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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 05, 2021

    By Glenn W. Wortmann, MD

    The use of monoclonal antibody therapy has proven promising in the treatment of many diseases—for example, in carrying chemotherapy or radiation agents directly to cancer cells, or in reducing inflammation from rheumatoid arthritis, ulcerative colitis, Crohn’s disease, and other medical disorders.

    And the good news for patients with early-stage COVID-19? Scientists have worked to develop a monoclonal antibody therapy that can fight the coronavirus, and certain treatment agents have been granted Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA).

    The EUA has spurred healthcare organizations, including our team here at MedStar Health, to develop robust programs to administer these treatments. The currently authorized antibody treatments show promise, and we expect more and better treatments soon—treatments that will give us even stronger, more effective defenses against future pathogens, the bacteria and viruses that cause disease.

    What Are Antibodies?

    Antibodies are proteins, the substance of the body’s immune response. The body models its antibody proteins to recognize and target the unique protein signatures of certain pathogens, foreign invaders that infiltrate the bloodstream and attempt to break into healthy cells. When an antibody spots a pathogen, it grabs hold of the invader and sounds an alarm to activate other components of the immune system and destroy the pathogen.

    Over time, as humans are exposed to various diseases, the body builds the antibodies it needs to fight them and retains them in case a disease tries to return. This is how we gain immunity to measles, mumps, chickenpox, and other diseases that generally appear once in a lifetime.

    But making these antibodies takes time. The infecting pathogen can make us very sick until our body is able to make and deploy enough antibodies to fight back. With a new infectious disease like COVID-19, patients may suffer serious ill effects before their immune systems are able to mount an effective defense. And some people, of course, do not survive.

    With antibody therapy, we’re able to give the body a shortcut, boosting its immune response by introducing antibodies that are pre-assembled and pre-programmed to fight the coronavirus.

    Monoclonal antibody therapy can reduce the severity of COVID-19 for patients in the beginning stages of the virus. Details from Dr. Glenn Wortmann. https://bit.ly/30mDtDn via @MedStarWHC
    Click to Tweet

    Effective Treatment Approaches

    The pathogens that present the greatest challenge to medicine are new ones like COVID-19, against which we have no immunity. This is why the novel coronavirus has spurred a global health pandemic—our bodies were not prepared to fight it.

    Antibiotic drugs target bacteria directly and have changed world health for the better in many significant ways. But effective antivirals are harder to make. Viruses are composed of the same stuff as living cells but, unlike bacteria, they’re not a life form in the traditional sense. That makes them difficult to eliminate using drug therapy.

    To treat an infectious disease like COVID-19, we can either target the virus directly or help the body develop its own defenses against it. Vaccines, antibody therapy, and plasma therapy all deliver more antibodies to our front line of defense, arming the body to fight the disease.

    • Vaccines accomplish this by teaching the body to make antibodies. The newly introduced Johnson & Johnson therapy is a viral vector vaccine that uses a modified virus—one that’s different from the targeted virus—to serve as a carrier of the vaccine; it instructs the cells of the body to make a protein from the targeted virus.

    On the other hand, COVID-19 vaccines from Pfizer and Moderna introduce a bit of synthetic genetic material, mRNA, to the body’s cells, enabling the cells to manufacture a harmless piece of COVID-19 protein.

    In each of these vaccines, the particle introduced cannot cause illness, but instructs our own cells to make a virus protein so that the body’s immune system learns to recognize and block the real thing.

    • In the case of plasma therapy, the blood plasma of a patient who successfully fought the pathogen is administered to another patient. The recipient’s immune system uses it to learn to fight the same pathogen.

    • Monoclonal antibodies are laboratory-developed and have an effect similar to a vaccine in that antibodies are developed to boost our immunity. But instead of preventing infection by prompting the body to create new antibodies like a vaccine, the monoclonal antibodies are used to help treat an infection which has started.

    Antibodies and COVID-19

    Emergency use is granted to experimental drugs or drugs under development that are shown to be safe and demonstrate some level of effectiveness in clinical studies. In the study supporting emergency use of monoclonal antibodies, the patients who received the antibodies were slightly less likely to need hospitalization, compared with patients who did not receive them.

    In November 2020, the FDA cleared two monoclonal antibodies for COVID-19 treatment: bamlanivimab, as well as a “cocktail” treatment of casirivimab and imdevimab. Both treatment approaches are currently available to early-stage COVID-19 patients at MedStar Washington Hospital Center, MedStar Southern Maryland Hospital Center, and MedStar Harbor Hospital.

    FDA guidelines recommend monoclonal antibody treatment only for the following patients who have tested positive but who are not hospitalized due to COVID:

    • 12 years or older

    • Weigh more than 88 pounds

    • Experiencing mild to moderate symptoms such as cough, fatigue, loss of appetite, and fever for fewer than 10 days

    • At risk to get very sick from COVID-19

    Currently, we have no real data on use of monoclonal antibodies to treat pregnant women who are sick with COVID-19. Consultation with a healthcare provider will help expectant moms to determine the best treatment approach, depending on individual risk factors.

