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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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  • August 07, 2017

    By MedStar Health

    The Centers for Disease Control and Prevention (CDC) reports that 22.1 percent of adults in Washington, D.C., are obese. Though that’s lower than the national obesity rate of 36.5 percent, it still means more than one in five adults in our area has a serious weight problem.  

    Many people who can’t lose enough weight through diet and exercise turn to weight loss surgery, or bariatric surgery. Bariatric surgery is a great option to help people lose weight. But we’ve noticed that patients who have bariatric surgery have a greater risk for kidney stones than people who haven’t had this procedure.  

    Kidney stones are a significant medical problem, and they can increase your chance of developing serious issues like kidney damage and recurrent infections. We can work to identify and lower your risk for having kidney stones after your weight loss surgery.  

    The relationship between bariatric surgery and kidney stones

    In one study, researchers looked at a group of obese patients who had bariatric surgery and compared them to a group of obese patients who didn’t have surgery. These two groups had similar rates of developing kidney stones at the start of the study.  

    But afterward, 11 percent of the patients who had surgery developed new kidney stones within six years of their surgery, compared to 4.3 percent of the patients who didn’t have surgery. Put another way, the patients who had bariatric surgery were over 255 percent more likely to develop new kidney stones than the patients who didn’t have surgery.  

    This happens because bariatric surgery causes changes to patients’ urine that make kidney stones more likely. The kidneys filter waste products from the bloodstream that are absorbed in the food we eat. Some of the urinary changes we commonly see after bariatric surgery include:

    • Decreased amounts of urine, which is caused by dehydration and can concentrate waste products to form kidney stones more easily
    • Increased levels of a compound called oxalates
    • Increased levels of calcium, which enters the bloodstream when a diet is too high in salt, or sodium  
    #BariatricSurgery causes changes to patients’ urine that make #kidneystones more likely. via @MedStarWHC

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    Having high levels of calcium and oxalates in concentrated urine increases the risk of developing calcium oxalate kidney stones, which are the most common type of kidney stone.

    Reduce your risk of kidney stones after weight loss surgery

    Reducing the risk of kidney stones is important for everyone, but it’s especially important for patients who have had bariatric surgery. Drinking enough water, decreasing salt intake and eating less animal protein are a few things everyone can do to lower their risk.

    Related reading: Kidney stone diagnosis and treatment

    But there are specific steps I recommend that patients who have had bariatric surgery take to reduce their risk. These steps relate to the levels of oxalates and calcium in a patient’s urine.

    Oxalates

    People who have had bariatric surgery need to reduce the levels of oxalates in their diets to avoid kidney stones. Oxalates are found in a wide variety of fruits, vegetables and grains. Oxalate levels in food can vary depending on many factors, including where they’re grown and when they’re harvested.

    People who have had #bariatricsurgery need to reduce the levels of oxalates in their diets to avoid #kidneystones. via @MedStarWHC

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    Your doctor can help you determine which foods to avoid. But in general, the following foods tend to be high in oxalates:

    • Spinach
    • Tea
    • Cola
    • Soy
    • Nuts

    I also recommend that you talk to your doctor if you take a vitamin C supplement. One study showed that men who took a 1,000-milligram vitamin C supplement on a regular basis had double the risk of calcium oxalate kidney stones over men who didn’t take a supplement. This may be because the body disposes of excess vitamin C in the form of oxalates, which end up in urine.  

    Calcium

    Oxalate levels in the urine aren’t just tied to oxalate-rich foods. Calcium levels also play a role in the amount of oxalates that end up in urine. A lack of calcium in your diet can increase the amount of oxalates that make their way to the kidneys.

    All of our bariatric surgery patients are instructed to take calcium supplements following their procedures. We recommend that patients take at least 1,500 milligrams of calcium per day. Taking calcium citrate supplements as opposed to calcium carbonate may help, as people with low levels of citrate are at increased risk for kidney stones. Citrate is a compound found in citrus fruits like lemons and oranges.  

