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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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  • October 02, 2021

    By MedStar Health

    MedStar Health has been conducting a large scale, multi-site Centers for Disease Control and Prevention (CDC) funded Community Research Partnership (CRP) study, “A Prospective Study of COVID-19 Using Real-Time Syndromic Surveillance, Scheduled At-home Serologic Testing, and Electronic Health Records”. The goal of the study is to determine how much of the population has been exposed to the COVID-19 virus by utilizing daily syndromic surveillance, monthly serologic testing, and electronic health record data. The CDC COVID-19 CRP is an at-home research study to help us better understand the best ways to treat and prevent COVID-19.

    The study began in November of 2020 and has gained more than 60,000 participants, over 4.5 million daily symptom updates, received over 150,000 serology results, and collected more than 17 million electronic health record data elements. At MedStar Health, there are 11,095 participants who remain engaged in daily syndromic surveillance. There are 8,538 participants enrolled in monthly serology testing with over 44,000 serology kits distributed. More than 50% of these participants have been participating in monthly serology for at least six months – representing incredible engagement from our community that allows the research team to evaluate antibody development and decay over time.

    Preliminary study results show that antibodies are identified at a detectable level around two weeks after natural infection or vaccination and these antibodies take longer to develop in older participants. The results also show that in participants with natural infection, antibodies drop to undetectable levels within two to three months as compared to vaccinated individuals with detectable antibodies lasting at least eight months. For patients who were infected with the SARS-CoV-2 virus, antibody decay is more rapid in participants with no or few symptoms as compared to more significant infection.

    For participants who seroconverted (serology results were first negative then positive), 35% reported symptoms in the month prior to seroconversion. Participants with positive serology results reported symptom combinations like congestion and anosmia or ageusia (loss of smell or taste). However, symptom combinations like diarrhea and nausea were strongly associated with negative serology. Cumulative reports of symptoms logged by participants in their daily symptom surveillance showed that self-reported symptoms persist weeks after seroconversion with runny nose, muscle pain, headache, fever, and fatigue being commonly reported.

    Significant work of the study team is focusing on vaccine effectiveness (with a research letter to be published in the New England Journal of Medicine on October 6, 2021). Looking at both the Pfizer-BioNTech and Moderna RNA vaccines in a case control evaluation, infections were significantly higher in unvaccinated than vaccinated participants, with effectiveness in preventing over 90% of self-reported positive tests for COVID-19. The study team is currently analyzing breakthrough infections and sharing findings to the CDC highlighting the need for ongoing surveillance, screening for novel variants, and possible booster vaccination programs.

    As part of daily symptom surveillance, participants self-report symptoms, healthcare utilization, COVID-19 exposures, and public health behaviors including mask use and social distancing. The research team found that mask use is higher in vaccinated participants than unvaccinated, regardless of the month of their first vaccination dose. Mask use remained relatively stable from December 2020 through April 2021 and declined in all groups beginning in mid-May 2021. In all groups, mask use increased again in July 2021, which aligns with public health concerns around the Delta variant. Independent predictors of higher mask use include vaccination, aged 65 and older, female sex, racial or ethnic minority group, and healthcare worker occupation, whereas a history of self-reported prior COVID-19 illness was associated with lower use.

    Supplemental surveys were distributed to participants in the winter of 2020 to collect self-reported information on protective behaviors while gathering with friends and family outside their immediate household and if they engaged in protective behaviors including hand washing, social distancing, mask wearing, gathering outdoors, and COVID-19 testing. Significant findings include self-report of gathering with non-household members at Thanksgiving (47%) and during the winter holidays (69%). Only 30-40% of participants wore masks and less than 1/5th were tested prior to gathering.

    The study team also distributed a supplemental survey to identify vaccine hesitancy. Results showed that 76% of those who responded intended to get the vaccine, but the data also identified hesitancy in African Americans, suburbanites, women, and those with prior infection. Participants most frequently cited concern over safety and lack of testing. Vaccine updates from participants were monitored through May of 2021. Subsequent vaccine uptake was 99% in non-hesitant participants and more than 50% in those who were initially resistant.

