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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • April 29, 2020

    By MedStar Health

    If you are one of the many people working remotely to maintain social distance during the COVID-19 pandemic, it’s important to set up a safe, ergonomic workstation at home.

    When you hop into a car for the first time, you move the mirrors, seat, and headrest to positions that allow you to see better, reach the pedals, and sit comfortably. Similarly, there are a few ergonomic adjustments you can make to your workstation to help you avoid injury and aches while improving productivity as you work from home.

    Set up your computer monitor at eye level.

    Maintaining good positioning while you work is important to preventing injury to your neck, shoulders, and back. Unfortunately, many people fall into the habit of using a laptop on their lap or a surface that just isn’t tall enough and requires you to flex your neck downward.

    To minimize the amount of strain on your head and neck, set up your computer or laptop at eye level using items you have at home, such as books or boxes. Positioning your monitor at eye level will help to keep your head and neck in a neutral position. It will also help your shoulders rest comfortably at your sides with your elbows at a 90-degree angle while typing at the keyboard.

    Did you know, you can avoid injuries by setting up an #ergonomic workstation at home using what you already have, like elevating your computer with books or boxes? Here’s how: https://bit.ly/2KniWqd #LiveWellHealthy @MedStarHealth.

    Click to Tweet

    Position your mouse and keyboard within an easy reach.

    Like your head and neck, you can minimize the amount of strain on your hands and wrist by maintaining a neutral hand position. To keep your forearm and hands straight, your keyboard and mouse should be within an easy reach. If your keyboard or mouse is too far away, you may have to lean forward to reach it. And if it’s too close, your hands won’t be flush with your wrist and forearm.

    If you’re using a laptop instead of a computer monitor and keyboard, you may need to adjust your positioning based on the tasks that you’re completing. If you’re doing a lot of reading on the screen, ensure the laptop is elevated to your eye level with the screen tilted down to prioritize your head position. On the other hand, if you are spending a lot of time typing, pull the keyboard close to you to optimize your shoulder and arm positioning. You can tilt the laptop screen as you need to see it.

    To see me demonstrate how to set up an ergonomic workstation at home, watch the video below.

    Adjust your seating to support your back.

    You don’t need to buy a fancy office chair to maintain an ergonomic workstation at home, but it is important to adjust your chair or positioning in a way that supports your lower back. The best way to do this without any extra equipment is to sit all the way back in your chair. If you need more lumbar support—support for your lower back—you can place a small pillow or rolled towel at the base of your back. This encourages your back to maintain its natural curve.

    You should also choose a chair that is tall enough to position your elbows comfortably at a 90-degree angle. If your feet don’t touch the ground, you can use a box or stack of books to keep your feet flat and your thighs parallel to the floor.

    Take frequent activity breaks throughout the day.

    The most important thing you can do for your body when you work at home is get up and move throughout the day. Whether you have the most ergonomic workstation at home or not, you need to take breaks that allow you to stretch, walk, and change positions. An effective break could look like:

    • Taking a short walk around the neighborhood (while maintaining social distancing)
    • Practicing some yoga and meditation
    • Following along with a stretching video
    • Walking up and down the stairs a few times
    • Dancing with your spouse or kids in the living room

    Consider setting an alarm to get moving at least once every hour so that you prevent any health issues that may arise from sitting or standing in the same place for too long.

    Apply the same principles to your stand-up workstation.

    If you prefer to stand while working, you need to apply the same ergonomic guidelines. In fact, how you position your body and equipment is even more important when you’re standing because being on your feet puts more strain on your body than sitting.

    Whether you have an at-home standing desk or you decided to build your own, it’s important to maintain a safe body position by doing the following:

    • Making the desk tall enough for your arms to rest comfortably at your sides
    • Raising your monitor to eye level
    • Positioning your keyboard and mouse as close as you can while maintaining a neutral position in your hands and wrists
    • Moving around at least once an hour

    Your new work-from-home life may be unexpected, but it doesn’t have to be detrimental to your health. With the proper chair height, equipment placement, and body positioning, you can work safely, effectively, and comfortably while you’re in your home.

    If you begin to experience or are already experiencing muscle or joint pain, you can now talk with an orthopedic specialist through MedStar Health Video Visits. MedStar Health Video Visits allow you to connect with professionals via your tablet, computer, or smartphone, who offer consultation and treatment to meet your needs.

