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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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  • January 22, 2021

    By MedStar Health

    The complex anatomy of the head and neck has long fascinated Andrew Lee, MD, an otolaryngologist at MedStar Washington Hospital Center and MedStar Southern Maryland Hospital Center. Part of the reason could be that it appeals to the Chicago native’s longstanding parallel interests in both medicine and engineering, which he was able to combine as a bioengineering major at the University of Illinois.

    Medicine eventually won out. Dr. Lee moved to New York City to continue his education at Albert Einstein College of Medicine, and complete his residency at the school’s Montefiore Medical Center. Family influenced Dr. Lee’s decision to join MedStar Health, as his wife is originally from the Washington, D.C., area. But he also found a new one waiting for him within the MedStar system.

    “I love the collegiality of the department,” he says. “The support from other physicians has been a great way to transition from residency to practice.”

    Dr. Lee also enjoys the opportunity to work with a variety of patients and treat conditions ranging from sinus and allergy-related disorders to hearing loss, obstructive sleep apnea, voice disorders, and head and neck cancers.

    “On any given day, you can be doing something relatively simple, or something very complex, such as an open-neck procedure,” he says. “Fortunately, otolaryngologists have a growing range of tools and technologies that allow us to address many complex conditions using minimally invasive procedures, which is much safer and comfortable for patients.”

    Although Dr. Lee is currently focused on building his practice, he hopes eventually to pursue research that allows him to apply his bioengineering background.

    “There are so many areas in this field to explore, such as sinus surgery and sleep apnea,” he says. “We’re learning about their relationship to other conditions, such as heart disease, diabetes, and obesity.”

    Away from work, the main focus for Dr. Lee and his wife is their 8-month-old daughter. “Once the pandemic is over, we hope to get back to doing other things, such as discovering new restaurants and travel,” he adds.

    An avid college football fan, Dr. Lee will also have to find new ways to spend his Saturdays, now that the season is over.

    “With my daughter, that shouldn’t be too difficult,” he says with a laugh.

    Ear, nose or throat issues?

    Schedule an appointment with Dr. Lee

    Call 202-788-5048 or Request an Appointment

  • January 21, 2021

    By Evan H. Argintar, MD

    Skiing, skating and sledding can be great wintertime fun. But the elements that bring the greatest thrill to these sports—gravity, speed and ice—can also make them quite dangerous.

    Sports injuries, in general, are the most common mishap sending people to the emergency room, second only to household accidents. In fact, for some age groups, sports injuries are the #1 reason for ER visits year-round—although winter sports present their share of unique hazards.

    By government estimates, over 3 million Americans hurt themselves pursuing winter sports each year. Of that total, 200,000 become injured seriously enough to need medical attention.

    On the Slopes

    With high speeds often involved, downhill skiing and snowboarding generate nearly 130,000 injuries requiring medical attention each year, nationwide. And ski resorts convenient to the Washington, D.C., metro area tend to be both icy and crowded. In icier conditions, skis become harder to control, especially for weekend warriors, and falls occur more frequently. Collisions with other skiers can result in injuries as well.

    For skiers at almost all skill levels, falling can seem as much a part of the sport as staying upright. Unfortunately, falling injury-free is probably more about luck than skill: “learning to fall” comes from hours of experience that many weekend warriors never achieve.

    However, there are things you can do to decrease your odds of a break or major joint injury:

