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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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  • March 31, 2017

    By MedStar Health

    Congratulations to all MedStar researchers who were published in March 2017. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors, and we look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

    Selected research:

    1. Complication Rate in Minimally Invasive Revision Lumbar Discectomy: A Case Series and Technical Note.
      Clinical Spine Surgery, 2017. DOI: 1097/BSD.0000000000000513
      Felbaum DR, Stewart JJ, Distaso C, Sandhu FA
    2. The Fanny Pack: No Ifs, Ands, or Buts.
      Pediatric Dermatology, 2017. DOI: 1111/pde.13090
      Habeshian K, Kirkorian AY, Marathe K
    3. The effects of framed messages for engaging adolescents with online smoking prevention interventions.
      Translational Behavioral Medicine, 2017. DOI: 1007/s13142-017-0481-5
      Mays D, Hawkins KB, Bredfeldt C, Wolf H, Tercyak KP.
    4. SAFE-HEaRt: Rationale and Design of a Pilot Study Investigating Cardiac Safety of HER2 Targeted Therapy in Patients with HER2-Positive Breast Cancer and Reduced Left Ventricular Function.
      Oncologist, 2017. DOI: 1634/theoncologist.2016-0412
      Lynce F, Barac A, Tan MT, Asch FM, Smith KL, Dang C, Isaacs C, Swain SM.
    5. The epidemiology of NCAA men's lacrosse injuries, 2009/10-2014/15 academic years.
      Injury Epidemiology, 2017. DOI: 1186/s40621-017-0104-0
      Kerr ZY, Quigley A, Yeargin SW, Lincoln AE, Mensch J, Caswell SV, Dompier TP.

     

  • March 30, 2017

    By MedStar Health

    At least once a month, a patient asks if I’ve read Dave Barry’s column about getting a colonoscopy. The humor writer discusses how fear kept him from getting the procedure until he was 60 – a decade after the recommended age to begin screening. After learning his brother had colon cancer, he finally scheduled an appointment and began his amusing journey into preparing for a colonoscopy.

    Not everyone finds such humor in colonoscopy prep. Who wants to choke down a large amount of sometimes disgusting-tasting bowel-clearing liquid and then cope with the resulting diarrhea? Many find it more uncomfortable than the actual procedure, during which they’re usually sedated and don’t remember it.  

    Colonoscopies may eventually be replaced by less-invasive, less-preparation-intensive screening methods, but for now, they are the best way to protect yourself from colorectal cancer. So let’s look at how the colonoscopy prep process works and how you can make it a little less uncomfortable.  

    You tell us: Have you found tricks to make colonoscopy prep easier? Don’t keep it to yourself. Share it with us on Facebook or Twitter.

    How does colonoscopy prep work?

    Colonoscopies detect colon and rectal cancers while they are still small and treatable, but they also are used to find and remove polyps, which are small growths that can develop into cancer. To see these growths, the doctor needs a clear view during the procedure. This requires emptying the colon of its contents.  

    If the colon isn’t completely clean, the danger is we may miss tumors or polyps. It also could lead to a longer colonoscopy because we need to spend more time washing away waste to see more clearly.  

    The preparation process may differ slightly between medical centers and doctors, or from patient to patient. You doctor will explain exactly what you should do. In general, the process involves a liquid diet and laxatives.  

    The form of laxatives can vary. We generally prescribe four liters of a generic lavage solution, which is cheap and easy to get. Four liters is a lot to drink. It’s the equivalent of nearly seven 20-ounce bottles of soda. Some patients can get away with drinking half of that if they take Dulcolax tablets first.  

    Many patients ask us about alternatives to this part of the prep: “I heard from a friend you can just take a pill.” This is sort of true, but it’s not one pill, it’s 32. And it has a “black box” warning – the strongest warning the Food and Drug Administration issues – for its risk to the kidneys. It’s also not recommended for people older than 65.  

    We sometimes use an off-label prep that’s basically MiraLAX dissolved in 64 ounces of Gatorade. It’s still a lot to drink, but it tastes better.  

    We ask that you do a split prep, which means you drink half the night before and the other half six hours before the procedure. I know this can be annoying if your procedure is at 8 a.m. and you need to get up at 1 or to finish the drink, but you’ll get a more thorough cleansing.

    How to make your colonoscopy prep easier

    I know this process isn’t fun. But it’s important, and there a few things you can do to make it a little easier:

    • Listen to your doctor’s instructions: Take notes and ask questions if you don’t understand something.
    • Arrange your schedule: You’ll want to be home – and in your own bathroom – during colonoscopy prep. If you have children, find someone to help care for them while you’re indisposed.
    • Cut back on fiber a couple days beforehand: Fiber is the indigestible part of plant foods and leaves a high amount of residue in the colon. Stick to a low-fiber diet, and avoid foods such as:
      • Beans
      • Nuts
      • Raw fruits and vegetables
      • Whole grains
    • Maintain a liquid diet: Water gets boring pretty quickly. Have a few other options on hand.
      • Clear broth
      • Coffee or tea
      • Italian ice
      • Jell-O
      • Popsicles
    • Drink your prep: Some of these solutions don’t taste great, but as mentioned, it’s the most important part of the prep process.
      • Add flavoring such as Crystal Light or Kool-Aid powder if the prep isn’t flavored.
      • Drink it cold.
      • Use a straw.
      • Suck on a lemon or hard candy afterward.
    • Prepare the bathroom: Once the prep solution starts working, you’ll want to stay close to a bathroom.
      • Wear loose clothing.
      • Stock up on soft toilet paper.
      • Use skin-soothing products such as baby rash ointment.
      • Keep entertainment handy; you may be there a while. This could include books, a laptop or a tablet.

