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  • January 14, 2022

    By Allison Larson, MD

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

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

    1. Do: Wear sunscreen all year long.

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

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

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

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

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

    2. Do: Skip products with drying ingredients.

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

    You may need to take a break from:

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

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

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

    3. Do: Pay closer attention to thick skin.

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

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

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

    Related reading:  Follow these 5 Tips for Healthy Skin

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

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

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

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

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

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

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

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

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

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog:
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    5. Don’t confuse skin conditions with dryness.

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

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

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

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


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

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

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

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  • June 15, 2017

    By MedStar Health

    The headlines may sound alarming: “Weight loss surgery tied to lasting digestive issues.” “After gastric bypass surgery, many experience eating difficulties.”  

    The stories were in response to a December 2016 study published in the British Journal of Surgery that followed 249 patients who had laparoscopic Roux-en-Y gastric bypass. It found that two years after surgery, gastric bypass patients were far more likely to suffer from digestive problems, such as indigestion, diarrhea and flatulence, as well as an inability to tolerate certain foods than the control group, which did not have the surgery.  

    However, these results aren’t that surprising. They simply highlight what we bariatric surgeons already know. Gastric bypass changes the way your body absorbs and processes food. Before surgery, patients spend months learning about the diet and lifestyle changes to which they must commit after surgery to mitigate the effects of how their bodies will change during surgery.  

    When you have gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. This will make you feel full sooner, meaning you’ll eat less, but it also affects how food is processed and the amount of nutrients including vitamins and minerals that your body absorbs.  

    Our patients are usually excited to follow their dietary recommendations to the letter before and immediately after the surgery. However, as they heal and time goes on, some of them fall off the wagon a little. They pay less attention to what they eat or try to push their diet a little further than they should. That’s usually when we begin to see gastrointestinal (GI) problems surface.  

    Common side effects of weight loss surgery

    Dumping syndrome

    This is one of the most common complications patients face after bariatric surgery. Dumping syndrome occurs when food, especially sugar, moves too rapidly from the stomach into the small intestine. This can result in diarrhea, nausea and abdominal cramps.  

    Dumping syndrome can be avoided by eating smaller meals and limiting foods high in sugar, as well as not rushing through your meal. We educate our patients about this syndrome, so they can recognize it. Patients often tell us that after it happens once, they learn pretty quickly what triggered it so it doesn’t happen again.  

    Small bowel bacteria overgrowth

    Everyone has a certain amount of bacteria living in their intestines. However, in rare cases, gastric bypass can cause bacteria to grow unchecked. This excess bacteria may eat up the nutrients your body needs and can cause bloating, cramping, gas and diarrhea.  

    In severe cases, small bowel bacteria overgrowth can inhibit the body from properly absorbing nutrients, leading to malnutrition and vitamin and electrolyte deficiencies, such as anemia.  

    Small bowel bacteria overgrowth usually can be successfully treated with antibiotics.  

    Food intolerance

    The study found that 71 percent of gastric bypass patients developed intolerance for fried foods, pastries and carbonated drinks. However, only 14 percent of those people said the intolerance was very bothersome.  

    We stress to our patients the importance of avoiding and cutting back on foods high in fat and sugar because the body just doesn’t process them as well after surgery. You’ll still be able to eat these foods, just not as often and in moderation. This is good advice for anyone, not just people who have had weight loss surgery!  

    We also see some patients who “develop” lactose intolerance after surgery. They most likely were mildly lactose intolerant before surgery, but the surgical changes caused it to surge. When they switch to lactose-free products, the problems go away.    

    How to reduce complications after gastric bypass

    In rare cases, complications from gastric bypass, such as small bowel bacteria overgrowth, can result in GI problems. But these problems usually are related to diet.  

    Our patients go through on average six months of education before surgery to learn about the diet and lifestyle changes they’ll need to make. In the weeks and months after surgery, they go through a diet progression: from liquids only, to thicker liquids, to soft food, then to solid food.  

