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  • January 14, 2022

    By Allison Larson, MD

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


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


    1. Do: Wear sunscreen all year long.

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


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


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


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


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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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


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


    3. Do: Pay closer attention to thick skin.

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


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


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


    Related reading:  Follow these 5 Tips for Healthy Skin

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

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


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

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

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

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

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

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

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

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
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    5. Don’t confuse skin conditions with dryness.

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


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

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

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

     

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


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • September 28, 2017

    By Lambros Stamatakis, MD

    Prostate cancer can be challenging to detect. Our screening and diagnostic tools—prostate-specific antigen (PSA) testing and transrectal ultrasound-guided (TRUS) prostate biopsy—aren’t perfect. And it becomes even more difficult when those tools contradict each other.

    Finding high levels of PSA, a protein made in the prostate gland, in a man’s bloodstream can indicate prostate cancer. However, PSA testing has a 15 percent false-positive rate, which means the test may detect cancer that isn’t present.

    And a high PSA level usually leads to a biopsy. A TRUS prostate biopsy samples less than 1 percent of the prostate, and the false-negative rate can approach 35 percent, meaning it shows no cancer even though cancer is present.

    Learn more: Should men get a PSA test to screen for prostate cancer, and when?

    So what are a man and his doctor to do when his PSA level indicates he has prostate cancer but his biopsy says he doesn’t?

    Your doctor may suggest doing another traditional biopsy, but because it takes random samples, it can be like trying to find a needle in a haystack. Your biopsy also may find a low-grade cancer, which means the abnormal cells are unlikely to impact your life and may only need close monitoring, not treatment. Also, there are risks associated with repeat biopsies, including bleeding and infection.

    When we encounter cases like these, we turn to two advanced options to guide our decision to do a repeat biopsy: MP-MRI or checking biomarkers. These options can:

    • Rule out clinically significant prostate cancer, which can reduce your anxiety and potentially avoid a repeat biopsy.
    • Indicate you may be harboring undetected cancer, which may prompt another biopsy and, potentially, treatment.

    Using MP-MRI to target prostate cancer

    Multi-parametric magnetic resonance imaging (MP-MRI) has emerged over the years as an imaging test that can improve the accuracy of detecting aggressive prostate cancer.

    MP-MRI uses the same machine as other MRI imaging but differs in that it uses multiple, specific imaging sequences instead of just one. If a patient has an elevated PSA level but a negative biopsy, we can use MP-MRI to detect suspicious lesions. If such lesions are found, we can target them with a biopsy using a unique platform that fuses the previously obtained MRI images with real-time ultrasound in our clinic.

    When an MP-MRI shows no suspicious lesions, the results are 89 percent accurate. And in men with a prior negative biopsy, up to 87 percent of tumors detected by MP-MRI are considered “clinically significant,” which means there is a tendency for these tumors to grow and potentially become metastatic.

    While we regularly use MP-MRI for repeat biopsies, it’s also being studied as a first line of testing for prostate cancer. We might be able to avoid the potential negative effects of PSA testing and biopsy by screening at-risk men with MP-MRI instead. Until we have more data on that use, we’re glad to offer MP-MRI to men whose other test results are inconclusive.

    Using biomarkers to guide our next step

    While MP-MRI has proven to be an effective tool in diagnosing prostate cancer, not every facility has the technology needed to perform it—the MRI machine and special biopsy platform—or radiologists with the expertise to read a prostate MRI. In addition, the test can take up to an hour in an MRI machine, which can be uncomfortable for patients, particularly if he is claustrophobic.

    In these cases, biomarkers can be useful to potentially avoid repeat biopsy. Biomarkers indicate whether a certain body process is normal or abnormal. These biomarkers can pinpoint men who actually need a repeat biopsy, as well as help us find more aggressive cancers.

