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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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  • June 19, 2020

    By Dr. Ryun Lee, DO

    You’ve probably heard of chiropractors and massage therapists who use a hands-on approach to relieve tension and improve function in the body. But did you know that there’s a specially trained medical doctor who can use the same manual techniques—and others—to promote healing in every part of your body?

    Osteopathy doctors (DOs) are experts in diagnosing and treating all kinds of conditions using osteopathic manipulative medicine, or OMM for short. OMM is a set of hands-on techniques that DOs use to apply pressure or force to any part of the body. This can:

    • Relieve pain
    • Improve mobility and range of motion
    • Restore function

    As a DO, I practice a holistic approach to patient care. When there is an illness or injury to one part of your body, the rest of your body is also affected. In fact, nearly 80 organs inside your body are working together to keep you alive and well!

    Your brain and nervous system tell your heart to beat. In the same way, your skeletal system needs nutrients from the digestive system to build strong bones. That’s why DOs don’t just focus on the injured part of your body. Instead, they apply OMM techniques to joints, muscles, nerves, and tissues that can impact all ten of the body’s systems.

    How does OMM work?

    Restriction and tightness in your muscles and nerves can be caused by or lead to other health problems. To correct this, DOs are trained in over 40 OMM techniques. Some of the most popular techniques include:

    • Soft tissue pressure application: Massaging or stretching the body’s soft tissues to improve blood flow and provide pain relief.
    • Release of muscle energy: A push-pull approach that involves you moving your muscles one way while a DO pushes or pulls in the opposite direction.
    • Myofascial release: Applying firm but gentle pressure to release tension in the tissue surrounding your bones, muscles, and organs called fascia.
    • Cranial manipulation: Applying soft pressure to different parts of the skull, which can encourage healing.

    How is it different from seeing a chiropractor?

    While DOs and chiropractors may use some of the same techniques, there are distinct differences between them.

    1. OMM treats more than just joints. While chiropractors focus on your bones, DOs use OMM to prevent and treat health concerns affecting any part of the body. So if your head hurts, they may work on other parts of the body that could be the root cause of your headache, including related joints, muscles, blood vessels, and fascia.
    2. OMM is performed by medical doctors. Just like doctors with an “MD” after their name, DOs complete medical school and a medical residency as part of their training. As a medical doctor, DOs can also prescribe medication, run tests, and conduct check-ups. In contrast, chiropractors are not considered medical doctors. Only DOs are trained and licensed to perform OMM.
    3. OMM uses more techniques. Chiropractors often use thrust techniques that result in cracking or a “pop” in the bones. DOs may occasionally use a thrust technique, but they’re also trained to use many other direct and indirect methods.

    What does OMM treat?

    OMM can be used to diagnose and treat all kinds of medical conditions and injuries. Most commonly, OMM is effective for relieving muscle and joint pain. Many of my patients find that it also helps relieve symptoms for conditions such as:

    • Asthma
    • Carpal tunnel syndrome
    • Headaches and migraines
    • Insomnia
    • Menstrual cramps
    • Overuse injuries (e.g. tennis elbow)
    • Sinus problems
    • Temporomandibular Joint Disorders (TMJ)
    Struggle with chronic pain, headaches, or sleep? Osteopathic manipulative medicine techniques can relieve pain and improve symptoms with no side effects or risks. Learn more via @MedStarHealth’s #LiveWellHealthy blog: https://bit.ly/3etZRjD.

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    While we can’t heal certain irreversible conditions such as rheumatoid arthritis or scoliosis, we may use OMM to improve related symptoms in combination with other treatments, such as physical therapy, medication, or surgery.

    Who can get OMM?

    DOs can use OMM on patients of all ages with just about any condition, from infants who struggle with breastfeeding to adults with symptoms of heart failure. Your DO will adjust the pressure of their techniques based on your condition.

    A patient with arthritis or osteoporosis may need a gentler approach than a high school athlete recovering from tendonitis. Likewise, a DO would not use thrusting techniques on an infant or child who is still growing.

    If you’ve recently experienced a more traumatic injury, such as a fracture, I recommend waiting to see a DO until your injury is healed. You don’t want to cause more stress to your injury!

    Is it covered by health insurance?

