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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:
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    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 21, 2020

    By Ross Krasnow ,MD

    Sean Kimerling was a successful New York TV sportscaster and a lifelong athlete.  When he started to experience unexplained back pain, it was chalked up to an old sports injury. But the pain got worse. It was testicular cancer, discovered too late. We lost Sean in 2003, at age 37.

    The death of any young man in his prime is a tragedy. But Sean’s was particularly heartbreaking. If he had been diagnosed early, he likely would have lived a normal life.

    If you’re like most guys, you don’t even want to think about testicular cancer, let alone talk about it. But talking about it and getting educated could save your life.

    Early Detection is the Game Changer

    Testicular cancer is treatable. Survival rates for stage I diagnosis are as high as 99 percent. But the odds drop as the disease progresses, so early detection is absolutely critical.

    Most guys don’t want to think about testicular cancer. But getting educated could save your life. @RossKrasnow via @MedStarWHC #TCa
    Click to Tweet

    Understand the Risk

    Cancer begins when cell production goes out of control. In healthy tissue, new cells surface as needed to replace older or damaged ones. With cancer, some cells mutate and replicate unchecked. Left untreated, these rogue cells can spread to other parts of the body, leading to cancer that is more difficult to treat or even death.

    Unlike other cancers, testicular cancer strikes young, healthy men. For men aged 30 to 39, it is one of the most frequently diagnosed types of cancer. All the causes are not well understood, but here’s what we do know:

    • White men aged 15 to 44 are at risk, but it is rare among African Americans
    • Men with a family history are at higher risk, as are those born with undescended testicles, even after surgical correction
    • Men previously diagnosed have a slightly higher risk of cancer in the other testicle
    • Research has uncovered no strong association with diet, exercise or occupational radiation exposure
    • There’s no link between testicular and prostate cancer
    • Past injury doesn’t seem to increase risk, but it’s not unusual for it to be discovered after trauma

    Know What to Check For

    In its early, most treatable phase, it produces no pain and shows no outward signs. So, self-examination is our best defense. It’s simple, painless and could save your life. We recommend a self-exam every other month to check for signs. It’s easy to do, and it can be done in the shower or bath.

    Once you know the lumps and bumps of your anatomy—how your “normal” feels—you will be on guard for something firm and less compressible, almost like a small marble in the midst of normal tissue. You should also report any significant change in size, shape, or consistency.

    What If I Do Feel Something Unusual?

    Your primary care provider can perform a more thorough exam. Most of the time, there is nothing to worry about. But if something is suspect, an ultrasound will be scheduled. If it turns up anything of concern, the next step is referral to a urologist.

    Urologists know what to look for, and we can also order special blood tests for tumor markers to better plan treatment strategy.

    Staging and Treatment

    Treatment almost always includes surgery. Other forms of therapy may be in order, depending on the stage.

    • Stage I is when the mass is confined to the testicle, the most treatable form. Most men present this way, with treatment at a 99% success rate
    • Stage II involves nearby lymph nodes as well, but the treatment odds are still good—at 96%
    • Stage III has spread to other parts of the body, like the lung, heart or brain. Treatment success rate is 73%, but it’s rare for the disease to get this far before detection
    • Unlike other cancers, this one has no stage IV.

    We don’t recommend biopsy—taking a sample of tissue for lab testing—as it can spread the cancer cells. The best course of action is removal of the affected testicle, a procedure known as radical orchiectomy.

    The tissue is tested and additional tests are administered on the pelvis, to identify the type and extent of cancer and determine if chemotherapy or other post-surgical treatment is needed.

    Planning a Family

    The testicles perform two major functions: producing sperm for reproduction and testosterone, which affects facial hair, musculature, and other hallmarks of the male sex. For most men, one testicle can do the work of two. The surgical procedure alone doesn’t generally affect testosterone production, semen quality, fertility or sexual function.