    Types of biomarkers we can use to detect prostate cancer include:

    • Urine-based: This test looks for prostate cancer gene 3, or PCA 3. These genes make prostate cells produce a particular protein, and prostate cancer cells make more of this protein than normal cells. There are two parts to this test. First, you doctor will do a rectal exam to massage the prostate gland. This helps move the PCA3 into the urine. Then, you’ll give a urine sample. The reading will give an indication of your risk of prostate cancer. A higher PCA3 score also can indicate a higher-grade cancer.
    • Blood-based: Tests, such as the Prostate Health Index (PHI) or 4K score, are based on PSA testing but are more sensitive than PSA alone. They combine multiple biomarkers, including total PSA, free PSA, proPSA and human kallikrein-2, to come up with a score that can tell what your risk of prostate cancer might be.
    • Genomic: Noncancerous prostate tissue located near a tumor will show a “cancerization” process at the DNA level. The ConfirmMDx text looks for that process in a sample from the first biopsy in which cancer was not detected. This can indicate whether that sample is near cancerous tissue. These tests have been shown in clinical practice to decrease repeat-biopsy rates from 43 percent to 4.4 percent, helping men avoid unnecessary biopsies.

    If a biomarker test suggests that the initial biopsy failed to diagnose prostate cancer, a repeat biopsy is recommended. Ideally, you would get an MP-MRI, but if you don’t have access to that technology, you may get a traditional prostate biopsy. However, if a traditional biopsy still doesn’t find high-grade prostate cancer despite biomarkers indicating it, you may want to travel to the nearest facility with MP-MRI.

    A high PSA level and negative biopsy can certainly cause you and your doctor to feel nervous. But MP-MRI and biomarkers can provide reassurance that our next step is the right one.

    If you’re considering your next step after a high PSA result and negative biopsy, or you want to know what type of prostate cancer screening you may need, request an appointment with one of our doctors.

    Request an Appointment

  • September 26, 2017

    By Louis Dainty, MD

    Talcum powder has long been a baby care and personal hygiene essential, showing up in everything from cosmetics to soaps to antiperspirants. It’s best known as an ingredient in baby powder, which has been used to keep babies’ and adults’ bottoms dry and odor-free since the 1800s.

    Women have historically used talcum powder on these areas to absorb vaginal moisture and odor. However, this practice has waned with younger generations, so it’s usually older women who use it this way.

    But the use by adult women has recently thrust the product into the media spotlight. A jury in August 2017 awarded a woman $417 million in a case against Johnson & Johnson. The woman claimed her terminal ovarian cancer was caused by the company’s baby powder, which she said she’d used for decades on her perineum, which in a woman is the area from the outer genitals (vulva) to the anus.

    The case reignited a decades-old question: Can talcum powder cause ovarian cancer if used in the genital area? Studies and the experts are mixed on the issue. Certainly there are other more significant risk factors for ovarian cancer. But because of the potential for a very small increased risk of ovarian cancer with the use of talcum powder, I recommend women not use baby powder in their genital area.

    Tune in to this podcast to hear Dr. Louis Dainty further discuss the potential link between talcum powder and ovarian cancer.

    What studies say about talcum powder and ovarian cancer

    The possible link between ovarian cancer and talcum powder dates back to the 1960s. The initial concern sprung from a contamination of talcum powder with asbestos, a known cancer-causing agent. Asbestos is often mined alongside the mineral talc, which is the main ingredient in talcum powder.  Asbestos was banned from cosmetic-grade talc in 1973, and the Food and Drug Administration reported finding no traces of asbestos in talc-based cosmetic products in 2012.  

    Recent studies looking at a potential link between talcum powder and ovarian cancer have been inconclusive. Some show a slightly increased risk, and others report no increase at all.  

    One problem with many of these studies is that they relied on people’s memory of their talcum powder use. Researchers asked women with ovarian cancer if they used talcum powder on their perineum and, if so, how long they had used it and how frequently. Memory is not always perfect.  

    A woman’s risk of developing ovarian cancer in her lifetime is 1.6 percent. Some studies suggest that risk rises to 1.8 percent with perineal talc exposure. That translates to 18 women out of 1,000 developing ovarian cancer instead of 16. While that may not sound like a lot, that’s two women who may not have gotten ovarian cancer if they had avoided talcum powder.  

