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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 04, 2020

    By Rachael D. Sussman, MD, Urology

    If you think bladder leaks are just a normal part of aging, think again. Although advertisements for absorbent pads and undergarments are plentiful these days, several effective treatment options can actually help resolve this annoying, and sometimes disabling, problem.

    Occasional urinary incontinence may be no big deal. But if you’re bothered by any degree of bladder leaking, it’s never too early to speak to a urology specialist. In most cases, we can help!

    Why Do Bladder Leaks Happen?

    Essentially, there are two major types of urinary incontinence:

    • Urge incontinence, also known as overactive bladder, is common for both men and women. It happens when your bladder is a bit out of sync—so you have strong, sudden urges to urinate but you’re not able to hold it long enough to reach a restroom. What causes this urge are abnormal bladder contractions, meaning your bladder starts to squeeze and empty on its own before you allow it. Sometimes this can happen due to things like a urinary tract infection or consuming too much fluid, which can be easily treated. Other risk factors include menopause in women and an enlarged prostate in men, both natural parts of aging that can prompt tissue changes and weakened nerves in the pelvic floor. Other causes may be nerve-related disorders such as multiple sclerosis or Parkinson’s disease, radiation treatment for prostate cancer, or lifestyle issues like obesity and smoking.
    • The other common type, especially in women, is stress incontinence. When you experience pressure to your abdomen—from laughing, coughing, lifting, even intercourse—weakened muscles that typically keep your bladder closed ease open and let urine escape. For women, the major risk factors are pregnancy and childbirth, which cause pressure that can damage nerves and tissues that support your bladder. Stress leaks are also more common in people who are overweight; who frequently strain themselves with weightlifting, chronic cough, or even constipation; or those who’ve had pelvic-area surgeries, such as a hysterectomy in women or prostatectomy in men.
    If you’re bothered by #bladderleakage, it’s never too early to speak to a urology specialist. There are lots of effective treatment options for #incontinence, says Dr. Rachael Sussman. bit.ly/2B2ni4r via @MedStarWHC
    Click to Tweet

    How Common Is Urinary Incontinence?

    It’s hard to say exactly how many Americans experience these two most common types of incontinence (and some people experience both). Recent studies suggest more than 50% of adult women and about 25% of men over age 65 have had some degree of urine leakage within the past year. That’s quite significant, and the problem tends to increase with advancing age. Yet, studies show that few incontinence sufferers ever seek treatment for it.

    That’s extremely unfortunate, because there are so many highly effective ways to treat incontinence, from conservative behavior changes to more advanced devices and procedures. If one doesn’t work well enough, I always encourage people to try another.

    Conservative Approaches to Bladder Leaks

    Try these simple steps first.

    • Dietary Changes: Cut back on bladder-irritating foods and beverages that can make incontinence worse. These include coffee, tea, spicy and acidic foods and beverages, carbonated drinks, and alcohol. Be sure to drink enough water as well, so your urine is very pale yellow. Dark, concentrated urine is another bladder irritant.
    • Constipation Control: Getting into a good bowel regimen can also help to ease an overactive bladder, since constipation can put pressure on your bladder, and worsen your control. Get more fiber in your diet from fruits, vegetables, and beans or add a fiber supplement. Talk to your doctor if you’re taking prescription pain relievers, allergy medicines, antacids, or certain blood pressure medicines, as they often cause constipation. You might also consider taking an over-the-counter stool softener. A general goal: one soft bowel movement per day.
    • Timed Voiding: Don’t wait until you get an uncontrollable urge before you hit the bathroom. Try to urinate every three hours, whether you feel the need or not. This can also help keep your bladder from becoming overly stretched and weakened over time.
    • Bladder Muscle Exercises: Kegel exercises can strengthen the muscles that help you control your bladder. These exercises are particularly helpful for stress-caused leaks but can also help those with other types. Squeeze your pelvic floor muscles (the ones you’d use to stop urinating). Hold that squeeze for 10 seconds, then relax for 10 seconds. Repeat ten times. Perform this cycle a few times each day while you’re seated and relaxed—although not while you’re urinating. Or consider working with a physical therapist who specializes in addressing pelvic floor issues.
    • Urge Suppression Technique: For people with urge incontinence, this exercise can give you time to reach the bathroom. When you feel a sudden urge to urinate, do a series of quick pelvic floor squeezes (again, the muscles you’d use to stop urinating), take a deep breath, then repeat. This exercise signals the brain to temporarily stop the involuntary bladder contractions and give you extra time to make it to the bathroom.
    • A Little Weight Loss: A recent study of women found that losing just 8% of your body weight can reduce bladder leak incidents by 50%.

    Bladder Control Medications

    If behavioral steps don’t offer enough relief, medication is available to treat urge incontinence (overactive bladder). There are two types:

    • Anticholinergics: These prescription medicines help relax your bladder by blocking receptors that make it squeeze uncontrollably. They can help reduce those sudden, urgent feelings that you need to urinate. Side effects can include dry eyes or mouth and constipation, so they’re not for everyone.
    • Beta 3 Agonists: This newer category of medicines activates receptors in the bladder that help it relax and allow it to hold more urine. It can be used alone or taken with an anticholinergic medicine. Some studies suggest the combination may be more effective.

