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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 13, 2021

    By Harjit K. Chahal, MD

    Do you drink coffee? If the answer is yes, you’re in good company. A majority of Americans—64%—drink two cups a day. But there’s one more thing that many Americans have: high cholesterol. In fact, well over 100 million Americans have elevated cholesterol or are at serious risk for it.

    So research scientists have posed an intriguing question: Is there a possible connection between coffee and cholesterol?

    The short answer: Yes. But the complete answer is a bit more complicated.

    What Is Cholesterol?

    Let’s first understand what “cholesterol” is. For many people, even the term can spark apprehension. But, the fact is, our bodies need cholesterol—it’s an essential fat.

    In the proper quantity, it serves as a building block for cell membranes, nerve tissue, and critical hormones. It enables our bodies to make vitamin D from sunlight. And it’s a key component of liver function, aiding in the digestive process. The liver makes most of the cholesterol that our bodies need in order to function well.

    So, what causes high cholesterol? Most problems with unhealthy levels of cholesterol begin when we take in too much fat and too many calories from food, yet don’t get appropriate levels of exercise. And occasionally, a patient may simply be genetically predisposed to elevated cholesterol—their liver makes too much.

    There’s reason for concern: high cholesterol is a well-known contributor to cardiovascular disease. It encourages the formation of plaque, a sticky deposit that coats the inner walls of our blood vessels. Like rust within an old pipe, plaque restricts blood flow, leading to heart attack, stroke, and peripheral artery disease.

    Understanding the Numbers

    When a cardiologist reviews a patient’s lipid panel—the blood test that measures low- and high-density lipoprotein and triglycerides—we like to see a total cholesterol level under 200. But we carefully consider each number individually.

    • Although low-density lipoprotein (LDL) is often dubbed the “bad” cholesterol, it is actually the one we can reduce and control most easily, through diet, exercise, and medication. LDL cholesterol should be below 100 in men over age 45 and women over 55, or below 130 in younger people.
    • High-density lipoprotein (HDL) is regarded as “good” cholesterol because it can protect against cardiovascular disease. But that effect is limited. If LDL rises to unhealthy levels, there’s only so much that HDL can do to help. And little can be done to increase levels of HDL, which are dictated mainly by genetics and metabolism. HDL should be at least 40 for men and 50 for women.
    • Triglycerides are a source of energy for the body but having too much in the blood can point to potential problems down the road. Triglycerides should be below 150 for everybody.

    The Research on Coffee and Cholesterol

    Interestingly, a number of studies have already explored the potential connection between coffee and cholesterol. Although most have been small studies, they’ve produced enough data to show that coffee consumption can indeed increase cholesterol. A meta-analysis, published in the American Journal of Epidemiology and consolidating results from several studies, showed that, in 89 percent of the results reviewed, coffee had increased patients’ cholesterol levels by an average of nearly 12 points.

    What element within coffee is causing this increase? It’s the natural fats in the coffee bean—particularly the oils cafestol and kahweol.

    But before you discard your coffee cup permanently, this news may not be as ominous as it seems. Here’s why: Most Americans drink a coffee brew that’s been passed through a paper filter, which blocks those natural oils from ever making it into the cup.

    Researchers found that the coffees with the greatest likelihood to increase cholesterol levels are unfiltered, either boiled or steeped, such as French press or percolated coffee. If you’re a coffee drinker who favors one of these methods, you may want to consider changing the way you brew your coffee, particularly if your doctor says your LDL cholesterol is too high.

    And what about that occasional coffee treat, espresso? Because its brewing process does not involve a filter, espresso is likewise high in natural oils. But, because it tends to be consumed in small quantities, its overall impact on the espresso drinker’s cholesterol is likely negligible.

    Coffee can increase cholesterol for some. Are you at risk? Cardiologist Dr. Harjit Chahal has the details. https://bit.ly/3daJ3Ql via @MedStarWHC
    Click to Tweet

    Moderation Is Key

    In studies examining coffee’s impact on cholesterol, people who experienced increased cholesterol levels were those who drank about five cups or more each day. So, moderation can also be important.

    The research studies made sure to data-correct in order to report reliable results specific to the coffee itself. But keep in mind that flavorful additives to your coffee can increase the calorie count of each cup by 300–500 calories—or, in the case of flavored coffees served at national franchises, as much as 1000 calories per cup. So, those additives can increase your LDL as well.

    Use moderation when you add the creamy and sweet stuff to avoid increasing bad cholesterol. A 500-calorie coffee may be fine as an occasional treat, but avoid having it become a regular indulgence. And don’t forget: most cases of high LDL can also be attributed to excess weight and lack of exercise—so try to achieve at least 20–30 minutes of some form of activity every day.