    Experiencing muscle or joint pain? Check out our orthopedic care options.

    Find an Orthopedic Specialist

    MedStar Health Video Visits

  • April 29, 2020

    By MedStar Health

    Watching the world we live in evolve and adapt with the ever-changing COVID-19 situation has been both scary and intriguing. As we continue to gain more insight, guidelines and recommendations will also continue to change. With so many moving parts, it may be hard to keep up with these changes, but there are a few things that have remained rather constant from the start of the coronavirus pandemic; maintaining a high level of self-awareness, good hygiene, and practicing social distancing.

    Although these constants make sense, it is worth delving into the wisdom behind them so that we can collectively ensure we are doing our part to remain healthy, and to mitigate spread and infection.

    Self-Awareness is Key

    Let’s start with the prerequisite for all things related to this issue: self-awareness. The more we are in tune with our actions, symptoms, surroundings, and the people in our immediate space, the more we become empowered to act in accordance with the best practices and guidelines. We have all heard of not touching our face, and for some, that can be difficult. The act of being self-aware makes one inclined to make adjustments that would otherwise remain unchanged. But there is a hidden benefit to becoming more self-aware. Self-awareness is the prerequisite for improving many aspects of your health, including focus, stress mediation, and sleep hygiene. Simply put, just being more in tune with the various aspects of your daily practices will inherently improve your life. I will discuss how to increase your self-awareness skills shortly.

    Good hygiene is a given right now. Although this primarily means handwashing, decontaminating surfaces, frequent changing of clothing after being in public, etc., I would like to add that good hygiene does include other important aspects that extend beyond the physical. Let me gently suggest that with more social distancing, closed schools, and working from home, our mental hygiene is bound to shift for better or for worse. These new changes may impart, whether we feel it or not, a new life stress. Stressors require both awareness and, in most instances, modifications in our actions to help offset them.

    To help tie all this together, it is important that our collective health and immunity improve, and that starts with each individual doing his or her part.

    Exercise Improves Physical and Mental Health

    With gyms closed and many Americans being overweight and sedentary, being diligent about activity and exercise is paramount. Exercise is a great way to improve overall health and wellbeing. After all, have you ever heard of health advice that doesn’t include some form of physical exercise?

    During this pandemic, those with “strong” immune systems have shown the best virus-related outcomes. With many municipalities restricting gatherings, some people have basically committed to isolation in the literal sense. It is important to note that there are reasonable allowances which include exercise and there is wisdom in this logic. Exercise improves cardiovascular health, moderates our balance with respect to weight and calories, and adds the benefit of pulmonary effort. The benefits may not seem so obvious to many, but even a 10-minute brisk walk daily can improve both physical and mental health. Just give it a try and you will feel the positive effects.

    As a podiatric surgeon, I am frequently asked about what types of exercises and sports are best for different age groups, as well as for those with certain health problems such as patients with diabetes, neuropathy, and those with peripheral arterial disease. COVID-19 poses an interesting perspective on overall wellbeing, health maintenance strategies, and how to optimize our physical condition while being socially responsible. To be compliant with current guidelines, wearing a mask and being outdoors does not pose any problems. If anything, for those with seasonal allergies, a face mask will greatly decrease dust and pollen related exposure. That being said, it is important to stay active within the confines of your personal limitations.

    At this time, it is more important to promote self-awareness, hygiene, and continue to respect social distancing. Exercise, in addition to its obvious benefits, can also be a good time to self-reflect, be self-aware, and if you are so inclined, engage in something new. Whether it's a walk, jog, hike, bike ride, game of outdoor tennis, or just shooting hoops alone, being active is more important now than ever before. My advice is to simply get up and pick an activity that you can easily partake in. It is more important to commit to being active than to sit and contemplate on what to do.

    We’re All In This Together

    Share your thoughts on how you are being active and encourage those around you. For those who are limited because of mobility issues, it is still a good practice to get some fresh air, even if that means simply opening a window and doing some good breathing exercises. Overall, the coronavirus pandemic has taught us, and will continue to teach us, many lessons. Perhaps, we can embrace our condition, and make the best of it in a simple and beneficial way.

  • April 27, 2020

    By Allen J. Taylor, MD

    Most people recognize the lifestyle problems that can raise blood pressure to unhealthy levels: smoking, being overweight or inactive, too much stress. In recent years, researchers have confirmed yet another controllable risk factor for high blood pressure—a lack of good sleep.

