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  • January 18, 2022

    By MedStar Team

    Structural racism is one of the most pressing issues facing healthcare today.  Unfortunately, academic medicine historically exacerbating the exploitation of vulnerable communities to achieve educational and research goals, especially in Black, Indigenous, and People of Color (BIPOC) communities. For example, many traditional research practices among marginalized communities highlight and, in most cases, magnify inequities in care. These can include:   

    • Community members are under informed about research methods and strategies. 

    • Researchers prioritize extraction of information from communities rather than community ownership of information.

    • Researchers accrue funding, prestige, and publications (in which academics’ voices predominate over the narrative perspective of community members) without similar accrual to participating communities.  

    • Researchers’ understanding of questions to be answered may lack cultural context because of their incomplete comprehension of community conditions.  

    The relationship between research institutions and many BIPOC communities is estranged and needs mending to dismantle racial disparities and inequitable research practices. As the area’s largest healthcare provider, MedStar Health is committed to do the work needed to address these issues in everything we do in order to advance health equity for everyone we serve.

    “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

    (March 25, 1966 speech to the Medical Committee for Human Rights)

     

    Advancing Health Equity in Early Childhood and Family Mental Health Research

    MedStar Health investigators Arrealia Gavins, Celene E. Domitrovich, Christina Morris, Jessica X. Ouyang, and Matthew G. Biel recently published research emphasizing the need to co-learn and to co-develop research with community members themselves to prioritize benefits for both participants and researchers. “Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health” was published in the Journal of the American Academy of Child & Adolescent Psychiatry. This work was done through the Early Childhood Innovation Network (ECIN),  a community-based partnership between two academic medical centers (MedStar Georgetown University Hospital & Children’s National Health System) and several community-based organizations in Washington, DC that strives to provide support to families through caregiver and child mental health services, family peer support, child social and emotional learning, initiatives to address social determinants of physical and mental health for families, and place-based support to families within select communities.  

    In this study, researchers found that to begin to undo the inherent inequities within academic medical research, particularly in studies involving children and caregivers, investigators need to consider how best to build equitable, long-term partnerships with communities through Community-Engaged Research (CEnR) or more specifically, Community-Based Participatory Research (CBPR). CBPR offers an alternative to traditional non-participatory research with a collaborative, strengths-based orientation that equitably involves researchers, community members and other stakeholders in all phases of research while embracing their unique expertise. 

    Recently documented increasing rates of depression, anxiety, and suicide in BIPOC youth, compounded by the disproportionate impact of the COVID-19 pandemic on BIPOC communities, has heightened the urgency for progress in community-based research.

    The research team started to utilize CBPR practices to advance antiracism in their clinical research work in child and family health along with working with BIPOC communities. This approach to integrate CBPR practices into the development, implementation, and evaluation of community-based interventions seeks to support early childhood mental health in primarily Black communities in Washington, DC. 

    Making an Impact: Insights & Lessons Learned from CBPR

    Through this work of the EICN, the research team found five valuable lessons from applying CBRP principles to research collaborations in community settings. 

    Intervention Practices

    Lessons Learned and Applied

    ECIN launched a group-based mindfulness parenting program to explore how to support the emotional health of parents at a Head Start early education center with the intention to reduce caregiver stress and enhance caregiver-child relationships.

     

    Lesson 1: Invest the time to build trusting relationships

    Providers set up several discussion groups with community partners and medical center-based researchers to review proposed assessment tools to be used with children and families receiving psychotherapy services.

    Lesson 2: Involve community partners in the development of the intervention theory of change and measurement strategy

     

    Clinical staff organized peer specialists to provide support to families with young children through 3 evidence-based strategies: enhancing parents’ knowledge about caregiving with young children;optimizingparent use of existing resources; and increasing parents’ access to social supports.

     

    Lesson 3: Create interventions in partnership with community members

    Clinical staff providedearly childhood mental health consultation (ECMHC) in preschool classrooms to enhance educators’capacitiesto support early childhood development and to recognize early signs of mental health concerns

    Lesson 4: Interpret findings in partnership with community members

    ECIN membersparticipatedin formal antiracism training with external experts to incorporate antiracism principles into ECIN’s operations and into the culture of the Network. ECIN formed a Racial Equity Community of Practice (RECOP), that supports 8 intervention teams in developing practices that advance racial equity goals.

    Lesson 5: Embed an antiracism focus in research structures and processes

     

    The research team found this community-based approach to be helpful in conducting research that will have a long-lasting impact on not only the community, but also on members of the research team. During a time where BIPOC families are experiencing the effect of COVID-related deaths and grief, unemployment, housing instability, and police violence; researchers have an opportunity to be engaged in the community and work to eliminate racial inequities within academic medicine and research. 

    Journal of the American Academy of Child & Adolescent Psychiatry, DOI: 10.1016/j.jaac.2021.06.018

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  • August 20, 2020

    By Ebony R. Hoskins, MD

    If you’re a woman over 50, you’re probably familiar with the signs of menopause and perimenopause. You know that menopause is a natural part of aging—but do you know what’s normal and what might signal a problem in this stage of life? 

