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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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  • September 02, 2015

    By MedStar Health

    ASE's 2015 Physician Lifetime Achievement Award: Fascination with Heat Echo Leads to a Four-Decade Career

    For nearly four decades, Steven Goldstein, MD, MedStar Heart & Vascular Institute’s director of Non-invasive Laboratory, has been a fixture in the field of echocardiography. A longtime member of the American Society for Echocardiography (ASE), Dr. Goldstein has organized and spoken at dozens of conferences, co-edited a textbook and served on numerous committees.

    So when ASE announced that Dr. Goldstein would receive its Physician Lifetime Achievement Award for 2015, only one person seemed surprised— Dr. Goldstein himself.

    “I couldn’t believe it,” he says. “I’m honored, of course, but I can think of several other people who, in my mind, are far more deserving.” But to fellow professionals like Neil Weissman, MD, president of ASE and head of MedStar Health Research Institute, the choice is no mystery.

    “Steve is one of those quiet people who enjoys teaching, answering ques- tions and sharing information,” says Dr. Weissman. “Multiply that over a whole career, and you have someone who has had a positive influence on literally thousands of cardiovascular physicians, both in the U.S. and internationally.”

    A native of Louisville, Ky., Dr. Goldstein’s passion for echocardiography was sparked when he took a break prior to his fellowship at Georgetown University in 1975 to spend a year at St George’s Hospital in London. There, he worked with cardiology pioneer Dr. Aubrey Leatham and ultrasound physicist Graham Leech.

    “I became totally fascinated with heart echo under their mentorship,”Dr. Goldstein recalls. “The technology was in its infancy, of course, but its poten- tial as a non-invasive means to study and diagnose heart conditions was clear.”

    Returning to the U.S. to complete his fellowship, Dr. Goldstein accepted an offer from Washington Hospital Center, which was in the process of expanding its cardiology department.

    “Dr. Leatham had advised me to go where there are good heart surgeons, so I came here,” he says. “It was marvelous decision.” Dr. Goldstein considers himself blessed to have developed the Hospital Center’s heart echo capabilities in step with advances in technology.

    “There’s been remarkable progress over the years,” he says. “Once we could detect only fluid in the heart, we now have tools like transesophageal echo and 3D echo, which can help support and guide procedures in the OR and cath lab.

    Having turned 71 in May, Dr. Goldstein shows no sign of slowing down. In addition to his work at the Hospital Center, he maintains an active speaking schedule and is revising an edition of his ASE textbook that will be more than three times the length of its original version.

    “I hope to work until I’m 75, or as long as I feel I can contribute,” he says. “To me, all the fun and interesting things that turn up in the heart come through an echo lab. And there’s no place I’d rather be.”

  • September 02, 2015

    By MedStar Health

    An inaccurate diagnosis at another hospital almost cost Steven Jones his life. Fortunately, his wife, medical director of Washington Cancer Institute at MedStar Washington Hospital Center, knew who to call. Within 12 hours, Jones was transferred, re-diagnosed, stabilized and had undergone surgery to repair his mitral valve. Both Jones and his wife, Sandra Swain, MD, FACP, credit the quick, round-the- clock expertise of Medical and Coronary ICUs and MedStar Heart & Vascular Institute (MHVI) team with his complete recovery.

    In the early hours of Wednesday morning, Feb. 25, Jones, 61, retired Treasury Department law enforcement executive, was using strong chemicals to clean up after a kitchen remodeling. His heart suddenly started pounding. “I went upstairs and took some aspirin,” he recalls. “I work out three times a week, have no health issues and—in typical fashion—was in complete denial anything could be wrong.” He went to bed not terribly concerned, but woke his wife to tell her what had happened. Soon he had difficulty breathing, and she said, “I can hear your lungs gurgling. We’re going to the hospital.”

    They arrived at a nearby hospital around 3 a.m. and told the staff he’d probably inhaled some noxious fumes. Jones was given a nebulizer and an EKG. His condition deteriorated rapidly. He lost consciousness and was placed on a ventilator. Increasingly worried, Dr. Swain called colleagues at the Hospital Center for advice and soon started working with Andrew Shorr, MD, medical director, Medical Intensive Care Unit, on a transfer that occurred Thursday afternoon.

    Dr. Shorr and Chris Woods, MD, were working when Jones arrived. “He was in shock,” says Dr. Woods. “His diagnosis was chemical inhalation, but that diagnosis didn’t fit his symptoms.” Dr. Shorr agrees, “His physiology was inconsistent with the diagnosis, so we backed up and started over.”