    The MedStar Health study site is led by William S. Weintraub, MD, Director of Population Health Research, MedStar Health Research Institute; and Kristen E. Miller, DrPH, Scientific Director, National Center for Human Factors in Healthcare, MedStar Health Research Institute.

  • October 01, 2021

    By Javairiah Fatima, MD

    When it comes to the aorta—the main artery that takes blood away from the heart to the rest of the body—any condition is challenging. But when the weakened area, tear, or degeneration of the aorta occurs in the chest and abdomen or pelvic area, we classify it as a complex aortic disease. 


    Problems such as aortic aneurysms, tears, ruptures, dissections, ulcers, and connective tissue disorders often occur in patients who may be poor candidates for open surgery. So, they need a specialized, minimally invasive procedure. Using fenestrated and branched endovascular aortic repair (FEVAR/BEVAR), I can implant a device that repairs the aortic pathology using stent grafts, without the need for big incisions or the physiologic stress of open surgery. 


    In most cases, anatomic location is the deciding factor between traditional surgery or an endovascular procedure, which uses tiny incisions and the body’s blood vessels as the route to repair the aorta. If we can say “yes” to any of these questions, complex FEVAR/BEVAR endovascular repair may be the best route:

    • Is the patient too weak or ill to survive open aortic surgery?
    • Is the problem area close to important blood vessels, such as the visceral or cerebrovascular vessels? 
    • Is there very little healthy tissue remaining on which to attach a stent graft?

    Devices used in fenestrated and/or branch technology are tailored to the patient’s anatomy. Two of the more common procedures we perform in the MedStar Heart & Vascular Institute include:

    • Fenestrated aortic aneurysm repair surgery (FEVAR): A mesh-supported fabric tube (stent graft) supports weakened areas in the artery. Blood supply is preserved through strategically placed “windows” (fenestrations) in the tube that are bridged into the respective blood (target) vessels using additional stent grafts.
    • Branched endovascular aortic aneurysm repair (BEVAR): A stent graft bridges the gap between the aorta and target vessels when the aorta is too wide.

    I am one of a handful of  vascular surgeons in the U.S. with an investigational device exemption (IDE) for aortic devices, and the only female surgeon to date. I have the expertise to not only implant these devices, but also design and assemble them to fit a patient’s aorta in a minimally invasive manner.

    What to expect at your visit.

    We receive many referrals from community vascular surgeons. Patients who come to me are often past the shock of their diagnosis but concerned about going to a specialty center instead of their normal hospital. 


    We counter this apprehension with knowledge. I like to draw out the patient’s aortic anatomy, and how a custom device and procedure might correct it. Then, I send the drawing home with the patient to show loved ones and help them get comfortable with their surgical plan. 

    We encourage patients to write down any questions they or their family have so we can give them answers by phone or at their next visit. Patients have said they appreciate the drawings as it helps simplify the understanding of this complex disease process.


    “Sketching out a patient’s complex #AorticDisease helps them and their loved ones visualize the treatment plan and think of more questions for informed decision-making.”—Javairiah Fatima, MD: https://bit.ly/3utIhoC.
    Click to Tweet
     

    Elite surgical teamwork, in and out of the OR.

    MedStar Health’s multidisciplinary aortic team is exceptionally well-equipped to provide complex patients with holistic care. 


    I trained in vascular surgery at Cleveland Clinic which is affiliated with the MedStar Heart & Vascular Institute through clinical care and research. Then, I completed additional fenestrated and branch technology training at Mayo Clinic. 


    However, even the most skilled surgeons need an elite team, top-of-the-line resources, and a sophisticated infrastructure to give patients the best outcomes. MedStar Health offers everything our patients with complex aortic conditions need, including:

    • Close collaboration with the cardiac surgery and thoracic surgery teams to provide the safest, most effective surgical outcomes.
    • Dedicated anesthesia and intensive care teams with advanced training in caring for patients with complex aortic disease.
    • Pre- and post-surgical support, including nutrition, patient navigation, and cardiac rehabilitation. 

