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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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  • September 18, 2017

    By Daniel Marchalik, MD

    Many of my patients don’t know that, in addition to my medical degree, I also have a master’s degree in English literature. As an English major during my undergraduate studies, I had always wanted to study both literature and medicine.

    These fields have a lot of overlap. When we first meet with patients and ask them to tell us about their medical conditions, we’re really asking them tell us their stories. What happened? What brings them to us today? What does their condition mean in the context of their lives?

    The better we can understand and relate to these stories, the better doctors we become.

    How the literature and medicine track works

    I started the literature and medicine track at the Georgetown University School of Medicine in 2014 We began as an elective class, but the student response was so positive that the courses expanded it into its own program. It’s the country’s first dedicated literature and medicine track.

    Students enrolled in the program work on special projects and meet once a month throughout their four years in medical school. At these meetings, we discuss works of fiction and how they can apply to our experience as physicians and medical students. In their third and fourth years, students have an additional meeting once a month with my colleague, Dr. Dennis Murphy, to discuss medical narratives – nonfiction writings that describe experiences in health care.

    This program gives aspiring young doctors helpful tools to manage the greatest challenges in medical education: student burnout and their ability to remain connected to others.


    Burnout, or exhaustion caused by overwork and stress, is a serious problem among doctors and medical students alike. In a 2008 study, nearly 50 percent of medical students at seven U.S. medical schools reported feelings of burnout. And a 2012 study indicated that nearly 46 percent of doctors surveyed reported at least one of the symptoms of burnout, including:

    • Physical and/or mental exhaustion
    • Feelings of detachment or inability to connect with patients
    • Feelings of hopelessness or ineffectiveness

    There are several ways to deal with burnout, including relying on a support system of friends and family members, as well as support from medical schools. And several studies have looked at involvement in the humanities—art, music and other ways of documenting the human experience—as ways to decrease burnout. For example, 62 percent of medical students reported in a 2013 study that a humanities journal could prevent burnout.

    As of September 2017, we’re studying the literature and medicine track at Georgetown to see if our students’ experiences with avoiding burnout match what students at other institutions have reported. Based on the responses we’ve gotten so far, I expect we’re going to show that our program has had a substantial impact in this area of medical education for our students.

    Cognitive empathy

    Cognitive empathy, or recognizing and understanding the perspectives of other people, is another benefit of the literature and medicine track. Studying literature helps medical students understand other people by empathizing with characters and their struggles.

    Studying literature helps medical students understand other people by empathizing with characters and their struggles. via @MedStarWHC

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    A 2016 study found that reflective writing in medicine improves connections to colleagues and patients. Being able to put yourself in your patient’s shoes is one of the most important things a doctor needs to be able to do. This program helps medical students build these critical skills.

    Learn more about the literature and medicine track and its goals.

    Applying literature to the medical field

    A lot of innovative, progressive thoughts and works are coming out of the literature and medicine track. One good example came about after we read Kazuo Ishiguro’s novel “Never Let Me Go.” This book deals with a frightening alternate future in which clones of humans are raised to have their organs harvested.

    We had a powerful discussion about this book during class. Afterward, one of my students came up to me and said that he’d donated a kidney to his step-uncle, whom the student hardly knew. At the time, he hadn’t had any doubts about his choice, but he later felt conflicted after learning about the medical difficulties kidney donors may face later in life.

    My student decided to write down and sort out his thoughts on the issue. He worked on the project for several months before submitting it to The Washington Post. It was the Post’s most-read article the week it was published and inspired many conversations on the subject of organ donation in the local and national media.

    Other students have applied what we’ve discussed in various ways. One of my students started a column in The BMJ, formerly the British Medical Journal, a widely read publication for doctors worldwide. In this column, we discuss themes that go along with what we’ve talked about in the literature and medicine track, but we’re sharing these ideas with an international audience of medical leaders.

    Another student completed a project tracing the writings of Charles Dickens, who wrote classics like “A Christmas Carol,” “A Tale of Two Cities,” “Oliver Twist” and others. This student’s project explored the idea that Dickens was one of the first Victorian public health advocates and that his writings were designed to bring about changes to health care in Victorian-era England.

    Not only are the students coming away from our discussions with new ideas and perspectives, but I am too. I regularly co-author articles for The Lancet, another well-known medical journal. Many of these articles discuss ideas raised in our meetings in the literature and medicine track. Every time I meet with my students and discuss literary works, I consider how these works influence me and how they can apply to the greater medical community.