    About 6 p.m., critical care fellow Adnan Hussain, MD, who was also monitoring Jones, says, “His oxygen levels and blood pressure were really low, even though he was on several medications.” By careful auscultation, Drs. Hussain and Woods heard a heart murmur. Dr. Hussain contacted on-call cardiology fellow Wunan Zhou, MD, who confirmed the murmur, and did a bedside trans- thoracic echocardiogram. She identified a valve problem, but wanted a more definitive test.

    Dr. Zhou contacted on-call echocardiologist Rachel Marcus, MD, who did a transesophageal echocardiogram (TEE) at 10 p.m., which showed clearly severe, acute mitral valve regurgitation. She says, “It was consistent with the chest X-ray findings showing focal/unilateral pulmonary edema likely related to the mitral regurgitation jet.”

    Jones would need surgery fast. Cardiac surgeon Ammar Bafi, MD, an expert in mitral valve repair, sched- uled emergency surgery for 6:30 a.m., but Jones was in cardiogenic shock—his blood pressure was critically low and he couldn’t breathe on his own. He needed an intra-aortic balloon pump to stabilize his circulation to withstand the surgery. Interventional cardiologist Robert Lager, MD, came in at 2 a.m. to insert the pump. He says, “It’s not at all unusual to come to do a procedure when I’m on call. What is unusual about this case is that the chemical inhalation diagnosis was an utter red herring, and the real cause was discovered by the CCU team here, leading to the subsequent emergent procedures.”

    Dr. Bafi says, “Mitral valve repair is something I have a lot of experience in. The beauty of repair is that patients keep their own valve. We removed the part of the valve with the broken mitral cords, and reconstructed it using his own tissues. The only foreign material is a ring to narrow the opening so the valve leaflets close perfectly. Jones probably progressed from minimal leaking of the valve to rupturing four cords with sudden torrential mitral regurgitation. I’ve encountered this situation before, but it’s quite rare.

    “Jones was very lucky,” he continues. “Because we’re an advanced cardiac and vascular center, we can mobilize quickly, 24 hours a day. Jones could not have survived another 24 hours. And finally, he’s fortunate we were able to repair, rather than replace, his valve.”

    Dr. Swain has a newfound understanding of the hospital where she works. “I have great insights as a patient’s family member,” she says. “The Heart & Vascular Institute is a fabulous place from A to Z, with a highly coordinated team of very professional, extremely engaged passionate people. From the MedSTAR Transport team to the highly trained nursing staff, I was just amazed. But it was a very lonely night for me, extremely lonely. I was told the mortality rate was 20 percent from this surgery, and I thought I would lose him. But Dr. Bafi gave me confidence, and I knew from every- one else that the whole surgical team was exceptional.”

    Dr. Bafi gave Dr. Swain the good news after the three- hour surgery. She recalls, “He said, ‘Yes, we were able to repair the valve, and his heart was so happy with the repair, he flew right off the table!’”

    Jones doesn’t remember many of the people who helped save his life, only those after he woke up. “Every one of them showed their compassion and care,” he says. “I am forever grateful that Dr. Bafi was able to repair my valve. I’m able to return to my normal life without a litany of medicine or restricted diet. I was on the edge of death and without batting an eye they figured it out, fixed it, and within days, I was up walking around.”

    18 Hours from Potentially Fatal, Inaccurate Diagnosis to Recovery 

    AndrewSchorr_3918Final

    Thursday, 12 p.m.Dr. Shorr helps arrange transport to MWHC

     

    ChristianWoods_1867Final

    Thursday, 4 p.m.Jones is admitted to the MICU at MWHC.Drs. Shorr and Woods begin questioningdiagnosis of chemical inhalation.

     

    Adnan_Hussein_3855Final

    Thursday, 6 p.m.Drs. Hussain and Woods hear heart murmor.

     

    WunanZhou_7831Final

    Thursday, 8 p.m.Dr. Zhou confirms heart murmor anddoes a bedside TTE. Suspects heartvalve problem.

     

    Rachel_Marcus_4102Final

    Thursday, 10 p.m.Dr. Marcus does TEE and confirms severe mitral valve regurgitation.

     

    RobLager_3733Final

    Friday, 2 a.m.Dr. Lager inserts baloon pump to stabilize Jones.

     

    Bafi_3001Final

    Friday, 6:30 a.m.Dr. Bafi repairs mitral valve.