    That insight comes with both good news and bad news. The bad news is that about half of American adults don’t consistently get the recommended 7 to 9 hours of shut-eye each night, according to the National Sleep Foundation. Even our children aren’t sleeping enough. This trend in poor sleep habits may partly explain why hypertension has become an increasing health burden in the U.S. over the past two decades. But the good news is this: better sleep—and, in turn, a lower risk of developing hypertension and other cardiovascular problems—is achievable for most people who make it a priority.

    What We Know—and Don’t Know—About High Blood Pressure and Sleep Deficiency

    Researchers estimate that people who frequently get fewer than 6 hours of sleep per night are up to 32% more likely to develop hypertension than those sleeping 7 to 8 hours. The consequences of too little sleep could be even bleaker for people who already have hypertension. In a recent study in the Journal of the American Heart Association, people with hypertension who slept fewer than 6 hours per night were twice as likely to die from a heart attack or stroke than those getting 7 to 8 hours.

    It’s still unclear exactly how sleep protects the heart, or how too little sleep can cause trouble.

    One problem may be that shortened sleep seems to disrupt the body’s ability to regulate or rebalance “stress” hormones, which can raise your blood pressure. Lack of sleep is also linked to increased inflammation, which can strain the heart. And it can interrupt the natural nighttime blood pressure dip that correlates with better blood pressure during the day. In addition, insufficient sleep appears to throw off the body’s appetite-control hormones, which can lead to overeating, obesity, and poor blood sugar control and, in turn, hypertension and other heart health risks.

    Learning more about what happens in the body during sleep is an active area of research these days. But clearly, sleep has important health-protective benefits.

    Sleeping Too Much May Also Be Risky

    While sleeping too little is a clear risk factor for hypertension and other heart risks, too much sleep is also worrisome. In a large analysis in the Journal of the American Heart Association, researchers found that people sleeping for 9 hours on average had a 14% higher risk of death, while 10-hour sleep routines carried a 30% higher risk. They also found a similar increasing risk in cardiovascular disease. Whether sleeping too much is a cause or just a warning sign of heart health risk remains to be seen. But the message is clear: to prevent and better manage hypertension, adults are wise to aim for a consistent 7–8 hours of sleep.

    While sleeping too little is a clear risk factor for hypertension and other heart risks, too much sleep is also worrisome. @TaylorMHVICard tells you how to get it right. https://bit.ly/2yJLYxA via @MedStarWHC

    Click to Tweet

    What Does Good Quality Sleep Look Like?

    While we have a good grasp on what constitutes a healthy amount of sleep, there are currently no standards for measuring sleep quality. Does good sleep mean no tossing and turning? That you don’t wake up during the night? That you spend a set amount of time in different stages of sleep? In the near future, I expect we’ll begin to develop evidence-based standards for sleep quality, along with tools like digital wearables, that help us see how our sleep quality measures up. For now, trust your personal sense of sleep quality and well-being.

    If you feel your sleep quality is suffering, be sure to tell your healthcare provider. One very common and treatable cause of poor sleep quality that contributes to elevated blood pressure is sleep apnea, an extreme form of sleep disturbance in which you stop breathing, wake often, and get little deep sleep. According to the American Academy of Sleep Medicine, an estimated 1 in 4 people has sleep apnea today. If you feel tired after a full night’s sleep, especially if you snore, sleep apnea is a likely cause. Today, you can be easily tested at home instead of at a hospital, and treatment options have expanded beyond uncomfortable face masks. We also know that treating sleep apnea helps reduce high blood pressure and other cardiovascular risks.

    Your healthcare provider can also identify other common causes of sleep disturbance you may not be aware of. These can include underlying health conditions, such as thyroid or gastrointestinal disorders, or particular medications you may take, such as allergy or asthma treatments, certain pain relievers, and some hypertension medicines.

    How to Get Better Sleep

    The first step to better sleep is to prioritize it! Sleep is largely a controllable behavior, so getting better sleep is doable by committing to some simple changes. Aim for 7 to 8 hours every night. (Children need even more: 8–10 hours for teens and 9–11 hours for school-age kids.) If you have sleep trouble, talk to your physician to help uncover health or medication issues that might be the cause. Then, stick to these proven sleep hygiene practices to get the health-essential sleep you need to prevent high blood pressure or to better control it.