    The Caffeine Effect

    On another note, caffeine and other components of coffee may likewise create issues for occasional coffee lovers, depending on their individual sensitivity. Some can drink coffee without a problem; others may experience sleeplessness, increased blood pressure, and heart rate problems. Coffee can contribute to anxiety, panic attacks, and “brain fog,” and may also interfere with medications, including certain antibiotics, antidepressants, and drugs for asthma, thyroid, and osteoporosis.

    It’s a good idea to moderate caffeine each day from all sources, including soda, tea, and energy drinks that you may be consuming in addition to coffee. Your daily total caffeine intake should be less than 400 mg.

    Interestingly, once the body becomes accustomed to the beverage over time, many of coffee’s perceived negative effects tend to decrease. In fact, a number of studies point out the potential benefits of regular coffee consumption: It may lower the risk of heart failure, help with weight loss, and improve our thinking and our mood. It offers some protection against diabetes, Alzheimer’s, and certain cancers. There is also evidence that women who drink coffee are at lower risk for stroke.

    Again, like most things, moderation is key.

    Pursue a Healthy Lifestyle

    To summarize, when it comes to cholesterol, the research confidently states that unfiltered coffee brews can increase cholesterol levels, primarily if you drink more than two cups per day and have other risks for high cholesterol; for example, if you’re ordering a “grande” specialty drink or refilling a jumbo mug at your favorite cafe, your intake of cholesterol-spiking additives is probably greater than you think.

    But rather than worry too much about coffee, I recommend that my patients focus on other critical factors that impact their health—controllable factors such as nutrition, weight, exercise, and use of tobacco and alcohol. It’s wise for everyone, coffee drinker or not, to exercise most days (for a total of 150 minutes each week), to avoid smoking, and to make an effort to eat healthy.

    I recommend the low-sodium Mediterranean diet, which emphasizes fish, whole grains, fruit, vegetables, oils, and nuts—an excellent blend of nutrients to help protect against long-term disease. And quantity is as important as quality. Excess food consumption creates excess weight, putting you at risk for cardiovascular and other diseases. Moderation is the key to health, no matter what you eat or drink.

    Self-Care Is Important

    High cholesterol and many other cardiovascular problems are preventable.

    Be sure to choose a primary care doctor that you are comfortable with and will see regularly. He or she will keep an eye on your general heart health, including cholesterol levels, and recommend a consultation with a cardiologist if any risk factors exist. MedStar Washington Hospital Center adopts all precautions and protocols to keep our patients safe, during the current pandemic and always.

    If the pandemic has one silver lining, it’s that it has caused many of us to do a better job of prioritizing our exercise goals and dietary habits. We’re not going out as much, so it’s a great time to create your own healthy meals, rather than depend on fast food. That’s what I’ve been doing, and I’ve never felt better. It can work for you, too.


    Time for a cholesterol check?

    Our specialists can help.

    Call 202-788-5048 or Request an Appointment

  • April 09, 2021

    By Lauren Maragh, MD, Internal Medicine Physician, MedStar Medical Group

    If you find yourself feeling under the weather this spring, you may be asking yourself, “Do I have COVID-19 or allergies?”

    While both can make you feel miserable, the good news that it’s usually easy to tell the difference between COVID-19 and allergies.

    How COVID-19 and allergies are different.

    Allergies develop as a result of your immune system responding to an external trigger, such as food, dust, pollen, or something else. Anyone can develop allergies at any point in their life, but they’re not contagious.

    In contrast, COVID-19 is a contagious virus that spreads through respiratory droplets passed through the air. COVID-19 can also be transmitted when someone touches a surface or object touched by an infected person.

    COVID-19 often causes a fever, while allergies don’t.

    If you have seasonal allergies, you shouldn’t experience a fever. And, in general, allergy symptoms are mild compared to COVID-19 symptoms, which may be similar to cold and flu symptoms. Common COVID-19 symptoms may include:

    • Coughing
    • Fever
    • Fatigue
    • Diarrhea or nausea
    • Loss of taste or smell

    COVID-19 symptoms can last between two to fourteen days, which is why it’s important to follow safety precautions to minimize the risk of spreading it. However, it’s important to know that not everyone experiences these symptoms when they’re sick with the virus. In fact, some people who test positive for COVID-19 don’t experience any symptoms at all.

    Do you have a runny nose or a fever? Dr. Maragh shares how to tell if you have #COVID19 or seasonal #Allergies and when to seek care: https://bit.ly/3t6Wlmv.

    Click to Tweet


    While people with recurrent or seasonal allergies may occasionally experience a slight cough or mild fatigue, allergies commonly cause less severe symptoms than COVID-19, such as:

    • Runny nose
    • Sneezing
    • Itchy or watery eyes
    • Post-nasal drip

    Allergy symptoms can last much longer than COVID-19 if left untreated. Many people with seasonal allergies experience symptoms for weeks or months.

