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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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  • December 08, 2021

    By Miranda Gordon-Zigel, MD

    Whether you play an organized sport or exercise for fun, being active is important for your physical and mental health. However, playing sports and exercising always comes with the risk of developing an injury, either suddenly or over time. While anyone can get injured at any time, your risk of injury is higher when you play sports or workout if you:

    • Play the same sport year-round without a break
    • Don't incorporate other forms of exercise into your training
    • Use the wrong techniques
    • Aren't eating enough or getting the right nutrients

    Knowing what you can do to prevent some of the most common sports injuries can help you lower your risk of being sidelined from pain for longer than necessary.

    Most common exercise and sports injuries are related to overuse.

    Most frequently, athletes and active individuals suffer from injuries caused by doing the same repetitive motion for too long. Overuse injuries can also occur if you increase the intensity, frequency, or duration of a particular exercise too quickly. Doing so puts unnecessary stress on the muscles and joints involved in the motion, which can cause pain. Overuse injuries often worsen over time, especially if you continue to repeat the same activity without rest. The following injuries are most commonly associated with overuse.


    #SportsInjuries are often caused by overuse. In this blog, primary care and sports medicine physician Dr. Gordon-Zigel shares tips for avoiding some of the most common injuries: https://bit.ly/3pHyJUQ.
    Click to Tweet

     

    1. Knee pain.

    Knee pain commonly affects people of all ages and can range from severe, sharp pain to a dull throbbing, pain, or feeling of weakness or instability. Knee pain can occur suddenly, after an unexpected bump or trauma to the knee, or it can develop slowly over time due to repetitive motion, like frequent jumping. Some knee injuries, like "runner's knee", respond well to rest, ice, and anti-inflammatory medication. Serious knee injuries caused by a collision during contact sports, like an anterior cruciate ligament (ACL) injury, may require surgery.

    2. Tendinitis.

    Tendinitis occurs when the tendon, which connects muscle to bone, becomes inflamed or irritated. The overuse injury can occur in the elbow, shoulder, knee, and ankle joints, causing pain in and around the involved tendon. If you play sports that require repetitive motion, like pitching a baseball or swinging a golf club, you may be more prone to developing tendinitis. That’s why some common names for certain types of tendinitis are tennis elbow, swimmer's shoulder, and jumper's knee. Other repetitive activities or exercises that may cause tendinitis include gardening, painting, and shoveling. Tendinitis pain can range from mild to severe, but in many cases, people with tendinitis can work through the pain because it lessens as you move.

    3. Stress fractures.

    If you repeatedly jump or run for long periods, you may develop a stress fracture, which is tiny cracks in the bone. Stress fractures are most common in women and tend to get worse over time. Because they often develop if you start or increase the intensity of an activity too fast, the best way to avoid this type of injury is by starting new exercise programs gradually.

    4. Shin splints.

    If you have a sharp pain in your lower leg near the shin bone, you may suffer from shin splints. Shin splints are caused by overuse and can also develop if you don't have proper foot support. Basketball players, cross-country runners, and other athletes who run and jump a lot are prone to shin splints. If you have minor shin splints, rest can provide relief.

    Other common sports injuries.

    5. Sprains.

    Another common sports injury is sprains or strains, with ankle sprains being the most frequent type. Sprains are typically caused by falling or a twisting motion near a joint, such as the ankle, knee, or wrist. A sprain can be mild or severe, causing pain, bruising, and swelling.

    6. Fractures.

    A fracture is a partial or complete broken bone. Sometimes, a fracture is accompanied by "snapping" sounds, bruising, redness, and visible deformity, like bone poking through the skin. In other cases, fractures develop in someone who has an untreated stress fracture. If you suspect you have a fracture, you shouldn't keep playing. This type of injury is common in contact sports and often requires immediate medical attention.

    7. Concussions.

    Concussions are also common injuries that occur during contact sports, like football. A concussion occurs when your head suddenly collides with something else. Concussions range in severity and can include symptoms such as headache, dizziness, and even temporary loss of consciousness. Anytime you experience a blow to the head, it's important to seek medical care. 

    How to avoid sports injuries.

