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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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  • April 23, 2021

    By MedStar Health

    A viable surgical treatment for deep vein post-thrombotic syndrome (PTS) and similar obstructive venous conditions is being pioneered by MedStar Heart & Vascular Institute’s Steven Abramowitz, MD.  

    Using a reconstructive technique called endovenectomy, Dr. Abramowitz carefully removes scar tissue from within a vein, which creates a clean channel for flow into an inserted stent, allowing blood to flow freely. “The procedure requires a connection between healthy sections of the vein,” says Dr. Abramowitz. “Usually a clean path, just over three inches, is all we need.” 

    Post-thrombotic syndrome is an under-recognized disease that affects patients’ quality of life, says Vascular Surgeon Misaki Kiguchi, MD, who teams up with Dr. Abramowitz on some cases.  

    “After deep vein thrombosis, the scar that forms in the vein often narrows the channel in which blood can flow back to the heart, increasing venous pressure in the legs. This leads to symptoms of heaviness, swelling, and in the most severe cases, ulcers. Dr. Abramowitz’s endovenectomy skill adds to the comprehensive venous team at MedStar Heart & Vascular Institute, by increasing the population of patients who can be treated endovascularly by adjuvant endovenectomy. These patients otherwise would have limited surgical options and limited success in revascularization without an endovenectomy.” 

    Dr. Abramowitz has used the procedure to treat PTS in the external iliac vein, femoral vein, and profunda vein. He reports that the two-to-four hour-long procedure has so far yielded good outcomes, and any patient with PTS is a candidate. 

    “Rather than having to rely on wound care and compression to treat chronic, non-healing venous wounds, we’re able to improve the patient’s own venous drainage, addressing the root of the problem,” Dr. Abramowitz says. “Many patients are healed within a matter of months.” 

    Dr. Abramowitz is using the results of adjuvant endovenectomy with endovascular stenting to study ways to refine the technique, from varying segment lengths to investigating ways to accelerate the healing process. Although there may also be ways endovenectomy can help address conditions in other parts of the body, Dr. Abramowitz says the procedure’s most promising area of treatment is in the legs, where deep vein clots and other occlusions most frequently occur. 

    Dr. Kiguchi adds, “At the MedStar Health Vein Centers, I treat a wide range of venous disease, from cosmetic varicose veins to large venous ulcers. Having a colleague like Dr. Abramowitz, and his success with endovenectomy to improve venous hypertension in many patients with PTS, is an asset to the comprehensive venous disease treatment paradigm.” 


    Swelling in the legs?

    Contact our vascular specialists today.

    Call 202-788-5048 or Request an Appointment

  • April 22, 2021

    For generations, head and neck cancer was largely a disease of smokers, especially smokers who also consumed alcoholic beverages. But the human papillomavirus (HPV) has expanded that disease landscape. Today, head and neck cancers are often HPV-related and found in younger patients who may not even smoke or drink.

    Cancers of the head and neck can affect the lips, mouth, salivary glands, throat, nose, sinuses, voice box, trachea, and thyroid. Each of these areas is vital to everyday living—eating, speaking, breathing—and each can have unique diagnostic and treatment challenges. So cancers of this type can most certainly be life-altering.

    The good news is that many of these cancers can be prevented.

    Head and Neck Cancer Risk Factors

    The major risks for head and neck cancer include:

    • Tobacco, alcohol, and HPV exposure, including “smokeless” tobacco products, chewed or held in the mouth.
    • Being male. We’re not sure why men have twice the risk of women, although it may be due to a greater tendency to smoke and drink.
    • Poor oral hygiene. Long-term inflammation of the tissues in the mouth can create damage at a cellular level that could evolve into cancer. Dentists are often the first to spot suspicious abnormalities in a patient.
    • Increasing age. As with any cancer, risk increases with age. Head and neck cancers are quite rare in children—most patients diagnosed are over the age of 50. Our cells continually replicate and replace themselves and, over the course of a lifetime, those cells may become exposed to and injured by carcinogens and move a step closer to becoming cancerous. The longer you live, the more likely that your DNA may sustain damage.
    • Vaping, or e-cigarettes. This potential new risk is not well regulated, and the possible effect of this vapor is an area of ongoing study.
    • Other risks include occupational hazards (such as chemicals), the consumption of smoked and preserved foods, and exposure to Epstein-Barr, the virus that causes mononucleosis.

    At this point, with the exception of thyroid cancer, there’s no indication that family history predisposes a patient to contract a head or neck cancer; so far, we’ve seen none of the genetic predictors of risk that we often see with other cancers.