    • First, be honest about your skills. If you’re a beginning or intermediate skier, don’t jump on the black diamond run expecting to handle it like a pro. To stay safe, ski at your skill level.
    • When renting equipment, state your exact skill level to the ski staffer who is setting up your skis and bindings. If you’re less skilled on the slopes and more likely to fall, you’ll want those bindings kept loose. Tumbling down a mountain with skis firmly fastened to your feet can place unnatural forces on your ankles, knees and hips. Ankles are particularly prone to sprains and breaks. So, the skis should pop off the second you fall to avoid or lessen injury.
    • Similarly, shoulder injuries can be caused by ski poles. Dislocations, rotator cuff injuries and broken collarbones are common. When a ski pole tethers your arm to the ground, forces on joints can be magnified. Although you can’t completely eliminate risk, consider not using wrist straps if your poles have them. This will give you a better chance of releasing the pole when you fall. Better to spend time looking for a lost pole than winding up in surgery.
    • Keep aware of your surroundings. A crowded hill creates opportunity for collisions, so avoid larger crowds whenever possible. Know where the trees, ski lifts and other objects are. When the run gets icy, tone down your speed—even seasoned skiers can have trouble navigating icy turns. Losing control can easily escalate to a crash.
    Gravity, speed and icy conditions can make skiing, skating and sledding a thrill. But the thrill can result in injury. Dr. Evan Argintar has winter sports safety tips. @MedStarWHC via https://bit.ly/3hqsG2I
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    On the Ice

    Ice is a hazard that keeps orthopedic surgeons busy throughout each winter. In the U.S. alone, about 48,000 ice skating injuries need medical attention every year. Although skiing is a lot faster than skating, good conditions on the slopes can give you a nice powder to cushion your fall. Not so in skating, where the ice is always hard and slippery—the perfect scenario for falls that cause fractures.

    When we fall, we instinctively extend our arms to break the fall and protect the head. This puts the wrist in danger of fracture. Ankles are also at risk from rotational forces, when the skate blade stays put as the leg rotates.

    • Again, the best way to prevent getting hurt: know your limits. If you’re not yet confident on skates, take it slow. Stay near the wall or skate with a more experienced buddy.
    • As in skiing, crowds can be problematic here, too. Avoid collisions by staying aware of the surroundings.
    • Don’t exceed safe speeds, even if you’re a skilled skater.
    • Fortunately, most skaters fall on their rear ends, which provides adequate padding for most of us. We don’t see a lot of orthopedic injuries to that area—bruising is more common. So, opt to land on your rear when possible. In fact, if you moderate your speed, you’ll naturally fall that way.

    On the Sledding Hill

    For most, sledding is probably the winter sport you engaged in at the earliest age. But even if you’ve been sledding for years, it can still be hazardous. In fact, around 22,000 serious injuries occur due to sledding, tobogganing and tubing activities each year.

    • Most of the sledding injuries we see happen with kids. Collisions can cause problems, particularly when a child on the sledding run is hit by another sledder and suffers a leg, arm or ankle injury.
    • Head and neck injuries are less common, but can be catastrophic, especially if the sledder strikes a tree. It’s best to sled downhill feet-first. And helmets are a must. Fortunately, kids are accustomed to them these days—although you may need to remind them.
    • Again, know the surroundings, and be sure you and your kids take note of any obvious perils. Kids should stay out of the sled run when they’re not sledding.
    • Because most sleds have no brakes, and saucers and tubes have no mechanical steering, be sure kids know how to roll off if they spot trouble ahead.
    • Especially avoid sledding near a busy road or parking lot. Cars and sleds don’t mix, and being struck by a vehicle becomes a tragic reality for a number of sledders every year.

    Prep Before You Go

    Wintertime weekend warriors often hit a sport hard without preparing. You’re more likely to get hurt when you’re stressing muscles and tendons that don’t typically get pushed in the course of everyday activities.

    Winter sports are demanding, so get in condition before you play. Devote attention to the calves, hamstrings, hip abductor muscles and iliotibial (IT) band—the long piece of connective tissue joining the hip, knee and shinbone. You can work each of these areas safely at home, without special equipment. Of course, if you’re recovering from an injury or unsure about a technique, speak with your doctor before attempting any of these sports.

    And, if you’re at a beginning level, take a lesson. Lessons can help you have better control and learn to fall more safely.

    Get Help Sooner, Not Later

    Most of us spend three-quarters of the year not engaged in winter sports, so the first few times on the slopes, rink or sledding hill are likely to result in some level of aches and stiffness. How can a weekend warrior know if pain is serious enough to warrant medical attention?

