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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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  • October 18, 2016

    By MedStar Health

    By Leslie Whitlinger

    At a standstill in bumper-to-bumper Beltway traffic, now-57-year-old Gary Silverman watched his rear view mirror in horror. A car going 60 miles per hour was about to barrel into him, and the only thing he could do was brace for the inevitable.

    The 2003 collision set in motion a multiple-car pileup, and sent Gary on a decade-long search for relief from the accident’s aftermath: Lingering pain in both shoulders from rotator cuff injuries.

    “Over the years, the pain would come and go, but every time it came back, it was worse than before,” says the attorney and tech business entrepreneur. “I saw a lot of doctors but didn’t see many results.”

    By 2010, Gary was miserable. He finally asked his physical therapist (PT) at MedStar National Rehabilitation Network if she knew of a really good surgeon. She did.

    “I had avoided shoulder surgery as long as I could,” he says. “I always heard that recovery was long and hard and that scar tissue could make range of motion even worse than before. But I simply couldn’t stand it anymore.”

    Once unable to lift books, Gary is now lifting weights following repair of torn rotator cuffs in both shoulders by Brent Wiesel, MD. Photo by Breton Littlehales.

    At his PT’s recommendation, Gary made an appointment with Brent Wiesel, MD, a fellowship-trained and board-certified orthopaedic surgeon and chief of the shoulder service at MedStar Georgetown University Hospital, part of the MedStar Orthopaedic Institute. A leader in arthroscopic rotator cuff repair surgeries, Dr. Wiesel dedicates his practice to shoulder and elbow disorders.

    Dr. Wiesel’s experience and understanding extend beyond his professional background, however. As a member of the USA Canoe/Kayak whitewater slalom team, he injured his shoulder while preparing for the 1996 Olympics and went through two surgeries. Although the injury derailed his dreams of Olympic glory, it cemented his commitment to a career treating shoulder and elbow problems in adolescents and adults.

    “Shoulders are the most flexible joints in the body, with a wide range of motion that let us push, pull, lift and throw,” says Dr. Wiesel, an expert in minimally invasive arthroscopic surgery, reverse shoulder replacement, and research on advancing treatment for shoulder and elbow disorders.

    “But they’re also very vulnerable to wear and tear, and other injuries like dislocations, separations and rotator cuff tears that can be debilitating for the patient and complex to repair,” he says.

    “With fully torn rotator cuffs in both shoulders at the same time, Gary’s case was particularly unusual.”

    Dr. Wiesel first operated on Gary’s left rotator cuff, the more badly damaged of the two. Gary subsequently spent four weeks in a sling and about six months back in physical therapy, a typical recovery for shoulder procedures. By then, he was eager for Dr. Wiesel to tackle the right shoulder as well—a full 10 years after the initial accident.

    “I couldn’t believe the difference,” says Gary, who now admits his previous fears about shoulder surgery were unfounded. “Before my operations, I spent my life asking myself, ‘How long can I type before the pain becomes unbearable?’ ‘Can I lift that book?’

    “Now I can do whatever I want again—including lifting weights. Dr. Wiesel helped me gain my strength back, and that has changed my life. I’m so grateful for the expert care I received.”

    Learn More

    Visit Dr. Wiesel’s profile to learn more about the services and treatments he offers at MedStarGeorgetown.org/WieselMD.

    Treatment Options

    To learn more about the shoulder conditions we treat, visit MedStarGeorgetown.org/NoMorePain or call 202-295-0552 to make an appointment.

  • October 18, 2016

    By MedStar Health

    By Patrick Zickler

    Austin Thomas is young and fit and has always been careful about what she eats. She earned a master’s degree in nutrition in part to understand the digestive problems that had bothered her since she was a teenager, which included bloating, diarrhea, sometimes rectal bleeding and often discomfort or pain. But a week before her 27th birthday, she began experiencing intense pain that was unlike her usual symptoms.

    “I had never felt anything like it. And I was so bloated I looked pregnant,” Austin says.

    She called her parents and headed for the hospital, where a gastroenterologist examined her and scheduled a colonoscopy. She woke up in a recovery room and the doctor told her they had found a mass in her colon. She had stage 4 colon cancer, and it had spread to her liver.

    Uncertain but determined, Austin asked her doctors, friends and family for recommendations for an oncologist. That led her straight to John Marshall, MD, at MedStar Georgetown University Hospital.

    Dr. Marshall, chief of hematology and oncology at MedStar Georgetown, sees a lot of colorectal cancer. Increasingly, he sees cancer in patients who represent a puzzling new pattern.