    MedStar Health is one of just a handful of Complex Aortic Disease centers in the U.S. Strategically positioned in the Mid-Atlantic, we are within two hours of travel for patients from Virginia to Washington, D.C., to Baltimore. The next closest centers with similar services are in Boston—too far for very sick patients to travel.


    Planning is paramount for device design and surgery. 

    When a patient decides to have surgery, we start planning their procedure by ordering a CT scan of their chest, abdomen, and pelvis. Then, we import the patient’s imaging into a special software called TeraRecon Aquarius. 


    This software helps create a “center line of flow” in the patient’s aorta—it essentially “straightens out” the aorta visually so we can determine all the aortic measurements with precision.


    Using the software, we can take very fine measurements of the patient’s aortic arc length, where fenestrations and branches will need to be made, and distances between the diseased segment of the aorta and nearby important structures, such as the blood vessels that feed the brain, intestine, or kidneys. 


    On the day of surgery, we use those precise measurements to create the patient’s personalized aortic device. We cannot form the device in advance—there is no sterile storage option once it has been assembled.


    Creating individualized aortic devices.

    While the patient is being prepped for surgery, I work at a sterile back table in the operating room, creating and assembling their device. Once the patient is ready, we make one or two small incisions in their groin. Then we insert a catheter—a long, thin, flexible tube (sheath)—into a large blood vessel called the femoral artery. 


    We place the device through the sheath and, under CT-fusion image guidance, place the device accurately at the intended location. CT-fusion allows us to use lower levels of contrast dye and radiation during surgery. While both are safe, lowering contrast/radiation levels may reduce patients’ treatment time, financial obligations, and potential side effects.


    Once we are in position, we deploy the stent-graft in healthy aortic tissue. Like a hand in a glove, the device perfectly matches the patient’s anatomy, closing functional gaps caused by their disease. 


    Recovery from endovascular aortic surgery.

    Compared with traditional surgery, patients typically go home within a few days rather than weeks—with only a few small incisions and their aorta repaired. Minimally invasive endovascular procedures reduce the risk of post-operative complications, such as infection and decreased muscle tone from being laid up in the hospital. 


    These devices can last the patient’s lifetime and are a safe, effective pathway for patients who, in the past, would have been told they were out of options. We can give patients more active years of life with manageable follow-up.


    While patients are more than welcome to travel to our offices for follow-up care, we often meet with patients and their local cardiovascular doctors by conference call, exchanging imaging results through our secure messaging system. Telehealth has given patients even more valuable time back, as well as the comfort of getting specialist care close to home. 


    We form lifelong relationships with our patients, and we enjoy hearing about milestones they were able to meet since their procedure: welcoming grandchildren, seeing their kids graduate college, retiring on their terms. Plus, we give patients and their doctors our cellphone numbers so they can reach us at any time with questions or concerns.


    The future of complex aortic disease treatment. 

    Participating in clinical trials keeps our team on the leading edge of the latest technology and approaches. Specialists across our team are involved in nearly every ongoing branch and fenestrated technology trial that involves the aortic arch or thoracoabdominal aorta


    We also conduct many of our own clinical studies, which requires exceptional organization, communication, and top-notch facilities. For example, as part of my IDE, we are conducting a clinical research study of the quality of life of patients who receive a fenestrated or branch device over a five-year period. Specifically, we are working to determine the lowest levels of contrast dye and radiation we can use during treatment and follow-up to give patients the best outcomes. 


    All aortic conditions require expert care. But for particularly complex cases, getting personalized treatment from a team of experts soon after diagnosis can offer patients a longer, healthier life.


    Get exceptional care for complex aortic disease.

    Talk with an expert surgeon about minimally invasive surgery options today.

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

  • September 29, 2021

    By Christian Shults, MD

    No matter how many greens you eat or hours of sleep and exercise you get, you can’t stop the aging process—and aging is the No. 1 driver of atrial fibrillation (AFib), which increases the risk of stroke and is the most common type of arrhythmia


    However, forming healthy habits can reduce your risk of
    developing AFib. And a newly FDA-approved treatment—which uses technology that MedStar Health experts have mastered for 10 years—is 70% effective at stopping AFib symptoms if you do develop it. 


