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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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  • May 22, 2020

    By Jasmeet Singh Bhogal, MD, MBA

    Kids who attend public schools in the U.S. collectively miss nearly 3 million days of school every year because of pink eye, according to the Centers for Disease Control and Prevention.

    While it can spread quickly from person to person, especially among children, there are ways you can avoid spreading pink eye—or prevent it altogether.

    Nearly 3 million cases of #PinkEye are reported each year in the U.S. On the #LiveWellHealthy blog, family medicine physician Dr. Bhogal shares how you can prevent the spread of pink eye if you or your kids have it: https://bit.ly/36z8oP7

    Click to Tweet

    What is pink eye?

    Just like it sounds, pink eye is an eye condition that causes the whites of the eyes to turn red or pink. Pink eye is also known as conjunctivitis because the pinkish color is a result of an inflamed membrane that lines the eyelid and whites of the eyes, called the conjunctiva.

    Typically, pink eye symptoms include:

    • Redness in the whites of your eyes
    • Watery eyes
    • Eye swelling
    • An itchy, irritated, or burning feeling in the eyes
    • Eye discharge that results in crust between the eyelids or lashes

    How is pink eye spread?

    There are four different causes of pink eye, including:

    • Viruses
    • Bacteria
    • Irritants, such as fumes, chemicals, dust, or smoke
    • Allergens, including mold, pollen, or pet dander

    However, viral and bacterial pink eye are the only types of conjunctivitis that are contagious. Unlike irritants or allergens which can cause pink eye as a result of environmental factors, viral or bacterial pink eye is easily spread through direct contact with infected people or surfaces. That’s why it’s important to understand how to avoid spreading pink eye if you or your child have it.

    6 ways to avoid spreading pink eye.

    1. Wash your hands often.
    Frequently washing your hands with soap and water is the best way to prevent illness of any kind. The same principle applies to avoid spreading pink eye, too. Because pink eye is easily spread through contact with an infected surface or person, washing your hands for at least 20 seconds each time is the best way to avoid spreading pink eye to those around you.

    Regular hand soap is strong enough to keep the virus or bacteria from spreading. In fact, antibacterial soap doesn’t offer any additional protection. Alcohol-based soap is also a good option, and you can even do a combination of washing with regular hand soap and alcohol-based soap.

    2. Avoid touching your eyes, nose, or mouth.
    If you have pink eye, try not to rub or touch your eyes. You should also try to avoid touching your eyes, nose, or mouth if you know someone around you has pink eye. Be sure to wash your hands before and after touching your face.

    3. Don’t share towels, sheets, or pillows.
    Avoid sharing items that you use on your face, including pillowcases, washcloths, and sheets, as they can carry the virus or bacteria. Be sure to promptly wash any linens that have been used by someone with pink eye.

    4. If you wear contacts, switch to glasses until pink eye clears up.
    If you wear contact lenses, consider wearing glasses until your eyes heal to avoid spreading pink eye and also prevent it from coming back. In fact, it’s a good idea to throw away any contact lenses you wear or contact solution you use while you have pink eye.

    5. Don’t share eye makeup.
    Since eye makeup comes into close contact with your eyes, avoid sharing mascara, eyeliner, or eyeshadow with those around you. You may even want to throw away old makeup so that you don’t reinfect your eyes when they’re starting to heal.

    6. Just stay home.
    Since pink eye is so contagious, it’s best to stay home from school or work when you have pink eye—at least until any eye discharge clears up. If you’re able to work remotely, that’s a great way to avoid spreading pink eye in the office.

    If your pink eye isn’t clearing up on its own, you can seek medical care from your home using eVisit. This ensures you can talk to a doctor and get prescription eye drops to help relieve pink eye without the risk of exposing others in the doctor’s office. Using eVisit, you can talk to a doctor 24/7, 365 days a year—and you don’t need an appointment.

     

    When and where should I seek pink eye treatment?

    While most pink eyes typically clear up on their own, you may need to see a doctor if your symptoms are severe or impacting your daily life.

    Whether you suspect pink eye or something else, talk to a doctor if you are experiencing any of the following in one or both of your eyes:

    • Pain
    • Pressure
    • Feeling or something in the eye
    • Sensitivity to light
    • Difficulty seeing or blurred vision
    • Redness in the whites of your eyes

    Get the care you need, now.

