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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 05, 2020

    By MedStar Team

    Throughout the national health systems, social determinants of health are frequently present which negatively impact health-related outcomes despite excellent medical care.  Four of these determinants, namely food insecurity and access to housing, medications and transportation are prevalent in our region as cited by MedStar Health Community Health report. Because of the impact of these social determinates of health, Medstar Health is testing this new initiative. Food and Friends is a community-based NGO which provides nutrition consultation services and 3 medically tailored meals per day for several months to eligible clients with chronic complex medical conditions, including diabetes.

    The Department of Emergency Medicine at MedStar Health Washington Hospital Center and the MedStar Health Diabetes Institute are partnering with Food & Friends on a pilot project to identify individuals with diabetes, hyperglycemia, and food insecurity, and link them to medically tailored meal delivery service for 6 months.

    Food insecurity is defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Of tremendous concern, there are 700,000 people at risk of hunger in Washington, D.C., Those living with diabetes and food insecurity are at particularly high risk of adverse events, in part because of the high cost of medication and the subsequent struggle to decide whether to spend their limited financial resources on food or medication. Screening for food insecurity in patients is an important step towards finding solutions in the community. The MedStar group has described that 46% of hyperglycemic patients presenting to the MedStar Washington Hospital Center Emergency Department with a blood sugar greater than 250 g/dl screened positive for food insecurity, and that these food insecurity patients were 1.9 times more likely to be hospitalized than those without food insecurity.  Among the subset with a HgbA1c measured, the mean level was very high at 11.2% and 96% had a HgbA1c > 7.5, which would be considered a reasonable target for many of these persons.

    In an emergency department study at MedStar Washington Hospital Center, senior Georgetown University medical students will enroll participants examining the impact of direct food referral for hyperglycemic patients.  The study is designed to determine the feasibility, adherence to, and impact of 6 months of no-cost, medically tailored meal delivery among diabetes patients experiencing Food insecurity directly linked from the emergency department..  

    The study team members are: Munish Goyal, MD, PI, MedStar Emergency Physicians; Michelle Magee, MD, MedStar Health Diabetes Institute; Yumi Jarris, MD; Rebecca Breed, MD; Gavin Koenig; Katie Povey; Donya Enayati; Virginia Chan; Heng Nhoung and Christopher Wagner. In the attached picture, Drs Goyal and Magee are volunteering at Food and Friends to get first-hand experience!

     
  • December 05, 2020

    By MedStar Team

    Congratulations to all MedStar researchers who had articles published in November 2020. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

    Selected research:

    1) COVID-19: associated morbidity and mitigation strategies
    Infectious Diseases, 2020. DOI: 10.1080/23744235.2020.1799071
    Mahmood SN, Woods CJ, Chan CM.

    2) Development and validation of a simple risk score for diagnosing COVID-19 in the emergency room
    Epidemiology & Infection, 2020. DOI: 10.1017/S0950268820002769
    Sung J, Choudry N, Bachour R.

    3) Evaluation and Treatment of Amiodarone-Induced Thyroid Disorders
    The Journal of Clinical Endocrinology & Metabolism, 2020. DOI: 10.1210/clinem/dgaa686
    Ylli D, Wartofsky L, Burman KD.

    4) An unusual presentation of inhalation injury in a patient with high voltage electrical injury: A case report
    International Journal of Surgery Case Reports, 2020. DOI: 10.1016/j.ijscr.2020.10.139
    Keyloun JW, Travis TE, Johnson LS, Shupp JW.

     

  • December 02, 2020

    By Gillian Louise Adams, MD

    Mental health refers to the general state of how you regulate your behavior, feelings, and thoughts. There’s no standard for measuring what’s normal for you versus what could be a reason for concern in someone else, but poor mental health could negatively affect:

    • How well you get along with family and friends
    • Your productivity at work or school
    • Your interest in activities, social settings, and other situations
    • Energy levels
      …and more.

    Anxiety is an appropriate response to stressful situational triggers.

    From navigating a public health crisis to feeling high political tensions, it’s no wonder that many people are feeling a little uneasy in 2020. And truthfully, stress is a perfectly normal and appropriate way to respond to situational triggers such as COVID-19, a job loss, or uncertainty around the election.