    While no medicines are currently FDA-approved for stress incontinence, the following well-tested interventional therapies can dramatically improve bladder control.

    Devices and Minimally Invasive Procedures

    For urge incontinence:

    • Percutaneous Tibial Nerve Stimulation: Similar to acupuncture, this technique involves inserting a fine needle electrode into nerves in the ankle that connect to nerves controlling the bladder. The electrode sends mild electrical impulses to the bladder that can minimize its unpredictable squeezing. Weekly sessions take about 30 minutes and continue for 12 weeks. A recent study showed that more than 70% of patients who had this low-risk therapy experienced at least 50% fewer incontinence episodes.
    • Sacral Neuromodulation: This nerve stimulation technique involves placing a small pacemaker just under the skin in your hip area. The lead wire sends electrical impulses to the nerves controlling bladder contractions, helping minimize the sudden urges. Once placed, it can be set for up to five years, when battery replacement is needed. The only downside may be that you can’t undergo an MRI with the current device in place; however, a new MRI-compatible model may be available by 2021. A rechargeable version is also in the works.
    • Botox®: The same substance used to paralyze your frown muscles for a younger-looking face can also calm an overactive bladder. The liquid is injected into the bladder through a small needle that we guide with a camera. The results last from three months to a year, with very few side effects. Again, patients often experience half as many urgency episodes after this treatment, although it must be repeated. A new Botox gel formulation in development for incontinence will allow us to place it directly in the bladder area without an injection—for even less discomfort.

    For stress incontinence:

    • Vaginal Pessary: This small device made of silicone can be inserted into a woman’s vagina to help support her pelvic organs and provide compression to help prevent stress-induced bladder leaks. It’s a simple device that can offer immediate results. The device can stay in for up to three months and be changed by your doctor, or a woman can take it in and out as frequently as they like (similar to a diaphragm). A recent review of studies found that women report high levels of success and satisfaction with the pessary, particularly if properly fitted by a healthcare specialist. It’s an excellent option for someone who is not a good surgical candidate or who only leaks occasionally, such as during exercise.
    • Bulking Agents: This low-risk, quick-fix approach involves injecting a silicone or other filler material into the urethra to plump the area and help it stay closed during sneezes, lifting, exercise or other activities that cause bladder leaks. Bulking therapy works better for women than men, and may need to be repeated, since the material tends to break down within a couple of years. However, it can be a good option for older patients who may not be good candidates for surgery, or those who want quick results and don’t have time for other procedures before an event such as travel.

    Surgical Approaches

    • Sling: This gold standard for treating stress incontinence involves a 20-minute outpatient surgery to place a supportive sling under the urethra. Made of mesh or from tissue taken from the patient’s own abdomen or thigh, the sling acts like a firm backbone. It supports the weakened tissues and muscles that help keep the urethra closed to prevent bladder leaks. It has a 90% success rate for women and can also be used in men with stress-induced leaking.
    • Artificial Urinary Sphincter: This device, currently used for men only, includes a fluid-filled cuff that hugs around the urethra to keep it closed, a small pump in the scrotum, and a fluid-filled balloon in the abdomen. When you want to urinate, you squeeze the pump to empty the fluid from the cuff that is hugging the urethra into the balloon that sits in the abdomen. The cuff stays open for a few minutes so you can urinate. Then, it automatically closes again to reseal the urethra and keep you dry. This device works very well, can stay in place for up to 10 years, and offers a high level of patient satisfaction. It’s also being tested for use in women.

    What’s Ahead?

    At MedStar Washington Hospital Center, we offer all the latest urinary incontinence treatments from guidance on behavioral approaches to innovative surgical techniques. We’re also involved in researching potential new treatments, including autologous derived muscle cells to treat stress incontinence in women. This involves taking some muscle tissue from the leg, growing these cells in a lab and then injecting them into the urethra to help grow additional sphincter muscle, which could improve bladder control. So far, the study shows great promise!

    In the meantime, women and men have many highly effective treatments available to help relieve the most common types of incontinence. At the Hospital Center, we work with you to explore underlying causes, help you choose the right therapy, and explore another option if we don’t see results. Many patients tell me that finally treating their incontinence has been life-changing.

    I encourage anyone who’s more than mildly annoyed by this common condition to make an appointment with a urologist. Incontinence is not something you have to just deal with. We can take steps to treat it and dramatically improve quality of life.

    Bothered by leaks?

    Our specialists can help.

    Call 202-644-9526 or Request an Appointment

  • June 03, 2020

    By Dr. Ryan Anderson, MD

    While COVID-19 may be the health concern at the top of everyone’s mind, other illnesses and medical needs still require timely attention. That’s why our primary care teams have worked hard to maintain the same level of safety and quality as before COVID-19 affected our communities. You can expect us to protect your health whenever and wherever you see us for primary care during the COVID-19 pandemic. Here’s why.

    #COVID-19 shouldn’t delay your medical care. On the #LiveWellHealthy blog, internal medicine physician Dr. Anderson shares why and how you can safely seek #PrimaryCare: https://bit.ly/3dwkpHt

    Click to Tweet

    Minor health concerns can grow into more serious issues when left untreated.

