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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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  • May 24, 2021

    By MedStar Team

    Multiple myeloma is a cancer of the immune system that affects bone marrow and blood.

    When a bacteria or virus invades the body, plasma cells—a type of white blood cell found in bone marrow—fight back, creating special proteins (known as antibodies or immunoglobulins) that eliminate or disable the germ causing the infection.

    But, as with other cancers, the process may malfunction and cause the bone marrow to produce an excess of plasma cells derived from a single cell that has transformed into a malignant cell. This is referred to as a clonal cell. These cells can produce special types of proteins called cytokines that stimulate breakdown of bone, leading to the formation of holes in the bone known as lytic lesions. These lesions weaken the bone and can lead to fracture. Because multiple bone lesions can form, this condition is known as multiple myeloma.

    Malignant plasma cells can also secrete a single type of antibody or immunoglobulin known as monoclonal or ‘M’ protein that can be detected in the blood and/or urine. Overgrowth of these cells can cause significant decrease in the ability of the bone marrow to make normal cells. This can result in anemia, a condition which impairs oxygen delivery throughout the body.

    Multiple Myeloma Risk Factors

    The greatest risk of multiple myeloma occurs with advancing age, with the average age of onset at around 70. Men are at a slightly higher risk than women. Risk increases fourfold if a patient has a first-degree relative who has been diagnosed with the disease. It is also more than twice as prevalent in African Americans.

    Obesity can be a risk factor for myeloma as well, likely due to the patient’s long-term exposure to lipids or fat molecules. Myeloma is the most common cancer observed in patients with Gaucher disease, a lipid storage disorder.

    Although not well understood, a patient’s environment may also be a contributing factor—the disease is sometimes found in regional clusters, among people who are unrelated other than by location. And while myeloma is one of the few cancers not caused by tobacco, smoking may complicate treatment, especially when underlying conditions like diabetes and heart disease are present as well.

    Today’s myeloma patient has an excellent chance to lead a full life for a long time. Treatment is advancing dramatically, with promising developments on the horizon. https://bit.ly/3wjh9YU via @MedStarWHC
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    Multiple Myeloma Symptoms and Diagnosis

    The most common symptom of multiple myeloma is severe pain, often occurring in the back, hips, or legs. In addition, patients may report fatigue due to anemia or high calcium levels. Less commonly, the disease may also cause unexplained weight loss.

    In addition, proteins known as light chains secreted by dysfunctional plasma cells can damage the kidneys. And as myeloma attacks bone, calcium is released into the bloodstream, which can also affect kidney function.

    Back or hip pain from myeloma may occasionally be mistaken for a sprain, slipped disc, or other spinal problem. However, routine blood and urine testing can give clues to the diagnosis of multiple myeloma, thus facilitating an earlier diagnosis even before bone damage can begin. This underscores why everyone should seek regular health checkups from a healthcare professional, and why we must work to increase access and affordability to routine care for all segments of the community.

    To make a clear diagnosis, we of course begin with a comprehensive physical exam and patient history. In addition to blood and urine tests performed in-office or at the Emergency Department, we order lab tests that look for abnormal proteins. An X-ray can assess bone involvement and, where there’s evidence of multiple lesions, an MRI or PET study can provide a better picture.

    When these initial tests point to a possible diagnosis of myeloma, we obtain definitive information from specialized blood and urine testing and importantly, a bone marrow biopsy, where a small sample is taken for lab analysis. The sample helps make a diagnosis of myeloma and also obtains important genetic information about the disease, which helps determine prognosis and guide treatment.

    Multiple Myeloma Treatment and Management

    Initial treatment of myeloma consists generally of a three-drug regimen that is administered on an outpatient basis. Two of these drugs are taken orally and one is given subcutaneously. They are generally well tolerated, cause little to no nausea and do not result in hair loss. The treatment is given for several cycles and the effect of treatment is assessed at the end of each cycle. This is done via a series of blood and urine tests that assess the levels of monoclonal proteins. As the myeloma cells are killed, the levels of these proteins should diminish accordingly. After about four monthly cycles of this treatment, appropriate patients are then referred for a process known as “high-dose therapy.”

    Many patients are candidates for a procedure known as high-dose therapy with stem cell rescue, which has also been referred to as an “autologous bone marrow transplant.” During this process, a chemotherapy drug known as melphalan is given at high doses to target these malignant plasma cells. This agent excels at destroying the residual myeloma cells not killed by the initial cycles of chemotherapy. However, because the chemotherapy can also damage healthy cells, we follow treatment with stem cell rescue.

    We prefer the term stem cell rescue since the word transplant can create the impression that a donor is needed. In reality, the stem cells are the patient’s own, harvested before high-dose melphalan and deep-frozen for safekeeping.

    The day after the high-dose melphalan is given, we then reset and restore the immune system by infusing the preserved stem cells a day after high-dose melphalan is given. The stem cells find their way back to the bone marrow, where they restore normal blood-forming elements within a couple weeks.

    During this time, the patient remains in isolation at the hospital to reduce any risk of infection. Preventive antibiotics and blood transfusions also support the patient’s recovery, and we may readminister inoculations that may have been deactivated by the process, including vaccines against pneumonia, shingles, flu, and COVID-19.

    Following the isolation period, the patient is placed into maintenance treatment, receiving lower doses of medications that delivered the most promising results, as well as medications to support immune health and bone strength. During this maintenance period, we carefully monitor myeloma markers for any evidence of disease resurgence.

