MedStar Health Blog

As a cardiologist, I know how important it is to eat healthy and exercise. And, up until COVID hit, I applied the same tips for a healthy heart that I recommend to my patients in my personal life. However, when the pandemic began affecting our communities, I quickly abandoned some of those habits without realizing it.

I gained ten pounds, became less disciplined, and neglected exercise, which started a vicious cycle that many of my patients can relate to. I missed seeing my patients face-to-face, and I wasn’t able to see my friends and family, which felt isolating. Many of my patients needed a shoulder to cry on as they dealt with pain and loss from anxiety, stress, job loss, and more. And the truth is, I was going through the same emotional and mental turmoil that my patients were struggling with.

Monti Schmitt is one of those rare individuals whose idea of fun was riding off-road over rough terrain on a motorcycle at high speeds. For the former motocross race competitor, it was natural—and exhilarating. So were his “20-hour workdays” at his Fredericksburg, VA, motorsports business. He thought he was nearly indestructible, despite breaking multiple ribs twice in motorbike accidents. So, when the now 64-year-old had a pain in his chest during a walk, he thought little of it. But when the pain persisted for hours, Mr. Schmitt decided that his wife was right—a trip to the hospital was warranted.

“It was late December 2018,” Mr. Schmitt says. “When I woke up, it was January. I was shocked out of my mind when the doctor told me I needed a left ventricular assist device [LVAD] because I was in heart failure.”

Mr. Schmitt wanted a second opinion and did some research. That’s when he saw Mark Hofmeyer, MD, Director, Advanced Heart Failure Intermediate Care Unit at MedStar Washington Hospital Center. “He first tried some alternative treatment options. He took me off the drugs I had been put on at the other hospital and tried a defibrillator. But that wasn’t working.”

When his legs became swollen, Mr. Schmitt sent Dr. Hofmeyer a photo. “He told me to come into the hospital right away.” Two weeks later in early May 2019, Mr. Schmitt was implanted with an LVAD and was put on the heart transplant list. While the LVAD relieved Mr. Schmitt’s symptoms, he knew it was a temporary solution for his failing heart.

This past April, during the worldwide coronavirus pandemic, Mr. Schmitt got the call. “I was told a heart was available,” he says. “I remember I didn’t quite understand and said ‘What?’ Then I put Dr. Hofmeyer on hold. I was hesitant because of COVID. But I spoke to my wife and son who told me this was my heart, and this was my time. I said ‘Let’s do it!’”

“I know the hospital well and I knew that everyone would ensure my safety,” he says. “It was hard not to have my family there because of the no-visitors rule, but we got through it. Before I left, I had a lot of conversations with the team about post-procedure protocols for home. I had physical therapy at home, too. And in the time since, I’ve had lots of contact with the team—phone calls, video conferencing, especially with the Transplant Coordinator Kimberly Demirhan—she’s my gal!”

Now with his new heart, Mr. Schmitt says, laughing, “I’m a new person, like a 19-year-old iron man!”

As a longtime athlete, Kyle Reynolds, MD, knows that the course of a game can be altered in a heartbeat. The same holds true for his career, as the Queens, NY, native had his sights set on becoming a lawyer, until he was sidelined by a shoulder injury.

“I was just fascinated by anatomy and biomechanics of how everything worked,” Dr. Reynolds recalls, “so the doctor suggested I become an orthopaedic surgeon.”

A second career pivot occurred during his surgical rotation at New York Medical College. Unlike orthopaedic patients who tended to be younger and healthier, cardiovascular patients tended to be more diverse, and in greater need of help.

“Many had symptoms that were written off as chronic, when there were reasonable treatment alternatives to help ease the impact on their daily life and could also prevent worsening complications,” Dr. Reynolds adds.

After coming to MedStar Washington Hospital Center and MedStar Georgetown University Hospital for his residency, Dr. Reynolds knew he’d found a home.

“The other residents, attendings, APPs—they were all like family, and I wanted to keep working with them,” he says.

Now an attending vascular surgeon in MedStar Heart & Vascular Institute, Dr. Reynolds specializes in the treatment of aortic disease, including aneurysms and dissections, carotid artery disease, venous occlusive disease, deep vein thrombosis, and peripheral arterial disease, including claudication and critical limb ischemia. One of the most exciting treatment tools, he says, is transcarotid artery revascularization (TCAR), an advanced method for placing stents in blocked carotid arteries for patients who may face higher risks of stroke with conventional procedures.

New treatment alternatives are also available for wound healing, which can be influenced by both peripheral arterial disease and deep venous disease.

“Deep venous conditions were often treated medically, but it wasn’t enough to advance healing,” Dr. Reynolds says. “Now, we can treat some of these cases surgically, preventing complications and improving other aspects of the patient’s quality of life as well.”