    Menopause is associated with a significant shift in estrogen and progesterone levels. Though these hormonal changes are normal, extreme fluctuations can sometimes lead to abnormal symptoms, such as vaginal bleeding.    

    Although most likely not a serious situation, post-menopausal bleeding can sometimes be warning sign of cancer or a pre-cancerous condition. If you have entered menopause, it is important to tell your doctor about any vaginal bleeding. Together, you can choose the best way to identify and treat the cause.  

    Menopause vs. Perimenopause

    Many people associate menopause with hormonal side effects like hot flashes, irregular periods, and mood swings. However, these are actually symptoms of perimenopause: the transition period between a woman’s normal reproductive years and menopause. Some women experience perimenopause for months, others for yearsevery individual is different.  

    During perimenopause, you will likely experience irregular menstrual periods. When you have gone 12 months without menstruating, you have officially entered menopause.  

    Vaginal Bleeding After Menopause

    Once menopause begins, vaginal bleeding—whether occasional spotting or more significant in volume—is considered abnormal 

    To identify the cause of the bleeding, your doctor will likely perform a speculum exam and a pelvic ultrasound. Because most causes of postmenopausal bleeding are identified via tissue, he or she will take a small sample from the affected area.  

    What causes abnormal vaginal bleeding? There are many potential reasons for post-menopausal vaginal bleeding, including these common causes: 

    Endometrial Atrophy: Menopause naturally causes a decrease in estrogen and progesterone levels. This drop leads to a thinning (or atrophy) of the endometrium. While this thinning is normal, it can sometimes become too severe, which results in vaginal bleeding. 

    Bleeding caused by endometrial atrophy is often treated with estrogen. For women already on hormone replacement therapy (HRT)a simple adjustment in dose may prevent further issues. 

    Benign Cervical or Uterine PolypsBenign polyps can grow in the uterus or cervix at any time, but due to the changes in estrogen levels that occur during perimenopause and early menopause, these polyps are more common for women in their 40s and 50s 

    Polyps are usually identified using a surgical procedure called a hysteroscopy D&Ccamera is inserted into the uterus via the cervix, and tissue is removed from the uterine lining. This tissue is then tested in a lab to rule out cancer. If the growths are identified as benign, they can be removed using the same procedure.

    Vaginal bleeding after menopause? @drebonyhoskins recommends consulting with your gynecologist as soon as possible. https://bit.ly/3hC73Ll via @MedStarWHC
    Click to Tweet

    Atypical Endometrial Hyperplasia: While decreased estrogen and progesterone levels can cause excessive thinning of the endometrium, increased levels of these hormones may cause the endometrium to thicken.  

    When this occurs, abnormal cells can become overcrowded. This results in a pre-cancerous condition called atypical endometrial hyperplasia, which can cause abnormal vaginal bleeding. If left untreated, usually with surgery, this condition can lead to uterine cancer in some women. If you are diagnosed with atypical endometrial hyperplasia, your doctor will refer you to a gynecologic oncologist for treatment. 

    Uterine Cancer: This cancer is also associated with hormonal changes caused by menopauseThe average age at diagnosis is 60, while women under 45 are less likely to be diagnosed with the condition 

    There are two types of uterine cancer: endometrial cancer and uterine sarcoma. Endometrial cancer is far more common, accounting for over 90% of cases, and is closely associated with vaginal bleeding.  

    Women with endometrial cancer often undergo surgery as part of their treatment. For postmenopausal women, this may include a radical hysterectomy (removal of the uterus, cervix, upper vagina, and nearby tissues) and a bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).  

    Although age is a significant risk factor for this cancer, most women over 50 with vaginal bleeding do not have this condition. Still, vaginal bleeding in post-menopausal women should always be taken seriously as a potential symptom 

    Your Gynecologic Care at MedStar Washington Hospital Center

    If you have been diagnosed with endometrial hyperplasia or cancer, the team at MedStar Washington Hospital Center is here for you 

    Our multidisciplinary team includes radiologists, radiation oncologists, and gynecologic oncologists. We work closely with each patient to determine the treatment path that’s best for their specific needs.   

    LISTEN: Dr. Hoskins discusses post-menopausal bleeding in the Medical Intel podcast.


    Complications from bleeding?

    Reach out to our specialists.

    Call 202-644-9526 or  Request an Appointment

  • August 19, 2020

    By Alison M. Wogatske, CRNP, MedStar Montgomery Medical Center

    Public health experts and doctors agree that wearing a face mask is one way we can minimize the spread of COVID-19. Here’s what you need to know about the dos and don’ts of wearing a face mask or cloth facial covering.

    Experts agree wearing a #FaceMask can minimize the spread of #COVID19 but what’s the proper way to wear and care for one? Alison Wogatske, CRNP, shares the dos and don’ts on the #LiveWellHealthy blog: https://bit.ly/34gcf47.