    Learn how to tell the difference between cold and allergy symptoms.

    How and when to seek treatment for COVID-19 or allergies.

    Seeking care for COVID-19.

    If you think you have signs of COVID-19 or you know you’ve been exposed to the virus by someone else, call your doctor right away so they can help you take the appropriate next steps for care. In many cases, you may be able to recover safely at home. Talking to your doctor will help you understand what you need to do to ensure you don’t spread the virus to others by taking additional safety precautions, such as quarantining.

    It’s also important to continue properly wearing a facemask whether or not you have allergies or asthma. Mask-wearing is proven to be safe for both conditions, and it’s critical to preventing the spread of COVID-19 among our communities.

    Seeking care for allergies.

    Many people with seasonal allergies already take preventative measures to minimize their symptoms. However, if you develop new or worsening allergy symptoms, it’s important to talk to your primary care doctor so they can help you manage your symptoms through allergy medications such as antihistamines or nasal corticosteroids.

    Seasonal allergies shouldn’t cause shortness of breath or a fever, but if you experience one of those symptoms call your doctor right away. This is especially true if you have a history of asthma, which is a common condition that many people with allergies also have.

    Am I at a higher risk of complications from COVID-19 if I have allergies?

    Having seasonal allergies does not increase your chances of getting COVID-19 or experiencing complications caused by COVID-19. However, many people with allergies also manage related conditions, such as asthma. Because asthma can affect how you breathe, having asthma may increase your risk of complications from COVID-19. That’s why if you have asthma, it’s especially important to contact your primary care provider if you become infected with COVID-19. And if you ever have trouble breathing, call 911 immediately.

    What if I get COVID-19 while I’m suffering from allergies?

    If you become infected with COVID-19 while you have allergies, you will most likely still manage your seasonal allergy symptoms in the same way you usually do. Your primary care provider can help you manage your COVID-19 symptoms and take preventative measures to ensure you don’t spread the virus.

    Don’t delay care when you need it.

    Whether you experience seasonal allergies or have signs of COVID-19, your primary care provider can help determine whether or not you need to seek testing, in-person care, or treatment. And, you can also talk to a board-certified provider 24/7 using on-demand video visits through MedStar eVisit. If you have questions or are concerned about your health, don’t hesitate to seek medical care.


    Do you need medical care for COVID-19 or allergies?
    Click below to schedule an appointment with a MedStar Health primary care doctor today or to learn more about your care options.

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  • April 09, 2021

    By MedStar Health

    In her 14 years with MedStar Health, Nadia Braxton has had many growth opportunities to learn the many layers of our organization. Encouraged by her mother, a 20-year associate in the MedStar Washington Hospital Center lab, Nadia began her career at the Hospital Center as a unit secretary on 3C.

    “I was in my 20s, working in retail, and I didn’t know what I wanted to do,” said Nadia. “I came here and found my way into a career that I love.”

    After two years, she transitioned to medical office assistant 2 in the ambulatory clinic. Her next step was to Outpatient Radiology at Washington Cancer Institute, as a finance clerical representative. As her tenure continued, she learned about the Hospital Center’s X-ray Tech Program from 20-year associate El Mabry, who introduced Nadia to the program director. She completed the program and joined MedStar Prompt Care on Capitol Hill after graduation. Nadia spent two years there, moving up to team coordinator, then transferred to another MedStar Health facility in her native Baltimore. Then, fate intervened.

    During her X-ray tech training, she had been paired with a seasoned associate, Bernard Braxton, Jr., who toured her around the hospital. They fell in love and, after they married, she returned to the Hospital Center. She has achieved professional certifications since, including CT scan certification, and looks forward to earning MRI certification.

    “When you start here in clerical, you can’t imagine someday you would transfer to clinical,” said Nadia. “There’s room for growth here and within MedStar Health. MedStar Washington Hospital Center is a teaching hospital, so you can learn so much. And, if you do well here, you can handle anything.”

    Nadia credits Nadine Heron, her mentor and clinical manager on 3C, with encouraging her career growth. She said they have remained close, and Nadia has sought Nadine’s advice throughout the years. Nadia hopes to continue her upward career trajectory, which possibly includes a move to leadership, and earning all possible certifications.

    “What I love about my job is making patients happy. They’re here for various reasons, but we can make them feel better and that’s the best part.”


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  • April 08, 2021

    By Rachael D. Sussman, MD, Urology

    Incontinence. Constipation. Painful sex.

    Not necessarily topics you want to discuss with your friends, let alone your doctor. But if you suffer from such symptoms, it’s ok to speak up. At MedStar Washington Hospital Center, we understand and we can help!

