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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • March 30, 2021

    By MedStar Health

    For decades, Deirdre Roy struggled to speak. Sore throats and chronic hoarseness plagued the 51-year-old nutritional director, and she was sometimes mistaken for a male when she talked on the telephone.

    It began at age 15 when Ms. Roy lost her voice following a severe case of laryngitis. Once she began speaking, she strained to get her words out. In her early 20s, she sought treatment from an otolaryngologist, a physician trained in diseases of the ear, nose, and throat. After being diagnosed with vocal cord polyps, or callous-like growths, the doctor removed the polyps and recommended speech therapy.

    “There was some improvement,” recalls Ms. Roy, “but it didn’t last long. Within two years, I felt the straining returning. I had to work harder and harder just to get words out.”

    As the years passed, it got so bad, she says, that co-workers accused her of yelling at them. Strangers inquired if she was a lifelong smoker.

    “I wasn’t yelling but it sounded like that because I was always struggling to talk,” explains Ms. Roy, who notes she has never smoked. “I was reluctant to answer the phone and always the last to speak up in a work meeting.”

    Finally, she made an appointment with William Gao, MD, a board-certified and fellowship-trained laryngologist at MedStar Washington Hospital Center and MedStar Georgetown University Hospital. After performing a procedure that looks at the voice box, Dr. Gao diagnosed Ms. Roy with a large residual polyp and mild vocal cord scar.

    In October 2019, she underwent surgery to correct the problem. First, Dr. Gao inserted a narrow metal tube through Ms. Roy’s mouth to expose her voice box. He then used surgical instruments to create a small flap around the base of the polyp, eventually removing the problematic tissue from the healthy tissue.

    Dr. Gao then addressed the mild vocal cord scar by using a steroid injection to elevate the scar tissue that had been preventing normal vibrations.

    Following the outpatient procedure, Ms. Roy took several weeks off work to ensure complete voice rest and gradual transition back to normal voice use. She then began working with a speech language pathologist who taught her techniques for resonant voice use and reinforcing healthy vocal habits.

    “A clear voice is something a lot of people take for granted,” says Dr. Gao. “We don’t realize how important our voice is until we lose it, or until it is difficult for others to understand.”

    Nazaneen Grant, MD, a board-certified, fellowship-trained laryngeal specialist at MedStar Health who has special training in laser surgery of the voice box, agrees.

    “It is incredibly gratifying to help people regain their ability to communicate,” she says. “Many people, even in the medical profession, do not know that we have many tools to diagnose and treat this very complex and dynamic organ—from scopes with strobe lights to lasers and injections—and much of it has developed in just the past 20 years.”

    As for Ms. Roy, she is grateful for the care she received. “I feel so lucky to have found Dr. Gao,” she says. ” He knew exactly what needed to be done. This is the best my speech has been in years.”


    Chronic hoarse voice?

    Our specialists can help.

    Call 202-788-5048 or Request an Appointment

  • March 26, 2021

    By Evan H. Argintar, MD

    While the COVID-19 pandemic dominates this year’s headlines, another health crisis continues to rage as well—the opioid epidemic.

    Opioids are narcotic drugs made from compounds found in the opium poppy or from similar chemicals synthesized in the lab, like morphine, oxycodone, hydrocodone, codeine, heroin, and fentanyl. These drugs work in the body’s nervous system or in certain brain receptors to decrease the intensity of pain. Used medically, they can be very effective in this regard.

    But in the past two decades, almost 450,000 people in the U.S. have died by overdosing on these drugs. Opioid overdoses took nearly 47,000 lives in 2018; one-third of those deaths involved prescription opioids. Many victims are in the prime of their lives—people 25–54 years old are at greatest risk for misuse of these drugs.

    The good news is that healthcare providers are playing an aggressive role in fighting this epidemic. And the overdose rate is slowly dropping, thanks to effective and committed efforts regarding awareness and intervention.