    When you delay medical care or ignore symptoms, your condition can quickly get worse and become harder to treat. What you may think is a small health concern could grow into a larger one if you don’t receive care when you need it. A skin rash, for example, may not seem like an urgent reason to see a doctor. But, if that rash represents a minor skin infection, delaying care could cause that infection to become serious. More seriously, if you have chest pain, waiting could result in a heart attack or stroke that leaves permanent damage.

    While a phone call with your primary care provider (PCP) may be useful for addressing quick questions, in-person and video visits allow your doctor to see body language and visual cues that can inform a diagnosis. If you aren’t ready to visit your PCP in person, your PCP may be able to diagnose and treat the following illnesses or symptoms using video visits:

    • Allergies
    • Cold and flu
    • Diaper rash
    • Fever
    • Headaches and migraines
    • Head lice
    • Sinus infections
    • Skin rashes
    • Sore throat
    • Sprains and strains
    • Urinary tract infections (UTIs)

    …and more.

    In cases where labwork or a physical exam may be necessary, your PCP can counsel you on when and where to seek in-person care.

    Early detection and treatment results in the best outcomes.

    In addition to seeking care for acute conditions, like an infection or injury, your PCP is still here to help you prevent illness. Since disease is most effectively treated when it’s caught early, it’s important to stay on top of routine health care. Staying up-to-date with primary care during the COVID-19 pandemic can help you receive the care you need, allowing you to:

    Follow-up with your PCP after an in-person appointment.

    If you’ve recently visited your PCP for an acute condition, such as an infection or injury, you may want to follow-up with your provider to make sure it’s healing properly. Talking with a PCP allows you to give an update on your condition and ask any remaining questions. Your provider may provide additional instructions to ensure that your recommended treatment is clear and easy to follow.

    Get a prescription refill or discuss how to manage side effects.

    When you need a routine refill for a prescription or help managing unwanted side effects from a medication, your PCP can monitor and adjust your medication through in-person or video visits. A visit helps facilitate a conversation about what is and isn’t working well with your current medication. It also allows your doctor to ask questions to determine when an alternative may be beneficial.

    Stay up-to-date on preventative care.

    Primary care visits help maintain the provider-patient relationship. During your visit, your PCP can help you stay on track for routine screenings, annual physicals, and lifestyle modifications. Doing so can minimize your risk of disease, or at the very least, help you catch something early before it becomes serious and harder to treat. When it’s time for a screening, such as a mammogram, your PCP can advise on when and where you should go in-person to minimize any environmental risks without delaying your care.

    Enlist the help of your PCP to make lifestyle changes.

    Your PCP is a great partner in helping you maintain overall health and wellness. One of the ways they can keep you healthy using primary care visits is through lifestyle counseling. From diet recommendations and exercise modifications to addressing mental health concerns, your PCP can answer questions, offer advice, and help you formulate a plan for making any necessary changes to your lifestyle.

    Review lab and screening results.

    After lab work or screenings, your PCP can communicate results and recommendations during a primary care visit. Seeing each other in-person or via video helps to maintain the personal touch while reviewing the outcome of baseline, routine, or follow-up tests, such as:

    • Biopsies
    • Bloodwork
    • Cancer screenings
    • Urine tests

    …and more.

    It’s safe to see your primary care doctor in the office.

    With all of the messages about the importance of “staying home” during the pandemic, you may wonder if it’s safe to seek in-person primary care. At MedStar Health, our primary care and specialty facilities are working hard to keep our offices as safe as they’ve ever been.

    Here’s what you can expect when you visit your primary care provider in-person.

    Your care team—and you—will be wearing the proper safety gear.

    All of our primary care providers, nurses, and staff are dressed in appropriate safety gear to protect themselves and you. We also require all patients and visitors to wear a mask while in the office so. If you don’t have a mask, we can provide you with one.

    We thoroughly clean and disinfect every room multiple times each day.

    Your health and safety is still our top priority when you seek primary care during the COVID-19 pandemic. All patient exam rooms, waiting rooms, and procedure rooms are cleaned and disinfected at regular intervals throughout the day. We also offer multiple hand sanitizer dispensers throughout every facility so you can keep unwanted germs at bay.

    All patients and visitors are screened for COVID-19 symptoms.

    We have safety measures in place to ensure MedStar Health medical offices, hospitals, and facilities are the best places to receive care. We’re screening all patients and visitors for symptoms at every facility to minimize the risk of exposure to others.

    Appointments and public areas are spaced out to encourage social distancing—but you won’t feel socially distant.

    To minimize the number of people in our waiting rooms and public areas, we’re carefully scheduling patients throughout the day. And, when you’re here, you’ll see floor markers, signs, and reconfigured chairs in waiting areas to encourage social distancing. Despite the increased physical distance, you can expect to be treated with the same personalized and compassionate care that we’re known for.

    If you aren’t ready to visit us in person, there are other options.

    When you’re ready to see us for primary care during the COVID-19 pandemic, we’re here, we’re safe, and we’re ready to serve you. But if you aren’t comfortable visiting us in-person yet, your primary care provider is ready to care for you virtually through MedStar Health’s video visits.

    What are video visits?