    In fact, many people who have never had depression before 2020 have been diagnosed this year. And I’d estimate that about one-third of my patients who already have a depression diagnosis have experienced worsening symptoms during this challenging year.

    One-third of American adults who have #Depression experienced worsening symptoms during 2020. On the #LiveWellHealthy blog, Dr. Adams shares 6 signs that it’s time to prioritize your #MentalHealth: https://bit.ly/2JGCjx3.

    Click to Tweet

    For some, healthy habits can reestablish their mental health, helping them to maintain their equilibrium. For others, a situational trigger can cause a downward spiral that leads to anxiety or depression. When that happens, it may be time to reevaluate how you take care of yourself.

    If you just don’t feel like yourself, it could be a sign you need to take care of your mental health.

    If something just feels off, don’t ignore that feeling. When you don’t feel like yourself for an extended period of time–say three weeks–that’s a good sign that you should reprioritize your mental health. While it may be hard to pinpoint what exactly that feels like, it could manifest itself in the following six signs of a mental health concern:

    1. Disrupted sleep.

    Poor sleep could be a red flag that you’re experiencing depression or anxiety. Whether you have trouble falling asleep or difficulty staying asleep — also known as “early morning wakening”, when you wake up and cannot fall back asleep — it could be a signal of a mental health concern. Frequent oversleeping could be a sign as well, demonstrating that your body is fatigued to the point of burn-out.

    2. Irritability or being more emotional than usual.

    Experiencing irritation, anger, feeling snappy and easily frustrated, or mood swings that fly from one extreme to the other could be a sign that your mental health is out of whack. Depression and anxiety can make it harder to self-regulate your thoughts and feelings, which is why you may be more reactive or sensitive than usual.

    3. Loss of joy.

    It’s normal to have a bad day every now and then, and life is bound to bring you some sadness at some point. But, if you routinely find less happiness and enjoyment in activities that you used to love, it could be a sign that something’s not quite right. For example, if you used to enjoy golfing or playing guitar but feel uninterested in participating in either of those activities right now, that could be an indicator that your mental health is out of balance.

    4. Change in appetite.

    There are a variety of ways depression and anxiety can affect how much you eat. For some, stress and anxiety may result in a loss of appetite, as they may not feel hungry or have the energy to eat. For others, binge eating comfort food can provide temporary relief from depressing thoughts and feelings. If you notice that you are overeating or undereating to the point where you observe dramatic changes in your weight over a short period of time, it could be time to seek help for your mental health.

    5. Worsening physical symptoms.

    Depression and anxiety can bring on physical side effects, including sweating, rapid heart rate, dizziness, gastrointestinal symptoms, and headache. If physical symptoms come on suddenly with no other medical cause, it could be a sign that your mental health is declining.

    6. Low energy.

    Feelings of fatigue and lethargy are also common in people who are struggling with their mental health. Feeling mentally or physically sluggish can make it harder to concentrate, follow conversations, or think quickly. If you have low energy to the point where it’s hard to find the motivation to get out of bed, consider talking to your doctor.

    How to improve your mental health at home.

    Not every sign of a mental health concern means that you have a mental health disorder, like anxiety or depression. But it could mean that you need to change something in your routine before your mental health worsens, or leads to something more serious.

    One of the best ways you can care for your mental health is by establishing healthy habits. These may include:

    • Aiming for 7-8 hours of sleep per night with no screen time for 30 minutes before bed
    • Eating healthy, balanced meals that consist of whole foods
    • Exercising for 30 minutes a day, at least five days per week
    • Hydrating well with water, eliminating excessive caffeine
    • Practicing mindfulness and meditation
    • Talking to someone you trust and consider safely expanding your social bubble
    • Avoiding excessive alcohol consumption (Women should drink fewer than 8 alcoholic beverages per week. Men should drink fewer than 14)

    When to see a doctor.

    If healthy habits still don’t improve your mental health, don’t be ashamed to seek help from a professional. Talk to your primary care provider about what you’re going through and be prepared to answer questions related to your:

    • Medical history
    • Physical symptoms
    • Current concerns, thoughts, and feelings
    • Use of alcohol or drugs
    • Relationships
    • Routines

    A primary care doctor can recommend next steps, which could include treatment options such as counseling or medication. They can also provide advice for helping you to navigate the new normal that 2020 has forced upon us.