    AFib is a change in the way your heart beats. Your heart has two upper chambers and two lower chambers. To keep your blood circulating, these chambers contract in a specific rhythm: the upper chambers first, followed by the lower ones.


    When AFib develops, instead of contracting normally—slowly while you rest and more quickly during activity—the upper chambers get hijacked by chaotic electricity that makes them quiver rapidly. This causes the bottom chambers to contract abnormally.


    AFib affects one in four adults over 40, but many people don’t even know they have it. To help you avoid a surprise diagnosis, we’ll discuss how AFib develops, symptoms to look out for, life-changing treatments we offer—and why it’s important to be treated as soon as possible.


    How does AFib affect your heart?

    AFib is progressive over time, which is why age is the biggest contributor. The progression is similar to the growth of dandelions in your yard: These weeds often appear in just a couple of places and are fairly easy to manage. If you neglect your yard, they multiply until you eventually have no healthy lawn left.


    As episodes come and go, they stretch and alter your heart muscle tissue. We classify AFib into four types:

    • Paroxysmal: Irregular contractions, or “episodes,” come and go, never lasting longer than a week.
    • Persistent: Episodes last longer than a week at a time—even up to a year.
    • Long-standing persistent: Irregularities continue for over a year.
    • Permanent: Treatment can reduce episodes, but they’ll never go away.

    Restoring rhythm earlier can prevent downstream changes—and extend life expectancy. Patients with AFib who are over 65 have a worse five-year survival trajectory than patients with colon cancer or Hodgkin's lymphoma. 

     

    What causes AFib?

    Along with aging, internal and external factors can drive AFib. The condition is exacerbated by medical conditions such as:

    Contributing lifestyle factors include:
    • Alcohol
    • Caffeine
    • Dehydration
    • Poor sleep patterns
    • Stress

    How is AFib diagnosed?

    Diagnosis often begins with a patient’s awareness of an irregularity in their heart rhythm. Nobody shares identical symptoms, but we see common themes such as lightheadedness, neck or chest discomfort, shortness of breath, or what is often described as the feeling of a fish flipping in the chest.


    As we treat patients for other cardiovascular risk factors, we also consider their risk for AFib. If you might be at risk, we’ll use an electrocardiogram (EKG) to record your heart’s electrical signal and detect irregular rhythm. 


    We don’t currently have recommendations for asymptomatic screening. Fortunately, heart rhythm monitoring is becoming much easier and more common because of the ability to do it through phone- or watch-based apps. As more people use these tools to track their heart’s electric activity, we are seeing many more episodes of arrhythmia occurring in patients without symptoms.

     

    Can AFib be cured? 

    With AFib, it’s important to not get stuck on the term “cure.” Literally a lifetime of changes within your heart led to this condition, so our goal isn’t to eliminate every episode but to keep the burden of AFib lower than 1%. 


    Regardless of the type of AFib you have, we need to restore your heart’s rhythm. When determining the best treatment for your condition, we focus on:

    • Risk of stroke
    • Current symptoms 
    • Future symptoms

    Our first and foremost goal is to treat what’s most dangerous. With AFib, that’s stroke risk. Not every patient with AFib has the same risk, but AFib elevates the risk of stroke in everyone, regardless of any other health conditions they have. 


    Stroke prevention is primarily done in two ways: medicine (daily aspirin or a blood thinner) or an implantable device that detects rhythm irregularities. Once we address stroke prevention, we focus on symptom management.

     

    #AFib treatment focuses on #stroke prevention and current and future symptom management. Learn how @MedStarHealth experts collaborate to tailor new treatments to your specific symptoms: https://bit.ly/3zRkfVG.
    Click to Tweet
     

    Patients may be minimally symptomatic early on, but we must think of the long-term effects of your heart persistently being out of rhythm. Previously, treatment options were primarily drugs that either controlled blood clotting or heart rate. But we’ve learned many other treatment options can effectively get rid of AFib or reduce its burden significantly, which has huge implications for length and quality of life.