    How I advise women about using baby powder on themselves and babies

    While statistically the potential increased risk is very small, we want to do everything we can to reduce a woman’s risk for developing ovarian cancer. That’s why I recommend women not apply talcum powder on their sanitary napkins, diaphragms or directly to their genital area.

    If you’ve used talcum powder for these purposes, even for years or decades, you don’t need to run to your doctor or get special testing. Instead, just stop using the product.

    I advise patients who have or care for daughters in diapers to avoid talcum powder on them as well. While we know little for sure about the ovarian cancer risk to adults who use baby powder, we know even less about the potential risk to babies. If I had babies again, I probably would not use talcum powder on their bottoms. If you want an alternative, try dusting your baby or yourself with cornstarch instead.  

    When my patients ask if they should douche or use other vaginal hygiene products, I tell them that the vagina is designed just as it should be and should be messed with as little as possible. I don’t recommend the use of any artificial products that you don’t absolutely need. And if you do use them, find the product with the least number of additives, such as coloring or perfume.

    Know the symptoms and other risk factors for ovarian cancer  

    Ovarian cancer is known as a “silent killer” because most women will not experience symptoms until the disease is advanced.  

    Symptoms of ovarian cancer can include:

    • Abdominal or pelvic pain
    • Bloating
    • Difficulty eating or feeling full quickly
    • Unexplained weight gain  

    These symptoms can be attributed to a variety of conditions, including normal body changes that occur during a woman’s menstrual cycle.

    But if they suddenly appear and don’t go away, request an appointment with your doctor.

    Request an Appointment


    The main risk factor for developing ovarian cancer is age. The average age of a woman with ovarian cancer is 63. The older you get, the higher your risk for developing the disease.  

    The most commonly talked about ovarian cancer risk is familial risk, or a disease that runs in the family. While most ovarian cancers are not hereditary, family history certainly is very important. Genetic mutations, such as BRCA1 and BRCA2, account for about 15 percent of all ovarian cancers.  

    If a first-degree family member—parents, siblings or children—had ovarian cancer or breast cancer before age 50, you may want to consider seeing a geneticist to determine your potential risk. We include breast cancer because BRCA1 and BRCA2 mutations increase a person’s risk for multiple cancers, including breast and ovarian.  

    There’s nothing you can do about getting older or your genetic makeup, but you can do something about your weight, which is the No. 1 modifiable risk factor for ovarian cancer. If you are 25 pounds overweight, your ovarian cancer risk rises 400 percent. So while talcum powder may slightly increase your risk of ovarian cancer, it’s minimal compared to the risk of carrying extra weight.    

    We may never know for sure whether talcum powder absolutely can cause ovarian cancer, but not using it on your genital area is an easy way to avoid the potential risk. If you’re concerned about your risk for ovarian cancer, talk to your doctor. Together, you can work out a plan to manage your risk factors and feel comfortable with your feminine hygiene.  

  • September 25, 2017

    By Andrew Sokol, MD

    Women often find it embarrassing to talk about pelvic floor disorders—a broad category of issues also called pelvic floor dysfunction. These issues often stem from weakening or injury of the muscles and connective tissues of the pelvis. But these conditions are common, and women should feel comfortable discussing them with their doctor.

    A 2014 study found that 25 percent of U.S. women have at least one pelvic floor disorder. That’s only the number of women who have reported it; the actual number is likely quite a bit higher. By age 80, half of U.S. women will experience some type of pelvic floor disorder.

    25% of U.S. women have at least 1 #pelvicfloor disorder. via @MedStarWHC

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    Women often believe that the symptoms of these disorders are just a part of getting older or a side effect of having children, and there’s nothing that can be done. But that’s not true. While aging and giving birth do increase the risk, there are techniques and treatments available to give women relief.

