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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.
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    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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  • September 22, 2020

    By Maria Leber, PA-C, Director of Advanced Practice Providers for Surgery and Chief APP for Orthopedic Surgery

    Advanced Practice Providers (APPs), particularly those who specialize in Orthopedics, found themselves in unfamiliar territory during the height of the pandemic this past spring.

    As elective surgeries were postponed, leadership knew they needed a swift and dynamic response to utilize the talents of the APPs who had declining patient volumes.

    At the same time, APPs who serve the hospital’s inpatient population were seeing increasing volume and sicker patients. So the Orthopedic APPs did what they do best; they rose to the occasion and showed their resiliency by accepting deployments to treat new patient populations.

    The word unprecedented has been used to describe this virus and its impact, not just on healthcare, but on the world. The great work that is done by APPs is on display daily; on inpatient units and in outpatient offices. But the resiliency, the professionalism, and the commitment that our APPs displayed during our COVID-19 response was unprecedented.

    Special thanks to Jamie Chung, NP, Emily Fischer, NP, Yavonne Johnson, PA-C, Megan Skelton, PA-C and Virginia Tran, PA-C for their flexibility and determination, and to all of the inpatient APPs and medical colleagues who worked alongside them.

    The Orthopedic Surgery APPs include (seated) Megan Skelton, PA-C; Yavonne Johnson, PA-C; (standing) Maria Leber, PA-C; Virginia Tran, PA-C; Jamie Chung, NP; and Emily Fischer, NP. This photo was taken prior to the workplace requirement for proper PPE and physical distancing.


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  • September 18, 2020

    By Nicole Brandt, PharmD, MBA

    Medications play a key role in helping many individuals, especially older adults, maintain their quality of life. However, for some, managing medications to achieve the best outcomes, can be a challenge.

    Struggling with managing medications? On the #LiveWellHealthy blog, Nicole Brandt, PharmD, gives tips to help manage and achieve the best outcomes from your, or a loved ones, medication: https://bit.ly/35Qdloi.

    Click to Tweet

     

    Why is medication management important, and who does it affect?

    Medication management is a problem for a lot of people, particularly those with several physical or mental conditions. Many of these individuals are over the age of 65, a population that is more likely to take multiple medications and more susceptible to side effects due, in part, to the physical changes that accompany aging.

    In fact, according to the American Public Health Association, people age 65 and older make up just 12% of the population, but account for 34% of all prescription medication use and 30% of all over-the-counter medication use. What typically happens is an older adult will see different doctors for different conditions with each prescribing medication separately. As the number of medications increases, so does the risk of side effects and significant interactions, some of which can be serious. Plus, many of these patients are on complicated regimens, which further compounds the situation.

    4 tips for managing medications.

    Whether you’re dealing with medication management challenges personally, or caring for someone who is, there are things you can do to reduce the risk of the medications doing more harm than good. Here are some tips that can help you, or a loved one, manage their medication.

    1. Find a primary care provider.

    Designate one primary care provider—it can be a person or a team—to help manage the entire medication list. Seeing multiple different doctors with little communication about what medications they’re each prescribing you can increase the chance of side effects and significant interactions between medications. Going to the same primary care provider, or team of providers, that are up to date on your medication can help prevent this.

    Your primary care provider having your medication list available at all times is essential. It should include over-the-counter medications, vitamins, and herbal remedies, in addition to prescriptions. An annual “medication check- up” can eliminate what is no longer needed and ensure all medications are compatible.

    2. Don’t be afraid to ask questions.

    Listen carefully when a medication is prescribed and ask questions to find out the name of the drug, its purpose, proper dosing, and potential side effects. It’s important to know what’s going in your body, so don’t be afraid to ask. Take notes and remember that prescribed medicines should not be stopped without a provider’s instruction.

    3. Simplify your daily medicine routine.

    Having to take several different medicines a day at different times is a challenge. Work with your provider to simplify your medication regimen. They can help create a schedule that doesn’t make taking your medication so taxing, which in turn can improve the effects it has on you. Once-a-day dosing, if possible, is ideal.