    With the exception of salivary gland cancers, no fewer than 75 percent of head and neck cancers result directly from tobacco and alcohol use. While tobacco use alone can be considered a smoldering fire, alcohol can act as the gasoline that feeds it—research clearly shows that the two substances become significantly more lethal when used together.

    Rock musician Eddie Van Halen presented a classic case: a smoker and drinker from age 12, he eventually lost part of his tongue to cancer, and later developed throat cancer that helped contribute to his illness and death in 2020. A generation earlier, similar circumstances took the life of entertainer Sammy Davis, Jr., at age 64.

    Most cancers of the head and neck are preventable! Stay healthy by knowing the risks, particularly if you combine smoking and drinking, says Dr. Jonathan Giurintano. https://bit.ly/3a5LvFC via @MedStarWHC
    Click to Tweet

    The Concern about HPV

    In recent years, HPV, a sexually transmitted virus with hundreds of strains, has entered the picture as a major cause of head and neck cancers. Although most strains of HPV—for example, those that cause warts—are fairly innocuous, some create the potential for cells to mutate and become cancerous. Medical science has recognized the cancer link for decades, initially in cervical cancer where men were thought to be asymptomatic carriers of the disease.

    In recent years, we have begun to see HPV-related cancers affecting patients a decade younger than previously typical, many of them with no significant history of smoking or drinking. Younger people—both men and women—are developing cancers (very similar to HPV-related cervical cancer) in the throat and at the back of the tongue.

    With the great prevalence of HPV, it is felt that most people will become exposed to a strain of this virus at some point in their sexual history. This is why vaccination against HPV is so important, and best administered at an age before sexual activity begins. When HPV vaccines were first developed, they were targeted to protect young girls against cervical and other pelvic cancers; however, now we vaccinate both girls and boys to provide protection against all aspects of HPV for them and their future sexual partners.

    Current guidelines recommend that the HPV vaccine be administered to male and female patients ages 9 to 26—one of the most important ways to protect a young person’s health. This effort, as well as more aggressive screening, has resulted in a recent decrease in instances of cervical cancer. And, as HPV vaccines become more widely administered, we hope to see tongue and throat cancer rates drop as well.

    Head and Neck Cancer Symptoms

    What are the warning signs of head and neck cancers?

    Symptoms may include a sore or abnormal spot that doesn’t improve. Patients describe it as feeling like they bit their tongue or burned the roof of the mouth, but the sensation persists for weeks or months.

    Evidence of cancer can also present as swelling in the jaw; pain in the chin, face, or neck; hoarseness; or difficulty swallowing or breathing. As with many cancers, unexplained weight loss may serve as a warning sign as well.

    However, in the case of HPV-related cancers, the patient may experience little more than a swollen lymph node in the neck. Because it’s so easy to attribute this symptom to a more benign condition, a regular physical examination with your health care provider is very important.

    Diagnosing Head and Neck Cancer

    In assessing a patient, I begin with a health history and a thorough examination of the head and neck—looking into the mouth and throat and feeling the neck for enlarged lymph nodes or masses.

    I can conduct a non-invasive laryngoscopy on the patient by using a simple local anesthetic spray and passing a small camera into the nose. The flexible fiber-optic laryngoscope gives a good view of the entire back of the throat, down to the voice box.

    Sometimes we can also take a small sample of tissue for lab analysis; however, if the area is hard to reach, we’ll schedule a more complete exam and biopsy under general anesthesia. We may also use CT, MRI, or PET imaging to help with a diagnosis.

    Treatment

    Fortunately, HPV-related cancers tend to respond well to non-surgical treatment via radiation therapy. Many can be treated with no surgery at all.

    Other head and neck cancers, however, can be much more challenging and require extensive and complex surgery, as well as radiation. At MedStar Washington Hospital Center, our aim during surgery is to remove cancerous tissue while preserving the patient’s appearance and functional activities of swallowing, speaking, and breathing.

    For complex surgeries, I team with Dr. Matthew Pierce, also a head and neck surgeon. One of us concentrates on removing the cancer, while the other manages any necessary reconstruction. In situations where we must remove significant amounts of tissue, we can often rebuild the area with tissue harvested from another area of the patient’s body, such as the thigh or forearm. We can even rebuild affected bone with tissue from the lower leg.

    And while the surgeon essentially serves as the surgical team’s quarterback, the team itself makes all the difference. At the Hospital Center, the head and neck surgeons work closely with radiology and pathology for diagnostics; with nutrition, rehabilitation, and speech therapy in the areas of swallowing and speech; with neurology for pain management; with oncology and radiation oncology for cancer care; with psychologists to help the patient manage their feelings and reactions to the disease; and with skilled nurses who support us every step of the way. Every player contributes to the best possible outcome, with the patient at the center of the effort.

