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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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  • July 11, 2017

    By MedStar Health

    Excruciating neck pain brought Joe and Dan, from Chattanooga, Tenn., to MedStar Georgetown in search of neck and spine pain relief after years of failed treatments.
  • July 10, 2017

    By MedStar Health

    Heart disease and stroke are the leading cause and fifth-leading cause of death of adults in the United States, respectively. Studies show that statins – cholesterol-lowering drugs – can reduce the risk of heart attack, stroke and death from heart disease by 25 to 30 percent.

    Yet of the more than 78 million adults who are eligible to take statins, 45 percent don’t. There are plenty of reasons for this: some don’t realize they’re at risk for these conditions; others don’t want to take medication or have been scared off by misinformation about statins.

    But people who could benefit from a statin also face an additional barrier: it requires a prescription.

    A May 2016 study estimated that giving statins over-the-counter (OTC) status would result in more than 250,000 fewer major coronary events such as heart attack, more than 41,000 fewer strokes, and reduce heart disease- and stroke-related deaths by nearly 69,000 over 10 years.

    We’ve been using statins for 30 years, and they’ve proven to be some of the safest and most effective drugs for heart disease prevention. I think it’s time we remove the prescription barrier and allow people to buy them over-the-counter.

    Statins as OTC medication: Why now?

    Selling statins over-the-counter isn’t a new concept. It’s been discussed for years. In fact, one pharmaceutical company even began the process for developing an OTC statin before abandoning it due to sky-high requirements. But evidence found in a 2016 study really drove home for me that this is a valid idea.

    “The Heart Outcomes Prevention Evaluation” (HOPE-3) study, published in May 2016 in The New England Journal of Medicine, followed more than 12,000 participants age 55-65 with at least one heart disease risk factor, such as high blood pressure or tobacco use. Half of the participants were given 10 mg of rosuvastatin, more commonly known as Crestor, and half were given a placebo. After five years, those who took a statin had a 24 percent lower risk for cardiovascular events. And, importantly, there were few if any important differences in side effects between the statin and placebo.

    One interesting aspect of this study is that cholesterol levels were not used to select patients or to guide the treatment. The requirement was simply age and one heart disease risk factor. And to me, that’s the formula for an OTC medication: you don’t need a lot of fancy measurements to figure out if you could benefit from a statin. The HOPE-3 study showed statins were safe and effective in a broad population of people who didn’t already have heart disease, which I think is justification for conversion to OTC status.

    A few years ago, Pfizer sought Food and Drug Administration (FDA) approval to convert its statin Lipitor to an OTC medication. The FDA set a pretty high bar for Pfizer’s study, requiring patients to measure their own cholesterol and take appropriate action based on the test results – actions no other OTC drug requires. Basically, the FDA wanted patients to act as a doctor, and it proved too complicated for most study participants. Pfizer ended the trial early.

    The HOPE-3 study showed people don’t need to measure the effect of a statin on cholesterol for it to work. And by working, I mean it saves lives. So how do we narrow the gap between people who could benefit most from statins and those who take them?

    Options for how to make statins available over-the-counter

    There’s no question that giving a drug OTC status increases its use. One study showed an average 27 percent increase in utilization in several therapeutic drug classes, such as antihistamines and analgesics (a form of painkiller) after becoming available over-the-counter.

    There are a few ways to go about expanding the availability of statins.

    1. No longer require people to renew prescriptions

    This is sort of a step up to true OTC status. Currently, if you have a prescription for a statin, you need to return to your doctor every year to renew the prescription. What if instead, that initial prescription was a lifetime prescription? It would be noted in your electronic medical records and you could walk up to any pharmacy window and refill it on an ongoing basis, without visiting the doctor to get a new prescription.

    2.  Make statins available without a prescription

    There are some people who just don’t want to see a doctor, but realize they’re at risk for heart disease or stroke. They’d take a statin if it was available like an antacid for heartburn or Tylenol for headache.

    This would make statins available to anyone who stands to benefit from taking one: middle-aged individuals with one additional heart risk factor like in the HOPE-3 study. Given the poor job we do right now in getting statins to everyone who can benefit from them, it is time we begin to “think differently.”

    Suggesting these options doesn’t mean I never want you to see a doctor, but it does remove a barrier to taking a potentially life-saving drug. Plus, instead of needing to discuss your statin during every visit, we can take a little extra time to focus on other topics, such as lifestyle modifications or answering questions.

    How to keep people safe with OTC statins

    Every medication has potential side effects. Statins are no different, although I think some concerns have been exaggerated on the internet. The most common side effect of statins is muscle pain, although it’s usually mild. Other side effects include a slightly increased risk to develop diabetes, seen as an earlier time to the diagnosis among patients likely to develop diabetes.