    The most important thing you can do to prevent gastrointestinal problems is to follow the dietary guidelines. They may seem overwhelming at first, but you’ll likely find they become a part of your daily routine. And don’t rush to advance your diet or experiment with new foods before your dietitian gives you the OK.  

    A few general tips:

    • Eat small portions.
    • Eat slowly and chew food thoroughly.
    • Limit foods high in sugar and fat.
    • Keep a journal documenting food and portions.
    • Drink water between meals to avoid dehydration. 
    Following dietary guidelines is the best way to prevent gastrointestinal problems after #bariatricsurgery. via @MedStarWHC

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    We’ll test your vitamin and mineral levels six months after surgery, at a year, then yearly after that. This helps us catch potential nutritional deficiencies early and address them before they become a serious problem.  

    If you experience persistent gastrointestinal or eating difficulties, see a doctor. We can check for surgical complications and discuss your dietary habits. This is where a food journal can come in handy. By examining what you’re eating and how much, we usually can pinpoint the culprit and solve the problem. Even if you do experience GI symptoms at some point, for the majority of my patients, the overall benefits of the surgery outweigh them.  

    Bariatric surgery is not just about weight loss. It’s about improving your overall health and reducing the risks of life-threatening conditions caused by obesity, such as diabetes, hypertension and high cholesterol. By sticking to a healthy diet and lifestyle, you can reap the many health benefits of weight loss surgery and prevent or reduce potential complications.

  • June 12, 2017

    By MedStar Health

    Most of the time, welcoming a life is a beautiful, amazing moment. I understand the urge to want to share that with family and friends, and we’re good about accommodating delivery room guests. But I’ve had expecting moms ask if they can have upwards of 10 people in the delivery room with them.  

    I’ve seen women invite parents, in-laws, siblings, aunts, cousins and best friends. I guess their thought is the more the merrier.  

    Before you gather a support squad to witness your baby’s debut, consider these tips and safety guidelines for the delivery room.  

    Check your hospital’s delivery room policy  

    Every hospital has its own rules about how many people are allowed in the delivery room. Many only allow two or three people to be with mom. You may want to double check if your partner and doula count in that number. Some hospitals allow a certain number of people to be in the room during labor, but fewer during the actual delivery.  

    We allow up to seven people to be on the guest list, but only five people to be in the room at any time during labor and delivery. Our rooms are pretty large, so while five people can be a tight fit, it’s doable. Hopefully everyone likes each other! We do ask everyone to step out of the room during exams and the epidural.  

    If you want your older child to see the birth of their new baby brother or sister, ask for your hospital’s policy about allowing children in the room. We allow children in the room as long as there is an adult other than the expecting mother present to take care of them.  

    Talk to your doctor, midwife and nurses about what they expect from your visitors, and listen to what they say. They’re thinking of your comfort and safety. We want to be able to deliver the safest care possible while you are able to have your loved ones close.  

    Cesarean sections, however, are a whole other story. Most hospitals, including ours, allow only one person in the operating room with you. The rest of your family can stay in your room or the waiting room. We’ll keep them updated on what’s happening. 

    “We allow up to 5 guests in the delivery room for most births.” via @MedStarWHC

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    Prepare your loved ones for labor and delivery

    The day you give birth is one of the most important days of your life. Think carefully about who you want to share it with. If you’re concerned that your mother-in-law or another family member will add tension, don’t invite them. Feel free to blame it on the doctor’s policy!  

    Once you’ve decided who you want in the room, lay down the ground rules. Don’t be shy about expressing what you’re comfortable with. Do you want everyone near the head of the bed, or are you fine with some people getting an up-close look at the “miracle of life”? Do you want everyone there during labor, but only your partner present during and immediately after the birth?  

    It’s also a good idea to give everyone a rundown of your birth plan. This way, they’re not questioning your decisions on the big day.  