    Hippocrates, the ancient Greek doctor who’s considered the father of modern medicine, once wrote: “Wherever the art of medicine is loved, there is also a love of humanity.” At its core, being a doctor involves caring for patients, understanding where they’re coming from, and applying our skills to serve their needs. The Literature and Medicine Track is an important step in that direction.

  • September 18, 2017

    By MedStar Health

    By Tim McDonald, MD, JD

    A miraculous moment took place at 4 pm on the evening of April 25, 2012.

    In the picture above, I am holding a watch in my right hand while standing next to Barb Malizzo at a recent CANDOR Event in Dana Point, CA. Barb was one three patient and family speakers who brought the patient voice into the room for the health system that had commissioned us to teach them the value of open, honest communication in healthcare. The watch is a symbol of the power that results from that open, honest, and effective communication with patients and families following patient harm.

    Exactly four years earlier, on April 25, 2008 Michelle Malizzo-Ballog died in the Intensive Care Unit at the University of Illinois, where I worked as the Chief Safety and Risk Officer for Health Affairs with my friend and colleague, Dr. Dave Mayer. Michelle died as a result of a multitude of medical mistakes that resulted in our failure to rescue her. She suffered a respiratory and then cardiac arrest brought on sedative medications. Michelle died after several days of heroic measures in the ICU had failed to restore any neurologic function.

    At the time of her death, we discovered the multitude of mistakes that occurred, and openly and honestly shared them with Michelle’s family. I found myself in the critical, yet important position of conveying all we knew, including the errors, to the family, and particularly to Barb and Bob Malizzo, Michelle’s parents. Their sadness and anger were palpable, yet their desire to maintain contact was clear and obvious. They did not want to be abandoned and, instead, remained open to an ongoing dialogue as we all struggled to make sense of this horrific catastrophe that changed so many lives forever. We promised to stay with them and not to abandon them.

    We periodically stayed in contact by phone, and we eventually met in person for lunch in the spring of 2009, one year after Michelle had passed. At that time, we invited Bob and Barb and their youngest daughter, Krissy, to join the Medical Staff Review Board at the University of Illinois. This committee was charged with the review and development of solutions for serious safety events at the Hospital. Michelle’s family agreed to this appointment and joined as the “conscience of the community” – thereby meeting our ongoing promise to stay with them while they helped make sure what happened to Michelle did not happen to other people.

    On April 25, 2012 – on the four year anniversary of Michelle’s death, Bob and Barb came to the Medical Staff Review Board meeting with 3 small packages – they handed one to me, one to our Director of Safety and Risk Management, Nikki Centomani, and one to Bonnie, the nurse who had so kindheartedly and tenderly care for Michelle in the ICU.

    Bob and Barb explained that these presents had been given to us for the honesty, compassion, and empathy we had provided them from the time of Michelle’s initial cardiorespiratory arrest, up until this moment in 2012, four years later.

    When we each opened our own package, we found, to our immense surprise, beautiful Movado watches with “Michelle Malizzo Ballog 4-25-08” inscribed on the back. At that moment I tearfully promised the Malizzos I would wear the watch at all patient safety presentations and workshops going forward – as a symbol of the trust and the love we have for each other – while never forgetting Michelle. This was a miraculous, powerfully healing moment for our care giving team, and I hope, for Barb and Bob as well.

    Today, now more than 9 years after Michelle’s death I did a presentation about CANDOR at Connecticut Children’s Medical Center. I wore the watch. I remembered Michelle…

  • September 15, 2017

    By MedStar Health

    Brooke Wolvin, MD, an attending physician for MedStar Medical Group Radiology, also serves as assistant director of MedStar Washington Hospital Center’s Breast Imaging Center, and director of Breast MRI.

    That may seem like a long title, but it’s illustrative of imaging technology’s critical role in breast health. And it’s a field well-suited to Dr. Wolvin’s personal and professional interests. The Potomac, Md., native earned her medical degree at New York Medical College, followed by a radiology residency at New York Presbyterian Hospital-Weil Cornell campus. She then completed a breast imaging fellowship at Memorial Sloan Kettering Cancer Center before returning “home” to the Hospital Center in 2008.

    Why Radiology?