    At MedStar Washington Hospital Center, my colleagues and I are empowered to be part of this solution, as we refine new approaches to orthopedic surgery that require little or no use of prescription opioids. Recently, I authored a paper reporting the results of a study in which patients had undergone anterior cruciate ligament (ACL) reconstructive surgery. The study results detailed a novel incorporation of a long-acting local pain block during knee surgery that led to a statistically significant reduction in patients’ post-surgical use of opioids.

    What Are Opioids Used For?

    In orthopedic injuries, pain is often quite intense. Pain management plays an important role before surgery and is essential to successful rehabilitation after it. By alleviating pain, we improve healing and mobility—resulting in better results, shorter hospital stays, and reduced costs.

    For years, medical use of opioids for chronic pain post-surgery was typically endorsed as a suitable treatment. It was often felt that there was little risk of addiction if these drugs were being used to manage pain. And, although there was actually little evidence to support this belief, prescription rates increased unabated.

    Today, we see the alarming consequences for many patients—overdependence and, frequently, lethal overdosing. Other side effects of opioids for pain include troubling symptoms ranging from nausea and constipation to lethargy and slowed respiration. It has become clear that the negative aspects of these narcotics far overshadow any positives. This is why my colleagues and I are putting our efforts into safe, feasible alternatives.

    Managing Pain from ACL Surgery

    In the operating room, we’re finding new ways to employ non-opioid pain management—and to then reduce the need for opioid use as the patient recovers. During ACL surgery, I have been using an FDA-approved long-acting local anesthetic called EXPAREL®, a preparation of liposomal bupivacaine which blocks the nerve impulses that produce pain. Bupivacaine has been used as an agent for spinal block anesthesia for decades—for example, in epidurals administered to women in labor. EXPAREL® is unique in that it lasts much longer than traditional local anesthetics.

    Our study, published in the January 2021 edition of the journal Orthopedics, examined two years’ worth of outcomes in 67 ACL surgery patients. It confirmed what we already suspected: use of long-acting bupivacaine in the operating room can result in a marked decrease in the need for prescription narcotics afterwards.

    Patients who had surgery without long-acting bupivacaine had an average post-surgical consumption of 66 tablets of oxycodone, a powerful opioid. In patients for whom bupivacaine was used during their procedure, post-surgery dosage was just 10 oxycodone tablets.

    Patients in the long-acting bupivacaine study group were less likely to need prescription refills, and their average post-surgery pain levels were a full point lower. Some patients in our study required no narcotics after their procedure at all. These are compelling results that move us closer to opioid-free orthopedic surgery.

    I use long-acting bupivacaine as part of a treatment plan that includes other non-opioid agents, such as Tylenol® (acetaminophen), Celebrex® (celecoxib), and Neurontin® (gabapentin). Each of these agents works in a different way to alleviate pain. Some also target inflammation, which is beneficial to reduce stiffness and improve the effectiveness of physical therapy.

    Orthopedists are finding that decreasing the use of prescription opioids after—and even before—ACL surgery can significantly reduce a patient’s ongoing dependence on them. More from @drevanortho. https://bit.ly/38Q79Nt via @MedStarWHC
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    What Is a Torn ACL?

    The ACL is one of two short ligaments that form an X connecting the thighbone to the shinbone behind the kneecap. This connection stabilizes the knee during rotation.

    Injury generally occurs when the foot is planted and the knee rotates past the mechanical capability of the ACL. This excess force causes a pivot injury, a rupture or tear of the ligament. This type of tear is rare in mishaps such as falls or car accidents—it tends to be a sports injury. Although many types of athletes are at risk for an ACL tear, it occurs most commonly during stop-and-start action in field sports, like soccer and football.

    And it is not a subtle injury. When the ACL tears, it’s immediately apparent that something serious has happened. The tear causes pain and swelling and destabilizes the knee; most patients find themselves unable to walk unaided.

    Each year, as many as 200,000 Americans experience an ACL tear. Although it’s most common in those under 30, we’re starting to see more of it in today’s older athletes. Also, women are at slightly higher risk, for reasons we don’t yet fully understand.