    In the case of a fracture or other serious orthopedic injury, it will clearly cause the athlete severe pain or the inability to move a joint or put weight on a leg or ankle. These injuries typically command medical attention at the scene, from the ski patrol or other emergency responders trained in outdoor first aid.

    But not every orthopedic injury presents so dramatically. You may be in trouble without knowing it. If your pain and discomfort last longer than a day or two, worsen or give you an uneasy feeling, trust your gut and seek medical attention.

    In fact, the sooner you get attention, the better. We can fix almost anything, even an old injury that’s scarred or badly healed. But the longer you wait, the tougher the road to recovery can be.

    How We Can Help

    MedStar Washington Hospital Center offers orthopedic experts who can treat a range of cases—from the simple to the most complex—with precision and efficiency. In rare cases where an injury is unusually complicated, our team is supported by seasoned specialists in trauma care, vascular health and plastic surgery who can help as well. During the COVID-19 pandemic, we have staggered appointments and rearranged waiting rooms to maintain social distancing so patients can get the care they need in the safest possible environment.

    Remember the common-sense safety tips for all winter sports:

    • Warm up and stretch appropriately for the sport before you exert yourself.
    • Wear a helmet, especially when speed and ice are involved.
    • Know your limits.
    • Take frequent breaks, hydrate and stop when you’re tired.

    Now get out and enjoy the winter weather safely!


    Winter sports injury?

    Our orthopedic specialists can help.

    Call 202-788-5048 or Request an Appointment

  • January 21, 2021

    By Glenn W. Wortmann, MD

    As a former service member in the Army, I’m no stranger to vaccines. And today, as an infectious disease specialist, I’m grateful to be protected against the coronavirus after receiving the COVID-19 vaccine.

    As the COVID-19 vaccine becomes more widely available, you may have questions about whether or not you should get vaccinated. To help you make an informed decision about your own vaccination, here are answers to frequently asked questions about the vaccine.

    Are you thinking about getting the #COVID19 vaccine? On the #LiveWellHealthy blog, you’ll find answers to FAQs from Infectious Disease specialist Dr. Wortmann to help you make an informed decision: https://bit.ly/2LU4E4v.

    Click to Tweet


    What COVID-19 vaccines are currently available?

    There are currently two vaccines available for the COVID-19 vaccine. One is offered by Moderna and the other is offered by Pfizer. Both versions require two doses of the vaccine.

    Does it matter which COVID-19 vaccine I get?

    It does not matter which COVID-19 vaccine you get, but it is important to get both doses from the same manufacturer. I recommend taking the first vaccine that is available to you.

    Why are there two doses to the COVID-19 vaccine?

    The first dose is a prime dose to “wake up” the immune system. The second dose is considered a “booster” to give us long-term immunity, similar to many other vaccines we receive throughout our lifetime. It’s critical to come back for the second dose within the recommended time frame to be fully protected.

    What is it like to get the COVID-19 vaccine at MedStar Health?

    My experience getting the COVID-19 vaccine at MedStar was wonderful. It was quick and convenient to schedule appointments to receive both doses of the vaccine because the online scheduler automatically calculated when I would be due for the second dose.

    When I arrived for the appointment, there was no line and everyone I encountered was very pleasant. Following the shot, they have you wait in the office for 15 minutes to ensure you don’t have a reaction.

    My arm was a bit sore the evening after the shot, but the discomfort wore off by the next day. And, I had little to no soreness following the second dose of the COVID vaccine. Fortunately, I didn’t experience any other adverse side effects, such as a fever, either time.

    Is it common to experience other side effects after the vaccine?

    Both Moderna and Pfizer conducted large studies that revealed that the COVID-19 shot can cause reactions similar to the shingles shot. As a result, you may experience more soreness than you would after the flu shot. And, it’s not uncommon to have a mild fever or headache for a day following your COVID vaccine. However, almost all of the side effects in the studies wore off within 24 to 48 hours. Very few people needed to be hospitalized in response to the vaccine.