    Ask your doctor or midwife about any rules your loved ones need to know about. For example, when we roll in the delivery cart, it will be covered with a blue sterile sheet. We’ll ask everyone in the room to stay back and not touch anything blue. We find most people intuitively know when to get out of the way, but it never hurts to give a warning.  

    If at any point during labor and delivery you change your mind and want everyone to leave, just tell us. Don’t worry about hurting anyone’s feelings; we’re happy to take the blame and do it for you.    

    Keep your loved ones safe in the delivery room

    I’ve had the biggest of the biggest men pass out and hit the floor during delivery. It may sound funny, but it can be serious. I’ve seen one dad pass out during delivery and need to go to the emergency room. Another family member had a cardiac event.  

    I’ve gotten into the habit of quickly scanning the delivery room to make sure everyone looks OK. I usually can tell if they’re feeling hesitant or beginning to sweat. I’ll prop a chair next to them and tell them to sit down if they need to.  

    I tell delivery room guests there’s no shame in the game; I’ve had pro football players hit the ground! Hearing this usually makes people chuckle and feel more at ease about needing to sit down.  

    Set rules for after birth

    Think about who you want in the room after you give birth. Those first few hours of bonding are precious, and you’ll likely be exhausted. Are you going to feel up to entertaining?

    I know everyone is excited to meet the new baby, but they can wait. Tell your partner and healthcare team if you don’t want visitors, or if you only want specific people to visit. Let them be the enforcers!

    Childbirth is one of the most important stops along the journey of motherhood. It’s up to you whether you want it to be a private experience between you and your partner or a more public event surrounded by family and friends. Neither choice is wrong. But a little planning will allow you to focus on what matters most: welcoming your new family member. 

  • June 09, 2017

    By MedStar Health

    Who is Dr. Iqbal?

    The joyful anticipation of childbirth can also be fraught with anxiety, particularly if the pregnancy is considered high-risk, or unexpected problems develop. That’s when mothers and their families need more than just a capable physician. They also need a counselor, and a friend.

    Sara Naeem Iqbal, MD, makes sure they have all that, and more. As program director for MedStar Washington Hospital Center’s Maternal-Fetal Medicine program, Dr. Iqbal believes that while each pregnancy is unique, the goal is the same—to fully support the mother with the best possible care throughout a high-risk pregnancy, and the baby’s arrival.  

    A voracious student of science while growing up in Pakistan, Dr. Iqbal pursued medicine as a profession because it allowed her to apply her interests toward helping people.  

    “You get to make a difference in someone’s life,” she explains. “You ease the sufferings, cure the disease and are able to feel inner satisfaction and a sense of accomplishment.”

    Why Maternal-Fetal Medicine?

    Maternal-fetal medicine likewise provided the opportunity to not only care for a mother and baby, but also focus on what Dr. Iqbal calls “the un-routine” cases—women who encounter problems such as early labor, bleeding or high blood pressure.  

    “It was the perfect combination for me—prenatal care, ultrasound, genetic counseling, continuity of care and delivery,” she says. “I believe, by providing specialized clinical care, I can personally impact and make a difference in women’s lives.”  

    After completing medical school at Dow University of Health Sciences in Karachi, Pakistan, Dr. Iqbal joined her husband in the U.S. and completed her residency training in obstetrics and gynecology at Howard University Hospital. She focused on high-risk obstetrics during her fellowship in maternal-fetal medicine at the University of Maryland Medical Center in Baltimore.  

    Dr. Iqbal’s interest in gaining and sharing knowledge has proliferated through her many research interests, including intrauterine growth restriction, intrahepatic cholestasis and the effects of diabetes and obesity on pregnancy. She works with ob/gyn residents and fellows at MedStar Washington Hospital Center and MedStar Georgetown University Hospital to help shape their own research pursuits, and leads the Hospital Center’s periodic conferences on high-risk obstetrics and morbidity and mortality.  