    Many men diagnosed with testicular cancer are at the age for starting or growing a family. We recommend a discussion about sperm banking to protect the reproductive legacy, in case future treatment puts sperm production at risk. A urologist specializing in fertility can complete a full evaluation.

    Sperm banking may not be covered by insurance, but it is inexpensive, and grants or other forms of financial aid may be available.

    Life after Surgery

    Since most men present early, they don’t need chemotherapy or radiation, and their prognosis is very good. The procedure is generally very well tolerated, with a short recovery time. During the removal, the surgeon can implant a prosthesis, or artificial testicle, that looks and feels natural.

    Sexual function is rarely affected long term. Chemotherapy or radiotherapy can affect sperm quality and can cause fatigue that affects the mood for sex. After chemotherapy or radiotherapy, men should wait one year before trying to conceive to allow damaged sperm to clear from the body, and some men may not recover fertility after chemotherapy or radiotherapy. If surgery involved lymph nodes in the back, there is a small chance of complication that will prevent ejaculation. Although very rare, it’s another good reason to bank sperm.

    Most men treated early live normal, healthy lives. But since the risk of recurrence and other cancers is never zero, we recommend healthy lifestyle choices for the future, including maintaining good nutrition and a healthy weight; staying active and exercising; and limiting alcohol intake. Smokers are encouraged to quit, since tobacco use increases the risk of many other cancers and can complicate chemotherapy.

    It may seem a daunting prospect, but with early detection, testicular cancer is among the most treatable forms of cancer. The more you learn about it, the better prepared you will be. Ask your doctor for more information and keep doing self-exams. With vigilance and education, there’s no reason for this disease to keep you out of the game.

    Need to talk?

    Our specialists are available.

    Call 202-644-9526 or  Request an Appointment

  • April 21, 2020

    By MedStar Health

    MedStar Health is seeking people who have tested positive for COVID-19 and are fully recovered.  Patients who have recovered from COVID-19 infection may be able to donate plasma as a potential therapy for patients with serious COVID-19 infections.

    Plasma, the liquid portion of the blood, contains blood proteins (antibodies) that can attack the virus.  MedStar Health will be conducting a research project using plasma as a treatment for patients who are seriously ill from COVID-19.

    If you have had a COVID-19 positive test and have fully recovered and if you are interested in participating or would like to know more about this study, please call 202-877-6290.

  • April 17, 2020

    By MedStar Health

    While treatment for urinary tract infections (UTIs) are usually effective, they're not always necessary, as the body often can fight off simple UTIs on its own. Let’s discuss the implications of unnecessary UTI treatment and why it typically occurs in the first place.

    A UTI is an infection in any part of the urinary system, which includes the kidneys, bladder, and urethra (the structures through which urine passes before being expelled from the body). The most common symptoms of a UTI include:

    • Burning feeling when you urinate
    • Dark, cloudy, or bloody urine
    • Fever
    • Frequent or intense urge to urinate
    • Pain or pressure in your back or lower abdomen

    People most often develop UTIs due to age and sexual activity. Postmenopausal women are more prone to bacteria growing in their urinary tract, as their bodies often produce less estrogen, altering the bacterial mix. Sexual intercourse can cause bacteria in the vagina and rectum to get into the urinary tract, and using latex condoms during sex can promote bacterial growth (although you should still use a condom, but more on that later).

    UTI overtreatment issues.

    Overtreatment of UTIs typically occurs as a result of doctors routinely testing your urine for bacteria during office visits—even when you don’t have symptoms—and then suggesting you eliminate the bacteria right away with antibiotics.