    • Stick to a regular sleep schedule. Go to bed at the same time each night and get up at the same time each morning, including weekends. Get at least 30 minutes of natural light daily, especially earlier in the day. Try going for a morning or lunchtime walk.
    • Get some physical activity every day. Try not to exercise within a few hours of bedtime.
    • Avoid artificial light from televisions, phones, and computers within a few hours of bedtime. Use a blue-light filter on your computer or smartphone, or try blue-light filtering eyeglasses.
    • Don’t eat or drink within a few hours of bedtime, especially alcohol and foods high in fat or sugar. Steer clear of caffeine by early afternoon.
    • Keep your bedroom cool, dark, and quiet. No pets or devices nearby.

    Key Takeaways

    Good sleep is an essential part of maintaining and improving heart health. If you’re not sleeping long or well enough, make sleep improvement a priority. Consider these sleep hygiene tips first and foremost, and mention sleep concerns to your healthcare professionals. They should be taken seriously, as underlying conditions or medications may play a role. In turn, I strongly encourage the medical community to help their patients sleep better in the same way that we help manage other serious heart risk factors, such as high cholesterol, high blood pressure, and smoking. It may take a bit of effort, but the benefits of sufficient sleep on a regular basis are significant.

    Protect your heart health.

    Connect with our specialists.

    Call 202-644-9526 or  Request an Appointment

  • April 24, 2020

    By Rachael T. Overcash, MD

    The months leading up to the birth of your baby are supposed to be joyous ones. But COVID-19 has created anxiety and uncertainty. We’d like to share a message of hope by answering some questions you likely have during these unprecedented times.

    Q: Are pregnant women more affected by the virus than non-pregnant women?
    Dr. Rachael Overcash: Right now, the limited preliminary information we have suggests that pregnant women are not more adversely affected by it.

    Still, it's an incredibly hard time to be pregnant. In fact, we expect women to experience more symptoms of depression and anxiety during pregnancy and following birth. Depressive symptoms or moods can be exacerbated by stressful situations like the pandemic. Providers and patients should anticipate an increase in depressive symptoms and anxiety and should be ready to provide resources and support.

    Q: What precautions should pregnant women take to avoid contracting the virus?
    Dr. Sara Iqbal: Observe social distancing and stay home as much as possible, wash your hands often with soap for at least 20 seconds. Use MedStar Health Video Visits instead of in-person appointments, unless it's absolutely necessary. Please check out all of the prevention tips from the Centers for Disease Control and Prevention (CDC).

    Dr. Overcash: Also, follow the recommendations from the CDC to wear a mask. It doesn’t have to be a medical-grade mask—just something that covers your mouth and nose.

    Q: Which pregnant women should take extra precautions? Dr. Overcash: There are certain subpopulations of pregnant women who have complicated medical conditions and should take extra precautions. That includes women who have Type 1 or Type 2 diabetes, lupus, kidney disease, or other autoimmune conditions that require them to be on immune suppressant medications. They should really try to stay home as much as possible. Limit trips to the grocery store or other essential businesses.

    Q: Is it possible for a pregnant woman to have the virus without showing symptoms? Dr. Overcash: Yes, it is possible, although published information from New York shows that about 70% of asymptomatic women who have tested positive for coronavirus will eventually develop symptoms.

    Dr. Iqbal: Asymptomatic carriers do not have any symptoms; however, they are infectious, shedding the virus, and potentially transmitting it to other people. That’s why it's so important that pregnant women—and everyone—take precautions such as social distancing, hand hygiene, staying at home, and wearing masks when you must go out.

    Q: What symptoms of the virus should pregnant women be aware of?
    Dr. Iqbal: They should watch for any signs and symptoms that range from cough, shortness of breath, sore throat, fever/chills, headache, and body aches.

    Some patients can have gastrointestinal (GI) and neurological symptoms such as nausea, diarrhea, confusion, loss of appetite, and even loss of smell or taste. If they have a fever, cough, or other symptoms, they should call their Ob/Gyn or MFM physician for advice. Mild symptoms can be managed at home with isolation, adequate hydration, rest, healthy sleep patterns, and nutritious food.

    However, they should go to the hospital right away or call 911 if symptoms intensify, such as persistent or worsening shortness of breath, chest pain, dizziness, and sudden confusion. If you go to the hospital, try to call ahead to let them know you are coming so they can prepare.