    4. Fill your prescriptions at the same pharmacy.

    Having a trusted pharmacy that fills all of your prescriptions can be a big help in managing your medications. By going to the same pharmacy, the pharmacist knows all the medications you take, and can check for duplicates or possible drug interactions and explain any potential side effects.

    Medication management is an ongoing process, one that needs to be adapted continually, especially with changing physical or mental conditions. The use of medications is not something to be taken lightly. Making sure they are taken safely is the best way to achieve the optimal outcomes.

    Want more wellness advice?
    Download and read more articles like this for free in the latest issue of Destination: Good Health.

    Learn More

  • September 17, 2020

    By Ross Krasnow ,MD

    Prostate cancer is among the most common cancers in the United States, but also among the most survivable. Although it’s estimated that as many as 80 percent of men will develop it, most forms of the disease grow very slowly, are not problematic and are nonlethal. In fact, some men will never even know they have it.

    But, because this cancer can become deadly for approximately two percent of the male population, it’s important for every man to talk with his healthcare provider about it—especially since the early-stage disease shows no symptoms.

    Having that conversation is especially important for men in the District of Columbia, which has among the highest incidence of prostate cancer nationwide. This cancer affects about 138 men per 100,000 in the D.C. population. That’s higher than the national average of 104 per 100,000—and rivals the top four states of Delaware, Louisiana, Mississippi and New Jersey.

    We don’t have clear indicators for why men in these areas are at higher risk, but it’s likely demographic. Because African American men are at a greater risk in general for this cancer, we see higher instances in places with large African American populations.

    Exactly What Is the Prostate?

    As part of the male reproductive system, its main job is to secrete fluids that help transport sperm during ejaculation. A healthy prostate is about the size of a walnut and completely surrounds the urethra, the tube that passes urine from the bladder during urination.

    As men age, it’s common for the prostate to enlarge, squeezing the urethra and causing low urine flow, urgency, frequent urination and incomplete emptying. That’s known as benign prostate hyperplasia, or BPH. Cancer and BPH are distinct diseases. BPH alone does not increase the risk of cancer.

    In the early stages, cancer of the prostate shows no symptoms, confusing many men who assume it would interfere with urination, as BPH does. That can happen in the late stages, but it’s rare early on. I like to describe the prostate as being like an olive, with a pit. BPH occurs when the central core, the pit, grows to abnormal size. Cancer, on the other hand, tends to be found in the outer, fleshy section and behaves differently than BPH.

    With prostate cancer, we tailor screening and monitoring to each patient. To understand the potential risk and plan for a healthy future, have a discussion with your doctor. https://bit.ly/2QXy9S5 @RossKrasnow @MedStarWHC
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    Know Your Risk

    We tailor screening and monitoring to each patient—there’s no one-size-fits-all. That’s why it’s so important to talk one-on-one with your doctor to assess important risk factors, including:

    • Age (this cancer is most common in men over 55)
    • African American ancestry
    • Family history, especially if your brother or father was diagnosed
    • Presence of a BRCA gene mutation, the same genetic precursor that increases the risk of breast cancer in women. So you should be screened if there is a family history of BRCA among your female relatives

    Unlike other cancers, there are few known direct links to lifestyle or other diseases with this one. For example, we know conclusively that smoking causes lung cancer. But we don’t have as clear a picture when it comes to the prostate. Diet alone has not been implicated, nor have vitamin E, selenium, lycopene and other factors that get attention in popular media.

    However, we do have compelling evidence that metabolic syndrome can contribute. A byproduct of our Western lifestyle, the term describes a collection of risk factors—belly fat and unhealthy cholesterol—that can lead to cardiovascular disease, diabetes and other disorders. Men with metabolic syndrome are nearly two times more likely to develop prostate cancer compared to healthier men.