    Click to Tweet

    How do face masks prevent COVID-19 from spreading?

    COVID-19 is a respiratory virus which means it spreads through droplets that leave the mouth or nose when we talk, sing, yell, sneeze, or cough. So, if you’re standing near someone who is infected with COVID-19, and neither one of you is wearing a face mask, it is highly likely that you will also catch COVID-19.

    If the infected person is wearing a face mask, there is less risk that the droplets will spread to someone else because the mask acts as a barrier, if it’s being worn correctly. Since many people who get COVID-19 may experience delayed or very few symptoms, we all should wear a face mask to keep our droplets to ourselves, just to be safe. Even if you’ve tested negative for COVID-19, you should wear a face mask because you could quickly get infected after your test and not know you’re spreading it to those around you.

    I wear a mask to protect you from me—not the other way around. This is known as source control. It’s one of the best ways to prevent COVID-19 from spreading, and it’s a small way we can care for each other in an environment where it may otherwise feel like we have very little control.

    Wearing a face mask is not a substitute for handwashing.

    While wearing a face mask is an important part of minimizing the spread of COVID-19, we still need to prioritize good hand hygiene. Regular and frequent handwashing with warm, soapy water is the best way to protect yourselves and others from any kind of viral infection. Aim to frequently wash your hands for 20 seconds at a time or use a hand sanitizer with at least 60 percent alcohol.

    When should I wear a face mask?

    The Centers for Disease Control and Prevention (CDC) recommends wearing a face mask or cloth covering anytime you’re around people who don’t live with you in your home, especially when it’s difficult to stay six feet apart. Here’s what that means.

    DO wear a face mask if you are…

    • In a public setting
    • Around other people not in your household
    • Inside an enclosed space where it is difficult to maintain social distance
    • Outside in an area where you cannot stay six feet apart from others
    • Inside your home around a family member who is infected with COVID-19
    • Caring for someone with COVID-19
    • Exercising in close proximity to others

    DON’T wear a face mask if you are…

    • Alone or with your household inside a non-public setting (e.g. your home or car)
    • Somewhere you can easily maintain social distancing
    • Eating at a restaurant with dispersed, outdoor seating (but put it on if you leave the table!)
    • The CDC explicitly recommends against face mask wearing in the following populations:
        • Children under the age of 2
        • Those who are unconscious
        • Those unable to safely remove their mask for developmental or physical reasons

    Some local and state governments have specific policies in place, so do a quick search to find out what the recommendations are for where you live or are visiting.

    Use your best judgment.

    There are some instances where you should use your best judgment. For example, my husband and I take our toddler to a park to feed some ducks regularly. It’s a way for all of us to get some fresh air and a change of scenery. While we’re on the walking path to the lake, we often pass other people. So, we wear a mask out of courtesy. Once we get to our spot by the lake, we’re usually the only ones around and can take our masks off.

    To determine when and where it’s safe or appropriate to remove your mask, ask yourself, “Is it easy to maintain a distance of six feet between me and others?” If the answer is no, wear a mask.

    What’s the proper way to wear and care for a face mask?

    Viral particles can still spread to your mask. That’s why it’s important to take proper precautions before, during, and after wearing a face mask to minimize your risk of catching something.

    DO

    • Wear a mask that covers your nose and mouth
    • Wash your hands before putting a mask on
    • Put the mask on using the straps instead of touching the cloth
    • Remove the mask by the straps
    • Wash your hands after you take it off
    • Store it in a clean, dry container
    • Wash your mask daily in hot water

    DON’T

    • Hold onto the cover when you apply your mask
    • Adjust or touch the mask once it’s on properly
    • Slide it down under your chin
    • Wear it if it’s soiled, wet, ripped, or damaged in any way
    • Share your face mask with someone else

    Don’t forget to take other precautions.

    Wearing a face mask is a way to be kind to one another as it acts as a barrier to protect others from your secretions. Other important steps you can take to minimize the spread of COIVD-19 include:

    • Frequently washing your hands
    • Limiting unnecessary travel
    • Following quarantine guidelines if you’re in a new place
    • Cover coughs and sneezes with your elbow
    • Clean and disinfect frequently touched surfaces

    We’re all in this together, and if we do our part, we can make a difference!

    Want to more information from MedStar Health on COVID-19?
    Click below.

    COVID-19 Information

  • August 18, 2020

    By Tamika Auguste, MD

    Being pregnant in the District of Columbia may be hazardous to your unborn baby’s health and to yours—and climate change may be a major factor.

    A study recently published in the Journal of the American Medical Association (JAMA) presents some potentially alarming conclusions. That study connects the higher temperatures and increased air pollution in urban areas with negative birth outcomes such as premature, underweight, or stillborn babies.

    Black Women at Higher Risk

    According to the study, African American women, people of color, and members of marginalized communities are at greatest risk from the debilitating effects of climate change. It’s a danger not only to them but to their unborn children as well.