Currently resigned to spending most of his free time reading, Dr. Reynolds looks forward to getting back into team sports once pandemic-related health risks ease. He’s also working on becoming certified in scuba diving, which will open the door to travel opportunities.

“I’ve heard of some great places to dive and can’t wait to get out there,” he says.

As the COVID-19 vaccine becomes available across the nation, you may have some questions about whether or not you should get vaccinated. In part one of this series on frequently asked questions about the vaccine, I talked about side effects, safety, and importance of the vaccine, as well as other things that you should know.

In part two, I’ll continue answering common questions about the COVID-19 vaccine regarding:

• Who should get the vaccine
• When to get vaccinated
• Reactions to the vaccine
• Staying healthy after the vaccine

Did you know that bladder cancer is the fourth most common non-skin cancer in the U.S.?

Unlike prostate cancer, for which there is a standard screening, bladder cancer can frequently fall under the radar. Yet anyone between the ages of 20 and 90 may be affected by it—in particular, Caucasian males 60–70 years of age. So you should never delay a hospital visit if you’re experiencing issues.

Here at MedStar Washington Hospital Center, we use an advanced technology, blue light cystoscopy, both to detect this cancer and help minimize the risk of its return. Although this technology is in use in other regions globally, the Hospital Center is one of the few medical facilities in this region utilizing the blue light technology. We perform 5 to 10 such procedures a month—more than any other medical center in the District of Columbia.

But before we understand the benefits that blue light cystoscopy brings, let’s first understand what can cause bladder cancer and how it’s typically managed.

Risk Factors

Instances of bladder cancer may be localized and confined within the organ itself, or may potentially spread elsewhere. Multiple risk factors can encourage bladder tumors to appear and grow:

• Cigarette smoking: This is the primary offender. Carcinogens inhaled by the smoker travel through the bloodstream to the kidneys, which try to eliminate the poisons via the urine. This interaction between the bladder lining and carcinogens in the urine is thought to lead to malignancies in the bladder.
• Toxic chemicals: Chemicals such as aniline dyes (used in hair dyes or automotive paint), or those used in certain professions (some benzenes or aromatic amines), may also put exposed persons at higher risk.
• Chronic bladder infections: Recurring urinary tract infections or the chronic use of tubes within the urinary tract can lead to inflammation, which can lead to bladder cancer over time.
• Radiation: When used to treat cancers in the pelvis, radiation may spur a secondary malignancy in the bladder.
• Genetic susceptibility: Hereditary conditions, such as Lynch syndrome, when combined with some of the factors listed above, can increase a patient’s risk as well.

If a patient is diagnosed with this cancer, his or her survival rate can depend largely on the stage at which the cancer is detected, and whether it is muscle-invasive or non–muscle-invasive.

The Stages of Bladder Cancer

Tumors of the bladder are assigned very specific stages, based on these conditions:

• Stage 0: In this beginning stage, abnormal cells are discovered in the tissue that lines the interior of the bladder. Stage 0a—sometimes referred to as noninvasive papillary carcinoma—can resemble long, thin growths, while Stage 0is (carcinoma in situ) presents as a flat tumor.
• Stage I: Cancer has formed and spread to connective tissue adjacent to the bladder’s lining.
• Stage II: Cancer has spread to include layers of the bladder’s muscle tissue.
• Stage III: In Stage IIIA, cancer has spread to the fat layer surrounding the bladder and potentially to reproductive organs, but not to lymph nodes, or it has spread to a single lymph node in the pelvis not near its major arteries. In Stage IIIB, cancer has spread to multiple lymph nodes in the pelvis, or to at least one near a main artery.
• Stage IV: In Stage IVA, cancer has spread from the bladder to the abdominal or pelvic wall, or to lymph nodes above the main pelvic arteries. In Stage IVB, cancer has metastasized to parts of the body, such as the liver, lungs or bones.

How Is Bladder Cancer Diagnosed?

There is no standardized screening for this cancer. A tumor of the bladder may cause no pain or other symptoms and may even be randomly discovered during an unrelated imaging test. More commonly, a patient’s first clue that there is an issue comes when they spot blood in their urine (hematuria), prompting medical attention.

For women, although bladder cancer presents less frequently than it does in men, it tends to be caught at more advanced stages of the disease. This situation may occur because blood in a woman’s urine can be mistakenly connected with menstruation or a urinary tract infection.

Any patient who discovers blood in their urine should consult their healthcare practitioner, who may recommend a hematuria workup.

Or, if symptoms from conditions such as overactive bladder don’t improve with traditional therapies, it could also be a signal to discuss possible other causes with your practitioner.

In these situations, your doctor might refer you to a urologist, who may recommend a comprehensive workup, including a CT scan and cystoscopy.

