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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 20, 2017

    By MedStar Health

    An estimated 50 to 70 million Americans suffer from serious chronic or intermittent sleep disorders that undermine the quality of their sleep and, more importantly, their health. Sleep apnea, the most common disturbance, is also potentially the most serious, raising the risk of high blood pressure, arrhythmias, diabetes, heart failure, heart attack and stroke. At its most severe, it can even cause death.

    Fortunately, modern medicine can diagnose and treat obstructive sleep apnea before it ever reaches such dangerous stages. Key to our success was the development of the continuous positive airway pressure device known as CPAP. The front-line therapy for nearly 30 years now, CPAP is a safe, non-invasive and highly effective treatment for the disorder, when used as directed. However, compliance can be a problem.

    Why?  

    Some people find the devices noisy and uncomfortable. Those with claustrophobia have problems adjusting to a mask that covers the nose and, with some models, also the mouth.  And restless sleepers have trouble keeping them on.  

    As a result, only between 30 and 60 percent of patients with the devices actually use them regularly and for the prescribed amount of time each night.  

    So clinicians and researchers have come up with new methods to tackle the problem. 

    LISTEN: Dr. Stanley Chia discusses treatment options for sleep apnea.

    Understanding Obstructive Sleep Apnea

    First, it helps to understand the mechanics behind sleep apnea, which is marked by pauses in breathing called apnea episodes, or shallow breathing called hypopnea episodes, during sleep. When you sleep, the throat muscles that normally keep your airway stiff and open relax, narrowing the passageway. That’s normal.  However, certain conditions or even the physical structure of your mouth can momentarily prevent enough air from getting to your lungs. A partial blockage produces loud snoring or irregular breathing, while a complete obstruction usually results in a sudden snort or gasp as the oxygen-starved brain startles the body awake.

    These breaks in breathing can last from a few seconds to minutes, and have been recorded over 100 times an hour.  

    Among the causes of sleep apnea are age, sex (with males at a higher risk) and, increasingly, obesity as excess fatty tissue can thicken the wall of the windpipe, narrowing the opening.  

    Finding the Right Fix

    Beyond lifestyle changes and CPAP, specialists have a range of other approaches to treat sleep apnea. Choosing the right therapy depends upon determining the source of the problem and on patient preference. We start with a careful and thorough evaluation, including physical examination, a detailed medical history, an overnight sleep study and an endoscopy to look at the airways and arrive at the correct diagnosis.  

    For patients with large tonsils or an elongated soft palate, treatment can include removing the tonsils and shortening the palate. Another approach, especially when patients have excess or enlarged tissue at the back of the tongue, is transoral robotic surgery to remove the excess tissue, or radio frequency ablation which shrinks the tongue or soft palate.

    In other cases, the very structure of the upper or lower jaw is the culprit. To eliminate the condition, oral surgeons can actually advance the upper and lower jaws to open up the airway.  These procedures have a high success rate, sometimes accompanied by an unintended consequence: a better-looking jaw line!

    But a newer approach is proving to be even better for some individuals.   

    Novel Approach Offers Improved Solution

    Approximately two years ago, the FDA approved a promising new technology to treat sleep apnea called the hypoglossal nerve stimulator. (Full disclosure:  I sat on the final FDA review board.) Basically, the technology acts like a pacemaker, helping to synchronize the intake of air with the action of the tongue.  The pacemaker apparatus is implanted in your right chest, and connected to a wire that is wrapped around the nerve that controls tongue movement. A second wire implanted in the side of the right chest senses when you breathe in, causing the pacemaker to signal to the tongue to move forward and out of the way, opening the airway. The device is turned on and off by the patient, so daytime breathing is not affected.  