    If something just doesn’t feel quite right, don’t delay seeking help. With the right support, you can start feeling like yourself again, even if the world appears to be turned upside down.

    Want to learn more about our behavioral health services?
    Click the button below for more information.

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  • December 02, 2020

    By Robert A. Lager, MD, Interventional Cardiology

    Although COVID-19 is largely a respiratory illness, it does not limit itself to the respiratory system. This new virus can affect multiple organs and we’re learning that the virus can affect the heart in important ways both directly and indirectly.

    Besides its most commonly recognized symptoms (fever, shortness of breath, cough, headache, gastrointestinal distress and loss of taste and smell), some coronavirus patients have presented with chest pain and palpitations, an early clue that the virus has the ability to impact the heart.

    At the time of publication, well over a quarter million Americans have already died from symptoms related directly to the virus. And a number of areas hard-hit by the virus have seen an alarming spike in the number of patients succumbing to cardiovascular conditions, out of fear of visiting a hospital during the pandemic. Many of those deaths were undoubtedly preventable if these patients had received medical intervention early enough.

    Coronavirus and the Heart

    How might the coronavirus itself potentially affect the heart muscle? The answer is that fighting the disease puts a serious strain on a patient’s cardiovascular system. It can injure or inflame the heart directly, as well as triggering a number of reactive problems:

    • Clotting, a notable coronavirus symptom, may trigger heart attack if clots affect the heart arteries.
    • In patients with existing arterial disease, inflammation from the virus can destabilize plaque in the arteries and cause the plaque to rupture, causing a heart artery blockage, another path to heart attack.
    • The disease can put tremendous metabolic strain on the body, leading to stress cardiomyopathy—muscle weakness that can cause heart failure. It can also cause a buildup of fluid around the heart, interfering with its proper function.
    • Unlike other muscles, the heart is an engine that never quits. It requires oxygen around the clock. The body’s demand for oxygen rises as it fights the virus, but the supply of oxygen decreases as the virus replicates in the lungs. This creates significant stress on the heart which can lead to heart injury. It can also cause irregular heart rhythms, some of which can be life threatening.
    • At its worst, the disease can trigger a cytokine storm, putting the immune system into overdrive. After the body has battled respiratory symptoms for weeks, it can experience a sudden and severe loss of heart function, practically overnight. This scenario can occur even as the coronavirus patient is starting to improve. It’s where we see the most frequent incidence of sudden death related to loss of cardiac function.
    COVID-19 can significantly strain the cardiovascular system—and the virus can potentially injure the heart directly. Dr. Robert Lager has the details. @MedStarWHC via https://bit.ly/36o1Nsg.
    Click to Tweet

    What Research Shows

    In the past, we have seen similar viruses have a negative impact on heart function. For example, among the small studies of autopsies of patients who died during the SARS-CoV-1 epidemic of 2002, 35% showed viral invasion of the heart cells.

    So, it was not surprising to learn that COVID-19 might affect the heart as well. The earliest data came from China, Italy and New York City, and was focused on the sickest patients. On average, 20%–35% of that population showed elevated heart enzymes, an indication of heart muscle injury.

    Since then, we’ve seen additional, concerning results: heart injury might occur even when COVID-19 symptoms had been less severe and the patient appears to be fully recovered.

    In a highly publicized study of 100 German patients—with an average age of 49 and a typical distribution of underlying conditions like high blood pressure and diabetes—60% recovered at home and never went to the hospital. Half had mild symptoms, and 18 had none at all. Yet alarmingly, MRI results showed significant cardiac inflammation in 78% of them.

    Another study, reported in the Journal of the American Medical Association (JAMA), involved 26 collegiate athletes who’d contracted COVID-19. Despite normal echocardiogram results, 15% showed acute cardiac inflammation on an MRI. This study was a big motivator for the temporary shutdown of college sports last spring.

    It’s important to note that all of these research studies evaluated small groups, and we do see many coronavirus patients with low levels of these harmful cardiac enzymes without any evidence of long-term cardiac damage. Nonetheless, the findings have raised concerns in the medical and scientific community.

    Can a mild coronavirus infection carry risk higher than originally believed? How should we evaluate the cases of COVID-19 patients who were not sick enough to be hospitalized? These are difficult questions—especially with young people, who often fare well in spite of a COVID-19 infection. The appropriate standard of care to evaluate these patients is still evolving.  Guidelines using the different types of testing that are available—from EKG, echocardiogram, cardiac MRI and lab tests such as cardiac troponin, B-type natriuretic peptide and d-dimer—are not yet available.

