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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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  • January 27, 2017

    By Keith Kowalczyk, MD

    Prostate cancer is notoriously tricky to detect. It often doesn’t cause symptoms until it’s advanced, and there are no routine imaging tests, like mammograms for breast cancer.

    But a new study published in January 2017 in The Lancet showed promise for an advanced MRI to detect potentially aggressive prostate cancer, while also sparing some men from undergoing invasive biopsies.

    After skin cancer, prostate cancer is the most common cancer in American men. According to the American Cancer Society, more than 160,000 new cases will be diagnosed in 2017 and nearly 27,000 men will die from the disease. The District of Columbia has one of the highest prostate cancer incidence rates in the country, with 120 out of 100,000 men getting the disease.

    Our current prostate cancer screening process isn’t perfect. We hope this study is the first of many that leads to an improved standard of care.

    How we screen for prostate cancer now

    Most prostate cancers are first detected when a patient is found to have an elevated prostate-specific antigen (PSA), which is a blood test used for prostate cancer screening. The prostate is a walnut-sized gland that produces the fluid in semen. PSA is a protein made in the prostate, and elevated levels often are found in men with prostate cancer.

    There has been some controversy about when men should get PSA tests, but we follow the guidelines of the American Urological Association, which recommend patients and their doctors discuss the test at age:

    • 55-69 for men at average risk
    • 40-54 for men at higher risk for prostate cancer, such as black men and men with a family history of prostate cancer
    • 70 and older for men in excellent health with a 10- to 15-year life expectancy

    While a PSA test can give us a clue that something may be wrong, it isn’t fool-proof. For example, the test can be elevated in patients who have benign enlargement of their prostate or prostatic inflammation. In such cases, the abnormal PSA test can lead to an unnecessary biopsy.

    If your PSA levels are elevated, we’ll likely perform a transrectal ultrasound-guided (TRUS) prostate biopsy to gather small samples of the prostate to examine in the lab. We use a transrectal ultrasound to visualize the prostate. Then we insert a small needle into the gland to remove about 12 samples from different parts of the prostate.

    Unfortunately, this approach is not perfect and can miss a significant cancer. If we suspect you have prostate cancer even after clear biopsy results, we may recommend a repeat biopsy or multi-parametric magnetic resonance imaging (MP-MRI), which may help to identify an occult site of prostate cancer that can then be targeted by a subsequent biopsy.

    Study shows MRI can help detect prostate cancer more accurately

    The January 2017 study looked at the effect of using an MP-MRI earlier in the prostate cancer screening process. MP-MRI uses the same machine as other MRI imaging, but differs in that it uses multiple, specific imaging sequences to make a diagnosis instead of one essential MRI sequence.

    In the study, patients with an elevated PSA level underwent a MP-MRI before having a biopsy. The investigators then performed a standard TRUS biopsy on the patients, as well as a comprehensive “template” biopsy under anesthesia. This template biopsy was used as the “gold standard” for which to compare the performance of standard biopsy versus the MRI findings.

    The results were fairly dramatic. The study found that 27 percent of patients did not have MRI findings that would warrant a biopsy. Thanks to the MP-MRI, one in four men would avoid an unnecessary biopsy. For the patients who did need a biopsy, the MRI-guided biopsy found 93 percent of aggressive cancers, compared with just 48 percent when the biopsy was done at random.

    What does this mean for men today?

    While the results of this study are promising, routine MP-MRIs to screen for prostate cancer are not ready for clinical practice just yet. However, it’s studies like this that eventually lead to new standards of care. We can imagine a day when routinely using MP-MRI is considered best practice, allowing us to specifically target our biopsies to areas of concern, or even considered “good enough” at diagnosing cancer so that we can skip the biopsy altogether and move straight to treatment.

    While we won’t routinely be using MP-MRIs in the near future, if an informed patient asks for an MP-MRI early in the process, it’s reasonable to consider ordering one. And this study’s results may help us convince an insurance company to cover the cost.

    Until we have further data confirming the accuracy of MP-MRIs to detect prostate cancer, we urge men to talk to their primary care physicians about the pros and cons of PSA testing and at what age they should consider it.

    Schedule an appointment online or call 202-877-3627 to talk to a doctor about your prostate cancer risk and screening options.

    No imaging test is 100 percent perfect, but we’re working toward screening smarter. We hope in the future this process will be a win-win for patients and doctors as we catch more aggressive cancers and avoid unnecessary biopsies.

  • January 25, 2017

    By MedStar Health

    Tune in to the full podcast interview with Dr. Magee.

    According to the CDC, 29 million people in the United States today have diabetes.  Worse, one out of every three children born here can expect to be diagnosed with the disease, at younger ages than ever before.

    Yet the cause of this alarming trend often lies within our own hands.    

    “The rise in diabetes mirrors the rise in obesity,” says Michelle Magee, MD, a practicing endocrinologist at MedStar Washington Hospital Center and an associate professor of medicine at the Georgetown University School of Medicine. “Over the last 25 years or so, we as a nation started walking less and eating out more. As a result, many incidences of diabetes today are related to lifestyle.”

