MedStar Health Blog

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.

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.

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.

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.

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.