    The challenge will be developing these standards with limited data. For example, young elite athletes do not typically undergo cardiac MRI, so we don’t have very good control data indicating what is “normal” for that population. And pandemics don’t occur very often, so that data is limited, too. We know that various viruses can also affect the heart, including influenza, but we have very few cardiac MRI studies of patients with viral infections which might contribute clues about novel viruses. In a sense, we’re fixing the airplane as we fly it. But, with time, our available data will increase and the plan will gain clarity.

    What You Can Do

    Everyone, of course, should be ever-vigilant of any symptoms that may affect heart health.

    Today, this is especially critical for patients who have recovered from COVID-19. A few words of advice:

    • Keep taking your prescribed medicines. Early in the pandemic, fear developed around ACE medications, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs). The virus gains entry through ACE2 receptors, proteins on the surface of cells. Since these drugs can increase the number of ACE2 receptors, there was speculation that they might give the virus an easier pathway into a patient’s system. But we now have data to show there is no reason to stop these medications. They may even provide some protection against the virus by blocking these receptors, but that research is ongoing.
    • Stay in touch with your doctor. Some underlying conditions, including existing heart issues, can complicate recovery from the virus. And if you were infected with the virus and have recovered, it’s important to report any symptoms or lingering effects. Chest pain and palpitations have been reported by patients well after their recovery.
    • Live healthy. Keep yourself as healthy as possible, particularly when new bugs surface. Get regular exercise. Include plant-based foods, which are anti-inflammatory, in your diet. Moderate consumption of sodium and alcohol, avoid tobacco and get enough sleep.
    • Talk to your doctor before strenuous exercise. This is especially important for young athletes who may be harboring heart issues post–COVID-19. It is critical to return to the playing field safely. If moderate exercise brings unusual fatigue, chest pains, palpitations, light-headedness or shortness of breath, let your healthcare provider know.

    Our Commitment to COVID-19 Recovery

    MedStar Washington Hospital Center has a significant footprint in the Mid-Atlantic region when it comes to cardiac care. Our ongoing commitment is to provide access to all the care you need, at a location convenient to you.

    The current pandemic hasn’t changed that. We are staffed and equipped to provide all levels of care, from basic services to complex cardiac care such as interventional cardiology and cardiac surgery. Our patients have immediate access to a high level of subspecialty expertise and the most advanced technology.

    New vaccines are, of course, coming to fight COVID-19. We are also embracing emerging therapies such as recombinant antibody infusion which, when given early in the course of the infection, may reduce symptoms and lessen the need for hospitalization. This could enable some high-risk patients to begin fighting the virus after a single, one-hour infusion session. The agents have just received emergency-use authorization from the FDA and infusions have begun in our DC hospitals, with plans to expand to other sites, and potentially even directly to a patient’s home through visiting nurses.

    In summary, remember: when it comes to your heart, don’t delay care. Heart trouble can rapidly become irreversible and life-threatening, and it won’t wait for the pandemic to recede.

    At MedStar Washington Hospital Center, we are safe and ready to care for you. Contact us immediately if you or someone you love has the following cardiac symptoms (especially if you have recovered from COVID-19):

    • Chest pain or pressure that lasts more than a few minutes
    • Shortness of breath, which can happen without chest discomfort
    • Pain or discomfort in one or both arms, the back, neck, jaw or stomach
    • A cold sweat, nausea or light-headedness

    Health issues after COVID-19?

    Contact us today.

    Call 202-788-5048 or Request an Appointment

  • November 30, 2020

    By Alexis A. Dieter, MD, Urogynecology

    The human body is truly amazing. An expectant mother’s body prepares for and recovers from delivery in ways that are nothing short of miraculous.

    Pregnancy and childbirth can put a fair amount of stress on the pelvis and the pelvic organs, so it’s perfectly normal to experience changes and even a few challenges during postpartum recovery.

    As a urogynecologist, I receive calls from patients asking “what to expect after expecting.” These issues can feel embarrassing to talk about, but we are here to help. We want you to feel less apprehensive and more empowered as you learn more about what to expect post-delivery—especially if you’re a first-time mom.