  • September 02, 2015

    By MedStar Health

    Endovascular Iliocaval Reconstruction Heals Debilitating Wounds

    For years, the 38-year-old patient suffered with heavy, swollen lower extremities resulting in chronic venous ulcers lasting several months. The debilitating wounds required compression wraps, dressing changes and antibiotics when needed. After seeing several physicians, many of whom believed cellulitis was the cause, the patient was referred to MedStar podiatric surgeon John Steinberg, DPM. Though the wounds healed faster under Dr. Steinberg’s care, the cause of the ulcers remained uncertain. Dr. Steinberg enlisted the help of MedStar Heart & Vascular Institute (MHVI) vascular surgeon Steven Abramowitz, MD, RPVI. Dr. Steinberg relayed the patient’s history, which included a serious accident more than a decade earlier.

    “When I learned this patient had a history of trauma, my first thought was he may have had an occluded inferior vena cava (IVC) filter. IVC filters are often placed after trauma for pulmonary embolism prevention and can be missed or lost in follow-up care,” says Dr. Abramowitz.

    Dr. Abramowitz was correct. The patient had been in an accident in 2003 resulting in a broken pelvis, collapsed lung and internal bleeding. He had been treated with a non-retriev-able prophylactic IVC filter. A CT scan revealed an occluded filter, located in the inferior vena cava just below the patient’s kidneys. The device was completely embedded in the wall of the patient’s vessel. Removal would risk of hemorrhage or vessel rupture.

    Dr. Abramowitz explained to the patient about endovascular iliocaval reconstruction, an effective treatment in vena caval stenosis and occlusion.

    The two-stage procedure began with thrombolytic therapy to soften the thrombus, administered via two puncture sites in the popliteal vein, located behind the knee. Six hours later, Dr. Abramowitz used these access sites and wires, threaded beyond the occlusion, to start reconstruction. He deployed a balloon to disrupt the metal of the old filter. He then placed a large inferior vena cava stent with extensions into each iliac vein (referred to as a double-barrel reconstruction) and deployed additional stents to reconstruct the vessels down to the femoral veins. In total, he placed five overlapping stents.

    Dr. Abramowitz says improvements in blood flow are almost immediate. “If a patient makes it over the initial hurdle, long-term results are good,” he explains.

    Though it took several months for his ulcers to heal, the patient reports he has had no recurrence of venous ulcers. He also notes significant reduction in the swelling of his lower legs, and no longer needs pain medication.

    Currently, Dr. Abramowitz is the only physician at MHVI performing endovascular iliocaval reconstruction. “It is a new procedure and requires good patient indication,” he says. This patient was so young, he will likely see a very long benefit.

  • September 02, 2015

    By MedStar Health

    Ignoring Cornorary Artery Disease Signs Could Have Been Devastating

    The symptoms, at first, were subtle and easy to dismiss. Burning and chest discomfort—likely acid reflux. A nagging ache in the left shoulder—probably due to past rotator cuff surgery. And for Richard Kief, senior vice president and Chief Philanthropy Officer of MedStar Washington Hospital Center, the symptoms only occurred when he rode his bike. As soon as the 63-year-old stopped exercising, the symptoms disappeared.

    As time passed, Kief, an avid cyclist who routinely logged 25 to 40 miles several times a week, noticed the symptoms lingered longer and sometimes occurred at bedtime. He also found it increasingly difficult to ride through the pain.

    Finally, during a ride with former teammates last October, Kief realized he could barely keep up the pace for 10 miles. “The burning, the shoulder pain, it was just too much,” he recalls. “One of my teammates told me I should really get this checked out.”

    A hospital meeting a few days later involving Stuart F. Seides, MD, FACC, gave Kief the opportunity to share his symptoms with the physician executive director of MedStar Heart & Vascular Institute (MHVI). Dr. Seides recommended blood work and a stress test, both of which were inconclusive, but not enough to deter the experienced cardiologist from further investigation.

    “I continued to be troubled by the character and nature of his symptoms even though we didn’t have clear guidance as to what was going on,” Dr. Seides recalls. “So we proceeded with a cardiac CT that showed extensive coronary artery disease.”

    Armed with this knowledge, interventional cardiologist Augusto Pichard, MD, performed a cardiac catheterization. “I woke up in the cath lab and Dr. Pichard told me, ‘Richard, we’re finished. We found the problem, we’re admitting you tonight and you’re having surgery tomorrow,’” Kief recalls. “I was surprised,” he continues, “but I knew I was in good hands.”