    To date, the stimulator has been used in hundreds of patients with very good success. I’ve personally used it on about 15 patients with an 85% success rate. However, not everyone is a candidate for the approach.  Patients must have moderate to severe sleep apnea, as indicated by a sleep apnea severity score (Apnea Hypopnea Index or AHI) between 20 and 65, and a body mass index (BMI) less than 32. The latter, in particular, rules out many who could benefit from the procedure. As a result, I often refer my obese patients for consideration of bariatric surgery to help lose weight instead.

    But for those who fit the criteria, the hypoglossal nerve stimulator is an important breakthrough. And for specialists, it’s a nice complement to the range of other treatments available and yet another tool to give patients what they need to put sleep apnea to bed.   

    Call 703-552-4031 or click below to make an appointment with a sleep apnea specialist.

    Request an Appointment

  • March 20, 2017

    By MedStar Health

    Gynecological exams used to be simple: Get an annual Pap smear and pelvic exam.

    Current guidelines recommend Pap smears every three or five years depending on a woman’s age, as well as an HPV test after a certain age. And in March 2017, the U.S. Preventive Services Task Force (USPSTF) said there’s not enough evidence to determine whether annual pelvic exams should be routine for women who aren’t pregnant or have symptoms of disease.

    But I’ve heard from patients who feel like they’re not getting a full exam if they don’t get a Pap smear and pelvic exam. I try to explain that unless you have certain risk factors or symptoms, you may not need them every year.

    It can seem confusing, I know. But remember, these guidelines are not one-size-fits-all, which is why it’s so important to find a healthcare provider you are comfortable with and who can educate you about when to be screened and for what.

    Do I need a well-woman exam if I'm not due for a Pap smear?

    Annual well-woman exams are about far more than Pap smears. Just because you’re not scheduled for a Pap smear to screen for cervical cancer this year doesn’t mean you should skip seeing your doctor.

    First of all, they aren’t the only health screenings we recommend for women at different stages of life. For example, you may be due for a cholesterol screening, mammogram or colonoscopy. Depending on the time of year, this exam also may be a good time to get your annual flu shot.

    Well-woman exams provide the perfect opportunity to establish a good relationship with your doctor.

    During these visits, you can talk about any health concerns you may have, your potential health risks, your lifestyle habits and your contraceptive options, among other things.

    Don’t hold back and don’t be embarrassed. If something seems off with your health, ask. Too many women think some medical symptoms are “normal.” For example, they think incontinence is to be expected after having a baby or as they get older. It’s not. There are ways we can treat it. But first, we need to know it’s a problem.

    Under the Affordable Care Act, preventive services offered during a well-woman exam should be covered by your insurance. However, you may discuss concerns with your doctor during a well-woman visit that require additional examination or testing. In those cases, we may recommend you make another appointment to avoid billing becoming complicated, and to have enough time to fully discuss your concerns. I know this can be annoying, but we want to avoid you being “well” and “sick” on the same day!

    Young women should have their first well-woman visit starting at about 13. These appointments likely will not include a physical exam, but instead will focus on establishing a doctor-patient relationship and providing education on topics such as body changes, your period, living a healthy lifestyle, contraception and the prevention of sexually transmitted infections.

    Usually starting at 21, a physical exam will become an important part of every annual visit. Depending on your age, the physical exam may include a clinical breast exam, abdominal exam, taking vital signs and listening to the heart and lungs. You and your doctor also will discuss whether you need a pelvic exam.

    When do I need a pelvic exam?

    It’s a common misconception that a pelvic exam and Pap smear are the same thing. They’re not.

    Pelvic exams are done to detect illness or abnormalities in a woman’s external genitalia and reproductive organs, including the vagina, cervix, uterus, fallopian tubes and ovaries. Some women find pelvic exams uncomfortable – physically or emotionally – but they only take a few minutes.

    There are three parts to the test:

    • External visual exam: Your doctor will look for signs of redness, swelling, lesions or abnormalities on the external genitalia.
    • Internal visual exam: You doctor will insert a speculum, a metal or plastic medical tool, to widen the vagina in order to examine the vagina and cervix.
    • Bimanual exam: Your doctor will place one or two fingers in the vagina and use the other hand to press down on the outside of your body on the area they are feeling to check the size and shape of the uterus and ovaries, as well as feel for masses.