    Finally, remember that this screening could save your life. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in the United States, with more than 135,000 cases expected to be diagnosed in 2017. 

    When should you be screened for colon cancer?

    The U.S. Preventive Services Task Force recommends that people at average risk for colorectal cancer begin screening at age 50.

    Your doctor may recommend starting before age 50 if you have factors that put you at increased risk, such as:

    • Family history of colorectal cancer or polyps
    • Personal history of colorectal cancer or polyps
    • Personal history of chronic inflammatory bowel disease
    • African-American descent

    There are alternative screening methods, but colonoscopy is considered the gold standard for colorectal cancer screening. Don’t let the hassle and discomfort of colonoscopy prep keep you from getting this potentially life-saving procedure. Take it from Dave Barry: “If I can do it, you can do it. Don’t put it off. Just do it.”

    Ready to schedule your colonoscopy? Call 202-719-0839 or click below.

    Request an Appointment

  • March 30, 2017

    By MedStar Health

    National Doctors' Day is held each year on March 30th, as a day set aside to honor the significant contribution physicians and caregivers make to communities, and their unwavering commitment to providing care to patients each and every day.

    This year, Janelle Baliko wrote this heartfelt poem to share her 10 year healing journey under the care of Dr. I. David Shocket, director of Gastroenterology at MedStar Washington Hospital Center. Read her poem below.

     

    To Honor My Doctor

    3/30/2017  

    My body so very ill and weak
    To the point I could barely speak
    I reached out to you to consult
    So many expectations for my end result  

    You asked me to share my 23-year history
    Little did you know the grueling summary
    You listened intently and took lots of notes
    As I narrated my account with moderate Crohn’s  

    Already in your head you were planning my treatment
    But nothing would be done without my full consent
    You, the GI expert unequivocally  
    And I the expert of my own body  

    We were in this together as a team, you made clear
    The rush of hope slowly replacing my fear
    All I wanted was to feel better soon
    You assured me this was your priority too  

    How in the world is “GI” short for GastroENterology
    I may never know, I’m just grateful you made it your specialty  

    Through exams and tests all the way through to surgery
    From day one, you’ve always treated me like family
    You’ve seen me on some of my worst days at some of my worst moments
    When the slightest touch to my gut was sheer torment  

    The news wasn’t always good
    But you knew I could handle it and handle it I would
    I’ve evolved from weak into strong  
    Due to your knowledge and support all along  

    My Crohn’s struggles have been difficult over the years
    You knew when they were bad when you saw my tears
    You comforted and assured me that the treatment may take a while
    But we’d do whatever was necessary to bring back my smile  

    In your pocket you always had a Plan B
    And ensured it was discussed and approved by me
    We eventually achieved OUR goal
    Remission has thoroughly revived my soul  

    Your peers agree, an amazing doctor you are
    Preferring to stay under the radar
    But as your patient I won’t stay silent nor will I ever forget
    The doctor who gave me my life back, Dr. I. David Shocket  

    Thank you for nearly 10 years of caring and advisement. I wouldn’t be where I am today without you. Thank you.
    June 2007 – March 2017 

    --Janelle Baliko

     

    Thank you, Janelle, for sharing your story, and to all of our physicians and caregivers at MedStar Washington Hospital Center for everything you do. To learn more about how you can honor YOUR doctor, please visit our Doctors' Day page.

  • March 28, 2017

    By MedStar Health

    We care for about 3,500 pregnant women every year. While that number has remained fairly steady over the past decade, the number of those women with high-risk pregnancies increases every year.  

    Because “high-risk pregnancy” is a catch-all term that includes factors such as age and chronic health problems, it can be difficult to determine exactly how many of these women there are. But my colleagues and I can tell you that we’re treating more women who fall into this category than ever before.  

    The most severe pregnancy complications – such as eclampsia, heart failure and hemorrhage – are referred to as severe maternal morbidity. The Centers for Disease Control and Prevention reports that the severe maternal morbidity rate has more than doubled from 2000 to 2010, and now affects 650,000 women in the United States every year.  

    Many factors contribute to this increase, but the two we see most often in the District of Columbia are obesity and advanced maternal age. 

    1. How obesity can complicate pregnancy  

    Nearly one in four U.S. women was considered obese when they became pregnant in 2014. While the rate of pre-pregnancy obesity in D.C. was lower than the national average at about one in five women, we still feel the effects of this epidemic.