    Some sports injuries can't be prevented, but there are things you can do to minimize your risk of a severe injury, such as:

    • Gradually increasing the frequency, duration, and intensity of exercise if you've been sedentary
    • Using the proper technique while exercising
    • Wearing the appropriate gear, including supportive shoes and protective equipment, when necessary
    • Cross-training, or participating in a variety of different exercises rather than just one

    Young kids especially should always be encouraged to play a variety of sports rather than one sport all year. It’s also important to pay attention to the duration, frequency, and intensity of their sports practices. Coach A may not know what exercises Coach B is doing and too much of the same activity could be detrimental. A good rule of thumb is to ensure that the maximum number of hours they spend in sports training per week is no more than their age.

    When to call your doctor.

    In many cases, home remedies can relieve pain from sports injuries. Stretching, rest, ice or heat (whichever feels best), and anti-inflammatory medication can help you continue in day-to-day activities while a sports injury heals.

    If you have pain that continues to worsen or is interfering with your daily responsibilities, you should talk to a doctor. You should also seek medical care if:

    • You have difficulty bearing weight or picking things up
    • You experienced a collision to the head and suspect a concussion
    • You feel off-balance or dizzy
    • Your pain doesn't subside for a few weeks
    • You're worried about your injury
    The benefits of playing sports and exercising far outweigh the risk of injury. To avoid severe injury, remember to listen to your body, prioritize rest, and incorporate a variety of different exercises into your training regimen.


    Do you have a sports injury that isn’t getting better?

    Talk to a primary care physician near you and get back in action.

    Find a MedStar Health Primary Care Provider Nearby.

  • December 03, 2021

    By Glenn W. Wortmann, MD

    Change has been a constant theme throughout the COVID-19 pandemic. Regardless of what  professional athletes or celebrities might suggest, this is a good thing—science is all about learning and adapting to new information.


    The progress we’ve made worldwide in preventing and treating COVID-19 is nothing short of incredible. But it will continue to be a bit of a bumpy ride as we make new science-based discoveries. 


    The latest update many people are asking about is the COVID-19 booster shot—and how it’s different from additional vaccine doses recommended for immunocompromised patients. To provide more clarity, I’ll discuss questions we’re hearing the most from patients.


    Keep in mind that we still have much to understand about the coronavirus. When searching for answers, stick to trusted health professionals and the Centers for Disease Control and Prevention (CDC) for the most up-to-date and accurate information.

    It can be hard to keep up with #COVID19Vaccine information. Get answers to FAQs about the #COVIDBoosterShot from @MedStarWHC Section Director of Infectious Diseases Glenn W. Wortmann, MD: https://bit.ly/3pl0G4O.
    Click to Tweet


    What is a COVID-19 booster shot?

    Booster shots enhance your immune system’s ability to protect you from a COVID-19 infection. Boosters are approved from Moderna, Pfizer, and Johnson & Johnson, and include all the same ingredients as the manufacturer’s original vaccines.

     

    New data is showing that the effectiveness of the COVID-19 vaccine slightly decreases over time. By getting a booster shot, adults who have received two full doses of the Moderna or Pfizer vaccine—or one dose of the Johnson & Johnson vaccine—can increase and extend their protection against the virus. If these people do not receive a booster shot, they are still considered fully vaccinated.

     

    How is a booster shot different from an "additional dose" of the COVID-19 vaccine?

    A booster shot extends protection against COVID-19 in people who developed high immunity to COVID after being fully vaccinated. An additional dose of the vaccine increases immunity in people who developed a low amount of immunity after being fully vaccinated.

    Additional doses are not the same as booster shots. For example, the Moderna booster is only half of the dose administered for a primary series dose.

    People who are immunocompromised are not likely to develop much immunity to COVID-19 after receiving two full doses of the Moderna or Pfizer vaccine or one dose of the Johnson & Johnson vaccine. This includes individuals who:

    • Are receiving immunosuppressive treatment for cancer or other medical conditions
    • Have received an organ or stem cell transplant 
    • Have an advanced or untreated HIV infection

    The CDC recommends that immunocompromised individuals who received two doses of the Pfizer or Moderna vaccine get an additional full dose—from the same vaccine manufacturer—at least 28 days after the second dose. Sometimes a fourth dose is recommended, depending on the person’s health. 