    For some of our female patients, these symptoms, and other discomforts in the pelvic area, may actually be caused by pelvic organ prolapse—a quite common condition that up to half of all women will experience to some degree over time.

    In most cases, pelvic organ prolapse has few or no symptoms. But for some women, symptoms can begin to impair normal bodily functions and require treatment. It’s never too soon to start making things better.

    What Causes Prolapse?

    Within a woman’s pelvic floor, a group of muscles supports the pelvic organs—bladder, uterus, vagina, and rectum. Pelvic floor disorders begin when those muscles weaken and fail to give the organs the necessary support, causing organs to sag and bulge into the vagina.

    Several factors may lead to this weakening of pelvic floor muscles:

    • The hormone estrogen keeps pelvic floor muscles strong and elastic. As women age—and particularly at, and post-, menopause—estrogen levels drop, muscles weaken, and the lining of the vagina becomes dry and tender.
    • Childbirth may damage pelvic muscles and nerves during delivery, as the baby passes through the birth canal. This is especially true if the baby is large, if the mom has experienced multiple deliveries, or if a delivery requires forceps.
    • Any extra strain on pelvic floor muscles can weaken them over time. Obesity, chronic cough, straining to have a bowel movement, or lifting heavy weights can contribute.
    • Genetics may play a part as well: the strength of a woman’s connective tissue may be determined from birth. If you ask other females in your family, you may find you’re not the only one with this condition.
    When a woman has regular incontinence, constipation, or painful sex, pelvic organ prolapse could be the cause. It’s annoying, it’s common, and there’s a lot we can do to help, says Dr. Rachel Sussman. https://bit.ly/3d2y8ab via @MedStarWHC
    Click to Tweet

    Pelvic Organ Prolapse Symptoms

    A woman with pelvic organ prolapse may experience a particular pelvic sensation alerting her that something is not quite right. This sensation can vary from woman to woman, depending on the organs involved and the severity of the prolapse.

    Some women may feel, or even see, a bulge in the vagina. There could be a feeling of heaviness in the pelvis—some report that it feels as if they’re always wearing a tampon. These various sensations may also make urination, bowel movements, or sexual activity difficult or painful. And symptoms may worsen by day’s end or after a long period of standing.

    The female bladder is certainly prone to the effects of prolapse. Urine is stored in the bladder and leaves the body via the urethra. A prolapsed or “fallen” bladder is known as a cystocele; if either the bladder or the urethra begins to bulge into the vagina, it can become difficult for a woman to empty her bladder. Or she may feel she has to urinate frequently or that her bladder is never completely emptied. If the bladder cannot empty, this can cause urinary tract infections or, in rare cases, kidney disease. The same damage to muscles and nerves that causes prolapse can also cause leakage of urine with laughing, sneezing, or coughing, known as stress incontinence.

    The rectum can also bulge into the vagina; this bulging is known as a rectocele. The rectocele can make it difficult for a woman to pass stool. By applying perianal pressure (also known as splinting), some women find that they can direct the bulging organ back to its normal position and allow stool to pass unobstructed.

    Prolapse may also present as pain with intercourse. If a prolapsed organ causes protrusion of the vaginal walls outside of the body, the delicate tissue of the vagina may become irritated from rubbing against one’s underwear and there may even be some spotting or bleeding. In addition, some women may become self-conscious during sex because of the vaginal protrusion.

    Pelvic Organ Prolapse: Stages

    At the time that we diagnose a patient with pelvic organ prolapse, we assign a stage—or grade of severity—to her condition, based on the extent to which the affected organ has dropped:

    • In Grade 1, prolapse is mild—the organ drops a short distance into the space of the vagina.
    • In Grade 2, the organ has a moderate drop to the opening of the vagina. This is when symptoms typically become evident.
    • Grade 3 is a severe condition in which the organ drops slightly through the vaginal opening.
    • Grade 4 is total prolapse, in which the organ has completely descended.

    It is helpful for women to be aware of the possibility of prolapse, to recognize when it may be happening, and to know that they’re not alone in this scenario. If you’re unable to empty your bladder, feel that your bowel movements are being blocked, have painful intercourse, or feel an uncomfortable bulge in the vagina, it’s time to seek medical attention.

    We can often recommend specific exercises that will actually help improve the situation. And if the problem is severe, reaching out for treatment can be life-changing.

    Pelvic Organ Prolapse Treatment

    Degree of patient bother and severity determine the course of treatment.

    Mild cases may be monitored for worsening. We teach our patients how to correctly perform Kegel exercises, which can go a long way toward improving strength in the pelvic muscles. To do these exercises you squeeze the same muscles you would to stop the flow of urine, but don’t practice regularly while you are urinating!