    Specialists at MHVI have high-level skill in both percutaneous coronary intervention and coronary artery bypass grafting so the specific mode of revascularization is customized based on individual patient circumstances. Mr. Kief’s anatomy strongly favored a surgical approach.

    Early the next morning, Paul Corso, MD, chairman of Cardiac Surgery, performed a triple bypass, creating new pathways around the severe blockages in Kief’s left main and right coronary arteries, as well as the left circumflex artery.

    Kief’s overall fitness supported a quick recovery and after four days in the hospital, he returned home. He began taking slow, short walks until he started cardiac rehabilitation, a customized program that gradually increases exercise and teaches patients to monitor their heart rate and recognize cardiac symptoms.

    “People need to be attentive to all symptoms and seek advice when needed,” stresses Dr. Corso. “For most men, especially those who are active and athletic, if they feel a little something, they think it can’t be anything serious. But in heart disease, little symptoms can be very important. Richard is a very lucky man.”

    Kief agrees. “I am so fortunate this was caught in time,” he says. “It was fortuitous that I had that conversation with Dr. Seides when I did and that I was in the right place at the right time. We have the best of the best at MHVI, and I can now speak first hand to that.”

    Cardiac Rehabilitation Improves Outcomes

    RichardKief_1246Final

    Cardiac rehabilitation is a medically super- vised program that helps improve the health and well-being of people with heart problems. Typically, the program includes 36 sessions and is beneficial for people of all ages in terms of improving health and preventing future heart problems.

    “The American Heart Association/American College of Cardiology guidelines recommend participation in a comprehensive outpatient cardiac rehabilitation as a Class I recommendation for all patients who have an acute coro- nary syndrome or who have undergone coronary artery bypass grafting,” says Ana Barac, MD, PhD, FACC, medical director of the cardiac rehabilitation program at MedStar Washington Hospital Center.

    “There is plenty of evidence this leads to better outcomes and decreases the chances of subsequent myocardial infarction or death for patients who have had revascularization procedures, including both stents and cardiac bypass,” says Dr. Barac.

    The program, located at Trinity Washington University less than a mile from the Hospital Center, offers patients an individualized program that oversees exercise and cardiovascular endurance, all while under the trained eye of an exercise physiologist, physical therapist and physician. Heart rate and blood pressure are monitored during each session, offering patients added assurance should they experience any concerning symptoms.

    In addition to physical exercise on a treadmill, stationary bike or rowing machine, cardiac rehabilitation also includes an educational component with nutrition counseling and patient education on how to monitor heart rate, symptoms and pain.

    Cardiac rehab also partners with a patient’s cardiologist, alerting them to any potential issues. For patients with high blood pressure, printed reports that show dynamic blood pressure with increased workload can be faxed to a patient’s cardiologist, often a helpful tool for physicians in tailoring therapies.

  • August 12, 2015

    By MedStar Health

    New Innovative Procedures for Difficult Diseases

    The procedure is quick, inexpensive and has a 90 percent cure rate for some patients.

    Fecal Microbiota Transplantation, or FMT, is a hot topic in consumer medical literature. In fact, not since a former NBC News personality had a colonoscopy on live television 15 years ago has anything generated as much interest, believes I. David Shocket, MD, a MedStar Washington Hospital Center gastroenterologist with 26 years of experience.

    “I put FMT right up there with some of the big events in the field of gastroenterology,” he says. “When Katie Couric got a colonoscopy, it was mind-boggling, the number of people who got colonoscopies. But this is huge too, and will take off, once it’s approved.”

    Originally an ancient Chinese remedy known as “yellow soup,” FMT is a procedure that helps restore normal flora to the gastrointestinal tract, by transplanting stool from a donor by colonoscopy, endoscopy, sigmoidoscopy or enema. Currently considered an experimental treatment by the Food and Drug Administration for patients with Crohn’s or other Inflammatory Bowel Diseases (IBD), doctors may provide FMT to patients with Clostridium difficile infections, as long as the treating physician obtains informed patient consent. This position follows a January 2013 New England Journal of Medicine randomized study, which showed a 94 percent recovery rate for those who underwent FMT, compared to less than a third of patients who recovered when given vancomycin.

    “When you see the results it’s astounding,” says Dr. Shocket. “For C.diff it is absolutely amazing. There is no drug that can compete against it.”

    That was the case for a local college student who recently underwent FMT in January. After initially contracting C.diff after taking antibiotics for recurrent sinusitis and ear infections, the student was prescribed varying antibiotics to cure the infection, including FlagylTM, Bentyl and two tapering courses of vancomycin. While the patient would experience initial relief with antibiotic treatment, the C.diff returned four different times.