    Rebuilding the ACL

    Because the ACL is responsible for providing so much stability, the knee isn’t quite the same after the ligament tears. And the force that tears the ACL can also cause additional damage to other areas of the knee (much of which we can repair or improve during ACL repair).

    When a patient’s ACL is torn, surgery is frequently the only effective treatment. Rehabilitation to strengthen the area can help, but alone it cannot fully restore joint stability. Most active and athletic people who tear an ACL want to get back in the game and, for them, surgery tends to be the best path to recovery.

    When the ACL tears, it tends to shred, due to the physical characteristics of the tissue and the tension that it’s under. Although it can be repaired, it is more commonly replaced with a bit of tendon. The donor tendon can be autografted from another part of the patient’s body, generally from the kneecap or hamstring. With allograft, another alternative, the replacement tissue comes from a cadaver. No one approach is better than the other—we evaluate each injury and patient and tailor the best approach.

    ACL surgery is generally performed using an arthroscope, a thin tube mounted with a camera and surgical instruments. The procedure requires just a few small incisions and is much less invasive than in years past, when long incisions fully exposed the knee joint.

    Although tendons and ligaments are different, once tendon tissue is attached where the ACL used to be, it transforms to behave very much like the ligament it replaced.

    ACL surgery recovery is a slow process—it may take as long as eight months. Rehabilitation is crucial to restoring stability to the knee, so managing pain and stiffness becomes essential. We generally prescribe physical therapy twice a week for two months, followed by an at-home regimen.

    Moving in the Right Direction

    As we’ve all become aware of the true dangers of opioids—and because our work can easily give a patient a path to misuse of these drugs—orthopedic surgeons realize they have a special responsibility to seek change.

    I can confidently say that most of my patients recover well without narcotic pain medications. A number of them come to me already quite aware of the risks of narcotics, and many also know that I’m committed to reducing or eliminating the use of opioids. We explain all the options and answer patients’ questions, involving them in decisions about their surgical approach and the pain management that comes after. Most are quite willing to embrace surgery without narcotics.

    When it comes to decreasing the use of opioids, things are definitely moving in the right direction. The Hospital Center is very supportive of our commitment to decrease opioid prescription and use, and my colleagues are taking a leadership role in this process. With additional studies like ours, medical professionals will understand the tremendous benefits of non-opioid treatment strategies.

    There’s no better motivator than the ability to literally improve—and often save—lives.


    Knee pain that’s getting worse?

    Consult our orthopedic team.

    Call 202-788-5048 or Request an Appointment

  • March 26, 2021

    By Calvin Thomas Williams, Jr., MD/PhD, Chief of Infectious Diseases at MedStar Union Memorial Hospital

    After a long year of adjusting to life during the COVID-19 pandemic, it’s exciting to think about what it could look like to resume normal life. But while the vaccine offers hope of a future without quarantine or face masks, it’s not quite time to throw away the health precautions. Now, more than ever, we need to remain vigilant and patient as the vaccine becomes more widely available and we can collect more data.

    In the meantime, if you’ve received the COVID-19 vaccine, you may have questions about how life can change for you. If you’re wondering, “I’m vaccinated. Now what?”, read on for answers to commonly asked questions about what’s next.

    “I got the #COVID19 vaccine. Now what?” Infectious disease expert Dr. Williams answers commonly asked questions about what’s next after #vaccination: https://bit.ly/3fuOPhp.

    Click to Tweet


    When does immunity set in?

    The Centers for Disease Control and Prevention (CDC) just released updates that you are considered fully vaccinated two weeks after receiving the second shot in the two-dose series of the COVID-19 vaccine. If you get the single-dose vaccine from Johnson & Johnson, you are also fully vaccinated two weeks after the shot. The CDC recently added that those who are fully vaccinated do not need to quarantine if they are exposed to the virus within three months and do not develop symptoms.

    Can I ditch the face mask?