    Additional full doses of the Moderna and Pfizer vaccines have been shown to improve COVID-19 immunity in these patients. The CDC now recommends that anyone who received a single dose of Johnson & Johnson vaccine should get a second dose of a COVID vaccine 2 months after the first dose. It is preferred to use an mRNA vaccine (Moderna or Pfizer) for the best immune response. However, if this is unavailable, a repeat dose of J&J/Janssen can be given instead.


    Talk with your doctor to see if you might benefit from an additional dose of the COVID-19 vaccine. It is not recommended for people who had a serious reaction to their initial vaccine series; have a fever over 100.4 degrees Fahrenheit; or have received a monoclonal antibody infusion (Regeneron or Lilly) in the last 90 days to treat COVID-19.


    Who should get a booster shot—and when?

    The U.S. Food and Drug Administration recently approved the Pfizer booster shot for all adults 18 and older.


    We are following the CDC’s guidance to encourage all fully vaccinated adults to get a booster shot and strongly recommend it for people who are:

    • 18 or older and received the Johnson & Johnson vaccine two or more months ago
    • 65 or older and received the Pfizer or Moderna vaccine six or more months ago
    • 18 or older, received the Pfizer or Moderna vaccine six or more months ago, and have underlying medical conditions or live or work in high-risk environments (e.g., long-term care facility, health care setting, school, grocery or department store)

    You can get a booster shot from any of the three vaccine manufacturers, no matter which type you received the first time. Some data has shown that mixing vaccines could provide better protection, but we still can’t say for sure. What we do know is that all three are highly effective.

     

    Is the booster shot safe?

    Just like the first COVID-19 vaccines, which contain the same ingredients, booster shots are not only safe but also protective against the Delta variant

     

    Over 7 billion doses of the COVID-19 vaccine have been administered across the world, so we have excellent data showing that it is very safe. COVID-19 can become a severe infection that results in death or long-term symptoms, which is why we recommend vaccination so strongly. 

     

    I understand people’s hesitancy to receive a new vaccine, especially when it doesn’t completely erase your chances of getting infected—even with a booster shot.

     

    However, getting vaccinated significantly lowers your risk of experiencing severe COVID-19 symptoms if you do become infected. And it reduces the chances that you’ll spread an infection to people who have a high risk of developing severe COVID symptoms. Booster shots extend this protection to help you and the people you care about stay as healthy as possible.

     

    Does the booster shot have side effects?

    Reported side effects have been mild to moderate and similar to symptoms experienced after the first vaccines: fever, headache, fatigue, and pain at the injection site.

     

    Mild side effects are triggered by the immune system’s reaction to learning how to fight the virus—and everyone’s body acts differently. Experiencing side effects does not mean the vaccine or booster shot gave you a virus. The vaccine also does not cause cancer or infertility.

    Serious side effects from the COVID-19 vaccines are extremely rare. People who have an allergic reaction to their first dose should talk with their doctor about getting their next dose from a different manufacturer.

    Will we need booster shots every year?

    It’s too early to say what the future of COVID-19 vaccination looks like. It will likely depend on the spread of COVID over the next year or so—which should decrease as vaccination rates increase. 

    The best way to reduce the number of COVID vaccinations recommended in the future is to become fully vaccinated now and receive a booster shot when you’re eligible—even if you’ve already had COVID-19. The natural immunity that develops after an infection does not last as long as the immunity from the vaccine.

    MedStar Health patients can schedule a COVID-19 booster shot through their provider’s office. If you are not a current patient, review our list of clinics offering the vaccine.

    Are you ready to receive your COVID-19 booster shot?

    Request an appointment to extend your protection against COVID-19.

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

  • December 02, 2021

    By MedStar Team

    Women comprise more than half of the 38 million individuals living with HIV worldwide. This translates to more than 19 million women living with HIV. Since 2009, HIV/AIDS has been the leading cause of death among women of reproductive age around the world and remains a critical public health issue in our surrounding communities. Here are some fast stats:

    • Washington, D.C., is an epicenter of HIV in the United States with women of color disproportionately affected. DC Health reports that the prevalence of HIV among all women in DC is almost 1% but estimates that it is double that among women of reproductive age and again even higher among women of color.