    If you’re due for a Pap smear and HPV test, the doctor will collect the cell sample during the pelvic exam.

    Pelvic exams traditionally have been recommended for women 21 and older. But in recent years, the accuracy of the exam to detect problems such as ovarian cancer in women who didn’t have symptoms has come under scrutiny. Some medical societies also have noted the exam’s potential downsides, which include false positives that can lead to anxiety and potentially unnecessary and costly additional testing.

    The USPSTF said more research needs to be done to definitively recommend for or against routine pelvic exams. In the meantime, it advises women to discuss with their doctors when and how often they need pelvic exams.

    We never want to cause harm or put women through unnecessary exams. Analyzing an individual patient’s need for a pelvic exam offers us an opportunity to more actively discuss what’s going on with a woman’s body, including whether they are experiencing symptoms such as:

    • Abdominal pain
    • Bloating
    • Bleeding outside of your normal period
    • Constipation
    • Pelvic pressure or a sensation of a bulge coming outside your vagina
    • Problems during sex, such as pain or dryness
    • Urinary incontinence
    • Vaginal discharge

    If symptoms such as these aren’t present, we may recommend that you not need a pelvic exam that year. But other years, we may want to perform one to investigate potential problems.

    You don’t need a pelvic exam to be prescribed contraception such as the pill, patch, shot or implant if you are healthy with no abnormal discharge, bleeding or other concerns. We don’t want to put up unnecessary hurdles to getting birth control. However, you may need a pelvic exam if you want a diaphragm or intrauterine device (IUD).

    How often should I get a Pap smear and HPV test?

    Cervical cancer is nearly always preventable with HPV vaccinations and regular screening.

    Unfortunately, nearly 13,000 women in the U.S. will have cervical cancer and more than 4,000 will die of the disease in 2017, according to the American Cancer Society. And the District of Columbia is on the high end of states for cervical cancer rates, with 8.3 per 100,000 women getting cervical cancer. The national average is 6.7 per 100,000.

    We use two tests to screen for cervical cancer or cell changes that could turn into cervical cancer:

    • Pap smear: This test looks for precancerous cells on the cervix, which can become cervical cancer if not treated. To perform this test, your doctor will gently scrape cells from the cervix to be examined in a lab.
    • HPV test: This test looks for the human papillomavirus, which can cause cell changes, and is done at the same time as a Pap smear.

    HPV is thought to be responsible for more than 90 percent of cervical cancers, which is why we test for it. According to the Centers for Disease Control and Prevention, four out of every five women will have been infected with HPV at some point by the age of 50. Most will never know they have it.

    One note: If you’ve had the HPV vaccine, you still need to follow the screening guidelines.

    Your age and health determine when you need screening and which tests you should have.

    • Age 21-29: Women should have a Pap smear every three years.
    • Age 30-65: Women should have a Pap smear and HPV test (known as co-testing) every five years. An alternative is to have a Pap smear alone every three years.

    Talk to your doctor about the best pelvic exam and cervical cancer screening schedule for you based on your health and family history. Your doctor may recommend more frequent screening if you have certain health indications, such as a history of cervical cancer or a weakened immune system.

    Some women no longer need regular screening, such as if you’ve had a hysterectomy in which the cervix also was removed. Women older than 65 who’ve had regular screenings with normal results can stop unless there is:

    • History of cervical cancer.
    • Immunosuppression due to a transplant, human immunodeficiency virus (HIV) or other condition.
    • History of cervical intraepithelial neoplasia (CIN), which is the development of abnormal cells in the cervix.
    • Exposure to diethylstilbestrol (DES) in the womb. DES was a form of estrogen prescribed to some pregnant women for morning sickness until 1971 and is now known to increase the risk of cancer and potential precursors of cancer such as CIN.