    “I chose radiology because you get to deal with a wide variety of patients,” Dr. Wolvin says. “Breast imaging is a particularly interesting niche, as it also involves a lot of patient interaction. It starts with the mammogram—still the best way to initially detect a potential breast health issue—and continues across a variety of tools to treat patients who need extra care.”

    Among those valuable technologies is 3D imaging, also called tomography, which Dr. Wolvin calls “the greatest innovation in past 20 years.” She likens tomography to a CAT scan of the breast, allowing physicians to scroll through each layer of a scan to spot even the tiniest hint of a tumor or other condition.

    “Along with increasing the cancer detection rate, tomography also lowers the number of patients who need to be called back for additional tests,” adds Dr. Wolvin, who has been instrumental in implementing tomography across MedStar. “It’s wonderful that we’ve been able to bring this capability to so many of our breast imaging centers.

    Yet another of Dr. Wolvin’s responsibilities is serving as assistant medical director of Radiology at the new MedStar Health at Lafayette Centre in downtown Washington, D.C., There, she says, “we work with a different set of patients and issues, which enhances both our experience and the quality of our services.”

    Outside the Hospital

    What gives Dr. Wolvin the greatest sense of pride is setting a positive example for her two children, ages 4 and 18 months.

    “My mother was a full-time professor, and proved to me that a working Mom can successfully balance work and family,” she explains. “I want my kids to have the same sense of possibility I did.”

  • September 11, 2017

    By Norman Lester, MD

    It can be tough to tell the difference between a cold, a bacterial sinus infection and allergies. In fact, that’s probably one of the questions people ask doctors most frequently in this country. There’s a lot of confusion about what the signs are for these conditions—from patients and their doctors alike.

    Recognizing the variations between these three conditions is important. The treatment strategies for a cold are unlike those for a bacterial sinus infection. And treatment for allergies is different still than treatment for the other two.

    Let’s go through the symptoms that people often are confused about, as well as the process of deciding which condition a patient may have and what we need to do about it.

    Common symptoms of colds, sinus infections and allergies

    Many people have been told that the following symptoms are signs of a bacterial sinus infection as opposed to a cold:

    • Facial pain and headache
    • Discolored mucus or sinus drainage
    • Severe nasal congestion
    • Fever (usually above 101 degrees)

    But in reality, these symptoms don’t help us distinguish one condition from the other, at least in the first week to 10 days. Generally speaking, all of the “classic” symptoms of a sinus infection can be present in a cold.


    All of the “classic” symptoms of a #sinusinfection can be present in a cold. via @MedStarWHC

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    If you’ve had these symptoms for fewer than seven to 10 days, they’re almost certainly signs of a cold virus. When people have these symptoms for more than seven to 10 days without improvement, that’s when we start thinking it might be a bacterial sinus infection. It is also very unusual for a cold, or other viral upper respiratory illness, to worsen after five days. This suggests a transition to a bacterial process. This is important because antibiotics should only be used when a bacterial process is suspected.

    The symptoms of allergies don’t normally include fever or a lot of discolored sinus drainage. Classic allergy symptoms may include:

    • Cough
    • Nasal congestion/stuffiness
    • Itchy ears
    • Itchy, watery eyes
    • Runny nose, usually clear
    • Scratchy or low-grade sore throat
    • Sneezing

    Some of these are similar to cold or sinus symptoms. The difference is that allergy symptoms don’t follow the course of a cold, which runs through its symptoms as the cold progresses. Allergy symptoms are more consistent than cold symptoms. There is often a pattern to the symptoms related to a change in the indoor or outdoor environment (seasonal changes, exposure pets, mold, etc.).

    But people with chronic allergies over long periods of time may not have these symptoms, especially adults. These patients are more likely to have nasal congestion and post-nasal drip, much like the symptoms of a “chronic sinus infection.” Like many illnesses or life stresses, allergies can also be associated with significant fatigue.

    If you have sinus infections frequently or you have chronic (persistent or long-standing) upper-respiratory symptoms, it’s often tempting to think you know what’s wrong based on the symptoms. It can be easy to mistake one condition for another if all we go on are the symptoms.

    Somebody might treat “bad allergies” for months and months because of nasal congestion or blockage on one side and not get any better. Eventually, this person could find that they have a persistent sinus infection, or far less likely, a nasal tumor or some other serious condition.