    Types and causes of pelvic floor disorders

    There are several forms of pelvic floor disorders, such as:

    • Pelvic organ prolapse: Downward movement or dropping of the pelvic organs, including the uterus, vagina, bladder and rectum.
    • Stress urinary incontinence: Leaks of urine that can happen when a woman coughs, exercises or sneezes.
    • Urgency incontinence: Problems holding back the urge to urinate.
    • Fecal incontinence: Leakage from the bowel, ranging from gas to stool.

    Many factors can contribute to a woman developing a pelvic floor disorder, including:

    • Pregnancy and delivery
    • Injuries during a hysterectomy or some other surgical procedure in the pelvic region
    • Obesity
    • Strain in the abdomen, or belly, such as lifting heavy objects

    Pelvic floor disorder treatments

    Women may be able to improve mild symptoms through changes in their behavior. Decreasing the amount of fluid you drink per day means the bladder isn’t as full, which can make it easier to hold back urine. Scheduled bathroom breaks or Kegel exercises to strengthen the muscles of the pelvic floor also can help.

    Related reading: Why women don’t have to live with an overactive bladder

    Another non-surgical option for urinary leakage and pelvic floor relaxation is a “pessary,” which is a device similar to a diaphragm used for birth control. The device is inserted into the vagina and provides support for the pelvic organs. Some women use pessaries all the time, while some only use them during the daytime. They need to be cleaned regularly to prevent infections.

    Surgery for pelvic floor disorders

    If behavioral changes or a pessary don’t work, or if a woman doesn’t want to try a pessary, minimally invasive surgery is an option to treat many pelvic floor disorders. The more surgeries a doctor or hospital does to treat these conditions, the better outcomes are for patients. Our pelvic floor disorder program is the largest such program in the country.

    Surgery to correct pelvic floor disorders used to be very invasive, but nearly all of these procedures are minimally invasive today. We can perform these surgeries either through the vagina or laparoscopically, which involves tiny incisions in the abdomen. These surgeries are often performed as an outpatient, without the need for a hospital stay.

    Minimally invasive surgical procedures have several advantages over traditional surgery, such as:

    • Fewer complications
    • Less pain and discomfort
    • Shorter hospital stay, if a stay is needed at all
    • Quicker return to work and normal activities

    Some women may have been told in the past that they’re not good candidates for minimally invasive surgery to treat these issues. There are very few reasons nowadays for women to need open surgery for pelvic floor disorders. This might be more of a reflection of the surgeon’s expertise than anything else.

    Our program is well known for our expertise in this area of surgery. When I came to MedStar Washington Hospital Center in 2005, I was the first surgeon in Washington to perform a minimally invasive sacralcolpopexy, which is a procedure to lift the vagina. And we were one of the first centers in the world to perform robot-assisted pelvic floor surgery. In fact, we are a recognized Center or Excellence in the treatment of pelvic floor disorders, and are one of the largest programs in the country training doctors in female pelvic medicine and reconstructive surgery.

    Bathroom trouble and pelvic relaxation aren’t just normal symptoms of getting older. These are common conditions that we have the tools and expertise to treat. I urge all women who are suffering with these symptoms to ask their doctors for help. We can help you get your life back.

    Request an appointment with one of our urogynecologists to explore your options for treating pelvic floor disorders.

    Request an Appointment

  • September 25, 2017

    By MedStar Health

    By Melanie Powell, MD, MPH

    Hello! I am the inaugural fellow in Quality and Safety at the MedStar Institute for Quality and Safety. Over the next year, I’ll provide monthly insights and document my transition from Family Medicine chief resident at one of MedStar’s community-based hospitals to the administrative fellow at MIQS, an institute housed within one of the largest hospital systems in the Northeast United States.

    As residents settle into the new academic year, the most common question upper levels face is: “What’s next?” My former co-residents, having figured this out and starting their new positions, now ask, “How did that go by so fast?”

    Times of transition are both challenging and incredibly exciting. Trainees across the healthcare spectrum transitioning to independent practice may feel high levels of anxiety, stress, and concerns about inadequacy, isolation, confusion, and fear. This can lead to underperformance, burnout and ultimately compromise the delivery of safe, high-quality care. In response, organizations such as the American College of Surgeons and residency programs like University of Iowa Health Care Anesthesiology developed Transition to Independent Practice Programs to help fill perceived gaps in training. The National Council of State Boards of Nursing recently completed a national study to transition new nursing graduates into clinical practice. Initial results show that nursing clinical competence significantly increased after 9-12 months of participation.