    In fact, the District of Columbia has one of the highest maternal mortality and morbidity rates in the country—particularly in Wards 4, 5, 7, and 8.

    D.C. has one of the highest maternal mortality and morbidity rates in the country. @OByourself shares how climate change can affect pregnant women and their babies. https://bit.ly/3fs2kKV via @MedStarWHC

    Click to Tweet


    How Climate Change Affects Communities

    Hotter, more polluted environments can cause women to deliver premature, underweight, or stillborn babies. Overall, 40% of low-income residents in the District of Columbia live in communities with an overabundance of apartment buildings and asphalt, but few trees. Our local TV weather regularly reports that these neighborhoods are anywhere from three to five degrees hotter than the suburbs or rural areas.

    Also, minority communities tend to be located closer to factories or industries that regularly release particulate matter, smog, and other pollutants into the air.

    Potential Lifelong Consequences

    With emerging science clearly showing the negative effect of climate change on pregnancy, we must consider the possible effects on newborns. In many cases, we worry if babies are effectively able to reach full term.

    And there could be lasting consequences for newborns, particularly for those with a birth weight of less than 5.5 pounds. Infants born at or below this weight may have a multitude of issues that last a lifetime, ranging from not meeting developmental milestones to chronic health problems.

    For instance, babies with low birth weight may experience:

    • Impaired brain development, potentially impacting the ability to learn
    • Vulnerability to diseases such as asthma and allergies
    • Underdeveloped lungs and respiratory system

    How High Temperatures Can Affect Pregnancy

    Pregnant women, like all people, can become dehydrated in dangerously hot temperatures, when the heat index is oppressive and the air is uncomfortably humid. Signs of dehydration include:

    • Extreme thirst
    • Dry mouth
    • Lack of urination or sweating
    • Dark-colored urine
    • Tiredness
    • Dizziness

    Uterine contractions are one of the things we worry about most when a pregnant woman is dehydrated. The body tries to conserve fluids and water, so it releases ADH (anti-diuretic hormone). ADH comes from a similar place in the body as another hormone, oxytocin, which causes contractions.

    It’s not uncommon to see a dehydrated woman begin to experience uterine contractions. If she’s not near full term when these contractions start, her dehydrated state could lead to pre-term labor and, ultimately, pre-term delivery, imposing a health burden on the newborn.

    How Air Pollution Affects Oxygen Levels

    According to the World Health Organization, extreme heat can encourage higher levels of pollen. In addition, air pollution and the deterioration of the ozone layer can make it harder to breathe, especially for expectant mothers with asthma or other respiratory problems.

    The better that mothers can breathe, the more efficiently they supply oxygen for themselves and their babies. If mom cannot breathe well, we have greater concern about her baby getting adequate oxygen. And the effects of climate change are year-round, not seasonal, so it’s not likely that this situation improves in the colder months.

    What You Can Do: Optimize Your Health

    As healthcare consumers, we need to change the culture a bit and recognize the importance of well-woman care. That means caring for our health not only when we have a problem or are pregnant, but before and after pregnancy as well. Now more than ever, the relationship between a pregnant woman and her provider is vitally important.

    If you’re thinking about becoming pregnant, here’s a simple checklist to help you optimize your health:

    • Visit your doctor before you conceive
      • Make an appointment with your Ob/Gyn for well-woman care
      • Discuss and evaluate your overall health
      • Ask about your ideal weight and body mass index
      • See your primary care doctor to help control preexisting conditions such as obesity, diabetes, or high blood pressure
    • Pursue healthy habits
      • Stop smoking or vaping
      • Exercise
      • Eat a healthy diet high in protein, good fats, and vegetables and low in carbs, sugars, and saturated fats
      • Get close to your ideal body weight and body mass index
    • Seek prenatal care early in your pregnancy
      • For the best outcome, seek prenatal care within the first trimester (first two or three weeks after your positive pregnancy test)
      • Work with your Ob/Gyn to identify a potentially high-risk pregnancy
    • Be aware of how climate change can affect your pregnancy
      • Recognize signs of dehydration
      • Hydrate! Hydrate! Hydrate!
        • Drink at least 64 ounces of water a day
        • Avoid soda or juice
        • Drink coffee or tea according your doctor’s advice
      • Use air filters, air purifiers, or allergen removers
      • Use air conditioning or fans to keep air moving and flowing
      • Visit a cooling center for relief from the heat
    • Share with your Ob/Gyn
      • Don’t be afraid to ask questions
      • Speak up and voice any concerns
      • Describe how you feel physically, emotionally and mentally

    A Collaborative Effort for the Women of D.C.

    The effects of climate change on pregnancy need to be more widely recognized. MedStar Washington Hospital Center, the Washington, D.C. Department of Health, the American College of Obstetrics and Gynecology, and other area hospitals are working with various organizations to optimize the health of pregnant women within Black and other minority populations. Issues like inadequate food and water or undesirable living conditions must be addressed.

