may harm themselves. For example, you may notice a change in personality, that they’re becoming withdrawn or isolating themselves. Or maybe they’re not eating or sleeping as well as they used to.

    While we respect patient’s privacy, we always encourage them to include family or friends in their medical care. That way the patient has support in managing their treatment plan and taking care of themselves.

    There’s always an opportunity to include family in treatment. For example, if a patient has significant developmental or childhood issues in their background, family members may be integral in treatment. Marital counseling or family therapy may be encouraged in some cases.

    Finally, hospital patients often are pressured to “keep a positive outlook.” While we want to foster hope, it’s important to allow your loved one a safe space to discuss their fears and anxieties. Be supportive, but not demeaning or condescending.

    Illness, especially when it’s serious enough to require hospitalization, can cause distress. But you’re not alone. If you or a loved one is experiencing signs of depression, request an appointment or call 703-552-4036.

    Request an Appointment