    • Nationally, Maryland ranks as the 5th in new adult HIV cases and the 8th highest in cumulative HIV cases, the majority of which are concentrated in Baltimore City. Women comprise almost 30% of new cases and a little over a third of all HIV cases in Maryland
    • In terms of behavioral health, women living with HIV have higher rates of childhood and adulthood trauma with a notably higher prevalence of mental illness and substance use than the general population.

    Yet, despite these facts, HIV prevention remains critically underfunded and understudied relative to the severity of this pandemic, particularly among cisgender women.

    MedStar Health Research Institute investigator, Rachel K. Scott, MD, MPH, is committed to bringing awareness to HIV and HIV prevention among cisgender women, particularly in pregnant women. A practicing OBGYN, Dr. Scott is the Director of the Women’s Center for Positive Living, a comprehensive Obstetrics and Gynecology practice and regional referral center for women with HIV within the Women’s and Infants’ Services Department of MedStar Washington Hospital Center. As Scientific Director of Women’s Health Research for MedStar Health Research Institute, and the Associate Chair for Research for the MedStar Washington, Dr. Scott leads research to address medical comorbidities of HIV among pregnant women and their infants and to improve HIV prevention among cisgender women. 

    Most recently, Dr. Scott was awarded two National Institutes of Health (NIH) grants including a R34 award to address the culturally specific, socio-structural barriers to HIV prevention specific to black and cisgender women, and an R21 award which aims to use population pharmacokinetic modeling and clinical trial simulation to evaluate the dosing of pre-exposure prophylaxis (PrEP) medications in pregnancy.

    The National Institute of Mental Health (NIMH) R34 award for “Socio-Structural Intervention to Improve Pre-Exposure Prophylaxis (PrEP) Services for Cisgender Women (CGW) (PrEP-CGW)”  adapts and pilots a Center for Disease Control (CDC) recognized evidence-based intervention to reduce HIV incidence among cisgender women developed in Tanzania and is informed by Dr. Scott’s previous work on a GHUCCTS pilot award followed by a Gilead investigator sponsored research award to study engagement and retention in the PrEP cascade among cisgender women. Dr. Scott had previously partnered with colleagues from the DC Center for AIDS Research to prospectively identify and populate the PrEP cascade among cisgender women and to study a multi-component educational intervention for providers and patients, including implementation of provider training, an EHR prompt, and educational videos on PrEP in the waiting room to increase awareness and knowledge among providers and patients and promote provision of PrEP to cisgender women. 

    The implementation of these initiatives proved to be highly feasible and had a positive effect on the proportion of cisgender women who were offered and initiated PrEP. However, the study team concluded that the interventions were effective but insufficient alone to overcome the barriers of stigma, medical mistrust, low perceived risk of HIV, and competing external priorities among cisgender women most at risk. The NIMH R34 award will allow the research team to tailor this CDC recognized evidence-based intervention to prevent HIV among women in Tanzania to meet the needs of cisgender women in DC, integrating provider trainings and increased virtual provider PrEP visits, with peer navigation, and community support centers to address the shortcomings of current educational interventions.

    The R21 award for “Optimization of HIV Prevention in Pregnancy and Postpartum: Population Pharmacokinetic Modeling and Clinical Trial Simulation” seeks to evaluate the adequacy of dosing of HIV pre-exposure prophylaxis (PrEP) in pregnancy. Despite the importance of HIV prevention in pregnancy, pregnant women have been excluded from the clinical trials that established the efficacy of HIV pre-exposure prophylaxis (PrEP) with oral emtricitabine in fixed dose combination with either tenofovir disoproxil fumarate (F/TDF) or tenofovir alafenamide fumarate (F/TAF). F/TDF levels are lower in the blood during the second and third trimesters of pregnancy and there is concern that levels may be too low to be protective against HIV; less is known about F/TAF in pregnancy.  