    Have you ever bought aspirin or ibuprofen over the counter? Sure you have. In my view, statins are, in fact, safer than these drugs, and provide more benefit. Nonsteroidal anti-inflammatory drugs such as these are incredibly effective when needed, but they do have potentially serious side effects, including increased risk of bleeding in the brain and gastrointestinal bleeding. However, like statins, the benefits of these drugs greatly outweigh the potential harm.

    Labels for OTC statins should carry warnings and recommended uses just like any other drug. And not every variation of statins should be available over-the-counter. For example, if you needed a dose higher than 10 mg, your doctor should have to write a prescription, just as you would for high doses of other OTC drugs.

    There are still questions to be answered before statins become available over-the-counter, such as who will pay for them. Most OTC drugs aren’t covered by insurance. But statins prevent health events that insurance companies ultimately would have to pay for, so I think they should be a reimbursable expense. How that happens needs to be worked out.

    Statins have a solid 30-year track record of preventing heart attacks, stroke and death from heart disease. They’re ready for prime-time. We’re entering a new era of empowering people to take charge of their health. It is time to give the public more control of their cardiovascular destiny by making statins available over-the-counter.

    Schedule an appointment with one of our cardiologists today.

    Request an Appointment

     

  • July 07, 2017

    By MedStar Health

    Why Palliative Care?

    In recent years, more and more patients facing a serious illness have turned to the complimentary discipline of palliative care to help cope with the physical and emotional demands of their condition. Because communication is critical in assisting patients and loved ones through what are often difficult treatment decisions, palliative care is the ideal discipline for MedStar Washington Hospital Center attending physician Clint Pettit, MD, who chose medicine as a career in part because he enjoys talking with people.

    When dealing with an illness of his own as an undergraduate engineering student at Tulane University in New Orleans, Dr. Pettit found that he enjoyed interacting with the physicians who helped him understand his course of treatment and recovery.

    “I still wanted to do something in science,” he says, “but I liked the people aspect of medicine. So, I switched my major to biochemistry.”

    After returning to his hometown of Omaha to earn a medical degree at the University of Nebraska Medical Center, Dr. Pettit began a residency in internal medicine at MedStar Georgetown University Hospital. There, he embraced the difficult task of helping patients and family members navigate through the medical system in a way that respected their wishes and helped them achieve their goals.

    Palliative Care and Common Misconceptions

    Dr. Pettit admits that palliative care is often perceived as a “depressing” field because all too many cases deal with end-of-life issues. But, he insists, that’s only one aspect of what is a multi-faceted, multi-disciplinary area of medicine.

    “Palliative care emphasizes quality of life at any stage of serious illness and treatment,” Dr. Pettit explains. “We collaborate with the patients’ primary physicians and other specialists on treatment strategies, including managing pain and other symptoms, to help make the patient as comfortable as possible. We also provide counseling to help patients and loved ones cope with an illness’s emotional stress, and help them plan for post-hospital care.”

    Dr. Pettit believes that with time and experience, palliative care will become better understood among both patients and other medical professionals. As research is one way to bridge the information gap, Dr. Pettit is studying how rapid response team nurses can better identify potential candidates for palliative care.

    “We want to see if getting palliative care involved earlier in a hospitalization will have a positive effect on outcomes,” he says.

    Dr. Pettit is also chairing the Clinical Competency Committee for MedStar Washington Hospital Center’s upcoming Hospice and Palliative Medicine fellowship program, which will help bring more newly minted physicians to the field.

    Life Outside the Hospital

    Because palliative medicine can be as emotionally draining as any other field of medicine, Dr. Pettit strives to maintain a balanced outlook through exercise, hiking and playing classical guitar. Yet even when confronted with a difficult case, Dr. Pettit and his team remain committed to finding a way forward.

    “Difficult situations exist whether we like it or not,” Dr. Pettit says. “We try to face these situations head on, to make sure patients and their families always feel comfortable, supported, and respected, even when the medical outcome isn’t something we would have hoped for.”

  • July 05, 2017

    By MedStar Health

    Kidney stones are very common: Men have a nearly one in five chance of developing kidney stones over their lifetime, and women have a nearly one in 10 chance. And as part of what is known as the “Kidney Stone Belt,” D.C.-area residents are at even higher risk of developing kidney stones.  

    This is a major problem, and it’s one that’s only gotten worse with time. The overall risk for kidney stones in the late 1970s was calculated at 3.8 percent. In the late 2000s, that number had jumped to 8.8 percent. That’s more than a 231 percent increase in the overall risk of kidney stones in just 30 years.