    Based on how advanced your AFib progression is, we start with simpler approaches and work our way up to more complex, invasive strategies.


    Medication.

    We typically start with medication to slow your heart rate and calm the chaos by suppressing the rapid quivering of your upper chambers—a chill pill, if you will. It can work reasonably well but usually not long term.

    Catheter ablation.

    Our next best step is pulmonary vein isolation, also known as a catheter ablation. We perform this same-day procedure by inserting a thin tube into your heart through the large vein in your thigh.

    Delivering radiofrequency energy through this tube, we create scar tissue within your heart to block the chaotic electric signals. This method can be effective for persistent AFib, but it usually needs to be performed more than once. Long-standing persistent AFib often requires a more advanced procedure.

    Hybrid AF Convergent Therapy.

    If catheter ablation isn’t effective, we will consider Hybrid AF™ Convergent Therapy, which was recently FDA approved. This type of ablation is hybrid because it combines two specialties—electrophysiology and cardiac surgery—to treat both the inside and outside of the heart.

    During this minimally invasive surgery, a cardiac surgeon makes a small incision below the breastbone and three small incisions in the ribs to access the outside of the heart and create scar tissue on its back walls. Then, an electrophysiologist accesses the inside of the heart through the groin and delivers radiofrequency energy that eliminates the abnormal electrical activity. This procedure is available at MedStar Washington Hospital Center and MedStar Union Memorial Hospital.


    Convergent therapy is best suited for patients with long-standing persistent AFib, which can be incredibly frustrating. Returning to the dandelion example, at this point the heart is so overrun by “weeds” that drugs and catheter ablation are not enough.


    The convergence of technology, specialties, and expertise in a physical location on the heart tissue blunts the progression of AFib and restores normal rhythm, which improves symptoms, helps patients feel better, and improves quality of life. 

    This hybrid procedure is the perfect example of our collaborative approach at MedStar Health. We keep your best interest as our focus as we bring different experts into the same room to solve complex problems. We have seen tremendous progress in patients who were told they had no treatment options in the past.


    MedStar Health introduced convergent procedure technology to the Baltimore area in 2011 has performed close to 300 procedures, one of the highest volumes across the country. We also participated in the clinical trials that helped convergent therapy achieve FDA approval. These trials showed that convergent therapy has a significant advantage over catheter ablation for the treatment of persistent and long-standing persistent AFib.

    Watch the video below to learn more about long-standing AFib:

    What is the recovery process after convergent therapy? 

     Patients generally tolerate the procedure well. After convergent therapy, you will:

    • Be up and walking the day after surgery
    • Stay in the hospital for two or three days
    • Have small drains in your chest to make sure fluid is not accumulating—we take them out before you go home
    • Need to avoid heavy lifting, exercise, or other activities that require exertion for two weeks
    • Be able to resume your regular activities after two weeks
    • Come see us in two or three weeks so we can perform an echocardiogram to check your heart rhythm and to discuss how you’re feeling overall

    If you were taking medication prior to the procedure, we’ll recommend continuing that regimen for at least three months. Depending on how you’re doing, we might consider gradually reducing your medications after that.

    Unique symptoms require a unique approach.

    AFib is different in every patient; treatment has to be just as unique. Regardless of the type of AFib you have, we take a thoughtful, tailored approach to your therapy to ensure it’s right for you. 

    The older we get, the more likely we are to develop AFib. It is not something to be afraid or ashamed of, but if you have it, we need to take your condition seriously to avoid dangerous consequences.


    Convergent therapy might not be the best solution for you, and we can take several approaches to your condition, such as combining treatments or considering more advanced surgeries.


    We are happy to review your case if you have been told you have no options. The greatest satisfaction we get as physicians is reducing risk and improving quality of life.

    In need of AFib relief?

    Our providers have a decade of expertise in unique technology that significantly reduces symptoms of persistent AFib. Meet with us today.

    Learn more or request an appointment

     

  • September 24, 2021

    By Monique Chheda, MD

    A former patient of mine had psoriasis symptoms that were so severe they couldn’t work or drive due to thick, painful plaques on their hands. I prescribed a biologic therapy—a medication that targets a specific part of the immune system. Six weeks later, the patient was 100% clear and a completely different person.