    If myeloma returns, the treatment strategy varies. Some patients do well with a second stem cell harvest and rescue. We have good data on which drugs work best in relapsed patients and can develop an effective combination of medications that will address the relapse and be well tolerated by the patient. Apart from ongoing monitoring, most myeloma patients are able to live fairly normal lives, with few restrictions on low-impact exercise and other activity.

    A Promising Future

    While combining chemotherapy and stem cell rescue is currently our best treatment strategy, studies are underway to determine the effectiveness of chemotherapy alone. Research is ongoing, robust, and exciting, and MedStar Washington Hospital Center has participated in trials for several drugs now in use.

    The wave of the future is targeted therapy, for myeloma as well as other cancers. Agents such as the new monoclonal antibodies daratumumab, isatuximab, and elotuzumab can accurately identify, target, and destroy cancer cells without harming healthy cells.

    Another effective medication, belantamab mafodotin, latches onto cancerous cells and introduces a specific toxin that kills just those cells. Also on the horizon are bispecific T-cell engagers, or BiTE agents, which can direct T cells to detect and destroy tumor cells. These agents are not yet approved, but the research is very promising.

    A challenging aspect of myeloma is the fact that it behaves differently in each individual. Here at MedStar Washington Hospital Center, our team of hematologists, radiation oncologists, orthopedic oncologists, and pathologists is committed to tailoring management of this disease accurately and effectively. A diagnostic board meets weekly to discuss challenging or significant cases. The team also collaborates closely with cardiologists for patients with heart issues, and with our orthopedic surgeons for patients who need surgery to stabilize affected parts of the skeleton.

    Years ago, multiple myeloma life expectancy was only three years from diagnosis. Today, with the right care, patients can live much longer.

    Like all cancers, of course, the earlier we can begin to treat a patient, the better our chance of making a positive difference. The best way to beat a disease like multiple myeloma: stay regularly connected with your medical professional, and don’t skip your annual physical and lab tests.

    Unexplained back pain?

    Contact us today.

    Call 202-788-0402 or Request an Appointment

  • May 20, 2021

    By Steven J. Svoboda, MD

    The hips are a critical source of power and force, not just in sports but also in everyday living. Hip mobility and strength are vital to function, performance, and quality of life. Yet the health of the hip joint can tend to be overlooked by athletes—both pros and weekend warriors—when they train for and play sports, and this can result in hip flexor pain and a loss of hip mobility.

    To understand hip function, let’s look quickly at their structure:

    The body has two sets of ball-and-socket joints, the hips and shoulders. In the hip, the uppermost part of the thighbone forms a ball that fits into a cavity in the pelvis, the socket. Though mechanically similar to shoulder joints, hip joints have a deeper socket, with a greater mass of surrounding muscle and connective tissue. This makes the hip joint much more stable and resilient than a shoulder joint tends to be.

    The hips serve as the strongest link in the kinetic chain, anchoring and powering nearly every sporting activity. Whether throwing, running, kicking, jumping, or just walking from point A to point B, the muscle, bone, and connective tissue of your hips move together in a well-coordinated rhythm.

    Also very important, the hips function as the body’s shock absorbers. Strengthening them is like upgrading the shocks on your car to help steady the ride and avoid damage from continual impact.

    When Injury Occurs

    Despite their inherent sturdiness, hips can be susceptible to many issues that cause pain and loss of function:

    • As mentioned, a large, complex array of muscles, tendons, and ligaments surround and stabilize the hip joint. Any one of these can be strained, pulled, or otherwise damaged by overuse, trauma, or instability, causing pain and limiting range of motion without involving the joint.
    • The IT band is a long strip of connective tissue on the outside of each thigh, running from the pelvis to the knee. Overuse can cause it to rub against bone and create inflammation felt in the hip.
    • Tendinopathy may degrade tendons over time, creating mechanical weakness and lack of flexibility that can translate to pain and stiffness.
    • The labrum is the ring of cartilage that surrounds and cushions the area where the ball and socket connect. Tears of the hip labrum are extremely common and can cause pain and instability; however, many people can have small labral tears yet feel nothing in the early stages—a testament to the hardiness of the hip joint.
    • Anatomical variations can cause mechanical problems with the joint and are described as femoroacetabular (hip) impingement syndrome. For example, cam impingement occurs when the ball end of the femur becomes egg-shaped, instead of perfectly spherical, hastening cartilage wear. Pincer impingement is caused by excess bone coverage of the acetabulum (or socket). Both types of impingement can cause hip labral tears.
    • Osteoarthritis may begin to erode hip cartilage, the slippery, flexible tissue that acts as a cushion between the femur and pelvis, causing pain and loss of flexibility.

    How does an athlete know that a hip injury has occurred? Symptoms may begin with pain, weakness, and stiffness in the thigh, groin, buttock, or inside or outside of the hip (particularly when walking or flexing the hip), and decreased range of motion in the hip. If these issues linger, it’s time to speak with an orthopedic specialist.

    Diagnosing the Problem

    When I first examine a new patient with hip pain, I can often determine a lot just by watching their posture and how they walk. Even sitting can be uncomfortable for some, which is usually readily apparent.