    Today’s techniques have brought us a long way from the days when survivors experienced significant disfigurement or had basic functions like swallowing permanently disrupted. Many current research efforts focus on preserving function for the patient and on decreasing the trauma of surgery and follow-up treatment.

    In other areas of research, medical scientists are working to develop a testing procedure, similar to a Pap smear, which could identify cellular changes within the tonsil or lingual tonsillar tissue and predict possible future development of an oropharyngeal cancer. New operating room advances include use of radio fluorescence to identify the margins of cancer in areas that are difficult to assess via physical examination and to help ensure more thorough removal of cancerous cells during surgery.

    The Best Strategy Is Prevention

    It’s an unfortunate reality that the longer that these cancers grow, the more difficult they are to treat. And it’s important to remember that this type of cancer can be aggressive and fast-growing. Once head or neck cancer has spread, the prognosis for the patient can be very poor. Patients with small tumors can have an 80 percent chance of survival. But in patients who neglect treatment for just a few months, the head and neck cancer survival rate may be only 30 or 40 percent over the next five years.

    Some of our greatest hope comes in spreading the word about prevention. A few words of preventative advice:

    • Visit your healthcare provider for an annual checkup. If you smoke, it’s never too late to quit. Regular users of tobacco and alcohol should have an open and honest discussion with their physician about risks and strategies for early detection of head and neck cancers.
    • Drink in moderation, particularly if you are also a smoker.
    • Visit the dentist regularly. Unhealthy teeth increase the risk of cancerous conditions, and dentists are trained to recognize problem areas.
    • Vaccinate your kids against HPV—or, if you’re a young adult under 26, request the vaccine for yourself.

    Don’t Delay Care

    The COVID-19 pandemic has had an unfortunate effect—we saw more advanced cases of head and neck cancers than we normally would, as people feared seeking medical treatment during the early stages of the pandemic.

    Nearly every week, a patient apologizes for “wasting my time” when I find something benign. Be assured, this is never a “waste of time.” I’m always happy to tell a patient that he or she does not have cancer.

    But discovering something more serious is much sadder—especially when it’s too late to make a real difference. The best approach: stay in touch with your doctor and get checked if you see or feel anything suspicious.


    Mouth soreness?

    Trust our specialists to help.

    Call 202-788-5048 or Request an Appointment

  • April 20, 2021

    By MedStar Health

    (L to R) Pictured is the leadership team for the Safe Babies Safe Moms program: Neil Weissman, MD, Chief Scientific Officer, MedStar Health; Tamika Auguste, MD, interim chair, Women’s & Infants’ Services; Angela Thomas, DrPh, MPH, MBA, assistant vice president, Healthcare Delivery Research, MedStar Health Research Institute; Loral Patchen, PhD, CNM, clinical project lead and director, Advanced Practice Providers, Women’s & Infants’ Services; and Chief Medical Officer Jeffrey Dubin, MD, MBA.

    Imagine reducing infant mortality rates by as much as 30 percent in five years, so the District of Columbia becomes known as having the most effective infant mortality reduction program in the nation, rather than the current state, where we stand as among the highest rates of infant death. Imagine we can accomplish this phenomenal transformation by creating new relationships that support individuals’ health through to adulthood, throughout all aspects of our community, without limitation by race or ethnicity, and one that translates on into the next generation.

    Thanks to a landmark endowment from the A. James & Alice B. Clark Foundation, MedStar Health is poised to change the face of maternal/infant health in the nation’s capital. Called Safe Babies Safe Moms (SBSM), the effort brings together experts in women’s health, family medicine, behavioral health, and pediatrics, at both MedStar Washington Hospital Center and MedStar Georgetown University Hospital. The Clark Foundation has allocated $27 million—the largest philanthropic donation in MedStar history—supplemented by an additional $3 million from MedStar Health, to move the needle decidedly in a positive direction.

    “We at MedStar and the Hospital Center’s Women’s and Infants’ Services are fortunate to receive this gift from the Clark Foundation,” says Tamika Auguste, MD, interim chair, Women’s and Infants’ Services (WIS). “This extraordinary gift will enable us to do the work to improve the birthing experience, maternal, and infant mortality in the District of Columbia. We have the drive, the innovation, and now the resources. We will not only take care of the women here at the hospital, but also work with our community partners, to ensure our mothers and babies thrive. This will ensure lasting excellence in maternal and infant care for years to come.”