    A video visit is a virtual healthcare appointment that allows you to see and talk to a healthcare provider using your smartphone, tablet, or computer. You can schedule video visits just like you would schedule an in-person appointment, and in most cases, they’re covered by insurance.

    How to schedule a primary care video visit.

    Scheduling a primary care video visit is easy, convenient, and done from the comfort of your own home.

    1. Call your primary care provider or office to schedule an appointment.
    2. When it’s time for your appointment, your primary care provider will send you a link via email or text message.
    3. Using your smartphone, tablet, or computer, click on the link to open up the secure video visit app.

    To learn more about what to expect during your video visit, read our patient experience guide.

    If you’re experiencing symptoms, have a health concern, or are due for routine care, call your doctor so they can help you with the care you need. You can count on your MedStar Health primary care providers and specialists to deliver the highest quality of care in the safest settings, whether you see us in the doctor’s office or virtually.

    Find care now.
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  • June 02, 2020

    By Allen J. Taylor, MD

    When the virus that causes coronavirus (COVID-19) first appeared in the United States, the medical community warned that patients with an underlying disease would find their pre-existing condition to be a significant complicating factor if they also contracted the virus. High blood pressure—or hypertension—was among those potential risk factors. Cardiologists and other researchers also began to examine whether antihypertensive medications might make patients more vulnerable to the virus as well.

    But with each passing week, we’ve come to understand more about what makes the novel coronavirus tick. We haven’t learned everything, but time, experience, and research have unlocked many of its secrets and behaviors, as we pursue new treatment and prevention strategies.

    At this stage of managing the virus, we can confirm that cardiovascular disease in general presents a known risk for complications and adverse outcomes. But hypertension alone does not.

    Elevated blood pressure plays a role if coupled with other cardiovascular diseases, like coronary artery disease, congestive heart failure, and heart attack—and it tends to affect older people. So, it’s together with these other factors that high blood pressure may become more dangerous for someone who contracts the virus.

    Don’t Avoid the Hospital

    Because we’re increasingly aware of the risks—and because cardiac disease exists in most communities—we continue to recommend that patients with cardiac illness be extra-vigilant about their health. Take all the precautions to prevent infection, like social distancing, limiting exposure to others, wearing a mask when out in public, and frequent handwashing.

    The new virus targets the respiratory system—which, in many cases, is already compromised in those with cardiovascular illness. We don’t see evidence that cardiovascular disease patients are more likely to contract the virus, except those with compromised immune systems. But we do know that people with heart disease fare an average two to three times worse with COVID-19 than those without heart disease. The multitude of issues just makes it more difficult for the body to weather the infection storm.

    So, getting the cardiovascular care you need is as important as ever, and there’s no reason to stop your ongoing treatment. This is not the time to avoid the doctor or hospital for fear of a virus—especially if you experience signs of a heart attack.

    We know “COVID phobia” is real. Medical centers have experienced significant reductions in patient volume since stay-at-home orders went into effect. But I can’t stress this enough: if you need medical attention, even routine monitoring or checkups, you have options. A MedStar Video Visit, for example, is a great way to stay in touch with your cardiologist, without leaving home.

    If you do need to be seen, visiting a MedStar Health facility is as safe as it’s ever been. We take every possible precaution to protect both patient and practitioner—limiting exposure, using protective equipment, monitoring temperatures, and isolating infected persons.

    In fact, since the beginning of March, MedStar Heart & Vascular Institute has performed 11 heart transplants and 20 artificial heart procedures, without a single problem or complication related to the virus. We continue to provide the highest level of care for those who need it, safely and reliably.

    Every day, cardiologists know more about how COVID-19 interacts with cardiovascular diseases. @TaylorMHVICard covers the latest developments. https://bit.ly/3cfwUpi via @MedStarWHC
    Click to Tweet

    Coronavirus and Blood Pressure

    We know COVID-19 latches onto receptors in cells that trigger the vessels to regulate blood pressure. These same receptors are the target of some of the more popular blood pressure medications: ACE inhibitors such as benazepril, enalapril, lisinopril, and ramipril, as well as angiotensin receptor blockers (ARBs), including candesartan, irbesartan, olmesartan, and valsartan.

    That has caused people to wonder if they should stop taking their medications. The answer is almost always “NO.” Any evidence showing that medications make the virus worse is both sparse and speculative. The risks of elevated blood pressure are far greater and well known—so it’s never a good idea to stop your medications.

    Naturally, if you’re concerned, have a conversation with your doctor to determine the best course of action.

    There is also some evidence indicating that some blood pressure medications might actually help protect against the virus. We don’t know all the details yet, but studies are underway to shed more light on potential effects.

    Other Cardiac Issues

    Most of the other cardiac problems we see associated with this condition are not a complete surprise. We see similar issues in severe cases of flu and other viral infections. For example, when the body mounts an immune defense against any invader, the heart and blood vessels register stress. That can increase the risk of heart attack, make symptoms of heart failure worse, and sometimes weaken the heart muscle.

    Although the new pathogen is creating some unique problems, we see less impact on heart patients than we first expected. However, the virus can mimic heart attack, even in people without compromised cardiac blood flow. It causes unusual blood clotting which can affect the heart and its network of blood vessels. This may be the cause of heart damage observed in a very small percentage of victims—and it can be picked up with blood tests.

