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  • January 14, 2022

    By Allison Larson, MD

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


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


    1. Do: Wear sunscreen all year long.

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


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


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


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


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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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


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


    3. Do: Pay closer attention to thick skin.

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


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


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


    Related reading:  Follow these 5 Tips for Healthy Skin

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

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


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

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

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

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

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

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

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

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

     

    5. Don’t confuse skin conditions with dryness.

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


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

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

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

     

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


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • August 03, 2017

    By MedStar Health

    A Rare Condition

    Joel Patton was the quintessential picture of health, boasting a strong body and mind. An IT professional working on his PhD, the 35-year-old was a personal trainer during his off hours. In May 2016, his left foot began hurting, and he assumed it was an overworked muscle. When numbness and tingling followed, and he began walking differently, Mr. Patton sought medical advice.

    Several doctor visits found little. But one alert physician recognized something was gravely wrong, and quickly referred him to Rajesh K. Malik, MD, RPVI, FACS, a vascular surgeon at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.

    “By then, Mr. Patton’s left foot was ischemic—rubric, red and cold to the touch,” says Dr. Malik. It required immediate treatment.

    “When Dr. Malik described the blood clot and noted that amputation was a possibility,” says Mr. Patton, “it was a horror story coming true.”

    RARE AND DANGEROUS THROMBOSIS

    A thrombosis this severe is rare in young adults, Dr. Malik says. He started Mr. Patton on a heparin drip and began diagnostic tests. “A CT-angiogram confirmed extensive thrombosis at the left popliteal artery,” Dr. Malik says. “Blood flow was restricted from the knee to his foot.”

    The thrombosis was so extensive, and had gone untreated for so long, that finding options for bypass was difficult. “Endovascular/minimally invasive surgery wasn’t possible, and open surgery was risky," says Dr. Malik. "In an open procedure, we might have been able to take a piece of vein from above the popliteal artery, remove the clot and create a bypass. But the risk of failure was great.”

    TACKLING TOUGH CHOICES

    “Other surgeons might have opted to bypass,” Dr. Malik says. “But I thought we should sit tight and watch.”

    Within a few days, some feeling returned to Mr. Patton’s foot.

    “There was some improvement—the blood thinner was doing its job,” says Dr. Malik, but the clot’s cause remained unclear. A complete work up, including an MRI, pointed to a rare condition called popliteal artery entrapment syndrome. Mr. Patton’s muscles and tendons near the knee were compressing the popliteal artery, restricting blood flow to his lower leg. “The muscle band was not in the correct position,” Dr. Malik says. “Because it was a birth anomaly, we knew it would also be present in his right leg.”

    The condition is most often seen in young athletic patients with no other vascular problems. Their workouts enlarge the calf muscle, resulting in compression of the artery.

    CORRECTING A BIRTH ANOMALY

    Dr. Malik believed corrective surgery to release the entrapped muscle would provide a cure for Joel.

    “I entered through the back of the knee, and resected the muscle band,” he says. “We then performed an angiogram to visualize blood flow, and immediately saw tremendous improvement, from just 20 percent to 80 percent. A month later, I performed the same procedure on the right leg."

    The surgeries were successful, and Mr. Patton is in physical therapy to regain his strength.

    See the full print story here!

  • August 03, 2017

    By MedStar Health

    The title on Erin O’Neill, MD’s business card reads “Attending Radiologist.” But it could just as accurately say “Puzzle Solver.”

    That’s because Dr. O’Neill uses MedStar Washington Hospital Center’s array of state-of-the-art imaging technologies to help other physicians diagnose and treat a variety of illnesses, from the routine to more complex, medically challenging conditions.

    “We see all the best cases,” Dr. O’Neill says. “That’s a privilege not all other specialties have, but it also keeps us on our toes.”

    Why Radiology?

    Originally from Minnesota, Dr. O’Neill considered training in surgery until she became fascinated with radiology’s procedural and analytical aspects. After medical school and internship at Creighton University Medical Center, it was on to Chicago where she completed a radiology residency at Rush University Medical Center, where she served as chief resident. Dr. O’Neill remained in the Windy City for an MRI Predominant Body Imaging and Musculoskeletal fellowship at Northwestern Memorial Hospital.

    Training at some of the country’s leading research centers for radiology helped prepare Dr. O’Neill for keeping up with a technologically fast-paced field.

    “It does require a lot of reading, and a lot of collaboration with my colleagues here at the Hospital Center and at MedStar Georgetown University Hospital,” she says, “but the strides that have been made in both the quality of imaging and patient safety are amazing.”