    Are there instances when antibodies are not recommended? Yes, antibodies have little effect if a patient’s case of COVID-19 is advanced enough to warrant hospitalization. By the time a patient is sick enough to need inpatient treatment, they may already be experiencing the massive inflammatory response that makes advanced COVID-19 so dangerous. At that point, the antibodies would have little effect.

    The Process

    When a high-risk individual contracts COVID-19, the process to receive antibodies at our hospital begins with a one-on-one consultation with one of our providers, followed by appointment scheduling for those who qualify for the treatment.

    When the patient arrives for antibody treatment, a mask is required. We meet patients at the door to the hospital and escort them directly to our infusion center.

    Antibody infusion takes about an hour. We then observe the patient for another hour or so, to avoid the rare allergic reaction. Down the road, we hope to be able to shorten infusion time to as little as 15 minutes.

    After infusion, the patient goes home to quarantine and must continue to follow the standard isolation precautions established for people who have tested positive for COVID-19. He or she is also scheduled for a telehealth follow-up with their primary care physician or one of our providers.

    Once recovered, should a patient who received monoclonal antibody treatment get the COVID-19 vaccine? Because active antibodies would likely interfere with the vaccine’s effectiveness, we advise waiting at least 90 days before getting a vaccine. Giving the antibodies time to clear the system leaves the immune system primed to respond to the vaccine.

    The Future of Treatment

    At MedStar Washington Hospital Center, we have already delivered antibody treatment to hundreds of patients, preventing a number of hospitalizations and potentially saving lives. New treatment agents are on the horizon, and development will continue on others.

    We’re confident that future treatments will be even more effective. For example, EUA was granted in February for a new combination of bamlanivimab and etesevimab. This combination targets two of the coronavirus spike proteins, compared to just one for previous treatment agents.

    We’re already very encouraged by what we have seen with the current monoclonal antibody treatments. And we’re excited about the opportunity to keep introducing new and better treatments here in the future.


    Experiencing COVID-19 symptoms?

    Connect with our team today.

    Call 202-788-5048 or Request an Appointment

  • March 03, 2021

    By Sara E. Berkey, MD, Colon & Rectal Surgery

    With increased awareness and better screening, medical science has made great strides toward preventing colorectal cancer. In general, death rates from this cancer dropped 50 percent between 1970 and 2016. That’s the good news.

    The bad news? The rate of colorectal cancer is increasing in younger adults. The American Cancer Society reports a 51 percent increase in colorectal cancers since 1994 in patients under 50. This year, nearly 18,000 patients under the age of 50 will be diagnosed in the U.S., and as many as 3,600 may die. Compared with older adults born around 1950, those born closer to 1990 currently have twice the risk of colon cancer and four times the risk of rectal cancer.

    Long considered a disease of the elderly, colorectal cancer recently took the life of 43-year-old actor Chadwick Boseman. His death turned a spotlight on the increasing prevalence of this disease in young adults, and the importance of awareness and screening as first steps toward prevention.

    Colorectal cancer still remains rare in younger-adult age groups, affecting only about one percent of those under 50. But because it’s so rarely suspected in young adults, it can often be undiagnosed in its early stage, when it’s most treatable.

    What Is Colorectal Cancer?

    The colon and rectum make up the bowel or large intestine, which absorbs nutrients and expels waste from food. The colon curves through the abdomen like a capital C; the last five inches or so form the rectum. Cancer can occur in either the colon or rectum.

    Stage 1 colorectal cancer affects just the first layers of the wall of the colon. In Stage 2, deeper layers are involved. At Stage 3, the disease has spread to the lymph nodes near the colon. Stage 4 is metastatic—cancer has migrated to other areas of the body, most commonly the liver and lungs.

    In younger adults, it’s not unusual for the disease to be misdiagnosed initially as something less dangerous, such as irritable bowel syndrome or hemorrhoids, and often the cancer has already reached stage 3 or 4 before it is discovered.

    Colorectal cancer is on the rise in Gen-Y and Millennials: risk is significantly higher for adults born around 1990, compared to those born in 1950. Dr. Sara Berkey explains. https://bit.ly/3qdWnXe via @MedStarWHC.
    Click to Tweet

    What’s Causing the Increase in Younger Adults?

    So far, medical scientists can only speculate on why instances of colorectal cancer are increasing within the younger adult population in recent decades.

    Suspected causes include a diet low in fiber and high in red meat and processed foods; obesity and lack of exercise; and tobacco and alcohol use—certainly all known risk factors for colorectal disease in older adults.

    And we’re just starting to understand the role played by the microbiome—the diverse population of microbes, mostly beneficial bacteria, that live in the digestive tract and work to break down food into nutrients the body can use. Infections or other issues can cause an imbalance in the biome and spur inflammation, a potential precursor to cancer.

    Who Is at Risk?

    In addition to diet, weight, and alcohol and tobacco use, your risk is higher if your father, mother, brother, or sister has had colorectal cancer. A few genetic disorders are linked, but these are rare and will affect very few in the under-40 age range.