    Dr. Scott’s pharmacometrics team’s preliminary work found that more than 50% of cisgender women would be under-dosed in the third trimester being given the standard daily dose of F/TDF, suggesting the need for dose adjustment for pregnant women as their pregnancy progresses for PrEP to remain effective. The National Institute of Child Health and Human Development (NICHD) R21 award will allow Dr. Scott and her team to expand their pharmacokinetic model to include additional PrEP drugs (F/TAF) and additional data sets (from all currently available PrEP pharmacokinetic and clinical trials for cisgender women), as well as incorporating pharmacodynamics, to create a more robust model. The goal of the subsequent planned clinical trial simulation is to inform a prospective trial on oral PrEP dosing in pregnancy to improve HIV prevention during this critical time.  

  • December 01, 2021

    By Sarah Heins, Medical Student, COVID Recovery Program

    Experiencing “long-term COVID” or as it is medically termed, post-acute sequelae SARS-CoV-2 infection (PASC), can be a confusing and circuitous process, full of uncertainty and non-linear progress. Firstly, it can be difficult for many people to know whether they are experiencing long-term COVID symptoms, and even more difficult to know what to do about them. To provide some clarity and firsthand knowledge, three MedStar Health COVID Recovery Program patients—Patrick, Stephanie, and Debbie— have generously shared their perspectives on this journey. 


    Any patient’s first step in joining the program is realizing that acute COVID-19 symptoms are transitioning into long-term sequelae. Many patients report that some of their initial COVID symptoms tend to improve before PASC symptoms occur, while other acute symptoms—such as shortness of breath, respiratory difficulties, or loss of taste and smell—might linger from the acute period into the PASC period. Finally, other symptoms—such as brain fog, anxiety and depression, fatigue and exercise intolerance, or other more unique symptoms—may not arise at all until later in the PASC trajectory.

    When interviewed, Patrick stated that after his acute infection he “felt better and thought I would bounce back easily, but then didn’t get to 100%, and instead stayed at 90% for months
    .” He described lingering fatigue relating to long standing exercise intolerance, explaining that heused to go to gym every other day, but then it took 3 months before I could even go on a light jog without winding myself.


    Choosing MedStar Health and the initiation of care at the clinic.

    Prior to being established in our program, patients reported difficulty finding providers who understood and had experience with treating lingering symptoms of COVID—which was a key motivator for them to seek care in our program. Many began with treatment through their primary care providers (PCP), or tried to navigate the healthcare system on their own by requesting to see specialists they felt could treat their symptoms. Lack of widespread knowledge and understanding about PASC led patients to feel frustrated, dismissed, and ignored. Then, as specialized clinics devoted to seeing and treating patients with PASC began to emerge across the country, many patients were able to establish care at MedStar through word of mouth or referrals from their PCP or other providers. 


    To enter our COVID Recovery program, patients must be 6 weeks out from symptom onset and have either a laboratory confirmed positive COVID-19 test from their initial infection, or a clinical presentation indicating COVID-19. Patients complete an online medical-history form and standard patient assessment prior to their first appointment. For the initial visit, patients may be seen by one of the physical medicine and rehabilitation (PM&R) doctors that have dedicated part of their practice to helping patients suffering from PASC. A comprehensive medical history is performed, including details of the acute phase of a patient's COVID illness, as well as focusing particularly on addressing PASC symptoms and goals for recovery. From there, referrals are made to various specialists to address the specific needs and symptoms of each person.

    The role of the COVID Recovery Program is not to replace a patients’ PCP, but instead to serve as the patient’s PASC “home-base” and provide the framework of care during their recovery journey.  Finally, as treatment proceeds and patients see the various specialists and rehabilitative therapists relevant to their case, they will also complete online assessment forms at two, four, and six-month intervals, which helps track their progress and the program’s effectiveness.


    Perspectives on the journey’s beginning.

    In describing their outlook after the initial intake appointment, one of the main emotions patients described was “validation”. One of our patients, Patrick, stated his initial visit with the MedStar Health COVID Recovery Program was the “first time I talked to someone who actually understood and validated the reality of my symptoms, and also the first time the doctor explained that other people had those symptoms too.” Another patient, Stephanie, explained her first experiences with our program made her “feel like people really want to listen and help me get to the other side.” This validation came alongside feelings of relief and a return to self-control, but also came with feelings of apprehension. 