    There’s still a lot we don’t know but the science is advancing rapidly, and every cardiac patient affected by the virus increases our knowledge as we move toward reliable treatments and a potential vaccine.

    Heart Disease Doesn’t Wait

    We know many people are staying away from healthcare thanks to fear of the virus. But heart disease won’t wait for this pandemic to end. The MedStar Heart & Vascular Institute team is doing everything possible to keep the community healthy, providing front-line care for cardiovascular disease at all levels.

    Now, more than ever, it’s a time to be vigilant. Coronavirus is a triple-edged sword. It can create some heart disease; make existing disease more serious; and may keep people with disease away from the care they truly need.

    Turn to Telehealth

    But one big silver lining is the dramatic progress of telehealth, removing roadblocks between patient and physician. This new crisis has prompted regulators and insurance companies to relax restrictions on remote care and gives providers and patients countless opportunities to streamline and improve the process. In fact, we currently conduct as many as 90 percent of outpatient visits remotely.

    To get the most out of your MedStar Video Visit, make the appointment! Telehealth is easy, convenient, and brings the benefit of interacting face-to-face with practitioners who care deeply about your well-being. You can have a friend or loved one by your side to help take notes and answer the doctor’s questions. You can even include a loved one from a distance, something nearly impossible with a traditional office visit.

    If you have a blood pressure monitor, keep track of your pressure a few days before the video visit. This is valuable information for the cardiologist. Have your medications handy: we typically do a full medication review on each call, and you can save time by assembling them beforehand. Write down all your questions before the visit, to make them easier to remember.

    Although this virtual visit isn’t a traditional physical exam, we learn a lot by observing how you look and sound and by asking the right questions. Answer those questions honestly. Be sure you have a good Internet connection and a reliable video device with a charged battery. We like smartphones since they can be easily pointed around when it comes time to look at your medications, your extremities, or other indicators. If you need help, consider recruiting a family member with technical skills. Keep pen and paper handy to write down any new instructions.

    Beyond the convenience, telehealth visits are proving to be a very positive experience for both patients and providers. We miss seeing you…and technology provides the next best thing. Another benefit: because it removes the distractions of travel, the waiting room and the busy office, we can focus on what matters most, a meaningful conversation about your health.

    Remember, in an age of elevated infection risk, keeping your heart healthy is more important than ever. It’s up to you to do the right thing. Stay on your medications. Keep an open dialogue with your doctor, that’s why we’re here. And if you feel something isn’t quite right, don’t delay, report it right away.

    Keep your heart healthy.

    Connect with us conveniently from home.

    Call 202-644-9526 or Request an Appointment

  • May 28, 2020

    By William Z. Gao, MD, Laryngologist

    Like the Beach Boys, your vocal cords appreciate good vibrations. But illness or vocal trauma can affect the vibrations in your voice box (larynx), resulting in hoarseness—or, in some cases, a complete loss of voice. So, why does this happen?

    Colds and Infections May Affect Your Voice

    One of the most common causes of damage to the vocal cords is viral infections like the common cold. In those situations, you can experience inflammation and swelling in the throat. When swollen, your vocal folds (vocal cords) become stiffer than normal and don’t vibrate as well. You may then experience different degrees of hoarseness (rough or raspy) because the two sides are vibrating at different frequencies. When we say we’ve lost our voice (aphonia), the stiffened vocal folds may be so swollen that they don’t vibrate, which prevents us from getting any sound out.

    While hoarseness is a symptom, laryngitis refers to inflammation of the larynx. Laryngitis may arise from viral infections as mentioned or, more uncommonly, bacterial or fungal infections. Those with weakened immune systems may be more prone to these infections. Fungal laryngitis is also more frequently seen in people on steroid inhalers such as those with asthma.

    When we become hoarse or lose our voice, it can be from a number of causes including the common cold and vocal overuse. @WilliamGaoMD explains when to get help. bit.ly/2TIQLqE @MedStarWHC @MedStarGUH @MedStarHealth
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    Why Does My Voice Get Hoarse the More I Use It?

    Vocal overuse (phonotrauma) is a common cause of hoarseness, especially in people with a greater need to use their voice, or in those who stress their voice box—for example, by cheering, yelling, or coughing repeatedly. Our vocal folds normally vibrate anywhere from 100 to over 200 times per second when we speak. When those vibrations are multiplied over the course of a day, we may generate millions of vibrations per day.

    This high degree of sheer stress on the vocal folds can cause problems. We tend to notice it reflected in the quality of our voice the next day, when we wake up. Fortunately, though, permanent damage doesn’t typically occur from a single incident. However, repeated injury to your vocal cords can lead to the development of various vocal fold lesions ranging from nodules to polyps to cysts. Continued injury can even lead to scar tissue, which is a difficult problem to address and may cause permanent hoarseness.

    Vocal Health: Tips to Preserve Your Voice

    How can you protect your voice? It’s a matter of how you use it, and optimizing conditions for using the voice. Vocal hygiene is frequently overlooked, but it plays a big role in safeguarding your voice.