    On the exam table, I put the hip and other joints through range-of-motion testing and check for level of strength. Often, one hip is shown to be much weaker than its counterpart. By demonstrating this imbalance, we help the patient better comprehend the issue, as well as any potential need for physical therapy or other interventions. While the hip joint may be the root of the problem, it’s frequently the surrounding structures that create issues for athletes and other active people.

    Of course, X-ray imagery can often give us the view we need to rule out serious deficiencies in the joint. But I like to emphasize that “we don’t treat the image, we treat the patient.” One patient may very well have advanced arthritis, labral tears, and other problems causing impingement, yet continue to function perfectly normally. At the same time, someone else may strain a muscle and end up practically debilitated. Everyone responds to injury differently, so functional testing is critical.

    The strongest link in the kinetic chain, the hips anchor every activity. Keeping them healthy is key to success in sports and can improve everyday life as well, says @SvobodaSportDoc. https://bit.ly/2S8qaWg via @MedStarWHC
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    Treating Hip Issues

    Thanks to the abundant muscle mass surrounding the hip, strengthening and conditioning of this area can often get an athlete back on the road, field, or court. Fortunately, the hip responds very well to rehabilitation, and that’s generally where we start.

    Physical therapy can address two problems: Conditioning strengthens the hip muscles to improve stability in the joint, and therapy can help the athlete reprogram certain movements to prevent future problems. (For example, a runner who returns to the road with the same unstable gait is almost sure to experience a recurrence of their issue, and perhaps some new problems as well.)

    In addition, anti-inflammatory drugs or corticosteroid injections can sometimes enhance the effectiveness of therapy by reducing short-term pain and inflammation. Our goal is to get the joint moving well as quickly as possible. In orthopedics, “motion is lotion”—helping the patient to heal and get back in the game.

    Most hip problems can typically be treated without surgery but, in cases where it’s the best course of treatment, we can perform minimally invasive hip arthroscopy. We insert a small camera and other instruments into the affected area to view the damage, correct problems, and make repairs, as needed.

    Hip replacement surgery can be especially effective for people who have severe degenerative disease that has damaged bone and cartilage beyond repair.

    Back in the Game, Safely

    If you’re bouncing back from injury, it’s important to work with your orthopedic surgeon to prepare for a safe return to your sport. Likewise, jumping back into a particular sport that you haven’t played for years can take some prep as well.

    After a decade off the court, suddenly deciding to join a five-on-five league with no preparation may have your feet, knees, and hips aching quickly. Part of the reason: your shock absorbers are not yet ready for strenuous activity on a hard surface. Weekend warriors can prepare their hips for the rigors of team sports and pick-up games by focusing on regular flexibility and strength.

    And beyond managing the hard surface, dribbling, and shooting, basketball also requires constant stopping and starting, not to mention the need for endurance. So, regardless of your sport or favorite activity, break it down: what does it take to play basketball, ski, run long distances, or play rugby or hockey?

    The web is a rich source of exercises specifically tailored to the needs of athletes beginning or returning to specific sports and activities. It’s fine to prepare for increased levels of activity on your own, as long as you use common sense with strength and flexibility exercises. However, if you’re unsure or still managing a prior injury, don’t hesitate to speak to a member of our orthopedics team to get yourself started.

    A few other notes: Durable core muscles can help you be successful in nearly every activity—the stronger your core, the stronger your game. Aerobic fitness is vital, too, but be sure to build up gradually. Rushing out to perform at a high level of activity without prepping aerobically can be a recipe for problems as well.

    We highly recommend cross training, a tactic that many of our professional athletes use. Athletes with the longest careers tend to be those who diversify their training activity, rather than stick solely with one single sport.

    Experts at Orthopedics

    In the current pandemic, many athletes—from professionals to weekend warriors—have been far less active physically. At the Hospital Center, we’re seeing a greater-than-normal amount of overuse injuries as athletes try to intensify activity too quickly.

    If you’ve been inactive over the winter, yes, it’s certainly important to get moving! But it’s even more important to do so safely and gradually.

    Our orthopedic surgeons are highly qualified to consult on hip injuries and the wide array of other injuries that athletes sustain. Most of our doctors have also played sports, some at the college level, and several of them currently work with our Washington, D.C., - and Baltimore-area professional sports teams.

    Our team is also involved in important orthopedic research and was asked to manage the 2021 Annual Cherry Blossom Seminar. Held locally each spring for the past four decades, the Seminar is the oldest sports medicine and arthroscopy symposium in the United States and one of the most highly respected.

    With this experience and involvement, we can assure every athlete—champions, weekend warriors, and everyone in between–that they’re in very good hands here at the Hospital Center.

    Hip pain that won’t quit?

    Our orthopedics team can help.

    Call 202-788-0402 or Request an Appointment

  • May 18, 2021

    By Hedy P. Smith, MD, PhD, Hematology

    Are you familiar with Sickle Cell Anemia (SCA), a serious genetic blood disorder that is caused when the sickle trait is passed from both parents to a child?  Some individuals inherit a sickle trait from one parent and another trait such as hemoglobin C or thalassemia from the other, causing Hb SC disease and hemoglobin S-thalassemia. Together, this group of diseases where two abnormal traits are inherited is referred to as the sickle cell diseases (SCD).

    The precipitation of the hemoglobin in SCD causes red blood cells to become misshapen, impairing their ability to transit the blood vessel and deliver oxygen to tissues.  This is called vaso occlusion and can give rise to severe pain attacks.