    Outside the Hospital

    Given such a busy, intense schedule, it’s no surprise that Dr. Iqbal enjoys spending as much time as possible with her husband and three daughters. And if she can help her patients achieve that same degree of serenity, it makes the long hours and hard work worthwhile.

     “I feel a sense of fulfillment when I help women,” Dr. Iqbal says, “and in turn give them and their child a healthy, happy life.”  

    Thank you, Dr. Iqbal, for everything you do!


  • June 08, 2017

    By Savyasachi C. Thakkar, MD

    When you get new tires on your car, it’s important that they are balanced and in alignment. This will keep the car from vibrating or pulling in one direction and help the tires last longer.  

    But you wouldn’t expect your mechanic to check tire alignment and balance just by eyeballing it. They have specialized tools to help them. It’s the same when the joints in your knees or hips are replaced.  

    For many years, surgeons largely relied on bony landmarks and their intuition to make sure joint implants were placed in the correct position and properly aligned, leading to a straight leg. But not every person’s body is the same, so even an experienced surgeon could miss the mark by just a little. Being even slightly out of position can lead to an implant wearing down unevenly, requiring a new one years before expected.  

    With people living longer and more people having joint replacement surgery at a younger age, it’s more important than ever to do what we can to extend the life of these implants and reduce the number of future procedures a person may need.  

    Related reading: Am I too young for knee or hip replacement?

    Thankfully, many surgical teams, including ours, now have surgical navigation systems that help position and align new joints with a degree of accuracy we can’t get by eyeballing it.  

    ‘GPS’ for knee and hip replacement

    In traditional joint replacement surgeries such as knee replacement, we would use simple tools such as alignment jigs and rods inserted along the thigh bone (femur) to help us see and feel when the knee was properly positioned and aligned.  

    A surgical navigation system is similar to a GPS system in a car. We input where in the limb we want to go, and the system shows us, in real time, the location and movement of our instruments. We can clearly see and test position, alignment and ligament tension every step of the way. 

    Surgical navigation systems are similar to GPS in a car. Showing location and movement of our surgical tools in real time. via @MedStarWHC

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    There are two types of navigation systems:  

    • Computer-assisted navigation systems provide information about our surgical tools and the implant in relation to the target position.  
    • Robot-assisted navigation takes this one step further, using robotic arms to align cutting guides and increase the precision of bone cuts. This doesn’t mean the robot does the procedure; it just refines our surgical execution. The surgeon still controls every step. This technology is still emerging and fairly expensive, so it’s not as common as computer-assisted navigation.

    Benefits of using navigation during joint replacement surgery

    Every person’s body is a little different, which can make getting an implant into the correct position tricky. We can’t always rely on bony landmarks and a patient’s anatomy. For example, if you have hip arthritis in addition to a spine disease, you may hold your pelvis in an odd way. Without a navigation system, we may place the implant slightly off of where it should go because of how you’ve held yourself for years.  

    Navigation systems give us an extra set of eyes, along with a certain amount of confidence and predictability. Some benefits include:

    • Providing the surgeon with real-time information and the ability to correct potential errors during surgery
    • Improving overall function of the new joint, including greater stability and range of motion
    • Potentially allowing the use of less-invasive surgical techniques because the system gives us improved visualization of the field without large incisions
    • Increasing the life of the implant and reducing the need to replace the implant, known as revision surgery  

    Revision surgery often is more complex than the original knee replacement or hip replacement surgery. The surgeon may need to remove some of the bone because the implant may have grown into it. This would require a bone graft, or transplanting a piece of bone from either another part of the body or from a donor to replace the removed bone along with the implant.  

    A 2015 study showed that 5.2 percent of patients who had a total knee replacement without computer navigation needed revision surgery within nine years, compared with 4.6 percent who had computer-navigated surgery. This may look like a small variance, but if you have 1 million knee replacements, it could mean the difference of 6,000 of them avoiding revision surgery within nine years.  