    At the Hospital Center, we are dedicated to seeing more positive birth outcomes by working to help moms avoid potentially long-term consequences from climate change.


    Newly pregnant?

    Connect with our prenatal care team.

    Call 202-644-9526 or  Request an Appointment

  • August 13, 2020

    By Wiemi Douoguih, MD, Director of Sports Medicine

    COVID-19 may have recently put a damper on some team sports, but weekend warriors—athletes who practice a sport on weekends or otherwise infrequently—are making their way back out to golf courses and tennis courts. And, some are experiencing swing-related injuries.

    In any sport, the act of swinging creates an eccentric contraction. Essentially, the muscle actively contracts, but the mechanics of the swing force it to stretch, even as it attempts to contract.

    At some point, the muscle may become overloaded and tear—picture what would happen if you were playing a game of tug-of-war and the rope were to break. It’s that eccentric load that puts muscles and tendons at greatest risk.

    Summertime swing injuries often seem to appear suddenly, but almost all of them result from a chain of events. Even when the player’s form is perfect, swinging a bat, racket or club places the body under repetitive stress, with long-range potential for injury. Injury is more likely when the swing-rate spikes—for example, after an intense period of training. Athletes are also at greater risk if they don’t warm up and stretch properly.

    And once injury occurs, you’re significantly more likely to injure the same area again. That’s why prevention should be your number-one strategy. No matter what the sport, conditioning, strength training, warm-up and stretching, and a proper training regimen are critical to avoid injuries that might mean “game over” for you.

    Swinging a bat, racket or club puts the body under stress, with the potential for injury. In every sport, conditioning, stretching and strength training can prevent injuries that mean “game over.” https://bit.ly/30sPKXF via @MedStarWHC

    Click to Tweet


    Stages of Injury

    We grade orthopedic injuries across a spectrum:

    • A grade 1 injury—a sprain or strain—results in very little structural damage but brings pain, swelling and inflammation
    • In a grade 2 injury, we see moderate tissue damage, but everything is still attached and connected
    • Grade 3 injuries are the worst—a complete tear to a muscle or tendon

    Grade 1 and 2 injuries will generally heal with time, anti-inflammatory medications, and either complete rest or some form of active rest. Physical therapy with active rest can be essential to recovery. Muscles and tendons should be carefully worked to prevent atrophy and maintain strength of the uninjured tissue, but not worked so hard that the injury worsens or fails to heal.

    Most grade 3 injuries require a period of rest and often involve surgery. Although we see grade 3 problems in all sports, fortunately they are not as common as lesser degrees of injury. However, mismanagement of a grade 1 or 2 problem can lead to a grade 3 injury down the road.

    Batter Up

    Rotation is what powers a baseball swing and the forces generated are tremendous. Arms, wrists and hands play a big role in the swing, but they’re not where we see the most serious injury. Mishaps that can sideline a player out of the game tend to affect the shoulder and abdominal oblique muscles.

    Swinging a baseball bat can put a lot of strain on the rotator cuff and labrum (the cartilage ring surrounding the socket of the shoulder’s ball-and-socket joint). The repetitive nature of swinging a bat can lead to cumulative micro-trauma that results in what’s known as “batter’s shoulder.”

    This condition generally affects the non-dominant, or inside, shoulder. It is thought to be the result of resistance to the large distraction forces that occur with hitting. The resulting damage and inflammation can be intensely painful and need time to heal, putting a player on the disabled list for weeks or possibly months.

    Within the athlete’s core—where the power of the swing is generated—injuries to the abdominal obliques can likewise take a long time to heal. They attach along the rib cage and at the iliac crest, the top of the pelvis, where tears and separations are serious injuries.

    Recovering from this damage involves active rest followed by a gradual resumption of swinging over a period of weeks. But, as in other sports, prevention is always the best medicine: strength training, conditioning, stretching and warming up.

    Teeing Off Safely

    Golf may be perceived as a low-risk sport, but the swing can cause problems.  Among the most common is “golfer’s elbow.” As in baseball, swinging a golf club generates a lot of force that can damage muscles and tendons connecting the elbow to the wrist. This is another example of an eccentric load causing muscle and tendon damage: the wrist and fingers attempt to rotate inward, in conflict with muscles stretched by the force of the swing. Again, issues can result from a chain of events—overuse, fatigue or micro-trauma over time.

    The torque of the golf swing also puts the back at risk, especially disks between backbone vertebrae. Over years, repetitive micro-trauma can lead to disk degeneration, herniation and a constellation of associated mechanical and chemical changes that put pressure on nerves or cause arthritis. Fortunately, the most common back problem in golfers is a simple muscle or tendon strain or sprain of a ligament. These cause little structural damage and can resolve quickly with active rest.

    Braces, sleeves and other devices golfers use to mitigate pain and strain are of little value. Generally speaking, if you feel the need to use a brace, you’re likely already injured and should seek medical attention to prevent the situation from getting worse.