    After more than a year of struggling with diarrhea, weight loss and overall malaise, the student was willing to try anything, including FMT from a screened donor. She said she noticed significant improvements within the first two days after FMT, which was administered by colonoscopy.

    On a recent follow-up visit to Dr. Shocket, who did not perform the FMT but follows the patient in clinic, repeat stool testing was negative for C.diff.

    Crohn’s and IBD

    While the FDA has not approved FMT for uses outside of C.diff, clinical trials are underway for Crohn’s and other inflammatory bowel diseases. Ira Rabin, MD, vice president, Medical Operations, is part of one such trial. Eleven years ago, Dr. Rabin developed Crohn’s disease after taking an antibiotic for bronchitis. He had a fecal transplant in June 2014, and is awaiting the results of the trial.

    According to Dr. Rabin, the FMT was no different than a routine colonoscopy. “Two hours after having it done, I was on an airplane, and I was back at work the next day,” he says.

    While Dr. Rabin admits his Crohn’s is generally well-controlled by diet and probiotics, he has noted clinical improvement after the transplant. He also encourages others who suffer with IBD to talk to their doctor, about whether they would be a good candidate to pursue FMT.

    “People should be open to it,” Dr. Rabin says. “There is no aspect about it I regret, and I would do it again if needed. And, if people are sick enough,” he adds, “all the preconceived notions that people may have about this will go out the window. I believe this will become a standard treatment for C.diff.”

    An Infectious Disease

    A spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins, C.diff can cause nausea, abdominal pain, loss of appetite, fever and watery diarrhea. Generally, the elderly and those with compromised immune systems are most susceptible to the infectious disease. According to the Centers for Disease Control and Prevention, C.diff was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011.

    Glenn Wortmann, MD, director, Infectious Diseases reports most people who acquire C.diff respond well to initial antibiotic treatment. Approximately 15 to 20 percent will suffer a relapse, he notes, and most of those patients will recover with a second course of antibiotics. FMT, he explains, is limited to people who have failed repeated traditional therapies for C.diff.

    “I do foresee seeing the Hospital Center doing this down the road,” he says. He is also hopeful that the bacteria from stool can be harnessed and eventually designed to be taken in other formats.

    Gregory J. Argyros, MD, MACP, FCCP, sr. vice president, Medical Affairs and Chief Medical Officer also embraces FMT. “C.diff is becoming an increasingly common infection,” he says. “It can happen to anyone with exposure to antibiotics, and can be a serious and life-threatening disease.”

    “This is a great example of thinking outside the box,” he continues. “What initially may seem like an idea that is way out there may truly have life-saving benefits. I think we will be seeing more and more of it in the future.”

    For more information about FMT,
    please call 202-877-3627.

    What is FMT?

    FMT, or Fecal Microbiota Transplantation, is a procedure in which fecal matter is collected from a tested donor, mixed with a saline or other solution, strained and placed in a patient, by colonoscopy, endoscopy, sigmoidoscopy or enema. The purpose of FMT is to replace good bacteria that has been killed or suppressed, usually by the use of antibiotics. The elimination of good bacteria causes bad bacteria, specifically Clostridium difficile, to over-populate the colon. This infection causes a condition called C.diff colitis, resulting in often debilitating, and sometimes fatal diarrhea.

  • August 11, 2015

    By MedStar Health

    In Spring 2013, we interviewed three incoming residents: Jason Chen, MD, Surgery; Guillermo Rivell, MD, Internal Medicine; and Alex Shuster, MD, Emergency Medicine, who talked about their expectations for their residencies—their goals, fears and dreams. Last spring, they gave candid interviews about their first year. Here is an update on their second year.

    Year Two

    “The second year in Internal Medicine is not necessarily easier,” says Dr. Rivell. “You aren’t taking care of minutia but you definitely have more responsibility and accountability. That is hard. It's also a challenge running a team because of the fine balance between being supportive, congenial, and holding people accountable for their actions.”

    Dr. Shuster agrees. “Every year is challenging in a different way. This year, we had some of the key knowledge we need, but with that knowledge comes more responsibility. The biggest challenge I’ve found in the ED is teasing out a patient’s symptoms, and differentiating between a chronic, non-life threatening problem with one that could be a very serious heart attack or pathology. It's not always as obvious as you think.”

