MedStar Health Blog

Annual Enrollment is the time to assess your healthcare options for next year and select the coverage that best meets your needs. You have until Nov. 16 to make your selections during 2021 Annual Enrollment. Visit myHR from StarPort or myHRMedStar.net from any computer or mobile device.

If you wish to keep your current benefits coverage for 2021, you do not need to enroll online. Your 2020 benefit selections and eligible dependents will roll over to 2021, except for Flexible Spending Accounts (FSAs)—you must enroll each year to participate.

FSAs allow you to set aside pre-tax dollars from your paycheck to use for out-of-pocket expenses, such as eligible medical, dental and vision costs, as well as child care and adult day care services.

Contact the HR Solution Center at 855-674-myHR (6947), select option 4, for questions about your benefits offerings.

Save $360 on your medical premium

Complete the MyHealth Questionnaire at MedStarMyHealth.org by Nov. 30 and save approximately $360 a year on your MedStar Select or CareFirst medical premium for 2021.

Oftentimes, there is confusion surrounding with Exempt research and the requirements for IRB or institutional review. This is perfectly understandable, particularly given that the Common Rule has been revised in recent years and more research involving human subjects may fall into an exempt category.

Although federal regulations do not require IRB review of exempt research, federal agencies have issued guidance recommending that exempt determinations should be made by an individual that is not otherwise affiliated with the research. In other words, institutions should not permit study investigators to make exempt determination for their own projects.

To ensure that exempt determinations are issued by individuals that are not directly involved with the research, MedStar Health Research Institute policy states that exempt determinations must be made by either an IRB member or qualified / trained / designated members of the ORI staff.

In order to make these determinations, a formal submission is required through the Huron system. As with all other Human Subjects Research projects the formal determination must be issued before any research activities may begin.

If you have any questions regarding this process, please contact MHRI’s ORI Director, Jim Boscoe, at James.H.Boscoe@medstar.net.

Congratulations to all MedStar researchers who had articles published in October 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. Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure
   American Journal of Cardiovascular Drugs, 2020. DOI: 10.1007/s40256-020-00400-6
   Mouradjian MT, Plazak ME, Gale SE, Noel ZR, Watson K, Devabhakthuni S

    

2. Externally Validated Prediction Model of Vaginal Delivery After Preterm Induction With Unfavorable Cervix
   Obstetrics & Gynecology, 2020. DOI: 10.1097/AOG.0000000000004039
   Kawakita T, Reddy UM, Huang JC, Auguste TC, Bauer D, Overcash RT.

3. Galectin-1 production is elevated in hypertrophic scar
   Wound Repair and Regeneration, 2020. DOI: 10.1111/wrr.12869
   Kirkpatrick LD, Shupp JW, Smith RD, Alkhalil A, Moffatt LT, Carney BC.

4. Micropuncture technique for femoral access is associated with lower vascular complications compared to standard needleCatheter Cardiovasc Interv, 2020. DOI: 10.1002/ccd.29330
   Ben-Dor I, Sharma A, Rogers T, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Forrestal BJ, Zhang C, Hashim H, Bernardo N, Satler LF, Waksman R.

5. Management of recurrent granulosa cell tumor of the ovary: Contemporary literature review and a proposal of hyperthermic intraperitoneal chemotherapy as novel therapeutic option
   The Journal of Obsetrics and Gynaecology Research, 2020. DOI: 10.1111/jog.14494

Those with nagging digestive issues have probably heard or read about probiotics and prebiotics by now. Often touted as a cure-all for digestive worries, they seem to pop up everywhere these days—from yogurt to baby formula to pet food!

So, do they live up to the hype? That’s actually difficult to say, given the current limited amount of reliable data supporting them as a treatment option.

But they may very well be an unnecessary addition to most people’s diets. In fact, the American Gastroenterological Association (AGA) recently issued a statement recommending against their use in any but a few specific digestive health issues. Let’s answer a few common questions:

Exactly what are probiotics and prebiotics?