    These tips can help:

    • Avoid hurtful behavior: It’s key to “respect the instrument.” Use your voice in a way that’s not damaging. Avoid yelling, repeated coughing, and throat clearing as they cause the vocal cords to slam together, which can be quite traumatic to them.
    • Hydrate: The vocal cords require adequate moisture and lubrication in order to vibrate well. So be sure to drink plenty of water! Avoid excessive sweet, carbonated, and caffeinated beverages as they may not be as hydrating or may even be dehydrating to drink.
    • Pro tips: In line with ensuring adequate hydration, singers often find it helpful to use a humidifier and/or facial steamer. It is also important to avoid laryngeal irritants such as smoke, dust, and environmental allergens that may be more prevalent in some areas.
    • Voice rest: If you’ve been dealing with a hoarse voice, it may be beneficial to reduce how much you use it or even go on complete voice rest. As hard as it is to do, you’ll likely find that the silence is restorative to both mind and body. Even a day of voice rest can improve the voice, but longer periods up to a week may be needed.
    • Use it or lose it: The voice changes as we get older and move into the golden years. I see patients in their 60s and beyond who start to notice more troubles with the strength of their voice that is related to thinning or atrophy of the underlying muscle in their vocal cords. Preserving and restoring the voice in these cases relies on using it more!

    To Speak or Not to Speak

    Hoarseness that continues for more than two to four weeks means it’s time to be evaluated. There are many different medical conditions beyond the common cold and vocal overuse that can cause hoarseness. These include acid reflux, neurologic problems like paralysis, and even cancer of the voice box. It is important to get an accurate and timely diagnosis to ensure a favorable outcome. If issues persist, it is helpful to schedule an appointment with a specialist, such as an otolaryngologist, also known as an ear, nose, and throat (ENT) doctor, or even an ENT who specifically specializes in voice disorders. They can determine the underlying cause of hoarseness, and provide the optimal treatment, whether medical or surgical.

    Patient-Centric Multidisciplinary Approach

    Care of the voice—especially care of the professional voice—involves a team approach at MedStar Health. We can bring you the perspective and expertise of specialists across different disciplines to provide the best treatment. If your voice disorder stems from a medical condition, we engage with experts such as gastroenterologists, pulmonologists, and neurologists, depending on the cause. Additionally, speech-language pathologists or voice therapists are instrumental to vocal rehabilitation, as they are experienced in administering voice therapy, which is like “physical therapy” for the throat and voice box.

    At MedStar Health, our aim is to help you enjoy a healthy voice for a lifetime.

    Hoarse voice?

    Our specialists can help.

    Call 202-644-9526 or  Request an Appointment

  • May 27, 2020

    By Shoshana Feldman, CRNP

    As COVID-19 changes our daily routines, many of us may be struggling to remain active or make healthy food choices while we’re at home.

    But, now is as good a time as ever to start taking care of ourselves and make changes that will stick long after the pandemic. If you’ve struggled to lose weight on your own, weight loss surgery could be the push you need to embrace a healthier lifestyle. While weight loss surgery isn’t for everyone, for some, it can be life-saving.

    Struggling to lose and keep weight off? Now may be a good time to think about your #WeightLoss options. Here’s how 3 types of bariatric surgery may help jump-start a healthy lifestyle via #LiveWellHealthy blog: https://bit.ly/2TJfsTL

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    What is bariatric surgery?

    Weight loss surgeries are collectively referred to as bariatric surgery, although there are many different types of bariatric surgery. During bariatric surgery, a surgeon makes adjustments to the stomach and the digestive system which results in significant weight loss and a minimized risk of serious weight-related health complications, such as:

    • Type 2 diabetes
    • Heart disease
    • High blood pressure
    • Sleep apnea

    It’s not a magic solution for getting skinny, although that would be nice! But, bariatric surgery can be the beginning of a life-changing journey. A journey that allows you to enjoy the activities and people you love for years to come when coupled with a lifelong commitment to exercise and healthy eating. That’s why we offer nutritional counseling, support groups, behavior modification, and anything else you need to stay dedicated to your health after your surgery.

    What are the 3 types of bariatric surgery?

    There are different types of bariatric surgery and each one offers pros and cons. If you’re considering weight loss surgery, ask your doctor what type could offer you the most benefits based on your weight, medical history, goals, and habits. You can also learn more about the types of bariatric surgery by attending our informational seminar online.

    1. Gastric bypass surgery.

    During gastric bypass surgery, a surgeon divides the stomach to make a smaller stomach pouch, restricting how much you can eat. The new pouch is then attached to a lower part of the intestines, bypassing the rest of the stomach and first part of the intestines. This method allows decreased absorption and restriction. As a result, many people experience effective weight loss.

    Minimally invasive techniques can be used to perform gastric bypass surgery. One technique uses a small instrument attached to a camera, called a laparoscope. Because the laparoscope requires just a few small incisions, laparoscopic surgery offers a faster recovery, less pain, and fewer scars than open surgery. Many times this can be preformed using robotic technology as well, which offers a high level of precision under the guidance of an experienced bariatric surgeon.

    Advantages of gastric bypass surgery.

    Gastric bypass surgery has been around the longest and offers many advantages. Many patients experience excellent short-term and long-term weight loss. Often, patients also see a reduction in weight-related health concerns, including getting off of medication.