    Getting the calcium you need in your diet is the best option. Foods that are rich in calcium include:

    • Watercress, kale and arugula
    • Green beans 
    • Low-fat cheeses, milk and other dairy products

    Reducing salt is important for maintaining healthy calcium levels. Salt, or sodium, causes the body to lose more calcium than normal. That calcium ends up in urine. Most people get far too much salt in their diets in the form of processed foods, so watch for sodium levels on nutrition information when you shop for groceries.  

    What to watch out for after bariatric surgery

    It’s a good idea to ask your bariatric surgeon about the risk of kidney stones. We work closely with our bariatric surgeons to minimize patients’ risk after surgery.

    Make sure to watch for the signs of kidney stones if you’ve had bariatric surgery. These symptoms include:

    • Blood in your urine
    • Loss of appetite
    • Nausea or vomiting
    • Sudden, severe pain in the side or mid-back  

    You may also notice a fever or chills along with any of these symptoms. This can be a sign of an infection.

    Request an appointment with one of our urologists if you notice any of these symptoms.

    Request an Appointment


    Bariatric surgery can be life-changing—not to mention lifesaving—for many patients who struggle with obesity. But it can increase your risk of kidney stones. Making smart decisions about your diet after surgery can help you reduce this risk so you can focus on living a healthier life. 

  • August 04, 2017

    By MedStar Health Research Institute

    Pediatric and Adolescent Gynecology for the Primary Care Provider 2017—Oct. 6, 2017

    Pre-pubertal and adolescent girls can experience a myriad of gynecologic problems. Most of these issues can be safely managed by primary care providers who specialize in pediatrics, family practice or gynecology. However, pediatricians are often not comfortable with gynecologic problems, and gynecologists are often not comfortable with children. Some aspects of the pediatric and adolescent gynecology subspecialty with which many providers may have little knowledge or firsthand experience include care of transgender adolescents, indications and regimens for prevention of HIV, prepubertal gynecologic complaints, and surgical issues in pediatric and adolescent gynecology.

    Course Co-Directors: Veronica Gomez-Lobo, MD, and Lauren F. Damle, MD

    Learn more and register today.

    Friday, October 6, 2017
    7:30 AM - 4:00 PM
    Hyatt Regency Bethesda
    Bethesda, MD

  • August 04, 2017

    By MedStar Health Research Institute

    This one-day educational symposium will examine kidney and pancreas transplantation, with an emphasis on the multidisciplinary approach to pre- and post-transplant care. The conference will provide updates on clinical trials in kidney transplantation and immunosuppressive therapies, review measures that could enable live kidney and pancreatic transplantation, offer insight on complex post-transplant issues with a focus on specific population subsets deemed higher risk, such as patients with HIV infection, HCV infection, preformed anti-HLA antibodies, high BMI, and those at risk of medical non-adherence. Additionally, the course will discuss avenues to explore advances in immunosuppression to enable a personalized approach to minimize the risk of post-transplant complications. 

    Course Co-Directors: Matthew Cooper, MD, and Basit Javaid, MD

    Learn more and register.

    Saturday, October 7, 2017
    7:00 AM - 3:30 PM
    Georgetown University Hotel and Conference Center
    Washington, DC

  • August 04, 2017

    By MedStar Health

    Daniel Marchalik, MD, is Director of Ambulatory Urologic Surgery and Director of Medical Education at MedStar Washington Hospital Center. He is also a current MedStar Teaching Scholar. His interest in literature has helped him craft a depth of care that is unique in the field of surgery.

    “The thing that interests me most in medicine is academics and teaching,” said Dr. Marchalik. He is the creator and director of the Literature and Medicine Track at the Georgetown University School of Medicine. Dr. Marchalik is the author of a monthly column in the Lancet for the past two years and in BMJ for the past year.