    The guidelines for pelvic exams and Pap smears may not be as simple as they once were, but their importance has not lessened. Discuss your screening and exam schedule with your doctor at your next well-woman visit.

  • March 17, 2017

    By MedStar Health

    The last several years have produced significant advances in the field of genetic testing. Doctors are utilizing preventative measures to decrease cancer risk, and are now using genetic testing to help patients and their families understand their cancer risks. So how does genetic testing work and what are the potential positive outcomes for those with a breast cancer diagnosis?  What are the concerns about the risk?

    When and How Genetic Testing Is Used

    Genetic testing can be considered at various stages, depending on the individual and their background. For example, an individual recently diagnosed with breast cancer may undergo genetic testing in an attempt to understand why she developed cancer and whether her family is at risk.

    On the other hand, healthy women with a family history of breast cancer may want to know their risks.

    Modern genetic testing can be performed using either a blood test or a saliva sample collected to look for specific genetic information. The sample is sent to a lab, where a team of specialists looks for unique genetic mutations that indicate an increased risk for breast cancer.

    Today, there are two primary forms of genetic testing:

    • Single or limited numbers of gene testing which analyzes a small number of genes to test for the presence of mutations.

    • Multigene panel testing which analyzes many genes for mutations. While this field is evolving rapidly, some of the gene mutations included in these panels do not yet have clearly defined cancer risks or clear data on the impact of more intensive screening or prevention options.

    While both tests are useful, many factors such as family history, personal preference, health coverage and a need for immediate results, will influence which test is most appropriate for an individual.

    Benefits We've Seen from Genetic Testing

    Georgetown University's Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research in Washington, D.C., has served as the epicenter for research to improve cancer identification and diagnosis, including the use of genetic testing.

    People who test positive for mutations in BRCA1 or BRCA2 (two of the most common cancer genes) can take preventative action to decrease their risk of developing or succumbing to ovarian or breast cancer. This is one of the most compelling benefits of modern genetic testing.

    There are, of course, concerns regarding the added stress of knowing one carries a mutation or from receiving an inconclusive outcome from testing. However, multiple studies conducted at the Fisher Center have concluded that the benefits of genetic testing far outweigh those challenges, as the genetic testing results allow patients to make better-informed decisions about the most effective treatment options and course of action in their medical care.

    What's more, genetic testing can also determine that some relatives of people with a known mutation in a breast cancer gene understand that they do not carry mutated genes. This can relieve a significant amount of mental and emotional stress and alleviate a person's concern about an increased risk for cancer. 

    What to Keep in Mind

    It is possible to test for either one gene or multiple genes associated with breast cancer. While this is an exciting possibility, choosing which test to perform can be extremely complicated, but working with a genetics counselor will help ensure you choose the right test for you.

    Genetic testing is complex, and in many cases, the results of the test may have implications for other members of their family such as a sibling or cousin. Patients should keep in mind that results may not resonate in the same way with their family members and should be prepared for how to handle that conversation. A genetic counselor can be instrumental in helping to understand genetic test information and in disseminating the information gleaned from it.

    Finally, it's critical to keep in mind that genetic predisposition only accounts for 10 to 15 percent of all breast cancer cases.

    The Case for Genetic Testing

    If you were tested over three or five years ago, you should consider getting tested again in light of the recent advances that have taken place. Genetic testing for breast cancer has the potential to increase the health and longevity of women and men around the country.

  • March 16, 2017

    By MedStar Health

    As many as 90 percent of burn patients report itching after their injuries, according to data cited by the Phoenix Society for Burn Survivors. Itching usually subsides over time, but more than 40 percent of one study’s participants reported long-term itching after their initial burn.

    Chronic itching on a burn wound is annoying and can be tough to control. But there are treatment methods that have helped relieve our patients’ symptoms at the Burn Center. Let’s discuss why burn wounds itch, available treatments and what our researchers are doing to relieve post-burn itching for future burn patients. 