    In addition, certain medical conditions can increase the risk as well, such as type 2 diabetes, Crohn’s disease, and ulcerative colitis.

    Colorectal cancer is also more common in African Americans than in other patient populations. This is likely genetic or related to socioeconomic factors that may limit access to care and testing. This connection is being studied intensively, and it’s where my research is focused—determining causes of racial disparity and developing ways to improve screening in our Black and Brown communities.

    Signs & Symptoms of Colorectal Cancer

    Colorectal cancer screening guidelines from the Centers for Disease Control currently recommend routine colonoscopy screenings at age 45 for those with no family history of the disease. Because colorectal cancer remains rare in people under 40, routine screenings are not yet conducted on this population.

    So, for younger adults, the best defense is awareness. Watch for these potential colorectal cancer symptoms, and seek medical help if you experience:

    • Bleeding. Most rectal bleeding has a benign cause, such as hemorrhoids or small tears known as fissures. But it is never normal, so let your doctor know right away if you notice it.
    • Change in bowel habits. Connect with your provider if you become irregular or constipated, or you notice a significant change in stool texture or color persisting for more than a month.
    • Persistent abdominal pain.
    • Unexplained weight loss.
    • Any combination of these symptoms.

    Most people feel awkward talking about these topics, but don’t hesitate to reach out. Your doctor wants to be aware. The more we know, the better equipped we are to help you.

    Making a Diagnosis

    Compared to a decade ago, we’re increasingly considering any potential for cancer in our younger adult patients and evaluating cases when colorectal cancer screening may be advisable. Depending on your symptoms, your doctor will determine next steps. When we see you here at MedStar Washington Hospital Center, we’ll start with a physical and patient history. In most cases, we’ll find the cause of your colorectal issue pretty quickly, and work with you to resolve it.

    If symptoms linger or family history suggests that we should investigate further, we’ll perform a colonoscopy. Colonoscopy is the gold standard screening test, especially for people under 50. It gives us a direct visual view of the colon and access to anything out of the ordinary. The procedure is routine, non-invasive, and does not require general anesthesia.

    With the patient under sedation, we pass a small camera mounted on a tube into the large intestine. The scope also has a variety of other tools that allow us to remove any polyps we find. Polyps are small growths that may have the potential to become cancerous; we generally remove them all, just to be safe. I can also perform colonoscopy when treating other issues; for example, when treating internal hemorrhoids.

    Doing Your Part

    There is no question that colorectal cancer is serious. It is the third most common cancer and the second most common cause of cancer death, after lung cancer.

    While certain patients have risk factors they can’t change, virtually everyone can take steps to reduce their risk. And although risk is small before age 40, preventative actions deliver a big advantage. It’s essential to adopt healthy habits, including the following:

    • Maintain a healthy weight. Excess weight increases the risk of colorectal cancer for all adults, although the link may be greater for men.
    • Be active. Regular exercisers have a lower risk—and exercise helps with weight control. Try to get 30 minutes of moderate exercise, five times a week. It can be as simple as taking the dog for a longer walk.
    • Eat well. Consume more high-fiber foods, like fruits, vegetables, and whole grains. Limit red meat and processed foods in your diet, especially processed meats like hot dogs and deli meat.
    • Don’t smoke. This strategy helps prevent countless diseases and cancers, so it’s always a good idea.
    • Go easy with alcohol. It’s best not to drink at all but, if you do, the American Cancer Society recommends no more than two drinks per day for men and one a day for women. Like tobacco, limiting alcohol has many overall health benefits.

    A final suggestion: Advocate within your family. Encourage parents and siblings to get colonoscopy screenings beginning at age 45. Some may need screening even earlier, depending on family history. Their screening results could be critical to your health as well; you may help to save their life—and your own.


    Blood in your stool?

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  • February 25, 2021

    By Micheas Zemedkun, MD, Cardiologist

    Most of us have had our blood pressure taken, generally in the left arm if you are right-handed.

    But should blood pressure potentially be taken in both arms? For patients with hypertension or risk factors for cardiovascular disease such as diabetes, the answer is yes.

    Cardiovascular experts have long known that a significant difference in blood pressure between the two arms can indicate potential problems such as atherosclerosis—plaque buildup in the arteries. Too much plaque on artery walls can block blood flow to critical organs such as the heart or the brain and result in heart attack and stroke. Catching it early saves lives.

    A new study published in the journal Hypertension confirms the importance of measuring blood pressure in both arms. Led by researchers in the UK, the study merged data from 24 other studies and looked at 54,000 adult patients around the world.

    The research is the first to show strong evidence that the greater the difference in blood pressure between arms, the higher the additional risk for developing heart disease. For each extra point of difference, researchers reported a one percent increase in the 10-year risk of a new episode of angina, heart attack, or stroke.

    What Is Systolic Pressure?

    The heart is a pump that works in tandem with the lungs. The right side of the heart sends oxygen-deficient red blood cells to the lungs for gas exchange and the left side of the heart receives back oxygen-rich blood to pump to the rest of the body.