    There have been reports of allergic reactions to the vaccine, which happens with all vaccines and medications, in general. But, the odds are 1 in 100,000 people who get vaccinated. That is far less than the risk of an allergic reaction with common medications, like penicillin.

    Does the COVID-19 vaccine hurt?

    When Allia Noel, a registered nurse at MedStar Franklin Square Medical Center, got vaccinated, she felt that she actually experienced less soreness in her arm than she did with the flu shot. In fact, she felt so good that she worked the day after her first dose. Because of this, she got a mild headache and nausea but didn’t need to take any medication.

    After her second dose, she stayed in bed with mild chills and took some over-the-counter medication to alleviate her headache and she felt better in less than 24 hours. She says that one or two days of discomfort was worth the long-term protection for her overall health and wellbeing. “My chills were minimal compared to what I’ve witnessed from my patients struggling with a COVID-19 positive diagnosis,” adds Allia. “I would do it over and over again.”

    How can I be assured that the vaccine is safe?

    MedStar Washington Hospital Center Chaplain Tahara Akmal had many concerns about the vaccine before getting vaccinated. She wondered if the speed at which the vaccine was developed would affect its effectiveness and safety. She sought out information from the Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, and experts within the MedStar Health system to better understand the risks associated with getting vaccinated—or choosing not to.

    Ultimately, Tahara determined that in order to keep herself, her family, students, patients, and her colleagues safe, she wanted to get vaccinated. She decided that was the best way to protect her health and serve as a role model to those around her.

    Can people get the virus in response to the COVID-19 vaccine?

    When you get coronavirus, your body responds by breaking down the virus into pieces. One of the pieces of the virus that our bodies develop a response to is called a spike protein.

    Rather than using a live virus, the COVID-19 vaccines send messenger RNA which tells your body to respond by making a spike protein. Your immune system thinks that’s part of the virus and responds accordingly, which means it’s primed and ready to fight the real virus if you get it in the future. Since there is no live virus in the vaccine, it’s impossible to develop COVID-19 in response to getting vaccinated.

    Why do we need to keep wearing masks and practicing social distancing after getting vaccinated?

    There’s still information we don’t know about the virus and its response to the vaccine. For example, if someone coughs on me and I inhale the virus through my nose, my body will prevent the virus from entering my body because I’ve been vaccinated. However, it’s unclear whether or not I could spread the virus to someone else who may not have been vaccinated. We just don’t know yet whether or not the virus could live within the nose for a few days. That’s why it’s important to continue following safety precautions, like mask-wearing, frequent hand-washing, and social distancing. Once more data comes out, this may change.

    What is herd immunity?

    The vaccines currently offer 95 percent protection and we can’t take a chance in or outside of the hospital. Since we know there are some populations who will choose not to get vaccinated, it’s not safe to lower precautions until we achieve herd immunity.

    Herd immunity is when 80 to 90 percent of the population is vaccinated, which means the virus isn’t ping-ponging among the community. At that point, even those who aren’t vaccinated are unlikely to get the virus. If we can get the majority of the population vaccinated, we can potentially protect everybody.

    Why is it important to get vaccinated?

    Registered Nurse Allia is so grateful to have been vaccinated, as someone who’s seen the COVID-19 surge and witnessed the challenges that COVID-19-positive patients are experiencing. She’s held countless people’s hands who desperately wish that they could have a support person with them, regardless of if they’re in the hospital for COVID-19 or a heart attack. People are sick, afraid, and alone. Seeing the first hand struggle in the hospital gives her the perspective that it’s a privilege to get vaccinated so that we can all get through this and get rid of the virus. Allia says, “Getting a vaccine is not just to protect me but those around me as well.”

    For more information from MedStar Health experts on the COVID-19 vaccine, watch our Facebook Live broadcast:

    Have more questions about the vaccine? Read part two of the COVID-19 vaccine FAQ series.