    What causes burn scars to itch?

    Itching is known medically as pruritus. Itching often is caused by a substance called histamine. Histamine is a key part of the body’s immune system. It produces many of the symptoms we associate with allergic responses, including swelling, rashes and itchiness.

    In this process, your body recognizes some foreign agent — something you’re allergic to, such as pollen or grass — on your skin. That causes your immune system to fight off the invader and release histamine, which causes itching.  

    Some itching after a burn is a normal part of the healing process. But itchiness at burn scars isn’t caused by histamine. In this form of itching, nerves misreport an itch on the skin at the burn site, but the irritation actually is coming from the central nervous system. This is a condition known as central itch — basically an internal itch that can’t be scratched. A bigger or more serious burn doesn’t necessarily lead to worse itching at the scar. 

    What treatments provide relief for burn scar itching?

    The traditional treatment for itchiness is antihistamine. But because central itch isn’t caused by histamine, antihistamine pills and most itch-relief creams won’t always help.  

    It may be tempting to scratch an itchy burn wound or scar, but that’s not a good long-term solution. In fact, scratching can damage fragile, healing skin, which is a particular concern for patients who have had skin grafts to treat burns.  

    Some of my patients find relief with lidocaine ointment. Lidocaine can temporarily numb the area of skin where it’s applied. Other patients look to alternative treatments to relieve the itch, including:

    • Acupuncture
    • Hypnosis
    • Massage
    • Reiki therapy (a Japanese technique for relaxation and stress relief)  

    Many of these alternative therapies help patients focus on something besides the itching. They don’t eliminate the sensation, but it’s not as persistent or top-of-mind as it ordinarily would be.

    Some patients can’t find anything that helps with the itch and just live with it. For others, their itchiness comes and goes. There hasn’t been much research on why the symptom varies and what we can do about it — until now.  

    If you have itching at a burn site that persists for months or years afterward, talk to your doctor about your treatment options and whether you need a referral to a burn specialist. 

    New research into treating burn scar itching

    Our early research into burn care focused on emergency care and preventing infections. We’re now turning our attention toward techniques for patients who are living with burn scars after treatment. We’re just starting to get data from patients who have lived with burn scars for 10, 15 or even 20 years. This information will guide our future treatment decisions.  

    As of December 2016, we’re enrolling patients in a study to test a medication we could potentially use to treat central itch. We registered the study’s first participant nationwide just before the holidays in 2016, and we’ll be signing up more participants soon.  

    We hope to better understand in the coming years why post-burn itching happens and what we can do to stop it. For now, pain-relieving medications and alternative techniques are our best weapons against itchy burn scars. 

  • March 14, 2017

    By MedStar Health

    Atrial Fibrillation Facts

    Atrial fibrillation (A-fib) is the most common arrhythmia—or abnormal heart rhythm—in the United States today, affecting between 2.7 and 6 million adults. Why such a wide ranging estimate? While some patients report debilitating symptoms from A-fib—including strong palpitations that feel like a fish flip-flopping in their chest—others only experience shortness of breath, fatigue or less energy than usual. And some have no symptoms at all. As a result, many people with A-fib have yet to be diagnosed and, by extension, treated.

    Unfortunately, A-fib puts people at a five times greater risk of stroke than the general population, especially if they’re also 65 and older with high blood pressure. Put another way, 20 percent of all A-fib patients will eventually have a stroke. Even more alarming, strokes from A-fib are more severe than those arising from other causes and twice as likely to cause death or debilitation.

    That’s the most worrisome aspect of A-fib for heart specialists everywhere, and why stopping blood clots from forming through blood thinners is our typical first line of defense. Not everyone can tolerate the powerful medications and their side effects, however, especially those who are at high risk of dangerous internal bleeds. As a result, those patients, who may account for up to 45 percent of all people with A-fib, are left unprotected from stroke.

