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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:
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    5. Don’t confuse skin conditions with dryness.

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

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

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

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


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

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • October 10, 2017

    By Ivanesa Pardo, MD

    Men or women can develop hernias. When they do, an organ or tissue can squeeze through a weak spot in a muscle wall. When surgery is called for, several options are available.

    A hernia is a weak spot, defect, or hole in the muscle layers of the abdomen, through which a part of an organ or piece of fatty tissue can poke. Hernias most often occur in the groin or at the umbilicus (belly button). But they can also occur elsewhere, such as the sites of previous surgical incisions.

    What Causes Hernias?

    The belly button, for instance, is where our umbilical cord attached us to our mother when we were in her womb. After birth and the cord’s cutting, the hole usually will close itself. But some people have a persistent opening that eventually can enlarge to become a hernia.

    People sometimes develop an “inguinal hernia” in the groin. This can happen with strenuous activity, or sometimes after birth, a baby’s inguinal canal does not close behind them, leaving a weak spot, which eventually can become a hernia.

    Other hernias can occur at weak spots like old incisions, from strenuous activities or incomplete healing.

    LISTEN: Dr. Pardo discusses hernias further on the Medical Intel podcast.

    What about Activities such as Lifting Heavy Items?

    Physical activity, especially strenuous and high-intensity exercise, can exacerbate or even cause a hernia. There are definitely some stories about people who exercise a lot and do a lot of heavy lifting, and they suddenly feel a “pop” and have a hernia. Those are acute cases; however, there is no need to put strict limits on how much someone should exercise, rather to be smart about it. When lifting heavy things or exercising, everyone should know -- and observe -- their limits. Anyone with signs of a hernia should be careful when straining or lifting, because the hernia can become “symptomatic,” which means it requires medical attention.

    An “incarceration” occurs when something – such as a piece of intestine or fatty tissue – gets stuck in an opening (hernia) and can’t be pushed back in. A more serious situation is “strangulation.” That’s when the stuck piece of tissue or organ is losing its blood supply and starting to die. That requires emergency surgery.

    When Should I Seek Medical Help?

    Pay attention if you feel a lump that gets larger, or more tender, when you sneeze, cough or strain. If this occurs, see your primary care physician, or a specialist, for a diagnosis.

    I recommend elective surgery when the defect (hernia) is large enough that, even if it’s reducible, a segment of intestine could get stuck, which could lead to incarceration or strangulation. We can repair hernias in several ways. There’s the old-fashioned “open repair” approach, which involves a larger incision. Then, there are more modern “minimally invasive” repairs. They can be laparoscopic or robotic. Their appropriateness will depend on the particular patient, the availability of the medical facility in question, and the skills of the surgeon.

    Sounds like you might have a hernia?

    Meet with one of our specialists to confirm if you require medical help.


    Request an Appointment

    Most hernia repairs today involve implanting a mesh. This is a screen that is made of synthetic material that reinforces the muscle layers where the defect, or hernia, is. The advent of the mesh has reduced the chances of a hernia coming back after it’s been repaired.

    You should talk with your surgeon about whether you need a repair, and whether mesh is appropriate.

  • October 06, 2017

    By MedStar Health

    ­­For as long as he can remember, Norman Lester, MD, wanted to become a physician. Choosing a specialty, however, took a little longer.

    It wasn’t until his third year at the University of Maryland School of Medicine that he discovered otolaryngology—more familiarly known as the diagnosis and treatment of ear, nose and throat (ENT) disorders.

    Why Otolaryngology?

    “Honestly, I thought an ENT might just take out tonsils,” Dr. Lester says with a laugh. “I quickly learned that head and neck anatomy is fantastically complicated. There a lot going on in a small space.”

    Dr. Lester remains fascinated by otolaryngology’s sheer breadth of conditions and diseases, with surgical treatments that range from intricate oncology procedures to, yes, routine tonsillectomies.

    Otolaryngology also affords Dr. Lester the opportunity to cultivate lasting relationships with a variety of patients. Many of them have referred their children to him when they needed treatment.

    “Now, the occasional grandchild is showing up,” he says.

    Team-Based Treatment for Specialized Patient Care

    While Dr. Lester considers himself a generalist, he enjoys a close relationship with MedStar Washington Hospital Center’s otolaryngologists who have specialty expertise in various head and neck conditions.

    “If our initial diagnosis indicates they need additional help, we can refer the patient to a sub-specialist, who will prescribe the treatment, then we handle the follow-up,” he says. “It’s a really good system.”