In bladder cancer’s earliest stages, when it remains localized within the bladder, patients require close surveillance and sometimes local therapies within the bladder. But they generally do well under treatment, and their bladder can often be preserved.

Blue Light Cystoscopy

The conventional first-line treatment for the removal of bladder cancer is via transurethral removal of bladder tumor, or TURBT for short. TURBT is used for surveillance and treatment of non-invasive bladder cancer, or if there are multiple sites to check for cancer cells and growth. It’s also a critical aid for identifying recurrences early on, and potentially preventing progression of the disease.

The “incision-less” TURBT process, usually performed as an outpatient procedure, involves resection of one or more tumors—that is, cutting out the diseased tissue—performed with the patient under anesthesia. Using a specialized endoscope inserted into the bladder, we scrape the tumor off the bladder’s inner lining. This allows us to not just eliminate the diseased area but also to diagnostically examine if it is invasive or non-invasive and whether it has spread.

Blue light cystoscopy is the newest tool in our TURBT toolbox, a unique technology for pinpointing tumors of the bladder. It allows us to locate problem areas more easily than standard white light cystoscopy, which can miss very small tumors or lesions.

An hour or so before TURBT, with the patient in pre-op, we first inject an imaging dye known as Cysview® through the urethra and into the bladder, giving it time to interact with the bladder lining and accumulate within abnormal tissue, such as cancerous cells. The dye is absorbed quickly by the rapidly dividing cancer cells. A compound within this dye—hexaminolevulinic acid—is photo-luminescent; exposed to blue light, it causes abnormal cells to glow pink (“fluorescence”).

TURBT surgery generally takes about an hour. We use a thin, lighted, tube-like cystoscope to inspect the bladder. While typical cystoscopes use just white light, the blue light instruments allow the surgeon to switch between white light and blue light.

Under this blue light, cancerous cells—which have absorbed the Cysview dye—glow a fluorescent pink, drawing the attention of the surgeon to the abnormal tissue. Thanks to this fluorescence, the surgeon can more readily note the edges of the bladder tumor, and remove even tiny lesions more quickly and thoroughly.

After the Procedure

Most patients do quite well immediately following this procedure, apart from some temporary irritation, frequent urination for a short time or residual bleeding in the urine. Generally, patients may return home immediately after surgery, with their urinary health back to normal in a week or two. Sometimes, the patient will go home with a catheter in their bladder for several days to facilitate bladder healing.

Post-recovery, patients will return to the Hospital Center to discuss next steps in the management of their bladder cancer. We’ll meet with patients every three to four months to assure there has been no recurrence of the tumor. In many cases where we’d like to continue surveillance on a patient, we’re able to perform blue light cystoscopy as an outpatient service in an office setting, thanks to the flexibility, speed and ease of the procedure.

If we find no issues after a period of observation, the patient’s check-ups can be spaced out over time.

The good news: Multiple studies in the U.S. and Europe show that the recurrence rate of non-invasive bladder cancer is lower for patients who undergo resection using blue light cystoscopy, compared with patients under white light. Depending on the tumor type, performing a TURBT with blue light has been shown to prevent recurrences by 12–43%.

Reducing Your Risk

So, what measures can the average individual take to protect themselves against bladder cancer? Here are some recommendations:

• If you smoke, take measures to quit. And if you don’t smoke, don’t start.
• Blood in your urine can be a signal. Talk to your healthcare provider and ensure that you receive the appropriate tests. Together, determine a necessary treatment path.

Lastly, don’t let COVID-19 cause you to delay care. We’re available to you, ready to answer your questions and help you consider options. Even in the midst of the pandemic, cystoscopy, CT scans and other screenings can be done safely and efficiently on-site here, without exposure to other patients.

Whatever the cause—burns, trauma or surgery—scars can have a negative impact on a patient’s quality of life. In decades past, treatment of symptomatic scarring (scars that result in discomfort, itch, pain or reduced range of motion) was limited and often complicated.

That has changed dramatically. Today, high-powered lasers shrink and relax symptomatic scar tissue, giving it flexibility closer to that of uninjured skin. Measurable improvements are possible in just a few months’ time, helping patients resume a happier, more normal lifestyle.

Why Lasers Help

Scarring is the body’s natural way to repair damaged tissue. But all scars are not alike. Depending on the individual and extent of the injury, some scars can critically limit the patient’s functional capability.

For example, consider a burn survivor with scarring near a joint. Scar tissue is naturally tighter, denser and stiffer than uninjured skin, and scars around elbows, shoulders, hips, knees or fingers might significantly limit that patient’s functionality and range of motion in that portion of their body. Laser treatment gradually makes such problematic scars thinner and suppler, so they behave more like normal tissue, improving movement. The treatment can also improve scars that feel continuously itchy, painful or “foreign” to the body.