    During the pumping phase, pressure in the blood vessels naturally rises. We measure that as systolic pressure—the top number of your resting blood pressure. Normal systolic blood pressure should be around 120.

    The UK study identifies 10 points as the critical threshold of difference between the arms. That’s lower than the previous guideline of 15. For example, systolic blood pressure of 118 in one arm and 120 in the other causes little concern. But a reading of 120 in one arm and 131 in the other does. Recognizing this often-overlooked difference and delving further into a personal history and physical exam, together with additional targeted testing, may prevent a catastrophic cardiovascular event down the line.

    Taking blood pressure in both arms is best practice for patients with cardiovascular risk factors. Dr. Micheas Zemedkun explains the latest research. https://bit.ly/37vsIT0 via @MedStarWHC
    Click to Tweet

    Blood Pressure Can Fluctuate

    In everyday life, of course, the average person’s blood pressure is variable. It changes frequently, around the clock. It rises with exercise or any other physical activity or with emotional excitement and drops during sleep and during times of relaxation.

    Doctors focus most often on resting blood pressure for diagnosing and treating hypertension. It is immensely important to get several blood pressure readings, both at your doctor’s office and outside, for accurate diagnosis and appropriate management of hypertension.

    In recent years, durable, inexpensive, accurate, portable blood pressure monitors have become readily available to patients. This has helped both patients and doctors to improve blood pressure management. With a portable monitor, my patients are able to monitor their blood pressure at home—under consistent circumstances and over a longer time period—giving me a solid snapshot of their condition on an ongoing basis.

    Playing an Active Role

    Hypertension is often known as a “silent killer” because a patient can have mild or no symptoms for several years, in spite of ongoing damaging effects of high blood pressure on their critical organs, such as the heart, brain, or kidneys. Because they “feel fine,” some people may resist taking the steps needed to correct their high blood pressure—typically a combination of weight management, reducing sodium in the diet, and medication.

    Education is a key part of treatment planning and execution, and fortunately, my patients tend to be very responsive once we emphasize the serious potential for heart attack, stroke, kidney failure, and peripheral vascular disease, vision loss, bowel disease, limb loss, and other problems.

    At-home blood pressure gauges can store results, empowering our patients to provide us with high-quality and detailed information that is valuable in helping us tailor a specific treatment plan for them.

    My patients also bring their portable units to their office visit, where we can also check its readings for accuracy by comparing them to those of our medical-grade, calibrated office equipment. Access to the portable machine’s recorded results is useful during telehealth visits as well.

    An Accurate Assessment

    To ensure accuracy when taking blood pressure at home, we recommend using a machine designed for use on the upper arm, which generally delivers a more precise result than one that measures at the wrist.

    For the best results, follow the American Heart Association’s guidelines for taking your blood pressure at home:

    • Take your blood pressure at the same time each day.
    • Don’t exercise, smoke, or drink caffeinated beverages for at least 30 minutes before screening.
    • Sit upright with feet flat on the floor for five minutes.
    • Place the cuff on bare skin.
    • Position the cuff according to your machine’s instructions.
    • The first few times that you measure, measure both arms two minutes apart. After that, use the arm with the higher reading, unless your doctor instructs you otherwise.
    • Take two readings, two minutes apart. Record the readings if your machine doesn’t do it automatically. This also gives you a permanent record for yourself, should the machine malfunction at some point.

    When to Check Both Arms

    The practice of taking blood pressure in both arms is not yet a mainstream activity with all patients. But, as mentioned, it is best practice for those with hypertension and other risk factors for heart disease, from age, sex, or family history to the presence of underlying conditions like diabetes.

    As we learned from the UK study, a difference between the arms of 10 points or more is reason for the physician to dig more deeply into the patient’s condition. For example, it may indicate a narrowing in the artery that feeds the arm from the shoulder. Atherosclerosis, or plaque, is a systemic process, and narrowing in an arm artery could be an early warning of narrowing in other critical areas. A narrowing in the coronary arteries that supply blood to the heart could cause a heart attack; in the arteries of the neck, it might lead to stroke.

    Everyone’s metabolism, risk, and genetic makeup are different, and your doctor is the best source of sound advice. If you have risk factors for heart disease and routinely monitor your blood pressure, it’s best to have a conversation with your doctor about checking both arms. He or she will work with you to determine next steps and any additional testing required, such as a CT scan to detect arterial calcification, a stress test, or an ultrasound of the blood vessels to determine plaque burden.

    Communication Is Key

    At MedStar Heart & Vascular Institute, we encourage you to be in contact with your physician for a regular physical exam. This is increasingly important as you age: men over 45 and women over 55 in general are at higher risk for heart disease.

    If risk factors are identified, our cardiology team works with you to determine the best way to mitigate your risks and will conduct regular monitoring and testing to suit your unique medical profile.

    And of course, we want to emphasize the most important point of all: Seek emergency aid immediately if you experience any cardiovascular symptoms—chest pain, tightness, or heaviness; shortness of breath; nausea; dizziness; and pain in the jaw, neck, or left arm.

    When the heart muscle is involved, time is of the essence. Our experts in heart and vascular care want to see you today to help you live a long and happy life.