    The five-year program went live Nov. 1, welcoming its first patients, with plans to serve some 3,600 women who deliver each year at the Hospital Center. Women can enter the program at any point—pre-pregnancy, prenatal care, delivery, postpartum/postnatal care, and maternal/infant/family care to age 3.

    Loral Patchen, PhD, CNM, is the clinical lead for the hospital’s WIS portion of SBSM. “Our goal is to provide maternity care that women describe as respectful of who they are as people and was delivered by a team that took their concerns seriously, listened to what was important to them, and provided the information they needed to make the best decisions for themselves and their baby.”

    The genesis of the program is the dismal statistics for infant and pregnancy-related mortality in the District, which are higher than the national average. Looking closer, infant mortality is almost four times higher for Black mothers. Black women are three times as likely to die of pregnancy-related causes when compared to White women.

    SBSM is part of MedStar Health’s vision of advancing health through lifelong care, delivered at each stage of life, and incorporating best practices imbedded into the community. “There are opportunities for all of us to improve across all aspects of care,” says Jeffrey Dubin, MD, MBA, Chief Medical Officer. “We’ll find what gaps there are in performance, and close those gaps.”

    “As an academic health system, we live at the crossroads of academics with real world medicine, which gives us an opportunity to bring the best and brightest to the delivery of care in our community,” says Neil Weissman, MD, Chief Scientific Officer for MedStar Health. “Medicine tends to be reactive when someone gets sick, while health is proactive, in preventing medical problems. This program focuses on advancing the health of babies and moms, by preventing complications during pregnancy. This is the future of care that focuses on health.”

    Reinforcing cultural sensitivity

    Because SBSM is based in the District, which has a large Black community, it is imperative that caregivers are sensitized to the needs of city residents, says Angela Thomas, DrPH, executive lead for the program. “We need to address the clinical, environmental, social, and health system risk factors our families face,” she says. “We are looking to reach women where they live and work, with programs that address their individual circumstances. We need to address systemic racism within health care.”

    “Our current health structure is riddled with historic and cultural inequities,” Dr. Patchen adds. “To change care delivery, we have to adopt an anti-racist approach. We need to rise to that level of intentionality.”

    Identifying risk factors

    Work is underway to identify the risk factors associated with poor outcomes for mothers and infants. For mothers, many of those risk factors—hypertension, diabetes, obesity—are part of the medical record. Other parameters are more difficult to identify—for example, family support, adequate nutrition, and access to transportation.

    An interdisciplinary approach to identify all the factors associated with poor outcomes is ongoing, aiming to target ways to improve outcomes at each step. “When we identify these factors, we can provide interventions tailored to women’s needs,” Dr. Thomas says.

    Assigning resources

    SBSM participants will have access to health care and community resources, geared to support efforts to establish healthier patterns. “Working with outside resources, SBSM is building bridges into the community,” Dr. Thomas explains. “Community of Hope provides services for families in need, including health care, housing service, and workforce development. Mamatoto Village creates career pathways for Black women, provides perinatal support for maternity care, along with information that supports parenting and daily living requirements. A partnership with the Health Justice Alliance adds medical/legal services.”

    Integrating multi-generational care

    Integration of services across the healthcare spectrum, including the integration of pediatric and mental health services, is key to the program’s success.

    Accordingly, SBSM establishes links among hospital programs, which too often operate in silos, Dr. Thomas notes. “We are co-locating services and addressing transportation when needed. Patient navigators are the glue that holds the initiative together. Accordingly, the program is recruiting women with a shared living experience, to assist SBSM participants in navigating the system.”

    “Our goal is alignment, not duplication of services,” Dr. Patchen says. “We need a comprehensive approach, from the front desk to the bedside.”

    Measuring results

    A critical component of SBSM’s success is the ability to measure results. Under the guidance of MHRI, statistical analysis will assess progress and fine-tune evidence-based initiatives.

    “In five years, we hope to move the numbers, with a 25 to 30 percent reduction in infant mortality,” Dr. Weissman says. “Five years after that, we hope there is a full reversal, and we are among the best in the country for infant mortality. We want the District to be held up, as the place that provides great care for moms and babies.”

    “If it was simple, it would have been done already,” Dr. Thomas adds. “But it’s complex, so we’re rolling up our sleeves. We will crack that nut.”


    Expecting a baby?

    Connect with our team today.

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  • April 16, 2021

    By David E. Stein, MD, Colorectal Surgeon and Regional Chief of Surgery in the Baltimore region at MedStar Health

    You may be surprised to hear that everyone has hemorrhoids. In fact, I often introduce the topic to my medical students by walking around the room and pointing to unsuspecting individuals exclaiming, “I know you have hemorrhoids!”