    The hope of recovery was mixed with worry that symptoms may not improve. Amidst this unshakeable worry, however, is trust. Patrick commented on his appreciation for his providers’ honesty. With his initial infection occurring back in March 2020, he was at the forefront of COVID long-haulers, and the providers in our program admitted that they may not have answers to explain some of his symptoms. Yet he still “felt grateful to be talking to someone who is aware of what is happening.” Stephanie expressed similar sentiment, describing a feeling that she was “getting a fresh set of eyes on a problem,” and that particularly in such a focused clinic, the providers’ “knowledge of other patients and situations has really helped.”

     

    Through our COVID Recovery Program, many people not only find their long-term COVID symptoms improving, but also feel a renewed sense of hope for their progress. Learn more about how our program can help from patient's perspectives: https://bit.ly/3xIp8Rh.
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    Treatments and specialists.

    Though the list of specialists differs for each patient, the most common referrals have been to cardiologists, neurologists, pulmonologists, rheumatologists, and rehabilitative therapists. The treatment trajectory can also vary from patient to patient, and for some may involve medical testing and specialist visits in the early weeks, followed by more time with rehabilitative therapists later on. 


    To give further insight into the integration of these multiple treatment specialties, Debbie gave a detailed outline of the care each specialist provided:

    • Cardiologist: Performed an electrocardiogram (EKG) and an echocardiogram and gave her a wearable heart monitor to assess her tachycardia (fast heart rate) and check for associated abnormalities. 
    • Neurologist: Performed a magnetic resonance imaging (MRI) to rule out a stroke as possible explanation for the cognitive symptoms she was facing. This confirmed that her cognitive and mental-health issues were COVID related.
    • Gastroenterologist: Did exams and provided treatment to help with reflux.
    • Neuropsychologist: Performed a 4-hour cognitive assessment to further address cognitive symptoms. 
    • Psychiatrist: For help with anxiety and panic attacks. 
    • Occupational therapist: Helped establish techniques for energy conservation and provided help with the more physically interactive elements of maintaining energy.
    • Speech and language therapist: Also established techniques for energy conservation, as well as making return to work plans. 

    Debbie explained that working with such a diverse group of physicians and therapists to find the treatment plans that worked best for her was like “throwing darts at a dartboard and hoping something would hit the middle.” In this sense, treating PASC often involves lots of trial and error, in which the physician and patient work together to track all attempted treatment tactics, assess what is and is not effective, and move forward with the best methods.


    Rehabilitative therapies are the cornerstone of treatment, playing a particularly effective role in helping patients overcome fatigue, malaise, and cognitive challenges. These therapists help patients incorporate concrete tools into their daily lives that help mitigate PASC’s impact on functioning. For example, Patrick uses a G-Mail plug-in that helps read his emails out loud to him, while Debbie implemented a plan with her coworkers in which they communicate with her largely over email rather than in-person. This allows for control of her information intake and offers her the ability to respond to them at her own pace. 


    Managing all aspects of PASC.

    Our comprehensive program requires patients to communicate with a wide range of specialists and manage various integrated therapies on top of keeping track of their own medications and symptoms. Following this complicated schedule requires personalized strategies to control its multiple moving pieces. The online patient portal is one central and extremely helpful tool that allows for easy communication with specialists and care navigators. However, in addition to using the portal and following the care provided by the program, many patients establish their own coping strategies to stay on top of their care needs. Patients report using an app or online calendar to keep track of all appointments, medications, and exercises, which ensures that every element of treatment is updated in real time and preserved in a central location. 


    Stephanie checks her online calendar every night to make sure she knows what is scheduled for the next day. She has also developed a strategy of leaving schedules and to-do lists in strategic locations—such as the car, bathroom, or dresser—to provide immediate reminders of her daily tasks. She emphasizes the value of finding someone in your own life to help you as you recover from PASC. Relying on a spouse, child, or friend can be an enormously beneficial asset. An additional coping strategy she suggests is to make a file of all the notes and resources provided by each specialist, which can be helpful to keep track of progress and treatments, as well as provide a way to keep information easily accessible at all times.


    Our program's environment.