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  • February 24, 2021

    By Sunjeet Sidhu, MD, Cardiac Electrophysiologist

    Atrial fibrillation, or AFib, is the most common type of arrhythmia, affecting more than 5 million people in the U.S. While it’s mostly common in the elderly, AFib can affect people of all ages. It’s important to know the signs and symptoms of AFib so you can seek proper treatment, and prevent other possible health risks that could come from having AFib, such as stroke and heart failure.

    What is AFib?

    AFib is a chaotic rhythm in the upper chamber of the heart. During AFib, the heart beats irregularly and out of rhythm with the lower chamber, which oftentimes causes poor blood flow. Episodes of AFib can come and go, or they can be continuous and not go away. There are many risks associated with AFib, such as increased risk for hospitalization, stroke, heart failure, and cognitive decline as you age.

    There are many different things that play a role in causing AFib to occur. For example, your age, heart health, blood pressure, diabetes, and weight. As mentioned, AFib is common within the elderly population, but can affect people at any age. It’s more common amongst white Americans, those who are obese, and patients with high blood pressure.

    Is AFib hereditary?

    In patients who have AFib, there are certain small changes in your genes that make it more likely for you to have it. There are also some rare genetic mutations that make a person much more likely to have AFib. But in general, it’s more common that patients with AFib have those small changes in their genes that could have been passed down from a parent. But unfortunately, there’s no way to know for sure because it’s not just one gene that if you have it, you have AFib. It’s a combination of multiple genes that play a role.

    Atrial fibrillation, or AFib, is the most common type of arrhythmia. Cardiac electrophysiologist Dr. Sunjeet Sidhu shares what you need to know about #AFib, including symptoms, prevention, and treatment on the #LiveWellHealthy blog: bit.ly/3srCUUO.

    Click to Tweet


    What are symptoms of AFib?

    Interestingly enough, many patients with AFib don’t show symptoms at all. It’s not until they go to their doctor for a routine electrocardiogram (EKG) that they discover for the first time that they’re in AFib. But for those who do experience symptoms, some common ones include:

    • Heart palpitations, sometimes described as a fluttering in the chest
    • Chest pain
    • Shortness of breath
    • Lightheadedness
    • Dizziness
    • Fatigue
    • Sweating
    • Confusing and anxiety
    • Heart failure

    As mentioned before, people experience AFib differently. AFib can be…

    Persistent. An irregular heartbeat that lasts longer than seven days, but the abnormal rhythm can be stopped with treatment.

    Paroxysmal. An irregular heartbeat that lasts less than seven days, usually less than 24 hours, and has recurred at least twice.

    Lone. An irregular heartbeat that is paroxysmal or persistent and occurs without another form of heart disease.

    Permanent. An irregular heartbeat that lasts longer than one year and does not respond to treatment if it has been attempted.

    It’s important to see your doctor if you’re experiencing these symptoms, and seek treatment as soon as possible after being diagnosed. The quicker you receive treatment for AFib, the easier it will be to manage.

    How is AFib detected?

    The easiest way to see if someone has AFib is through an electrocardiogram, also known as an EKG, which records the electrical signal from your heart. If the patient is in AFib during their EKG, then it will clearly show the heart’s irregular rhythm. But, if the patient is not experiencing an AFib episode, their EKG will be completely normal.

    If that’s the case, there are other tools to test if a patient is in fact experiencing AFib, such as a holter monitor, which is similar to an EKG. A holter monitor is a patch that patients wear on their chest for 24 to 48 hours that continuously records your heart’s electrical activity, just like an EKG. The patch just gives more time for the arrhythmia to be detected, whereas the EKG could only pick it up if you’re experiencing an episode while getting the test done at your doctor’s office. Even devices like smart watches can monitor irregular heart rhythms. While they’re not 100% reliable, they can be a great starting point to bring awareness to those not already diagnosed with AFib that their heart is beating irregularly, and they should go see a doctor to get it looked at.

    Treatment options for AFib.

    Generally speaking, there are two realms of treatment options when someone is first diagnosed with AFib, medication and surgery. The main goal of either type of treatment is to suppress the AFib, reset your heart rhythm, and prevent blood clots which lead to strokes.

    Strokes are one of the biggest risk factors associated with AFib, and it’s strongly recommended that patients with a greater than 1% risk of stroke per year go on some sort of blood thinner to help reduce that risk, including many patients with AFib. But being on blood thinners is independent of managing AFib itself. In terms of the medications used to help manage AFib, usually doctors will start their patients out with medications that help control their heart rate. For example, Metoprolol and Cardizem, which primary care doctors and cardiologists use routinely with their patients. As your treatment becomes more specialized overtime to fit your needs, doctors will prescribe more medications like antiarrhythmic drugs to help prevent future AFib episodes.

    One possible surgical option is a minimally invasive procedure called cardiac ablation that can be used to help control AFib. During this procedure, a tube is placed through a vein in the leg leading to the heart and then freezes the areas that are causing the irregular heartbeat. This option is usually best for someone with early onset AFib and no other significant risk factors. The optimal patients who choose cardiac ablation typically show a significant reduction, greater than 95%, in their AFib.