    Unfortunately, for decades, this debilitating and life-altering group of blood disorders was considered to be benign, implying that it was not a serious threat to affected individuals. Today, we know that it is. SCD can harm both children and adults, causing severe pain throughout the body, and can lead to damage of every organ and a significantly shortened lifespan.

    The National Institutes of Health (NIH) estimates that more than 2 million U.S. residents carry the genetic mutation, with more than 100,000 actively living with the disease. Those affected are predominantly of African descent; and about one in 365 Black children are born with some form of the disease. A smaller percentage of affected patients are of Hispanic, southern European, Middle Eastern, or Asian Indian descent.

    Sickle cell disease can be serious and debilitating, and treatment can be challenging. But we can help prevent this disorder. Dr. Hedy Smith explains. https://bit.ly/33CurDM via @MedStarWHC
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    The Sickle Cell Trait

    Most people who carry a single copy of the sickle gene—the sickle cell trait—will not develop symptoms of the disorder and may never know that they are carriers.

    However, when both parents carry the sickle trait, their children have a 50 percent chance of inheriting the trait, and a 25 percent chance of developing sickle cell anemia (SCA).  Interestingly, SCA causes a broad spectrum of symptoms in our patients—no two cases are alike, and we must therefore individualize disease treatment and management.

    SCD is, unfortunately, on the rise. The most effective way to reduce its incidence is by preventing genetic transmission. Public awareness of sickle cell disease and education about testing for a hemoglobin trait are critical to help reduce the incidence of the disease.

    The presence of the hemoglobin variants, such as the sickle hemoglobin, can be determined by a simple blood test called a hemoglobin electrophoresis, and most states require sickle cell testing for pregnant women and newborns. But, by the time we see many young women who carry the trait, they are already pregnant or have children, and we rarely get the opportunity to counsel their partners. To prevent the abnormal sickle gene from being passed to offspring, we must intervene earlier, help people understand the danger of this disorder, and encourage testing for the hemoglobin gene traits in at-risk ethnic groups.

    Symptoms of Sickle Cell Disease

    Individuals affected by SCD experience episodes of acute, sudden onset pain—known as pain crises—for which they commonly require hospitalization. Pain can occur when the misshapen red sickle cells obstruct the blood vessels, causing bone pains, commonly in the legs, back, arms, and chest.

    SCD patients are also prone to develop chronic pain that we believe is due to nerve damage and inflammation. Pain levels or scores are unique to each patient and can vary in intensity and duration. There is no cure for this and management is complicated. Chronic pain is the most common cause of poor quality of life in sickle patients.

    The abnormal blood cells can place every major organ at risk of injury and disease. As the patient ages, he or she may experience systemic organ failure—not unlike what happens with uncontrolled diabetes. Sickle cell organ disease can include stroke, retinopathy, heart, lung, and kidney disease. Blood clots, especially to the vessels of the lungs (pulmonary embolus) are also common in SCD and we are beginning to appreciate a high incidence of cognitive deficits in our patients, with some developing early dementia. Priapism (sustained painful erection of the penis) is seen in young males and can lead to sexual dysfunction; other complications include leg ulcerations and gallstones.

    How Sickle Cells Behave

    In SCD, the bone marrow produces red blood cells containing defective sickle hemoglobin. When the blood oxygen levels in the body are low, the sickle hemoglobin polymerizes and precipitates in the red blood cells, giving rise to the elongated or sickle-shaped cells (like a crescent moon) that give the disease its name.

    While normal red cells survive for up to four months, sickle cells survive only 15 or 20 days, causing individuals with sickle cell disease to have anemia or low hemoglobin count. While normal hemoglobin molecules are very adept at switching conformation when carrying oxygen versus releasing it to tissues, sickle cells do not perform this function well. This is when polymerization of the hemoglobin can occur, with change in the red blood cell shape that can lead to the obstruction of the blood vessel and blood flow. The blockage can cause severe, debilitating pain and other complications in the lungs and other organs.

    Sickle Cell Treatment

    Our hematology team of medical doctors, advanced practice providers, nurses specializing in care of patients with blood diseases, and our colleagues in various specialties across MedStar Washington Hospital Center work collaboratively to manage SCD patients, following the published NIH guidelines.

    We are very aggressive with sickle cell crisis treatment and pain management. Experience has shown that relieving the patient’s pain as quickly as possible can prevent additional, sometimes life-threatening, complications. Our Cancer Infusion Center and Emergency Department are well equipped to deliver the prompt attention that acutely ill patients need. We are also able to give patients red cell transfusions if needed in our infusion center.

    In addition, we routinely screen our patients in the outpatient clinic for organ complications of SCD and administer preventative vaccinations because we recognize that sickle patients are at high risk for pneumonia, urinary tract, and other infections.

    On the Horizon

    Since the late 1990s, drug therapy for SCD patients has been focused on hydroxyurea (HU), which can reduce the number and severity of pain and organ crisis in some patients. HU also improves patient mortality. New drugs approved in 2019, Oxbryta® and Adakveo® can modify the disease by preventing the sickle hemoglobin from polymerizing and the RBCs from sticking to the blood vessel lining, respectively. The drug L-Glutamine (Endari), approved in 2017, makes sickle red cells less susceptible to oxidant damage.

    Treatment of SCD has evolved to include bone marrow transplantation. In years past, a bone marrow donor needed to be an exact match with the patient—requiring a relative with the same genetic profile. Today, we see promise in the ability to use donors that are half-matched, known as haploidentical transplantation. This is very good news, as it may substantially increase the number of potential donors for patients.