    Variety may be the “spice” of otolaryngology, but Dr. Lester has noticed some trends in his cases, including a rise in sudden sensory hearing loss (SSHL), an urgent, yet sometimes difficult-to-diagnose condition that typically affects only a few thousand people a year.

    “In the last four months, I’ve treated 15 to 20 SSHL patients—as many as we used to see during an entire year,” he says.

    The need to quickly address SSHL is not lost on Dr. Lester, who has experienced the condition a few times himself. When other issues began accompanying his hearing difficulties, however, he suspected the presence of an acoustic neuroma—a slow-growing, noncancerous tumor that develops on the main nerve of the inner ear. The condition was verified by a colleague, and successfully treated with surgery.

    “I’m probably the only ENT who diagnosed his own acoustic neuroma,” Dr. Lester says. “Experiencing things from the patient’s perspective was interesting.”

    Outside the Hospital

    It should come as no surprise that someone so closely associated with hearing as a professional would also be a musician. In addition to occasionally playing bass with a friend’s band (“mainly alternative rock,” he says; “loud and obnoxious.”), Dr. Lester builds custom guitars on a semi-professional, word-of-mouth basis. He’s crafted instruments for several area musicians, including legendary “power-pop” guitarist and Bethesda native Tommy Keene.

    Never harboring any illusions about his own musical talent, Dr. Lester finds plenty of satisfaction in a field that he once misunderstood, but has since come to love.

    “Each week, I can point to something where what I did made a difference—where I did something important for a patient,” he says.

  • October 06, 2017

    By MedStar Health

    Madden now makes better nutritional choices thanks to the advice she received from her endocrinologist Dr. Kulkarni.

    Vanessa Madden suffered from type 2 diabetes for 13 years. She lived with extreme fatigue and found it difficult to complete normal, daily activities, despite the fact that she was taking a range of medications prescribed by her primary care physician. Then a friend suggested that she see an endocrinologist, a physician who specializes in treating diseases, such as diabetes.

    Thinking that she had nothing to lose, Madden scheduled an appointment with Rani Kulkarni, MD, at the Diabetes and Endocrine Center at MedStar Harbor Hospital. After her very first appointment, everything changed.

    “Dr. Kulkarni adjusted my dosages and the time of day that I was taking my medications, right from the start,” says Madden. “I felt 100 percent better very quickly. Suddenly, I had energy again. I couldn’t believe it.”

    Rani Kulkarni, MD

    Since that life-changing day, Madden has continued to see Dr. Kulkarni every three months for ongoing care and continued medication adjustments as needed. She also made many lifestyle changes, including incorporating exercise into her routine and making better nutritional choices to further boost her progress. As her health improved, Madden was able to gradually decrease her medication intake.

    “Before, I had to carry around a bag of needles everywhere I went because I needed to give myself four shots each day,” she notes. “Now, I don’t have to do that because I only need insulin one time each day. That alone has made my life so much easier.

    The Diabetes and Endocrine Center at MedStar Harbor is designed to support, educate and treat patients just like Madden, who are motivated to gain better control of their disease, but need guidance from specialists to get their health back on track. Dr. Kulkarni recommends that any patient with diabetes whose Hemoglobin A1c level is consistently over eight percent seek treatment from an endocrinologist.

    “An endocrinologist will pay close attention to all of the factors that are impacting the patient’s diabetes, from comorbidities and drug interactions, to lifestyle factors that can be controlled,” she says. “Vanessa’s story is inspiring because once she was educated about how to selfmanage her condition on a dayto-day basis, she got her diabetes under control and started to feel so much better.”

    And making good lifestyle choices really does make a difference, Dr. Kulkarni stresses.

    “Once our patients realize how much they can control themselves, they feel empowered,” she adds. “They see what is possible and become more motivated to eat healthier and make time for exercise, just like Vanessa did.”

    Location Information

    For more information, please call



    MedStar Harbor Hospital
    3001 South Hanover St.
    Baltimore, MD 21225

  • October 05, 2017

    By Daniel Marchalik, MD

    Left Image: The target from an MRI is merged with an ultrasound image for targeting. Right Image: The biopsy locations are captured by the MRI-Ultrasound fusion technology.

    Ideally, doctors would catch every case of prostate cancer early, before it has time to grow and spread. Early detection gives men more options, whether that involves treatment or active surveillance to make sure the cancer doesn’t continue to develop.