    Many, but not all. Type 2 diabetes – the most common type - does run strongly in families.  This means that your family genetics definitely play a role in whether you will get it or not. But Dr. Magee—who is also director of the MedStar Diabetes Institute’s clinical, education and research programs—concentrates on the risk factors that patients at risk for diabetes, known as pre-diabetes, or with diabetes can change and control.

    The first step you can take is to know the numbers that tell you if you have pre-diabetes or diabetes.

    There are two major blood tests that physicians use to help determine the presence or absence of diabetes…or the risk of developing it. The first is the fasting blood glucose (sugar) test. This provides a snapshot of how well your body is balancing what you eat and your physical activity at the point in time that your blood is tested.   The second, called the A1C test, measures the average amount of sugar in your blood stream over a two- to three-month period. In both tests, numeric results are broken down into ranges classified as normal, pre-diabetes or diabetes.

    The good news is that risks and complications—as well as those tell-tale numbers—can often be driven downward by eating right and exercising regularly. Large national studies have proven that intensive lifestyle changes can reduce risk for going from pre-diabetes to diabetes by up  to 60 percent…and help prevent complications of diabetes itself.  This includes preventing blindness, kidney disease, nerve damage and limb amputation.  Lifestyle changes also help prevent cardiovascular disease, heart attack and stroke which are more common in people with pre-diabetes or diabetes than those without these conditions.   

    For those living with pre-diabetes, “As little as a 7 percent weight loss can make a big difference,” Dr. Magee says.  “For a 200- pound person, that’s only 14 pounds. Exercising 30 minutes a day at least five times a week is also key.”    

    Once you have diabetes, because it is a progressive disease, most patients will eventually need some form of medication. But this isn’t your grandfather’s treatment. Advances in research and technology have produced 12 different classes of pills and two classes of shots, with delivery systems ranging from needles to pens to patches to pumps. And even more drugs, approaches and management techniques are on the horizon. As a result of advances in diabetes treatments in the past 20 years, people living with diabetes are living well and with less problems from complications than used to be the case.

    Even the best of modern medicine can get a boost from a patient’s personal efforts. Toward that end, education is key, so patients understand their readings, how to correct low or high blood sugar levels, what to eat and when, how to recognize side-effects from medication and more. Unfortunately, studies show that nearly 50 percent of patients with diabetes never get the grounding they need to understand their condition and what they can do.

    Ever the educator and advocate, Dr. Magee urges people with diabetes to do their own “due diligence” into the disease, and take advantage of management and support programs offered by the MedStar Diabetes Institute and others within the community.

    “My biggest message to patients is this: Learn about diabetes.  Then you can take control of it, versus it taking control of you.”

    Tune in to the full podcast interview with Dr. Magee.

  • January 20, 2017

    By Jeffrey Shupp, MD

    Survival rates for burn patients have improved drastically over the years thanks to advances made in burn treatment. Unfortunately, the physical needs of patients often overshadow their emotional needs.

    As more patients survive their injuries and return home, we must direct more energy toward efforts to reintegrate patients into society and home and treating the psychosocial effects of burn injuries. The emotional trauma caused by a burn can affect all parts of a person’s life: put stress on relationships, lead to depression or substance abuse, and even put additional strain on their physical health.

    According to a study in Neuropsychiatric Disease and Treatment, stress disorders, including post-traumatic stress disorder (PTSD), are reported in as many as one-third of burn patients. These problems can develop up to a year or more after the injury. And these aren’t just people who had severe burns. Even a moderate burn that didn’t require much treatment can be emotionally devastating.

    A few years ago, a patient of mine brought into sharp focus the challenges that accompany helping someone deal with the emotional side effects of a burn injury. This experience caused me to ask myself how my team could better address that aspect of the burn recovery process and ultimately led to a new position on our staff – a dedicated psychologist for The Burn Center.

    How burns can take a psychological toll

    Along with the physical pain of burns and the treatments they may require, patients also may face psychological stressors, such as:

    • Changes in body image
    • Depression
    • Family problems
    • Financial concerns
    • Vivid memories of the accident

    These stressors can manifest in many ways. For example, symptoms of PTSD can include:

    • Avoidance of places that are reminders of the accident (such as a burn center)
    • Difficulty sleeping or having nightmares
    • Flashbacks of the accident
    • Irritability
    • Loss of interest in previously enjoyable activities
    • Negative thoughts about oneself
    • Social withdrawal

    If you or a family member are experiencing depression or PTSD symptoms or are struggling to adapt to life after a burn injury, know that you’re not alone. There are resources in your community to help. Talk to your doctor about your options.

    Just as physical recovery occurs in stages, psychological needs differ over time as well. Patients often are elated when it’s time to go home. However, that also tends to be when they start to melt down. They didn’t expect the stares they would get. Food doesn’t taste the same. Families didn’t realize the amount of care their loved one would need.