    Another very exciting area of research is in gene therapy, in which the editing and repair of the faulty sickle disease gene, or the silencing of other genes that can attenuate the effects of the sickle gene, begins to address the root cause of sickle cell disease.

    Although many great strides have been made, much work remains. Sickle cell disease strikes young people, often in their 20s. It is a life-long struggle with enormous cost to society, not just in terms of the high economic cost of medical treatment, but also in lost productivity of young people who experience interruptions in work and school.

    Many organizations advocate for patients who suffer because of health care disparities. But compared with other diseases, significantly fewer research dollars are allocated to sickle cell disease. Public health awareness, disease education, and access to genetic counseling could significantly reduce the spread of SCD and are as important as finding a disease cure.

    During the Pandemic

    COVID-19 infections can trigger pain events and temporarily worsen disease symptoms and complications. SCD patients also have a higher risk of death from the SARS CoV-2 coronavirus, similar to that seen with obesity, diabetes, and hypertension.

    At any time, not just during a pandemic, prompt medical attention is critical to managing complications of sickle cell disease—especially during a sickle cell crisis. If you have SCD, always stay connected with your health care provider or specialist. This is not a disease you can manage alone if pain or other symptoms become severe, so it’s important to get to the hospital quickly during any crisis.

    And if you are of African or Hispanic descent and are unsure about your potential for SCD, consider having a conversation with your general practitioner about any potential risk—particularly if you would like to start a family. This is truly the key to getting rid of sickle cell disease in the population—and giving children who are yet to be born the chance to avoid the complications of a disease that causes pain, suffering, and decreased life expectancy.

    Chronic or persistent pain?

    Our hematology team can help.

    Call 202-788-0402 or Request an Appointment

  • May 14, 2021

    By MedStar Health

    Si perteneces a la comunidad negra o latina, es posible que tengas algunas preocupaciones sobre la eficacia de la vacuna contra la COVID-19. Desde la desigualdad histórica en la investigación médica hasta las preguntas sobre el rápido desarrollo de la vacuna, es válido tener dudas acerca de vacunarse.

    Tener dudas sobre la vacuna contra la COVID-19 es algo bueno porque significa que te preocupa tomar la decisión correcta. Nos sentamos con algunos de los expertos de MedStar Health para recopilar información sobre la vacuna contra la COVID-19 a fin de que puedas tomar una decisión informada cuando se trata de tu salud.

    Si tienes preguntas sobre la vacuna contra la COVID-19, eso es algo bueno. Obtén información de nuestros expertos en #LiveWellHealthyblog para que puedas tomar una decisión informada: https://bit.ly/3tMToHf.

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    ¿Cómo puedo confiar en la seguridad de la vacuna habiéndose desarrollado tan rápidamente?

    Es cierto que las tres vacunas contra COVID-19 disponibles en la actualidad se desarrollaron rápidamente. Debido a los graves efectos de la pandemia, pudimos invertir más recursos en el desarrollo de una vacuna rápida a fin de reducir el impacto de la pandemia lo antes posible. Pudimos canalizar más expertos y dinero para averiguar cómo avanzar con la vacuna usando la tecnología del ARN mensajero (ARNm) que ya estaba en desarrollo.

    Hasyln Hunte, PhD, MPH, científico investigador de MedStar Health, eligió vacunarse a pesar de las preocupaciones iniciales sobre la seguridad del virus. Él dice,

    “No estaba obligado a vacunarme a pesar de que estoy en la industria de la salud. Al principio fui cauteloso sobre si una agenda política podría afectar la ciencia detrás de la vacuna. Me sentí más seguro en el desarrollo de la vacuna a medida que la información sobre los ensayos clínicos se hizo pública, especialmente cuando los que no resultaron exitosos se suspendieron. Eso marcó una gran diferencia al darme cuenta de que los investigadores solo buscaban vías exitosas y efectivas”.

    Los investigadores y desarrolladores de vacunas siguieron los mismos procesos y protocolos rigurosos para garantizar la seguridad y eficacia de la vacuna. En los Estados Unidos, la Administración de Alimentos y Medicamentos (FDA) debe revisar y aprobar todas las vacunas después de pruebas y observaciones exhaustivas. Más allá de la FDA, las juntas de revisión de investigación compuestas por diversos expertos en género, raza y temas especializados evalúan y aprueban exhaustivamente estudios como este para garantizar que se escuchen todas las inquietudes.

    ¿Es segura la vacuna contra la COVID-19 para mí si…

    Ya sea que tengas alergias, estés embarazada o tomes medicamentos, es posible que tengas preguntas específicas sobre si es seguro o no recibir la vacuna.

    Esperemos que tenga un proveedor de atención primaria de confianza con quien te sientas cómodo hablando sobre tu situación particular. Aunque los componentes de la vacuna COVID-19 son diferentes de los que se pueden encontrar en la vacuna contra la gripe o en las alergias alimentarias comunes, tu proveedor de atención médica puede confirmar que es seguro que te vacunes y responder a cualquier pregunta para ayudar a alivianar tus preocupaciones.

    Si bien las mujeres embarazadas no fueron incluidas en los ensayos clínicos, una madre saludable generalmente se traduce en un bebé sano. Habla con tu obstetra o partera si está embarazadas o planeas quedar embarazada. Debido a que las mujeres embarazadas son más susceptibles a las complicaciones de COVID-19, puede ser lo mejor para usted vacunarse.