    But this practice doesn’t follow the current guidelines set by the Infectious Disease Society of America and the American Urologic Association, which states that you shouldn’t be screened or diagnosed with a UTI until you experience two or more of the symptoms mentioned above. This is important, as it helps you avoid taking unnecessary antibiotics. Taking antibiotics you don’t need or taking them too often can lead to consequences, including:

    • Allergic reactions
    • Potential side effects, such as vomiting, diarrhea, abdominal cramps, vaginal itching and discharge, and more
    • Resistance to the antibiotics when you truly need them

    Taking #antibiotics for a potential #UTI can do more harm than good, unless you’ve experienced multiple symptoms, such as a #fever or a burning feeling when you urinate. Learn more via @MedStarHealth

    Click to Tweet

    Keep in mind though, that if you do experience symptoms, it’s important that you seek treatment. Untreated UTIs can cause the infection to spread throughout the body. For example, in some cases, the infection can spread from the bladder to one or both kidneys, which can damage the kidneys and permanently reduce their function.

    When UTI treatment is necessary.

    If you’re experiencing multiple symptoms of a UTI and we have confirmed that you have abnormal bacteria growth in the urinary tract, antibiotics usually are the most effective way to fight off the bacteria. The dosage and type of antibiotics you take depend on the severity of your infection. Make sure to speak to your doctor about your particular situation and what medication would be best for you.

    If you’re experiencing recurrent UTIs (more than two in six months or three in a year), your doctor will likely suggest you undergo screenings to identify any potential abnormalities in the body that could be contributing to your UTIs. One such screening is a cystoscopy, in which a doctor uses a thin tube called a cystoscope to examine your urethra and the lining of your bladder.

    Tips to prevent UTIs.

    There are several ways you can help prevent UTIs from developing. Some of my top recommendations include:

    • Drink more water: Drinking more water helps dilute your urine and ensure that you’ll urinate more frequently, which allows bacteria to be flushed from your urinary tract before an infection can begin.
    • Use the bathroom before and after sex: This can flush bacteria away from the urethra. And while we’re on the topic of sexual activity, although condoms can contribute to UTIs, I still recommend using them, as they’re important for preventing sexually transmitted infections.
    • Wipe from front to back: When you do this after urinating and after a bowel movement, it helps prevent bacteria in the anal region from spreading to the vagina and urethra.

    UTIs can be painful and difficult to deal with. However, it’s important that you don’t opt for UTI screenings or treatment until you experience multiple symptoms in order to avoid taking unnecessary antibiotics.

    Don't delay care.

    If you're experiencing UTI symptoms, don't delay your care. MedStar Health Urgent Care offers extended hours and online check-in. 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. You can also schedule an online appointment for primary care, specialty care, and other services through MedStar Health Video Visits.

    Experiencing symptoms of a UTI? We provide multiple options to help you get the care you need now.

    Learn more.

  • April 16, 2020

    By Christopher M. Gallagher, MD

    Managing cancer is a constant battle. As with all serious illnesses, cancer patients have critical needs that can’t wait. And the COVID-19 pandemic doesn’t change that.

    Although the virus surge calls for new approaches to how we deliver care, it will not stop us from doing so. We are working tirelessly to design new protocols that ensure that all of our cancer patients have access to the life-saving treatments they need, in the safest possible environment.

    What We Know

    COVID-19 is caused by a novel coronavirus, meaning it’s brand new in the environment. Medical science hasn’t yet had the time to fully research it, and we’re still compiling hard data on the nature of the virus. Clues to its inner workings are yet to be unlocked.

    At this stage, it’s hard to predict exactly how the virus may affect individual cancer patients. But what we do know from experience is that many cancer treatments can suppress the immune system, which may leave patients more susceptible to infection.

    The disease presents among cancer patients as it does within the general population: some will experience severe symptoms; some will not, regardless of how advanced their cancer is. Although data are in short supply, our mission is certain: we do all we can to protect every patient.

    The pandemic is changing the way we deliver cancer care, but every patient who needs care is getting it. All you need to know, from Dr. Christopher Gallagher. via @MedStarWHC
    Click to Tweet

    Taking Decisive Action

    Our Washington Cancer Institute is taking decisive steps to protect our patients. Social distancing is the best tool we all have, and we take it exceptionally seriously here.