    Unlike cancers with more definitive causes, prevention isn’t straightforward either. But I encourage all my patients to maintain a healthy lifestyle with good nutrition and exercise, to control weight, cholesterol and blood pressure. The resulting benefits for prostate health and beyond are many and very well documented.

    The Screening Process

    Prostate cancer is a disease that most men will get if they live long enough. But, in the vast majority of cases, it is not ultimately the cause of death. So screening and treatment protocols have changed dramatically in recent years.

    At MedStar Washington Hospital Center, we follow the latest guidelines from the American Cancer Society, the American Urological Society and others. We are very careful to reserve aggressive screening and intervention for men at the highest risk and for cases that are truly life-threatening. Screening priority depends on the age of the patient—we are more aggressive with patients aged 55–69 and less so for those over 70.

    The most common screening is the prostate-specific antigen—or PSA—blood test. It’s important to understand that the PSA is not a cancer test, as cancer is just one condition that can cause elevated PSA. Elevated PSA can also result from enlargement, infection and inflammation.

    The digital rectal physical exam also does not detect cancer directly, but it’s important for other reasons and definitely recommended for men as they age. We also look for biomarkers in blood and urine that can help bring the condition into focus.

    Later-stage symptoms can indicate if the disease has spread—typically to the bones and lymph nodes. Symptoms can include back and bone pain, blood in the urine, fever, chills, night sweats and weight loss, especially when it comes on suddenly. If we see a patient with one or more significant risk factors or symptoms, we approach it more aggressively, including biopsy.

    Making a Definitive Diagnosis

    As in other parts of the body, cancer in the prostate happens when cells go rogue and multiply at an abnormal rate. During a biopsy, we use a needle to harvest a small amount of tissue for laboratory analysis. This is the definitive test—observing those cells under the microscope to determine if they are cancerous and life-threatening.

    Although biopsy is low risk, it’s not without risk. We are always careful to use it sparingly, when all the other indicators align. MedStar Washington Hospital Center and MedStar Georgetown University Hospital are the only hospitals in the region applying the most advanced biopsy techniques (such as transperineal biopsy) to limit risk to the patient from the procedure itself.

    Biopsy is quick and typically performed in the office using local anesthesia. We use rectal ultrasound to locate and visualize the biopsy site, since the prostate is very close by. For decades, the needle was passed through the wall of the rectum, but that can seed the prostate with bacteria and cause a potentially life-threatening infection. With the improved transperineal technique, the needle is passed through the perineum, the skin at the base of the scrotum. Fewer bacteria are present on skin, and sterilizing it is much more effective, nearly eliminating the risk of infection.

    Treatment Options

    Like diagnosis, treatment varies depending on age and risk. Because most men with the disease are likely to pass away from other causes, prostate cancer can often be monitored.

    Active surveillance is the most common strategy. We keep an eye on indicators, watch the PSA level and, on occasion, repeat the biopsy. If the disease isn’t progressing, it can be monitored indefinitely, without further intervention.

    With radiotherapy, we focus photons on the cancer cells to kill them or slow their growth by damaging their DNA. Traditional radiation is administered every weekday for 40 days. But at MedStar Washington Hospital Center, we use much more advanced treatments that safely deliver more radiation in less time, achieving similar results in as little as five days. We can also target diseased areas of the gland, limiting exposure to healthy parts.

    Testosterone and other male hormones fuel cancer cells. In some cases, we will also add androgen suppression therapy to temporarily reduce male hormone levels and starve the cancer cells.

    When surgery is found to be the right option, we use leading-edge, minimally invasive robotic surgery to remove the prostate. Robotic surgery can limit the hospital stay, usually to just one night, with less risk of urinary side effects. MedStar Washington Hospital Center and MedStar Georgetown University Hospital specialize in the technique of a “retzius-sparing” robotic prostatectomy, which expedites the recovery of urinary control.

    Side effects are not uncommon after treatment. The prostate is very close to the urethra and the nerves affecting sexual function, so the most common post-treatment problems are erectile dysfunction and urinary incontinence. This is why we are so careful in treatment planning, as both these conditions have significant lifestyle implications. We also have very sophisticated and effective treatments for the side effects that can improve function once the cancer is taken care of.