    How you can reduce your chances of experiencing AFib.

    The best way to reduce your chances of developing or continuing to experience AFib is simply by living a heart-healthy lifestyle. This will help manage the other risk factors that play a role in AFib, like weight and blood pressure. Ways you can do this include:

    • Exercising at a moderate intensity for 30-minutes a day, five days a week
    • Refraining from drinking alcohol in excess
    • Eating heart healthy foods
    • Quitting smoking
    • Maintaining a healthy weight
    • Working with your doctor to make sure your blood pressure is well controlled

    Most importantly, you should seek help as soon as possible from a cardiologist or cardiac electrophysiologist if you feel you are experiencing AFib, or have already been diagnosed. The earlier you seek treatment, the easier it is to treat and decrease your risk of developing other possible health conditions.

    Watch our Facebook Live broadcast with Dr. Sidhu to learn more about atrial fibrillation:


    Want to learn more about AFib and treatment options with MedStar Health?
    Click the link below.

    MedStar Heart and Vascular Institute

  • February 23, 2021

    By Hayder Hashim, MD

    How does the heart work? Your heart is a lot like your house, complete with a framework, plumbing, and an electrical system. It has one mission: to keep blood moving.

    The framework is provided by the heart muscle itself. The coronary arteries function as the external plumbing, supplying the heart muscle with oxygen-rich blood. The heart’s internal plumbing—its four chambers—squeeze and relax in precise sequence, controlled by the electrical system, the nerves that regulate heartbeat.

    A disturbance at any point in this well-choreographed process might impede the blood’s movement and create cardiovascular disease. For instance:

    • Over time, plaque can become deposited on the walls of arteries, narrowing the pipeline and reducing blood flow. When the narrowing blocks a coronary artery, cells within the heart muscle can die, a condition known as heart attack. A narrowing can cause angina—pain or pressure in the chest; more severe blockage can lead to more extensive muscle damage—heart attack.
    • Things can also go wrong in the internal plumbing, the chambers and valves. Some problems result from physical defects in the heart structure, often congenital—something we’re born with. These may include defective valves or deviations in the heart wall, both of which can prevent the heart from filling and emptying normally.
    • Electrical problems can cause arrhythmia, an unstable heart rhythm. The worst case is cardiac arrest, when the heart is unable to pump a life-sustaining volume of blood. Other electrical problems include irregular heartbeat, when the heart beats too fast or too slow; and fibrillation.

    Disease can also directly affect the heart muscle. A common example is heart failure, defining a heart that is in a weakened state. As the pump weakens, some blood is left behind with every heartbeat. This blood backs up and congests the circulatory system, triggering palpitations, shortness of breath, even potential organ failure.

    Inflammatory or infiltrative conditions—such as cardiac sarcoidosis and cardiac amyloidosis—can hijack normal cardiac muscle cells, replacing them with diseased tissue. Infection in the heart can cause endocarditis, a life-threatening inflammation of the inner surfaces of the heart and valves.

    Some risks for cardiovascular disease cannot be controlled. But many can. The better we manage them, the better our odds of leading a long life. More from @HashimHayder. https://bit.ly/2LDk2Ch via @MedStarWHC
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    Risk Factors for Heart Disease

    As we age, to some extent, all of us have a greater risk of heart disease. But each person’s actual risk is unique, a product of their own inherited and acquired factors.

    • A person at low-risk has few or no existing risks and avoids them by pursuing healthy habits.
    • A person at average risk perhaps has a few unmodifiable risks and some lifestyle risks.
    • A person at high-risk may have unmodifiable risks and also eat poorly, have high blood pressure, not exercise, not see the doctor, and use tobacco. These factors can culminate in a serious health event.

    We can’t control genetic makeup, family history, age, sex, or race—all of which can contribute to our personal level of risk. But we can delay the onset of disease and/or reduce the severity of illness by concentrating on risk factors for coronary heart disease that we can control, such as blood pressure, diabetes, inactivity, weight, smoking, and stress.