    For inpatient care:
    • We continue to perform critical cancer surgery, with the most pressing cases taking precedence. Some ancillary surgeries are being deferred—for example, breast reconstruction following cancer surgery—although surgery to treat tumors continues.
    • Visitors to the Cancer Institute are limited.
    • We have created a special sanctuary area for inpatients with compromised immune systems, including cancer patients. Stringent protective and preventive measures are in place to protect this area.
    For outpatient care:
    • Every cancer outpatient is pre-screened for symptoms before being cleared to visit the clinic.
    • Again, other visitors are not permitted. Fortunately, friends and family members have stepped up to embrace this potentially difficult policy. They understand how important it is.
    • Exposure to multiple providers is kept to an absolute minimum.
    • Walk-in patients are not admitted.
    • We have removed some chairs from waiting rooms to allow space for social distancing, and we’re staggering appointments to reduce waiting time and limit exposure.
    • We are combining as many services as possible, such as lab work and imaging studies, to minimize multiple visits.
    • Masks are strongly recommended for everyone—and offered to providers and patients alike.

    And, of course we screen ourselves regularly as well, to ensure our healthcare team stays healthy.

    As situations change, many other resources are available including social workers, nurse navigators and financial navigators. For example, the coming months may be difficult for those whose work has been affected by the shutdown. We can help manage access, scheduling, insurance and other details during this “new normal.”

    The Promise of Technology

    We are fortunate to have sophisticated telemedicine technology during the crisis. We utilize MedStar eVisit as much as possible throughout the continuum of care. Patients on oral chemotherapy, for example, can be monitored via eVisit from the safety of their homes.

    Telemedicine can be especially useful for the initial appointment after a cancer diagnosis. That office visit can be emotionally difficult for the patient under normal circumstances, and even harder to handle during the pandemic when a family member or friend cannot accompany them. But with telemedicine, the patient can include as many people as they would like, to help them absorb the news and process information. Family members are encouraged to write down questions for subsequent eVisit sessions.

    Although not perfect, telemedicine works very well and allows the patient to get the attention they need while limiting exposure to others.

    If You Need Treatment

    Anxiety over COVID-19 is completely understandable. Each week, I encounter patients nervous about coming to the hospital for their much-needed treatments. Fortunately, in almost every case, their worries diminish when they learn about all the extra measures we take to keep them safe.

    We have put stringent protocols in place and are following them to the letter. I can confidently say that we are making the Washington Cancer Institute as safe as possible. If you need treatment, evaluation or consultation for a new or established cancer diagnosis, know that we are taking patient safety very seriously. If possible, please don’t consider skipping a treatment—your health depends on it.

    If you are participating in a clinical trial, moving forward will depend on the parameters of the trial and your unique situation. Discuss it with your doctor.

    If you experience a medical emergency, our healthcare team is on-call around the clock seven days a week, reachable by phone or eVisit. Because emergency rooms throughout our region are busier than ever, your best course of action in an emergency is to contact the team before making the trip. They know what questions to ask to determine if you should come in. Making that call is one more way to keep yourself and your family members safe.

    Protecting Yourself

    In or out of the hospital, everyone should follow the guidelines the healthcare community has been recommending since the crisis began. The rules are the same for cancer patients.

    Maintain social distancing, stay at home as much as possible, refrain from touching your face, and wash your hands frequently or use hand sanitizer when you’re away from running water. Covering your face with a cloth or surgical mask in public spaces is also a good idea. If we all follow the guidelines, we will better protect one another.

    Silver Linings

    This coronavirus outbreak will advance our knowledge and increase our readiness for public health emergencies. Many of the scenarios we’ve considered and drilled for at the hospital are the new reality. Every member of the healthcare team stays on top of current research, guidelines and recommendations, and inter-team collaboration is at an all-time high.

    In cancer care, the large medical academies and societies issue new guidelines frequently. Our team reviews this guidance carefully, and shares it to keep team members sharp and prepared as the situation evolves.