    It’s important that you don’t delay your medical needs or ignore symptoms that would typically make you seek care. Early detection and treatment improve our ability to provide the most comprehensive and effective care.

    Since the COVID-19 pandemic reached our region, MedStar Health has made innovations to ensure we are still the best and safest place to receive care.

    We have worked hard to make sure we can provide the care you need in the most appropriate and safe setting. MedStar Health Video Visits are still options for a variety of appointment needs, but in some cases, an in-person visit may be best. We’re here to help you get the right care that reflects your needs and comfort level.

    We’re open and prepared to safely offer the same high-quality care you expect from MedStar Health, when you are ready to see us.

    Find care now.
    Click the buttons below for more information on our services.

    Urgent Care

    MedStar Health Video Visits

    MedStar Health eVisits

  • May 21, 2020

    By Min Deng, MD

    Did you know that skin cancer is the most common type of cancer? And, even more concerning, it often goes unrecognized.

    Understanding signs and symptoms can help you determine whether that spot on your skin is normal—or something potentially more serious.

    What Are the Three Main Types of Skin Cancer?

    #1: Basal Cell Carcinoma

    Basal cell carcinoma is the most common. With an estimated 4.3 million cases diagnosed in the U.S. each year, this condition affects more people than lung cancer, breast cancer, and prostate cancer combined.

    Basal cell carcinoma is caused by an abnormal growth of basal cells, which originate from the base of the topmost layer of skin. This type of cancer appears most often on parts of the body frequently exposed to the sun, like the head and neck. It is often mistaken for a "pimple," except this "pimple" doesn't go away and will often bleed with minimal trauma. Surgery is the most common treatment. The prognosis for basal cell carcinoma is generally very positive when caught early, with most patients making a full recovery after treatment.

    #2: Squamous Cell Carcinoma

    Squamous call carcinoma is the second most common type, with an estimated 1 million cases diagnosed in the U.S. each year.

    Like basal cells, squamous cells originate from the epidermis, the top layer of the skin. Damage to these cells, caused by cumulative ultraviolet (UV) exposure, can lead to squamous cell carcinoma. These can look like red crusty lesions. While the majority of squamous cell carcinomas have a good prognosis, this condition should be caught early to avoid deeper invasion and spread.

    #3: Melanoma

    Melanoma, although less prevalent than basal cell carcinoma and squamous cell carcinoma, is typically more aggressive. In 2020, approximately 196,000 cases of melanoma are expected to be diagnosed in the U.S. Unlike non-melanoma skin cancers, melanoma can occur anywhere on the body, including areas not typically exposed to the sun. This type of cancer can spread beyond the skin to other parts of the body and therefore early detection and treatment is key to a good prognosis.

    Although melanomas can often be fully treated with surgery, they may require radiation, chemotherapy, and other drug treatments if they have spread beyond the skin. The prognosis for this condition depends on several factors, including the thickness of the melanoma and the extent of spread. The five-year survival rate for all people diagnosed with melanoma is 92%.

    LISTEN: Dr. Deng discusses skin cancer in the Medical Intel podcast.

    What Causes Skin Cancer?

    There are several significant risk factors, including:

    Sun Exposure: Sun exposure is cumulative. Each time a person gets a sunburn, their skin is damaged on a genetic level. The damage increases over the individual's lifetime and may eventually cause this condition.

    Use of Tanning Beds: Because indoor tanning beds emit more UV radiation than the sun, their use is directly tied to increased risk for this type of cancer.

    Genetics: Some people are more genetically predisposed to it than others. People with fair skin, and especially individuals with red hair, are at greater risk of developing both non-melanoma and melanoma skin cancers. Individuals with a family history also have a higher chance of developing one of these conditions.

    The A-B-C-D-Es of Skin Self-Exams

    Conducting regular skin self-exams can help you detect skin cancer early. I recommend checking your skin for any bleeding or changing lesions no more than once a month. If you check too frequently, you run the risk of not noticing that a spot has changed.

    When it comes to basal or squamous cell carcinoma, keep an eye out for any spot on your skin that keeps recurring. These spots can bleed, often with minimal rubbing, but don't usually hurt.