    In general, it’s too early to stop wearing a face mask. Once you’ve been fully vaccinated, you will have up to 95 percent protection from developing symptoms, and almost 100 percent protection from being admitted to the hospital or dying from COVID-19, should you become infected (depending on the manufacturer of the vaccine you receive). So while the vaccine is highly effective, there’s still a chance that you could catch the virus. And, we’re still learning important information about the vaccine, like how long immunity will last and whether or not we can pass the virus to others even after we’ve developed immunity. Right now, we believe it’s still possible to be vaccinated but carry the virus. Even if you don’t have symptoms, you may still be able to transmit COVID-19 to someone else who isn’t vaccinated, although the chances are fewer than if you weren’t vaccinated.

    In addition, new variants of COVID-19 are developing across the globe in the same way other viruses adapt and change. We are unable to predict how well the current vaccines will fully protect against new variations of COVID-19.

    As a result, properly wearing a face mask is still one of the best ways you can protect yourself and those around you until we know more about the duration and effectiveness of the COVID-19 vaccines. I say “properly” because a face mask only protects you to the degree which you wear it. More recently, the CDC has recommended wearing a second well-fitted cloth face mask over a surgical mask to reduce the amount of air that leaks around the mask, which may offer additional protection.

    Stay up to date on the latest recommendations from the CDC for those who are fully vaccinated. 

    Is it safe to freely hang out with friends and family?

    The answer to this question depends on a variety of factors. Since we don’t yet know how much immunity from vaccination affects transmission of COVID-19 to others, there is still risk involved with physical touch, especially if one of the individuals you want to spend time with is not vaccinated.

    At the same time, complete isolation isn’t good for anyone, and it’s unreasonable to avoid all contact with friends and family. Ultimately, you have to weigh the risks and benefits of gathering, taking into consideration the following:

    • Is everyone in the group vaccinated?
    • Are the individuals attending at a higher risk of complications from COVID-19?
    • Will we be gathering indoors or outdoors?
    • How big is the space where we will be gathering?
    • What is the ventilation like if the space is indoors?
    • How many people will be in attendance?
    • To what degree will people be practicing safety precautions, such as wearing face masks and maintaining six feet of space?
    • What will we be doing together?

    The CDC recently announced that if you’ve been fully vaccinated, you may gather with other fully vaccinated people indoors without masks. Additionally, you can also gather indoors with unvaccinated people from one other household without masks, as long as they are not at an increased risk of developing COVID-19 complications.

    Therefore, if everyone in the group is vaccinated, then yes, you can safely gather. And, you may gather with one other household, even if they’re not all vaccinated yet. However, be aware that the risks of transmitting COVID-19 increase as the number of unvaccinated people who are gathering increases, so you should continue taking precautions if there are unvaccinated people from more than one other household in attendance. You should also take extra caution when meeting with someone who’s at an increased risk of developing complications from COVID-19, such as an elderly family member or someone undergoing cancer treatment.

    Can I travel wherever I want?

    Now is still not a great time to travel domestically or internationally, even if you’re fully vaccinated. As more variants of COVID-19 emerge around the world, it’s important to remain cautious for your safety and the safety of others. If you need to travel for business or personal reasons, continue taking safety precautions to minimize your risk of exposure or spreading the virus to others.

    Can I start frequenting indoor restaurants, sporting events, and other large gatherings?

    After you’ve been fully vaccinated, your personal risk of having a negative outcome if you get infected with COVID-19 is extraordinarily low. However, you can still contract the virus, and potentially spread it to other people who have not yet been vaccinated. For now, it’s probably best to continue avoiding medium and large crowds, especially if the venue is indoors and involves eating or drinking. It’s impossible to wear a mask while eating dinner, and it’s hard to know how good the ventilation is inside different environments, even if your seat is six feet from other tables or seats.

    Outdoor concerts or sporting events, for example, would be far safer. As always, you have to weigh the risks to yourself and others with the benefits when deciding what activities you will engage in after you’ve been vaccinated. You should continue practicing the recommended COVID-19 prevention measures, which include proper mask wearing, social distancing, and hand hygiene to help keep your risk as low as possible.