    Today, experiences like this aren’t unique. Because of the advancements in psoriasis research, the ability to be 90-100% clear when using newer medications is very achievable. In the past, our expectations for clearance were much lower. Today, we have so many wonderful options that are much more effective and can truly change a person’s quality of life.


    Many #Psoriais patients experienced flare-ups during the #COVID19 pandemic. Stress relief is an important part of a holistic treatment plan. Via @MoniqueChheda: https://bit.ly/3i381D8.
    Click to Tweet
     

    How to treat psoriasis—and options to avoid.

    The three main types of psoriasis treatment include:

    • Topical therapy—a cream or ointment you apply directly to the affected area. This approach is better suited for patients with early localized psoriasis or mild symptoms.
    • Light therapy—regular exposure to ultraviolet light, which can be done at our outpatient dermatology clinic or at home using a special unit. Not many facilities have light boxes on site, but we have a full-body machine that patients can use multiple times each week. I often recommend this approach to patients with moderate to severe symptoms for whom biologic therapies are not an option and topical therapy is not feasible.
    • Biologic therapy—often recommended for patients with moderate to severe psoriasis. These injectable medications target a specific part of the immune system to help decrease inflammation.

    A decade ago, we were limited to only a few options for biologic therapy. Now we have nearly 11 choices available, thanks to a tremendous amount of research on psoriasis causes and triggers. Because these new medications effect only one part of the immune system instead of its entirety, they are safer and have fewer side effects. 


    Newer biologics include Cosentyx®, Taltz®, Tremfya®, Skyrizi®, and Siliq®. These have all come to market in the past several years. They are highly effective with long-lasting results, and generally very well tolerated.


    Patients often seek complementary and alternative therapies, but we don’t have robust data pointing to their success. Furthermore, many supplements and herbal remedies are not regulated by the U.S. Food and Drug Administration (FDA). So, you can’t be sure that the product you get is what you’re expecting. It’s better to stick to what we know is effective and helpful instead of experimenting and potentially making things worse.


    Some studies do show a benefit to turmeric supplements which can offer anti-inflammatory benefits. Other than that, meditation, weight loss, and stress relief methods have been shown to be helpful. 


    A holistic approach.

    At MedStar Health, we evaluate each patient thoroughly, taking all their medical conditions into consideration and discussing how the disease affects their life. 


    Our collaborative team approach allows us to work closely with
    rheumatology because many people with psoriasis also have psoriatic arthritis—joint pain, swelling, and stiffness that can intermittently flare up damage the joints. Approximately 30% of patients with even mild psoriasis have psoriatic arthritis, as reported by the National Psoriasis Foundation

    Increasingly clearer is the connection between the skin and mental health. Stress can make skin diseases worse, particularly in psoriasis. The COVID-19 pandemic, for example, triggered many psoriasis flare-ups, and we continue to see more links between psoriasis and depression. 

    This is why, in addition to medical therapy, we often recommend behavioral therapy. Stress relief techniques, such as yoga, meditation, and exercise, are an important part of a holistic psoriasis treatment plan.

    As we are learning more about psoriasis, we have realized that this is a systemic inflammatory condition that goes beyond the skin and joints. Patients with psoriasis are also at increased risk for heart disease, high blood pressure, diabetes, high cholesterol, and fatty liver disease. So, it’s also important to see your regular primary care physician for routine health screenings.


    Another challenge many psoriasis patients face is insurance coverage. We understand how many hurdles there can be to accessing therapies, so we work closely and carefully with our patients to help facilitate insurance approval. We have nurses dedicated to making this process easier for patients and to help provide biologic injection training for patients to do their treatments at home.


    The research continues.