    Q: Should pregnant women be tested even if they have no symptoms?
    Dr. Overcash: We are performing universal COVID-19 testing for women who are admitted to our labor and delivery, those who have not delivered yet but are admitted due to complications with their pregnancy, and of course to women with symptoms. They will get the nasopharyngeal swab (the test for the virus).

    @MedStarWHC provides universal #COVID19 testing for women who are admitted to the labor and delivery unit. https://bit.ly/3eL6n5X @RachaelOvercash
    Click to Tweet

    Q: Are there other virus-screening procedures at MedStar Washington Hospital Center?
    Dr. Overcash: Anyone entering the hospital is screened by security. Screeners at every hospital entrance check for symptoms. They also perform a temperature check with a monitor near the forehead. If that's normal, the patient can enter; if not, they are moved to an isolation clinic, where we screen patients and staff.

    Q: How does the virus affect the health of a pregnant woman and her child before she gives birth?
    Dr. Iqbal: So far, we know that severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and influenza during pregnancy are associated with adverse maternal and neonatal outcomes including miscarriage, growth restriction, and preterm birth. However, limited data of pregnant women with COVID-19 show no intrauterine transmission and no clinical differences in severity of respiratory symptoms. Though these results are promising, they must be interpreted with caution given minimal data.

    Q: How many people are permitted in the labor and delivery room right now?
    Dr. Overcash: We limit visitors to the labor and delivery room to one person. And once that visitor has been with the patient, they may not leave the hospital, and must stay with her for the duration of her hospitalization. If they do leave, they're not allowed back. Pregnant moms envision a certain type of birth experience—having family members, grandparents, other children visiting them in the hospital after their child is born. Unfortunately, this is not the experience they can have right now, so that can be really hard. By limiting the number of visitors, we limit potential exposure of our patients and staff.

    Q: Are there potential complications during birth for women confirmed with the virus?
    Dr. Overcash: Women can potentially experience complications during birth and after delivery, similar to someone who is not pregnant.

    Traditionally, when a woman is in labor, we give her extra intravenous (IV) fluid hydration, especially before administering an epidural. Now, we're judicious about giving that IV fluid to a woman with the virus because we want to avoid potential pulmonary issues that may be caused by COVID-19 infection. So, traditional management of these women has changed.

    Dr. Iqbal: We know that, theoretically, pregnant women may be at increased risk of severe disease because of their immunocompromised state. However, with this virus, the incidence of severe disease in pregnancy is unclear.

    And possibly due to increased oxygen consumption and decreased functional residual capacity (the amount of air remaining in the lungs after normal exhalation is decreased by approximately 20% in pregnancy), the mom may be more vulnerable to respiratory issues.

    Q: If a pregnant patient tests positive for COVID-19, how should the baby be delivered?
    Dr. Iqbal: The data on mode of delivery is limited. COVID-19 is not an indication for a cesarean delivery and mode of delivery should be determined by the clinical circumstances and obstetrical factors.

    We were able to report a successful vaginal delivery of a woman with confirmed COVID-19. To our knowledge, this is the first published U.S. case of a COVID-19 patient with an uncomplicated vaginal delivery and the efforts of our multi-disciplinary team were documented in the New England Journal of Medicine. This was a message of hope! A safe vaginal delivery for all involved. The baby was tested at 24 hours, 48 hours, and 10 days of life and remained negative for COVID-19.

    Q: Are there complications for either the mother or the baby after a mother with the virus delivers her child?
    Dr. Iqbal: The baby is at risk for contracting the virus after birth through maternal respiratory secretions. The baby must have a physical exam and a baseline workup, including a complete blood count (CBC) test and COVID-19 testing after delivery. At our hospital, the newborn COVID-19 testing is done by the neonatology team at 24 hours and 48 hours after birth to make sure the baby remains asymptomatic and negative for the virus.

    So far, we are not aware of any delivery-related complications in the mother. However, COVID-19-related symptoms can worsen during the second week, which is when some patients can quickly decompensate. Therefore, it's very important to monitor Mom's serial labs and symptoms clinically, to ensure that she remains afebrile and asymptomatic prior to discharge.

    Q: Does the virus affect breast milk?
    Dr. Overcash: Although it’s not known for sure, the limited information about this subject suggests that the virus is not transmitted through breast milk. Current guidelines recommend that women who have tested positive should be separated from their infant for least seven days after symptoms started or three days of normal temperatures without Tylenol, whichever is the longest.