    Body MRI, for which Dr. O’Neill serves as the Hospital Center’s associate director, is one of the fields most widely used tools, as it can provide extremely clear, detailed scans without the use of radiation. Still, not all patients are comfortable with the procedure, which often involves spending long periods in an enclosed tube.

    “We do what we can to make them comfortable and feel at ease during the procedure,” Dr. O’Neill says. “We also look for the best alternative to evaluate a particular condition, such as using ultrasound for younger patients to limit their cumulative radiation doses.”

    Outside the Hospital

    Dr. O’Neill could easily add another business card title, “Mom.” She and her husband, who works in finance and real estate for a national accounting firm, love spending time with their 2-year old son and the family dog. But while they enjoy the attractions of the Nation’s Capital, they’ve also gotten to know the area’s airports quite well.

    “We’re both from the Midwest, so we travel back often to see family and friends,” Dr. O’Neill explains. “There are a lot of places that we get to call ‘home.’”

  • August 02, 2017

    By MedStar Health

    Orthopaedic and Geriatric Teams Focus on Caring for Fragile Bones

    George Hennawi, MD

    Fractures are common among the elderly and as the population ages, the incidence of breaking bones increases. At MedStar Good Samaritan Hospital, we use a team approach to provide the best care for this population through our Ortho-Geriatric Service. “Our Ortho-Geriatric Service is a multidisciplinary way of managing the medical needs of elderly patients admitted for fractures and other orthopaedic conditions. Our geriatric team partners with the orthopaedic, nursing and rehabilitation teams to achieve the best function and outcomes for these often-frail patients,” explains George Hennawi, MD, chief of Geriatrics at MedStar Good Samaritan and director of the Center for Successful Aging. “Simply fixing a fracture or joint problem does not address the reason a fall or a problem occurred. In the case of a fracture, identifying the underlying cause can help us to minimize the chances of that patient having a repeat episode,” he adds.

    Carmen Pichard-Encina, MD

    When 79-year-old Marie Kelly fell and fractured her hip while cleaning her house, the ortho-geriatric team was there for her every step of the way. “Hip injuries can be dangerous for the elderly. Older patients have a higher risk of complications, and many need treatment beyond surgery,” says Carmen Pichard-Encina, MD, an orthopaedic surgeon with MedStar Orthopaedic Institute who cared for Kelly. “The fact that Marie had previous fall-related injuries was a red flag that she had other medical conditions. Prior to her hip surgery, we met with members of our geriatrics team and her family to evaluate her medical, cognitive and emotional status so a personalized geriatric-based plan could be developed. This helped to ensure she would have a successful recovery.” Kelly was wheeled into surgery less than 24 hours after being admitted to MedStar Good Samaritan. This is one of the goals of the program. “Reducing delays before surgery reduces complications and results in better outcomes, as well as a shorter hospital stay,” Dr. Pichard-Encina notes.

    After her surgery, Kelly spent two days in the orthopaedic surgical unit then completed inpatient rehabilitation. She was home in two weeks. During her stay, Malek Cheikh, MD, an endocrinologist who specializes in caring for patients with osteoporosis, began working with Kelly and her family. They created a plan to prevent future fractures and improve both her short- and long-term outcomes. Dr. Cheikh also scheduled her for a visit to the Center for Successful Aging, which provides care for older patients with complex medical and social conditions.

    Malek Cheikh, MD

    There, the first step was a bone density test, called a DEXA scan, to determine if she had osteoporosis. Osteoporosis is a debilitating disease common in elderly women in which the bones become fragile and are more likely to break. Kelly’s test showed that she had experienced significant bone loss. Dr. Cheikh explains, “We are taking steps to slow the bone loss, increase her bone density and reduce her risk of fractures in the future. Dietary changes, appropriate exercise and medication are all essential to this. Making sure her home environment is safe and as fall proof as possible is important too.”

    Today, Kelly is on the mend and her family is grateful for the integrated care she received at MedStar Good Samaritan. “Falls and fractures go hand-in-hand with aging and are extremely common. That’s why we don’t just patch up a fractured hip and send a patient home. When a geriatrician cares for a patient in concert with an orthopaedic surgeon, the results are much better,” Dr. Hennawi adds.”

    This article appeared in the summer 2017 issue of Good HealthRead more articles from this issue.

    Learn about Healthy Aging

    Learn about the services provided by our Center for Successful Aging. 