    ¿Qué vacuna contra la COVID-19 es más efectiva?

    Todas las vacunas contra COVID-19 son efectivas, por lo que es seguro recibir la vacuna que se le ofrezca primero. Hay un suministro limitado de cada una, por lo que es útil que haya múltiples desarrolladores que suministran vacunas.

    Se sabe que las series de dosis doble de la vacuna de Moderna y Pfizer son casi 95 % efectivas para prevenir la COVID-19. También se ha demostrado que recibir una dosis de la vacuna de Johnson & Johnson es 100% efectivo para protegerlo de la muerte causada por COVID-19.

    Cómo la vacuna puede llevarnos de vuelta a la normalidad.

    Hemos visto que las comunidades negras e hispanas han sido afectadas de manera desproporcionada por el virus. Según un informe reciente, los hispanos han perdido alrededor de dos años de vida debido solo al coronavirus. Y los negros han perdido alrededor de un año y medio de vida. Si no nos vacunamos, perderemos. Necesitamos protegernos a nosotros mismos, a nuestras familias y a nuestras comunidades para proteger nuestro legado.

    El especialista en enfermedades infecciosas, Calvin Williams, MD, dice: “Los riesgos del virus son reales. Y la vacuna es eficaz para prevenir el peor resultado”. Añade que la vacuna marca un antes y un después porque significa que podemos empezar a reunirnos de nuevo de forma segura sin mascarillas. “Las directrices actualizadas de los Centros para el Control y la Prevención de Enfermedades (CDC) establecen que las personas que están completamente vacunadas pueden reunirse sin peligro en el interior sin necesidad de usar mascarilla. Para muchos, eso significa abrazar a sus familiares por primera vez en más de un año.”

    Si bien debes continuar con las mismas precauciones de seguridad que antes cuando estés cerca de personas que no han sido vacunadas, vacunarte significa que puedes comenzar a reunirte con familiares y amigos que también han elegido vacunarse. El Dr. Williams tiene esperanzas para el futuro, explica,

    “Soy cautelosamente optimista. Estamos en una posición diferente ahora después de lidiar con esto durante un año, y la vacuna nos ofrece una salida más segura de esto. Todavía tenemos pacientes que luchan por sus vidas, por lo que el camino a futuro requiere que hagamos algo. Esto no terminará por sí solo. Cada uno de nosotros debe participar colectivamente en la vacunación”.

    Qué esperar al recibir la vacuna.

    El suministro de vacunas es el mayor problema en este momento, ya que miles de personas están en la lista de espera para ser vacunados. Pero esperamos que la distribución de suministros siga aumentando y podamos proteger a estas personas.

    Las reglas sobre quién puede vacunarse varían según el estado y el condado. Puede resultar confuso saber cómo y cuándo califica. Todo el mundo calificará en algún momento, pero lo mejor que puedes hacer mientras esperas es registrarte proactivamente en línea. Si no eres experto en tecnología, solicita la ayuda de alguien que lo sea y que pueda ponerte en la lista de espera de vacunas para que cuando sea tu turno, estés listo.

    Una vez que recibas la vacuna, puedes esperar efectos secundarios leves que demuestren que la vacuna está desarrollando inmunidad en tu cuerpo. No ha habido efectos secundarios graves causados por la vacuna. Asegúrate de evitar programar otras vacunas o inmunizaciones alrededor del tiempo que esperas recibir la vacuna contra la COVID-19, ya que está diseñada para funcionar sin ninguna interferencia inesperada dos semanas antes y después de tu dosis final.

    Obtén más información sobre lo que puedes esperar después de la vacunación.

    Vacunarte es una opción personal que nos puede ayudar a movernos hacia la luz al final del túnel.

    Como proveedores de atención médica, nuestro trabajo no es forzarte o convencerte de que te vacunes. Te animamos a hacer preguntas para que puedas obtener las respuestas que necesitas para tomar una decisión informada. Daremos respuesta a todas las preguntas, y si no tenemos la respuesta, lo resolveremos.

    La experta en enfermedades infecciosas María Elena Ruiz, MD, dice: “Como mujer hispana, es difícil ver que muchos de mis pacientes hispanos contraigan COVID-19. Así que cuando hablo con ellos, trato de abordar sus preocupaciones específicas. Ha sido una idea errónea que solo los débiles, los ancianos y los enfermos mueren. Lo más difícil ha sido ver que aquellos en su mejor momento sin comorbilidades también sufren y mueren por el virus. Ahora, necesitamos que todos nos ayuden a seguir adelante vacunándonos y que sigamos pensando en usar mascarillas cerca de aquellos que están en alto riesgo y no están vacunados”.

    Angela D. Thomas, DrPH, MPH, MBA, también se siente animada y señala: “En esta época hace un año, nuestro problema era diferente, así que hemos progresado bastante. Creo que hay una luz al final del túnel pero tenemos mucho trabajo que hacer. A medida que se aprueben más vacunas, a medida que avancen nuestras estrategias de distribución y a medida que crezca la aceptación de vacunas, llegaremos a este punto. Esto es algo que tenemos que abordar juntos como comunidad, y todos tenemos un papel que desempeñar”.

    Obtén más información en el siguiente video, en el que nuestro panel de expertos discuten acerca de la seguridad y eficacia de la vacuna.