    So, what are hemorrhoids?

    Hemorrhoids are a normal part of the anal canal that help us to control bowel function. There are two locations where hemorrhoids can be found. Internal hemorrhoids exist within the lining of the rectum and anal area, or the inside of the body. In contrast, external hemorrhoids are located on the outside of the body where the skin has very sensitive nerve endings.

    When hemorrhoids become inflamed, they can become extremely painful, especially if they’re located externally. Unfortunately, over 10 million people suffer from inflamed hemorrhoids every year. How can something so small cause so much pain and discomfort?

    Symptoms of hemorrhoids.

    Hemorrhoid symptoms vary based on which ones are causing the problem.

    External hemorrhoids often bring on abrupt excruciating—and sometimes debilitating—pain. Bleeding and a formed clot that stretches the skin of the anal area are the cause of the pain.

    Internal hemorrhoids are graded on a scale of one to four, with painful symptoms that increase as the grade does. They’re rarely painful, although you can experience some bleeding and burning.

    • Grade 1: Painless rectal bleeding
    • Grade 2: Pain and discomfort from prolapsing or protruding from the anal opening
    • Grade 3: Pain and discomfort from prolapsing or protruding from the anal opening that requires you to manually push them back inside
    • Grade 4: Pain and discomfort from hemorrhoids that are stuck in the prolapsed position and generally require surgery

    It’s important to note that some symptoms may be similar to other conditions, such as colon cancer. If you are over the age of 40 and experiencing bleeding, talk to your doctor about getting screened for colon cancer to rule out anything life-threatening.

    Did you know you have #hemorrhoids? Everyone does, but they’re practically invisible until they become inflamed. On the #LiveWellHealthy blog, Dr. Stein shares everything you wanted to know about hemorrhoid treatment but were afraid to ask: https://bit.ly/3uXDnze.

    Click to Tweet


    Causes of hemorrhoids.

    A lack of fiber. There are a variety of things that can cause hemorrhoids to inflame, but the most common reason is a lack of fiber in your diet. The United States Department of Agriculture (USDA) recommends that women eat a minimum of 25 grams of fiber and men consume over 30 grams of fiber every day. Yet many of us don’t eat enough fiber.

    Irregular bathroom habits. Still, even if you eat enough fiber, it’s possible to develop an inflamed hemorrhoid. Constipation, straining, and irregular bowel habits are also common causes of hemorrhoids. That’s why expecting women are also prone to developing inflamed hemorrhoids—as if they don’t suffer enough uncomfortable symptoms during pregnancy. Individuals with Inflammatory Bowel Disease (IBD) may also be at an increased risk of developing hemorrhoids.

    Genetics. Unfortunately, if your parents frequently developed inflamed hemorrhoids, there’s a greater likelihood that you will, too. Over fifty percent of patients with hemorrhoids have a family history of dealing with the same affliction.

    Treating hemorrhoids.

    Sometimes, people with inflamed hemorrhoids don’t experience any symptoms. Other times, symptoms may dissipate quickly as hemorrhoids can resolve themselves within a few days. However, for some unlucky individuals, the only way to get hemorrhoid relief is by seeking treatment from a doctor.

    Request an appointment.

    Treating hemorrhoids at home.

    Over-the-counter medications like Preparation H may offer some pain relief for hemorrhoids. But unless you modify your fiber intake, they’ll probably keep coming back. If you have internal hemorrhoids, I will almost always recommend diet modifications to incorporate more fiber. A high-fiber diet is the best way to eliminate and prevent most cases of hemorrhoids, as fiber helps to regulate bowel movement. 70% of the time, eating more fiber will relieve symptoms of internal hemorrhoids.

    Consider upping your fiber intake with the following high-fiber foods:

    • Berries
    • Nuts
    • Legumes
    • Veggies
    • Whole grains

    Treating hemorrhoids at the doctor.

    No one dies from hemorrhoids. But if you’ve had one, you may wish that you had! Living with persistent hemorrhoid pain is miserable and there are many treatment options available so you don’t have to. Treatment options vary based on the location and severity of your hemorrhoid.

    Treatment for internal hemorrhoids.

    When dietary adjustments don’t relieve pain, you may benefit from a quick, in-office procedure to remove internal hemorrhoids grading one or two. Called rubber band ligation, this simple procedure involves placing a small rubber band around the hemorrhoid to help it naturally fall off within ten days. It can be uncomfortable, but it’s not painful and it’s extremely effective.