    Register for Our Healthy Aging Guide

     Click below to register for our free Healthy Aging Guide.

    Related Services and Conditions

  • August 02, 2017

    By MedStar Health

    Sexual assault is a sensitive topic, no matter how we discuss it. But it’s an important topic to discuss honestly and openly. People who have been sexually assaulted need to know that they can get help and medical care in an understanding environment that’s specially designed for these sensitive cases.  

    In an ideal world, no one would ever be sexually abused or assaulted. But that’s not the world we live in. Crime data from the Metropolitan Police Department in Washington, D.C., show that there were 346 reported cases of sexual abuse in the metro area in 2016—that’s almost one per day. Sexual assaults are underreported, and it is estimated that only 28 percent of cases are ever reported to law enforcement.  

    Many victims just want to move past what happened and get on with their lives. Regardless of a person’s desire to report sexual assault to police, the person still needs medical attention as soon as possible. If you are sexually assaulted, call 911 right away. When you arrive at MedStar Washington Hospital Center, you’ll be cared for by a dedicated, specially trained sexual assault nurse examiner, or SANE nurse.  

    Dedicated care for District patients who have been assaulted

    We are the only hospital in the Washington metro area with SANE nurses, so all adult victims of sexual assault in the area come to MedStar Washington Hospital Center for examinations. Sometimes patients come here directly, sometimes they go to other hospitals and are transferred here, and sometimes they’re brought here by police after reporting an assault. In 2016, we saw 411 patients who had been sexually assaulted.

    Our emergency medicine doctors have a great deal of empathy for all our patients. And we’re keenly aware of the physical and emotional trauma victims of sexual assault go through, whether they’re coming to see us hours, days or weeks after the incident. We try to make them feel at ease. The first thing I say to a patient who’s been sexually assaulted is, “I’m very sorry this happened to you.” Then we talk through the care they’ll receive from the doctors and SANE nurse.  

    The initial examination process

    Some patients who have been sexually assaulted have other injuries, such as severe bleeding, broken bones, sprains or injuries related to choking. People who have been choked may have damage to the blood vessels leading to the brain, which can lead to a stroke without treatment.

    We provide diagnostic testing as soon as possible to rule out injuries that may not be obvious at first glance. If a patient shows signs of abuse in the home environment, we speak to the patient privately and try to determine if that person feels safe at home or needs help.  

    The most common question I get from patients who have been sexually assaulted is whether they’re at risk for sexually transmitted diseases (STDs). During the examination, we offer treatment to protect them from any STDs they might have contracted during the assault, including gonorrhea, chlamydia and HIV. For women of childbearing age, we also offer emergency contraception—commonly known as the morning-after pill—for pregnancy prevention. Patients can take all the time they need to ask questions before we move on to the next step.  

    When the patient arrives, we contact a dedicated patient advocate who will stay with the patient throughout the entire process. As much as possible, we work to minimize the trauma of the hospital experience for patients. We have a dedicated family room area where a patient can wait with family members and their advocate away from the emergency department’s general waiting room  

    Care from the sexual assault nurse examiner

    SANE nurses are employees of the District of Columbia Forensic Nurse Examiners (DCFNE), a separate not-for-profit program we work with as part of the District of Columbia Sexual Assault Response Team (DC SART). DCFNE partners with the Network for Victim Recovery of DC (NVRDC) to provide advocacy, case management, legal services and therapeutic programs if necessary and desired.  DC SART is a network of agencies in the Washington metro area that provide coordinated responses to sexual assault.  

    SANE forensic nurses are in our hospital 24 hours a day, so they’re always available when they’re needed. If a patient is too badly injured to be transferred here, SANE nurses travel to other local hospitals.  

    The SANE nurse will take the patient into our dedicated exam room, which is designed and set aside for victims of sexual assault. This room provides a private area with a locked door where the nurse can perform a detailed examination of the patient. The examination includes:

    • A conversation with the patient to find out what happened
    • Documentation of the patient’s injuries, including photographs
    • Evidence collection  

    Many patients are unsure if they want to press charges. While this is a personal and sometimes difficult choice some people must make for themselves, in most cases, we reassure them that they don’t have to press charges or go to court just because they’re having an examination and having evidence collected.  We are legally required in special, mandatory reporting circumstances to report suspected sexual assault to the police.  Examples of this include:

    • When the victim is younger than 18
    • When the victim is cognitively or physically disabled
    • When a firearm is involved  

    For most victims, getting their story, documenting their injuries and collecting evidence by the SANE nurse makes it possible for the victim to press charges later if they decide to do so. Unless it’s a mandatory reporting situation, no one will pressure victims to press charges if they don’t want to. We don’t work for the police or the prosecutors. Our top priority is empowering patient victims and providing the medical care, support, and resources that they need.  