    Psoriasis is still not curable, but causes and treatments are continually studied, so new products will be coming to market soon:
    • Two new biologic therapies, Bimekizumab and Mirikizumab, are currently in clinical trials to determine whether they are effective and/or fast-acting for psoriasis clearance.
    • A new oral therapy, BMS-986165, is a daily pill and may not require bloodwork monitoring. Current oral therapies on the market—methotrexate and Otezla®—are not as effective as biologic therapies. Methotrexate requires bloodwork monitoring and can be harmful to the liver over the long term.
    • A new steroid-free topical agent, Tapinarof, seems to be very effective in early clinical trials.

    Skin diseases can fluctuate over time. Psoriasis might start mild, but it can progress and affect other areas where it didn’t show up initially. Seek care at the first sign of symptoms for a better chance of skin clearance.



    Is skin disease affecting your quality of life?

    Safer, faster treatments can help you enjoy more flare-free days. Request a visit with a MedStar Health dermatologist today.

    Request an Appointment

  • September 17, 2021

    By Jonathan Hwang, MD

    For years, the main goal of prostate cancer surgery was to get rid of the cancer, potentially adding years of life. But advances in prostate cancer screening and treatment have led to radical shifts in treatment recommendations, centered on a key question: How can we not only extend life but also improve a man’s quality of life after prostate cancer surgery?


    Prostatectomy—surgery to remove the prostate due to cancer—has evolved over my 15 years of performing these procedures at MedStar Health. 


    As the Mid-Atlantic’s most experienced nerve-sparing robotic prostatectomy provider, I’ve seen techniques shift from open surgery with long-term urinary, sexual, and mental health side effects to a modern, precise, minimally invasive procedure that greatly reduces negative side effects with dramatic improvements to patients’ long-term quality of life.   


    For men in the U.S., prostate cancer is the second most common cancer and second leading cause of cancer death. By the end of the year, nearly 250,000 men are expected to receive a new diagnosis and just over 34,000 men will die from prostate cancer. 


    The good news is that
    diagnosis of new prostate cancer cases continues to decline while survival rates increase. Reduction of stigma around men’s mental health—paired with advanced screening and imaging technology and refinements in robotic surgery—are making all the difference in not only successful cancer treatment outcomes but also men’s happiness and satisfaction with their care.

    Focusing on men’s mental (and physical) health.

    Having prostate cancer and undergoing treatment historically has been associated with negative side effects men might be hesitant to discuss, including:

    Because better screening technology helps us detect cancer sooner, patients are living longer—and our modern treatment options support both longevity and quality of life.  


    At MedStar Health, we look at the whole picture to determine the most effective treatment options that give patients the best chance to maintain or regain their sense of well-being. Our multidisciplinary team includes not only cancer experts and surgeons but also licensed therapists to help manage mental health symptoms. We make every effort to provide a safe, honest environment where patients feel comfortable discussing their concerns. 


    Quality of life will be a leading area of focus in our fall 2021 study with our research partner, Georgetown Lombardi Comprehensive Cancer Center, in collaboration with Hackensack Medical Center in New Jersey. The study will research treatment options that lessen the long-term effects of prostate cancer, as well as bladder and kidney cancer, to help patients live longer, healthier lives.

    MRI technology revolutionizes screening results.

    Advances in magnetic resonance imaging (MRI) technology over the past five years have revolutionized the way we screen men for elevated levels of prostate-specific antigen (PSA)—a protein made in the prostate and released into the bloodstream. 

    Men with prostate cancer typically have elevated levels of PSA. Previously, when high levels were detected through a PSA blood test, we would conduct a biopsy to collect and test prostate gland tissue for cancerous cells. This process had several drawbacks:

    • PSA tests can show elevated levels when no cancer is present. 
    • Elevated PSA can be a sign of other conditions, such as benign prostate enlargement, a urinary tract infection, or an inflamed prostate gland. 
    • Not all prostate cancers are life-threatening, since the cancer is slow growing in many men. Thus, the current goal is to identify patients at high risk of having clinically significant prostate cancer while avoiding unnecessary biopsies in men at low risk.

    Using advanced MRI technology, we’ve reduced the number of biopsies we perform by almost half while detecting the same number of cancer cases. Getting sharper, clearer MRIs also helps clinicians and patients make better decisions about who should undergo biopsy for prostate cancer—and who might benefit from certain treatments, including nerve-sparing robotic prostatectomy.