    If neither diet nor rubber band ligation provide relief, there are numerous surgical options that, while painful, are effective in eliminating hemorrhoids. These include:

    • Hemorrhoidectomy: When a large piece of skin is prolapsing every time you go to the bathroom, you may need surgery to remove hemorrhoids. An anesthetic will help to keep you comfortable during the procedure. However, you will likely experience pain for about two to three weeks of recovery.
    • Stapled hemorrhoidopexy: This procedure pulls the hemorrhoids back into their usual position with the use of a stapling device. The recovery is significantly less painful than the classic excision.
    • Hemorrhoid artery ligation: This new technique uses ultrasound to detect blood vessels supplying the hemorrhoids. Then, your doctor will suture the arteries so no blood enters the hemorrhoids, causing them to shrink.

    Treatment for external hemorrhoids.

    If you have an external hemorrhoid and see a doctor within three to four days of experiencing symptoms, your doctor can treat it using a procedure called thrombosis. During thrombosis, your doctor will numb the area before removing the inflamed hemorrhoid, resulting in instant relief. Unfortunately, if you’ve experienced symptoms for at least five days, the best thing to do is wait it out as the clot inside the hemorrhoid is likely already going away.

    This is an updated version on an article previously posted on October 23, 2020.


    Do you have a hemorrhoid that’s causing you discomfort?
    Request an appointment with a MedStar Health specialist today.

    Request an appointment.

  • April 15, 2021

    By Ross Krasnow ,MD

    Testicular cancer is among the most treatable, curable cancers today—a disease that medical science has truly mastered. But it’s still a disease that the average guy prefers not to talk about, even though talking about it could save his life.

    Caught early, the odds of beating this cancer are greater than 99 percent. But untreated, it can turn deadly. That’s a powerful motivator to be aware of the potential risks.

    Here are five important things to keep in mind:

    1.This Cancer is Quite Curable

    Testicular cancer is a younger man’s disease—unusual for cancer but also a reason why it’s so treatable. It generally affects males between the ages of 15 and 44 who have little or no other medical problems; average age at diagnosis is 33 

    When found, the cancer has generally remained localized, and responds very well to surgery, with a survival rate of 99 percent. Even in cases where it has spread, it responds well to chemotherapy, with a survival rate of 95 percent 

    Although testicular cancer seems to strike randomly, a short list of risk factors can be at play; for example, at slightly higher risk are men whose dad or brother have been diagnosed, as well as men born with an undescended testicle. So far, we’ve seen no connection to other typical contributors to cancer, like diet, obesity, inactivity, tobacco, or other lifestyle factors. 

    Men whose testicular cancer is treated with chemotherapy or radiation have a slightly higher lifetime risk of other cancers, although this percentage is very small. 

    This cancer will affect about one in every 250 men, with about 9,500 American men diagnosed each year. While still fairly uncommonit appears to be on the rise worldwidewe’ve also seen an increase in infertility at nearly the same rate.  

    There’s no clear data to explain either increase, but I would not be surprised if we eventually find a link to industrialization. Perhaps something in our environment disrupts normal metabolism in the reproductive system. But any evidence of that remains to be discovered.

    2.Most Guys Discover It Themselves

    So, what are the signs of testicular cancer? It most commonly presents as a testicular massa lump you can feel on the surface of the testiclewhich grows over time. Unlike more common cancers, there is no established screening protocol or routine imaging studies to find and diagnose such a massThis is why I recommend that every guy get into the habit of self-examinationevery month. 

    The lump may feel like a marble, harder and less compressible than surrounding tissue. It’s unlikely to cause any pain or discomfort. Most men discover it on their own and seek medical attention when they realize it’s getting larger. That’s the right thing to do. Most lumps and bumps are not cancerous, but let your doctor make that diagnosis.

    The majority of lumps we see have remained localizedtotally encapsulated. However, left untreated, this disease can spread to other parts of the body, most commonly the lymph nodes in the back or abdomen, spurring symptoms such as: 

    • Dull ache or soreness in the affected area 
    • Back pain 
    • Swollen glands in the neck  
    • Shortness of breath  
    • Anorexia or nausea leading to weight loss 
    • Breast enlargementvery rarely, hormones from some tumors may cause this condition, known as gynecomastia 
    Testicular cancer is among the most treatable, curable cancers, but it can be deadly if you ignore it. Five things every guy should know, from @RossKrasnow https://bit.ly/3d2UOIo via @MedStarWHC
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    3.Treatment Is Very Effective

    We don’t biopsy testicular tumors, as this type of cancer can spread very easily and biopsy increases that risk. Rather, the gold standard for confirming testicular cancer is ultrasound, which hardly ever returns a false positive.  