    Related reading: Specialized Equipment, Training Needed for Sexual Assault Patients

    The value of dedicated sexual assault forensic nurses

    SANE nurses are specifically trained to work with patients who have been sexually assaulted. When a patient who’s been sexually assaulted comes in, the SANE nurse is focused on just that person for however long the process takes.  

    SANE nurses are forensic nurses, which means they are extremely well-trained and experienced with collecting evidence for these cases. Studies conducted by the National Institute of Justice have found that SANE programs have many benefits for the community. In addition to better health care for patients who have been sexually assaulted, the benefits of SANE programs include:

    • Higher-quality forensic evidence
    • Increased ability of law enforcement to collect information, file charges and present cases to prosecutors
    • More successful prosecutions

    In hospitals that don’t have SANE nurses, the doctor, nurse practitioner or nurse works with patients as they come into the emergency department. They see many patients during a normal shift and have to care for several patients all at once. They may see only a handful of sexual assault cases per year—maybe only one a year or every other year. So they’re not as familiar with the evidence-collection kit. They may not get as much evidence or do so in a way that’s completely compliant with the kit’s requirements.  

    If the case goes to trial, doctors or nurses may have their experience questioned during testimony. It’s hard for someone to present themselves as an expert witness when they’ve only done one evidence collection for sexual assault in the past two years. It’s potentially a much stronger case with a SANE forensic nurse who can testify in court, “I’ve done 50 sexual assault exams in the past six months.”

    In an ideal world, we wouldn’t need special exam rooms and dedicated SANE nurses. Unfortunately, these resources are necessary. And we won’t waver in our dedication to caring for and supporting people in our community who have to face emotionally and physically traumatizing sexual assault.  

    For local support resources and more information, please visit the following:

  • July 31, 2017

    By MedStar Health

    Does this sound familiar? You go to the doctor. They diagnose you and tell you what the treatment will be. The end.

    This one-sided approach to decision-making involves the doctor dictating care without much, if any, input from the patient. But this is now beginning to change. We’re moving away from that sort of “doctor knows best” model of medical decision-making and toward a newer approach known as shared decision-making.

    We’ve moved away from a “doctor knows best” model of decision-making and moved toward shared decision-making. via @MedStarWHC

    Click to Tweet


    Here’s the big idea:  I have expertise in medicine. You have expertise in you. Shared decision-making recognizes the expertise of patients and empowers them to engage in the medical process. This is illustrated in the principle “Nothing about me without me.”  

    Shared decision-making provides numerous benefits to patients. One review of 105 studies compared patients who received usual care with those who used decision aids, which are tools designed to facilitate shared decision-making. These tools can include written materials, videos or interactive web-based programs. The review found that patients who used decision aids felt more knowledgeable and confident in decisions, better understood the benefits and risks of treatment options and had a greater likelihood of receiving care aligned with their values.  

    As patients increasingly play a more active role in their health care, learn how shared decision-making works and how you can take an active role in it. But first, let’s look at a hypothetical situation to see how shared decision-making can influence your treatment.  

    What shared decision-making looks like in practice

    You come to the hospital after having a small heart attack. You’re stable but have blocked arteries. We discuss your condition and treatment options, which include medication and bypass surgery.  

    Often, I’d recommend surgery for a patient with blocked arteries. But if you’re unable to be off work for the eight weeks it will take to get back to full function after bypass surgery or you serve as the primary caregiver for an elderly parent, we may be able to delay surgery and discuss alternatives.

    There’s no confrontation or hard feelings. Rather, it’s a negotiation about the interaction between a medical recommendation and your personal situation. Instead, we may tailor your medications to your situation, discuss warning signs of which to be aware, and send you home with the understanding that we may discuss surgery again in the future.  

    This situation illustrates how shared decision-making is meant to work. The doctor and patient have an open, honest conversation and a decision is reached based on the perspective of both parties.  

    How shared decision-making works

    Shared decision-making may sound like common sense. And it is. Unfortunately, medicine got away from this type of doctor-patient collaboration as quality measures focused on enforcing care guidelines.  

    In the past, if you came in with high cholesterol, quality care was defined as you leaving with a prescription for a statin – whether you wanted one or not. It didn’t matter if you didn’t understand why, didn’t agree, or threw the prescription in the garbage the second you left the doctor’s office. By gosh, the guidelines said to give you a statin, so the doctor gave you a statin.  