    Conducting regular skin self-exams can help you detect skin cancer early. bit.ly/2ZmxkYd via @MedStarWHC
    Click to Tweet

    When checking your skin for signs of melanoma, remember your A-B-Cs...and don't forget D and E! If you notice one or more of these indicators, schedule an appointment with a dermatologist:

    • Asymmetry: Regular moles are usually symmetric, while melanomas often lack symmetry.
    • Borders: Regular moles typically have smooth, round borders. If you have any spots with jagged or irregular edges, have them checked by a dermatologist.
    • Color: Regular moles tend to have one or two brown shades at most. A mole with multiple colors, such as grey, black, white, or pink, could be a melanoma.
    • Diameter: Any mole with a diameter larger than about 5 mm (around the size of a pencil eraser) should be checked by a doctor. However, keep in mind that melanomas can start out much smaller than this. Don’t wait for an irregular mole to grow larger before having it examined by a dermatologist.
    • Evolution: This is the most important sign! Any mole that is changing in appearance should be examined, even if you haven’t noticed any of the other four signs above.

    Protect Yourself

    Although skin cancer is the most common type of cancer, it’s also the most preventable. The best step you can take to reduce your risk is to protect yourself from the sun.

    When you spend time outside, be sure to wear sunscreen. The American Academy of Dermatology recommends SPF 30 sunscreen or higher. However, people often don’t apply enough sunscreen, so I recommend using SPF 50 to ensure your skin is protected. Try to choose a broad-spectrum sunscreen with zinc oxide and titanium dioxide for the best protection. And don’t forget to reapply your sunscreen every two hours, or every hour if you’re swimming.

    It’s also important to minimize your time spent in direct sunlight. Of course, there’s no need to stay indoors all the time, but be aware of the time you’re spending in the sun—particularly between 10 a.m. and 2 p.m. Wear protective clothing, including a hat, and stay in the shade as much as possible.

    If you notice any changes in your skin, schedule an appointment with a dermatologist. At MedStar Health, our team of board-certified dermatologists can conduct a head-to-toe skin check to help you examine any areas of concern.

    Spot on your skin?

    Our dermatologists can help.

    Call 202-644-9526 or Request an Appointment

  • May 20, 2020

    By MedStar Health

    In the U.S., skin cancer is by far the most commonly diagnosed cancer, according to the American Cancer Society. Since most skin cancers develop as a result of exposure to harmful ultraviolet (UV) rays, taking steps to protect your skin in the sun can help you reduce your risk of skin cancer.

    #SkinCancer is the most commonly diagnosed cancer in the United States. Minimize your risk by protecting your skin in the sun with these 7 tips from family medicine physician Dr. Bhogal: https://bit.ly/2XebRy5 #LiveWellHealthy.

    Click to Tweet

    It’s important to use sun protection while enjoying the benefits of getting outside.

    Our skin makes vitamin D naturally when it’s exposed to the sun, which can positively impact our body’s mental and physical function. In fact, vitamin D can help to boost your immune system and improve your mood by increasing serotonin levels in the body. Still, there are many dangers to the sun, which is why most doctors recommend getting vitamin D from what you eat or supplements.

    While there are many benefits to getting outside, the sun’s UV rays can be harmful if we don’t take precautions to protect our skin in the sun. The sun gives off two different types of UV rays, both of which can be dangerous:

    • UVA rays are responsible for sunburn, hyperpigmentation, and skin cancer.
    • UVB rays can contribute to skin aging and skin cancer.

    Although both types of UV rays can negatively affect the skin, UVB rays are more likely to cause skin cancer, including melanoma.

    Factors affecting UV exposure

    It’s important to protect your skin from both types of UV rays because neither one is safe. And, your environment can impact how strong they are. The following factors can impact how much your skin is exposed to UV rays:

    • The time of day: 10 am to 4 pm is when UV rays are strongest.
    • Distance from equator: The closer you are to the equator, the stronger the UV rays are.
    • Elevation: Higher elevation means more exposure.
    • Reflection off surfaces: Sand, snow, and water may reflect sunlight, increasing UV ray exposure.
    • Length of time: The longer your skin is exposed, the greater your risk.

    By taking the right steps to protect your skin in the sun, you can reduce your risk of getting skin cancer—and prevent premature skin aging, like wrinkles, dark spots, and leathery skin.

    How to protect your skin in the sun.

    Even if it’s not sunny, your skin is still exposed to harmful UV rays any time you’re outside. Here are seven simple ways you can limit your UV exposure and protect yourself in the sun.