    The MedStar Washington Hospital Center Difference

    Prostate care is a lot more effective than it was decades ago. We are one of the highest-volume centers in the region for prostate screenings and treatments. We use the newest, evidence-based techniques and protocols. And—most importantly—we have the experience to assess each man’s unique needs, risks and circumstances safely and accurately.

    We consider each patient to be a key member of the healthcare team. Working closely with you and your family, we make the best decisions for good health, together.


    Time for a prostate check?

    Our experts are here to help.

    Call 202-644-9526 or  Request an Appointment

  • September 16, 2020

    By John A. Kuri II, MD, Orthopedic surgeon at MedStar Orthopaedic Institute at MedStar St. Mary’s Hospital

    We use our shoulders to do just about everything, from pushing and pulling to lifting and carrying. That’s why it’s common to feel tension—or even pain—in our shoulder joints, especially after doing the same motions over and over again.

    While shoulder pain caused by an injury or trauma should be treated by a doctor specializing in orthopedics, there are stretches and exercises you can do at home to get rid of shoulder pain. Exercises that target the shoulders and surrounding muscles can strengthen and stabilize the joint, helping to relieve tightness, improve range of motion, and prevent injury.

    Do you have #ShoulderPain? On the #LiveWellHealthy blog, Dr. Kuri shares 5 stretches and 7 exercises to relieve tightness, strengthen and stabilize your shoulder, and prevent injury: https://bit.ly/33zhfin.

    Click to Tweet

    Common causes of shoulder pain.

    Proper shoulder movement requires supporting muscle groups to work together in a coordinated fashion. While shoulder pain can be caused by direct trauma to the shoulder, if the muscles and soft tissues that support the shoulder weaken, become stiff, or are injured, our shoulders become susceptible to injury.

    There are a variety of causes of shoulder pain, but most conditions can be broken down into the following categories:

    • Degenerative conditions that occur gradually over time as a result of wear and tear, such as arthritis.
    • Chronic or overuse conditions that result from repetitive overhead motion such as throwing a baseball or painting the walls of a house.
    • Acute injury and trauma after a direct blow to the shoulder or sudden forceful stretch during a fall, car accident, or other unexpected event.

     

    Request an Appointment

     

    Why it’s important to stretch your shoulders.

    Stretching gets your blood flow circulating so you can safely and gradually improve motion and perform shoulder exercises. Shoulder exercises strengthen your shoulder muscles and encourage proper shoulder function, which helps you to:

    • Improve flexibility
    • Increase range of motion
    • Stabilize the joint
    • Prevent future injury
    • Reduce muscle soreness

    Exercises and stretches that can relieve shoulder pain.

    These five easy shoulder stretches, along with a few exercises, can help you relieve shoulder pain at home with minimal equipment. Consider performing these stretches and exercises three to four days a week to maintain and improve shoulder motion, and gradually progress to the strengthening exercises to improve function. If you feel pain, stop the exercise and call a doctor specializing in orthopedics.

    Stretches.

    1. Pendulum

    • Lean forward, placing your right hand on a counter or table for support. Allow your left arm to hang relaxed at your side.
    • Gently swing your left arm forward and backward, side-to-side, and in a circular motion. Repeat the motion 10 times.
    • Switch arms and repeat the sequence.

    Repetitions: 2 sets of 10 on each side
    Tip: Keep your back straight and your knees slightly bent.

    2. Crossover arm stretch

    • With relaxed shoulders, gently pull your left arm across your chest.
    • Hold your upper left arm using your right hand, pulling it until you feel the stretch at the back of your shoulder.
    • Hold it for 30 seconds and then release it for 30 seconds.
    • Perform the stretch three more times.
    • Repeat with the opposite arm.

    Repetitions: 4 on each side
    Tip: Avoid putting pressure on your elbow.