    I tell my patients to perform Kegels three times a day when the pelvic muscles are at rest: while brushing your teeth or sitting at a red light—really, whenever you think of it. Simply squeeze the pelvic floor muscles for 10 seconds, then relax for 10 seconds. Repeat 10 times, three times a day. Your doctor may ask you to demonstrate your Kegel during an exam to ensure that you are doing it correctly. A good indicator: If you can halt the flow of urine midstream, you’ve mastered the technique.

    Some physical therapists are trained to address pelvic floor issues. We may refer you to one of these specialists for training on when and how to contract and relax pelvic muscles, in order to minimize pain and improve muscle tone.

    Post-menopausal women with symptoms of pelvic organ prolapse may be prescribed estrogen applied as a cream, suppository, or ring. Use of the hormone can help strengthen vaginal tissue and make it less dry and painful.

    As part of treatment, we sometimes recommend that the patient use a pessary—a silicone disc placed into the vagina like a diaphragm. The pessary, which may be inserted for up to three months, provides structural support for the vagina, lifting the walls and preventing adjacent organs from bulging inward. The doctor can remove and replace the device as appropriate. The patient can learn to remove it temporarily as well; it should always be removed prior to sex.

    Pelvic Organ Prolapse Surgery

    In situations when surgery is required, we can often correct prolapse with vaginal native tissue repair, requiring no abdominal incisions. We correct weak areas and anchor the vagina to stronger structures, pulling organs back to their proper position. This procedure may or may not be done in conjunction with a hysterectomy, which eliminates the weight of the uterus and reduces risk of future prolapse.

    For younger women, we may recommend an abdominal surgery known as sacrocolpopexy, which can be done with minimally invasive techniques, using tiny abdominal incisions. This type of repair is generally longer lasting.

    Prevention and Action

    Of course, it’s always better to prevent a problem than to treat it. Women can take some very basic measures to preserve pelvic muscle tone:

    • Maintaining healthy weight helps prevent a multitude of health issues, including pelvic organ prolapse. Excess weight can place more pressure on the muscles and organs of the pelvis, causing strain, wear, and tear.
    • Practicing Kegels is advisable for all women, particularly after childbirth and when approaching menopause. Ten repetitions, three times a day may be all it takes to keep pelvic muscles strong and functioning well.
    • Adding fiber to your diet increases the bulk of the stool, preventing both constipation and diarrhea. If a rectocele is present, this additional bulk may prevent stool from becoming stuck. This regimen requires some patience—a minimum two to four weeks is a fair trial period to see if the additional fiber is helpful.

    Pelvic floor problems can worsen over time, making activities of daily living more and more difficult. Untreated, this condition can also set the stage for recurrent urinary tract infections, kidney disease, and other long-term problems.

    If you find you are having pelvic problems, don’t wait to address them. Here at MedStar Washington Hospital Center, we take every precaution to ensure that your visit to the doctor’s office or hospital is safe, with COVID-19 protocols in place.

    We have a full range of professionals to meet the unique needs of every patient—from gynecologists and urologists to surgeons and specially trained physical therapists. To examine you for pelvic organ prolapse, we do need to see you in person. But telehealth checkups from the comfort of your home are often useful for follow-up visits, as needed.

    Our capable and caring team will tailor a care plan that works for you.


    Unusual pelvic symptoms?

    Trust our urology team to help.

    Call 202-788-5048 or Request an Appointment

  • April 07, 2021

    By MedStar Health

    If you are part of the Black or Brown community, you may have some concerns about the efficacy and effectiveness of the COVID-19 vaccine. From historical inequity in medical research to questions about the speedy development of the vaccine, it’s valid to feel hesitant about getting vaccinated.

    Having questions about the COVID-19 vaccine is a good thing because it means you care about making the right decision. We sat down with a few of MedStar Health’s experts to gather the facts about the COVID-19 vaccine so you can make an informed choice when it comes to your health.

    If you have questions about the COVID-19 #vaccine, that’s a good thing. Get the facts from our experts on the #LiveWellHealthyBlog so you can make an informed decision: https://bit.ly/2OwCQok.

    Click to Tweet


    How can I trust the safety of the vaccine when it was developed so quickly?

    It’s true that the three currently available COVID-19 vaccines were developed quickly. Because of the grave impact of the pandemic, we were able to invest more resources into developing a speedy vaccine in order to lessen the impact of the pandemic as soon as possible. We were able to funnel more experts and money into figuring out how to move along the vaccine using mRNA technology that was already under development.

    Hasyln Hunte, Ph.D., MPH, research scientist at MedStar Health, chose to get vaccinated despite initial concerns about the safety of the virus. He says,

    “I wasn’t required to get the vaccine even though I’m in the healthcare industry. I was initially cautious about whether a political agenda might affect the science behind the vaccine. I gained confidence in the vaccine development as information around the clinical trials became available, especially when those that didn’t result in successes were shut down. That made a big difference in believing that researchers were only pursuing successful and effective avenues.”