    In most cases, OMM is covered by health insurance. The amount that is covered my vary based on your insurance company, so it’s always best to call your insurance company to find out what’s included.

    What can I expect at an OMM appointment?

    Going to an OMM appointment is very similar to going to see your primary care doctor. In fact, your doctor may even be the same as your primary care doctor. I’m a DO who specializes in family medicine so my patients benefit from receiving OMM in the same place they go for their annual check-ups, flu shots, and other preventative care. Other DOs may specialize in internal medicine, pediatrics, or specialty care.

    Keep in mind that your OMM visit may take a little longer than a traditional primary care visit. During your OMM appointment, your doctor will:

    • Ask you about your medical history and your current condition.
    • Conduct a physical exam that checks your nerves, muscles, and bones.
    • Apply stretching, gentle pressure, or resistance techniques to various parts of the body (e.g. neck, back, arms, legs, or head).

    Often, your doctor will not start where you’re experiencing discomfort. For example, if you have pain in your neck, I may check some other areas that could be causing the pain. But don’t worry—we’ll get there! Many patients feel relief for symptoms immediately, while others notice a positive change over a longer period.

    Your doctor will determine how often you should receive treatment based on your condition and how your body responds to OMM. Depending on your condition, your DO may suggest other supplementary treatments to go along with OMM.

    Watch the video below to see Dr. Ryun Lee explain and demonstrate OMM techniques.

    Is OMM right for me?

    With no side effects and the convenience of being done in a doctor’s office, OMM may be just what you need to get relief from your health problems. OMM doesn’t cure everything, but it does offer risk-free benefits for patients with chronic pain, sleep problems, and other injuries or illnesses.

    Those interested in learning if OMM may relieve your pain or symptoms should talk to your MedStar Health primary care doctor today. If your primary care is a DO, they’ll be able to offer you OMM treatment right there in the office. Otherwise, they can refer to you a MedStar Health DO nearby.

    Learn about additional benefits of having a primary care provider.
    Click below to read more from our blog.

    4 Reasons Why You Should Have a Primary Care Provider.

  • June 17, 2020

    By John F. Lazar, MD

    MedStar Washington Hospital Center’s newly opened Lung and Esophageal Center provides comprehensive care for patients with the full range of benign and malignant thoracic conditions, with a focus on diagnostics and surgical treatments. Conditions we commonly treat include lung nodules and cancer, esophageal cancer, hiatal hernia and GERD, achalasia, chest wall deformities, and airway disease, among other conditions. Our providers, three board-certified thoracic surgeons, an interventional pulmonologist, and two advanced practice providers work together to create individualized treatment pathways for each patient.

    Close collaboration with colleagues in specialties such as medical oncology, radiation oncology, gastroenterology, and interventional radiology, as well as participation in weekly interdisciplinary thoracic oncology conferences, ensures that our patients are presented with the best possible treatment options for their unique condition.

    We employ a breadth of novel and traditional diagnostic and surgical tools in caring for our patients. Our Center was one of the first in the nation to receive the Auris Monarch Navigational Bronchoscope that allows us to navigate more precisely within the lung and biopsy nodules that previously would have been unreachable or too small to sample. Our surgeons are well versed in the use of both open and minimally invasive, including robotic, thoracoscopic, and laparoscopic, surgical techniques, in addition to endoscopic and bronchoscopic treatment options.

    Our Doctors

    The core of the Lung and Esophageal Center is a group of four fellowship-trained surgeons and an interventional pulmonologist who together offer unmatched, collaborative expertise. Our sub-specialty training and unique interests allow us to offer expert care for a wide variety of thoracic conditions.

    I’m John F. Lazar, MD, and I am a board-certified thoracic surgeon and the Director of Thoracic Robotics at MedStar Washington Hospital Center. I am an Assistant Professor of Surgery at the Georgetown University School of Medicine and serve on the executive board of the Eastern Cardiothoracic Surgical Society. My interests are in surgical innovation and the treatment of early stage lung cancer utilizing both surgical and endo-bronchial robotic platforms. I have interest in applying minimally invasive surgery to the treatment of airway diseases.