    3. Table and wall slides

    • Place both hands on a long table in front of you while sitting down and upright.
    • Slide your hands together forwards along the table to gently stretch overhead as you lean forward.
    • Hold the movement for 5 seconds once you reach your maximum stretch, then slowly return to the upright position.
    • As you progress, move to a wall and try the overhead stretch while standing, using the wall to slide your hands along.

    Repetitions: 3 sets of 10 slides
    Tip: To make sliding easier, hold a towel or walk your fingers along the surface.

    4. Passive internal and external rotation stretch

    Internal rotation

    • Hold a yardstick, golf club, or other light stick behind your back with your left hand.
    • Lightly grasp the end of the stick with your right hand.
    • Gently pull the stick horizontally with your right hand until you feel a stretch in the front of your shoulder.
    • Hold the stretch for 30 seconds. Release for 30 seconds.
    • Repeat on the opposite side.

    External rotation

    • Grasp a broomstick, yardstick, golf club, or other light stick with your left hand in front of your body and the other end of the stick with your right hand.
    • Push the stick horizontally with your right hand until you feel the stretch in the back of your shoulder.
    • Hold the stretch for 30 seconds and then relax for 30 seconds.
    • Repeat on the other side.

    Repetitions: 4 of each on both sides
    Tip: Keep hips facing forward and avoid leaning or twisting while pushing or pulling the stick.

    5. Sleeper stretch

    • Lie down on your left side on a flat, firm surface.
    • With your shoulder under you, bend your left arm at a 90-degree angle.
    • Use your right arm to push your left arm down until you feel a stretch in the back of your left shoulder.
    • Hold the movement for 30 seconds and then relax for 30 seconds.
    • Switch sides and repeat.

    Repetitions: 4 on each side
    Tip: Avoiding pressing down on or bending your wrist.

    Strengthening exercises.

    For each exercise, use light dumbbells that allow you to perform the minimum number of eight repetitions in a set. As the exercise gets easier, progress to three sets of 12 repetitions. Add weight in one-pound increments up to five pounds. Each time you increase weight, begin with three sets of eight repetitions before progressing to 12 repetitions.

    1. Scapular retraction/protraction

    • Lie down on a table or bed on your stomach. Let your arm hang over the side with a light dumbbell in your hand..
    • Keep your elbow straight and squeeze your shoulder blade toward the opposite side of your body.
    • Slowly return to the starting position and repeat.
    • Switch sides.

    Repetitions: 2 sets of 10 on each side
    Tip: Be careful not to shrug your shoulder toward your ear.

    2. Forward elevation strength

    • Hold light dumbbells in both hands with arms outstretched in front of you.
    • Slowly raise both hands to a slightly overhead position at the same time.
    • Slowly return to a resting position and repeat.
    • As you get stronger, increase your weight while lowering the number of repetitions.

    Repetitions: 3 sets of 8 to 12 repetitions on each side
    Tip: As you get stronger, widen your hand position so they are raised approximately 6 to 12 inches outside of your shoulders.

    3. Trapezius strengthening

    • Place your right knee on a bench, leaning forward to support your body with your right hand on the bench.
    • With your left hand palm facing your body, slowly raise your left arm and rotate your hand to the thumbs-up position.
    • Stop when your left hand reaches shoulder height and your arm is parallel to the floor.
    • Count to five as you lower your left arm to the original position.
    • Repeat on the opposite side.

    Repetitions: 3 sets of 20 on each side
    Tip: You can add light weight (2 to 3 lbs) to increase the difficulty as the exercise gets easier.

    4. Internal and external rotation strength

    Internal rotation

    • Make a loop with a 3-foot-long exercise band, tying the ends together. Attach the loop to a doorknob or other stable object.
    • Hold the band with the hand closest to the loop with your elbow at your side and bent at a 90-degree angle.
    • Keeping your elbow tight by your side, bring your arm across your body.
    • Slowly return to the start position and repeat.
    • Switch sides.