    What these programs have in common is mentorship. Mentorship is critical to the development of confident and clinically competent healthcare providers. Typically, it is implied and assumed by residency programs but actualized with varying degrees of value to residents and faculty. Reviewing the ACGME Milestones for Family Medicine Residents, mentorship is mentioned only once (within the description of a Level 5 achievement for professionalism) and in the context of a resident becoming a successful mentor herself. While it’s expected and vital that residents become effective mentors so they may train the next generation of leaders and support their colleagues, all health care providers require guidance to do so.

    I am excited to be part of a health system that recognizes the value of mentorship and feel privileged to have been mentored by two very strong women during my Family Medicine residency at MedStar Franklin Square Medical Center. In addition to the research mentorship provided through the MedStar Health Research Institute, the MedStar Institute for Quality and Safety is generating a network of quality and safety mentors to pair with young trainees. Further, the Academy for Emerging Leaders in Patient Safety (AELPS) continues to educate an interdisciplinary group of young trainees in the US and abroad that includes medical and nursing students, connected with each other through a shared love of patient safety and dedication to culture change.

    The question we must always ask ourselves going forward is: “How can we improve?” There are abundant opportunities to add to the curricula of nursing/medical schools and residency programs so that future clinicians can start building their skills as early as possible. To do this, we must identify ways to make mentorship, quality improvement, patient safety, and leadership a part of trainees’ everyday experiences. I think this includes encouraging interdisciplinary collaboration whenever possible. We grow professionally and make our patients safer when each front-line voice is heard and connected.

    I hope those of you reading this post reply with your insights and share the innovative changes happening at your medical schools, nursing schools, hospitals, and elsewhere.

  • September 21, 2017

    By John Steinberg, DPM

    One-fourth of the bones in our body are in our feet. These bones, combined with numerous joints, muscles, tendons and ligaments, work together to support the body’s weight, maintain balance, act as a shock absorber and make us mobile.

    We ask a lot of such a small part of our body. It’s no wonder that nearly 80 percent of Americans will experience foot problems at one time or another. But while a little pain now and then can be expected, living with foot pain every day is not normal.

    A problem with the foot also can lead to the development of issues elsewhere in the body. For example, if you have foot pain, you may slightly change the way you walk. While that may alleviate the foot pain, it can end up putting additional stress on your knees or hips. In fact, I see quite a few patients who went to the doctor because of pain in their knees or hips, when in fact the foot was the main culprit. Once we fix the original problem with the foot, the knee and hip pain may disappear as well.

    Foot pain can impair your quality of life. The good news is there may be some simple things you can do to reduce or eliminate foot pain. The first step is to see a foot doctor, also known as a podiatrist or podiatric surgeon, to figure out what is causing the pain and learn how you can treat it as well as prevent it from returning in the future.

    Daily foot pain is NOT normal. See a podiatric surgeon to figure out the cause & learn how to treat and prevent foot pain. via @MedStarWHC

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    Common foot problems

    Many foot problems start with genetics. And while you may not be able to change the type of feet you were born with, you can influence the amount of potential pain they cause. For example, if you have wide feet and try to force them into narrow shoes, you’re going to have pain.  

    Foot pain frequently can be traced back to ill-fitting shoes, which can cause or aggravate foot problems. And overuse is a common culprit of foot pain as well.