    We’re not in the clear yet, but there is hope ahead.

    Getting vaccinated is a safe and necessary step towards bringing this pandemic to an end in a way that minimizes the heavy burden the COVID-19 pandemic has on families and communities all over the world. The vaccine offers the safest path towards the day when the risks associated with many routine activities are low and we can resume life as we did before the pandemic. Until then, let’s continue caring for ourselves and one another by following public health guidelines and encouraging our friends and family to get vaccinated when it’s their turn.


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  • March 23, 2021

    By Munaza M. Akunjee, MD, Endocrinology

    Living with diabetes can bring daily challenges, and the COVID-19 pandemic has intensified concerns in the diabetic community. Although diabetes doesn’t necessarily make someone more susceptible to catching the coronavirus, it can significantly increase the risk of severe illness if one does catch it, say the Centers for Disease Control and Prevention.

    Diabetics who contract COVID-19 are more likely to be placed in the Intensive Care Unit (ICU) and intubated. And their risk of death from the coronavirus is 50 percent higher than it is for most other patients.

    Understanding the Risk

    For diabetics, moderating blood sugar is of course always essential. But it becomes even more critical during a pandemic.

    Individuals with Type 2 diabetes often have several markers of metabolic syndrome (a combination of high blood sugar, high triglycerides, high blood pressure, and obesity), making the patient more likely in general to experience inflammation, blood clotting issues, cytokine dysregulation, and immune dysfunction. Add to that a coronavirus infection that causes many of the same issues and patients with both diabetes and COVID-19 become doubly vulnerable to ill effects, both short- and long-term.

    Generally, patients with Type 1 and gestational diabetes don’t share the same level of complicating factors and risk as Type 2 diabetics and are less likely to experience issues with inflammation and clotting.

    Studies have found that people of color have suffered disproportionately throughout the coronavirus pandemic. A study in The Journal of Clinical Endocrinology and Metabolism found that Black and Hispanic patients with diabetes were three times as likely to be infected with COVID-19, and twice as likely to die.

    Research does not suggest that this is due to biological or genetic factors, but rather to dense living conditions, limited access to healthcare, and working in essential occupations, where risk of exposure is higher. If you are in one of these demographic groups, monitoring of your condition becomes even more critical.

    Medications

    Certain medications may also leave Type 2 diabetics more vulnerable to a severe case of COVID-19.

    The cells of the heart, lungs, gut, and nasal passages are lined with a protein called angiotensin-converting enzyme 2, or ACE2. The coronavirus can potentially use this protein to gain access to our cells and reproduce. Drugs that help regulate ACE2 levels are commonly prescribed for blood pressure and to protect the kidneys of Type 2 patients—for example, ACE2 inhibitors such as enalapril, lisinopril, and ramipril, or angiotensin receptor blockers (ARBs) such as losartan, olmesartan, and valsartan.

    Although these drugs are known to affect COVID-19 response, the connection is still being studied. However, until we have more data, it is not recommended that a patient discontinue any medications as prescribed by their physician.

    Managing Glucose

    If you are Type 2, any infection can make it more difficult to keep blood sugar in the desired range. COVID-19—no matter how mild the case—is no exception. For a patient feeling ill from the coronavirus, the ability and desire to eat and drink may be affected, impacting their blood sugar levels. Hormones released by the body to fight the coronavirus could raise their blood sugar as well.

    If you are a Type 2 patient sick with COVID-19, your doctor may ask you to check and record your blood sugar more frequently. Drink plenty of fluids, eat as regularly as possible, and stay with your medication regimen.

    Fortunately for the diabetic community, the current pandemic has not affected the availability of insulin, oral diabetes medications, or blood glucose testing equipment.

    Diabetes can make COVID-19 an even bigger challenge. Moderating blood sugar is always essential, but even more critical during illness, including COVID-19. Dr. Munaza Akunjee has more. https://bit.ly/38QqZsa via @MedStarWHC
    Click to Tweet

    Ketoacidosis and COVID-19

    Diabetic ketoacidosis (DKA) is a life-threatening complication that can occur when illness accompanies diabetes. When the body doesn’t have enough insulin, it breaks down fat for fuel. That process generates chemicals in the blood, known as ketones.