    ¿Estás listo para dar el siguiente paso para protegerte a ti mismo y a los que amas?
    Regístrate para recibir la vacuna.

    Obtén más información

  • May 13, 2021

    By Yongwoo Kim, MD

    As the command center for every system in the body, a healthy brain requires a lot of blood to stay functional; in fact, every minute, it makes use of ¼ of the blood pumped by the heart. A diminished blood supply (for example, caused by a blood clot) starves the brain of oxygen, and brain tissue begins to die—a condition we recognize as stroke.

    Stroke is the fifth most common cause of death in the United States (and number two worldwide). It occurs suddenly and often leaves very little time for effective medical intervention.

    This deadly byproduct of cardiovascular disease affects over two million Americans each year, and 150,000 of those affected do not survive. Among the survivors, nearly eight million Americans must live with the aftereffects: often irreversible damage that impacts their daily lives.

    And stroke is not necessarily a disease of older age—risk factors are increasing across all age groups, particularly younger adults. Our best defense is prevention.

    Time Is Brain

    What causes a stroke? There are two types of stroke:

    • Ischemic stroke is similar to heart attack: an artery supplying the brain with blood is blocked, usually by a clot, resulting in tissue death. Ischemic stroke is four times more common than hemorrhagic stroke.
    • In hemorrhagic stroke, a blood vessel in the brain ruptures and bleeds. Brain tissue is damaged as blood accumulates where it doesn’t belong.

    The moment that a stroke begins, the clock is ticking. Damage sweeps very rapidly through the affected area of the brain, so the faster medical attention can be given, the more likely we are to save brain function and avoid devastating consequences for the patient.

    Without treatment, brain tissue can be damaged beyond repair in about 4½ hours. Surviving stroke victims may suffer from paralysis, numbness, or weakness on one side of the body, creating difficulty in walking and use of the hands. Stroke can also affect speech, swallowing, memory, learning, and emotional health.

    Stroke recovery is typically very slow and often limited. The brain cannot heal the injured tissue—stroke damage is permanent. In many cases, some areas of surviving brain tissue can learn new skills and compensate. But that rewiring typically takes six to eight months—and full functional recovery is rare.

    The moment that stroke strikes, the clock is ticking. The more quickly it is treated, the less likely the patient will experience serious consequences. Dr. Yongwoo Kim explains the signs. https://bit.ly/3ekbpXD via @MedStarWHC
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    Symptoms of Stroke: BE FAST

    In some patients, a small blood clot may cause what we refer to as a mini-stroke or a transient ischemic attack (TIA), which behaves almost the same way that a larger stroke does. However, mini-stroke symptoms may subside very quickly, often in as little as five minutes.

    TIA is a warning sign that a larger stroke may be imminent. Consider it a medical emergency and get the medical attention needed to prevent a larger event.

    If or when that larger event occurs, urgent action is vital to preserve brain tissue. Stroke rarely produces pain, so look instead for these five classic stroke symptoms that happen suddenly. Use the acronym BE FAST to remember what to look for.

    The BE FAST Checklist

    Call 911 immediately if any of these stroke symptoms suddenly occurs:

    BBalance: leaning, staggering, or difficulty walking

    EEyes: any visual impairment of one or both eyes, including visual field narrowing, blurry or double vision, or one eye not moving normally

    FFace: drooping on one side or a lopsided smile

    AArms: weakness on one side, such as inability to fully raise the arm or hold onto something

    SSpeech: speech is slurred or hard to understand, or the patient is inarticulate, unable to make meaningful conversation

    TTime: act immediately if you see or experience one or more of the symptoms above. Call 911 and get to a hospital as quickly as possible, where emergency treatment can begin.

    Treatment

    For a stroke victim who reaches the hospital quickly, treatment involves recanalization—opening vessels to restore blood flow.

    We first complete a thorough neurological exam, and may order emergency radiology imaging studies. We use CT and MRI to confirm stroke and assess any bleeding damage. We treat quickly, potentially using both drugs and surgery to clear a blocked blood vessel, depending on location and severity.

    When a blood clot causes a small blockage, we use thrombolytic medications, also known as tPA or clot-busters, to get the blood flowing again. We perform surgery to stop bleeding in the case of hemorrhagic stroke, when a larger artery has ruptured. In some cases, catheterization alone may be effective—we can potentially pass a thin tube through a large blood vessel and navigate it to the site of the blockage.

    Because about one in four stroke patients will suffer another stroke within five years, we typically prescribe antithrombotic medications such as aspirin to prevent clotting that may cause additional strokes. And after treatment and initial recovery, rehabilitation is typically recommended, to help the patient strengthen weakened muscles and improve swallowing, speech, and other critical functions.

    Patients are in the best possible hands here at MedStar Washington Hospital Center. We are a Comprehensive Stroke Center, with an advanced care team that includes highly trained neurologists, neurosurgeons, emergency physicians, nurses, and rehabilitation professionals. Many of our team members participate in key research in the area of stroke.

    The Hospital Center makes use of the latest and most effective medications, and offers advanced imaging technology focused specifically on diagnosing neurological problems. We are equipped to act in the shortest amount of time to achieve the best possible results for our stroke patients.

    Prevention, the Best Medicine

    Traditional stroke risks include high blood pressure, high LDL cholesterol, atrial fibrillation, diabetes, tobacco use, advanced age, and a prior stroke history. And recently, the COVID-19 virus has caused life-threatening clotting in some patients as well.