    External rotation

    • Using the same 3-foot-long loop attached to a doorknob or stable object, grasp the loop with the hand furthest from the loop.
    • Keep your elbow tight by your side and bend it at a 90-degree angle.
    • Slowly rotate your arm outward.
    • Return to the start position and repeat.
    • Switch sides.

    Repetitions: 3 sets of 8 on each side
    Tip: Keep your elbow pressed into your side. You can also do this exercise laying on your side, using light dumbbells to perform a similar motion as when using the bands.

    5. Bent-over horizontal abduction

    • Lie down on a table or bed on your stomach. Let your arm hang over the side with a light dumbbell in your hand..
    • Keep your arm straight and slowly raise the dumbbell to eye level.
    • Slowly return to the starting position and repeat.
    • Switch sides.

    Repetitions: 3 sets of 8 on each side
    Tip: Use slow and controlled movement when lowering the weight.

    6. Elbow flexion

    • Stand tall with light dumbbells in each hand.
    • Keeping your elbows close to your sides, bring the weight toward your shoulders.
    • Hold for two seconds and slowly lower to the starting position.
    • Repeat.
    • Increase weight by 1-pound increments as the exercise gets easier.

    Repetitions: 3 sets of 8 to 12 on each side
    Tip: Use slow and controlled movement when lowering the weight.

    7. Elbow extension

    • Stand tall with a light dumbbell in your left hand.
    • Raise your left arm, bending your elbow behind your head. Support your left arm by grasping your upper arm with your right hand.
    • Slowly straighten your elbow, bringing the weight overhead.
    • Hold for two seconds and slowly lower to the starting position.
    • Repeat.
    • Increase weight by 1-pound increments as the exercise gets easier.

    Repetitions: 3 sets of 8 to 12 on each side
    Tip: Avoid arching your back by tightening your abdominal muscles.

    When to see a doctor for shoulder pain.

    If you experienced a sudden injury or trauma to your shoulder, or your shoulder pain is worsening and affecting your sleep or quality of life, don’t wait to visit an experienced orthopedic expert.

    A highly trained doctor specializing in orthopedics can accurately diagnose your shoulder pain and determine the best course of treatment. From non-invasive treatment options, such as icing, biologic injections, and physical therapy, to minimally invasive or complex surgery, you can count on the fellowship-trained orthopedic experts at MedStar Orthopaedic Institute at MedStar St. Mary’s Hospital to get you back to the activities you enjoy without shoulder pain.

    Is your shoulder pain getting worse? We can help.
    Visit our orthopedic experts at MedStar Orthopaedic Institute in Leonardtown.

    Learn More

  • September 15, 2020

    By Ebony R. Hoskins, MD

    The Pap smear is an essential procedure that yields valuable information about a woman’s cervical health. But it’s normal to feel a little nervous about this exam—especially if you’ve never had one. Knowing what to expect can ease your mind and get you mentally prepared.

    Here are some frequently asked questions about this procedure: what it is, why it’s important for your health, and what will happen at your appointment. 

    1) What is a Pap smear and why should I have one?

    It’s a screening test to detect abnormal cervical cells which might indicate cervical cancer. In the United States, 13,800 women will be diagnosed with cervical cancer in 2020. Without this screening, the number of women being diagnosed would likely be much higher. 

    2) What should I expect from the procedure?

    During the test, you will lie on the exam table and place your feet into stirrups. Your doctor or nurse practitioner will gently insert a device called a speculum into your vagina to open your cervix. Then, they will use a small plastic tool to take a small sample of cervical cells. Depending on your medical history and age, they may also use a swab to collect a sample for a human papillomavirus (HPV) test.  

    3) How long does the examination last?

    It’s quick—usually just a few minutes.

    4) Does the test hurt?

    Although the insertion of the speculum might cause mild discomfort, the test should not hurt. I always tell my patients that by the time they get back to their car, they’ll forget they even had the procedure. (So far, no one has told me I was wrong!)

    5) Can I be tested while I’m on my period?