    Joint replacement surgery can dramatically improve a person’s quality of life, and demand for these procedures is growing. The American Academy of Orthopaedic Surgeons says nearly 1 million knee and hip replacements are performed every year in the United States. The organization predicts that number will rise to 4 million, due to an aging population and increase in obesity and osteoarthritis.  

    As these procedures become even more common, computer- and robot-assisted navigation will continue to play a larger role in helping us improve patients’ outcomes and increase the longevity of their implants.

  • June 07, 2017

    By MedStar Health

    I see hundreds of people every year who ask for help controlling their allergy symptoms. Allergies can be serious and even life-threatening in some cases. But at least half of the patients I see for ear, nose and throat allergy symptoms don’t have allergies at all.

    It’s a common mistake to make. Symptoms like nasal obstruction, “post-nasal drip,” runny nose and cough also may be caused or contributed to by other conditions having nothing to do with allergies.

    Good treatment sometimes requires that we determine exactly what’s causing a person’s symptoms. That way, we can prescribe the right treatment for the right problem. Let’s examine the top three problems patients commonly mistake for allergy symptoms or sinus infections and see the impacts they can have on sufferers.

    Symptom 1: Nasal obstruction

    Nasal obstruction, or a blockage of the nasal airway, is a common symptom of allergies and sinus infections. But the anatomy of the nose, or the way the nose is shaped, can have a major effect on a person’s ability to breathe easily.

    Deviated septum

    The nasal septum is the thin, wall-like structure that separates the right and left nostrils in the nose. Ideally, the septum is straight to divide the nostrils evenly. But birth defects, injuries to the nose or even rapid growth during puberty can cause the septum to become crooked, or deviated.

    Most of us have septums that are less than perfectly straight, but it’s usually not noticeable. For some people, though, a deviated septum, depending on its shape, may lead to an obstruction of one or both nostrils.

    A nasal steroid may be prescribed, or, in more severe cases, we can correct a deviated septum through a surgical procedure called a septoplasty.

    Learn about our minimally invasive ear, nose and throat surgical options.

    Swollen turbinates

    The turbinates are another structure of the nose. They’re located on either side of the septum inside the nostrils. The turbinates filter, warm and humidify air and keep it from being too dry as you breathe in.

    If the turbinates are too large (a condition called turbinate hypertrophy) or misshaped, they can block the airway in the nose. This can lead to a similar type of nasal obstruction as one caused by a deviated septum, and the conditions can also occur together. Someone who has turbinate hypertrophy can feel like they have a stuffy nose or trouble breathing all the time.

    A nasal steroid may decrease inflammation (and therefore, the swelling) of the turbinates, or surgery can be performed to decrease their size.

    Symptom 2: Chronic cough and sore throat

    Allergies or sinus infections can be associated with other inflammatory symptoms, such as:

    • Chronic coughing
    • Hoarseness, or a harsh, strained or raspy voice
    • Sore throat

    But these also can be symptoms of other problems, such as chronic acid reflux. Acid reflux occurs when stomach acid backs up, or refluxes, out of the stomach and into the esophagus. The chronic type of acid reflux is called gastroesophageal reflux disease, or GERD. In some cases of GERD, referred to as laryngopharyngeal reflux (LPR), stomach contents can back up and cause symptoms all the way up into the throat, which can damage the soft tissues in that area. LPR can lead to coughing, hoarseness or sore throat, which could be mistaken for allergy symptoms or signs of a sinus infection.

    Symptom 3: Headache and facial pain

    I frequently see people who come in complaining of “sinus headaches.” They have “congestion” all the time. They have debilitating pain on one or both sides of their head and face and are sensitive to bright lights.

    Some of these people actually do have sinus infections or other sinus conditions, but others don’t. Many people who think they have sinus conditions actually are undiagnosed migraine sufferers.