    But standard approaches can’t always locate the prostate cancer. That’s an issue for many of my patients. One man had previously had five standard biopsies, all of which were negative for prostate cancer. But he still had high levels of PSA, or prostate-specific antigen, which is a potential indicator of prostate cancer. I told him, “You really should get an MRI.”

    The patient’s MRI (magnetic resonance imaging) test showed there was an abnormality in an area of the prostate where we don’t usually see tumors—one that’s difficult for us to access during a standard biopsy. So we used an advanced technique called an MRI/ultrasound fusion biopsy, which uses both MRI and ultrasound, to help detect this patient’s prostate cancer.

    This patient would not have been diagnosed as early as he was without having an MRI/ultrasound fusion biopsy. And this is just one of the many examples I’ve seen of this technology’s value to patients.

    The benefits of MRI/ultrasound fusion biopsy

    Prostate cancer is a serious problem, both nationwide and in the Washington, D.C., area. Locally, we have a prostate cancer incidence rate of 120.1 men per 100,000. That means more than 120 men out of every 100,000 in the area have prostate cancer—a rate that’s nearly 18 percent higher than the national average.

    I recommend a prostate biopsy for men who repeatedly have test results that show high PSA levels. We traditionally use an ultrasound probe to first see if there are any abnormal areas in the prostate. If there are, we target the biopsy in those areas. If there aren’t, we sample 12 random areas to see if we can locate any cancerous cells. The challenge with this approach is that it’s possible to still miss cancerous cells.

    As we’ve begun to use MRI scans more often, we’re able to find tumors within the prostate. MRI scans are especially helpful for detecting aggressive prostate tumors. Many times, I see patients who have high PSA scores but negative biopsies, and prostate tumors show up on an MRI scan.

    MRI/ultrasound fusion biopsy combines the best parts of MRI and ultrasound for prostate biopsies. The fusion approach starts with an MRI scan of the prostate. We then use that to guide us as we perform an ultrasound and biopsy at the same time. Merging these images is almost like having a homing device in the prostate, telling us to change angles or move our probe slightly.

    MRI/ultrasound fusion biopsy combines the best parts of MRI and ultrasound for prostate biopsies. via @MedStarWHC

    Click to Tweet

    Following the completion of the procedure, the distribution of the biopsy sites in relation to the targets can be easily visualized.

    This technique increases the number of cases of prostate cancer we’re able to diagnose, especially higher-risk cases of the disease. One study found that targetedMRI/ultrasound fusion biopsy helped doctors diagnose 30 percent more high-risk cases of prostate cancer compared to standard biopsy.

    During my training at Georgetown University, I had the opportunity to train at the National Institutes of Health (NIH) for four months. The NIH is where the MRI/ultrasound fusion biopsy system was developed. I use it frequently, and other centers are starting to use it more as well.

    Related reading: Can an advanced MRI improve prostate cancer screening?

    MRI/ultrasound fusion biopsy harnesses the strengths of both MRI and ultrasound to do more than either can do alone. The result: We can catch more cases of prostate cancer that might not otherwise be found. My hope is that MRI/ultrasound fusion biopsy becomes the standard method doctors everywhere use to detect prostate cancer.

    Request an appointment with one of our urologists if you’ve had several high PSA scores but negative prostate biopsy results in the past.

    Request an Appointment

  • October 04, 2017

    By MedStar Health

    (Photo L to R: Dr. Gregory Argyros, chaplains Teklu Gudeto, Emmanuel Saidi, Christopher Oranyeli, Jerome McCallum, Anthony Akinlolu,  Sheila Brown, Paulette Davidson and President John Sullivan; Not in the photo: Bro. John Thomas Fisher, Sr. Daria Moon and Bro. Anthony VanBerkum)

    Many patients and families turn to MedStar Washington Hospital Center chaplains for spiritual and emotional support while in the hospital. Over the summer, the chaplains visited often with a terminally ill patient. Sadly, she took a turn for the worse and her care team had to share with the family that she might not make it home. That meant she would not be able to live out her greatest wish–to witness and attend the wedding of her son.

    The chaplains refused to let the patient’s final wish go unfulfilled, so they immediately sprung into action. They brought together the patient’s son and the care team to find a way to meet the patient’s wish. The question was: ‘Can we have the wedding here at MedStar Washington Hospital Center?’

    A  Hospital Center Wedding

    The chaplains got to work on the wedding plans, tackling one of the most important details: finding a venue. Without hesitation, the team chose the hospital’s Chapel of Intercessions–a very special and sacred place–which was moved in its entirety from Episcopal Eye, Ear and Throat Hospital, one of the three hospitals that merged to form MedStar Washington Hospital Center in 1958.