    If the mom and the infant are not physically together, the mom can pump her breast milk and then have a healthy caregiver provide it to the baby. If the mom and the infant are together and the mom is breastfeeding, the CDC recommends she wash her hands before and after the feeding, and wear a face mask during feeding, to minimize transmission through respiratory secretions. Any breast pump supplies should be thoroughly cleaned and sterilized between feedings.

    Dr. Iqbal: Breast milk is highly recommended, as it provides optimal nutrition and protection against many illnesses; however, transmission of the virus after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, the CDC recommends temporarily separating (e.g., separate rooms) the mother from her baby until the mother’s transmission-based precautions are discontinued. Separation between a mother with COVID-19 and her infant is a mutual decision that is made by a healthcare team based on the mother’s wishes and her health status.

    Per CDC guidelines, during temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. The expressed breast milk should be fed to the newborn by a healthy caregiver.*

    Q: Are there procedures in place if a mom is confirmed to be positive for the virus after the birth?
    Dr. Overcash: We've designated a wing in the hospital for patients found to be positive for COVID-19, to limit exposure to other patients and staff.

    If patients are meeting all their postpartum goals—they're walking, going to the bathroom, their pain is well controlled, their virus symptoms and vital signs are stable (meaning they are not on supplemental oxygen), and they don't have any signs that their respiratory condition has worsened—our goal is to have them go home and self-isolate. It’s not necessary to keep them in the hospital that entire time.

    Q: Are preventive measures realistic in all cases?
    Dr. Overcash: Sometimes, it’s just not possible to follow the precautions. There may be situations when you are pregnant, live in close quarters with a person who is starting to have symptoms, and share one bathroom. Social isolation and mask-wearing can be hard for a lot of families.

    Dr. Iqbal: It’s hard to say, given so much uncertainty with the COVID-19 virus. Despite of all the recommended preventative measures there is going to be a vulnerable population who could potentially be severely affected, such as the elderly population, people with underlying lung diseases such as asthma, COPD, chronic heart disease, renal failure, and those who are immunocompromised.

    Q: How should patients talk with their obstetricians or pediatricians about the virus?
    Dr. Overcash: Many patients schedule telehealth or electronic visits over video chat where they can discuss their situation.

    I've spoken individually to several patients about precautions they can take. Many patients are quite anxious, but we talk through their uncertainties and anxieties and try to help them manage the unknowns.

    Q: How can patients help reduce exposure during this pandemic?
    Dr. Iqbal: Telehealth is an effective option, especially since we are trying to reduce the spread of coronavirus. There are, however, certain things that need to be done in person—for example, physical examination including vital signs such as blood pressure checks and pelvic exam if necessary, labs, obstetric ultrasound and fetal monitoring to evaluate fetal well-being during pregnancy.

    Otherwise, everything else can be discussed through telehealth. If there is an issue, the mom-to-be should call the OB provider and can always come to the hospital for evaluation if needed.

    Dr. Overcash: One of the strengths of MedStar Washington Hospital Center being part of a large hospital system is that we have the resources and expertise to tackle major strategic planning events of this kind. I've used telehealth and find it easy to use. It allows you to see the patient and offers a great connection. Patients have been incredibly happy with it. It's helped us to consult with our patients while still allowing for social distancing.

    Q: What can you tell expectant moms to ease the anxiety around this whole pandemic?
    Dr. Iqbal: I understand the challenges this virus is bringing to our lives. However, I advise my patients to stay positive, adapt, be creative, and limit news and social media to reduce anxiety. I suggest spending quality time with their family, daily light exercise, and maybe getting a meditation app such as Calm and using that to help with relaxation.

    Dr. Overcash: We have to focus on the present and what we can be grateful for. We need to remember that social distancing does not necessarily mean social isolation. You and your baby can still have that positive emotional connection with your loved ones and do it safely. As this becomes the new normal, people have become more accepting of that and have found ways to engage. It helps us deal with the stress and anxiety we all have right now.

    Dr. Iqbal: Right. We can still engage with each other—have video conversations with the grandparents, connect through Skype and FaceTime. Stay positive, be creative, and connect. We all should support the fight against COVID-19 together!

    *Reference: Centers for Disease Control and Prevention. Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, March 2020.