    No one wants to have decisions made for them, or to have their thoughts and opinions not taken into consideration. We now consider quality treatment to be achieved if three steps have been followed:

    • The doctor explains the treatment options
    • The doctor and patient have a thoughtful discussion about each one
    • A decision is reached that is right for the patient

    In this meeting between the doctor and the patient:

    • The doctor contributes knowledge about the condition and treatment options
    • The patient contributes their past experiences, preferences, goals and values, along with information they have from research about their condition and treatment options  

    In a perfect world, the doctor’s recommendation and patient’s wishes align. But sometimes they don’t, and in those cases, we come up with another plan. Or maybe we decide it’s not right today, but we keep the topic open and talk about it later.  

    I find that patients usually have valid reasons for why they don’t want to follow certain treatments. “I tried it in the past and it didn’t work.” “A friend did it and it didn’t turn out well.” “My family doesn’t think I should do it.” “My primary care doctor disagrees.”  

    At the end of the day, I want my patients to feel comfortable with their care decisions. To do that, doctors need to sit down at the table and talk with you eye to eye – not stand up and dictate what you should do. We need to encourage patients to open up by asking questions and listening to the answers:

    • Do you understand your condition?
    • What do you think about the treatment recommendation?
    • Is it right for you, and if not, how can we make it right for you?
    • What are your concerns?  

    Your role and responsibility in shared decision-making

    Shared decision-making is a two-way street. The doctor must be willing to involve you and respect your expertise and preferences, but you also must take an active role in the process.

    • Learn about your condition and treatment options: Listen to your doctor and read the information they give you. You also can do your own research before or after appointments.
    • Speak up: Ask questions when you don’t understand something. Share your concerns, goals and preferences.  
    • Recruit family or friends to help: Needing medical care can feel overwhelming. Sometimes it helps to have a loved one with you as a second set of eyes and ears. They can take notes to help you remember details later and ask questions you may think of later.  

    The first step toward making a medical decision is to fully understand your options. While each condition is different, here are a few questions to ask to get started:

    • What are my treatment options?
    • What are the risks and benefits of each?
    • What is the goal of each option? Is it to treat the condition or improve the symptoms?
    • How will each treatment make me feel?
    • What are the side effects and how will they affect my quality of life?  

    When you and your doctor actively collaborate on care, you’re more likely to feel confident and satisfied in your decisions. Find a doctor who engages in shared decision-making, and play your role in it as well.  

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  • July 26, 2017

    By MedStar Health

    Some of my patients have come to me worried after seeing media coverage of a report about knee arthroscopy, a minimally invasive surgery used to diagnose and treat knee joint conditions. The report, which was published in May 2017 in the journal BMJ, compares the effectiveness of arthroscopic surgery for treating degenerative disease with conservative treatments, such as physical therapy and medication.  

    The authors reported that fewer than 15 percent of patients who had knee arthroscopy felt long-term improvement in pain or function. As such, they strongly recommend against the procedure for patients with degenerative knee problems. But I disagree with their conclusions.  

    I’m not trying to be a snake oil salesman. Knee arthroscopic surgery is one of the most common orthopaedic procedures, with more than 2 million performed around the world each year. I’ve performed about 5,000 knee arthroscopies during my career, and the vast majority of my patients see improvement afterward. Many doctors in the trenches would say the same.  

    While it’s true that not every patient with knee problems will benefit from arthroscopic surgery, the key is to look at each patient’s situation individually. Let me explain why I take issue with the report, how I treat patients with degenerative knee disease, and what you should consider before undergoing the procedure.

    Why I disagree with the report’s knee arthroscopy recommendations  

    Degenerative knee disease is an umbrella term for conditions in which the cartilage that covers the ends of the bones in the knee breaks down, causing pain, stiffness and limited mobility.  

    The authors of the BMJ report define degenerative knee disease as patients older than 35 who have knee pain with or without:

    • Imaging evidence of osteoarthritis, the most common degenerative knee condition
    • Tears in the meniscus, a type of knee cartilage  
    • Locking, clicking or other mechanical symptoms
    • Symptoms that occur suddenly or have been ongoing  

    The first issue with the report is that this is a huge category of people. The only patients they exclude are those whose symptoms appeared immediately after major knee trauma and have joint swelling.  