    The team transformed the chapel into the most perfect on-site wedding venue, complete with decorations, food, music, ushers and a photographer. Even the chaplains’ offices were converted to dressing rooms for the wedding parties.

    The day of the ceremony arrived. The bride and groom wore full wedding attire, and 30 of their closest family members and friends filled the chapel. The care team escorted the patient down to the chapel. The Rev. Christopher Oranyeli, a Hospital Center chaplain, began the wedding Mass, and two of the family’s priests officiated. As the ceremony concluded, the patient’s final, greatest wish had been fulfilled.

    The family could not have been more appreciative of the outpouring of support they received from the chaplains–it meant so much to them and to the patient.

    Six days after this wonderful occasion, the patient was transferred to hospice services where she died shortly thereafter. At her funeral Mass, the family requested the presence of Fr. Christopher.

    Above all, patients first

    MedStar Washington Hospital Center is dedicated to ensuring that above all, our patients are always our first priority, and the Spiritual Care team played an integral role in upholding that commitment.

    Here is a family experiencing one of the most difficult times in their lives, and our chaplains came together to turn tragedy into what will forever be a special memory for all. That is the patient first, quality care the Hospital Center strives to provide to every patient, every day.

    At a recent leadership meeting, the hospital recognized the team of chaplains with a special SPIRIT Shout Out for their unwavering commitment to serve the spiritual needs of this patient and all of our patients.

  • October 04, 2017

    By MedStar Health

    By Anne Gunderson, Ed.D, MS, GNP

    In 1999, the Institute of Medicine (IOM) released a report that estimated 44,000 to 98,000 people were dying each year in hospitals as a result of medical errors. Even the lower estimate suggested that medical errors were the eighth leading cause of death, higher than motor vehicle accidents or breast cancer. A little over a decade later, medical errors are now the third leading cause of death and account for more than 400,000 deaths per year.

    Recent studies have reported that as many as one-third of hospitalized patients may experience harm or an adverse event, often from preventable errors. For more than a decade, reports of the IOM have focused attention on a persistent set of problems within the American health care system, including: poor quality, lax safety, high cost, and questionable value. The traditional systems for dissemination of new knowledge can no longer keep pace with scientific and quality improvement advances. According to the IOM, if unaddressed, the current shortfalls in the performance of the nation’s health care system will deepen on both quality and cost dimensions, challenging the well-being of Americans now and potentially far into the future.

    According to the IOM, the culture of health care is central to promoting learning at every level. The need for a new culture of care is common to all types of health care organizations. Continuous improvement requires understanding of the scientific method, systematic problem solving, the application of systems engineering techniques, operational models that encourage and reward sustained quality and improved patient outcomes, transparency on cost and outcomes, strong leadership with a vision devoted to improving health care processes. The goal is to create continuously-learning organizations that generate and transfer knowledge from every patient interaction to yield greater performance predictability and reliability.

    The absence of such training leads to medical errors – a serious problem that affects not just patients, but also the health care workers involved.  Many good physicians, nurses, pharmacists and other health care professionals have left the field due to depression and lack of support from their colleagues. Even more unfortunate, a growing number of health care professionals take their own lives each year when involved in a preventable medical error. If we cannot take care of our own, how could we possibly administer care for our patients?

    There is finally a solution for practitioners and their patients. The Executive Master’s in Clinical Quality, Safety and Leadership at Georgetown University and MedStar Health provides an opportunity to change the world with a Patient-First Education. The Executive CQSL degree program unleashes a systematic, evidence-based education that will achieve striking results in safety, quality, reliability, and healthcare value. A fundamental tenet of the program is that all health care professionals must work in concert toward the wellbeing and safety of each patient. The Executive CQSL will allow learners across the world to access the safety science and quality learning opportunity provided by our Executive program.

    Healthcare practitioners and leaders need new skills and attitudes to meet the changing needs of patients in a medical environment that has complex, multi-layered systems, informatics, assessment, outcomes, and quality indicators. Secondary to these changes, health care has become a high-risk industry. With a learner-focused environment, the CQSL program will equip learners to become leaders in the advancement of safety science and quality healthcare, and leadership. The curriculum includes online, asynchronous coursework, simulations, team training, and one onsite residency. The future is yours…and your patients’.

    Change the World with a Patient-First Education