Believe it or not, our guts have been home to a thousand different bacteria, fungi and microscopic organisms called protists since the day we were born. Approximately 30 or 40 of these will influence 99% of our digestive health. These helpful organisms are known as probiotics. Yogurt and sauerkraut are some examples of probiotic-rich foods.

Prebiotics, on the other hand, are fiber-rich foods like fruits, vegetables and whole grains that help the probiotic strains to grow and flourish in the gut.

Why the hype about them?

Probiotics can be helpful in many ways. Without them, the complex digestive process would run less smoothly. They help break down the food we consume to produce vitamins and amino acids that regulate our body’s functions. Plus, they also promote immune functions in the gastrointestinal (GI) tract and protect us against harmful pathogens. There is evidence they may even help to improve mental health.

Why are the right bacteria in the gut so important?

Let’s say your colon contracted a C difficile infection. The probiotic microbiota already present in your gut would likely fight it off successfully. But if you’re perhaps taking a high-powered antibiotic or other medication that suppresses the immune system, or if you have a chronic disease, bad bacteria may be able to grab hold and do damage within the gut. This is why it’s so important to consistently maintain good gut microbes through a healthy diet.

So why the current pushback against probiotics from the AGA and others?

That’s the tricky part. There are so many formulations of single- and multi-strain probiotics—and so many different recommended dosages with randomized research trials—that it’s still difficult to conclude their effectiveness as a viable treatment option. This is a relatively new area of ongoing research, so there’s not much scientific evidence to refer to.

Is there any documented proof they’re helpful?

Yes. A type of probiotic called VSL#3 was found to be beneficial in rigorous studies in a small group, such as ulcerative colitis patients with surgically removed colons. Subsequent inflammation within the remaining part of their small intestines responded to treatment with VSL#3. But since testing involved a very small group, there is no way to standardize the result.

If I do want to try probiotics, what should I choose?

If you really want to try probiotics for minor digestive issues, go for the multi-strain type, and continue with it only if you start feeling better. Otherwise, it’s too early in our research to prescribe a particular type for a specific condition and discuss the pros and cons.

Are there any natural remedies for improving gut health?

Yes, absolutely. To be specific, there currently aren’t many options for accurate food-sensitivity testing, but we do know that, in 75% of people living with functional GI disorders, dietary triggers can worsen symptoms. So, it’s a little difficult to point out which foods may cause those triggers and which to continue eating.

The general rule: eat healthy. Consume less processed food, red meat, alcohol, fats and sugars. Switch to more natural foods, like fresh fruit, vegetables and other fiber-rich options instead.

To sum up, in 2020, there isn’t much conclusive research on the efficacy of probiotics. We can’t definitively state they are a good treatment for specific GI disorders, although the risk in trying them seems low at this point. If you choose to give them a try, stick to the multi-strain varieties and see if they work for you. Most importantly, eat a healthy diet full of natural food for long-term benefits.

Are you a tea drinker, sometimes drinking multiple cups a day? It may be time to “cool things down.” A recent study suggests a significant link between hot tea and esophageal cancer.

Surprising? Don’t worry, there’s plenty you can do to minimize your risk of developing this cancer. Let’s look at the tea-drinkers’ study and explore other risk factors for esophageal cancer, then review the options for patients diagnosed with this cancer.

What is Cancer of the Esophagus?

Esophageal cancer occurs in your “food pipe,” also known as your gullet or esophagus, the long tube that runs from your throat to your stomach.

This cancer, while relatively rare, can be one of two types, based on its location and the cells lining that area of the esophagus. In the upper part of the gullet, it is referred to as squamous cell carcinoma; in the lower two-thirds, adenocarcinoma. Treatment differs for each type.

This year, more than 16,000 patients will die of esophageal cancer, and another 18,000 will be diagnosed with it. Unfortunately, if this cancer is not caught in its early stages, the five-year survival rate for patients is only about 20%.

Hot Tea and the Esophagus

A recent transformational study found links between hot tea and squamous-cell carcinoma in the upper part of the esophagus. Based on 50,000 patients tracked over 10 years, the study took a close, long-term look at patients’ behavioral characteristics, such as their smoking and drinking habits and the socioeconomics of their lifestyles.