    Vaccine researchers and developers still followed the same rigorous processes and protocols for ensuring the safety and efficacy of the vaccine. In the United States, the Food and Drug Administration (FDA) has to review and approve all vaccines after thorough testing and observation. Beyond the FDA, investigative review boards composed of diverse experts across gender, race, and subject matter expertise thoroughly evaluate and approve studies like this to ensure all concerns are heard.

    Is the COVID-19 safe for me if I…

    Whether you have allergies, are pregnant, or take medications, you may have specific questions about whether or not it’s safe to take the vaccine.

    Hopefully, you have a trusted primary care provider who you feel comfortable talking to about your unique situation. While the COVID-19 vaccine components are different than those that may be found in the flu vaccine or common food allergies, your healthcare provider can confirm that it’s safe for you to get vaccinated and answer any questions to help ease your mind.

    While pregnant women were not included in the clinical trials, a healthy mom usually translates to a healthy baby. Talk to your obstetrician or midwife if you’re pregnant or planning to become pregnant. Because pregnant women are more susceptible to complications from COVID-19, it may be in your best interest to get vaccinated.

    Which COVID-19 vaccine is most effective?

    All of the COVID-19 vaccines are effective, so it’s safe to get whichever vaccine is first offered to you. There is a limited supply of each which is why it’s helpful that there are multiple developers supplying vaccines.

    The Moderna and Pfizer vaccine double-dose series are known to be nearly 95% effective in preventing COVID-19. Taking one dose of the Johnson & Johnson vaccine has also been shown to be 100% effective at protecting you from death caused by COVID-19.

    How the vaccine can get us back to normalcy.

    We’ve seen that Black and Hispanic communities have been disproportionately affected by the virus. According to a recent report, Hispanics have lost about an expected two years of life due to the coronavirus alone. And, Blacks have lost about one and a half expected years of life. If we don’t get vaccinated, we’re going to lose. We need to protect ourselves, our families, and our communities in order to protect our legacy.

    Infectious disease specialist, Calvin Williams, MD, says, “The risks of the virus are real. And the vaccine is effective at preventing the worst outcome.” He adds that the vaccine is a game-changer because it means we can start safely meeting again without face masks. “Updated guidelines from the Centers for Disease Control and Prevention (CDC) state that those who are fully vaccinated may safely gather together indoors without masks. For many, that means family hugs for the first time in over a year.”

    While you should still follow the same safety precautions as before when you’re around people who have not been vaccinated, being vaccinated yourself means that you can begin to resume gathering with family and friends who have also chosen to get vaccinated. Dr. Williams is hopeful for the future, explaining,

    “I’m cautiously optimistic. We’re in a different position now after dealing with this for a year and the vaccine offers us a safer way out of this. We still have patients fighting for their lives and so the path forward requires us to do something. It won’t end on its own. Every one of us needs to collectively participate in getting vaccinated.”

    What to expect when getting the vaccine.

    Vaccine supply is the biggest issue right now as thousands of people are waiting on the list to be vaccinated. But we’re hopeful that supply distribution will continue to increase and we can get those folks protected.

    Rules about who can get vaccinated vary by state and county. It can be confusing to know if and when you qualify. Everyone will qualify at some point. But the best thing to do while you wait is to sign up proactively online. If you’re not tech-savvy, enlist the help of someone who is and can get you on the vaccine waiting list so when it’s your turn, you’re ready.

    Once you get the vaccine, you can expect mild side effects that demonstrate the vaccine is building up immunity in your body. There have been no serious side effects caused by the vaccine. Be sure to avoid scheduling other vaccines or immunizations around the time you expect to get the COVID-19 vaccine, as it’s intended to work without any unexpected interference two weeks before and after your final dose.

    Learn more about what to expect after vaccination.

    Getting vaccinated is a personal choice that can help move us towards the light at the end of the tunnel.

    As healthcare providers, our job isn’t to coerce or convince you to get a vaccine. We encourage you to ask questions so you can get the answers you need to make an informed decision. There’s nothing we won’t answer, and if we don’t have the answer, we will figure it out.

    Infectious disease expert Maria Elena Ruiz, MD says, “As a Hispanic woman myself, it’s hard to see so many of my Hispanic patients get COVID-19. So when I talk to them, I try to address their specific concerns. It has been a misconception that only the frail that only the elderly and the sick die. The hardest has been to see those in their prime with no comorbidities also suffer and die from the virus. Now, we need everyone to help us continue moving forward by getting vaccinated and continue being thoughtful about wearing masks with those who are at high risk and unvaccinated.”