    Oncology and hematology are also at the forefront of research toward prevention and treatment. Modern cancer care is often focused on immunology—the study of how the immune system helps fight cancer. That puts the cancer care team in the pipeline for new information on this disease.

    What You Can Do

    During challenging times, healthcare professionals are good at learning new things and multitasking. The current health crisis is putting those skills to the test. We must provide needed care, manage increasing volume, master new technologies, stay up on new developments, and care for our own homes and families.

    You can help by following all of the recommended guidelines, keeping yourself and your family safe, and consuming and sharing accurate information from trusted sources, like MedStar Washington Hospital Center. We consider every interaction with a patient or family member to be a new opportunity for teaching—and education is one of the most powerful tools we can use to combat this virus.

    Together, we’ll relieve pressure on the healthcare system, get back to normal social discourse, and save more lives.

    Questions about cancer care?

    Reach out to our specialists.

    Call 202-644-9526 or  Request an Appointment

  • April 14, 2020

    By Puja G. Khaitan, MD

    If the fiery feeling of heartburn affects you more than twice a week, you may be at risk for more serious health issues. Frequent or long-standing heartburn is a symptom of gastroesophageal reflux disease (GERD), which can lead to esophageal cancer.

    Feeling the Burn: How Acid Reflux Changes the Esophagus

    This common condition occurs when acid from your stomach backs up (or refluxes) into your esophagus (or the foodpipe). Typically, our stomach produces about 1.5–2 litres of acidic fluid on a daily basis, and that same acid causes heartburn when it backs up into the esophagus. The reflux then leads to severe inflammation of the inner lining of the esophagus and transforms it, a process that is termed metaplasia. Eventually, the cell transformation can progress into low-grade, and later high-grade dysplasia, or Barrett’s esophagus, which can then lead to cancer of the esophagus, if left untreated.

    Although there are different types of cancer of the esophagus, it’s typically the adenocarcinoma variety that we associate with acid reflux. This used to be a disease of 60- and 70-year-olds. But unfortunately, we now see it even in younger patients—in their 20s and 30s—primarily because of obesity, increased BMI, and poor eating habits, all of which affect our lower esophageal sphincter and relax it.

    Surprisingly Common Symptoms

    The symptoms of gastroesophageal reflux disease are very common. Some people don’t even realize that they have reflux disease and, while others do, they ignore it because they associate it with stress or certain meals. And because they get immediate relief from Tums®, they continue to just “fight through it."

    Common alarming symptoms to watch out for include:

    • Heartburn
    • Waking up with a sour taste in your mouth
    • Persistent cough
    • Constant hoarseness
    • Frequent throat clearing

    Be Aware of Risk Factors

    Many patients diagnosed with cancer of the esophagus have a history of risk factors for the disease, including:

    • Hiatal hernia or para-esophageal hernia
    • Long-standing acid reflux
    • Smoking cigarettes
    • Alcohol abuse/routine alcohol use
    • Obesity
    • Collagen vascular diseases such as rheumatoid arthritis or scleroderma
    • Multiple pregnancies
    • Consistently drinking burning hot coffee or tea
    • Exposure to nitrosamines, a probable carcinogen found in tobacco products, processed foods, cured meat (cold cuts and bacon), and beer

    And some patients have no risk factors. In a fraction of the patients on whom we operate for cancer of the esophagus, we actually find no evidence of reflux. Research still has not figured out why patients who are male, nonsmokers, nondrinkers, and without a history of reflux or hernia still get the disease. Unfortunately, we are miles away from identifying why this group of patients develop esophageal cancer.

    Stopping Heartburn Does Not Stop the Progression

    When people are diagnosed with long-standing acid reflux or believe they’re having heartburn, they typically will take an antacid and dismiss the symptom because they have instant relief.