    If the ultrasound points to the presence of cancer, we proceed with surgical removal of the entire testicle. Although this measure sounds extreme, the procedure is not difficult and is extremely effective at treating the cancer. 

    Surgery to remove the cancerous tissue generally involves making a single small incision. For men who prefer it, we can simultaneously insert a prosthetic at the same time—a saline-filled silicone device, matched for size, that looks and feels like the original. The patient may also have the prosthetic placed at a later date, if desired.

    The tissue that we remove is sent to the lab, where we perform additional imaging studies to determine if the cancer has spread. Most of the time, it’s confined to the testicle and we simply conduct routine monitoring for another five years or so, to be safe.

    Post-surgery, most men do well with anti-inflammatory medication for minor discomfort and can resume their normal routine within a few days. 

    In the unlikely event that a patient’s cancer has spread to surrounding lymph nodes, this disease responds very well to chemotherapy and radiation, although we don’t always treat with both. Occasionally, more extensive surgery is required to remove diseased lymph nodes, but this is not typical. 

    4. Your Love Life Won’t Be Affected

    It may seem like a big deal to have this particular part of the body removed. But the reality is, most patients have few, if any lingering effects. It doesn’t negatively impact sexual function, and most survivors still make enough sperm to begin or expand their family.  

    The exception may come in situations when the disease has spread—chemotherapy and radiation can damage sperm cells. Although the damaged sperm will clear with time, it’s best to postpone pregnancy plans for one year following treatmentVery occasionally, I may recommend banking sperm, in case sperm production is permanently affected. A urologist specializing in fertility can complete a full evaluation. 

    The lifetime risk of recurrence, or of developing other cancers, is very low. But it’s not zeroso I encourage all my patients to eat wellstay active to maintain healthy weight, limit alcohol intake, and quit smoking (tobacco increases the risk of many other diseases and may complicate treatment). 

    5. If You Find Something, Say Something

    I recommend that every man perform a selfexamination at least once a month. This can be done most effectively in the shower, when warm water relaxes the scrotum and makes it easier to feel for anything out of the ordinary. Simply grasp each testicle, one at a time, and roll it around in your fingers. You’re feeling for anything firmer than the surrounding tissue on the testicle itself. 

    Of course, it’s not unusual to discover something that raises a red flag, but turns out to be completely benign—for example: 

    • Lumps can occur in the epididymis, a spongy structure behind the testicles where sperm mature before leaving the body. These lumps can include benign cysts such as a spermatocele, a collection of sperm that settles in one spot. 
    • A varicocele is an enlarged blood vessel. A hydrocele is a buildup of fluid. Either one may feel strange during self-exam. 
    • It’s not unusual to find vestigial bumps that are just a normal part of your anatomy. When you do the exam regularly, you’ll know what’s normal and can be on the lookout for anything new. 

    I’ve diagnosed all these situations in my practice and very few require treatment, unless they become symptomatic and irritating.  

     But if you find something, say something. Getting checked for nothing is far better than ignoring something critical. 

    MedStar Washington Hospital Center has a comprehensive program for the diagnosis and treatment of urological problems. We have all the resources neededfrom advanced testing to the most skilled and highly trained surgeons and support professionals.  

    We take every precaution to prevent the spread of COVID-19, and we encourage you to check in with us whenever you notice a testicular issue, rather than potentially giving a disease like testicular cancer time to get worse.  


    Unusual lump?

    Trust our urology experts to help.

    Call 202-788-5048 or Request an Appointment

  • April 14, 2021

    By Kevin Scruggs, MD, Emergency Medicine Chair at MedStar Southern Maryland Hospital Center

    When a serious unexpected illness or injury strikes, you may wonder whether you should seek treatment at the Emergency Department, visit an urgent care clinic, or schedule a visit with your primary care provider.

    Seeking care amidst the COVID-19 pandemic adds a layer of confusion, as many people are hesitant to come to the hospital for fear of exposure to the virus, even if they need immediate medical attention. But, waiting too late to seek emergency care could result in medical complications, long-term disability, or even death.

    Serious symptoms warrant a visit to the ED.

    Anytime you’re experiencing a time-sensitive medical emergency, you should go to the Emergency Department (ED) where healthcare providers are trained to deliver life-saving treatment for critical conditions that require fast responses. If your condition ends up being less serious than you thought, it’s better to get checked out and cleared rather than to delay necessary care and experience the opposite.