    Angela D. Thomas, DrPH, MPH, MBA, is also encouraged, noting “This time last year, our problem was different, so we’ve made so much progress. I believe there’s a light at the end of the tunnel but we have a lot of work to do. As more vaccines get approved, as our distribution strategies advance, and as vaccine acceptance grows, we’ll get there. This is something we have to tackle together as a community, and we all have a role to play.”

    Learn more by watching our panel of experts discuss the safety and efficacy of the vaccine in the video below.


    Want more information on the COVID-19 vaccine and how to get it?
    MedStar Health is here to help.

    Learn More

  • April 06, 2021

    By Puja G. Khaitan, MD

    Do you know what and where your esophagus is? Situated just in front of the spinal cord, this muscular tube connects the mouth to the stomach. It provides a critical pathway to deliver food and drink to the stomach after we chew and swallow.

    So, it’s no surprise that a disease of the esophagus can severely impact your life. In fact, although this type of cancer accounts for just 1% of cancers diagnosed each year in the U.S. (about 18,000 cases), the esophageal cancer survival rate is grim—at least 16,000 of those affected will not survive.

    In the U.S., adenocarcinoma is the most common type of esophageal cancer. Unfortunately, because early esophageal cancer symptoms can often resemble less serious conditions, this cancer can go untreated for years.

    And its relative rarity means that it doesn’t typically receive the same level of research as more prevalent cancers. But the future looks brighter. Adenocarcinoma is associated with genetic markers, and strong research is underway to refine that science. This research may produce better tools for early detection of esophageal cancers and increase the patient’s chances of successful treatment.

    What Causes Esophageal Cancer?

    Why does cancer of the esophagus occur? Many of the causes are not yet completely understood.

    The #1 cause of esophageal cancer in the U.S. is reflux, which is commonly associated with unhealthy diet and obesity.

    Our stomach typically produces 1.5 liters of gastric acid to digest the food we eat on a daily basis. Occasionally acid may backflow from the stomach to the esophagus, where it causes irritation, inflammation, and pain—what we commonly refer to as heartburn. When reflux is left untreated, it bathes the esophagus in acidic juice. And although the stomach is resistant to acid, the esophagus is not.

    This uncontrolled reflux and constant inflammation of the esophagus then becomes a gateway to reflux esophagitis and esophageal cancer.

    Of course, the presence of gastroesophageal reflux disease (or GERD) is not a guarantee that cancer will result. But the more vigilant and aggressive we are about treating reflux, the more malignancies we can avoid.

    The other type of esophageal cancer is squamous cell carcinoma. This is more commonly associated with the consumption of tobacco, particularly when combined with alcohol. We’re not sure if alcohol has a direct effect; however, we do know that smokers tend to increase their smoking habit when they drink.

    Daily consumption of hot beverages that burn the inner lining of the esophagus, as well as of cured and pickled foods, may also contribute to the incidence of esophageal squamous cell carcinoma. The latter practice is very common in Asian cultures.

    We know that age and genetics play a role. While squamous cell cancer is more common among African Americans, adenocarcinoma more commonly affects Caucasians. Men are also more likely to be affected than women.

    Another risk factor is achalasia, a condition that occurs when the contents of the esophagus fail to empty into the stomach due to a muscular defect where the lower esophageal sphincter fails to relax. This is, in essence, the opposite of reflux. The esophagus is not meant to contain food for long periods—if food becomes lodged there, inflammation and fermentation can occur. This can indeed foster the development of cancer.

    Not as common but certainly also a risk factor is alkaline burn injury. It’s critical to keep household chemicals locked away from children who may ingest them accidentally, as swallowing an alkaline chemical like lye can cause deep burns within a child’s GI tract. This predisposes them to development of esophageal strictures and esophageal squamous cell cancer.

    Why OTC Remedies Aren’t Enough

    It’s not unusual for anyone to experience a bout of heartburn or abdominal discomfort after consuming a spicy or acidic meal or overdoing it with food and drink. In a healthy GI tract, long-lasting issues are not common, and occasional episodes can be easily managed with simple antacids. But unfortunately, millions of people do experience repeated heartburn and may self-medicate for years without medical supervision.

    Dozens of over-the-counter heartburn remedies are available, such as TUMS® and Maalox®. These are just temporary fixes and, while they provide intermittent relief, they are not long-term solutions. Prescription drugs such as omeprazole (Prilosec OTC®), esomeprazole (Nexium®), lansoprazole (Prevacid®), cimetidine (Tagamet®), and famotidine (Pepcid®) reduce stomach acid production at the cellular level and can be extremely effective against GERD. A surgical fix where the stomach is brought down into the abdomen from the chest and the lower esophageal sphincter is reconstructed is another option for reflux if medical therapy doesn’t work.