    Stay up-to-date with information on the COVID-19 vaccine.
    Click the link below.

    MedStar Health COVID-19 vaccine information

  • January 20, 2021

    By Dr. James Houston, Director of Pain Management at MedStar Health

    When you have chronic pain that gets in the way of everyday activities, you may benefit from pain management treatment. Not all pain management clinics offer the same options that can improve your quality of life and offer long-lasting pain relief. Here’s what you need to know about your pain management options.

    You don’t have to live with chronic #BackPain, #SpinePain, or #NeckPain. On the #LiveWellHealthy blog, pain management expert Dr. Houston shares what you need to know when seeking treatment: https://bit.ly/3izUh1J.

    Click to Tweet

    What is pain management?

    When people think of pain management, they often think of anesthesia services offered during surgery or other inpatient procedures. Pain management experts are also highly skilled at using a variety of techniques and technology to relieve chronic pain in outpatient settings.

    There are many effective and safe ways to minimize your pain, restore function, and improve your quality of life while limiting the use of opioid medications. Typically, this combines advanced pain management treatments aimed at addressing the root of your pain with other forms of care. For example:

    Who could benefit from pain management services?

    Acute pain that emerges suddenly after an injury, such as a broken bone, should be treated by a primary care or urgent care provider. Chronic pain is pain that doesn’t resolve on its own past a normal period of healing. Typically, this means pain lasting over 90 days.

    If you have persistent pain that’s interfering with your ability to live the life you want, you may benefit from seeing a pain management specialist. Just as other types of injuries and illnesses require the attention of a medical specialist, such as a neurologist or shoulder surgeon, our pain management specialists primarily treat chronic pain using the latest techniques and tools to relieve symptoms and improve your quality of life.

    A customized pain management plan may be right for you if you have chronic pain related to:

    • Arthritis
    • Back pain
    • Cancer pain
    • Complex regional pain syndrome (CRPS) or Reflex Sympathetic Dystrophy Syndrome (RSD)
    • Joint pain
    • Migraines
    • Musculoskeletal pain
    • Neck pain
    • Neuralgia
    • Sciatica
    • Spine pain

    … and more.

    Request an appointment.

    The most effective pain relief starts with an accurate diagnosis.

    Medication may relieve your pain temporarily. But for pain relief that lasts, you need an expert to find the root of your pain. At MedStar Health, we believe an accurate diagnosis is the best way to ensure effective treatment that relieves your pain. We’re able to correctly identify the source of your pain and design customized treatment plans to manage your pain by collecting comprehensive information about your condition through a combination of the following:

    • A review of your medical history
    • A physical exam
    • Analysis of blood or lab work
    • Examination of imaging tests, such as CT scans, MRIs, or x-rays
    • Performing diagnostic nerve blocks

    A diagnostic nerve block is a procedure that uses a needle to inject a local anesthetic into a nerve to block the pain signals to the brain. If it’s successful, we know the source of the pain. A diagnostic nerve block may be used for joint pain. For example, knee pain, or in the spine for back and neck pain. Similarly, a sympathetic nerve block targets a group of nerves, helping to diagnose CRPS or RSD.

    Long-lasting chronic pain relief requires advanced therapies that extend beyond medication.

    Once we identify the source of your pain, our first approach typically involves interventions to manage your pain while limiting the need for opioids. Together, we’ll develop a treatment plan that uses a variety of techniques to meet your individual needs and goals.

    Unfortunately, evidence suggests that long-term chronic opioid therapy is ineffective in most situations due to well-established side effects. This includes immunosuppression, endocrine abnormalities, constipation, sedation, and worsening pain from opioid-induced hyperalgesia. While we will prescribe opioids in certain situations when clinically necessary—and in combination with other treatment modalities—we extensively evaluate our patients, keep dosages low, and seek other ways to control pain.

    Pain management treatment options at MedStar Health.