    Puja G. Khaitan, MD, FACS, is the Director of Esophageal Surgery at MedStar Washington Hospital Center and Associate Professor of Surgery at the Georgetown University School of Medicine. Her practice interests include minimally invasive treatment of lung and esophageal cancer, including mesothelioma. Her research interests include the treatment of esophageal cancer from a molecular standpoint and markers for long-term survival.

    Marc Margolis, MD, FACS, is a board-certified thoracic surgeon and Associate Professor of Surgery at Georgetown University. His surgical interests include robotic lobectomy for lung cancer and treatment of benign and malignant esophageal disease. He has extensive experience working with chest wall disorders (both benign and malignant) that require complicated reconstruction, as well as surgery for thoracic outlet syndrome.

    Jessica Wang Memoli, MD, is the Director of Bronchoscopy and Interventional Pulmonology at MedStar Washington Hospital Center. She specializes in the diagnosis and management of pulmonary diseases, as well as the evaluation of lung cancer and lung nodules.

    Announcing the new Lung and Esophageal Center @MedStarWHC! Our surgeons are dedicated to applying their skills to the unique profile of every patient. https://bit.ly/2BhQLYx via @MedStarWHC @jflazar
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    How We Work With You

    Every patient that receives care in our Center is unique in their anatomy and underlying condition, whether benign or malignant. The expertise of our clinicians allows us to recognize the unique profile of each patient and their overall goals to ensure excellent outcomes.

    Let’s look at how this works for a typical patient with possible lung cancer. A life-long smoker is seen in the Lung Cancer Screening Program and their CT scan detects a suspicious lung nodule. The patient is then referred to the Lung and Esophageal Center where they would meet both me, the surgeon, and Dr. Wang Memoli, the interventional pulmonologist, on the same day. We call this a multi-disciplinary visit where two specialists work together to create an individualized plan to biopsy the nodule. Any additional necessary pre-procedure testing is coordinated for the patient while they are here for their visit.

    A multi-disciplinary visit and in-person care coordination can reduce additional appointments and the time to diagnosis, allowing for more expedited treatment. Dr. Wang Memoli and I will perform the biopsy together, usually within one week of the patient’s initial clinic visit.

    If the biopsy results show cancer—and surgery is indicated—the patient has already established a rapport with me and we can proceed with scheduling the surgery, avoiding the typical two- to three-week delay between diagnosis and procedure. When the biopsy reveals later stage disease or when surgery is not the best treatment option for a patient, their case is discussed at our multi-disciplinary thoracic oncology conference and alternative treatments, such as radiation and/or chemotherapy, are promptly initiated. A weekly tumor board creates a platform for each case to be critically evaluated from multiple angles within a single discussion. Our collaboration with the Washington Cancer Institute allows for our patients to participate in cutting-edge clinical trials, when applicable.

    Our patients have been extremely satisfied with the flow and continuity of this multi-disciplinary approach. We pride ourselves on ensuring that our patients do not get lost to follow-up and our close collaboration with related specialties allows our patients to be seen and treated in a timely manner.

    Continuously Serving Patients Better

    When we work with a patient who requires a surgical procedure, a key determination is deciding when it’s time to bring a patient into the operating room. I discuss each case with my partners and frequently consult with my colleagues in radiology, gastroenterology, and medical oncology.

    With many experienced resources at hand, we develop informed recommendations about whether surgery is indicated and share our rationale with the patient. This empowers the patient to make the most educated decision about their treatment and care.

    Our staff looks forward to serving the community. We encourage patients to contact us for help in considering the options that are most likely to produce a successful outcome.

    Experienced Surgeons. Innovative Technology.

    Connect with our Lung and Esophageal Center today.

    Call 202-644-9526 or Request an Appointment

  • June 17, 2020

    By Dr. Maggie Arnold, MD, Vascular Surgeon

    Summer is just around the corner, and the warmer weather means it’s time to break out those shorts hidden in the back of your closet.

    Unfortunately, many people will be apprehensive about reaching for those shorts and showing off a little more skin due to their varicose or spider veins. But luckily there are treatments that can help get rid of them and leave you feeling more confident, especially during the hot summer months.