    Related reading: The top 3 symptoms mistaken for allergies

    In general, if you have unexplained symptoms that last more than two or three weeks, talk to a doctor. It doesn’t necessarily have to be a specialist like me first. You certainly could start with your primary care doctor whenever possible.

    Talk to one of our doctors about your symptoms and what the right treatment options are.

    Request an Appointment

    Taking the right medication for the right illness

    The best thing to do for cold or sinus symptoms during the first seven to 10 days is to treat the symptoms, not the illness. You can do this with medications such as:

    • Cough medicine
    • Decongestant or saline spray for nasal congestion
    • Pain reliever

    Cold viruses don’t respond to antibiotics, so taking them during the first seven days probably won’t help. In fact, taking antibiotics when they’re not needed can increase your risk for being infected with antibiotic-resistant bacteria, or other serious antibiotic related problems.

    After seven to 10 days, when the symptoms are more likely to indicate a sinus infection, it may be time to ask your doctor about antibiotics. However, sinus infections can and do sometimes go away on their own, just like colds. Ask your doctor if you need an antibiotic or if the infection is likely to go away on its own without medication.

    If your symptoms point to allergies, many effective medications are available over the counter to control symptoms, such as antihistamines and nasal steroid sprays. These medications work on all sorts of allergies because they suppress the body’s reactions to allergens, rather than treating the specific allergen. Some antihistamines can cause drowsiness, however, so be cautious of that when taking them. They also do not help stuffiness or pressure symptoms, so adding a decongestant plus a pain reliever as needed can help you “ride it out.”

    Avoiding what ails you

    Of course, the best option would be to not get sick in the first place if possible. You can help your immune system fight off viruses and infections by doing the following:

    • Get enough sleep. Most adults need at least seven hours of sleep per night.
    • Maintain a healthy diet and weight. Diets high in fruits, vegetables and whole grains and low in saturated fat are best.
    • Drink plenty of fluids (alcohol and caffeine don’t count)—dryness is the enemy of a healthy respiratory system.
    • Stop smoking. Smoking lowers the body’s immune response and makes it more vulnerable to viruses, as well as much more serious risks. Our Pulmonary Services team offers smoking cessation services if you need help to quit smoking.

    Minimize your risk for catching cold viruses by avoiding people who have colds. If you have to be around them, try not to touch them without washing your hands immediately afterward. This can eliminate cold viruses before they cause sickness. If you have a cold, try to avoid close contact with other people for a few days to minimize the chance of them getting sick. If you must be around others, cough or sneeze into your elbow instead of your hand to reduce the virus’ spread.

    Bacterial sinus infections aren’t contagious, so you don’t have to worry about being around someone who has one. However, the general tips listed above can help the body better fight off the bacteria that cause sinus infections before you get sick.

    As for allergies, it’s a good idea to avoid known allergens if possible. Sometimes that’s not practical. Make sure to follow your doctor’s advice for reducing or eliminating your allergy exposure, and use allergy medications to keep symptoms under control.

    It’s easy to mistake the symptoms of a cold for those of a sinus infection or vice versa. And it’s tempting to think we know what’s wrong with us based on how we’ve felt before. Be patient, and talk to your doctor about your symptoms. A little caution and the right plan can help you feel better fast—without taking medication you don’t need to treat an illness you may not have.

  • September 07, 2017

    By Marc F. Schlosberg, MD

    Most people know they’re at increased risk for certain health conditions as they age: heart disease, stroke, cancer, arthritis, etc.

    But there’s a risk you may not be aware of: epilepsy.

    Epilepsy tends to make its first appearance during two stages of life: childhood and after age 60. About 447,000 adults older than 65 in the United States have epilepsy, or about 1 percent of that population. That would translate to nearly 800 Washington, D.C., residents who are older than 65. And up to 10 percent of patients in nursing homes are on anti-epileptic drugs.

    “A person’s risk of epilepsy spikes in childhood and again after age 60.” via @MedStarWHC

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    There are challenges to diagnosing and treating epilepsy in older adults that don’t exist in young people. As our population ages and we live longer, we can expect to see more adults with epilepsy in the future, so it’s important to understand what can trigger epilepsy as we age and recognize the symptoms, both in ourselves and our loved ones.  

    What causes epilepsy in seniors?

    Epilepsy in children tends to have a genetic component. But in seniors, it’s often the result of an underlying condition.