    Ketone production is normal and rarely a significant concern for non-diabetics. But when ketones are generated too quickly, they make the blood acidic, which can cause loss of consciousness or even death.

    If you are a Type 2 diabetic, your doctor may ask you to check your urine when you are sick, using test strips available at most pharmacies. Contact your healthcare provider immediately if the test is positive.

    Diabetics with COVID-19

    Many cases of COVID-19 go undetected because infection does not always cause symptoms. This is one reason the virus spreads so quickly. Testing positive for the coronavirus does not necessarily mean you will become sick, even if you have diabetes and metabolic syndrome. Of those who do test positive, about 80 percent experience mild to moderate disease.

    But for a Type 2 diabetic who tests positive for COVID-19, it is vital to keep blood sugar levels within the desired range, monitor for symptoms of respiratory illness or low or high blood sugar, and keep in touch with a health care provider. It’s also important to isolate, so as not to spread the virus to others.

    Blood sugar may need to be monitored more frequently than usual, and oral medications or insulin may require adjustment. The prescribing physician might temporarily discontinue SGLT2 inhibitor drugs, like canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin. These diuretic drugs increase urine output, which may contribute to dehydration and lactic acidosis (when lactic acid accumulates in the blood, causing weakness, nausea, vomiting, and even coma).

    If you are diabetic, notify your care provider or come to the Emergency Department if you experience:

    • Uncontrolled blood sugar
    • Urine positive for ketones
    • Nausea, abdominal pain, or vomiting
    • Dehydration
    • Shortness of breath
    • Rapid breathing
    • Fever greater than 100.4° F

    Telehealth options are widely available to keep in touch with your provider if you contract a mild case of COVID-19 and your doctor recommends managing it at home.

    At MedStar Washington Hospital Center

    Some cases of COVID-19 may, of course, require hospitalization. If you are diabetic and are hospitalized to treat the virus at MedStar Washington Hospital Center, we advise that you bring your personal blood glucose monitor and a list of all your medications and dosages when you check in.

    Upon your arrival, our team will assess the severity of your illness. Some patients are managed in the COVID-19 unit; more severe cases are assigned to the ICU.

    Within a patient room, the diabetic patient will most likely be able to test blood sugar using their own meter. This reduces repeated exposure between patient and staff and helps to conserve personal protective equipment.

    On the other hand, in the ICU, where insulin is delivered to the patient via IV, a nurse will check blood sugar levels every hour. Certain medications used to treat COVID-19 can cause blood sugar levels to go high or low and can slow wound healing, among other complications, so our team maintains a watchful eye on these conditions.

    For patients who take metformin to treat their diabetes, use of the medication may be halted temporarily to avoid lactic acidosis. Its use may be continued when the patient is discharged.

    Stay Safe and Healthy

    Patients with well-controlled diabetes who are hospitalized for COVID-19 recover better, with a higher survival rate. So, it’s important for diabetics to stay disciplined about their blood glucose control and reduce the risk of COVID-19 complications. Regular monitoring of blood glucose levels, adherence to all medications, maintaining a healthy weight, and following up with a healthcare provider are key to staying as healthy as possible.

    Over the past year of the pandemic, the team at MedStar Washington Hospital Center has gained considerable experience and knowledge in treating COVID-19—and that has saved lives.

    If you are visiting us on-site during the pandemic, you have our assurance that the Hospital Center is a very safe place to be. And telehealth has provided a useful tool for our diabetic patients to have timely follow-up visits with us after we’ve seen you in person.

    Our most important message to you? If you are diabetic and feeling symptoms of COVID-19, don’t delay care! We’re here to keep you healthy and safe.


    Diabetic, with COVID-19?

    Our endocrinology team can help.