    “The second year is a big step from the first,” adds Dr. Chen. “Less paper and floor work, and more OR time. That has been enjoyable, but what is harder is more hours and responsibilities. The hours can be really long, so sleep deprivation can get to you. My eating habits have worsened and workouts have declined; the baggy clothes can hide a lot.”

    “A major challenge,” he continues, “is now learning to take on more leadership roles, delegating to your juniors and teaching them what you learned your first year. Looking back, I realize how difficult I found prioritizing. You're told, ‘You need to do A, B, C right now,’ but honestly, maybe only A should be done first. This year, you also learn to work more efficiently. Last year I took 20 or 30 minutes to interview patients, when it can easily be done in 10. But you've got to go through that.”

    Outside the Hospital

    All three residents love Washington, D.C., and try to enjoy city life in their free time. Dr. Rivell says, “My wife and I try to venture out, but we always circle back to the same few restaurants: Cuba Libre, Umi Sushi, Beau Thai; Cava supports me during my night shift rotations.”

    Dr. Chen celebrated his 30th birthday on 24-hour call at Children's National Health System, but when he does get out, his favorite restaurant is Izakaya Seki. He took his fiancée there on their first date. “They have an amazing miso-based grilled bass, and they do tempura really well; great noodle and rice dishes,” he says. He’s moved closer to the hospital, “so now my bike ride is half a mile instead of a mile. It's nice to get that extra five minutes of sleep.”

    Dr. Shuster also lives nearby, in the U Street area. The commute, to the Hospital Center and Georgetown, is about 12 minutes by car in each direction. “I don't have a lot of free time,” he says, “Big things are exercise, movies and sleep. I like 14th Street a lot, great bars with some nice rooftops, like Marvin Restaurant on 14th and U.”

    Year Three

    “In my third year,” says Dr. Chen, “I'm looking forward to operating more and working with attendings, learning how to quickly assess and develop a plan for surgical consults. I expect to mature as a young surgeon, and develop more leadership skills.”

    Dr. Shuster says, “In our third year, instead of seeing individual patients, we’ll learn how to run a department, help manage the team and prioritize studies based on cost, time and doing what's right for the patient.”

    Looking Ahead

    Dr. Chen has three more years as a surgical resident, while Drs. Rivell and Shuster will complete their residencies at the end of next year. Dr. Rivell plans to apply for a hematology-oncology fellowship upon graduation. Dr. Shuster says he hopes to stay in D.C. He says, “I was born and raised here, and really like the D.C. area, and there are so many great hospitals here.”

    Dr. Chen says, “I have a strong sense of serving the country where it needs me most—general surgery—but am also drawn to breast oncology. You develop a strong relationship with the patients. Some surgeons prefer to operate only; I like the hand-holding. I like learning the story, what the patient’s life has been. Also, you’re collaborating with radiologists, pathologists, medical oncologists, plastic surgeons and other providers to determine the plan of care. It's very gratifying.

    Advice to First Year Residents

    “My advice,” says Dr. Rivell, “is that you should understand not all octogenarians should be considered comfort care patients. Find out what their lives were like before they came to the hospital.”

    “Roll with the punches,” says Dr. Chen. “Some surgeons are demeaning and patronizing, but that should drive you to get better. I don't completely resent this negativity in teaching. In surgery, the wrong move can be lethal, so a harsh reprimand is sometimes necessary to learn quickly. Every day, you've got to read your surgical textbook, and ask yourself, ‘what could I do better?’”

    “Being a resident can be such a humbling experience,” adds Dr. Shuster. “It's tough to compare yourself to someone who's been practicing medicine for 30 years, so you have to have an appropriate set of expectations, but only be competitive with yourself. There is so much to learn, so try to be open to feedback. The more you can listen, the faster you grow, and the better you become.”

    Jason Chen, MDSurgery

    30, engaged; lives in Columbia Heightsfrom San Mateo Valley, Calif.BS in Molecular Biology, University of California at BerkeleyMD, Vanderbilt Medical School, Nashville, Tenn. 

    guillermorivell_3753 

    Guillermo Rivel, MDInternal Medicine

    32, married; lives in Adams Morganfrom Augusta, Ga. BS in Biology, Wake Forest University, Winston Salem, N.C.MS in Biomedical Research, Colegio de Medicos, Pamplona, SpainMD, MedicalCollege of Charleston 

    resident Alex Shuster, MD 

    Alex Shuster, MDEmergency Medicine

    29, single; lives in the U Street area from McLean, Va.BS in Cognitive Science, University of VirginiaMD, Georgetown University Medical School