    1. Choose the right type of sunscreen.

    Sunscreen is an effective way to minimize your risk of skin cancer and signs of early skin aging caused by the sun. Except for babies under the age of six months, everyone should wear sunscreen anytime they’re outdoors. When picking a sunscreen, it’s important to choose the right kind. The American Academy of Dermatology also recommends selecting a sunscreen that is:

    • A broad-spectrum option, offering protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays.
    • Sun protection factor (SPF) of 30 or higher.
    • “Water-resistant”.

    Keep in mind that while sunscreen can be “water-resistant”, it is not waterproof or sweatproof. As a result, it’s important to reapply frequently, especially if you are swimming or sweating.

    2. Apply and reapply sunscreen regularly.

    The way you apply sunscreen impacts how effectively it protects your skin. The best way to apply sunscreen is to lather it on 15 to 30 minutes before you expose your skin to the sun. That’s about how much time it takes for your skin to absorb it. After you apply, wait 10 to 20 minutes to avoid accidentally rubbing off the sunscreen. You can reduce your risk of sunburn by reapplying every two hours—or sooner if you're swimming.

    How much sunscreen do I need to apply?

    Following the "teaspoon rule" is a great way to ensure you’ve used enough sunscreen to protect uncovered skin. The “teaspoon rule” suggests applying a teaspoon-sized amount of sunscreen according to these guidelines:

    • One teaspoon on your face and neck.
    • One teaspoon on each arm.
    • Two teaspoons on your front torso.
    • Two teaspoons on your back.
    • Two teaspoons on each leg.

    3. Wear protective clothing.

    Covering up in clothing is a great way to minimize your exposure to UV rays, but different types of clothing offer varying levels of protection. The following types of clothing offer the most protection:

    • Thicker fabrics (e.g. denim) compared to thin fabrics (e.g. cotton)
    • Darker colors
    • Dry fabrics

    Many clothing brands also make comfortable, lightweight tops and bottoms that can offer protection from the sun’s UV rays. Look for garments that are labeled with a UV protection factor (UPF). A higher number means more protection from UV rays.

    4. Cover your head with a wide-brimmed hat.

    Hats with brims at least three inches in diameter are an effective way to limit your face’s exposure to UV rays. Baseball caps or other hats with a narrower brim may not protect all of the areas on your face that may be exposed to the sun, like your ears, nose, and neck.

    5. Protect your eyes with sunglasses.

    Sunglasses are important for protecting your eyes and the skin around your eyes from the sun. It's hard to judge how well a pair of sunglasses can protect you from the sun just by looking at the color of the lenses. Instead, look for sunglasses that say they block 99% or 100% of UVA and UVB rays.

    6. Avoid the sun during peak hours.

    The sun’s UV rays are strongest between the hours of 10 am and 4 pm. Try to stay in the shade if you must be outside during that time of day—or avoid it altogether, if you can.

    7. Seek shade wherever you can.

    Staying under shade can be a great way to get outside while limiting your UV exposure. Whether you seek shelter under a tree or set up a tent on the beach, it’s important to find shade, especially during the sun’s strongest hours. This is especially true for babies who should avoid any unnecessary sun exposure. Babies younger than six months should always be protected from the sun with strollers, hats, and umbrellas.

    What to do if you get a bad sunburn.

    Most cases of sunburn are mild to moderate, which can be uncomfortable. Ibuprofen, aloe vera gel, or cold compresses can help to minimize swelling and pain while it heals. If you have any blisters, avoid picking them open. If they do rupture, clean them with soap and water and cover with a wet dressing to avoid any infection.

    In more severe cases that result in vomiting, fever, or disorientation, you may need to seek medical attention from an urgent care center.

    You don’t have to stay indoors altogether, but being cautious can help you protect your skin and minimize your risk of skin cancer. Limit unnecessary sun exposure by correctly applying sunscreen, covering up with clothes, hats, and sunglasses, and staying in the shade.

    Get the care you need, now.

    It's important that you don’t delay your medical needs or ignore symptoms that would typically make you seek care. Early detection and treatment improve our ability to provide the most comprehensive and effective care.

    Since the COVID-19 pandemic reached our region, MedStar Health has made innovations to ensure we are still the best and safest place to receive care.

    We have worked hard to make sure we can provide the care you need in the most appropriate and safe setting. MedStar Health Video Visits are still options for a variety of appointment needs, but in some cases, an in-person visit may be best. We’re here to help you get the right care that reflects your needs and comfort level.