    Daniel Marchalik, MD

    “Books allow you to take on the perspective of someone else, and that’s one of the most important things you can do in medicine,” Dr. Marchalik said. "There's a tremendous value in carefully listening to patients and taking the time to discuss values and preferences that are important to each individual. I spend a lot of time thinking and writing about books’ ability to help you take on patients’ perspectives and better understand the value of patient stories.”

    Among his many articles, “We, the animals,” uses literature to open a conversation about the limits of scientific research. Meanwhile, his article “Kazuo Ishiguro's uncanny science” sparked a conversation with his students about the ethics of organ donation.  All of these articles in Lancet and BMJ provoke the reader to think about medicine, education and research in a different light.

    Dr. Marchalik completed his undergraduate studies at Rutgers University, where he graduated summa cum laude. He then stayed at Rutgers to receive his medical degree from the Robert Wood Johnson Medical School and was inducted into the Alpha Omega Alpha Honor Medical Society Honor Medical Society. He completed his master’s degree in English Literature Masters at Georgetown University and his internship and residency training at MedStar Georgetown University Hospital.

  • August 04, 2017

    By MedStar Health

    MedStar Health policies require that all individuals engaged in the conduct of research complete the annual conflict of interest disclosure. The annual research conflicts of interest disclosure process is designed to manage financial and nonfinancial research interests. As you probably know, MedStar Health Research Institute is required to manage conflicts of interests as a condition of receiving federal funding for research.

    If you have completed the questionnaire as a researcher previously, the link to the conflict of interest disclosure was sent to you via email on July 11, 2017, and weekly reminders are also being sent to you. Please follow the link in that email to complete this disclosure. If you held a research role at MedStar in FY17, you may have already entered data into the COISmart system during the fiscal year. In such cases, we ask that you use the “revision” links in the questionnaire to update your answers and resubmit the questionnaire to ensure that it accurately reflects a full fiscal year of reporting (July 1, 2016, through June 30, 2017). Please make sure you confirm the information in the FY 2017 Questionnaire is accurate and resubmit it. The FY 2018 questionnaire is also open for your use between July 1, 2017, and June 30, 2018.

    If you have any questions about the conflict of interest policy or accessing the COISmart system to make disclosures, contact the Research Compliance Program at researchcompliance@medstar.net.

  • August 04, 2017

    By MedStar Health

    A team of researchers from the Georgetown University School of Medicine and MedStar Health Research Institute recently evaluated the confidence of residents in terms of milestone training. “Procedural Skills of the Entrustable Professional Activities: Are Graduating U.S. Medical Students Prepared to Perform Procedures in Residency?” was published in the Journal of Surgical Education. The authors were Adrienne N. Bruce, MD, Department of Student Research, Georgetown University School of Medicine; Anagha Kumar, MA, MS, Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute; and Sonya Malekzadeh, MD, Department of Otolaryngology, MedStar Georgetown University Hospital and a graduate of the MedStar Teaching Scholars Program.

    This research was undertaken to evaluate the efficacy of competency-based medical education. Competency-based medical education has been instituted in graduate medical education through the development of Milestones. A Milestone is a behavioral descriptor that marks a level of performance for a given competency. These markers are used to better define requirements at key transition points in the growth of physicians throughout their education career, as defined by the Association of American Medical Colleges.

    Evaluating members of the MedStar Georgetown University Hospital resident class through an electronic survey, the researchers sought to identify the residents’ confidence in their procedural skills training during medical school and to assess their learning experiences. The responses were compared to examine whether there was a link between respondent confidence and the presence of formal evaluation.

    The results showed that most respondents identified that cardiopulmonary resuscitation, bag/mask ventilation, and universal precautions were evaluated by and important to their medical school. Results from biostatistical analysis established a significant effect between confidence and evaluation of universal precaution skills. This result suggested a correlation between the formal evaluation of procedural skills and increased confidence of the learner.

    Journal of Surgical Education, 2017. DOI: 10.1016/j.jsurg.2017.01.002