  • April 24, 2020

    By MedStar Health

    Parents and kids alike are finding themselves navigating new routines at home while businesses and schools are closed because of the COVID-19 pandemic. For many, it can be tough to balance work and family life when they overlap at home.

    That’s why it’s more important than ever to prioritize your family’s physical, mental, and emotional health. All of the change can feel overwhelming, but keeping your family healthy doesn’t have to be.

    It’s tough to balance work and family life when they overlap. On the #LiveWellHealthy blog, primary care doctor Rachelle Toman shares 10 tips to keep your family physically, mentally, and emotionally #healthy while you’re at home: https://bit.ly/3500qO4

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    How to keep your family healthy while social distancing.

    Try these ten tips to keep your family healthy while you’re at home.

    1.   Stay active together and get outside.

    It’s important for both adults and kids to get moving throughout the day, especially as we’re spending more sedentary time working from home or participating in distance learning. Staying active is great for our physical health, and it can also help fight stress and anxiety that may arise as your family deals with a loss of daily normalcy.

    Kids should move for at least one hour each day in an activity that increases their heart rate. While your family is limited in the places you can go to exercise, there are a variety of activities your family can do together at home, like a virtual fitness class or an impromptu family dance competition. As long as you maintain six feet from others, it’s safe to take your family outdoors for exercise, such as going for a walk or a bike ride.

    2.   Drink enough water.

    Staying hydrated is important for your body to function properly. Water also has a significant impact on your energy levels, brain function, and general health. With everything that’s going on, it can be hard to remember to drink enough water, but try these creative ways to get your kids to increase their water intake:

    • Use a silly straw
    • Freeze water into fun shapes and add it to their drinks
    • Incorporate more fruits and vegetables into your diet
    • Flavor water with pieces of fruit or a splash of juice

    You can also teach your kids to monitor their water intake by checking the color of their urine. If it’s a pale yellow or clear, they’re doing great. If it’s dark, they should drink more water.

    3.   Avoid too much caffeine.

    Too much of anything can be a bad thing, and that includes drinking too much coffee, tea, or soda. Caffeine can increase your heart rate and blood pressure, which may negatively affect your health. Since we don’t know how long we’ll be quarantined, try to avoid drinking an extra cup of coffee, as it will be harder to eliminate as things return to normal.

    4.   Encourage everyone to eat a well-balanced diet.

    You may not be taking as many trips to the grocery store while social distancing, so it can be harder to make healthy food choices. Do the best you can. If you have room in your freezer, take advantage of frozen fruits and veggies, which are picked at the same time as fresh produce and then “flash frozen” to store nutrients. They offer the same nutritional value, but will last longer.

    It can be tempting to snack more while you’re working at home, but try to maintain a normal eating schedule of three balanced meals each day. You can certainly give in to a craving here and there, but again, you want to make choices that will be sustainable since we don’t know when we can resume our regular routines. On the other hand, it’s not uncommon for kids to eat much less at mealtimes, so don’t be afraid to offer them healthy snacks throughout the day.

    5.   Take time to build community.

    In today’s digital era, it's harder than ever to focus on your family because of constant distractions from social media and technology. On top of that, many extended families are geographically dispersed, making it challenging to have “a village” around to help. Leverage technology and host virtual family gatherings with extended family.

    Social isolation is stressful. That’s why now is a great time to strengthen your family unit by being intentional with your time together. One of the best ways to do this is to share meals together.

    Aside from your immediate family staying connected, you can also join in on virtual gatherings hosted by local or national organizations. Many zoos, parks, museums, and churches are using video feeds to provide entertainment, connect over shared interests, and maintain cultural and religious traditions.

    6.   Follow a bedtime routine and get enough sleep.

    Checking how you feel in the morning is one of the best ways to determine if you’re sleeping enough. Do you feel tired or refreshed? Getting enough sleep is important to having enough energy and being able to concentrate throughout the day. If you or your kids are struggling, try to go to bed earlier. A regular bedtime routine can help you fall asleep more easily because your body knows what’s coming.

    Bedtime can also be a great time to connect with your kids emotionally, as they may be processing the day. That’s why now is a great time to...

    7.   Talk about your feelings.

    Many people are feeling more anxiety than usual with all of the uncertainty and change. It’s okay to experience worry, grief, anger, or any variety of emotions. Encourage your kids to talk about how they’re feeling, and acknowledge that anything they’re feeling is normal and valid.