    The culture of our program is extremely team-oriented, emphasizing communication, integration of care between specialists, and doctor-patient collaboration. One of our patients, Debbie, describes her experience as characterized by partnership with her physicians, explaining that they give her the autonomy to diagnose and identify her needs, and then they work alongside her to address them. Furthermore, Patrick, another of our patients, says he was given the opportunity to provide feedback on his rehabilitative therapy sessions, thus playing a role in bettering his own care experience.


    Final thoughts and valuable advice.

    Through our COVID Recovery Program, many people not only find their physical PASC symptoms improving, but they also feel a renewed sense of hope for their own progress. Patrick also describes a welcome feeling of empowerment, explaining that he “now can make it all day without logging off or closing my eyes,” and “no longer feels defeated.”


    Another common feeling is one of being increasingly accepted and heard. Stephanie explains that she is finally confident enough to be a part of her own treatment. She feels more capable of participating in her medical care and much less afraid to wonder if a new symptom is part of her long-COVID or not. She no longer hesitates to describe her symptoms or feelings to providers because she knows that she will be cared for.


    In sharing their experiences, current patients of the program say that their main piece of advice for those just embarking on their treatment journey is to be patient. Debbie offers further advice, saying: “Believe that it will help. It may not fully heal you, and might not happen as fast as you want, but believe that the steps are making a difference.” 


    Debbie also encourages people not to give up—as “everyone is different and has different problems to focus on.” 


    The MedStar Health COVID Recovery Program is one of just a few comprehensive COVID recovery programs in the country, and just like the knowledge of PASC itself, is constantly evolving in its understanding of the illness and its strategies for treatment. As Patrick explains to future patients, “you are at the forefront of what the medical community knows—so they are still learning,” highlighting the fact that our program will continue engaging in learning and research that will only make its treatment stronger.


    Interested in the MedStar Health COVID Recovery Program?

    Click below to learn more.

    MedStar Health COVID Recovery Program

  • December 01, 2021

    By MedStar Team

    Gun violence in Washington, D.C., has plagued our community with almost 200 homicides this year, an increase of 13% from last year. The trauma unit at MedStar Washington Hospital Center in D.C. is one of the busiest in the region, with about 600 patients who survive violent injuries every year. Investigators at MedStar Washington are working to understand how tailored interventions can help violent injury patients recover, help reduce violent re-injury, and address prominent and specific needs of violence survivors with an aim to break the cycle of violence in our community.

    Under the direction of Dr. Erin Hall & Millie Sheppard through funding made available by D.C. Office of Victims Services and Justice Grants, the Maryland Governor's Office of Crime Control and Prevention and the National Crime Victim's Legal Institute, the MedStar Health Community Violence Intervention Program (CVIP) was designed to reduce and prevent new injuries and retaliatory violence through promoting an improved sense of self for each patient. The goal of this research program is to help survivors during their recovery to reduce risk factors for violent reinjury and increase protective factors through engagement, empowerment, support, and advocacy.

    “We really want to take that therapeutic opportunity to say, ‘We have some resources to help you overcome this, to look forward to the future, to start to set your own goals about what you want and use this period of time and reexamination to set a trajectory toward better health,’” said Dr. Erin Hall, in a recent interview with NBC4.

    The MedStar Health Community Violence Intervention Program is also a part of a national study sponsored through the American College of Surgeons Committee on Trauma on non-fatal gunshot wounds. MWHC-CVIP also works collaboratively with other hospital-based violence intervention programs in the DC area to track and analyze recurrent violent injury for patients through a multi-pronged approach. This includes frequent follow-ups and standardized close-out questionnaires. The findings help the team analyze the impacts of interventions, pre-existing risk factors, and identify novel independent risk factors for recurrent violent inury.

    The team is dedicated to helping violence survivors heal physical and hidden wounds and providing support in the hope of reducing the number of repeat visitors to the hospital. Each potential program participant is assigned to a social worker, treatment navigator and violence intervention specialist, who are then responsible for engaging the survivor with ongoing support to help them find resources in education, employment, physical therapy and more. The program follows up with patients for six months and oftentimes there are success stories and the promise of making change in people’s lives to help address their trauma and look to a better future. 