    Many people who think they have sinus headaches actually are undiagnosed migraine sufferers.

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    When I bring this up to patients, some don’t believe me at first. They’ve never considered that their symptoms might be caused by migraine. They say things like, “I’m not seeing sparkly lights or an aura. I didn’t throw up. Aren’t you supposed to throw up if you have a migraine?” That’s not always the case.

    I start thinking of migraine whenever I see a patient who complains of sinus headaches but who doesn’t have any other symptoms relating to the sinuses or nasal cavity, such as abnormal nasal drainage or obstruction. If you think you have frequent sinus headaches or infections, but you don’t have nasal symptoms like obstruction, abnormal drainage or other upper respiratory symptoms, ask your doctor if you might actually have migraine.  

    Smoking: A major contributor to mistaken allergy symptoms

    Symptoms of upper-respiratory conditions are a common thread among people with allergies: runny noses, coughing, sore throats, hoarseness, etc. But those are also symptoms we associate with irritation from first- or second-hand smoke. Smoking contributes to many upper-respiratory conditions patients often think of as allergy symptoms. 

    Smoking contributes to many upper-respiratory conditions patients often think of as allergy symptoms.

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    One of the things we ask during a routine allergy examination is whether the patient smokes or lives with a smoker. It’s surprising how many people don’t know or haven’t accepted that their smoking is the cause of their problems.  

    When I see a patient for allergy symptoms, and I learn that the patient smokes, I always begin by recommending that the patient stop smoking. It often can resolve the respiratory problems that brought them to see me in the first place. And even if smoking isn’t the root cause of the problem, it’s often very difficult for us to deal with the issue while the body is under constant respiratory distress from the person’s smoking.

    Find the root cause of symptoms to get lasting relief

    Allergies are a common condition, and they’re easy to misdiagnose. Most patients don’t need full skin or lab testing for allergies, so doctors often make a diagnosis based on patients’ symptoms, which can be similar to those of other conditions.  

    People often assume they have allergies based on a Google search of their symptoms without checking with a doctor. Or they dismiss allergies or sinus problems as something not worth caring about; they just want relief from the symptoms that are interfering with their lives. Talk to your doctor about chronic symptoms, even if you think you know what’s causing them.  

    My job as a doctor is to get to the root of what’s harming my patients. If that’s an allergy or a sinus condition, we have treatments available to address those problems. But these symptoms could be signs of more serious issues. If allergy or sinus treatments aren’t giving you relief, talk with your doctor about other potential causes of your symptoms to make sure you’re getting to the root cause—and treating it appropriately. 

  • June 05, 2017

    By MedStar Health

    I’m never content with the same old burn treatments. I love pushing the envelope and learning new and better ways to care for my patients.

    Not only that, but our patients expect the most advanced burn care possible. That means we have to be on the leading edge of research and study in this area of healthcare. And we are.

    Our researchers at the Firefighters’ Burn and Surgical Research Laboratory have studied and improved three highly effective burn treatment tools: animal skin grafts, stem-cell skin grafts and laser therapy.

    Skin grafts from animals

    The first known use of a skin graft to treat a burn wound was reported in 1881. Since then, skin grafting has become a mainstay of burn treatment that continues to evolve.

    One type of skin graft we perform is called a xenograft. A xenograft uses animal skin to cover a burn wound while the patient’s skin heals underneath. It’s only temporary, but it’s an effective approach we can use to promote healing.

    A xenograft uses animal skin to cover a burn wound while the patient’s skin heals underneath. via @MedStarWHC

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    fish skin graft
    Fish skin graft

    We usually use pigskin in xenografting procedures. But some patients prefer not to use pigskin for religious or other reasons. One alternative we’ve tested with a few patients is fish skin. What’s interesting to me is that the indentation from the fish scales still are visible while the temporary graft is in place!  