Researchers looked carefully at the type, quantity and temperature of the tea that these patients consumed. They found that all types of tea, particularly black tea, showed a connection to esophageal cancer; however, the main differentiators were not type of tea, but temperature and amount consumed. The study indicated that people who like their tea really hot—above 140 degrees F—and who drink at least 50 ounces of it daily have a 90 percent greater risk of squamous-cell esophageal cancer than those who drink cooler tea or none at all. Hot water alone does not seem to constitute a risk, it is the combination of very hot water with tea that creates the issue.

Fortunately, most people in the U.S. don’t drink as much scalding hot tea as do other regions of the world. But for Americans, it may be advisable to stick to one or two cups of tea a day, allowing your cup to cool a bit before drinking to avoid damage to the esophagus.

Other Risk Factors

Esophageal cancer is on the rise in America, mostly in middle-aged white men. We believe that long-standing gastroesophageal reflux disease, commonly known as GERD or reflux, is a critical risk factor. Typical candidates may be overweight and in their 50s and have pursued a generally unhealthy diet for years. For these patients, acid has regularly traveled up from the stomach and burned the lining of the esophagus. The scar tissue that forms in that region can become pre-cancerous, and then, over time, cancerous.

If you’ve experienced reflux for several years, inform your primary care doctor if you’ve been on antacid medication for a long time or have regularly used over-the-counter options (like Tums® or Rolaids®) and ask if you may need to move to stronger medication. Your health care professional may recommend an endoscopy—a procedure allowing the specialist to take a look at your stomach via a scope inserted through the mouth and throat.

Beyond factors like acid reflux and hot tea, other risk factors for esophageal cancer can include long-term smoking or alcohol consumption, as well as a family history of this type of cancer.

Treatments

At MedStar Washington Hospital Center, we use a multi-modality plan to treat adenocarcinoma in the lower portion of the esophagus. This includes chemotherapy and radiation to shrink the tumor and help with microscopic disease, then surgery to remove any cancerous cells potentially left behind.

In the case of squamous cell carcinoma, because the upper portion of the esophagus is difficult to reconstruct and because this carcinoma responds well to current chemotherapy agents, we typically opt for chemotherapy and radiation treatment.

When surgery is called for, we must essentially remove the portion of the esophagus with the cancer and replace it with another organ that can continue its function of moving food from mouth to intestines. We reconstruct the stomach from a sac into a tube, bring it up to your chest, and connect it to the part of the esophagus that has no cancer.

Previously, this four- to five-hour procedure was performed through two openings, one in the abdomen to create the tube, the other in the chest to remove the cancer and connect the tube. Today, we use minimally invasive laparoscopy, using a long scope with a camera at the end. In addition, many surgeons are moving toward robotics, which allow a very precise 3D approach to the procedure.

After Surgery

Because surgery of this type affects two areas of the body, patients are generally in the hospital for five to ten days, followed by recovery at home for two to four weeks.

Surgical removal of the cancer requires the surgeon to sever the nerves along the esophagus, so it loses the ability to contract and push food to the intestines. What remains are a muscle and a tube that depend on gravity to push food along. For this reason, post-surgery, the patient must adhere to a softer diet and cut solid food into very small pieces.

At MedStar Washington Hospital Center, our care team is very involved in supporting the patient’s recovery. Our interaction with patients is an ongoing, collaborative process, working through all the options and any challenges together.

It is important to understand potential risk factors and, if you are deemed high-risk, to visit your primary care doctor or a gastroenterologist regularly for diagnoses and advice on medication. High-risk individuals should adjust their diet and adopt a fitness plan to maintain a healthy weight and control GERD.

This is a tough disease but, if identified early, the odds of curing it can be much better.

LISTEN: Dr. Lazar discusses esophageal cancer in the Medical Intel podcast.

You may be surprised to hear that everyone has hemorrhoids. In fact, I often introduce the topic to my medical students by walking around the room and pointing to unsuspecting individuals exclaiming, “I know you have hemorrhoids!”