    The Core Components of CVIP are:

    • providing culturally competent first contact with eligible participants within 24 hours of injury
    • providing trauma-informed care
    • eliciting patient-generated goals and needs
    • delivering intensive case management to meet those goals and needs
    • facilitating a warm hand off to community resources tailored to each participant
    • providing consistent follow-up after discharge from the hospital

    Developing community partnerships is another goal of CVIP to help break the cycle of violence in our community. So far, their outreach efforts have secured relationships with external groups such as the Office of Neighborhood Safety and Engagement, Cure the Streets, Collaborative Solutions for Communities, Training Grounds, Network for Victim Recovery of DC, Victims Legal Network of DC, Black Mental Health Alliance, Georgetown Law Health Justice Alliance, and Alliance of Concerned Men. Future work includes working with the Network for Victim Recovery of DC to increase knowledge and understanding of Crime Victim Rights within the District and with Georgetown Law Center’s Health Justice Alliance to identify and address civil legal needs of survivors. The goal of this program would be to help educate survivors of their rights as crime victims, identify health harming circumstances that may have a civil legal remedy, and assist participants with obtaining appropriate legal services, if necessary.

  • November 30, 2021

    By MedStar Team

    Heart disease disproportionally effects American Indians and is double that of the general US population. The Strong Heart Study has been examining why there is such disparities in health in this population for more than 30 years. Lessons learned from the Strong Heart Study are being applied to improve the health of the American Indians and other underserved communities across the nation.

    Since 1988, MedStar Health Research Institute has been one of the three main collaborating institutions of the Strong Heart Study. Funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), the Strong Heart Study is the largest and longest study of heart disease among American Indians. It includes more than 7,600 participants representing 12 communities across three main field centers in Arizona, Oklahoma, and the Dakotas. Analysis of more than 30 years of data has allowed MHRI investigators and collaborators to better understand how cardiovascular disease risk factors vary among American Indians, offering insights into how clinicians and public health groups might evolve and adapt disease prevention and treatment approaches to be more equitable and impactful across populations. 

    Some of the key findings produced by this study include:

    • Heart and vascular disease among American Indians has increased over the past 50 years and is now double that of the general U.S. population.
    • While recent data shows slow improvement, there is still work to be done to reduce rates among this population, including continued investment in public health programs to raise awareness about lifestyle and other risk factors. 

    • Known cardiovascular disease risk factors, including high blood pressure, cholesterol, and smoking are all important in American Indians, even though levels may be lower than in other populations. Strong Heart data showed that having type 2 diabetes is the strongest risk factor for cardiovascular disease in American Indians and did so before this was recognized in other groups. 
    • Genetic risk factors have also been identified among American Indians, some of which mirror risks in other populations and others which have been discovered first in the Strong Heart Study, underlining the importance of genetic studies in diverse populations. 
    • Environmental factors may also play a role in cardiovascular disease development, with research finding that exposures to arsenic and cadmium, at levels thought previously to be safe, are prospectively associated with higher risk.

    As one of our longest continuous research initiatives, the Strong Heart Study is one of the Institute’s foundational efforts into understanding the root causes of health disparities among underserved populations. We know that addressing health disparities involves understanding the needs of the community beyond those typically addressed in the medical care system, such as housing, nutrition, transportation, and culture. In addition to conducting important data collections about cardiovascular disease, the Strong Heart team has worked to develop strong, trusted relationships within tribal communities that honor each participant’s culture. 

    Using community ties to fight COVID-19

    Strong Heart program leaders have stepped up to help American Indian communities fight the COVID-19 pandemic. In partnership with the participating tribal communities, the Strong Heart field center teams have pivoted their efforts to prevent the spread of the virus among local tribes. The staff has volunteered to help distribute masks and educational materials, and most recently, collaborated with local public health officials on encouraging uptake of the COVID-19 vaccine among younger tribal members. 

    Investigators in the Strong Heart Study have also recently partnered with the NHLBI-funded Collaborative Cohort of Cohorts for COVID-19 Research (C4R), an observational study of more than 50,000 individuals nationwide to determine factors that predict disease severity and long-term health impacts of COVID-19.