    For more permanent solutions, we turn to grafts from human skin. An awesome approach would be to grow skin from the patient in a lab and then use that skin for the graft. Right now, the only way to do that is by taking cells from the patient and growing them with cells called fibroblasts. Fibroblasts are the active cells in connective tissue, and the ones we use in skin grafts come from mice. Combining skin cells from the patient and mouse fibroblasts produces a substance called cultured epidermal autograft, or CEA.  

    The Food and Drug Administration (FDA) hasn’t approved CEA because it uses mouse fibroblasts, so we’re working with researchers at Georgetown University to develop chemical alternatives to the mouse cells. We’re hopeful that this will revolutionize the field of skin regeneration.  

    Skin grafts from stem cells

    Some of the latest research in skin grafts for burn treatment comes from the use of stem cells. Stem cells can grow into many different types of cells. They also can copy themselves many times, unlike some other cells of the body. These two factors make them useful in creating skin for skin grafts.  We’ve participated in clinical trials for a procedure to actually spray skin onto a burn wound. This technique harvests a patient’s stem cells to create a solution that a doctor sprays onto the wound. If everything goes as planned, skin will begin to grow back at the burn site. As of January 2017, we are in the second phase of a clinical trial for this procedure, and the manufacturer is seeking FDA approval.   

    We’ve participated in clinical trials for a procedure to actually spray skin onto a burn wound. via @MedStarWHC

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    We’re also researching treatments that use substances released by stem cells known as stem-cell-secreted factors. A major problem in burn care is wounds that get worse after the initial examination and diagnosis. This process is called burn wound progression, and it can make treating burns even more challenging. So far, we’ve found that stem-cell-secreted factors can keep burn wounds from progressing and help them heal faster.  

    Talk to your doctor about whether you’re a good candidate for one of our research studies.  

    Treating burn scars with lasers

    Burn scars can be big, itchy and embarrassing for patients, so reducing or eliminating burn scars is something patients often ask about. And lasers have been used for many types of dermatological conditions – though not commonly for burns. So I was surprised when patients began to ask about using lasers to treat their burn scars.  

    At first, I didn’t have an answer for them. There hasn’t been much research into the process, so I decided to learn all I could. I joined the American Society for Laser Medicine & Surgery, started going to meetings, and learned that laser treatment for burn scars does seem to be effective, despite limited research.  

    This revelation led us to buy a fractional CO2 laser to better understand how laser therapy works for burn patients. In addition to offering laser therapy to some patients, we’re going to start a clinical trial offering early laser therapy free to selected burn patients. We’ll be working with our colleagues in the Department of Dermatology on this trial. We’ll also work in the lab on models that investigate several aspects of laser therapy for burn scars, such as:

    • Amount of power to the laser
    • How much laser therapy is needed
    • Timing of when patients receive laser therapy
    • Whether blending laser therapy with other treatments can be helpful  

    Advanced burn diagnosis and wound healing

    An early, accurate burn diagnosis helps doctors decide whether a patient needs specialized treatment or basic care and observation.  

    We hope to improve that with a new technique for infrared imaging, which was developed by a biomedical engineering student in our lab. The new technique gives us more information about a burn wound right from the beginning and improves on the forward-looking infrared, or FLIR, system that’s currently in use. Once the patenting process is complete, we hope to collaborate with the company that manufactures the infrared camera to put the process to wider use.  

    Another issue in the early stages of burn care involves the removal of dead tissue from a burn wound — a process known as debridement. To promote healing, we must remove enough dead tissue while preserving as much live tissue as possible.  

    We’ll soon start a study on a new technique that uses an enzyme for wound debridement. The doctor will simply wipe this enzyme onto a burn wound, and the enzyme will remove just the dead tissue from the wound, leaving the live tissue in place for better healing.  

    I’m excited to see the results of our research, and I’m eager to learn about the new ways in which we’ll be able to better care for our patients in the months and years to come.