    But a novel, new device called WATCHMAN™ has given such patients a safe and effective alternative.  

    How does the WATCHMAN work?

    WATCHMAN works by blocking the source of most strokes caused by A-fib: the left atrial appendage (LAA). Basically a pouch extending from the left top chamber of the heart, the LAA acts like a reservoir where blood can pool and cluster into clots which can then migrate into the bloodstream. If a clot reaches the brain and gets stuck, it causes a stroke.

    During a WATCHMAN procedure, we thread a catheter—a thin, plastic tube— up through your groin to the heart, and then deposit the self-expanding device at the entrance to the left atrial appendage.WATCHMAN’s mesh-like filter, shaped like a parachute, then traps clots inside the LAA where they can do no harm.  Over time, the body lays down scar tissue over the device, effectively sealing off the LAA forever.  

    WATCHMAN received FDA approval in the summer of 2015, following two large, well-constructed national trials that I and my colleagues at MedStar Washington Hospital Center, hub of the MedStar Heart & Vascular Institute, participated in.  Study findings and subsequent experience have shown that WATCHMAN is just as good as blood thinners in preventing strokes, with the additional benefit of protecting against bleeding in the brain, the most serious risk associated with such traditional anticoagulants as Warfarin and Coumadin.

    Experienced WATCHMAN site

    Our team has performed more than 100 WATCHMAN procedures to date (the largest volume on the mid-Atlantic seaboard) with the same great results. Minimally invasive, the procedure is safe, simple and effective, generally taking less than an hour. It’s also easy on patients, who go home the day after the procedure with no pain or discomfort.     

    WATCHMAN is currently only approved for patients who have atrial fibrillation not caused by a valvular problem, so not everyone is eligible.  Furthermore, candidates for the procedure must be able to tolerate a short-term treatment with blood thinners for about 45-days. While that’s a drop in the bucket compared to the life-long blood thinning regimen other A-fib patients face, it’s still enough to rule out individuals with a very high risk of bleeding.

    Fortunately, new developments are occurring all the time. Right now, we’re studying an investigational device similar to WATCHMAN but without the 45-day blood-thinner requirement. If approved, the new device, called “Amulet,” could widen the field of patients eligible for these clot-trapping mechanisms.

    In the meantime, WATCHMAN’s been a game-changer in how we manage certain high-risk A-fib patients and protect them from stroke. With the aging of the U.S. population and an attendant rise in people with A-fib, WATCHMAN and similar devices will play an ever larger role in the years ahead.

    Tune in to the full podcast with Dr. Shah.

    View the WATCHMAN story featured on WUSA-TV (Channel 9).

  • March 11, 2017

    By MedStar Health

    Below are excerpts from Washington Hospital Center’s 25th Anniversary History, published in 1983 and called, “Building on Yesterday, Becoming Tomorrow”

    Introduction:

    “D.C. Hospital Center is a Dream Come True.” The Washington Star, September 2, 1956 (18 months before Washington Hospital Center opened)

    When the Washington Hospital Center opened its doors in 1958, the vast red brick hospital on Irving Street not only marked a beginning, it also stood as a symbol of evolution and growth. The Center represented a merger of the experience and expertise of three of the city’s leading hospitals, whose roots in Washington reached back nearly 90 years.  In this ultramodern setting, the hospital families from The Central Dispensary and Emergency Hospital, Garfield Memorial Hospital, and Episcopal Eye, Ear, and Throat Hospital would be able to pursue a long tradition of providing Washingtonians with fine medical care.

    Day 1: Opening Day at Washington Hospital Center

    At 8 a.m., March 10, 1958, a young Army couple expecting their third child was waiting. The red-haired, 24-year-old mother, the Hospital Center’s first patient, was whisked through admitting and into the labor room, and soon the loudspeaker system was announcing that the baby was due “momentarily.” 

    The message could be heard by the expectant father who was waiting in the hospital’s Stork Room along with a clutch of photographers and a number of well-wishers. 