    Disadvantages of gastric bypass surgery.

    While there is a slightly higher risk of complications with the procedure when compared to others, the complication is rare. The benefits of gastric bypass surgery far outweigh any disadvantages.

    2. Sleeve gastrectomy.

    The most common type of bariatric surgery done today is the sleeve gastrectomy, which drastically shrinks the size of your stomach. During the procedure, a surgeon cuts a portion of the stomach, reducing its size by approximately 80%. The removed portion is the primary area where the hunger hormone ghrelin is made. Ghrelin is the hormone that tells your body it’s hungry.

    Like gastric bypass surgery, sleeve gastrectomy can be performed laparoscopically or using robotic technology, so you can get home faster and experience less pain and scarring than open surgery. You can expect to lose weight quickly after a sleeve gastrectomy because:

    • Your stomach can hold less food
    • Your appetite decreases
    • You get full faster

    Advantages of sleeve gastrectomy.

    Sleeve gastrectomy offers similar benefits to gastric bypass surgery, as you can expect dramatic weight loss within a short time. There is also a good chance you will see a positive impact on any weight-related health conditions, such as diabetes.

    Disadvantages of sleeve gastrectomy.

    Complications are uncommon, but in rare cases, the stapled portion of the stomach is at risk for leaking. This occurs in less than one percent of bariatric surgeries at MedStar Health, which is less than the national average of three percent.

    3. Laparoscopic gastric banding (Lap-Band System®).

    Commonly called Lap-Band® surgery, laparoscopic gastric banding is the least invasive type of bariatric surgery since no organs are being cut or moved. During the surgery, an adjustable band is placed around the top portion of the stomach. This creates a smaller stomach pouch so you eat less and feel full sooner. A doctor can adjust the band until you’ve reached your goal weight.

    Advantages of Lap-Band® surgery.

    Depending on your weight, eating habits, and medical history, Lap-Band® surgery may offer you many benefits, including a quicker recovery with fewer follow-up appointments. While weight loss is slower than other types of bariatric surgery, you can expect to lose weight at a controlled pace as you change your eating habits over time.

    Disadvantages of Lap-Band® surgery.

    The risks of Lap-Band® surgery are low. Weight loss is slightly slower than the more invasive procedures, but many people have success.

    Am I a candidate for bariatric surgery?

    Not everyone is eligible for weight loss surgery. And, because it’s an expensive procedure, your health insurance coverage may affect your decision. If you’re ready to start your weight loss journey, your doctor can help you understand your eligibility and recommend next steps, whether it’s surgery or a medical weight loss program.

    Your doctor may recommend bariatric surgery if:

    • You have had difficulty losing weight with diet and exercise.
    • Your body mass index (BMI) is greater than 40 and you have no existing obesity-related health conditions.
      OR
    • Your BMI is 35 or higher and you have one obesity-related condition that requires you to take medication.

    The best thing you can do is educate yourself about each type of bariatric surgery. That’s why we encourage patients interested in weight loss surgery to attend our online informational seminar. It’s free, and you’ll benefit from hearing success stories from other patients who made the brave decision to change their lives for the better. You can also talk with a doctor via computer, tablet, or smartphone through MedStar Health Video Visits.

    Ready to take the first step in your journey to weight loss?
    Click below to complete our online seminar.

    Take Your Online Seminar

  • May 26, 2020

    By Craig DeAtley, PA-C, Director, Institute for Public Health Emergency Readiness

    Any emergency is a challenge. And without advance preparation, that challenge can quickly become overwhelming. Emergency management calls for being prepared, beforehand.

    The COVID-19 pandemic is the latest example of why both individuals and families should create their own specific, actionable plans to manage any emergency—well ahead of time.

    Preparing for potential illness is similar to what emergency planners recommend for adverse weather events, like a flood, tornado or hurricane. In the pandemic, although we’re not experiencing the types of damage that severe weather causes, we do see many similar effects—illness, hospitalizations, shelter-at-home, and all the commercial and economic consequences. So, we follow similar guidelines to stay prepared.

    Readiness is a Family Affair

    A strong, successful plan is not a solo effort.

    Even if you are single and living alone, planning should involve friends and extended family to help create the plan, then put it in motion and keep it in motion if needed.

    In the family unit, planning is a group project, with all members of the family involved—kids, adults and the elderly. The group dynamic is of utmost importance: planning works best when everyone knows his or her role and precisely what to do in a crisis.

    Develop a simple, concise plan and rehearse it together periodically, to help keep the family healthy, connected, and ready for a variety of challenges, including a house fire or other calamity that makes the home uninhabitable; a natural disaster that may disrupt travel and phone service; or other types of emergencies that require sheltering in place. These preparations will help you and your loved ones better manage any disruption—including a pandemic caused by a virus.

    Managing an emergency means being prepared, beforehand. COVID-19 is a good reason for every individual and family to have an emergency plan. bit.ly/2ZEWPV9 via @MedStarWHC
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    COVID-19 Planning

    During the pandemic, if any family members continue to leave the house for work, they are most likely coming in contact with others. Disinfecting to the best of your ability helps protect the rest of the family.