     

    The benefits of robotic surgery.

    MRI technology helps us precisely visualize where the cancer is located and whether it is spreading. Based on this information, as well as a patient’s age, overall health, and personal preferences, prostate cancer treatment can include:

    • Surgery
    • Radiation
    • Medication

    Surgery is typically the best way to remove the cancer, and MedStar Health continues to lead the Mid-Atlantic region in robotic surgery expertise. Using the da Vinci® surgical robot system, I have performed over 3,000 robotic nerve-sparing radical prostatectomies to treat prostate cancer by removing the entire prostate.

     

    Robotic surgery uses small incisions in the abdomen, through which the surgeon inserts tiny instruments. The robot’s movements mimic the human wrist but with greater dexterity, and its small camera provides a 3-D, magnified view of the prostate and surrounding tissue. Using a console to guide these instruments with extreme precision, we remove the prostate with minimal disruption to the surrounding healthy nerves and tissue that support normal urination and erection. 

    Benefits of this approach compared to open surgery include:

    • Shorter recovery time
    • A faster return to your normal urinary and sexual function 
    • Lower risk of surgical site infection
    • Less blood loss
    • Less pain overall

    Robotic surgical removal of the prostate is most beneficial for younger men because radiation can still be used if they have a cancer recurrence after surgery. Regardless of the patient’s age, I approach every patient’s treatment as if it were my own or a family member’s. I am frank and transparent about the risks and complications, such as urinary or erection problems, and remind them that healing is not the same in all men.

     

    MedStar Health has 15 years of follow-up data on men who have had the procedure. Many of my former patients are willing to share their experience with men who are considering the surgery. Every patient who is strongly considering surgery will have the option to speak with a former patient of a similar age and circumstance, which gives them more relatable expectations for life before and after surgery.


    As my practice is solely dedicated to performing robotic nerve-sparing prostatectomies, I  have assembled a robotic surgery team around me  which allows me to be directly available to all of my patients and their families through my email and our
    myMedStar Patient Portal; this communication approach has been especially helpful for men who travel more than one hour away from DC for their surgeries. I am here to support my patients and their families all the way from consultation through surgery and recovery.

    What to expect during recovery.

    After surgery, patients stay in the hospital for 23 hours or less—a major reduction from the three- to five-day stay typically required for open surgery. Most patients can walk independently the day of surgery, and most feel well enough to go back to work after three weeks.

     

    You will need to keep a catheter in for seven days (instead of three weeks with open surgery), and patients can safely remove the catheter at home. After it’s out, you can start driving right away—but you don’t have to drive to follow-up appointments! If you have no post-operative issues, we can conduct our follow-up visits virtually to save you time and stress.


    Considering #RoboticProstateSurgery? Benefits include shorter recovery time, lower infection risk, and less pain. #ProstateCancer #ProstateCancerAwareness: https://bit.ly/3CqYTQH.
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    New technologies and research.

    Beyond the da Vinci robotic surgery system, many more technologies in the pipeline will continue to allow surgeons to deliver increasingly precise prostate cancer care.


    Experimental studies and trials
    are using energy-based technology, such as cryotherapy, laser therapy, and high intensity focused ultrasound (HIFU), to develop effective treatments that focus only on the affected tissue. Whether robotically or manually driven, energy-based therapies are the new frontier in prostate cancer treatment.

    To determine if prostate cancer screening is right for you, first consider the risk factors: age over 50; being of African descent; having a family history of prostate cancer or an inherited gene mutation linked to colon, breast, or ovarian cancer. 


    Falling into one or more of these categories doesn’t mean you should be screened immediately, however. Current prostate cancer screening guidelines from the
    U.S. Preventive Services Task Force recommend that:

    • Men age 70 or older should not be routinely screened for prostate cancer.
    • Men age 55 - 69 should discuss the risks and benefits of screening with their doctor and decide together when to begin screening.

    When you and your doctor decide to proceed with screening, your well-being will continue to be our highest priority.

    Interested in a screening or visit with a robotic prostatectomy expert?

    Schedule an appointment today.

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