    If you have one kidney stone, the chances of developing a second one or more over your lifetime are more than 50 percent. And having kidney stones also can put you at greater risk for long-lasting problems such as kidney failure, recurrent infections, and multiple other conditions.  

    Fortunately, making smart dietary choices can prevent kidney stones from developing in the first place. And if you develop a kidney stone, we can determine what’s causing it and lower your risk for developing another one.

    LISTEN: Dr. Daniel Marchalik discusses kidney stones in this Medical Intel podcast.

    A formula for kidney stone protection: Drink enough water

    Dehydration is the biggest risk factor for kidney stones that most people face. Our kidneys filter blood to remove waste products. These waste products enter our bloodstream from what we eat and drink. When urine is more concentrated, it’s more likely that the waste products filtered out by the kidneys will form a stone. The darker yellow urine is, the more concentrated it is. Urine should be light yellow or clear if you’re getting enough to drink.  

    #Dehydration is the biggest risk factor for #kidneystones that most people face. goo.gl/4rKg5v via @MedStarWHC

    Click to Tweet


    Sadly, most of us don’t get enough to drink. Kidney stones tend to be more common in areas of the world with warmer temperatures, where the heat makes it easier to get dehydrated. We call this the “Kidney Stone Belt,” and it includes Maryland, Virginia and Washington, D.C., among other places.  

    The simple answer for dehydration is to drink more. Water is best, of course. Citrus fruits like lemon can lower the risk for kidney stones because they contain a compound called citrate. Therefore, adding lemon to water or drinking lemonade also can help.  

    Of course, drinking more water is easier for some people than others. I’ve seen patients who come in with kidney stones, and they tell me, “I have no idea what my risk factor is.” Then I find out they don’t drink water all day because they can’t go to the bathroom during the workday.  

    Avoid soda and other drinks that are high in sugar when possible. Sugar alters the way the body absorbs minerals and can increase the risk for kidney stones. Sugar also increases the acid levels of urine, which makes stones more likely to form.  

    A diet to prevent kidney stones: They are what we eat

    It’s not just the amount of fluid in urine that determines a person’s risk of kidney stones. This risk also is based on the amount of waste products the kidneys have to filter from the blood. When there are more of certain types of waste products relative to the amount of fluid in urine, the risk of kidney stones goes up.

    One of the reasons our risk for kidney stones has increased so much since the 1970s is because our diets have changed since that time. Two of the main dietary culprits for kidney stones are proteins and salt.

    Protein

    The modern American diet contains a lot more protein than it did in the 1970s, especially animal-based protein. We consume animal-based protein in the form of:

    • Chicken and other poultry
    • Eggs
    • Red meat
    • Seafood

    I tell my patients to limit their protein intake to two servings per day. That takes some planning and thought about what you eat. If you know you’re having fish for dinner, and you had sausage with breakfast, avoiding that chicken-salad sandwich for lunch is one way to control your protein.

    Salt

    The salt, or sodium, that we eat plays a huge role in the formation of kidney stones. Since the 1970s, a lot more of the food we eat is processed and packaged, and that means more salt. Plus, people are eating saltier foods and more of them.

    For example, just 1 ounce of potato chips can have about seven to 10 percent of the average person’s daily recommended maximum serving of salt. And as the U.S. Department of Agriculture notes, an average single-patty plain cheeseburger at a fast-food restaurant has 469 milligrams of salt—more than 20 percent of the maximum daily serving of 2,300 milligrams per day.  

    That would be bad enough if people stuck to the upper limits of salt intake per day. But most people eat much more salt than the recommended maximum amount. As noted by the U.S. Department of Health and Human Services, the average woman consumes 2,980 milligrams of salt per day. And the average man consumes 4,240 milligrams of salt per day—nearly twice the recommended maximum. So people are putting tremendous loads of salt into their systems, and the kidneys have to filter all of that salt out. 

    The average man consumes 4,240 mg of #salt per day—nearly twice the recommended maximum. goo.gl/4rKg5v via @MedStarWHC

    Click to Tweet


    Everyone can decrease the amount of salt in their diet. Salt is such a prevalent ingredient in food, even when you might not expect it. Most of the salt we eat comes from commercial food processing operations. And it can be found in unexpected places: ketchup, cereal, tomato sauce, bread and canned vegetables have some of the highest salt contents of our everyday food. Pay attention to the nutrition information on packaged foods, and choose low-sodium or no-sodium options when possible.

    When you cook, limit the amount of salt you use in your recipes. Fresh herbs, pepper and other ingredients can add flavor to dishes without the need for a lot of salt.  