    It’s important to stay in contact with your healthcare provider, trust yourself and listen to your body. It knows how to recover quite well and, if problems or concerns arise, reach out to our team—this is what we do!

    Mom Needs Attention, Too

    After delivery, everyone—including mom—is focused on the baby’s health and well-being. That’s normal and expected. But we also need to make sure we focus on helping moms take care of themselves, and we hope that their partners, friends, family, fellow moms and support systems will do the same.

    Even the smoothest, most problem-free childbirth can be traumatic to the body. And a complication or two can make recovery more challenging. Be patient as your body recovers—getting better is a process that takes time.

    After delivery, it’s important that we pay just as much attention to mom’s health as we do to baby’s. Learn more from Dr. Alexis Dieter. @MedStarWHC via https://bit.ly/36rJwZW
    Click to Tweet

    Exercise and Lifting During Recovery

    Long-term problems are rare, but most women will experience a “new normal.” Parts of your body will change during pregnancy and after delivery, and some of these changes may be more permanent than others. This is healthy, to be expected and, in most cases, perfectly normal.

    For at least six weeks after delivery, we generally tell moms to limit lifting as much as possible, while your body is still healing. This can be hard when caring for a newborn and other young kids. When my son was born, he weighed 10 pounds, my daughter weighed 25 pounds, and my obstetrician told me not to lift anything over 10 pounds! So, we understand that you must take care of your kids and that lifting can be a necessary part of life for many new moms. If you have someone who can help, please ask them!

    You may also reduce abdominal strain and pressure and feel more comfortable with movements such as turning on your side or pushing yourself up with your arms instead of doing a sit-up when sitting up.

    Of course, moving around is good and helps your body stay healthy and regain strength and muscle tone. But don’t overdo it. We would not recommend that moms begin a new exercise routine right after delivery (no CrossFit!). Walking is usually best. During the early days after having my first baby, walking my driveway felt like miles, so please be patient with yourself and listen to your body—you have just finished an amazing but strenuous marathon! As your body recovers, trust that movement will get easier with time. Stay hydrated, and rest when you can. As long as you feel better over time, you’re doing fine.

    Bleeding and Bruising

    Postpartum bleeding is normal, although it can be disconcerting (especially the first time you stand up after delivery, as everything seems to fall out!).

    Bleeding can be pretty heavy and can be on and off during the first several weeks. But if at any time you’re using two or more sanitary pads per hour, or you are lightheaded or dizzy or have other concerns, call your doctor.

    The postpartum underwear given to you in the hospital is excellent and works well to hold pads so that you feel protected and supported. Ask for some extras before heading home!

    I also advise my patients to refrain from looking “down there” for at least a month, as what is a normal appearance during recovery can seem quite concerning to some women and cause unnecessary anxiety. Bruises and swelling are totally normal. Just like a black eye, the vagina and outside tissues will look bruised and swollen as everything begins to heal and improve—they have been through a lot! So, unless you have a specific concern, let your doctor do the looking and focus on caring for yourself and your new baby.

    Pain

    Short-term, some pain is normal. The postpartum medications you’re provided should help but won’t necessarily make you pain-free. They should lessen your discomfort so you can manage daily responsibilities and feel comfortable when resting. If they don’t do that, please reach out to your doctor.

    Beyond prescription medications, other helpful aids that I often discuss with my patients are over-the-counter ibuprofen, a warm or cold compress, or “padsicles.” Padsicles are made various ways, but I recommend either using an ice pack or making one by filling a few plastic zipper bags with aloe gel, molding them into the shape of a pad and putting them in the fridge or freezer. Once frozen, wrap the frozen pad with cloth or place under your sanitary pad so it is not directly against your skin. You can also add witch hazel on top of your sanitary napkin to help provide additional relief. Some women, particularly those who had a C-section, feel better with an abdominal binder or support, which you can get in the hospital and online. If your pain is worsening or doesn’t resolve over time, definitely reach out to your provider, as we want to make sure you are OK and talk about possible treatments.