    There is no clinical reason not to be tested while on your period. However, many patients don’t feel comfortable being examined during this time. If you find you’re not comfortable with having the procedure during your period, reschedule your appointment ahead of time, if possible. 

    Nervous about a Pap smear? Dr. Ebony Hoskins answers questions to prepare you for this essential screening. https://bit.ly/3hongUa via @MedStarWHC @drebonyhoskins
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    6) How often should I be tested?

    Frequency depends on a few factors, including your age and medical history. If you’re not sure whether you need the procedure, speak to your doctor. 

    As a general rule, screenings begin at age 21. Women with normal screening results retest every three years until they reach 30; those with an abnormal result may require more frequent exams.

    After age 30, screening may be reduced to every three to five years, depending on the patient’s history. HPV testing also typically begins at age 30. Women over 30 who have tested positive for HPV typically undergo yearly Pap smear screening, as this group is at higher risk for cervical cancer. 

    7) Do I need to be tested if I’ve had the HPV vaccine?

    Even if you’ve been vaccinated, you still need to undergo regular screening for abnormal cervical cells and HPV. The HPV vaccine protects against several types of HPV that can cause cervical cancer and genital warts, but it can’t prevent you from contracting all strains of the virus—there are over 100 types of HPV!

    Regardless of whether you’ve had the HPV vaccine, it is important to follow your doctor’s recommendations about regular screening. 

    8) What if my results are abnormal?

    Approximately 5% of results come back abnormal. If you have an abnormal result, your doctor will likely recommend follow-up testing to rule out the possibility of pre-cancerous or cancerous cells. Depending on your age and medical history, this may simply mean repeating the procedure.

    If you’ve had more than one abnormal test, you may need to undergo a diagnostic test to determine the cause. The prospect of a diagnostic test can be scary, but keep this in mind: While approximately 3 million women in the United States have an abnormal Pap each year, less than 1% of those cases eventually lead to a cervical cancer diagnosis.

    The follow-up diagnostic test is called a colposcopy. Your doctor will use a speculum to open your cervix. He or she will then use a magnifying device known as a colposcope to closely examine your cervix for abnormalities. A biopsy may also be performed, depending on what the doctor sees. The procedure usually takes 10 to 20 minutes.

    If you are feeling anxious about abnormal results, or if you’re worried about having a colposcopy, tell your doctor your concerns. 

    Your Gynecologic Care at MedStar Washington Hospital Center

    If it’s determined that you have cancerous or pre-cancerous cervical cells, the staff at MedStar Washington Hospital Center is here to help.

    Our multidisciplinary team of radiologists, radiation oncologists, and gynecologic oncologists can offer you the knowledge and care you need. Our door is open. 

    LISTEN: Dr. Hoskins discusses pap smears on the Medical Intel podcast.


    Test results a cause for concern?

    Schedule time with a specialist.

    Call 202-644-9526 or  Request an Appointment

  • September 10, 2020

    By James E. Tozzi, MD

    As patients age and their concerns about maintaining a better quality of life grow, joint reconstruction surgery becomes a reality for more and more of them. Nationally, there are over a million joint replacement procedures every year, with the large majority being hip and knee replacement surgeries.

    At MedStar Washington Hospital Center, we perform more than 1,000 joint replacement surgeries annually at our state-of-the-art orthopedic facility. Our comprehensive program begins with Joint Class, a sort of dress rehearsal to help prepare patients for what they will experience in their procedure, from beginning to end.

    The expertise of our fellowship-trained surgeons, combined with the strengths and resources that come with being part of a major medical center, help us achieve a patient satisfaction level of over 95% for our total knee and total hip replacement surgeries.