    “Why Austin?” Dr. Marshall wonders. “And why so many other young patients? When I was a medical student, we learned that colorectal cancer is something that targets 50- to 70-year-olds. Now, we are seeing patients in their 30s, even in their 20s.”

    According to the Colon Cancer Alliance, the incidence of colon cancer is steady or declining in older age groups but is increasing in people 50 and under. And in younger patients like Austin— a dietitian and nutritionist who lives in Reston, Va.—the disease advances more aggressively than in older patients.

    After surgeons removed tumors from Austin’s colon and liver, MedStar Georgetown cancer specialists developed a comprehensive treatment plan designed specifically to attack her cancer.

    “Cancer care at MedStar Georgetown involves a multidisciplinary approach, and it’s different for each case,” says Dr. Marshall. “Patients are not alike, and neither are their cancers.”

    MedStar Georgetown oncologists use techniques such as molecular profiling to identify specific biological markers that unveil each tumor’s genetic blueprint. This approach allows the oncology team to choose treatment options that have been most successful in treating that specific tumor type. If the cancer changes, treatment is refined to stay focused and effective.

    “Treatment involves more than medication,” Dr. Marshall says. “Our approach involves the whole person.”

    For Austin, that meant support from surgeons, interventional radiologists, gastrointestinal specialists, nutritionists, and an oncology nurse who helped navigate the frightening and complex passage. Now, nearly two years after she was diagnosed, there is no sign of her cancer.

    Like Dr. Marshall, Austin wonders why a healthy 20-something-year-old would get colon cancer, and why more and more young people are being diagnosed. The answers are still elusive, but for Austin the underlying message is simple: Be aware of the warning signs, and if your symptoms hint at the possibility of colon cancer, “Get a colonoscopy. Absolutely. It doesn’t matter how old you are.

    Austin Thomas is just one of a growing population of young colon cancer patients seen by John Marshall, MD. Following treatment, Austin is back to her regular activities and recently participated in a run for colon cancer awareness in Washington, D.C.,  Photo courtesy of Yvette Rattray
    Austin Thomas is just one of a growing population of young colon cancer patients seen
    by John Marshall, MD. Following treatment, Austin is back to her regular activities and
    recently participated in a run for colon cancer awareness in Washington, D.C., Photo courtesy of Yvette Rattray

    Learn More

    To learn more, visit MedStarGeorgetown.org/Colon or call 202-295-0520 to make an appointment.

    Inside Cancer, a blog from the MedStar Georgetown Cancer Institute, features articles written by MedStar cancer specialists and cancer survivors. Visit MedStarGeorgetownCancer.org/InsideCancerBlog to read the latest articles.

  • October 18, 2016

    By MedStar Health

    Healthcare Close to You

    We are pleased to announce the opening of MedStar Health at Lafayette Centre, in downtown Washington, D.C., The multispecialty care facility, which includes an Orthopaedic and Sports Medicine Center, is located at 1123 21st St., NW.

    MedStar Health at Lafayette

    Centre is staffed by more than 60 physicians from MedStar Georgetown University Hospital, MedStar National Rehabilitation Network and MedStar Washington Hospital Center. These physicians provide care in a range of specialties, including primary and preventive care, cardiac and vascular care, women’s and men’s health, orthopaedic care, outpatient surgery, radiology and laboratory services, and rehabilitation.

    The new Orthopaedic and Sports Medicine Center at the location also provides comprehensive, state-of- the-art services using the latest techniques and technologies in sports medicine and orthopaedics, physical therapy and rehabilitation, sports performance enhancement, and education, research and community outreach.

    “The opening of MedStar Health at Lafayette Centre is a major win for patients,” says Bob Gilbert, vice president of MedStar Ambulatory Services. “Organizing care around patients’ needs, with respect for their busy work and life schedules, makes it easy and convenient to get care.”

    The new center also offers a dedicated parking garage, easy access to Metro’s Blue, Orange and Red lines, and a community room for health screenings, educational sessions, and community group gatherings.

    Learn More

    Visit MedStarHealth.org/NewLocation or call 202-416-2000 to learn more about the services offered at MedStar Health at Lafayette Centre.

  • October 17, 2016

    By MedStar Health

    Almost all of us have four parathyroid glands, located next to the thyroid gland in the neck. They are an organ only the size of a grain of rice, but critical for controlling  our body’s calcium levels. Unfortunately, hyperparathyroidism - when an excess of parathyroid hormone is produced - goes undiagnosed or diagnosed late. This can be because many patients do not showcase apparent symptoms or their symptoms go unrecognized as being caused by hyperparathyroidism.