    But we must remember that the reflux is coming from something. It could be a structural defect, like a lax lower esophageal sphincter (a ring of muscles connecting the esophagus to the stomach).

    If a patient feels less burning by simply taking the medicine, he or she may just be fooling themselves into thinking their reflux is gone, yet the mechanism could still be there. These patients should ideally be on antacid therapy for their lifetime or until the acid reflux is well-controlled. And they should see their doctor for regular evaluation, so it doesn’t lead to Barrett’s esophagus.

    About Barrett's Esophagus

    Barrett's esophagus is essentially a change in the type of cells within the lining of the esophagus. The cells transform from a normal to an abnormal type of cell. When this change happens, you’re at risk of the condition progressing to cancer of the esophagus.

    We currently recommend that those patients undergo some sort of treatment after a thorough evaluation with endoscopy. If you have Barrett’s, your gastroenterologist will first biopsy you to prove it and then either treat you with medicines or other endoscopic modalities, such as radiofrequency ablation, a minimally invasive treatment that treats the diseased tissue.

    Extremely Aggressive

    People suffering from frequent heartburn should be aware of two facts about esophageal cancer:

    • It is extremely aggressive
    • It has no cure

    About 20 years ago, the five-year survival rate for esophageal cancer was 18%. Currently, the five-year survival rate is 19.5%. So, we have hardly made any progress in detecting it early or treating patients appropriately.

    @PujaGKhaitan says that having heartburn more than twice a week could be GERD in disguise. via @MedStarWHC
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    Stages of Esophageal Cancer

    Cancer of the esophagus is quite complex, and so are the various ways we can classify it. Each patient and situation is different, so it’s best to talk with your doctor if you or a loved one is diagnosed with the disease. In general, though, we can classify this cancer into these stages:

    • Stage 1—a lesion in the lining of the esophageal wall Treatment: Removal of the lesion through minimally invasive surgery.
    • Stages 2 or 3—a deeper tumor and/or involvement of lymph nodes Treatment: Chemotherapy and radiation, followed by an esophagectomy, surgery to remove 70% to 80% of the esophagus, leaving a little piece to connect to the stomach. We perform the surgery only if the tumor has responded well to the chemotherapy and radiation. If the tumor has progressed, as far as the size or number of involved lymph nodes, or it has spread to other parts of the body, the patient will no longer be a candidate for surgery.
    • Stage 4—the tumor has spread Treatment: Anti-cancer drugs that reach all parts of the body and/or palliative care to improve the patient’s quality of life.

    No Routine Screening Guidelines

    Unfortunately, there are no standard screening guidelines for cancer of the esophagus. If it could be diagnosed at an early stage through endoscopy, we could take action before it gets worse. But, because we don't screen for it on a routine basis, we tend not to diagnose patients at an early stage.

    I hope that increased awareness will encourage patients to think, “Okay, I’ve got persistent symptoms. Something could be wrong. I should go see a doctor.”

    Prevention Is the Best Medicine To Care for Your Esophagus

    I highly encourage people, if you've had symptoms of GERD for more than 5 years, to get an endoscopy to make sure you don't have any long-term effects of acid reflux, Barrett’s esophagus, dysplasia, or early-stage nodules that might be malignant. You don't want to wait until you have food getting stuck in your throat or you've got a large mass—the earlier you see your doctor about your heartburn or other symptoms, the better the outcome may be.

    • Recognize the symptoms. We all think we are invincible. When you're in your 30s and 40s and you have acid reflux, you may not be concerned about your symptoms. When the effects of the risk factors finally hit you in your 60s and 70s, significant damage may exist. Many patients can benefit from awareness of the effects of acid reflux on their esophagus, earlier surveillance, and monitoring their symptoms.
    • Be your own advocate. If you think you're having reflux and you have had it for a long time, ask your primary care doctor for a referral to a gastroenterologist, who may perform an endoscopy and, if you have reflux, see that you get appropriate treatment. If the treatment is not working, ask your doctor to be referred to a surgeon because you may need anti-reflux surgery. And if an endoscopy finds damage to your esophagus, you may need other work done.
    • Stay vigilant. It’s important to remain aware and take care of your own health. Ensure you are under the care of a good doctor who keeps current with your symptoms, to avoid potentially being diagnosed with a form of cancer in its later stages.