    In the Bathroom

    Almost every new mom I’ve known is concerned about the prospect of that first bowel movement after delivery. Will it hurt? Will I tear again? It’s always better to have a loose BM rather than constipation, so hydrate and start a stool softener like Colace® (docusate), if you had not already started one and if you’re prone to constipation. Or, if you’re very worried about straining, you may also want to try a laxative like MiraLAX® (polyethylene glycol), an over-the-counter powder that you can mix into any drink to help make the stool looser and stimulate a bowel movement. Do not be alarmed if there is some bleeding and pain, it will get better! If you are having a hard time, try increasing the MiraLAX or reach out to your provider.

    Hemorrhoids are common during pregnancy and typically disappear on their own during recovery. If you are having discomfort or irritation, witch hazel pads can help soothe and reduce swelling, and you can also use over-the-counter hemorrhoid creams. If your hemorrhoids become really uncomfortable, let your doctor know.

    Urination can be uncomfortable as well, especially if you’ve had stitches, as sometimes it can sting the healing tissue. To find relief, some women dilute the urine as it comes out by spraying water on the vulva and vagina while urinating, either using a squirt bottle (they usually have this on the postpartum hospital unit so ask before you leave) or a bidet sprayer on your toilet that can be ordered online. Or you can even just pee in the shower or bathtub.

    Sitting with your vulva and vagina in a few inches of warm water in the bathtub for up to five minutes a few times a day can help you feel a lot better. Sitz bath kits are available at drug stores or you can use your tub at home. After soaking, use a towel to dry off or, if the tissue is too sensitive, use a hairdryer on the cool setting.

    Bladder leakage may persist for months after delivery. Although distressing and annoying, this is normal! As your body recovers, this should improve. If you are 6–12 months out from delivery and your bladder symptoms are no longer improving, see your provider about what to do next.

    Sexual Activity

    After delivery, we recommend “pelvic rest,” which means avoiding tampons, baths and swimming, and, of course, refraining from penetrative vaginal sexual activity. Most women will be healed enough to resume sexual activity after about six weeks; however, the timeframe varies from person to person so listen to your body and what your provider recommends. It’s perfectly OK to wait longer if you are not feeling up to it.

    When the time does come, to help set yourself up for success, I always tell my patients to use a high-quality, silicone-based lubricant. Reduced estrogen levels, which are normal after delivery, can often cause dryness. However, please avoid lubricants with scents, flavorings or products that heat up, until everything is healed and you are at your new normal.

    If pain occurs during sex, do not worry. Stop, take some time, and try again in a few days. It should get better but, if the pain persists, please talk to your doctor.

    Dryness

    Estrogen levels are naturally lower following delivery and can take time to return to normal. When you have low estrogen, the vaginal tissues can become thinned, drier and more prone to irritation. Delivering a small, safe dose of estrogen directly to the area—as a cream, tablet or vaginal ring—can make a real difference. Because it acts locally on the vaginal tissue, it does not significantly change the level of estrogen in your body and therefore is safe for most women. Also, for breastfeeding moms, it shouldn’t interfere with breastfeeding, but talk more with your provider if you have any concerns. It’s available only by prescription, so it’s important to consult with your doctor to see if this is right for you.

    Laxity

    Vaginal laxity or looseness can be a common concern, even up to a year after delivery. Although the vagina may not completely return to its pre-pregnancy state, you should not have any bothersome bulge or pressure in the vaginal area. If you do, please see your doctor so we can discuss how to make this better.

    When Laxity Becomes Prolapse

    The vagina is like a sock, with the toe of the sock at the cervix or mouth of the uterus. With stretching of the vaginal tissues and during recovery, sometimes the toe end of the sock can start to fall and the vagina starts to turn inside out a bit, causing a feeling of heaviness or pressure in the vaginal area. Some women even see or feel a bulge at the entrance or coming out of the vagina.

    Prolapse usually resolves with recovery and I am constantly amazed at the body’s ability to heal itself! But if it doesn’t improve as expected, we have a few strategies. A simple and time-tested option is a vaginal pessary. It’s like a diaphragm but designed to provide structural support to the vaginal tissues. The concept has existed for thousands of years, in nearly every corner of the world, with historical evidence of women using everything from waxed pomegranates and potatoes to cork and forged metal. Today, pessaries are made of silicone—comfortable to wear, simple to maintain.

    Some of my patients wear them all the time; some during the day or during exercise. It’s totally up to you, but it’s a simple way to provide a helping hand to relieve bothersome symptoms of a bulge and pressure.