    We’re open and prepared to safely offer the same high-quality care you expect from MedStar Health, when you are ready to see us.

    Find care now. Click the buttons below for more information on our services.

    Urgent Care

    MedStar Health Video Visits

    MedStar Health eVisits

  • May 19, 2020

    By Hayder Hashim, MD

    Feeling stress or strain on your heart these days? Here’s a sobering fact: Anxiety about the novel coronavirus is causing people in our community to avoid seeking medical help for their heart issues.

    So-called “COVID phobia” is delaying treatment and causing needless suffering. Since the pandemic began, the number of patients going to emergency rooms for heart attack and stroke has plummeted.

    If you have chest discomfort or other warning signs of a heart attack, don’t delay! Come to the ER. At MedStar Washington Hospital Center, we’re well equipped both to safeguard you from the virus and to give you cardiac care that could save your life or protect you from long-term injury.

    Coronavirus vs. Chronic Medical Conditions

    During the pandemic, as always, it’s critical not to dismiss warning signs of a potential medical issue—like the crushing pain of a heart attack. Your condition may become even worse if you don’t get appropriate medical care when needed or neglect your planned therapy, preventative treatment, or screenings.

    At the Hospital Center, we are, of course, trying to prevent patients of all types from exposure to this new virus. But at the same time, our mission is to avoid a potential increase in deaths from other serious or chronic conditions.

    Feeling the warning signs of a #heartattack? Don’t avoid the hospital because you fear #COVID19. Head for the ER, says @HashimHayder bit.ly/3bIZqzm @MedStarWHC #COVIDPhobia
    Click to Tweet

    Listen to Your Body’s Warning Signs

    My patients often describe their heart attack pain as an elephant sitting on their chest. Pain might also travel down the left arm, or up to your neck or jaw. Other symptoms include:

    • Shortness of breath
    • A sense of impending doom
    • Vomiting
    • Sweating profusely even if not exerting physically

    Women may experience different and more vague symptoms:

    • Pain in the upper part of the abdomen right below the ribs
    • Indigestion

    And studies show that the novel coronavirus itself can impact the heart. It can imitate certain heart attack symptoms, such as difficulty breathing, shortness of breath, abnormal EKGs, and severe inflammation of the heart muscle (myocarditis) among others.

    Only a proper medical examination can determine whether you’re experiencing a heart attack, virus symptoms, or some other issue.

    When the Pain Goes Away

    For some patients, that characteristic crushing pain may very well subside. But this doesn’t mean you tackled death and won. This is just the body saying, “I tried everything I could to alarm you. I gave you pain, nausea, shortness of breath. I give up.”

    The damage remains, and most likely you will eventually suffer from a chronic, hard-to-treat illness. Ignoring symptoms of heart disease can lead to death of the heart muscle.

    Complications of Delayed Treatment

    Traditionally, our patients arrive from Maryland, Washington, D.C., and Virginia by ambulance or helicopter. The emergency medical service crew sends the EKG ahead, so we’re ready to work on patients as soon as they arrive. Because we can treat them within 50–60 minutes of onset, many heart attack victims are able to sit up shortly after treatment. They text, they call their family—even though they just suffered a heart attack!

    Unfortunately, these days many heart attack victims are staying home, wary of COVID-19. They opt to treat themselves with aspirin and wait for the pain to go away. After 24 hours, they don't feel pain anymore, but they will grow sicker over time.

    For example, before this new virus, we saw maybe one or two cases a year of ventricular septal defect (VSD), a hole between the chambers of the heart typically caused by delayed treatment. But in the last three weeks alone, we’ve already treated three patients with VSD.

    How Sick Is Too Sick?

    Some patients who are chronically ill with heart disease also try to stay home and self-treat. Unfortunately, without regular medical attention, their illness can progress to the point where it's too late to help them.

    Here’s an analogy: When 80% of your house is on fire, the house is already beyond help, even though 50 fire trucks might arrive to put out the flames. The minute you see the fire is the time to summon help, and extinguish it while damage is still minimal.

    In the same way, ignoring warning signs because of virus phobia can eventually make a weakened heart muscle difficult to salvage. Even if we can help you, you could be permanently injured or ill for the rest of your life. That’s what we want to prevent.