    An estimated 25 million people have #VaricoseVeins. Though often harmless, their appearance and uncomfortable symptoms can cause frustration. Dr. Arnold discusses causes, treatments, and more via #LiveWellHealthy blog: https://bit.ly/30Mkcwq.

    Click to Tweet

    What are varicose and spider veins?

    Both varicose and spider veins are enlarged superficial veins that most commonly develop on the legs. Varicose veins tend to be larger and described as “ropey”, whereas spider veins are smaller and look more like plant roots. Other vein qualities that are identifying factors include:

    • Bulging
    • Blue or red color
    • Starburst pattern (spider veins)

    Most varicose and spider veins are easily visible through the skin, but they’re sometimes more difficult to identify if you’re lying down or your legs are elevated. So if you’re concerned and want to check for yourself, stand up for a few minutes in the same position and then take a look. Standing and putting pressure on your legs will allow them to be more visible.

    Are they just cosmetic or something more serious?

    When most people first seek help for their varicose veins, it’s because of a cosmetic issue. However, they can cause other uncomfortable symptoms, such as:

    • Painful sores
    • Heaviness in their legs
    • Burning sensation
    • Leg cramps

    Experienced symptoms vary by patient, and some of these can also be symptoms of other serious issues, which is why it is important to see a board-certified vascular surgeon if you have concerns.

    What causes varicose and spider veins, and can they be prevented?

    While the exact cause is unknown, a contributing factor to them is excess pressure on the veins. Veins are responsible for returning blood from your feet back to your heart, but they don’t have the muscle to get that blood to your heart. Your calf muscle acts like a pump and squeezes the blood to push it up every time you step. You have valves inside of the veins that prevent the blood from moving backwards, but over time they can weaken, which causes the blood to pool. This can lead the veins to distend and the walls to weaken, which then leads to varicose veins.

    Factors that can lead to developing varicose and spider veins.

    Although anyone can develop varicose and spider veins, there are some who are more prone than others, including those that are:

    • Female
    • Pregnant
    • Overweight
    • Smokers

    Men can certainly develop varicose and spider veins, but many female patients say they got their first varicose veins after their first pregnancy. Weight gain during pregnancy, as well as being overweight, increases the pressure on the veins which leads to the formation of varicose veins.

    Ways to prevent varicose and spider veins.

    As mentioned earlier, varicose and spider veins are formed because of increased pressure on the legs and weakened vein walls. Doing little things such as wearing compression stockings, walking, and elevating your legs can help prevent them. Since being overweight is a common cause of them, watching your weight and exercising can also help prevent them from forming. Getting up and moving around rather than sitting all day is one of the best ways to decrease your chances of developing varicose and spider veins.

    But sometimes, despite doing all the right things, people still develop them. It’s frustrating, but we can help treat the ones you do have, and hope to help you prevent new ones from forming.

    Watch the video below with Dr. Arnold to learn more about varicose and spider veins.

    How do you treat varicose and spider veins?

    The first step towards treatment for varicose and spider veins is scheduling an appointment to talk with a vascular surgeon so they can determine the best treatment option for you. During this appointment, your doctor will ask you questions about your daily routine like “are you on your feet a lot?” and “do you spend a lot of time sitting at a desk?”, along with questions about symptoms. They will then take a look at your legs and evaluate your varicose or spider veins. After, they typically will order a test called a venous reflux ultrasound study, which takes a closer look at your veins to assess whether or not they’re functioning properly. It is a simple, painless test that takes about 45 minutes to complete.

    After your examination, your doctor will be able to better determine the best treatment option for you. Here are the three main types of treatment.

    1. Conservative management.

    This is usually the first line of treatment, and includes making lifestyle changes. Most of us have jobs where we spend all day sitting at a desk. Getting up and walking around is a great way to activate your calf muscle so that you return the blood back to your heart. Another thing you can do is elevate your legs for a bit on a stool or something at the office or at home. Just doing this for five minutes every hour can make a big difference to help the blood drain.

    Compression stockings are another form of conservative management, and it is something I prescribe to all my patients. They work by squeezing the vein to help the blood from pooling and prevent the wall from getting weak. While compression stockings are very effective, they won’t get rid of varicose veins, but they can help manage the symptoms.