    Advanced pain management techniques offer a variety of benefits with fewer risks than most medications. Your doctor will take into consideration your unique condition and goals before designing a pain management treatment plan that will work best for you. Your treatment will vary based on the source and location of your pain but may include:

    Radiofrequency nerve ablations.

    This uses a needle to deliver controlled and precise heat to reduce or stop affected nerves from sending pain signals to the brain. Radiofrequency nerve ablations may be used for pain in the knee, hip, sacroiliac joint, and shoulder, as well as the cervical, thoracic, and lumbar spine. Nearly two-thirds to 90 percent of patients report pain relief following the procedure.

    Steroid injections and epidural steroid injections.

    During this method, a pain management specialist injects local anesthetics near nerves near inflamed tissue or the spine to reduce pain and inflammation caused by herniated discs, degenerative disc disease, arthritis, and more. Many patients experience pain relief within three to seven days after the procedure.

    Neuromodulation.

    Neuromodulation includes:

    • Peripheral nerve stimulation, which uses temporary or permanent nerve implants to block pain signals, thereby reducing lower back pain, shoulder pain, post-amputation pain, chronic pain, and more.
    • Spinal cord stimulation, which provides pain relief by electrically stimulating the spinal cord to block pain signals. You may or may not even feel the stimulation, and you are given a remote control for the implanted device.

    Intrathecal pump implants.

    Also called pain pumps, these are used to inject medications directly into the spinal fluid via a catheter. This is typically effective in relieving pain for patients living with cancer.

    Trigger point injections.

    This involves injecting medication directly into myofascial trigger points, or sensitive fibers within a muscle. These injections offer immediate pain relief for patients experiencing chronic muscle pain and other issues affecting the musculoskeletal system.

    Ketamine and lidocaine infusions.

    These are anesthetics delivered intravenously that can treat pain caused by nerve injury or chronic pain. Ketamine is most commonly known as an effective way to treat depression, and the FDA-approved infusion formulation offers those mood-boosting benefits to patients receiving the infusion for pain. MedStar Health offers one of the only pain management programs under which ketamine and lidocaine infusions are covered by insurance.

    Pain management services.

    We’re one of the only comprehensive pain management clinics in the area.

    Some pain management clinics focus on interventional services that provide pain relief but don’t necessarily address the root of your pain. Others emphasize medication, managing your use of opioids or other controlled substances, which are unfortunately proven to be ineffective and risky over time.

    At MedStar Health, we offer comprehensive and integrated pain management options using a holistic approach to relieving pain, while minimizing opioid use when possible. And, we offer outpatient pain management services within hospitals or multi-specialty care centers. This allows many of our patients to benefit from sedation options that keep them comfortable during the procedure while still being able to return home the same day.

    Pain management services near you in Maryland and the Washington, D.C., region.

    There are few other pain management programs in the region that offer a full spectrum of services aimed to treat the source of your pain. At MedStar Health, you can expect care from pain management experts who are all fellowship-trained by the Accreditation Council for Graduate Medical Education (ACGME). And, you’ll reap the benefits of our academic program, which offers access to the most advanced medical technologies, innovative treatments, the latest research, clinical trials, and more.

    We accept most major insurances, and, with more than 10 locations throughout region, you won’t have to travel far.

    You don’t have to live with chronic pain. Talk to your doctor about a referral today.


    Ready to get back to a life without pain?
    MedStar Health is here to help. Call 877-313-3605 or click below to learn more and request an appointment.

    Pain Management Services

  • January 20, 2021

    By Krystal C. Maloni, MD, Vascular Surgery

    There is good news for those who have varicose veins or are worried about developing them in the future. Today’s treatments for removing these enlarged veins are much less invasive than in years past. And taking steps early on may even help you minimize or avoid them altogether.

    What Causes Enlarged Veins in Legs and Feet?

    In most cases, weakened veins are to blame. Varicosities and their smaller cousin, spider veins, can occur anywhere in the body, but they are far more common in the lower extremities.