    Time is of the essence. As we cardiologists say, time is muscle. Make the phone call. Come to the ER if you have symptoms. Don’t wait for symptoms to improve—call 911 or have a telehealth visit with your doctor. Describe what you’re experiencing and get their advice.

    Equipped to Protect You

    Throughout MedStar Washington Hospital Center, we have developed new pathways and protocols to create a safe environment for you during this pandemic.

    We have the right personal protective equipment to keep you safe while we treat you. The minute you enter the Hospital Center, you will wear a mask. If you don't have one, we'll give you one.

    We take your temperature. If no fever is recorded, you will be guided to admissions or registration. Seating in our waiting areas is separated by six feet or more. There is enough staff to receive you and work to treat you quickly.

    If you’re going to the cardiac catheterization lab, a concierge associate will escort you. They’ll operate the elevator and help you arrive at the lab without contacting quarantined areas or hallways.

    As we adapt to life with the coronavirus, I am conducting more telehealth visits. I sit with my patients virtually, face-to-face, review their symptoms, discuss their medications, review their chart, and discuss their treatment plan. They don’t have to worry about the new virus. And if we determine they do need medical attention right away, they know what to expect when they get here.

    Avoid the Virus…But Take Care of Yourself!

    If you’re nervous about coming in to the hospital, but have some health concerns, speak with a medical professional. Schedule a telehealth visit. Mammograms, colonoscopies, and screening for cancer are still essential to detect life-threatening conditions. Maintaining your health to avoid future medical issues is as essential as getting your groceries or prescription medications.

    COVID-19 is just one illness that we face today. But other illnesses still require our attention. It’s worth repeating: if you think you’re having a heart attack, stroke, or other medical emergency, call 911 and come to the ER. For less urgent matters, schedule an appointment with your doctor.

    Let us give you the treatment you need when you need it.

    Your Heart Deserves Expert Care.

    Our specialists are here to help.

    Call 202-644-9526 or Request an Appointment

  • May 15, 2020

    By MedStar Health

    Experiencing bladder leakage is common, and it can negatively impact quality of life. Thankfully, there are many treatment options available.

    Urinary incontinence is the involuntary loss of urine. It affects about one in three women at some point in their lives, and becomes more likely with age. The three main types of urinary incontinence for women are:

    • Urge incontinence (overactive bladder): When you experience a loss of urine with a sudden strong desire to urinate immediately.
    • Stress incontinence: When you experience a loss of urine while performing activities that increase pressure in your abdomen, such as laughing, sneezing, or exercising.
    • Mixed incontinence: Leakage that includes symptoms of both urge and stress incontinence.

    In most cases, urinary incontinence can be treated successfully. I can’t tell you how many times I’ve heard patients say, “I wish I would have seen a doctor sooner,” following their treatment. Read on to learn about common treatment options.

    Urinary incontinence treatments.

    There are many different treatments for urinary incontinence. This gives you the freedom to work with your doctor to determine the best option for you. In most cases, we start with conservative measures like lifestyle changes and bladder training. If they don’t alleviate your symptoms, we move on to other options, such as medications, office procedures, or surgical procedures.

    First-Line Treatments

    First-line treatment for all types of urinary incontinence typically involves:

    • Physical therapy.Certain exercises strengthen the muscles in and around your pelvic floor, which can help prevent leakage and calm down your urge to use the bathroom.
    • Avoiding certain foods and drinks. Beverages high in caffeine, such as coffee and energy drinks, as well as acidic and spicy foods, are known to irritate the bladder and contribute to urinary incontinence.
    • Using a pessary. You sometimes can help prevent leakage by using a pessary, a vaginal support device made of silicone.
    #PhysicalTherapy can treat urinary incontinence by strengthening muscles in and around your pelvic floor. Learn about other common treatment options, via @MedStarHealth: https://bit.ly/2zLLzen.

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    Make sure to speak to your doctor if you’re interested in any of these first-line treatments. To use a pessary, you’ll need to visit your doctor for a fitting and to learn how to insert, remove, and clean it. Your doctor can teach you physical therapy exercises or refer you to an expert physical therapist.

    Medications

    Daily medications are often a great treatment option for our patients, especially those with urge incontinence. Some of the most common medications include:

    • Anticholinergics. These help relax your bladder and reduce your leakage and urge to use the bathroom.
    • Mirabegron (Myrbetriq). This helps relax your bladder, increase the amount of urine your bladder can hold, and increase the amount of urine you’re able to urinate at one time.