    8.   Limit screen time as much as possible.

    It’s important to know what’s going on in the world, but too much time on social media or watching tv can increase stress and anxiety. While your kids may need to use technology more than usual for distance learning, incorporating other activities in small blocks of time in between screen time can help to break it up.

    9.   Practice preventative medicine, like regular handwashing.

    Hand hygiene is always one of the best ways to minimize the spread of germs and prevent illness. You can reduce the risk of illness by practicing other preventive medicine guidelines, such as:

    • Coughing or sneezing into your sleeve
    • Disinfecting frequently touched surfaces in your home
    • Staying up-to-date on regular screenings and immunizations

    10.  Partner with your primary care provider using video visits or other forms of virtual communication.

    Information changes rapidly and it can be hard to sort through fact and fiction. Your primary care provider (PCP) is your best source of accurate information and they’re here to answer any questions or alleviate any concerns you may have.

    Use technology to connect with your doctor about the best place or time to seek care. Many physician offices are communicating virtually through different services, such as MedStar Health’s Video Visits, which connect patients to medical professionals via smartphone, tablet, or computer. Find a primary care provider near you or call your current PCP to find out the best way to stay in touch.

    If you or someone in your family has shortness of breath, persistent cough, or worsening fever, contact your doctor immediately.

    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.

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    MedStar Health Video Visits

     

  • April 23, 2020

    By Ira Rabin, MD

    We, as doctors, nurses, and healthcare professionals, often think we will be fine. I was one of the lucky ones. This virus has to be respected. If you are sick, don’t try to be a hero.

    I started feeling sick on Sunday, March 15. I got tested the same day at a MedStar Health Urgent Care location, and called the Hospital Center’s Occupational Health department. My wife had been sick for three days already; she had also been tested, and we were waiting for her results. But honestly, I was sure she had COVID-19. In the 20 years we have been married, I have rarely, if ever, seen her have a fever.

    I would say my symptoms were relatively mild. On Sunday, I had fever, chills, some body aches, and fatigue. I did not have a cough or any respiratory symptoms. On Monday, I felt equally bad, if not worse. My fever reached 101.8 degrees, and I had almost no appetite. I also was experiencing a loss of smell. The good news was that the day I started getting sick, my wife started getting better. My three kids, ages 17, 14 and 11, were definitely on house arrest, but they stayed busy with their online school work and were very helpful, so we could rest. I took a pragmatic approach; my wife and I didn’t stay locked up in one room. My family had already been in the same car, the same house and eaten at the same table. I did stay away from my parents and mother-in-law. Luckily, my kids never became symptomatic or sick.

    By Tuesday, I started feeling a little better, and by Wednesday I felt fine. On Thursday, I was playing basketball in the backyard, and on Friday, I got the call saying I tested positive. I was actually playing basketball when I answered the call, and by that point, I really did feel completely fine.

    Honestly, if I was not aware of COVID-19, I would have called this the flu. Don’t get me wrong, it wasn’t pleasant, but I never felt in serious risk of needing hospitalization. Fortunately, I do not have any underlying respiratory medical conditions such as asthma, or any other conditions that put me at higher risk for complications. Even so, I consider myself fortunate that my case was mild.

    Dr. Rabin after donating plasma

    In regard to how I contracted this virus, it’s hard to really know. My wife, who has a non-medical job, rides the Metro to work every day. Prior to COVID-19 really taking hold in this country, we had traveled to Seattle and to New Jersey for family events. Who really knows if we were exposed on the plane, at a rest stop on the New Jersey Turnpike, or from community exposure? She was sick and down for the count the Thursday, Friday and Saturday before I got sick, and on Monday we got her test results. She was positive. Luckily, by then her symptoms had mostly resolved.

    My advice to others is we don’t need to live in fear of COVID-19, but we need to respect it. I would also say that if you are having respiratory symptoms, monitor your heart rate, respiratory rate and oxygen levels if you have access to a pulse oximeter. And if you are having trouble breathing or any other serious symptoms, seek help.

    I understand how unnerving this situation can be. The unknowns surrounding COVID-19 are contributing to increased stress and anxiety everywhere. But thankfully, we are making progress by practicing social distancing, staying home whenever possible and continuing to be mindful of good hand hygiene. With patience and resilience, we will get through this together.