    2. Venous closure.

    If conservative management doesn’t work, venous closure is another treatment option that is very successful. During this procedure, a small tube is inserted into the vein and heat is used to close it. This prevents blood from going into the vein that is not working properly, and forces it to go to the veins that are.

    This procedure is low-risk, done in the office, causes only minimal pain or discomfort, and patients are up and moving the same day. Most patients experience mild bruising with this form of treatment, but it typically lasts only a couple weeks.

    3. Sclerotherapy.

    Sclerotherapy is the procedure used to treat spider veins. A chemical is injected into the little spider veins, which closes off the vein. The procedure itself only takes a few minutes.

    This procedure is also a well tolerated, low-risk procedure with a fast recovery. Some patients may experience minor side effects such as bruising, swelling, and skin discoloration.

    Why is it important to see a vascular surgeon about varicose and spider veins?

    Even though a lot of providers can perform vein treatment options, it is best to see a board- certified vascular surgeon if you have concerns about your veins and are seeking treatment. As mentioned earlier, non-cosmetic symptoms of varicose veins can be signs of more serious issues, and vascular surgeons are better able to look for other problems that may be going on with your legs. What you may think is a problem your veins could be a life-threatening arterial problem. Vascular surgeons can not only diagnose that, but can also potentially treat it. They offer a full spectrum of care, and are the ones who can help you best.

    If you want to schedule an appointment with Dr. Arnold, please call her office at 443-777-1900.

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  • June 12, 2020

    By MedStar Team

    Every day, millions of Americans experience the debilitating symptoms of irritable bowel syndrome (IBS). If you have recurrent abdominal pain at least once a day over the course of three months, you may be suffering from this chronic gastrointestinal (GI) disorder.

    It affects the large intestine, causing two major symptoms—abdominal pain/cramping and a change in bowel movement frequency or form. Other symptoms can include:

    • Abdominal bloating
    • Straining
    • Urgency with bowel movements
    • Passage of mucus
    • Sense of incomplete evacuation

    Underlying Causes

    Patients may not be aware they have IBS because several different GI issues may cause similar symptoms. It may overlap with another underlying disorder that hasn’t been diagnosed, or it may develop after an acute episode of gastroenteritis, aka, the stomach flu.

    A growing body of literature indicates that small intestinal bacterial overgrowth, or SIBO, may be a major overlapping cause of similar symptoms. Treating SIBO can actually help improve chronic underlying bowel issues.

    The disorder may also be accentuated by the gut-brain axis, meaning the nerves in the gut react to stress, depression, anxiety, and other mental stresses felt in the brain.

    Women and Younger People Are Affected Most Often

    This disorder has a 30% higher prevalence in women. And although my practice has a predominance of females with this disorder, it certainly can affect males as well.

    Also, the incidence is traditionally lower in people over the age of 50 compared with patients younger than that.

    How MedStar Health Can Help

    MedStar Health has a comprehensive approach to patients suffering from this GI disorder. We want to make sure we conduct a full history and physical exam, to identify the red flags and apply appropriate interventions or diagnostic procedures, such as a colonoscopy or endoscopy when appropriate.

    At MedStar Health, we have the ability to diagnose SIBO via an objective test called the lactulose breath test. Using the lactulose breath test, we can objectively diagnose or rule out SIBO as an underlying cause of gastro-intestinal issues and begin to treat patients appropriately.

    We have a registered dietitian as part of our team, which means that a patient who may need to go on a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet—one that avoids complex carbohydrates and alcohols that trigger digestive symptoms—can do so under supervision and guidance. Our team also has physicians who have advanced training in diagnosing and treating inflammatory bowel disease (IBD), if that’s pinpointed as the underlying cause of a patient’s symptoms.

    Identifying Inflammatory Bowel Disease

    Generally, physicians can check for blood markers to look for inflammation, a good way to differentiate between IBS and inflammatory bowel disease.

    A stool study called the fecal calprotectin test can help with this differentiation and potentially avoid unnecessary diagnostic testing, while at the same time pointing toward the need for endoscopy, if abnormal.

    Discovering the Right Treatment Approach

    First and foremost, we look to rule out SIBO, which is increasingly identified as the cause of bloating and diarrhea in patients with irritable bowel syndrome.