    As in other sports, a good warmup and stretch are very important. Don’t start swinging cold at full power. Also, when you’re not on the links, strength training and overall conditioning will keep your body strong and the whole system in balance, reducing your risk of getting hurt.

    Keep the Advantage on the Court

    Tennis can place enormous stress on many areas of the body, including the shoulders, wrists, elbows, knees, ankles, and back. Although “tennis elbow” gets a lot of attention, injuries to the ankle and back are more common. Repetitive back-and-forth motion, sudden stops, turns and other directional changes demand a lot from your joints.

    An inversion ankle sprain is very common in tennis—when the foot rotates to a point that exceeds the structural capability of the ankle. Similar to swinging a baseball bat, swinging the racket is powered by rotation in the trunk, which can cause injuries and inflammation in the vertebrae and strains to the trunk muscles.

    Footwear is very important in tennis. It has evolved and adapted over decades to help prevent the most common injuries. Also key is the right grip size for your racket. So is adapting your training for different court surfaces.

    As in other sports, keeping your entire body conditioned and warming up before play will help you avoid injury on the court.

    How We Can Help

    Because the body is an integrated system, no sports injury is assessed without a look at the bigger picture. When the elbow hurts, for example, we observe the whole chain and mechanics that affect how that elbow moves. Problems in one area frequently manifest somewhere else. Sports performance often requires joints and muscles to move in ways that exceed their natural capability. Our job is to treat the whole athlete, no matter the age or experience level.

    We understand the importance of sports and working out to those who participate. One thing we try to avoid is telling an athlete to stop playing.

    Athletes in our area are fortunate to have access to MedStar Washington Hospital Center’s full-service clinic, where we perform motion analysis to assess joint function at each segment of the throw or swing. That kind of assessment is especially important as the athlete progresses through stages of experience, training, aging and adapting to new conditions.

    Our team works with athletes of all ages and levels of proficiency—from children to professionals. In fact, we are the official medical team of the Baltimore Ravens, the Washington Capitals, the Baltimore Orioles, the Washington Wizards, and the Washington Mystics. That experience benefits all of our patients, as working with professionals lets us hone our skills at the highest level.

    Whether weekend warrior or professional athlete, each of our patients has unique requirements. We work very carefully and collaboratively with athletes, trainers and coaches to develop safe, effective training protocols. A good program for most patients includes cross-training for flexibility, strength and conditioning; practice management to prevent overuse trauma; and developing exercises that mimic game conditions in a controlled environment.

    In sports medicine, what seems like a minor issue could warn of bigger problems, so it’s always in your best interest to seek professional guidance. Don’t hesitate to find out what’s really going on.

    Reach out to us. We’re committed to keeping you in the game.


    Golf or tennis injury?

    Our sports medicine specialists can help.

    Call 202-644-9526 or  Request an Appointment

  • August 12, 2020

    By Glenn W. Wortmann, MD

    While many of us were hopeful that the spread of COVID-19 was slowing down, some states are seeing record spikes as COVID-19 cases are rising. The increase may have you wondering, why are COVID-19 cases rising? And, what can we do about it?

    Some states are seeing record spikes as #COVID19 cases are rising. Infectious disease specialist Dr. Wortmann explains why and what we can do about it on the #LiveWellHealthy blog: https://bit.ly/33W5DrA.

    Click to Tweet

    Many states lifted stay-at-home orders and people are resuming daily activities.

    Around Memorial Day, many states began relaxing lockdown restrictions, which means more people began leaving their homes. As bars, restaurants, and other businesses reopen, people have more opportunities to interact with one another. Because COVID-19 is spread person-to-person, any time people are within close proximity to each other, the risk for transmission increases.

    This risk is even higher indoors where there is less ventilation and it is harder to socially distance from others. And, while many states reinforced the importance of wearing a face mask as a precaution, others have been more lenient. Since the virus is spread through respiratory droplets that leave the mouth and nose when someone coughs, talks, or exhales, there is an increased risk of spread in environments where people are not wearing face masks.

    What you can do: Before deciding to go out, weigh the risks against the benefits of resuming daily activities. When it’s necessary to engage in public activities, follow safety precautions, such as:

    • Wearing a face mask
    • Maintaining social distance
    • Washing your hands thoroughly and frequently

    Quarantine fatigue means people may not be as careful as they were before.

    Months of quarantining inside our homes have been difficult. It’s not only taken a toll on our schedules, it’s affecting our mental and emotional health. So, when businesses reopened, many of us were desperate to resume normal life and social interaction. With many stay-at-home orders lifting right around summer holidays, it’s likely that many people began attending large social gatherings where their risk of exposure increased. For example, some states have seen a spike in COVID-19 cases among young adults as a result of bars and restaurants reopening.

    While it’s tempting to get back to our regular social events, we still need to consider when, where, and how it’s safest for us to do so. Interacting with more people raises the risks, as does being in groups where people aren’t six feet apart or wearing masks. COVID-19 cases are rising because more people are spending more time interacting with others in person. When you can’t establish six feet of space between you and others, the risk increases. And the more time you spend with people who may be infected, the higher your risk of becoming infected, especially if you’re not wearing a face mask.