    Here at MedStar Washington Hospital Center, our specialists will make sure that your symptoms get addressed and you get started on the right treatment in time.

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  • April 10, 2020

    By MedStar Health

    Every 37 seconds, someone in the United States dies from heart disease.

    The good news is there are things you can do today to reduce your chances of developing heart disease, and you don’t have to do it alone. With the onset of the COVID-19 pandemic, many may be delaying medical care that can help with this important prevention. But telemedicine is changing that.

    Your primary care provider, or PCP, knows your health and medical history better than anyone else. You’ve built a trusting relationship that helps you talk openly and honestly about your health changes, which is why they’re great partners in helping you maintain a healthy heart. Through the MedStar Health Video Visits, you can connect with your PCP in the comfort and safety of your home. These scheduled visits allow you to talk with your provider over secure video from your computer, tablet, or smartphone.

    Someone in the U.S. dies from #HeartDisease every 37 seconds. Internal medicine physician Dr. Newkirk explains 4 ways a PCP can help you maintain a #HealthyHeart on @MedStarHealth’s #LiveWellHealthy blog:

    Click to Tweet

    A PCP can help you prevent heart disease by:

    1. Identifying your risk for heart disease.

    Your primary care provider’s main goal is to help you stay healthy. One of the ways they do this is by looking at your risk factors for various diseases, including heart disease.

    A risk factor is something that increases your chances of developing a disease. By looking at your medical history and talking to you about your current lifestyle, your PCP can better understand your risk.

    The following risk factors increase your chances of developing heart disease:

    • High blood pressure
    • Tobacco use
    • History of diabetes
    • Obesity
    • Being of certain ethnicities, including African American or Hispanic
    • Aging

    Your doctor can evaluate your risk factors to determine if you have a low, moderate, or high risk of developing heart disease. Knowing you have a moderate or high risk can help you and your PCP determine if you need to make lifestyle changes to lower your risk and improve your chances of preventing heart disease. If you have a low risk, chances are you are already living a healthy lifestyle and maintaining a good heart.

    2. Setting realistic goals for preventing heart disease.

    If your primary care provider identifies you as someone who is at risk for heart disease, you can count on them to help you set achievable goals that will reduce your chances of developing it. Since your primary care provider knows you, they’ll make sure your goals are realistic.

    A primary care provider can also offer resources and suggestions to make healthy habits easier. They’ll help to keep you accountable by checking in regularly on your progress towards those goals. And, they may help you enlist your family to support your lifestyle changes.

    3. Supporting your lifestyle changes.

    Once your PCP helps you set goals, it’s time to take steps toward achieving your goals. Many times lifestyle changes can help you reach your goals. That’s because healthy habits have the biggest impact on your blood work and can greatly reduce your risk of heart disease.

    Lifestyle changes may include:

    • Regularly checking and managing your blood pressure
    • Increasing your activity level to at least 30 minutes a day, most days of the week
    • Making healthier food choices, such as:
      • Eating more vegetables and fish
      • Limiting fatty meats (e.g. Choose chicken breast instead of chicken thigh)
      • Avoiding sugary foods
    • Quitting smoking

    One of the most important things your PCP can do is help you figure out WHY you want to reach your goals because that will help you stay motivated to follow through with your lifestyle changes. Do you want to be around to walk your daughter down the aisle? Or, do you want to make sure you can run and play with your grandchildren ten years from now? Understanding your personal reasons for lowering your risk of heart disease will help you stay focused and persistent in your lifestyle changes.