    This is particularly troublesome for older patients, in particular, because women are the most at-risk for developing hyperparathyroidism until they have developed bone loss or kidney stones. So if you’re a woman who is 65 years or older, how do you know if you have hyperparathyroidism? And most of all, what are the risks of remaining undiagnosed?

    Signs of Hyperparathyroidism and Risks if Left Undiagnosed or Untreated

    Parathyroid hormone plays a critical role in your body’s metabolism of calcium. Hyperparathyroidism causes the loss of calcium from your bones and elevated calcium levels in your blood. For older patients, however, they may only experience depression, bouts of memory loss, as well as pain in their bones and joints.

    Often, these symptoms are dismissed as signs of stress or other more benign troubles, and the option of a diagnosis of hyperparathyroidism is entirely overlooked.

    The effects of hyperparathyroidism can result in other health concerns, if left untreated. In addition to kidney stones and osteoporosis, older patients may physical symptoms including depression, mood changes, fatigue, muscle, and bone aches and pains, or even cardiac dysrhythmias.

    4D CT Scanning: A New Way of Diagnosing Hyperthyroidism

    Traditionally, abnormal parathyroid glands were found using two distinct techniques. Ultrasound is the first technique, which involves rubbing a probe covered in gel over the neck to search for abnormal glands. Although it's a noninvasive procedure, it mainly relies on the size and general appearance of the gland to determine whether or not it's abnormal. The second approach is known as sestamibi scanning (also known as MIBI), which is designed to showcase an abnormal gland's overfunction. Although these two techniques together are relatively accurate for some, others still fail to see a productive result from either of these two techniques. Often patients get wrong or conflicting information from these studies alone, and we are left without a clear answer before surgery as to which parathyroid gland is the culprit.

    A new technique known as 4D CT scanning can show both parathyroid gland structure and parathyroid gland function in a single test. However, because of the small amount of radiation exposure, it's typically reserved for patients who have not gotten definitive results via other means.

    First, a preliminary scan is done for comparison purposes. Then a contrast material is injected into the patient's veins to follow its progress through the body. Scans are done two or three times after the injection, generally at 30- to 90-second intervals. Although complications can happen even in the best of hands, they are very rare for this kind of study, and patients go home while a radiologist examines the results.

    Successes We've Seen at MedStar Washington Hospital Center

    At MedStar Washington Hospital Center, many of our patients have gone a long time between being symptomatic and being diagnosed with primary hyperparathyroidism, as they had been given the wrong diagnosis or had unsuccessful operations performed elsewhere in the past. But in our work with 175 patients so far, we have found a high degree of accuracy in the 4D CT technique when the CT scan identifies an abnormal parathyroid gland.

    This approach enables us to offer a minimally invasive approach to more patients with primary hyperparathyroidism or recurrent disease. This also gives us more confidence when going into surgery that we are likely to find the abnormal gland and cure the patient of their disease.

    Have any questions?

    We are here to help! If you have any questions or would like a consultation, call us at 202-877-3627.

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  • October 14, 2016

    By MedStar Health

    Tina Rosenbaum, MD, has been an emergency room physician at MedStar Washington Hospital Center for 12 years – and for much of that time, there was a gap in medical imaging as part of patient care in the middle of the night. “[But] now, we get our answers immediately,” Dr. Rosenbaum says.

    The reason? Our overnight radiologists who provide immediate coverage at the Hospital Center, as well as several other MedStar facilities.

    Radiology chairman James Jelinek, MD, says the program was the idea of Arnold Raizon, MD. Prior to instituting dedicated teams to cover the overnight hours, radiologists would generally work their normal daytime schedules and then trade off night-time shifts. In addition, MedStar hospitals were previously covered by five different groups, all using different computer systems.

    This approach didn’t make for the best patient care experience.

    The Rising Need for Overnight Radiology Coverage

    Laurie Abrams, MD, notes, however, that the need for dedicated overnight coverage wasn’t always necessary. Smaller radiology practices – which were the norm 20 years ago – didn’t lend themselves to dedicated teams to work the overnight hours. But as practices consolidated and grew larger, small teams of overnight radiologists became a more practical solution.

    Also, the technology changed. “Reliance on imaging technology is much greater than it used be,” Dr. Abrams says.

    Imaging tests can be used to diagnose an ever-increasing number of conditions. For example, head scans were previously considered to be a rare event, but now a busy hospital might find it necessary to conduct four or five head scans in a single hour. So having an overnight radiologist on-hand to offer advice, and interpret scans and films, can make a huge difference.

    Bridging Gaps, Provide Better Patient Care

    Thanks to the institutionalizing of the overnight radiologists at MedStar Washington Hospital Center and other facilities, many patients can be sent home quickly and safely. And when they need to be sent to the operating room, that too happens more efficiently.