    This just doesn’t make sense to me. If I have a 36-year-old patient with a meniscus tear whose X-ray shows no sign of osteoarthritis, this article seems to indicate arthroscopic knee surgery would not help. The weight of medical evidence from my experience says differently. I know repairing or removing a part of a damaged meniscus can improve pain and function.  

    My second concern is how the studies were carried out. These were double blind studies, which are a high standard, but the treatments didn’t take into effect the specifics of each patient.  

    The study split people with a meniscus tear and no evidence of arthritis into two treatment groups: arthroscopy and physical therapy. People with osteoarthritis also were split into arthroscopy and physical therapy groups.  

    But we already know that patients who have osteoarthritis and no other conditions will not benefit from arthroscopy. However, the surgery can benefit patients with meniscus tears. The study is basically comparing apples to oranges.  

    Finally, the report recommends physical therapy and medication in lieu of arthroscopy – or in severe cases total knee replacement. But many of these patients have tried physical therapy and medication such as lubricant injections, with no relief from pain. And they may be too young or not quite ready for a knee replacement.  

    What are we supposed to offer these patients? They can’t do physical therapy and take anti-inflammatory medications forever. I’d hate to tell a 45-year-old patient with a meniscus tear and a little wear and tear on his knee cartilage that if physical therapy and medication doesn’t work, he must live with the pain until the day he absolutely needs a total knee replacement.

    I never blanketly refuse surgery to all who have some degeneration in the knee, or those older than 35 as the article suggests. If something has occurred to the knee that is new and causing pain and it is subject to arthroscopic repair, I will always offer this option to the patient.  

    We must offer these patients something, like arthroscopy, that may relieve some or all their pain. The trick is to examine each patient to determine what’s causing the problem, walk them through their options and have an honest discussion about how much pain each option may alleviate.  

    How we treat degenerative knee disease

    The only true cure for degenerative knee disease is knee replacement. I never treat degenerative knee disease with arthroscopy as the primary treatment, only if there is a new meniscus tear, or a tear of a degenerative meniscus that has become suddenly painful from a new tear-within-a-tear.  

    But we almost always start with more conservative treatments, including:

    • Physical therapy
    • Anti-inflammatory medication such as ibuprofen
    • Injections that lubricate the joints
    • Corticosteroid injections for severe arthritis

    If these treatments do not provide relief, we may discuss arthroscopic surgery. Arthroscopy can, among other things:

    • Repair anterior or posterior cruciate ligaments (ACL and PCL)
    • Repair meniscus tears  
    • Remove pieces of torn cartilage that are loose in the joint
    • Adjust a kneecap that is out of position  

    I started performing knee arthroscopies in 1978, and I’ve learned who may benefit from the procedure and who won’t. I’ll be honest if I don’t think arthroscopy will help.  

    In fact, I had a patient several months ago come to me for a second opinion. Her doctor had recommended arthroscopy, but I told her that due to the amount of arthritis in her knee, arthroscopy would not help and she needed a total knee replacement. She decided to do the arthroscopy with her doctor, but ended up having a knee replacement when the arthroscopy didn’t relieve the pain.  

    As I said, arthroscopy will not cure or relieve pain from arthritis. However, we may recommend it to slow the arthritis down by removing loose fragments in the joint that can chip away at the cartilage.  

    Questions to ask your surgeon before undergoing knee arthroscopy

    We all need to be good healthcare consumers and do our due diligence when making medical decisions. Before you decide whether to have arthroscopic knee surgery, ask these questions:  

    • How many knee arthroscopies have you performed? A surgeon’s experience is crucial in knowing who may benefit and who won’t.  
    • What percent of pain will the procedure alleviate? If your doctor says you can expect 50 to 80 percent improvement in pain, you must decide whether that’s worth it. Some people say they’ll live with the pain, while others want to relieve at least some of the pain. Or your doctor may say the procedure can relieve pain for up to three years. For some people, that’s a long time to be free of knee pain. For others, it’s a sign to start considering total knee replacement.  
    • Are there alternative options? If you’re talking to a surgeon, you’ve likely already tried other conservative treatments, such as physical therapy, medications and injections. But it’s always worth asking if there’s anything else to try.  

    For arthritis, knee arthroscopy is more damage control than curative. But the majority of patients who get arthroscopy for the right reasons experience relief from knee pain.   Request an appointment with an orthopedic surgeon to discuss whether arthroscopic knee surgery can help alleviate your knee pain.  

     Request an appointment with an orthopedic surgeon to discuss whether knee surgery can help alleviate your knee pain.

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