    Office and surgical procedures.

    Surgical and nonsurgical procedures are common urinary incontinence treatments, especially for women who don’t wish to take medication. They are also the next options for women who haven’t seen the results they want with medication therapy.

    Office Procedures

    Common nonsurgical treatments we perform for people with urge incontinence include bladder Botox injections and nerve stimulation. Bladder Botox injections block the ability of some nerves to communicate with the bladder, reducing your leakage. Nerve stimulation is similar to acupuncture. It involves your doctor inserting thin needles into the skin to stimulate specific body points to reduce your urge incontinence.

    For stress incontinence, a urethral bulking agent—which a doctor injects around the walls of your urethra using a thin needle and camera— is a great way to reduce or eliminate stress incontinence. In fact, I had one patient in her 70s who had stress incontinence that was affecting her ability to travel, as she constantly had to carry around pads to deal with her leakage. After receiving a urethral bulking agent, she reported that she no longer needs pads and can finally enjoy her vacations again.

    Surgical Procedures

    Urethral support surgeries are more definitive treatments for urinary incontinence. Urethral sling surgery, for example, is highly effective in treating stress incontinence. A sling acts as a hammock under the urethra to support it, and can be made of tissue from your body or a synthetic material. Make sure to speak to your doctor to learn more about surgeries that may treat your urinary incontinence.

    Don’t delay care.

    Urinary incontinence is a common condition, and you don’t have to manage it alone. If you’re experiencing symptoms of urinary incontinence, please reach out for help right away. If you have concerns about potential exposure to coronavirus (COVID-19) and are staying home, you can access 24/7 on-demand video access through MedStar eVisit.

    Want to learn more about MedStar Health eVisit? Click below for more information.

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  • May 14, 2020

    By MedStar Health

    In this country and around the world, we are seeing a variety of abnormal skin conditions in patients infected with Coronavirus Disease 2019 (COVID-19). It’s too early to determine if these skin issues are hallmarks of the virus or simply a result of the body’s immune response in fighting off the infection. Medications used to treat the disease may also play a role.

    In the U.S., up to 20 percent of those infected have experienced some type of skin issue, much higher than the rate reported in China and Europe. We don’t yet know if the U.S. rate is truly higher or simply the result of better monitoring and reporting.

    The good news: most of the conditions are not serious and will go away as the infection clears. Some, however, may require testing and monitoring.

    Much of what dermatologists are seeing is anecdotal, meaning not yet proven or tested in a rigorous, scientific way. Since the pathogen is so new, we do not yet have enough data. But we are collecting it so we will be better able to quantify trends and causes in the future.

    Here’s what we know about certain skin conditions so far:

    COVID-19 may be causing some unique skin problems. Dr. Petronic-Rosic explains what is known so far. https://bit.ly/2zw6KRO via @MedStarWHC
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    COVID Toes

    COVID toes present as small red, purple or bluish patches on the toes. Occasionally, a blister may form, which can break and weep. It may be mildly uncomfortable and prickly or can sting or burn. It generally goes away after a few weeks with no repercussions.

    The lesions resemble chilblains, a kind of pre-frostbite that occurs when skin remains cold and wet for long periods. COVID toes can also be referred to as pseudo frostbite—or false frostbite—since those affected are actually not being exposed to cold or wet conditions. Unlike true frostbite, it heals with no permanent damage.

    Like so many aspects of this virus, it’s somewhat unusual. It seems to affect young people, including young adults and teenagers, some of whom have tested negative for the virus. They generally have no other symptoms and feel fine. This may be the reason it’s getting so much attention in the media, as patients and their parents share their stories.

    Most of the reported cases come from people who have been directly or indirectly exposed to the virus. Since we know that some can carry the virus and yet have no other symptoms, we treat those with affected feet as potentially positive, encouraging virus testing and limited exposure to others. As more data comes in, this foot problem might turn out to be an early warning, unlike other skin conditions that generally appear later when the illness has taken hold.

    Rash

    The most common skin issue associated with this virus is a red rash, appearing most often on the torso and less so on the extremities. It is mildly itchy, lasts a few days, and disappears as the virus runs its course and the condition improves.