    Pelvic floor physical therapy (PT) can also be very effective. And it can be a great way to learn how to lift and position yourself to reduce strain on the back and pelvis and also work on abdominal strengthening and reducing rectus diastasis (a separation along the middle of the abdominal six-pack muscles due to abdominal stretching during pregnancy). PT can help after a C-section as well, to increase abdominal strength and break up scar tissue. In some countries, every new mom gets pelvic floor PT, which I think is a great idea!

    In women with persistent symptoms that do not improve with time, surgery is an option to treat prolapse. But we always try to wait until after active childbearing, since subsequent pregnancies and deliveries would place extra stress on the repair.

    A couple of other things to watch out for during your postpartum recovery:

    • Fever: Fever is usually an indication that something is wrong. Infections can develop in the breasts, uterus or at the C-section incision site. If your temperature is 100.4 degrees Fahrenheit or higher, call your doctor without hesitation. The earlier we treat an infection, the better.
    • Nerve Issues: In rare instances, nerves may become stretched and damaged, causing numbness, tingling or other symptoms, mostly in the legs. Injured nerves will generally regrow, but the process is slow—about 1 millimeter per day, or an inch per month.  Persistent issues should be referred to your physician.

    Growing the Family

    Your first delivery doesn’t necessarily predict how future deliveries will go, but almost all women have an easier time with subsequent deliveries. Your body becomes accustomed to managing the process, and the initial “remodeling” is already done.

    And once you know what to expect, you’re less likely to stress about it. It’s like driving to a new place you’ve never been—the first time is challenging and seems to take forever, but, once you know the route, it becomes easier.

    If you are planning for more children, we generally recommend separating siblings by 18 to 24 months, to give your body time to recover and heal. It’s a personal decision that has many factors to consider, but data shows there are fewer complications if you allow adequate time to recover from childbirth.

    Expert Care in Washington, D.C.,

    At MedStar Washington Hospital Center, we’re fortunate to have a talented and experienced group of providers who have dedicated their careers to the treatment of pelvic disorders. If a pelvic disorder should present itself post-childbirth, we can offer many approaches to treatment, from conservative management with behavioral changes through physical therapy and surgery, if necessary.

    If surgery does become necessary, most of our surgeries are same-day, using minimally invasive vaginal, laparoscopic and robotic techniques; it’s very rare that we must make a large abdominal incision. We specialize in these minimally invasive procedures because we want to offer the best surgery for our patients. Minimally invasive surgery allows patients to recover more quickly and carries less risk of complications, so that women can return to their active lifestyles as soon as possible.

    Keep Talking, Keep Learning

    It’s important to keep seeing your provider throughout your postpartum recovery, even if you’re feeling great. And besides attending your regular appointments, never hesitate to reach out to your provider if you have a fever, significant bleeding or pain that’s getting worse. We can typically begin to get things under control right away.

    In rare cases, postpartum symptoms linger longer than they should—or disappear only to return later in life. So again, it’s very important to keep talking to your healthcare provider because, in almost all cases, we have strategies to help!

    And rest assured that, whenever we do see you in person, MedStar Washington Hospital Center is extremely safe with all COVID-19 protocols in place.

    Here’s to a happy, healthy postpartum recovery!


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    Our urogynecology team can help.

    Call 202-788-5048 or Request an Appointment

  • November 25, 2020

    By MedStar Health

    Stress, pressure from family, and tempting treats over the holidays can make it hard to choose nutritious choices from Thanksgiving through the New Year. But eating healthy over the holidays doesn’t have to be hard. With a few simple tweaks to your mindset, you can learn to both enjoy special meals and foods this season while practicing how to eat intuitively any time of the year.

    Eating healthy over the holidays doesn’t have to be hard, thanks to these 7 tips from dietitian, Wendy Chatham. Read the #LiveWellHealthy blog to learn more: https://bit.ly/2J8a7Dz.

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    Tip #1: Prioritize what you want to eat.

    Over the holidays, many of us prepare special recipes that are reserved for this time of year. For example, many people enjoy baking Christmas cookies that they can share with family, friends, and coworkers. Grocery stores and specialty shops also sell a variety of holiday treats that aren’t available throughout the year, making them exclusive to the holiday season.