     About half of the time, we don’t know why a senior citizen develops epilepsy. For the rest, we usually can trace the cause:

    • Stroke (33 percent)
    • Neurodegenerative disorders such as Alzheimer’s disease (11 percent)
    • Tumors (5 percent)
    • Head injury (2 percent)
    • Infection (1 percent)  

    When epilepsy arises from one of these causes, seizures almost always start in one part of the brain, known as focal onset epilepsy. This is in contrast to generalized seizures, which start in multiple areas of the brain. Generalized seizures almost never begin in adulthood.  

    If you have a stroke or suffer a head injury, seizures may not start immediately. When I tell a patient a stroke may have triggered their epilepsy, they often say, “But that was over a year ago.” It may take a year or more after the event for seizures to appear. This is because it can take that long for the damaged area of the brain to rewire itself. 

    “A stroke can trigger epilepsy, but seizures may not start until a year or more after the event.” via @MedStarWHC

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    Epilepsy symptoms in seniors

    It sometimes can be difficult to recognize seizures in older adults. Most people think of seizures as causing muscle jerks or spasms. But seizures can have more subtle symptoms, such as staring spells, chewing or nonsense speech, for example. They occur when a smaller, specific area of the brain is affected, such as with focal onset epilepsy.  

    Unfortunately, these symptoms often are mistaken as dementia or waved off as a sign of someone “just getting older.” Some people also may go to the emergency room because they think they’re experiencing symptoms of another medical condition, such as a stroke.  

    Symptoms of focal seizures include:

    • Confusion
    • Hearing or seeing things that aren’t there
    • Memory loss
    • Repetitive motions such as chewing, lip smacking or mumbling
    • Shifts in mood, such as becoming agitated or belligerent
    • Staring into space or appearing “out of it”  

    After one of these seizures, the person may become sleepy but eventually act like themselves again. They may not remember what happened.  

    If a person lives alone or with someone who doesn’t recognize these red flags, seizures can go on undetected for months or years.  

    The first step to control seizures is to make a diagnosis. If you or a loved one is experiencing any of these symptoms, including if their behavior has changed or they look like they’re spacing out, talk to a doctor right away.  

    Some people are embarrassed to admit they’re experiencing hallucinations, confusion or “losing time” during the day. Talk to loved ones regularly about their health. Make them feel comfortable about honestly telling you what’s happening in their daily lives.

    Challenges in treating epilepsy in seniors

    Focal onset epilepsy often is easier to treat than generalized seizures. If medication doesn’t control the seizures, surgery may be an option.  

    This doesn’t mean we don’t face challenges in treating seniors with epilepsy. Many older adults take medications for conditions such as high blood pressure, high cholesterol and diabetes. This means we need to find an anti-epileptic medication that doesn’t interact with these drugs.

    Anti-epileptic medications need to be taken consistently to keep seizures under control. This means taking it at the same time every day. This can be a challenge for anyone, not just seniors, and it’s compounded if you’re taking multiple medications every day. Your doctor can recommend tips for better medication adherence, such as using a weekly or monthly pill box or setting an alarm on your phone.  

    It’s likely we’ll see more cases of epilepsy in people older than 60 in the coming years, but with increased awareness and early diagnosis, these patients will have a better chance to control seizures and maintain their quality of life. 

  • September 05, 2017

    By Andrew Sokol, MD

    Urinary tract infections, or UTIs, are one of the most common problems doctors see in women. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 40 to 60 percent of women will have a UTI at some point in their lifetimes, and one in four women will have an infection that comes back after initial treatment.

    But even those high numbers may be under-reported. Many women have UTIs and never talk about them with their doctors. Some may not even realize they have an infection. I often don’t see patients until they’ve had multiple UTIs, when they’ve started missing work and are having trouble dealing with the symptoms.

    It’s important to know the facts about UTIs. Let’s discuss who’s at risk for UTIs and symptoms to watch for, as well as myths and tips about UTI prevention.

    Listen to Dr. Andrew Sokol discuss UTIs further on this Medical Intel podcast.

    What’s a UTI, and who’s at risk?

    Anyone can develop a UTI. They’re caused by bacteria, particularly bacteria from the bowel. Women have a higher risk for UTIs than men on average. That’s because, compared to men, the female urethra (the tube through which urine, or pee, passes on its way out of the body) is shorter, which makes it easier for bacteria to enter the urinary tract.