    When to treat kidney stones and reducing future risk

    It’s not always possible to avoid kidney stones. Request an appointment with one of our urologists if you notice the following symptoms:

    • Changes in your urine’s color or appearance
    • Nausea or vomiting that doesn’t go away
    • Sharp pain in the side or mid-back

    Related reading: Kidney stone diagnosis and treatment

    When I see patients for kidney stones, I use imaging studies to get a look at where the stone is and how big it is. Not every stone needs surgery. If you have a small stone, it’s probably one we can keep a close watch on with regular visits to make sure it passes on its own. If it’s a large stone that’s blocking the ureter (the tube that lets urine pass from the kidney to the bladder), it probably needs to be treated. Without treatment, those kinds of stones can lead to permanent kidney damage if they don’t pass on their own.  

    For some doctors, treatment stops as soon as the stone is gone. But that’s not how we should treat patients with kidney stones. As we know, more than half of the patients who develop a stone will have another stone in their lifetime. Therefore, as with any other chronic disease, we work to figure out why the patient has the problem and what we can do to fix it, and that’s how I treat kidney stones.  

    The process starts with a basic blood draw, called a BMP, which stands for basic metabolic panel. This shows us the basic chemistry of your blood, including levels of sodium, potassium, calcium and other substances.  

    Then we do a 24-hour urine collection, which involves taking all of the urine a patient produces for 24 hours and sending it to a lab for analysis. We look for the same factors in the patient’s urine as we do in the blood and compare the levels. If a patient has low levels of citrate in their urine, we know to increase the patient’s citrate levels. Chances are, that’s going to help you not make more kidney stones in the future. This is a personalized process based on each patient’s unique factors.

    Kidney stones may be little, but they’re a big problem for our country. Making smart choices about what goes into your body can reduce your risk for the pain and consequences of kidney diseases down the road. 

  • June 30, 2017

    By MedStar Health Research Institute

    The Georgetown-Howard Universities Center for Clinical and Translational Science is delighted to sponsor and support a three-day power and sample size workshop. The short course, taught by Keith E. Muller, Ph.D., professor in the University of Florida College of Medicine, and Deborah H. Glueck, Ph.D., associate professor in the University of Colorado School of Public Health, will give scientists training for selecting a valid sample size for longitudinal and multilevel study designs. The workshop is accessible to all, from graduate students to senior researchers, and requires only basic statistical background.

    Course Objectives:

    • Understand a framework and strategy for study planning
    • Write study aims as testable hypotheses
    • Describe a longitudinal and multilevel study design
    • Write a statistical analysis plan
    • Ensure sufficient sample size for subgroups for studies of disparities
    • Demonstrate the feasibility of recruitment
    • Describe expected missing data and dropout
    • Write a power and sample size analysis that is aligned with the planned statistical analysis
    • Write the design, analysis, power and sample size sections for a grant

    August 28-30, 2017
    9:00 am to 5:00 pm
    Louis Stokes Health Sciences Library, Room 138
    Howard University
    501 W Street NW, Washington, D.C., 20059

    To learn more and register, visit the website.

     

    The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Materials for the course were developed with support from NIH OBSSR and NIGMS via 1R25GM111901-01, “A Master Course on Power for Multilevel and Longitudinal Health Behavior Studies,” 08/25/2014-06/30/2018. Additional support was provided by the Center for Bioethics and Humanities of the University of Colorado Denver, the University of Florida (UF) Clinical and Translational Science Institute, the UF Department of Health Outcomes and Policy, and Federal funds (UL1TR001409) from the National Center for Advancing Translational Services (NCATS), National Institutes of Health, through the Clinical and Translational Science Awards Program (CTSA), a trademark of DHHS, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.

  • June 30, 2017

    By MedStar Health Research Institute

    With support from a Clinical and Translational Science Award from the NIH National Center for Advancing Clinical and Translational Science (NCATS), we are pleased to announce the next round of applications for our Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) KL2 award.

    This K-series career development award is nearly identical to our previous KL2 awards and analogous to individual K23 or K08 awards, with a focus on developing early-career (MD or equivalent; doctorally-trained nurses, pharmacists or dentists; and clinically or translationally-oriented PhD) faculty investigators through an inter- or multi-disciplinary mentored research experience so that they can become independent, extramurally-funded investigators. Given the goals of the GHUCCTS, awards will favor those: 1) who propose novel trans-, inter-, or multi-disciplinary and collaborative research projects, 2) from the entire T1-T4 translational continuum, 3) which span departments, disciplines, and institutions, and 4) address significant health disparities.

    Learn more and apply on the GHUCCTS website.   

    Anyone planning to submit an application in response to this request for applications should complete and submit the Pre-Application Form (online) by September 15, 2017 in order to ensure that the planned application will be responsive.

    Complete application due by 11:59 PM ON JANUARY 8, 2018