    Pocks or Spots

    More recently, we have seen other rashes emerge, including one that appears as small blisters or red, crusty spots very similar to chickenpox. With coronavirus, though, these spots rarely appear on the face—unlike true chickenpox, which often affects the face. And because it has affected people who’ve already had chickenpox or the vaccine, and test negative for the chickenpox virus, we are confident it comes from a different source.

    Hives

    Hives are not unusual in the aftermath of viral infections. They are generally caused by an immune system thrown off-balance by the disease. Hives are generally mildly itchy and last a few days with no significant after-effects.

    Bruise-Like Lesions

    Spots that resemble bruises or pressure sores are being seen in the sickest patients, those on ventilators to support their breathing. They appear on areas of the body where pressure is not an issue, one reason we suspect they may be unique to the virus.

    These start as retiform purpura, a lacy bruise-like rash, when small blood vessels become inflamed and tiny clots develop within them. Retiform purpura can signal tissue damage that might eventually evolve to gangrene as the disrupted blood supply results in the cell death.

    Skin disorders can occur in ventilated patients, often resulting from low blood pressure, a side effect of ventilation. However, the lacy, bruise-like lesions seen in COVID-19 patients are different and may be unique to the virus. Progression to gangrene generally appears only in the most gravely ill patients. It has resulted in some amputations.

    Treatment

    In healthy people who do not have a severe response to the infection, most lesions will go away on their own with no damage left behind. When itching or discomfort become issues, we treat them symptomatically with antihistamines or topical steroids.

    In the case of hives, because they can put the patient at risk of a larger allergic reaction, we tend to be more aggressive with treatment to head off complications. We also know that NSAID medications, like aspirin and ibuprofen, can make hives worse, so we take steps to ensure the patient avoids NSAIDs until the hives clear.

    If You Experience a Skin Issue

    A simple way to get any skin condition evaluated is through a MedStar Health Video Visit with a dermatologist. During this pandemic, we are seeing most of our patients remotely—as many as 60–70 per day, compared to only two or three urgent patients in person.

    The video technology is very easy to use, accessible, and best of all it can help put your mind at ease. We use it to make an examination and assess history and condition. We are also training our patients to take high-quality still photographs of the affected area, a powerful complement to the video visit.

    During the session, we can look for warning signs of something serious, ask the right questions to gauge symptoms and severity, and instruct the patient to perform simple tasks that help inform our decision-making.

    What’s Going On?

    We don’t know all the mechanisms behind the skin problems, so it’s too early to speculate.

    However, we know that certain hallmarks of the disease can cause skin problems. One big suspect is microthrombi, or tiny blood clots widely reported in patients around the world.

    These clots are unlike those experienced in everyday life due to age, cardiac disease or poor circulation. Rather, they can occur in almost any part of the body and are a known contributor to death from the virus because they interfere with the healthy function of vital organs.

    Viral infections also stimulate the release of cytokines, proteins that play an important role in regulating the life process. They tell cells what to do and when to do it. At the extreme end of the immune response, a sudden, systemic cytokine release—the cytokine storm—can quickly overwhelm the body, potentially triggering high fever, bleeding, low blood cell counts, and multiple organ failure.

    But even a mild immune response can affect normal cytokine levels, which may lead to some of the skin lesions we are seeing. A link is yet to be proven.

    Data for Knowledge

    As we learn more and collect more data, some of these skin effects may be added to the list of other known coronavirus symptoms, like fever, cough, shortness of breath, and loss of taste or smell.

    The professional dermatology community is working hard to speed that process. For example, the American Academy of Dermatology has launched a registry, collecting details about skin conditions potentially associated with the novel virus. It is tracking thousands of cases and related details.

    We are also seeing unprecedented speed in information sharing. As in many other medical specialties, our journals are fast-tracking papers and articles related to the novel virus, giving physicians swift access to new trends and information.

    SARS-CoV-2, the virus that causes COVID-19, is dramatically different from most pathogens we have seen before—so, it makes sense that some of its symptoms are different, too. These unusual skin conditions certainly qualify.

    This pandemic evolved lightning-quick—only four months ago, there were no reported cases in the U.S. The situation has advanced and changed rapidly. Fortunately, the science is also developing very quickly.

    The answers we don’t have today, we may have tomorrow.

    Need to see a dermatologist?

    Connect with us from home with a video visit.

    Call 202-644-9526 or Request an Appointment