    “1 in 5 women in D.C. is considered obese when they become pregnant.” via @MedStarWHC

    Click to Tweet

     Obesity is defined as having a body mass index greater than 29.9, and it can increase the risk of problems during pregnancy, including:

    • Birth defects
    • Gestational diabetes
    • Preeclampsia
    • Preterm birth or stillbirth  

    Excess body fat also can make it difficult to analyze an ultrasound and monitor fetal heart rate.  

    Obesity also increase a person’s risk for health problems such as diabetes, high blood pressure and heart conditions. Our patients are not nearly as healthy going into pregnancy as they once were. I commonly find myself caring for patients with a condition that requires me to collaborate with a specialist such as a cardiologist.  

    The number one thing you can do to decrease the risk of obesity-related pregnancy complications is to lose weight before you become pregnant. Talk with your doctor about lifestyle changes you can make to reach a healthier weight.  

    Also, talk to your Ob/Gyn or a maternal-fetal medicine specialist before you become pregnant about what to expect if you have a heart condition or another chronic health problem such as obesity. 

    2. More D.C. women delaying pregnancy until 35 or older

    Not even 15 years ago, I would have exclaimed, “Whoa! You have a 45-year-old patient who’s pregnant?” These days, we don’t blink an eye at a pregnant woman in her 40s.  

    The District of Columbia is somewhat unique in that we have more professional women who delay having children until they are older.  

    • The birth rate for D.C. women age 35 to 39 was 72.7 births per 1,000 women in 2015, compared with 51.8 nationwide.
    • The birth rate for D.C. women age 40-44 was 21.8 births per 1,000 women in 2015, compared with 11 nationwide.
    • The birth rate for D.C. women age 45-49 was 2.5 births per 1,000 women in 2015, compared with 0.8 nationwide.  
    “Statistics show women in D.C. are more likely than other U.S. women to delay pregnancy until they are 35 or older.” via @MedStarWHC

    Click to Tweet


    It’s wonderful to have the option to wait to have children until you’re in your late 30s and early 40s. However, it does increase certain risks for mom and baby, including:

    • Birth defects
    • Gestational diabetes
    • High blood pressure  
    • Miscarriage
    • Premature birth  

    We may recommend additional testing and screening if you are 35 and older to detect certain birth defects. The best thing you can do if you’re 35 or older and want to get pregnant is to talk with your Ob/Gyn about your specific risk factors and how to go into pregnancy as healthy as possible. 

    Reduce and manage pregnancy risks

    Obesity and advanced maternal age are just two factors for the increase in high-risk pregnancies. Thanks to advances in science, we’re also caring for more women who are having multiples (twins or more), have had organ transplants or are cancer survivors. We also see a number of pregnant women who have HIV.  

    With proper preparation, we’re better able to manage the increased risks of these health factors. Request an appointment with an Ob/Gyn or maternal-fetal medicine specialist to discuss your unique challenges. The doctor can help you prepare for pregnancy and manage your and your baby’s health during pregnancy, labor and delivery.  

    Don’t be afraid to ask your doctor questions. These can include:

    • How can I get healthier before I become pregnant?
    • What type of prenatal testing will be done?
    • Should I stop or adjust my medications?
    • Will I need extra ultrasounds to monitor my baby’s health?
    • Will I need additional prenatal appointments?  

    We may care for high-risk pregnancies more often, but each pregnancy is different and comes with its own challenges. We want the same thing for every woman: to go home with a healthy baby.  

  • March 24, 2017

    By MedStar Health

    Alexandra Learned Preston and her husband, John Preston, were longtime residents and supporters of the Georgetown community.
  • March 24, 2017

    By MedStar Health

    Getting active to stay healthy

    Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. But how much exercise do you need?  Fortunately, even a little exercise every week can help lower your risk.

    “I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough,” says Dr. James FitzGerald, a colon and rectal surgeon at MedStar Washington Hospital Center.  “You don’t have to live at the gym or train for marathons. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill.”

    Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include: aerobics, biking, climbing stairs or using a stair climber, dancing, playing basketball, swimming and yoga.  Just be sure to consult with your doctor prior to starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

    Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery.

    But what about if you have never exercised before?  For older adults, making that sort of lifestyle change isn’t always easy.

    “It can be intimidating to walk into the local gym and get started on a fitness plan, but I encourage my patients to do what they can,” says Dr. FitzGerald. “Even little changes in their activities or walking just a little bit can benefit them in the long term.”

    Other steps you can take in addition to exercise

    And exercise isn’t the only thing you can do to lower your risk for colorectal cancer.  Certain lifestyle and dietary modifications can also help.

    “You should try to eat a low-glycemic-index diet with more fruits, vegetables and whole grains, and don’t eat as many red and processed meats like beef, pork, hot dogs and bologna,” says Dr. FitzGerald.  “Try to quit smoking and avoid excess alcohol usage as well.”

    As colorectal cancer tends to affect people in older age groups, it is also recommended that people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer.  As always, be sure to consult with your doctor, as your needs might be different.

    Our specialists are experts in the diagnosis and treatment of colon and rectal cancer. Ready to schedule an appointment? Call us at

    202-877-3627

    As heard on WTOP Radio:

     

    Dr. James FitzGerald, MD
    MedStar Washington Hospital Center

     

     

    For an appointment, call 202-877-3627.

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