    That’s because gravity is a factor. Blood has a long uphill journey from the feet back to the heart. To keep it flowing upward, your leg veins—unlike those in your upper body—have valves along the way. These act like one-way doors, opening and closing as blood pushes upward with each muscle contraction. Healthy valves close tightly. But weakened ones let blood flow backward, putting extra pressure on the veins. That can create stretching and distortion, which leads to purple, cord-like veins bulging just beneath the skin’s surface.

    Varicose veins are extremely common, more so in women, and typically harmless. Common risks include having a family history of them, aging, pregnancy (especially more than one) excess weight and long periods of standing on a regular basis. A history of more serious clotting, known as deep vein thrombosis, can also increase your risk.

    In addition, some people are born with a condition called May-Thurner syndrome that can lead to varicosities, often in the left leg alone. This happens when an artery in your pelvis presses on an underlying vein carrying blood to your left leg. Although the condition is rare, it’s something we look for during the initial ultrasound when we evaluate each patient’s veins and valve function.

    Are They Cause for Concern?

    For many people, varicose veins are just an unattractive nuisance. But for others, they eventually cause bothersome symptoms, such as burning, bleeding, itching, aching pain and/or a feeling of heaviness in the legs and feet. Sometimes, minor blood clots develop, which can be treated with pain reliever and warm compresses until the body resorbs them. In severe cases, skin sores erupt.

    While the condition isn’t generally harmful to your health, it can be uncomfortable and negatively impact your quality of life. With the minimally invasive treatments we offer today, there’s little risk in having them removed.

    Varicose veins can be uncomfortable and negatively impact your quality of life. But with minimally invasive treatment, there’s little risk in having them removed. Learn more from Dr. Krystal Maloni. @MedStarWHC via https://bit.ly/3c0AF5F.
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    How Are They Treated?

    The most common way we treat varicosities today is with radiofrequency ablation. This minimally invasive technique involves injecting the area with numbing medication, then using a tiny needle to gain access to the problematic vein. A very thin, flexible tube (catheter) is inserted into the vein, with ultrasound imaging used to guide it into place.

    As we slowly draw it backward, the catheter uses radiofrequency to send out heat, which seals off the vein as it goes. Any veins attached to the main branch that we treat also tend to regress over the next three months or so. Blood flow naturally reroutes to healthy veins, and the body eventually resorbs the treated veins over the next few months.

    Radiofrequency ablation takes less than 30 minutes, requires no anesthesia or downtime and is highly effective for removing symptomatic veins with little risk. Most patients don’t need any further procedures and are happy with the results long-term.

    This technique works for most patients, whose varicose veins tend to branch from the superficial leg veins known as the greater saphenous, small saphenous or anterior saphenous. These long, straight veins can easily accommodate the thin catheter.

    A newer procedure we offer for treating veins like these is called VenaSealTM. It works much like radiofrequency ablation but, instead of using heat inside the vein, VenaSeal involves injecting a medical-grade adhesive to close it. The benefit is that no local numbing medicine is needed along the vein, so there are fewer injections overall, which some patients prefer. Occasionally, patients have a skin reaction to the adhesive, but for the most part, studies show it works well.

    Radiofrequency ablation and VenaSeal aren’t for every vein problem. For much smaller varicose or spider veins, we offer sclerotherapy. This involves injecting a solution into the vein that causes it to collapse and fade away over a few weeks. Some centers treat these smaller veins with laser therapy. While the laser can be effective, it’s actually more painful than sclerotherapy injections. It also takes more time, which means you may need multiple visits for laser treatments.

    Extremely dilated veins, which look like thick grapevines under the skin, sometimes require more complex treatment. For these, we may recommend a surgical phlebectomy. This requires general anesthesia at the hospital and involves making small incisions over the affected veins and actually removing them one by one. While surgical phlebotomy is more complex and invasive, it’s also highly effective for advanced cases.