    A UTI can involve any part of the urinary tract, which goes from the kidneys through the urethra. The most common form of UTI is a bladder infection. Put another way: All bladder infections are UTIs, but not all UTIs are just bladder infections. Infection could also involve the kidneys.

    All bladder infections are #UTIs, but not all UTIs are just bladder infections. via @MedStarWHC

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    UTIs often are linked to sexual activity, which can spread bacteria from the anus to the vaginal opening, which increases a woman’s risk of developing a UTI.  

    Younger women tend to have UTIs that are mild or uncomplicated. The risks for UTIs increase as a woman enters menopause, because a lack of estrogen lowers a woman’s defenses against infection in the urinary tract. Older women may have more UTIs that are more likely to come back after being treated. We call these recurrent infections.  

    Common UTI symptoms and when to see a doctor

    No matter where in the urinary tract a UTI develops, the symptoms are similar. Women who have a UTI may experience:

    • A burning feeling with urination, called dysuria
    • An urgent need to urinate
    • Blood in the urine
    • Cramping or pain in the pelvis
    • Having to urinate more often than normal  

    Older women may not necessarily experience these symptoms. They may feel fatigued or show changes in their behavior, such as confusion or irritation, instead of having the classic symptoms of a UTI.  

    Most women are fairly accurate at diagnosing themselves with a UTI, particularly if they have common symptoms. A primary care doctor or gynecologist often can prescribe antibiotics to treat a UTI after an in-office urinalysis (a test of the patient’s urine).  

    However, UTI symptoms are similar to those of other conditions, including:

    That’s why women who have symptoms that don’t go away on their own or that come back repeatedly need to see a urogynecologist like me. A urogynecologist specializes in problems of the female urinary system and pelvic floor. We can determine if these symptoms are due to a UTI or some other condition, such as a physical issue that makes a woman more likely to develop UTIs.  

    Request an appointment with one of our urogynecologists if you have UTI symptoms that keep coming back.

    One of our urogynecologists may be able to help.

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    The most common question I hear from women about UTIs is how to prevent them in the first place. Unfortunately, there are many commonly held beliefs about what women can do to treat or avoid UTIs which are not supported by scientific evidence.  

    Myths about avoiding UTIs

    Some women, and even some doctors, say cranberry juice or tablets can lower a woman’s risk. But recent research indicates that cranberry tablets may not make a difference in a woman’s risk for developing a UTI.  

    One of the suggestions I hear most often is that women should increase the amount of water they drink to increase how often they have to urinate and flush out any bacteria. That hasn’t been proven to work very well, but the “eight-glasses-of-water-a-day” myth persists despite no scientific evidence supporting its benefits.

    Drinking too much water can lead to having to urinate more often, a greater urgency to urinate and other symptoms similar to those of a UTI, making women think they have an infection when their bodies are just getting rid of the excessive fluid they’re drinking. This is especially true in women who consume excessive amounts of caffeine (such as by drinking coffee, tea and soda).  

    Tips to prevent a UTI

    There are many commonly shared strategies for lowering the risk of UTIs. For women who develop UTIs after having sex, I often suggest urinating after sexual intercourse, as well as washing with soap and water afterward. Some women are more likely to develop UTIs if they use certain methods of birth control, including spermicidal jellies, diaphragms or even condoms in some cases. If that’s the case, I may recommend changing the method of birth control a woman uses in addition to urinating after sex and washing with soap and water.  

    Wiping from front to back whenever going to the bathroom is another important tip. The idea here is to lower the chance of spreading bacteria from the anus to the vaginal opening, where bacteria could enter the urethra. Unfortunately, there isn’t much data on this, but it’s a common-sense strategy for women to try.

    If simple behavioral modifications such as cleaning with soap and water and urinating after sex fail, some women are candidates for prophylactic antibiotics—drugs used to prevent an infection, rather than to treat an infection that already exists. If a patient tests positive for two UTIs within six months or three within a year, she may be a candidate for preventative antibiotics which can be taken after sex, daily, or if symptoms develop.  

    When a woman experiences UTI symptoms, it’s natural for the mind to go to the worst-case scenario. It can be scary to see blood in the urine or feel a burning sensation during urination. But UTIs usually aren’t cause for great concern. And if a woman has symptoms that keep coming back or that don’t get better, seeing a specialist can ease her fears and point her toward the right course of prevention and care.