    We look forward to eating and preparing these foods that remind us of gathering with family and friends year after year. As a result, it can be helpful to plan ahead what special recipes and food you plan to enjoy throughout the holidays. Or, take an inventory of what food is available at a party before you start to fill your plate at a party. Think about the things that you enjoy the most, and determine what you’re going to say no to in advance so that you can eat the special things you love without stuffing yourself.

    Over the holidays, I enjoy making tamales for my family. Because tamales are filling and a complete meal all on their own, I choose to avoid tortilla chips or mixed nuts that fill snack bowls because I can have those any time I want. By planning the kinds of food we’ll refuse, like nibbling on appetizers before the main course, we free up space to enjoy the special foods that make the holidays unique.

    Tip #2: Avoid high-calorie beverages.

    From sugary sodas to alcoholic beverages like eggnog or hot buttered rum, it’s easy to go way over daily calorie recommendations by consuming high-calorie drinks. Consider that one small glass of hot buttered rum offers the same number of calories as a six-inch roast beef sub from Subway. Even juice, sweet tea, and Gatorade should be reserved for special occasions in the same way you would treat eating a birthday cake. That’s because high sugar levels can significantly increase your blood sugar and wreak havoc on your body.

    As you prioritize what you plan to eat and enjoy over the holidays, avoid drinking your calories and instead opt for low-calorie beverages. It’s one easy way you can choose to make healthier choices, as food will provide more nutritional value and feelings of fullness.

    Tip #3: You can say, “no, thank you.” No explanation required.

    Once you’ve determined what you do want to eat, don’t feel bad about saying “no, thank you” to what you don’t want to eat. It’s common for family dynamics to make you feel like you need to take a serving of everything or even have seconds when Grandma is guilting the table into finishing up a dish. But, no one should make you feel bad about what is or isn’t on your plate. Do your best to shake off any extra pressure and say no when you want to say no.

    Tip #4: Don’t feel obligated to clean your plate.

    Similarly to tip number three, you don’t need to clean your plate if you’re full. I like to tell people to “honor your hunger, but respect your fullness”. By all means, please eat when you’re hungry! It’s your body telling you that it needs nutrition. In fact, skipping meals only leads to overeating because you eat faster than your body can register your fullness. That’s why you shouldn’t fast all day before a holiday meal. Eat a snack or shake beforehand so you’re not starving by mealtime.

    When it is time to eat, pace yourself, eat slowly, and pay attention to when you’re full. Once you are, stop eating to avoid overeating or becoming sick. Some people think they need to finish their plate so they don’t “waste” any food. But, when you continue putting food into your body when you’re full, it’s still a “waste”. There will always be more food and opportunities to have leftovers.

    Tip #5: Ask for leftovers to be wrapped up for you to take home.

    If you’re full and can’t eat anymore, or you don’t particularly want something but feel obligated to try it so you don’t hurt anyone’s feelings, ask for something to be wrapped up. You can always take something home to have later when you’re hungry again—or if it’s something you truly don’t want, you can throw it away in the privacy of your own home and no one will be wiser.

    Tip #6: Be mindful as you eat.

    Mindfulness means being aware of what you’re putting into your body. Studies show that if you’re eating while doing something else, like watching TV, driving, or working at the computer, the following things happen:

    • Your body can’t absorb all the nutrients
    • You’re less aware of how much you’re consuming
    • You enjoy the food less because you’re eating on autopilot
    • You overeat because you’re not paying attention

    Instead of eating mindlessly, think about what you’re eating and focus on how you feel after every bite. Studies show mindless eating can interfere with nutrient absorption. We should eat for enjoyment and nutrition, not to numb emotions, pass the time when we’re bored, or react to stressful situations. Practice self-care by being mindful as you eat.

    Tip #7: Exercise because you enjoy it, not because you need to earn your food.

    Finally, avoid falling into the mindset that you need to earn your food through exercise. Punishment is a poor motivator, and viewing food as something you need to work off will only hurt your view of both food and exercise. Exercise is good for you, and is to be enjoyed! Get moving because of the benefits exercise offers beyond calorie burn, including:

    • Elevating your mood
    • Improving your sleep
    • Relieving stress

    Some people will tell you to avoid eating certain foods to stay healthy. While I’m a dietitian, you’ll notice I didn’t tell you not to eat this or that. Rather, these tips for eating healthy over the holidays will help you develop sustainable eating habits that allow you to view food as nourishment and pleasure, not something that you need to work for or overindulge in.


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