    What you can do: Close contact with others increases your risk of exposure to COVID-19, so be mindful of where and how you’re interacting with others. Consider the following questions before attending a social gathering:

    • Will there be a small or large group of people? The risk is higher if the group is larger.
    • Can you maintain six feet of space between each other? If not, the risk increases.
    • Will you be outside or inside? Outside activities offer more ventilation than indoor events.
    • Will people be wearing face masks? If not, the risk of exposure is significantly higher.

    Asymptomatic people who have COVID-19 may not know they have it and spread it to others.

    Most people know by now that if you have symptoms of COVID-19, you should stay home and quarantine to prevent spreading the virus to others. However, many people who are infected with COVID-19 are asymptomatic, which means they don’t experience any symptoms. And, some people infected with COVID-19 may not experience symptoms until days after they’ve been exposed to the virus. As a result, people who don’t know they’re sick could be spreading it to others as they visit the grocery store, a family barbecue, or a local cafe.

    What you can do: You may have been exposed to COVID-19 if you were within six feet of someone who had COVID-19. Contact could mean you:

    • Were caring for them
    • Had physical contact (e.g. hug or high five)
    • Were sneezed on

    If it’s possible that you’ve been exposed to someone who has COVID-19, the responsible thing to do is quarantine for the 14 days. Quarantine means that you stay home and separate yourself from others for a period of time to ensure you don’t spread the virus to anyone else.

    You can help reverse the rise in COVID-19 cases.

    We’re all anxious to get back to our normal lives. But right now, the best thing we can do is take measures to ensure the safety of ourselves and our community. That may mean making sacrifices for the greater good of the people around us, like wearing a face mask even in the summer heat.

    COVID-19 seems to thrive where we do—in social situations. The COVID-19 spread declined while we were at home because we experienced minimal social interaction. Now that we’re out and about, we need to continue being cautious by wearing masks and maintaining a six-feet distance between each other. It’s a simple and easy way we can care for one another.

    Want more information from MedStar Health on COVID-19 or need care now?
    Click below.

    Urgent Care

    COVID-19 Information

  • August 11, 2020

    By Cesar A. Torres, MD

    5-minute read

    This disease is a topic of interest to everyone: There is no cure. And it is always fatal.

    Known formally as major neurocognitive disorder, dementia is an umbrella term for neurodegeneration that causes cognitive decline—deficits in memory, language skills, problem solving and other higher brain functions.

    Although it has a variety of causes, in each case, the end result is the same. Chemical alteration poisons the cells of the nervous system, including brain cells. As the disease progresses, healthy brain tissue becomes scar tissue, and brain function is impaired.

    Here are some answers to a few commonly asked questions:

    Are dementia and Alzheimer’s disease the same thing?

    Not exactly. Alzheimer’s causes dementia—in fact, it’s the most common cause, accounting for about 80 percent of cases in the U.S.

    What else may cause it?

    The second most common cause is vascular disease, usually from uncontrolled blood pressure or from blocked vessels causing strokes that kill brain cells. Less commonly, it can result from lewy bodies—abnormal protein deposits that poison the brain. It can also be associated with certain kinds of Parkinson’s disease. Infections like HIV and syphilis are potential causes. Thyroid problems, anemia and vitamin deficiencies may contribute, too. Drugs can play a role, both prescription and recreational, including alcohol. Trauma and chemical exposure are in the mix, too.

    It definitely has genetic components. We know that the Apolipoprotein E (APOE) gene is involved. Every genetic trait in humans is the result of having two copies of the gene in your DNA. Having a pair of APOE genes increases risk up to four times. But we can’t use APOE for genetic screening, because some people with multiple copies of the gene never actually develop the disease.

    We also know the risk of developing Alzheimer’s-related dementia is higher if an immediate family member is diagnosed. But age remains the greatest risk factor, more so than family history.

    And it could be a one-two punch—a combination of genetics plus a trigger event, like a viral infection, that inflames the nervous system. We learn more every day, but we don’t yet know the full story.

    Can people be tested for it?

    Unfortunately, no definitive test currently exists. We can’t see it on X-ray or find it with a blood test.

    How do you approach diagnosis?

    First steps are to rule out and address any possible masquerading diseases. The big one is depression, which can present with apathy and memory deficits. We also check thyroid function and test the blood for anemia or vitamin deficiencies. We look for existing neurological diseases, like Parkinson’s.

    A CT, or better yet, an MRI, scan of the head can uncover physical abnormality—though rare, the disease can be associated with malformations, tumors, inflammation or abnormal fluid pressure in the brain.

    Once we rule out other causes, a diagnosis relies on the patient’s history of new or worsening deficits. However, it’s not uncommon for a patient to be unaware of his or her decline.

    We also apply a variety of cognitive tests. Some are exceedingly simple, but can really tell the story, like the coin test. I’ll ask, if you have a quarter, a dime, a nickel and a penny, how much money is that? It’s a really useful test, since it involves several aspects of brain function, like visualization, recall, calculation and interpretation.