    We usually treat SIBO with a non-absorbable antibiotic, meaning an antibiotic not absorbed out of the GI tract. It stays in the GI tract. We may follow that with a low-FODMAP diet for a short period of time under the guidance of our dietitian.

    The low-FODMAP diet has been shown to decrease symptoms of bloating and diarrhea in patients with SIBO and IBS. But rigorous trials of dietary manipulation in patients with the syndrome are lacking, so it’s difficult to make strong recommendations, but certainly helpful to try, especially with diagnosed SIBO.

    Identifying Anxiety and Depression

    If patients are suffering from concurrent anxiety or depression, their existing IBS may be exacerbated. Treating the anxiety or depression, in conjunction with treating the disorder both pharmacologically and with dietary manipulation, leads to a longer and more durable road of recovery.

    Diagnosing the Disorder: What to Expect

    No one specific test can diagnose this syndrome. Physicians may take an extremely detailed medical history and perform a thorough physical exam. The point of the physical exam and diagnostic testing is to make sure another disease isn’t causing similar symptoms—for example, celiac disease, IBD, microscopic colitis, or lactose intolerance.

    Generally, physicians can check blood markers to look for inflammation, a good way to differentiate between the disorder and inflammatory bowel disease. If symptoms began after an episode of gastroenteritis, the physician may sample the fecal matter to ensure there’s no lingering infection.

    The syndrome may not be very apparent from the physical exam, but your doctor may ask if you’re experiencing additional symptoms that may occur concurrently with the disorder and affect your quality of life:

    • Fatigue
    • Brain fog
    • Headaches

    Because patients with the syndrome may also have a higher prevalence of other functional diseases, your doctor may also ask you about your experience with:

    • Fibromyalgia
    • Chronic fatigue syndrome
    • Functional dyspepsia
    • Non-cardiac chest pain

    Therapies to Relieve Symptoms

    For constipation

    Certain FDA-approved drugs may help with constipation associated with this disorder. If a patient has constipation, we can prescribe linaclotide (brand name LINZESS®) or lubiprostone (brand name AMITIZA®). If a patient has pain as a major symptom, we can use an antispasmodic or a neuromodulator.

    For diarrhea

    An FDA-approved medication called eluxadoline (brand name VIBERZI®) can be helpful for diarrhea. Approaches such as using purified peppermint oil granules (brand name IBGard®) and other products that contain peppermint that are naturally antispasmodic can also be helpful.

    Exercise has a huge role in treating diarrhea. Moderate-level exercise, yoga, meditation, and acupuncture can all help patients via the mind-body connection.

    For associated urgent symptoms

    Natural therapies such as caraway seed oil, menthol, and ginger supplements may help if patients have concurrent nausea.

    Lifestyle changes can help

    Patients can take steps to work with their doctors in managing IBS, including:

    • Use of some prebiotics and probiotics
    • Avoiding foods with preservatives and additives
    • Adhering to a natural and clean diet
    • Staying away from foods loaded with sugar because high sugar content tends to cause a lot of bloating, diarrhea, and pain
    • Incorporating at least low- to moderate-intensity exercise into their daily routine
    • Practicing mindfulness to tackle the subconscious

    Also, I would advise patients to find a gastroenterologist they truly connect with. Mutual trust and respect can go a long way to help patients with irritable bowel syndrome and improve their quality of life.

  • June 12, 2020

    By Rebecca Schwender, PT, DPT, Clinic Coordinator

    As many of us are spending our days at home, finding new ways to exercise is increasingly important, especially with gyms and fitness centers being closed. Running is a great option for staying physically fit and healthy. It requires no equipment, and can be easily done while following physical distancing guidelines. Running is also a great way to get outside, get some fresh air, and enhance your mental well-being during this difficult time.

    With gyms closing due to #COVID-19, many people are starting to run as a way to stay fit. Whether you are an experienced or new runner, here are 7 tips from physical therapists to prevent injuries while running via #LiveWellHealthy blog: https://bit.ly/3cQKhgc.

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    If you’re interested in running, but haven’t been a runner in the past, don’t let that stop you. We’ve outlined some easy recommendations to get you started, while avoiding potential injury.

    7 tips to prevent getting injured while running.