    • Blood Pressure: High blood pressure makes the heart work harder. Uncontrolled hypertension can weaken blood vessels and accelerate the deposit of plaque. That increases the risk of coronary artery disease, stroke, and peripheral artery disease.
      Treating high blood pressure can be a challenge since it presents no symptoms. Checking blood pressure regularly, reducing salt in the diet, and taking any medications your doctor has prescribed are keys to success.
    • Diabetes: Uncontrolled diabetes causes blood vessel damage, and peripheral artery disease can result in loss of vision or limbs. It also puts a patient at higher risk for stroke and heart attack.
      Type 2 diabetes can often be prevented with weight control and healthy eating. Once a patient has been diagnosed, however, it’s very important to keep it under control with a doctor’s help.
    • Weight and Exercise: Excess weight makes the heart work harder to distribute blood over a larger body mass, potentially leading to heart failure. It often results from inactivity and poor diet, accelerating the buildup of plaque and increasing the risk for type 2 diabetes.
      Controlling weight is about burning the calories we consume, but most Americans eat far more than they burn. Managing weight isn’t easy, but exercise can make a big difference. Exercise strengthens your heart and burns more of the calories you consume. It can also serve as a useful sentinel for cardiovascular problems. People who exercise regularly are more likely to notice when they suddenly can’t complete their normal routine or feel chest pain or shortness of breath walking up a hill they climb daily.
      The American Heart Association recommends at least 150 minutes of moderate exercise each week for adults—that’s 30 minutes per day, for at least five days. If more Americans follow this guideline, we will see drastic reductions in cardiovascular disease.
    • Tobacco: Even if you eat right and exercise, smoking significantly increases your risk of heart disease. Tobacco acts very aggressively in the cardiovascular system.
      Like high blood pressure, it accelerates the growth of plaque. It calcifies the arteries, making them rigid and less flexible. It also hinders interventional treatments—stiffened arteries can resist expansion from catheterization and stents.
    • Alcohol: Alcohol in moderation may have a limited protective effect. While science has yet to prove a direct link between alcohol and heart health, we do see an association between red wine and reduced risk of death from heart disease. Antioxidants in red wine may improve cholesterol.
      Assuming that you exercise, avoid tobacco, and adopt other healthy habits, I recommend four ounces of red wine per day for women, eight ounces for men.
      Keep in mind that higher levels of alcohol consumption can alter liver function, increasing cholesterol levels. And excessive drinking can actually cause heart failure, a condition known as alcohol-induced cardiomyopathy.
    • Dental Neglect: When dental issues are present, bacteria in the mouth can enter the bloodstream and collect in the heart, causing endocarditis or valve problems. We also know that inflammation from poor dental hygiene can make plaque and coronary artery disease more aggressive.
      Everyone should have a dental exam at least twice per year.

    Relax

    A traumatic physical or emotional event can cause stress cardiomyopathy, also called takotsubo cardiomyopathy or broken heart syndrome. Stress cardiomyopathy behaves very much like a heart attack, but without ischemic muscle loss. Fortunately, most patients recover without long-term damage.

    Stress is part of life, especially during a global pandemic. But chronic, persistent, daily stress can take a slow and dangerous toll.

    You can’t change your basic personality, but you can change how you respond to stress. It’s important to de-stress in a way that works well for you: meditation, yoga, listening to music, chatting with friends. This is where exercise can also provide amazing benefits. Going for a walk, run, bike ride or swim can help off-load the negativity of the day.

    Don’t Delay Care

    When it comes to cardiovascular disease, any symptom must be taken seriously, including chest pain, tightness, or heaviness; shortness of breath; nausea; dizziness; or pain in the jaw, neck, or left arm.

    If you experience any of these indicators, don’t try home remedies or procrastinate—it’s time to seek emergency care. Even if you suspect it’s just indigestion, it’s safer to be examined by a medical professional, especially if you have pre-existing risk factors.

    This is particularly vital advice for women, whose symptoms are often less specific than men’s and could potentially also include discomfort through the shoulders, shortness of breath, chills, profound fatigue, or sudden dizziness.

    MedStar Heart & Vascular Institute is a national leader in the research, diagnosis, and treatment of cardiovascular disease. Our experts are well equipped with the knowledge and technology to offer the outstanding level of heart and vascular care that patients in our region deserve.


    Recurring chest pain?

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  • February 18, 2021

    By by MedStar Team

    When it comes to activities that affect the heart, there’s the good (a healthy lifestyle), the bad (unhealthy risk factors), and the ugly (hidden influences).

    Excessive stress is often found among the “ugly.” Behind the scenes, stress can work persistently to damage the heart, eventually leading to heart attack, abnormal heart rhythms, heart failure, or stroke. Yet, even then, an affected person may be completely unaware that stress is an underlying cause of his or her heart issues.

    Powerful Hormones at Work

    Research shows a relationship between chronic stress and abnormal production of the stress hormones epinephrine (adrenaline), cortisol, and norepinephrine.

    The body releases these same hormones when dealing with an episode of acute stress—for example, a situation that occurs within an instant, like when you narrowly avoid a car accident.

    • Adrenaline increases the heart rate, raises blood pressure, and increases energy supplies.
    • Cortisol floods the bloodstream with glucose and narrows the arteries.
    • Norepinephrine raises the heart rate, releases glucose into the bloodstream, and increases blood flow to the muscles.

    But when the body experiences chronic stress—day after day, for an extended period of time—these hormones can start to have a detrimental effect on heart health.

    In play together, these hormones may trigger a higher demand for oxygen in the body, spasms in the heart’s blood vessels, and an interruption in electrical impulses, resulting in irregular heartbeats/heart palpitations, chest pain, and/or shortness of breath.

    Other prolonged effects of chronic cardiovascular stress can include high blood pressure, increased heart rate, elevated blood sugar, blood vessel damage, and inflammation. And the physiological impact of stress can include damage not only to the heart, but to the overall health of the body, including weight gain, sleeplessness, irritability, headaches, or anxiety.