    That’s not to say there aren’t challenges to working overnight.

    From the moment they log into the Radiology platform, they have a worklist that generally keeps them busy for the entire shift – and that’s on a normal night. On nights when there are multiple trauma cases, the need for both speed and accuracy becomes enormous.

    “Your brain is always on. There is no downtime,” Gabe Schneider, MD, points out.

    But that is one of the very reasons why this group takes such pleasure in their work. All radiologists are integral to patient care, says Dr. Taner, but overnight, “you are often the decision point. You can make the most difference.”

    For instance, Dr. Rosenbaum says it’s not uncommon for the radiologist to take the initiative and inform the surgical teams when it is apparent that surgery will be necessary: “They will link together all the different teams and keep the lines of communication open. That helps everyone.”

    For Dr. Raizon, that type of teamwork is the entire key to what they do. “The technical staff has always had dedicated people who work at night. It makes sense that the physicians do, too. This way, we all get to know each other, which leads to better patient care.”

    It’s About People

    Even with spending their evenings and late nights intimately involved with some of the technologically sophisticated aspects of medicine, all four overnight radiologists stress that the personal relationships they have developed are the single best part of the job.

    Dr. Raizon, who has been there from the beginning, intends to work in this capacity for the remainder of his career. “I really like the people I work with at night,” he says. “It’s not just about reading X-rays. So much of medicine is about the people."

    Have any questions?

    We are here to help! If you have any questions, call us at 202-877-3627.

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  • October 13, 2016

    By MedStar Health

    Many women with breast cancer never experience any of its signs or symptoms, such as a breast lump, says Christopher Gallagher, MD, medical director of the Cancer Institute at MedStar Washington Hospital Center. Dr. Gallagher wants women to have their breast cancer discovered before it even has a chance to cause symptoms.

    But because not all women get regular mammograms, and because mammograms aren't infallible, women need to know the common signs of cancer and be willing to advocate for their own treatment.

    Changes in the Breast

    Women with early-stage breast cancer may notice a physical change in one or both breasts. “The main signs or symptoms would be feeling something that felt new or abnormal in the breast — a nodule or a bump," says Dr. Gallagher. "Or sometimes it’s breast pain." A lot of women and their primary care doctors overlook breast pain as a possible cancer symptom, he explains, but it's often the initial sign of a problem.

    Sometimes the first signs of breast cancer are visible to the eye. “There could also be skin changes to the breast that are new or different," Dr. Gallagher points out. Nipple discharge is another potential warning sign, though it's one of the less common symptoms of cancer.

    Changes Elsewhere

    In some women, the first sign of cancer appears somewhere other than the breast. That can happen in women whose cancer has spread to other parts of the body. Dr. Gallagher says that sometimes a woman will discover a lump or bump under her arm. "That would be indicative that maybe they had something in the breast that spread to a lymph node."

    "If a woman has a new pain in a bone that comes and doesn’t go away, that’s always to me suspicious of something that needs to be evaluated," he says. Other symptoms include involuntary weight loss and new abnormalities on routine blood work such as liver dysfunction and anemia.

    Self-Exams

    Unfortunately, telling the difference between normal breast lumps and cancerous bumps isn't easy. "Historically, we always told women to do breast self-examinations on a regular basis, whether that be every couple weeks or once a month," Dr. Gallagher explains. However, there's not much evidence supporting the diagnostic validity of these exams.

    Ultimately, Dr. Gallagher says, whether or not to do breast self-exams is a decision for every woman to make for herself. "I never say not to do it. But some women get so anxious they do it every day." He's noticed that this anxiety is especially strong in women who survived early-stage breast cancer and worry about it coming back.

    Familiarize yourself with the feeling and texture of your own breasts, and talk to your doctor about anything that feels unusual for your body. But don't obsess over self-exams.

    Next Steps

    It's important not to panic if you notice any symptoms that are tied to breast cancer. Dr. Gallagher advises going to your primary care physician, who can then send you for a mammography and imaging or refer you directly to a specialist. "Make sure your primary care physician takes your report seriously," says Dr. Gallagher.

    He's seen many breast cancer patients under the age of 40 whose doctors wrote their symptoms off at first. "Women need to follow their gut," he says. "If they think something is new and different ... they need to keep seeking medical attention until someone adequately explains what's going on."

    In addition to suggesting women advocate for themselves, he urges them to speak to their friends and other women in their community about getting regular mammograms. He wants women to spread the message that "early-stage breast cancer is curable and you need to have your screening," he explains. "That's the way you're cured — by [your cancer] being found early."