    Managing your health and adopting a healthy lifestyle are the best ways to prevent stroke—and prevention is significantly better than treatment.

    • Control weight gain—try to maintain a belly circumference of less than 34 inches.
    • Exercise at moderate intensity for at least 30 minutes, three days per week.
    • Avoid tobacco and illicit drugs.
    • Drink alcohol in moderation.
    • Eat nutritionally balanced meals that include more fruits and vegetables than meat and that minimize sodium and fat.
    • Take all recommended precautions against COVID-19—mask up, practice social distancing, avoid crowds, isolate when ill, and get vaccinated.
    • Schedule regular checkups with your primary care physician, who will work with you to manage any underlying conditions such as high blood pressure, diabetes, atrial fibrillation, or clotting disorders.

    Know the warning signs.

    Download our stroke checklist.

    Download now

  • May 11, 2021

    By Ebony R. Hoskins, MD

    Cervical cancer is the fourth most common cancer in women worldwide. Over 14,000 American women are diagnosed each year, and over 4,000 will not survive—including about 145 in the Washington, D.C., metro area.

    This number is hard to accept when we consider that cervical cancer is among one of the most preventable cancers. Education is the key to prevention—knowing what to do and when. If we’re vigilant, we can save lives now…and in future generations.

    The lowest part of the uterus, the muscular tube of the cervix, provides a very functional gateway. Menstrual fluids exit the uterus through the cervix, and it is via the cervix that sperm reaches an egg for fertilization. During pregnancy, the cervix cradles the developing fetus in place and opens fully during labor to allow the baby to emerge.

    When cells in the cervix become confused and start to multiply out of control, the result can be cervical cancer. While a number of factors can foster this situation, a leading cause is the human papillomavirus (HPV). When a woman’s sexual partners make contact with the cervix, it can become readily exposed to a variety of sexually transmitted diseases, including HPV.

    HPV exposure is, in fact, quite common. So common, in fact, that we assume sexually active adults will be exposed to at least one strain of HPV at some point in their life. Many strains are relatively harmless and purged by the immune system, with most people never knowing they’d been exposed.

    Other strains, however, can be more troublesome—one causes genital warts, while others lead to cervical, throat and other cancers later in life. In fact, certain dangerous strains of HPV likely cause 99 percent of all cervical cancers, far surpassing other causes of the disease.

    Preventing Cervical Cancer

    Early-stage cervical cancer is rarely symptomatic. Typically, by the time symptoms appear—abnormal bleeding, bleeding after sex, pelvic and back pain, and difficulty urinating—the cancer may have progressed significantly.

    So what’s the best strategy to prevent it?

    • Get vaccinated! Since 2006, we have had access to very safe, reliable vaccines that protect against HPV. Because there is no way of knowing which strain you might be exposed to, or whether your immune system is able to handle it, the vaccine is the best way to avoid issues.

    Vaccination is especially recommended for girls and boys before they’re sexually active. Getting your child vaccinated could save their life—or the life of someone they’ve not yet met—in years to come.

    Adults, of course, can be vaccinated as well.

    Get tested! A regular Pap smear and routine HPV testing can uncover problems early, even before they become cancerous. At that stage, we have the best chance for successful treatment.

    We routinely co-test—conduct the HPV and Pap tests together—which delivers a more effective result than the Pap test alone.

    We collect a small number of cells from the cervix and submit them for laboratory analysis. The lab can confirm a cancer diagnosis or indicate pre-cancerous changes.

    An annual Pap smear is recommended for women beginning at age 21. Both Pap and HPV testing are recommended for sexually active women after age 30. Because guidelines on testing can change, it is important to stay in touch with your primary care doctor to determine the best approach for your age and lifestyle.

    Regular testing is the best way for us to catch disease early, and gives us the strongest chance to cure it successfully.

    Dr. Ebony Hoskins has encouraging news: regular Pap smears and testing—and the HPV vaccine—can help prevent cervical cancer and save lives. Keep yourself informed! https://bit.ly/339KBV3 via @MedStarWHC
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    Diagnosis and Treatment

    If initial testing or a lab study indicate anything out of the ordinary, we investigate further, generally starting with a colposcopy and biopsy.

    In an outpatient procedure, we apply a liquid preparation to the surface of the cervix to highlight abnormal tissue, then use the colposcope to gain an up-close view of that tissue. We capture a small sample of tissue for additional lab testing: the biopsy. The colposcopy does not require anesthesia, and most patients experience minor discomfort during the procedure.

    In most cases we can then remove any affected tissue during a minor surgical procedure. Most patients recover quickly with no significant side effects—and most can have successful pregnancies and deliver healthy babies after treatment.

    The disease becomes more dangerous in cases where women don’t have access to proper screening or have serious symptoms due to delayed screening. Vigilance is key.

    Don’t Delay Care

    Remember: talk to your doctor about a regular testing schedule, catch up on any missed vaccines, and vaccinate your children. Here at MedStar Washington Hospital Center, women are in excellent hands with our full team of medical specialists that provide in-depth expertise and specialty care and can help streamline appointments and procedures across the Hospital network, as needed.

    Remember, every woman has the power to avoid cervical cancer. Let’s do it together!


    Abnormal bleeding?

    Trust our gynecologic specialists for help.

    Call 202-788-5048 or Request an Appointment