    4. Coordinating seamless care with a cardiologist.

    When lifestyle changes or other interventions aren’t successful in lowering your risk of heart disease, your PCP can refer you to a cardiologist or a cardiac surgeon if needed. Cardiologists and cardiac surgeons are experts in preventing and treating heart disease. Having a connection to a reputable heart specialist through your PCP can ensure you receive coordinated and seamless care.

    Your primary care provider probably has one or two cardiologists that they maintain a close relationship with. Many times, both the PCP and the cardiologist are within the same health system, which offers many benefits including:

    • Less duplicative care. Since your PCP is already communicating with the cardiologist, you won’t need to complete any repeat tests, screenings, or blood work.
    • More personalized, focused care. Your PCP will share your medical history and preferences with your cardiologist. That helps them to be prepared before you even arrive for your appointment.
    • Quicker treatment process. Because you have a direct link to the cardiologist through your PCP, you may not have to wait as long for an appointment. And since your cardiologist will already know what is and isn’t working, they can get started quickly on new treatment options.

    Concerned about your heart health? No need to leave home to talk to a doctor. Schedule a video visit and receive care from the convenience of your home.

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    How to catch heart disease early.

    Regular screenings or tests can help you prevent heart disease or catch it early. For example, you should have your blood pressure checked at least once a year. Monitoring your cholesterol is also important at various frequencies for the following age groups:

    • Ages 20-39 should get their cholesterol checked every four to six years
    • Ages 40 and older should receive more frequent checks

    If you already have a primary care provider, hopefully you are taking steps to minimize your risk of heart disease. If not, it’s important to know the first signs. Be sure to talk to a doctor if you notice any of the following heart disease symptoms:

    • High blood pressure
    • Diabetes symptoms, such as:
      • Increased thirst
      • Frequent urination
      • Unexplained weight loss

    Once heart disease has started, you may have other symptoms, including pain in the chest, arms, or jaw.

    In my experience as an internal medicine doctor, I’ve noticed that women may not experience some of the same traditional symptoms as men when it comes to heart health. For example, women are likely to experience more subtle symptoms when having a heart attack, which makes them easier to ignore.

    To learn more, take the women’s heart disease risk assessment from MedStar Heart & Vascular Institute.

    You know your body best, so if something doesn’t seem right, make it a priority to talk to a doctor.

    Interested in learning more about how a PCP can help you prevent heart disease? Watch Dr. Newkirk explain the role your PCP can play in helping you maintain a healthy heart.

    How to choose a helpful primary care provider.

    If you don’t already have a primary care provider, it’s important to find one who can help you minimize your risk of developing heart disease. Here are a few qualities to look for.

    Choose someone who comes recommended by friends or family. If you have loved ones with similar values, they may appreciate qualities in their PCP that will also resonate with you.

    Ask about their specialties or areas of interest. Every person has unique health needs, and those needs change as people age. You want to find a PCP that keeps your needs in mind.

    Find a PCP at a convenient and accessible location. You want it to be easy to see your PCP when and where you need them so that you’re more likely to show up for scheduled appointments.

    Pay attention to the atmosphere of the office. Once you visit your new PCP, think about how the office made you feel. Were they welcoming? Were they responsive when you needed them to answer a phone call or call back? Do they have availability and easy ways for you to make an appointment?

    Don’t wait to talk with a primary care provider.

    During these challenging times of COVID-19, you may be inclined to delay visits to the doctor as you take steps to limit any exposure to the virus. But even during a pandemic, your ongoing health needs remain of great importance.

    That’s why MedStar Health is offering virtual care through MedStar Health Video Visits. These scheduled video visits are designed to provide a secure way to keep up with medical appointments from the safety of your home, including ones with your PCP. You can schedule a MedStar Health Video Visit by calling your provider’s office.

    MedStar Health is committed to providing safe, easy at home care options during the COVID-19 pandemic and after, as part of out commitment to the most convenient access to our expert providers. Click the button below to learn more about MedStar Health Video Visits.

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