    Common foot conditions include:

    • Achilles tendonitis: This overuse injury of the back of the heel is caused by inflammation of the tendons that connect your calf muscles to your heel bone.
    • Bunion: This bony bump on the joint at the base of the big or little toe is a common deformity that causes the toe to push against the next toe. This condition can be genetic or caused by ill-fitting shoes.
    • Hammertoe: In this condition, the muscles, tendons or ligament that normally hold the toe straight instead cause your toe to bend or curl downward. This condition can be genetic or caused by injury or ill-fitting shoes.
    • High or low arches: An extreme arch of the foot one way or the other can cause pain, but often can be managed with an orthotic, which is a shoe insert that provides custom support.
    • Morton’s neuroma: This “pinched nerve” condition occurs when a growth of tissue forms between the third and fourth toes. It can cause numbness or a burning or tingling sensation.
    • Plantar fasciitis: This condition, in which the tough band of tissue that connects your heel bone to the base of your toes becomes inflamed, affects the bottom of the heel and is caused by overuse.  
    • Skin issues: Viral or fungal infections can cause conditions, such as athlete’s foot or warts.  

    How to prevent and treat foot pain

    The best gift you can give your feet are shoes that fit properly and are meant for the activity in which you are participating. Try on new shoes later in the day when your feet tend to be at their biggest, and replace worn-out shoes in a timely manner.  

    Inspect your feet regularly, paying attention to changes in color, peeling or scaling, and growths. Catching potential problems early may prevent pain before it starts. Wash and dry your feet, including between the toes, to prevent skin infections, such as athlete’s foot.

    If you have diabetes, you may need to take additional precautions to prevent foot injuries due to poor circulation.

    If you develop foot pain, treatment will depend on the cause. But often, simple things can help reduce or eliminate the pain, including:

    • Orthotics: Adding insoles to your shoes may provide the support you need to walk without pain. If over-the-counter insoles don’t help, we can make custom insoles.  
    • Physical therapy: A physical therapist can develop a plan that may include stretching, strengthening or balance exercises, or gait training.
    • Injection therapy: Corticosteroid shots can help relieve pain and reduce inflammation.  

    If more conservative treatment doesn’t work, surgery may be necessary to remove swollen tissue, straighten a toe or repair a tendon.  

    The average person will walk the equivalent of more than four times around the globe. If foot pain begins to impact your life by hindering work or leisure activities, get to the doctor. You have a lot more steps to take – don’t let foot pain stop you! 

  • September 19, 2017

    By Ross Krasnow ,MD

    Prostate cancer is the most common cancer in men, with one in seven men in the United States projected to get the disease in their lifetime. And the District of Columbia has the second highest prostate cancer incidence rate in the country behind only Louisiana, with 123 out of 100,000 men diagnosed with the disease in a given year.

    One of the best screening tools we have for this disease is the prostate-specific antigen (PSA) test. While there’s no doubt this simple blood test has saved lives over the years, it’s not perfect. There’s been a lot of debate over who should be screened and when—and whether men should be screened at all. Even national health organizations differ slightly on their PSA testing guidelines.

    PSA testing is not a one-size-fits-all approach to prostate cancer screening. The key is to have an honest conversation about the potential benefits and harms for each man based on his specific risk factors.

    Tune in to this podcast to hear Dr. Krasnow further discuss PSA testing, including what men may expect from future prostate cancer screening.

    Benefits and risks of PSA testing

    Prostate-specific antigen is a protein made in the prostate gland and present in semen. A small amount of PSA enters the bloodstream, but high levels in a man’s blood can indicate prostate cancer. After the PSA test’s introduction in the late 1980s, deaths related to prostate cancer began to decrease. In fact, mortality rates fell nearly 40 percent between the early 1990s and 2008.  

    This was a huge win in our fight against prostate cancer. However, there also have been some negatives associated with the test, the biggest being its 15 percent false-positive rate. A false positive is when the test detects cancer that is not present.

    This means 15 in 100 men who get an elevated PSA test result do not actually have prostate cancer. Unfortunately, to confirm this, they’ve likely undergone an unnecessary biopsy. While generally safe, biopsies can cause complications, such as bleeding or infection and can induce unnecessary stress for the patient.  

    PSA testing also can increase the risk of overtreatment. Most diagnosed prostate cancers are low-grade, which means the abnormal cells are unlikely to impact a man’s life in any way. Prostate cancer is a slow-growing cancer, taking 10 to 15 years to progress and even longer to cause death. These tumors may only need close monitoring over the years, also known as active surveillance, and not treatment.