    We try to help patients manage expectations while in the hospital. For example, we may tell them, “Your skin is never going to look the same again.” But these statements don’t always sink in because they’re grappling with everything else going on in that moment. In the back of their heads, they think that one day they’ll take off their compression garment and everything will look like it did before. When they realize this is never going to happen, it can be devastating emotionally.

    Clinical challenges of treating the psychological side of burn injuries

    Coordinating psychological care for burn patients is challenging, as was highlighted by my patient a few years ago. As an electrician, he suffered an electrical burn. We treat quite a few electricians and powerline workers with these types of burns, which can cause neuropathic pain for years despite all tests coming back normal. They require care from a neuropsychologist.

    Because neuropsychologists are so specialized, they may not address depression or PTSD, instead focusing on the patient’s physical pain. So the patient also may need a psychologist to provide psychotherapy or a psychiatrist to prescribe medication. Coordinating this interwoven care can become immensely difficult. And community-based mental health centers often are unable to provide such complex care for these specific needs.

    This was the challenge we faced with my patient. He had developed depression and substance use issues after his burn injury, and his relationship with his wife and children had become strained.

    It took seven months to line up care to address his emotional issues. That was too long. I knew we had to do more.

    How we treat the emotional side of the burn recovery process

    Along with the after-care programs and services we offer, we’re also one of 60 Phoenix Society SOAR (Survivors Offering Assistance in Recovery) hospitals. The Phoenix Society is a not-for-profit founded by burn survivors. Many of our therapists are certified to train past patients to become peer supporters. These volunteers meet with patients one-on-one and lead group sessions.

    Thanks to funding from organizations such as the DC Firefighters Burn Foundation, we also provide opportunities to attend adaptive recreation trips, in which an activity such as cycling or canoeing is adapted to accommodate a person’s specific needs.

    Because a burn patient’s PTSD likely will manifest differently from someone who experienced another type of trauma, we shouldn’t treat them the same. Unfortunately, there just isn’t a lot of research and data to guide us in effectively treating the psychosocial side of burn injuries.

    To help change that, we created a position within The Burn Center for a full-time psychologist. This person will provide more specialized, coordinated care for burn patients as well as study and develop best practices to treat psychosocial health from the moment of admission through treatment and beyond.

    I expect this to be just the tip of the iceberg. At any given time, 50 to 70 percent of our burn patients are eligible to enroll in a clinical trial. I expect these numbers to increase over the years as we include trials geared toward psychosocial health and reintegration into society and home.

    As one of only a handful of burn centers in the country to have a dedicated psychologist on staff, I’m positive we can make an impact in this important emerging field of study.

  • January 18, 2017

    By MedStar Health

    Dr. Allen Taylor cuts through differing recommendations on when to begin treatment for high blood pressure.
  • January 17, 2017

    By MedStar Health

    A diagnosis of lung cancer can leave you and your loved ones with a lot of questions, as well as fears. What treatment options are available? How will you recover? What will your quality of life be like?

    For lung cancer patients, there is good news on the horizon. Recent innovations in minimally invasive surgical approaches are presenting more positive outcomes than what has been available in the past.

    How is a minimally invasive approach different from traditional lung cancer surgery? And what benefits are patients seeing, as a result?

    Traditional Approach to Lung Cancer Surgery

    Unfortunately, this approach, known as a thoracotomy for lobectomy of the lung –in which the cancerous anatomical portion of the lung is removed – puts pressure on the ribs, as well as the underlying nerves causing significant pain for patients during recovery and for some patients, the pain is permanent. Moreover, this pain puts patients at increased risk for post-surgical health issues, including pneumonia.

    How the Minimally Invasive Approach Works

    Instead of relying upon one large incision and spreading the ribs, a minimally invasive approach only requires a few small incisions in which a camera and small surgical instruments are inserted.

    Benefits for Lung Cancer Patients

    Minimally invasive surgery translates into less pain for patients, as well as shorter recovery/healing time. This not only allows patients to return home within a day or two of their procedure, they are also able to return to their normal lives and routines with greater speed. This decreased recovery window enables doctors to administer follow-up treatments sooner.

    Patients that might otherwise have been considered ineligible for surgery now have a new minimally invasive treatment option available to them. For example, patients with diminished lung function or emphysema – who might not have been eligible for more traditional surgical approaches – now can be considered for minimally invasive surgery.

    Start by Having a Conversation

    Don’t write off surgery. Given the advancements for lung cancer patients available today, talk to your doctor, you may have more options than you realize.

    As a surgeon, I find it very rewarding to see a patient after surgery. They often look like they haven't had an operation and in a few cases, patients say they feel like they haven't even had an operation at all. With the minimally invasive approaches, they have a minimal amount of pain and recovery. What could be better than that?

  • January 17, 2017

    By MedStar Health

    Whether for an old ache or a new sports injury, Dr. Evan Argintar explains the options that can help return you to fighting form.