    The following symptoms warrant emergency care at the ED instead of an urgent care or telemedicine visit.

    Do you know signs of medical conditions that warrant a visit to the #ED? Expert Dr. Scruggs shares when you shouldn’t delay #emergency care on the #LiveWellHealthy blog: https://bit.ly/3gnTdiH.

    Click to Tweet


    Chest pain, which may indicate a heart attack.

    Severe chest pain or a feeling of your chest being squeezed or full could be a sign that a heart attack is imminent. A heart attack is a medical emergency that requires immediate care because the more time that passes, the more your heart is at risk for sustaining permanent damage. The sooner you seek treatment, the better your chances of medical interventions reversing the effects of a heart attack.

    The American Heart Association suggests that other signs of a heart attack may include:

    • Pain or discomfort in one or both arms
    • Shortness of breath or difficulty breathing
    • Pain in the back, jaw, neck, or stomach
    • Lightheadedness

    If you think you may be having a heart attack, call 911 immediately so you don’t delay care that could save your life.

    Stroke signs, including vision problems, dizziness, slurred speech, or a feeling of numbness in one or both arms.

    Like a heart attack, strokes are serious conditions that can be deadlier than COVID-19. If you experience any warning signs of a stroke, time is of the essence. During a stroke, a clot or plaque buildup blocks blood flow to the brain and heart which means that the longer you wait to seek care, the greater your risk of permanent disability or death.

    Fortunately, if you call 911 immediately upon experiencing symptoms, a trained emergency medical services (EMS) team can begin treating you while rapidly transporting you to the ED. Stroke treatment is more effective and safer the earlier it’s used, so when it comes to strokes, every minute counts.

    Even if you think the symptoms are minor or could suggest a mini-stroke, known as a transient ischemic attack (TIA), don’t hesitate to call 911. A TIA could be an early sign that a larger stroke looms ahead.

    Learn more about the signs of a stroke.

    High, persistent fever or trouble breathing.

    If you have mild COVID-19 symptoms, you most likely don’t need emergency care, although you may benefit from connecting with your primary care provider via a video visit. However, if you have a high fever, shortness of breath, and/or other chronic conditions, such as diabetes, heart disease, or asthma, you should seek care at the ED.

    And, if you have a child under three months with a fever of any kind, you should seek an evaluation in the emergency room. A high fever in a young child could be a sign of a serious, life-threatening infection.

    Other signs of a serious medical condition.

    In addition to the symptoms above, there may be other signs of significant medical problems that benefit from emergency treatment. If you’re involved in a major accident for example, whether it’s a car crash, a bad fall, or a gunshot wound, you should visit the ED for immediate treatment.

    Other symptoms that may warrant a trip to the ED include:

    • Heavy bleeding that doesn’t stop
    • Suicidal thoughts
    • Localized abdominal pain
    • Bleeding or trauma during pregnancy
    • And more

    It’s important to know that this is not an all-inclusive list. If you think you may be experiencing a medical emergency, it’s always better to seek care at the ED than wait for symptoms to pass, especially if you’re unsure if they’re life-threatening.

    Your safety continues to be our number one priority.

    Wherever you seek care at MedStar Health, you can expect extra precautions that ensure our facilities are safe, clean, and secure. This is also true in our emergency departments, where you’ll find safety protocols that minimize your exposure to COVID-19, including:

    • Regular cleaning and sanitizing of all rooms and surfaces
    • Separate entrances and rooms for patients experiencing COVID-19 symptoms
    • Face mask requirements
    • Reconfigured lobbies to encourage physical distancing
    • And more

    NEW! Expanded and renovated Emergency Department.

    Our completely renovated and expanded Emergency Department and new front entrance at MedStar Southern Maryland Hospital Center is now open! We’ve added 18 thousand square feet of treatment space in our ED for a total of 70 thousand square feet. Our new and spacious layout is equipped to provide you with the best care, featuring:

    • 50% more treatment rooms than before
    • Two large trauma and resuscitation rooms built to hold more equipment and providers
    • Special Pathogens Assessment Center (opening August 2021)
    • On-site imaging technology for faster, more convenient testing
    • Dedicated behavioral health space
    • Larger rooms to more comfortably accommodate visitors
    • Modern reception areas
    • A 24-hour café

    Whether you’re experiencing signs of a heart attack or stroke, or you sustained injuries after an accident, don’t delay emergency care that could save your life.


    The newly renovated Emergency Department at MedStar Southern Maryland Hospital Center is open and ready to help the community. 
    Click the link below to learn more about the new facility and the care we provide.

    Learn More