    Does Health Insurance Cover Treatment?

    Most insurance plans do not cover treatments that are purely cosmetic. But if your varicose veins are causing symptoms—such as the burning, itching, pain or heaviness mentioned earlier—insurance plans will usually cover the ultrasound evaluation and treatments if venous disease is confirmed.

    Can Varicose Veins Be Prevented?

    Compression stockings are the gold standard approach for minimizing varicose veins. I highly recommend them if you already have these veins or any risk for developing them, such as pregnancy or a job requiring lots of time on your feet. These tight-fitting knee-highs or thigh-highs keep blood moving instead of pooling or backflowing. In order for them to be effective, however, they must be worn consistently every day, putting them on in the morning when you get dressed and taking them off when you go to bed at night.

    Medical-grade compression stockings require a prescription and can be purchased online or at local medical supply stores. (Typically, a pressure of 20 to 30 mmHg is a good start.) If these are too uncomfortable, however, non-prescription varieties are less snug and cost less; you can often find these online. The key is to choose compression stockings that you will commit to wearing regularly.

    If you’re sitting for long periods, try to elevate your legs to 90 degrees when you can. Maintaining a healthy weight can also help to minimize pressure and swelling on your legs. Regular walking and other leg exercise are another plus, since the muscle stimulation helps keep blood flowing and veins healthy. I recommend avoiding herbs and supplements you see advertised, as there’s no good evidence that they can prevent or help varicosities.

    At the Hospital Center

    While medical treatment for varicose veins isn’t always a must, varicosities do tend to worsen over time for most people. Coming in early for an ultrasound evaluation and a conversation about prevention and treatment options is ideal.

    MedStar Washington Hospital Center addresses the full range of vascular problems, so we are able to look for the obvious causes of varicose veins as well as the more complex. And our team is multidisciplinary, so we easily consult with or refer to other specialists as needed—assuring you the most comprehensive care.


    Bothered by varicose veins?

    Schedule an evaluation today.

    Call 202-788-5048 or Request an Appointment

  • January 15, 2021

    By MedStar Health

    When Ed Palmer was a respiratory therapist student at Prince George’s Community College, he had a professor who worked at MedStar Washington Hospital Center. This professor encouraged Ed to apply here, which he did, starting part-time while he was a student and beginning full-time night shifts after graduation.

    “I was told this was a great place to learn,” said Ed.

    After five years, Ed became a supervisor, then a manager, crediting mentors for leading him down his path.

    “As I was moving through the ranks, I had wonderful mentors,” said Ed. “[MedStar Heart & Vascular Institute Chief Administrative Officer] Cathie Monge is a big part of why I have stayed this long when other opportunities arose, and I appreciated our thought-provoking discussions.  [Senior Director of Patient Experience Operations] Joe Lynott has been a valuable longtime mentor and friend as well. Joe has always been there to discuss situations and provide guidance; he has taught me many valuable lessons. [Vice President of Operations] Tiffany Northern is someone who will say ‘I’m going to challenge you and set you up to continue to learn.’ These are all good people who encourage you and support you, while they challenge you.”

    Because of this type of encouragement from leadership, Ed finished his bachelor’s and master’s degrees while working at the Hospital Center, taking advantage of the hospital’s tuition reimbursement program. Ed also sees value in participating on committees, as he has learned a lot from being on the Wellness, Hand Hygiene and Safety Committees. In addition, Ed says he believes his participation on these committees has led to him being able to better understand the views of others, get through challenges, and help all participants come up with better ideas.

    Five years after becoming a manager, Ed was promoted to Associate Director and has spent the last five years as Director of Respiratory Therapy.

    Ed encourages his family to consider the Hospital Center, both as a place to come for treatment (as he did for his father, who he says lived five years longer because of the care he received here), and as a place to consider for employment, as he does with his daughter.

    “It’s important for everyone to realize there are lots of opportunities here and you’re working with others who can help you get the skills you’ll need for your next role,” said Ed.


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