    Do the potential benefits of PSA testing outweigh the potential harms? It depends on the person. Some of my patients who have received a false positive were relieved to know their cancer status for sure. Others, while relieved, continued to worry about their elevated PSA level as we monitored them over the following years. And still others were frustrated that they had to go through the biopsy process, which, while not painful, is awkward and uncomfortable.  

    What studies and guidelines say about PSA testing

    Actor Ben Stiller made waves in 2016 with a blog post titled “The Prostate Cancer Test That Saved My Life.” In the article, he attributed surviving prostate cancer to having a PSA test at age 46—earlier than most guidelines would recommend—despite having no indicators that he was at increased risk for the disease.  

    He wrote: “If (my doctor) had waited (to get me a PSA test), as the American Cancer Society recommends, until I was 50, I would not have known I had a growing tumor until two years after I got treated. If he had followed the U.S. Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.”

    If you’re looking to various health organizations for guidance on when you should have a PSA test, you may be confused by the differing recommendations. And these recommendations also may change over time. For example, the U.S. Preventive Services Task Force slightly revised its guidelines since Ben Stiller had his PSA test based on new evidence and studies.

    Here is what some health organizations currently recommend:

    • American Cancer Society: The organization recommends that men at average risk for prostate cancer begin discussing screening with their doctors at age 50. Men at increased risk should consider screening at age 45.
    • American Urological Association: The organization recommends that doctors begin discussing screening at age 40 to 54 for men at high risk, 55 to 69 for men at average risk, and 70 and older for some men in excellent health with a 10- to 15-year life expectancy.
    • U.S. Preventive Services Task Force: The group in 2017 recommended that while the PSA test should not be used routinely, physicians should discuss the benefits and harms with men age 55 to 69. It recommends against PSA screening for men 70 and older. This is in contrast to its 2012 guidelines that recommended against PSA screening in men without prostate cancer symptoms.  

    So what’s a man supposed to do? The answer lies in the common theme to these recommendations: a discussion between doctor and patient.  

    How I advise men about screening for prostate cancer

    I once treated a man in his 40s who was exhibiting signs of benign prostatic hyperplasia, a condition in which the prostate is enlarged. We decided to do a PSA test, despite most guidelines recommending against PSA testing for a man younger than 50 with no increased risk factors for prostate cancer. The test showed elevated PSA levels, but a traditional biopsy only found very low-grade cancer.  

    This didn’t make sense considering his high PSA levels. We had a long conversation about how to proceed, and we decided to do advanced testing. An MRI-guided biopsy that is increasingly being used to detect prostate cancer revealed a high-grade prostate cancer that, left unchecked, would have been lethal.  

    PSA test guidelines aren’t hard and fast rules—as my patient and Ben Stiller would attest to. The key is an open, honest conversation in which the patient and doctor come to a decision together.

    Related reading: Shared decision-making: It’s no longer “doctor knows best”

    For a man at average risk for prostate cancer, the discussion may center more on the potential benefits and harms of a PSA test. However, the conversation may take on a more urgent tone if the man has factors that put him at increased risk for prostate cancer. These can include:

    • Family history: Having a first-degree relative, such as a father or brother, who had the disease.
    • Genetic mutations: We’re continually learning more about how certain gene mutations can increase a man’s risk for prostate cancer. This includes mutations of the BRCA1 and BRCA2 genes, which are more commonly associated with breast and ovarian cancers.  
    • Race: African-Americans have double the incidence of prostate cancer compared with white men, and their risk of dying from the disease is two to three times higher.

    A man’s age also should be taken into effect. Because prostate cancer grows so slowly, there’s little benefit to screening older men whose life expectancies are less than 10 to 15 years. When I see a patient who is 70 or older and has been referred to me for a PSA test, I usually advise against it unless they are extremely healthy for their age.  

    I think as medical professionals, we’re doing a better job of screening smarter and being more selective in who gets a PSA test. But discussion is the key.

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