    If you think there may be a knee or hip replacement in your future, we can provide you with the comprehensive background to help you make an informed decision about your treatment. Here are some questions we frequently get asked:

    • When should someone start to consider surgery?
      This is a complex question, as every patient is different. Usually, the affected party is experiencing chronic pain that is interfering with performing basic activities of daily living… and they’re noticing their pain medications no longer offer relief.The majority of people in this situation are 50 to 80 years old and suffer from age-related degenerative arthritis in the joint. Eighty percent of people who have total hip or total knee replacement have osteoarthritis; another 10–15% suffer from inflammatory diseases like rheumatoid arthritis. And occasionally we see a patient who’s had a traumatic injury to the joint, as in the case of professional football and baseball player Bo Jackson.
    • What factors lead to choosing surgery?
      The conversation around choosing surgery may begin when you tell your primary care doctor that “My knees (or my hips) are really hurting again… and I’m just not getting any better with the medicine you prescribed.” Your doctor will likely tell you it’s time to see an orthopedic specialist, and that’s when I’ll see you. Many patients also skip the primary care path and come directly to us with their serious joint pain.The orthopedic surgeon will give your affected joint or joints a thorough examination and take x-rays to view the level and type of damage present there. He or she can also help you understand options to better manage your pain via non-surgical approaches, such as reducing your weight, exercising properly, medication, or even injections to help reduce inflammation that causes pain.And of course, the orthopedic surgeon can help you assess if and when it’s time to consider surgical options and discuss which of those may be right for you. In the end, the decision is always yours.
    • How do I prepare for joint replacement surgery?
      Your surgeon will work with you, your doctor, and other specialists to ensure you’re medically ready for your procedure. This can include helping you with weight reduction, getting your blood sugar in line if you’re diabetic, and making sure no medical conditions are present that might complicate surgery for you.Before your surgery, we’ll enroll you in Joint Class, where you’ll use the time before your surgery to prepare, not just for the procedure but also for the post-operative rehab. You’ll learn what to expect and get practical experience with the exercises you’ll need to do afterwards. Besides the physical benefits, we find that Joint Class can help you feel less anxious going into surgery. So, you’re better prepared when you leave the hospital—and more likely to have a faster recovery.
    Most knee or hip joint replacement patients will leave the hospital in 1–3 days. And when they leave, they leave walking, says orthopedic surgeon Dr. James E. Tozzi. Learn more. https://bit.ly/31HtFoZ via @MedStarWHC
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    • What can I expect from my surgery… and from recovery?
      Typically, from beginning to end, the average total knee or total hip replacement surgery requires about two hours—perhaps a little less, depending upon the patient. At MedStar Washington Hospital Center, your surgeon is supported by a highly proficient surgical team, and the full resources of a major medical center in the rare instance where a complication might arise.Most recovering patients will leave the hospital in a range of one to three days. Day One following surgery, there’s usually physical therapy, sometimes even while you’re in the recovery room. And when you leave, you leave walking. So you return home already mobile, maybe even able to climb stairs. We control any pain with medication, which you may take for anywhere from a few days to up to three months.Depending on your unique scenario, we look for you to return to full activity at about six weeks. Of course, that can depend on what “full activity” means for you. You probably won’t be back on the golf course for about three months. But swimming is okay once the incision is fully healed. Walking is immediate—it’s just a matter of building up endurance.

    So What Can Joint Replacement Candidates Expect From MedStar Washington Hospital Center?

    When you come to see us, you’ll first be thoroughly evaluated. It’s critically important that we work together to ensure you have the most successful outcome from your joint surgery. This includes preparing a checklist of things that your primary care physician will help you complete to get you medically ready for your procedure.

    We also give you access to the physical therapists, social workers, and Advanced Practice Providers who work with us, and their input is also addressed as part of the process. Then, you will attend Joint Class to get you fully prepped and looking forward to your successful surgery. In addition, our Joint Coordinator will ensure that, when your prep is complete, you have a surgery date scheduled.

    Before, during, and after your surgery, we are caring and involved in a multidisciplinary way to effectively help worn-out or damaged joints. Our goal is always to give you the best outcome you can possibly expect and help you restore normal, healthy mobility to your life.


    Considering joint replacement surgery?

    Our specialists can help.

    Call 202-644-9526 or  Request an Appointment