    Call 202-788-5048 or Request an Appointment

  • March 22, 2021

    By MedStar Health

    John H. Sherner, MD, FCCP, didn’t require an extensive orientation when he joined MedStar Washington Hospital Center as chair for the Department of Medicine. Having spent most of his professional career in the Washington, D.C., area, Dr. Sherner has been a regular visitor to the Hospital Center for training, and has partnered with hospital faculty for educational meetings and programs. 

    “I’ve always been impressed with the energy and enthusiasm devoted to the mission of serving such a large and diverse patient population,” Dr. Sherner says. “I’m honored to now be a part of it.” 

    The Honolulu-born Dr. Sherner spent most of his childhood in Texas. Like many physicians, he chose a career in medicine, as it combined his love of science with the opportunity to work directly with people. Dr. Sherner earned a commission in the Army through ROTC as an undergraduate at the University of Notre Dame, and then trained at University of Texas Southwestern Medical School in Dallas. His next stop was Walter Reed Army Medical Center, for an internship and residency in Internal Medicine and a fellowship in Pulmonary and Critical Care Medicine. 

    Aside from a tour of duty in Iraq, Dr. Sherner has stayed close to Washington, with leadership roles at Walter Reed, the Uniformed Services University of the Health Sciences, and Ft. Belvoir Community Hospital, where he most recently served as Chief of Medicine. He’s been active in the American College of Chest Physicians and served as an executive board member of the Metropolitan D.C. Thoracic Society. 

    Dr. Sherner says that while he is still determining which areas he’ll focus on first, he is already well aware of what the Hospital Center’s Department of Medicine is capable of achieving. 

    “Obviously, we want to provide the highest quality of care,” he says. “To do that, we need an environment where our providers can do their jobs at the highest level, with systems that ensure their satisfaction and wellness. We also want to continue to grow and strengthen our standing training and research programs. The more we can do for our providers, the more we can do for our patients as well.” 

    While the coronavirus pandemic’s influence on the department’s near- and long-term practices has yet to be fully determined, Dr. Sherner has high praise for the Hospital Center’s response to date. 

    “The providers and other associates stepped up and worked extra hard, and the level of interdepartmental planning and cooperation was outstanding,” he says. “As we prepare for any future surge, we’re discussing what went well, and where we can improve.” 

    Dr. Sherner adds that the Hospital Center’s existing culture of multidisciplinary care provides an excellent foundation for evolving with both shared and discipline-specific changes and needs in the specialty treatment areas. He also hopes to bring a provider’s perspective to those efforts, remaining active as an attending in clinic, on the pulmonary consult service, and in the medical ICU. 

    “We certainly want to focus on developing more opportunities for team-oriented multi-disciplinary care, which will benefit our patients and providers,” he says. 

    Pursuing these and other objectives for the Hospital Center’s Department of Medicine will no doubt require a lot of energy, another familiar area for Dr. Sherner. He and his wife, a clinical psychologist, have twin 14-year-olds in high school. He also likes to stay active by playing tennis and basketball, and running. 

    “I’m going to be on the move a lot, for sure,” he says. “There’ll be challenges, but I’m looking forward to helping take the Hospital Center’s already outstanding reputation in medicine and patient care to even higher levels.” 


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  • March 19, 2021

    By MedStar Health

    Hemorrhoids seem to have a stigma to them, but the truth is, we all have them. It’s not uncommon for them to become inflamed and cause pain, itching, or bleeding. Many times, hemorrhoids go away on their own, but sometimes a trip to the doctor is necessary for faster relief, peace of mind, and tips to prevent them from coming back.

    What are hemorrhoids?

    Hemorrhoids are vascular cushions in the rectum that help us to control bowel function. When increased pressure causes the veins in your lower rectum and anus to swell, they can become inflamed and painful. Often this occurs as a result of:

    • Low-fiber diets
    • Straining during bowel movements
    • Prolonged sitting
    • Pregnancy
    • Obesity
    • Lifting something heavy with incorrect form

    There are two types of hemorrhoids:

    Internal hemorrhoids, which are located inside the rectum and often less painful than external hemorrhoids.