    In my family, we’ve assigned the garage as my quarantine space. It’s where I leave my work clothes for 72 hours before they are handled again for laundering. Any area can serve this function. If you live in a small home where all the rooms have traffic, keep one area as off-limits as possible, and use it to bag and seal soiled clothing and other items before laundering.

    Keep the home environment as clean as possible, wear a face cover when venturing out, maintain six feet of distance from others and be sure the entire family washes their hands frequently.

    If Illness Strikes

    Even with all the precautions—hand washing, masks, social distancing—it’s still possible that someone may contract the disease. Are you prepared, if you or someone you love is infected? The time to plan is before that happens.

    Most often, those fighting the disease are advised to ride it out at home unless severe symptoms develop. So, it’s up to you and your family to prepare your home for a potentially difficult situation: the need to do everything possible for a sick loved one, while protecting the health of the rest of the family.

    • Quarantine: Plan to isolate the ill family member to help protect everyone. Assign a suitable space, before you need it. If illness strikes, limit who may enter that room. Wear a face-covering when attending to the family member up close; be sure they wear one, too.
    • Medical supplies: Consider what the family will need to weather the storm. For fever, acetaminophen products (Tylenol® or others), as appropriate; a thermometer to monitor fever, if available; an ample supply of prescription medications; gloves; and masks or face covers. N-95 masks are neither needed nor recommended in this situation—they are designed for healthcare providers and must be properly fitted. Cloth or paper masks are sufficient in the home and community. If it’s difficult to find them in stores, masks can be made from a simple bandana or T-shirt, even if you don’t sew.
    • Food and water: Water is fine for hydration, but sports drinks, broth, Pedialyte or popsicles can make staying hydrated a little more pleasant. Consider stocking milder foods, like saltine crackers, soup or broth, in the event of upset stomach or intestinal symptoms. And consider how food will be served—for example, it can be left outside the door of the quarantine area, rather than carried into the room, to protect caregivers’ health.
    • Support: Designate your In Case of Emergency (ICE) contacts. Know who to call if the patient takes a turn for the worse or begins to experience shortness of breath, disorientation or other signs their illness is becoming severe. Write down doctor or hospital phone numbers or instructions for a MedStar Health Video Visit. Every family member should know what to look for and how to call for help—you may not be there at a critical moment. At a minimum, children should have access to a phone and know how and when to call 911, especially if Mom or Dad is not available.
    • Cleaning supplies: Cleaning and disinfecting take on new significance when managing a contagious disease. Be sure to have what you need to disinfect surfaces, launder linen and clothing, and keep the family’s hands clean. Establish rules for hand washing before and after entering the quarantine area.

    If you do have a thermometer, be sure you have spare batteries if it’s digital. If you have no thermometer, estimate fever by placing the back of your hand on the ill person’s forehead. Pulse oximeters, used to monitor blood oxygen level to assess lung function, also get a bit of attention these days. If you have one, use it. But don’t scramble to find one; they can be costly.

    Keeping careful watch over the sick family member is more valuable than any device. Be vigilant about the warning signs.

    Preparing for a Hospital Visit

    More than likely, any infected family member will recover in quarantine without leaving home. But in case hospitalization would ever be necessary, think about it before it happens, and have a plan to assemble and pack what’s needed for a hospital stay.

    • Write it down, carry it around: For each member of the family, prepare a printed copy of their medical history and list of their medications and allergies. Although we live in an age of electronic records, don’t assume the hospital will have access to your record on demand. A paper copy is the fastest, most reliable way to get the information into the hands of the healthcare providers who need it. Prepare a copy for everyone in the family and be sure they know where the copies are kept—or carry a copy in your purse or wallet if it makes sense.
    • Communication: The cell phone is particularly important, since most hospitals are restricting visitation during the pandemic. Be sure cell phones are working and charged. Prepare written and printed lists of family members’ names and contact numbers. That keeps communication flowing, regardless of which phone is being used and who is stored in its contacts library. Keep the charger near the phone, where it can be packed in a hurry.
    • Advance directives: Although the risk is low, prepare in case your loved one requires extreme measures, such as use of a ventilator to assist breathing. The time is now to discuss family members’ wishes and preferences for such care. Healthcare professionals will do everything in their power to save a life—but none want to intervene beyond the patient’s wishes. It’s best to determine those wishes well in advance of illness or accident. This form can help guide these difficult but important decisions.
    • Do’s and don’ts: Since it’s hard to predict how long a hospital stay may last, adding the iPad, game or reading materials to your hospital checklist is a good idea. But don’t bring favorite articles of clothing, jewelry and other valuables, or other items that the ill person won’t need at the hospital.

    Always Have a Plan

    Because the pandemic situation affects virtually everyone, it has moved emergency preparedness out of the “what-if” column and placed it firmly in the here and now.

    Consider this a good opportunity to prepare your family. Seek input from all. Creating a readiness plan today is a valuable aid if there’s an emergency tomorrow. Thinking about, talking about, and planning for adverse events before they happen can help you manage a crisis with less stress, give you peace of mind—maybe even save a life.

    You can find more tips and resources here.

    Be safe.

    Experiencing symptoms of COVID-19?

    Schedule a video visit today.

    Call 202-644-9526 or Request an Appointment