    The loudspeaker kept promising “momentarily,” but the baby – like the Center itself – took a lot longer than anyone expected; it was not until 2:40 p.m. that the 7-pound, 3-ounce boy arrived.

    By that time, the Center “had lost its deserted look,” The Washington Post reported.  The first of the patients to be transferred from the merging hospitals, a Washington, D.C., woman recuperating from surgery, arrived in the Emergency Hospital ambulance at 8:30 a.m.  And when the outpatient department opened at 9 a.m., about 15 people were waiting to be treated.

    Through the day, patients continued to arrive, including three premature infants transferred from Garfield to the Center’s new nursery. In all, 36 patients were admitted. 

    The Crusade to Build Washington Hospital Center: 1943 to 1946

    Overcrowding in Washington hospitals during World War II was severe. Persons with illnesses of every sort were mixed in together and space was so limited that beds were set up in sun parlors and halls…To further complicate matters, the war drained the city of doctors and nurses.  Two out of every three physicians were in the service and those who remained often worked 14-hour days. 

    Spurred by patriotism, persons from all walks of life volunteered to help out, many in the evening after their regular working day was over. A lawyer worked at night in the basement of Emergency Hospital repairing frames used for traction; a custodian of the U.S. Senate ran the laundry service.

    The hospitals’ shortcomings had not gone unnoticed by physicians, administrators and trustees. “But as reasonable men, these individuals recognized the short supply of labor, materials and money,” said Thomas Reynolds, treasurer of Emergency Hospital for 20 years. “And as reasonable men, they concluded that nothing could be done. Not so with the ladies.”

    Specifically, two of the ladies to whom Mr. Reynolds was referring were Red Cross nurse’s aides, both married to senators: Eleanor Tydings and Elysabeth Barbour (who volunteered at Garfield and Emergency hospitals respectively).  The two women were appalled at what they found – facilities that were outmoded and overcrowded.  The two young women enlisted the help of a prominent and influential friend, Bessie Huidekoper…Using her home as a base of operations, the three women met informally with the presidents of most of the city’s voluntary hospitals and many leading doctors, and they set up a Hospital Center Committee. 

    (Led by these three passionate and inspiring women, the Hospital Center Act, which provided the federal funding to build a modern facility for the rapidly growing nation’s capital, was finally signed into law on August 8, 1946 by President Harry S Truman. Then, the complex work began to merge three hospitals, three medical staffs and thousands of employees, culminating in the opening of Washington Hospital Center in 1958.)

    MedStar Washington Hospital Center Today: Facts at a Glance

    From those early days to today, the Hospital Center has been leading the way in providing the most advanced care.  Now a 912-bed major teaching and research hospital, it is among the 100 largest in the nation and renowned for handling the Washington region’s most complex cases. A pioneer in cardiovascular care, the hospital is home to MedStar Heart & Vascular Institute and literally thousands of Washingtonians and patients from around the country have received the highest level of heart and vascular care at the Hospital Center for the last 59 years. In addition, the Hospital Center operates the Washington region’s first Comprehensive Stroke Center and the District’s only Cardiac Ventricular Assist Device program, both certified by The Joint Commission.  The hospital is also home to MedSTAR, a nationally verified level I trauma center with a state-of-the-art fleet of helicopters and ambulances and also operates the region’s only adult Burn Center. At a quick glance, here are some key hospital statistics from fiscal year 2016:

    • 912 beds
    • 5,933 employees
    • 1,351 physicians
    • 369 residents and fellows
    • 36,816 inpatient admissions
    • 390,047 outpatient visits
    • 1,432 cancer admissions
    • 66,695 cancer outpatient visits
    • 1,733 cardiac surgeries
    • 86,771 emergency department visits
    • 2,551 MedSTAR Trauma admissions
    • 11,884 inpatient surgeries
    • 11,335 outpatient surgeries
    • 3,564 births
    • $17.7 million in charity care