    External hemorrhoids, which are found under the skin around the anus and are generally more painful.

    Learn more about hemorrhoid symptoms.

    When is it time to seek medical care for hemorrhoids?

    Drinking more water, eating more fiber, and taking over-the-counter medications may help hemorrhoids to resolve on their own at home. However, often a doctor can help you get effective relief faster than you might on your own. And, in some cases, your symptoms could indicate a condition more serious than hemorrhoids. That’s why it’s always better to be safe than sorry and get your hemorrhoids evaluated sooner rather than later.

    Request an appointment.

    If you notice bleeding before, during, or after bowel movements.

    If you notice blood before, during, or after bowel movements, you should seek medical care. Bleeding during bowel movements may be associated with hemorrhoids, but it could also be a sign of something more serious, such as colon or anal cancer. Call your doctor so you can get an accurate diagnosis and rule out anything life-threatening. Your doctor can help you identify and address the cause of your bleeding. And if it’s hemorrhoids, they can offer treatment, relief, and suggestions to help you prevent hemorrhoids from recurring.

    If discomfort from hemorrhoids isn’t resolved within a week.

    When you’ve had persistent discomfort, pain, or itching for a week, it’s time to talk to a doctor. While some symptoms of hemorrhoids resolve on their own, others do not and can be treated by a doctor, so you don’t have to live with the daily symptoms. Your doctor can recommend treatments that range from the conservative, like dietary and behavioral changes, or in-office procedures, such as rubber band ligation, to more invasive approaches like surgery.

    If your symptoms continue worsening.

    While many home remedies may provide temporary relief of inflammation, pain, or discomfort caused by hemorrhoids, they don’t necessarily cure the issue. That’s why it’s important to seek medical care for hemorrhoids, especially if your symptoms get worse. On top of treating your hemorrhoids, your doctor can help you reduce the chances of another hemorrhoid flare-up by discussing things like your diet, staying hydrated, and changing your bathroom habits.

    If you notice a bulge, you may have a prolapsed hemorrhoid.

    If an internal hemorrhoid becomes severely inflamed, it can prolapse, or fall outside of the anus. Many times it will retract on its own but not always. If it can’t easily be pushed back in, or it causes pain or bleeding, early hemorrhoid treatment from a doctor is important.

    If you’re not certain your discomfort is caused by hemorrhoids.

    When you have bleeding, discomfort, or pain in the anal region, it could be a sign of an inflamed hemorrhoid. Or, it could indicate that something else is wrong. This is especially true if you don’t have a history of hemorrhoids. That’s why it’s always better to play it safe and see a doctor, as they can accurately diagnose the cause of your symptoms. It’s much better to have an expert confirm that you don’t have something more serious like cancer than to avoid a hemorrhoid treatment just because you’re uncomfortable seeking care.

    We all have #Hemorrhoids, but if yours become painfully inflamed, a doctor can help. On the #LiveWellHealthy blog, colorectal surgeon Dr. Nicole Chaumont shares 5 signs that indicate you should seek care for hemorrhoids: https://bit.ly/2OQFntt.

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    What to expect at your doctor’s visit.

    Whether you see a primary care doctor or a colon and rectal specialist, you can expect that your medical provider will conduct a thorough evaluation that includes:

    • A review of your medical history
    • Discussion of your symptoms
    • Physical examination

    During your appointment, your doctor will ask you detailed questions about what makes your symptoms better or worse. It’s important to be honest and direct so that they can identify what’s causing your inflamed hemorrhoid.

    In most cases, the physical exam will require an internal exam of your anus and rectum. If that does not clarify the cause of your symptoms, or if you are at a high risk for cancer, your doctor may need to perform a colonoscopy to make sure your pain or bleeding isn’t caused by a more complex health issue.

    Regardless of what sends you to the doctor for hemorrhoid treatment, know that it’s as common as getting other routine care. Prompt treatment can alleviate unnecessary pain and discomfort so if you think you have hemorrhoids, don’t delay your care.


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

    Request an appointment.