    As with any new fitness routine, make sure that you have no underlying medical conditions that would make starting a new running routine unsafe. If you have any questions, consult your medical professional.

    1. Wear proper footwear.

    A safe and effective run starts with the appropriate footwear. Find yourself a pair of running shoes that fit well. Your shoes should provide you with enough stability and cushion to complete your training session comfortably.

    2. Warm-up before you run.

    You want to actively stretch muscles you will use while running, while also getting your heart and lungs pumping. A dynamic warm-up is a great way to accomplish this. Try butt kickers, high knees, skips, side lunges, and hip swings.

    Watch the videos below for demonstrations of possible warm-ups.

    Butt kickers:

    Skips:

    Side lunges:

    3. Start with run-walk intervals.

    If you are just starting out with running, a run-walk program is a great way to begin your training. As you become more conditioned, you can increase your running workout intensity by either increasing your run interval, decreasing your walk interval, or increasing total session time as tolerated. Try starting with a one-minute run followed by a two-minute walk. Repeat the intervals five times for a great 15-minute workout.

    4. Stretch post run.

    Stretching after a run is just as important, if not more important as before your run. Post-run stretching can help improve and maintain muscle flexibility as well as reduce muscle soreness post-workout. Below are a few key stretches to include in your routine:

    • Hamstring stretch
    • Calf stretch
    • Quadriceps stretch
    • Piriformis stretch
    • Hip flexors stretch
    • Three-way child’s pose

    Perform all of these stretches for a minimum of 30 seconds each.

    5. Progress gradually.

    When increasing distance or duration, follow the 10% rule. The total distance or time of your workout should increase by no more than 10% per week to avoid potential overuse injury. Also, be gradual as you work in other changing variables to your program, such as increased speed and different terrain, like running hills or trails instead of flat ground.

    6. Rest and recover.

    Whenever beginning any new fitness routine, your body will require recovery time. Allow your muscles to recover from the new stress. Begin by running every third day to see how your body responds to these new physical demands. Progress to running every other day until you feel comfortable running on consecutive days —this may take several weeks. Try taking an easy 15 minute walk on your recovery days to help with muscle soreness.

    7. Know the difference between soreness and pain.

    Muscle soreness and fatigue are normal responses to any new activity, pain is not. Muscle soreness can last for 24-48 hours after exercise, and you should modify your training program accordingly. If you are having pain, hold off on additional running until you can consult with a medical provider.

    If you are experiencing pain related to running, you can call 888-44-SPORT (888-447-7678) to schedule an appointment with one of our many MedStar Health sports medicine physicians or physical therapists.

    Want to learn more about physical therapy services at MedStar Health?

    Click here.

  • June 10, 2020

    By Zayd A. Eldadah, MD, PhD, Director of Cardiac Electrophysiology, MedStar Heart & Vascular Institute

    A steady, rhythmic heartbeat in you or someone you love may be the most reassuring sound on earth. Yet some people experience a heart rhythm that is occasionally too fast, too slow, or irregular—for no apparent reason. Any of these symptoms may indicate atrial fibrillation (or AFib), the most common abnormal heart rhythm in adults.

    This blog focuses on this condition, which—because of its widespread prevalence—is one we treat daily at the MedStar Heart & Vascular Institute. While the majority of Afib patients are older (70 years and up), we also see patients in their 40s, 50s, and 60s with this arrhythmia. Indeed, the primary driver of AFib is advancing age, and by the time we’re 80, about 15–20% of us will have this rhythm disorder.

    What Causes Heart Palpitations?

    The heart is an exquisite muscle that collects oxygen-depleted blood from the body, pumps it to the lungs for a refill, then propels this freshly aerated, life-giving blood back to our organs and tissues. Orderly flow of electricity though the heart muscle generates this squeezing sequence, a perfect choreography of electrical flow and mechanical contraction that emerges in the earliest weeks of life within the womb and continues until our last breath.

    AFib is an electrical “hijacking” of this process, rendering the organized and regular flow of electricity through the heart completely chaotic. While the pulse in these patients may be rapid, slow, or even within the normal range, it becomes irregular. The result is a heartbeat that resembles an engine that suddenly starts knocking because its pistons are firing out of sequence. In some people, this inefficient heart pumping may be barely noticeable, while in others, it can be debilitating.