    Other than forgetfulness, what are some signs and symptoms?

    It’s important to distinguish the degree of forgetting. We all slow down as we age, that’s normal. But there is a real difference between a “senior moment” and true impairment. With normal aging, it might take all day to remember a fact or a name, but at some point, most people will retrieve it. However, when the disease has damaged that memory, that fact or name is gone forever. We have all forgotten a word, misplaced the keys or the wallet. But when they’re repeatedly lost, gone for months or lost forever, that’s highly suspicious.

    The illness interferes with executive function—everything our brains need to do beyond keeping us alive: attention span, short-term memory, inhibition, problem solving, and keeping track of time and space. This is why the patient can have difficulty managing a calendar, balancing the checkbook or navigating while driving.

    There is no treatment for dementia. Dr. Cesar Torres recommends a focus on quality of life and living each day to the fullest. https://bit.ly/33NcR12 via @MedStarWHC
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    A first symptom I frequently see is apathy—for example, a golfer who absolutely loved the game suddenly gives it up, saying they just don’t feel like playing any longer. Other personality changes are typical. A patient may become irritable or combative, or resist eating or bathing. Loss of inhibition is also common—for example, the patient may say whatever is on his or her mind, even when inappropriate. We often see paranoia increase as the disease progresses, often manifesting when something is misplaced and the patient is convinced it was stolen.

    What are the treatment options?

    Doctors live to help others, so we find this disease to be among the most frustrating since we have no effective treatment options. The medications that target it do not halt neurodegeneration.

    Think of the nervous system as a collection of electrical circuits. The disease shorts the circuit, and medications can temporarily rewire the system to keep the current flowing. But then more circuits short out and so on and so on. The results of successful treatment with the medications are not robust, maybe just a few points of measured improvement over the course of six months or a year.

    Without a targeted treatment, we focus on quality of life. The diagnosis is hard on the patient and the family. My colleagues and I spend a lot of time counseling them, to prepare them for the road ahead and support their well-being through the journey.

    Can it be prevented?

    We have no control over certain components, like genetic predisposition. But we have solid evidence that taking good care of yourself can keep your brain in good shape in later years. That means staying active, eating well, avoiding tobacco and excessive alcohol consumption, getting enough sleep and protecting your head from injury when engaging in sports or other high-risk activities. Education, socialization and mental stimulation are important—a more active brain has more neural pathways.

    Exercise is probably the single most important factor. I recommend 30 minutes to an hour of moderate exercise, most days of the week. Exercise increases blood flow and releases endorphins that create a sense of well-being and improves metabolism. The benefits are virtually endless. It doesn’t have to be elaborate, walking is fine. Even into your 80s or 90s, there is a routine for you—like chair exercises or Tai Chi—which really helps with mental acuity, although we don’t know exactly why.

    What advice do you have for families?

    Go easy on the patient and yourself. You’re likely to get frustrated or angry. That’s perfectly normal. There’s no need to feel guilty about it. This is a one-day-at-a-time endeavor and it’s important to realize that you will have good days and not-so-good days.

    It’s easy to get into a battle with your family member. It’s bath-time, but she doesn’t want to. Or breakfast is ready, but he’s not hungry. Take a step back. Don’t rush into an argument. Try the bath later in the day. Let him eat breakfast whenever he wants. Flexibility and having realistic expectations are key, both for you and your loved one.

    Have some meaningful discussions about the future—finances, living arrangements and advance directives. As the disease becomes more debilitating, the family is faced with very difficult decisions. The situation becomes easier if the patient provides guidance before it’s too late.

    Is there any good news?

    I believe there is. Although the disease is progressive, it is typically slow—eight to 12 years. Most of us live with the belief that we have time to get things done. In reality, that’s an illusion—as was graphically illustrated for many families during the COVID-19 pandemic. As heartbreaking as the diagnosis can be, I help my patients and their families see it as an opportunity. It shatters the illusion and can inspire people to live each day to the fullest and do all the things they’ve wanted to do.

    As baby boomers hit their golden years and with life expectancy at record levels, the coming “gray tsunami” has the potential to bankrupt the healthcare system. That has given medical science enormous incentive to develop weapons against this disease. The volume of research is unprecedented and inspiring—a true example of human energy focused constructively.

    Even though we have no treatment today, there’s always the chance for a breakthrough tomorrow. Someday, we will be able to alter how we age. For the sake of all my patients, I hope that day comes sooner rather than later.

    The Hospital Center offers state-of-the-art clinical services for individuals affected by Alzheimer’s disease and related disorders, and our doctors conduct research aimed at improving treatment options. We also have many resources in place for individuals and families coping with these issues, including trained and experienced social workers, visiting nurses and a support group.

    We are here for you and your loved ones.


    Worried about a loved one?

    Our specialists can help.

    Call 202-644-9526 or Request an Appointment