    The physiological impact of stress can include damage not only to the heart but to the overall health of the body. Dr. Aly explains. https://bit.ly/3u3RN10 via @MedStarWHC.
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    Broken Heart Syndrome

    Broken heart syndrome—more technically known as stress-induced cardiomyopathy or Takotsubo cardiomyopathy—is an interesting medical condition. In broken heart syndrome, the heart may be physically overcome by intense emotions (grief, fear, or intense anger) or overwhelming stressful situations, causing a gush of stress hormones in the body and leading to symptoms and signs that mimic a heart attack and/or heart failure.

    Stress cardiomyopathy symptoms include sudden chest pain, shortness of breath, sweating, fast heart beats, and dizziness. Up to 30% of people who experience this condition are unaware of what triggered their symptoms.

    Most cases are temporary and, when treated, complete resolution of heart function is expected within a few weeks. On very rare occasions, it can be fatal. This condition brought our attention to the detrimental effects of stress on the heart and the cardiovascular system.

    Inflammation and Cardiovascular Health

    High stress can also affect the heart and cardiovascular system by spurring inflammation in the arteries, a risk factor for atherosclerosis/hardening of the arteries.

    As stress hormone levels rise in the bloodstream, blood sugar levels increase, too. If those sugar levels exceed the body’s needs, they can trigger an inflammatory response within the walls of the blood vessels. When this inflammation occurs, cholesterol-rich plaque can build in the arteries, potentially bringing about heart attack or stroke.

    Cycles of Stress

    Everyone reacts differently to long-term physical or emotional tension and it can be more damaging to some than to others. For instance, someone experiencing chronic aggravation or worry may eat more, leading to weight gain. Increased weight may raise blood pressure and trigger the risks inherent in diabetes. Lack of sleep due to worry increases cortisol and excess cortisol has been tied to high blood sugar and increased body weight.

    All these factors are detrimental to the condition of the heart. And stress may cause some people to compromise their hearts even further through unhealthy lifestyle choices such as smoking or alcohol abuse, intensifying stress on the cardiovascular system.

    A particularly ugly aspect of chronic tension is that we frequently don’t recognize its effect on us. We’ve all heard that smoking is bad for your health and bad for your heart, but it may never occur to us that chronic stress is harmful to our hearts as well. It’s time to recognize the negative role that it can play.

    Remember, the effects of stress and anxiety on the heart may not be readily apparent. Serious conditions like high blood pressure, increased hormone production, high cholesterol, and high blood sugar often have few or no symptoms. Yet their long-term impact can be profound. The crucial role of screening for these conditions and being proactive about our health can’t be overemphasized.

    Avoiding Stress

    Patients sometimes tell me they’re experiencing heart-related symptoms like chest pain and palpitations although follow-up testing shows no clear medical reason for their symptoms. Later, they realize that their symptoms, which were temporary, had aligned with a particularly stressful period in their lives. Their hearts were reacting to stress.

    Stress is a mechanism that affects your body. Anxiety is a symptom that you’re under stress. Even if a person takes medication to lessen their anxiety, it doesn’t mean that the root of the problem—chronic stress—is being addressed.

    Obviously, it’s not realistic to avoid stress entirely. In today’s fast-paced world, physical and emotional tensions are almost hard-wired into our lives. To reduce the effects of persistent tension on the heart, find stress-busting approaches that work for you, such as exercise, deep breathing, praying, meditation or mindfulness, yoga, or massage, to name a few.

    For anyone living with heart disease or risk factors for heart disease (e.g. hypertension, high heart rate, diabetes), it’s important to actively reduce stress factors and follow a heart-healthy lifestyle:

    • Quit smoking. It’s one of the best things you can do for your heart and overall health.
    • Manage diabetes. It’s a serious risk factor for heart disease.
    • Eat healthy. Explore approaches to healthy eating, such as the heart-friendly Mediterranean diet.
    • Consider intermittent fasting or other eating patterns that can encourage weight loss. Consult your doctor to be sure the approach you take is safe for you.
    • Stay active. Break out of a sedentary lifestyle. You don’t need to run marathons. Walking is excellent for your cardiovascular system.

    MedStar Heart & Vascular Institute Is Here for You

    When I meet a new patient, I inquire about their lifestyle—work, family, habits, exercise, diet, and stressors large and small.

    Answers to some simple questions can be really helpful in pinpointing major stress factors in their lives. It’s important to look beyond obvious medical questions and get to know someone a bit in order to help resolve their heart health issues. Patients may not even realize that their work, commute, or family situation is directly connected to heart symptoms.

    My message to anyone who is experiencing heart symptoms, stress-related or not: don’t delay care. If you are concerned about the effects of chronic stress on your heart, schedule a cardiology appointment or telehealth visit with us, even if current symptoms don’t seem urgent. We can conduct a virtual online visit with you to discuss your questions and concerns and determine if and when it is time for you to see us onsite for further attention.

    We have state-of-the-art diagnostic equipment and a variety of other resources to help deliver the safest and best care to our patients during these tough times. We have options to help you feel safe, comfortable, and less stressed.


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