    If you experience heartburn more than twice a week, or if it persists over weeks or months, consult your healthcare professional. This condition is often easily treatable by a physician, so don’t risk trying to manage it long-term on your own.

    It is also certainly time to be evaluated by a medical professional if your symptoms have advanced to consistent pain in the upper abdomen, or if you have constant hoarseness, persistent cough, chest pain, difficulty swallowing, or unexplained weight loss.

    Over-the-counter heartburn medications should never be taken long-term without consulting a doctor. They could mask symptoms of more serious issues. More from Dr. Puja Khaitan. https://bit.ly/31jt1Ne via @MedStarWHC
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    Diagnosis

    In order to diagnose problems of the esophagus, gastroenterologists rely primarily on symptoms and endoscopy. Endoscopy is an invasive procedure by which a camera is introduced into the patient’s food pipe, allowing a thorough examination of the esophagus and stomach.

    Other diagnostic approaches can include:

    Esophagram: The patient swallows a barium fluid, and X-ray images of the esophagus are examined for abnormalities highlighted by the barium. Other imaging studies may include a computerized tomography (CT) scan, magnetic resonance imaging (MRI), or a positron emission tomography (PETscan.

    Manometry: Pressure in the esophagus is measured to gauge how well it is functioning and moving food.

    Endoscopic ultrasound: This test helps us determine how deep a tumor, once diagnosed, may have grown and if disease has spread to regional lymph nodes.

    Biopsy: This procedure allows us to collect a small amount of tissue for pathologic analysis of an abnormal mass or nodule. This helps us decide on appropriate treatment tailored to the specific diagnosis.

    Bronchoscopy: An endoscopy of the windpipe and lungs to determine if a patient’s airway has been affected.

    Cytosponge: Small enough to swallow, this testing device measures acidity and can help us identify Barrett’s esophagus, caused when the lining of the esophagus becomes damaged by acid reflux.

    Treatment

    Some pre-cancerous conditions, particularly reflux disease, can be effectively treated with medication. Barrett’s esophagus may likewise respond to medication or to ablative therapy that uses laser or radio wave energy to remove diseased tissue.

    With surgery, we can often correct precancerous problems like reflux and achalasia. In a very limited number of cases, squamous cell cancer—when discovered early—may even respond well to radiation and chemotherapy, with no need for surgery. In some cases, minimally invasive surgery—called endoscopic resection—of the esophagus is possible, depending on the patient’s overall health and the stage of the disease.

    Sometimes we discover that polyps have formed in the esophagus—polyps similar to those found in the colon, but unfortunately not as easy to remove. Occasionally, we’re able to endoscopically remove a small tumor that has not yet penetrated deeply into the walls of the esophagus.

    However, most esophageal cancers require resection, removing part or the majority of the esophagus. In these cases, we may also use chemotherapy and radiation, either in a preoperative or postoperative setting. Transplantation is not considered a viable option, as it requires suppressing the immune system—inadvisable when cancer is present.

    After removing an esophagus, the most important element to one’s recovery is how to re-establish GI continuity. The most common choice of reconstruction is using the stomach and pulling it up in the chest. This works best for lower esophageal tumors. Tumors closer to the mouth and throat present greater challenges and may even require removal of the voice box.

    In cases where the esophagus requires removal, the cancer survivor faces some serious lifestyle challenges. Most patients require a feeding tube for nutrition for at least the first few months after surgery until their oral intake catches up. For example, the patient initially cannot consume large meals, because the stomach can no longer perform its original function of storing and processing food. Survivors must instead eat many small meals throughout the day, and the type of food must be strictly managed to aid digestion.

    Clearly, esophageal surgeries are life-changing events and not without potential complications—all reasons why it’s vital to help prevent this cancer from occurring and to recognize early signs.

    How to Reduce the Risk of Esophageal Cancer

    Until we have better ways to discover and treat esophageal cancer, prevention remains our most important strategy: the more that people know the risks, the more lives we can save.

    Here are some immediate ways to reduce your risk of esophageal cancer and precancerous conditions:

    • If you smoke, now is always the best time to quit.
    • Moderate alcohol consumption, especially if you are or have been a smoker.
    • Keep your weight under control (a step which benefits your health in many other ways as well).
    • If you experience long-standing GI problems such as heartburn, indigestion, diarrhea, or constipation, be sure to consult your primary care physician or one of the GI specialists here at MedStar Washington Hospital Center.

    Our Lung & Esophageal Center team provides comprehensive care for patients with the full range of benign and malignant thoracic conditions, with a focus on diagnostics and surgical treatments. We also work closely with other specialists—dietitians, social workers, rehabilitative experts—to help each patient maintain the best possible quality of life, as they manage or recuperate from aspects of this difficult disease.


    Heartburn a daily problem?

    Reach out to our specialists.

    Call 202-788-5048 or Request an Appointment