In some cases, tight scars around a wound may prevent it from fully closing. But laser treatment can loosen these scars so they’re less of an obstacle to healing.

And while no scar can be 100 percent removed, laser scar revision can reduce thickness and improve discoloration. The lasers we use at MedStar Washington Hospital Center are powerful and effective against thicker, stiffer scar tissue.

How Scars Form

When the body is injure, it repairs itself by laying down collagen, the protein that makes up connective tissue. But the process isn’t necessarily neat—the collagen can be deposited in random layers and bundles, which is why scars tend to look, feel and behave differently than the damaged tissue they replace.

Severe injuries generally produce severe scars. But everyone scars differently, for reasons we don’t completely understand—an injury in one person might result in completely different scarring characteristics than in another person. We do know that people with darker skin, particularly those with African American and East Asian lineage, are more at risk of severe scarring.

How the Laser Works

Our lasers are able to target this scar collagen very accurately. The laser creates scores of small, barely visible holes in the scar tissue, making incremental improvements by releasing tension in the tissue. Over time and subsequent treatments, more tension is released as we slowly and carefully destroy the thickest collagen bundles. This stimulates a sort of remodeling, as the flexibility of the scar improves with each treatment.

The most fascinating aspect of this process is that we know that it is successful—but we’re not sure exactly why it works at the cellular level. Existing research is largely incomplete. We are working diligently to fill the gaps via multiple studies, including some with patients who volunteer to participate here at the Hospital Center. With time, we will unlock the secrets of the laser’s efficacy.

Impressive Results

Laser techniques have replaced many types of scar revision surgery, which were often uncomfortable and psychologically disheartening, as patients with large scars often had to start over with scar excision and the need for repeat skin grafting.

Today’s laser scar revision is very gratifying because we can deliver dramatic improvements to the patient with no significant side effects or down time. After just one session, 96.5 percent of patients treated at the Burn Center report improvement in their scarring in the form of increased range of motion or reduction of pain, itch or other discomfort.

On average, problem scarring can reduce range of motion to as little as 70 percent of normal. After one or two treatments, we can see that number improve to 76 percent. After the third treatment, patients may approach as much as 90 percent of normal capacity. Such improvement frequently enables patients whose scarring had rendered them unable to work to return to their jobs.

Getting Started

Most patients with thick and problematic scarring are great candidates for laser treatment.

The patient meets with our burn rehabilitation therapists, who take photographs and careful measurements to assess range of motion, functionality and other symptoms. The next meeting is with the surgeon, who determines with the patient the best course of action and duration of treatment.

Before treatment, we submit a report to the patient’s insurance company, detailing how laser treatment will help the patient’s specific symptoms. Getting each protocol preapproved paves the way for a treatment schedule without interruptions that can slow progress.

Most patients with serious scars benefit from an average of six treatments, each four weeks apart. If we delay longer between treatments, we sometimes see symptoms return, so an interval of about a month is optimum.

Laser treatment at the Hospital Center is a same-day procedure that takes 45 minutes or less. Patients are sedated during the procedure; general anesthesia is usually not needed unless we are treating very large areas or the neck or face.

After the procedure, patients may experience a feeling like sunburn, easily managed with over-the-counter ibuprofen (Motrin®/Advil®) or acetaminophen (Tylenol®). Most patients can return to bathing, wearing regular clothing and the normal activities of work and school the following day.

Why MedStar Washington Hospital Center

The Hospital Center is the only adult medical facility in the Washington, D.C., area to own and operate this particular specialized laser equipment. We generally perform around 200 treatment sessions each year.

And while the laser is a superb tool for the treatment of serious scars, it’s not the only one in the Hospital Center tool kit. The Burn Center is at the leading edge of treating scars from injury or surgical incision with a wide array of other treatment options such as compression garments, massage and topical silicone. While the days of being limited to large-scar revision surgery are happily behind us, we often perform smaller, less traumatic surgical procedures that will help improve effectiveness of the laser and other strategies.

Careful rehabilitation also contributes to a patient’s good results. Experienced in scar management, our rehabilitation therapists carefully assess and evaluate patients’ functionality and help them take full advantage of the new flexibility delivered by the laser. Their work is further supported by our excellent team of advanced practice providers, social workers, psychologists and other specialists.

In years past, physicians waited at least a year before surgical scar revision. Today, we know that laser care can begin as soon as the patient’s injury heals. It can even improve and relieve older scarring that has been problematic for decades. And during COVID-19, we are following all virus guidelines carefully and consistently, with treatments that are quick and minimally invasive.

If scars are making life difficult for you or a loved one, we encourage you to reach out to the Burn Center team to discuss your needs with our specialists. Laser revision can help improve your quality of life significantly.

Click here to learn more about our laser scar revision program.