    Did you know that atrial fibrillation can cause your heart to flutter, beat too fast, or beat too slow? Learn more from Zayd Eldadah, MD, PhD. https://bit.ly/3cNYaf4 via @MedStarWHC
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    Symptoms and Timing

    Severe presentations of Afib can make patients feel very tired, even with minimal activity. Other symptoms may include lightheadedness, dizziness, shortness of breath, and a sensation of heart racing or “flip-flopping.” In milder cases, any of these symptoms may be present but not as severe. Patients may even just feel a generalized malaise. And in some lucky patients, there may not be any symptoms at all. They may have atrial fibrillation that progresses to being permanent without ever noticing anything wrong.

    For some individuals, symptoms during the day are more common—for instance, during physical exertion. In others, symptoms emerge at night, when the body is less active and the heart rate is slower.

    Two Types of Afib

    The combination of aging and an individual’s genetics underlies the most common type, known as Primary Afib, because no discrete, reversible cause for the rhythm disturbance can be identified. As noted, about 15–20% of people will experience Primary Afib by the time they’re 80 years old.

    Then there’s “Secondary Afib,” meaning the heart reacts to a trigger, such as an external insult. Once that provocation fades, so too does the Afib. Some examples of insults to the heart that can cause secondary Afib include alcohol intoxication, high fevers, extreme exhaustion, and too much caffeine. Other temporary conditions like a pulmonary embolus or chest surgery of any kind can also cause atrial fibrillation because the heart can become inflamed or irritated.

    Be Aware of the Risk of Stroke

    The single most severe risk of Afib is stroke. Patients with Afib are five times more likely to have a stroke than patients without it. Stroke is no joke. It can be debilitating and even deadly. Stroke is defined as the death of brain tissue that can result when a blood clot forms in the heart, breaks free, then lodges in a brain blood vessel, stopping the vital flow of oxygen and nutrients to brain cells. If the damage is small, mild symptoms, like weakness or minor visual loss, might occur.

    But if the tissue damage is extensive, symptoms could be extremely serious, such as permanent blindness, paralysis, or even death. If the blood vessel blockage is temporary and resolves on its own (for instance, a small blood clot that travels to the brain then dissolves after a short period of blood vessel blockage), the condition is called a transient ischemic attack (TIA). In TIAs, brain tissue is injured but recovers, and the symptoms may be mild, for example, brief visual loss or speech slurring that gets better.

    Strokes caused by AFib are twice as likely to kill patients and twice as likely to cripple them than strokes caused by other conditions. At MedStar Heart & Vascular Institute, our priority is our patients’ safety above all else. This compels us to put our full attention and effort into diagnosing atrial fibrillation in patients who may have it—and protecting them.

    A Message for the Community

    Our message is simple. Afib is serious, but it does not have to be scary. The body undergoes many changes as it ages, and an increasing risk of Afib is one of them. As our population gets older, more of us will develop it, so it is important that we be aware and ready, not upset or alarmed.

    We ask that you recognize possible signs—an irregular pulse, feeling unusual fluttering within your chest, having noticeable reduction in your energy or ability to exert yourself physically. These should be addressed promptly by a healthcare team that you trust. If you witness or experience any signs of brain symptoms like sudden visual or speech changes, that is a medical emergency that requires an immediate call to 911.

    Diagnosing and Dealing with Atrial Fibrillation

    We now have many tools to detect atrial fibrillation, even if it happens infrequently, and to assess symptoms and risks, then treat patients accordingly. If changes to your heart rhythm or unusual symptoms like those described above develop, please see your doctor right away. Like so many conditions, this one is better managed the earlier it is addressed.

    Our practitioners at MedStar Washington Hospital Center—whether primary care or internal medicine doctors, cardiologists, or heart rhythm specialists—are experts at dealing with heart rhythm disorders. Together, we’ll use the best tools, techniques, and scientific evidence to tailor our approach to the individual needs and risks of each of our patients. And we commit to follow the best science, practice with the best ethics, and deliver care with the greatest compassion.

    Erratic heartbeat?

    Talk with a specialist.

    Call 202-644-9526 or  Request an Appointment