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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.
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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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  • September 27, 2019

    By MedStar Health

    Few environments may seem more different than a hectic emergency room and a quiet mountain trail. But Matthew Wilson, MD, feels right at home in both. As vice chair of Emergency Medicine at MedStar Washington Hospital Center, Dr. Wilson has a leading role in evaluating ways to improve the safety, efficiency and quality of Emergency Department procedures. He also serves as course director for Wilderness Medicine at Georgetown University’s School of Medicine, teaching students how to apply their medical knowledge when treating sick or injured patients in remote settings.

    As medical director for the National Park Service’s National Capital Region, Dr. Wilson coordinates teams that provide care during major events, such as the Independence Day celebration on the National Mall.

    Love of the Outdoors and Emergency Medicine

    Not surprisingly, it was an affinity for the outdoors that led Dr. Wilson to a career in medicine. While attending Davidson College in North Carolina, he trained as a firefighter and emergency medical technician in order to be part of forest fires response teams. “I found that I preferred the EMT side, because it’s constantly changing,” he explains. While at University of Virginia’s medical school, however, his choice of a specialty was anything but a given.

    "I was tempted by other fields, but I liked the broad nature of emergency medicine,” he says. “Every day brings something different, and you have to be ready to treat it.”

    As his wife, Molly, was in law school at George Washington University, Dr. Wilson considered himself fortunate to be matched for his internship and residency at the Hospital Center and MedStar Georgetown University Hospital. In addition to his daily responsibilities, he has authored more than 50 original papers, abstracts, and reviews for professional journals. He also has contributed to numerous hospital research projects, in areas such as developing protocols for tele-triage, which allows physicians and nurses to diagnose and determine the urgency of cases remotely, and using medical literature to guide the course of treatment, based on a patient’s risk factors.

    Curbing the Opioid Epidemic

    Countering the spread of opioid use is also a focus for the Hospital Center’s Emergency Department.

    “This is something that MedStar has been on top of since I came here,” Dr. Wilson explains. “Prescribing medications can be a tough target to hit, but we continually strive to avert any potential for over-dependency and abuse.”

    Outside of Work

    Not surprisingly, Dr. Wilson’s outside interests are often outside with his wife and three children—ages 12, 6 and 3. In addition to hiking and rock climbing locally, the family enjoys taking the outdoor wanderlust on the road, with the most recent trip to the famed Camino de Santiago in northern Spain.

  • September 27, 2019

    By MedStar Health

    Now that MedStar eVisit is available, there are more ways than ever before to see a medical provider. However, many people still don’t know when it’s most appropriate to have an eVisit, versus seeking medical attention at an urgent care center or emergency room.

    An eVisit is useful for minor health conditions. It allows you to chat with a provider by using video on your computer or using the MedStar eVisit app on your smartphone or tablet. Read on to learn more about MedStar eVisit and signs when it might be best to visit an urgent care center or emergency room instead.

    When to Use an eVisit

    Using MedStar eVisit can be extremely convenient, because you can speak to a provider at home or work, or even while traveling. eVisits are most effective for straightforward medical issues that can be easily described or visualized via video.

    The most common conditions that are treated during an eVisit include:

    • Common cold: A cold is easy to spot, as it generally causes a runny nose, cough, and mild sore throat. When you meet with a provider over an eVisit, they can work with you to come up with a treatment plan that suits your needs and helps you recover as quickly as possible.
    • Flu (Influenza): When you’re experiencing symptoms that are a clear sign of the flu, such as a sudden onset of fever, body aches, and chills, a provider can prescribe you medication to help you get over it faster. The flu can be serious, however, so if you experience more severe symptoms, make sure to see a doctor in person.
    • Pink eye: Also known as conjunctivitis, pink eye is a contagious condition that causes your eye to become pink, watery, and itchy. During an eVisit, a provider can typically confirm you have pink eye and prescribe you an effective medication.
    • Seasonal allergies: Millions of people experience seasonal allergies throughout the year, suffering from symptoms such as itchy eyes, runny nose, and sore throat. Fortunately, a provider can easily evaluate your symptoms during an eVisit and provide you with a treatment plan that helps alleviate your symptoms.
    • Sinus infection: When you have a sinus infection—or infected, swollen, or inflamed nasal cavities—a provider with discuss the severity of your symptoms with you and a treatment plan which may include an antibiotic.
    • Urinary tract infection (UTI): This infection typically has unique symptoms, such as frequent and urgent urination with a burning sensation, which make it easy for a provider to diagnose it without seeing you in person. In many cases, a provider may prescribe an antibiotic during your eVisit and create a follow-up plan to ensure your treatment goes as planned.
    An #eVisit can be a great way to receive treatment for conditions such as the #flu, a #cold, and a UTI. Learn how MedStar eVisit works and when to go to #urgentcare, via @MedStarHealth.

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    If you have any questions about whether an eVisit is a good idea for you and your particular situation, reach out to your primary care office or local urgent care nearest you. If you have an eVisit, and the medical provider tells you that you need to be seen in person, your eVisit will be reimbursed. It’s also important to verify that your insurance plan covers an eVisit. Some insurance companies do cover it these days, but it’s still a good idea to check before your eVisit session. In cases when your insurance does not cover MedStar eVisit, the cost is $49 per visit. Click to watch the video below for more information on how to use MedStar eVisit.

    What About Urgent Care?

    Urgent care centers treat the same conditions that MedStar eVisit can, but urgent care centers are better for more serious conditions, especially ones that are causing you pain. This is because pain is difficult for a provider to evaluate without examining you in person.

    Make sure to visit the nearest urgent care center if you have any of the following conditions:

    • Abdominal pain: Because the cause of abdominal pain can vary greatly, it’s important that you visit with a provider in person to receive the most accurate diagnosis and treatment.
    • Back pain: When you have back pain, a provider needs to physically evaluate your back to determine the source of your pain. Your provider may also perform imaging tests, such as an X-ray, so you can receive the best possible treatment.
    • Cuts: It can be difficult to determine the severity of a cut during an eVisit. While MedStar eVisit providers may be able to determine if you need stitches, they cannot provide them virtually.
    • Severe sore throat: When your throat hurts so bad that you have difficulty swallowing, it might be a sign that you have a condition that’s more serious than a cold. Make sure to visit an urgent care center for treatment.
    • Sports injuries: These can range from an ankle sprain to a broken bone (we wouldn’t handle a dislocated shoulder) or an anterior cruciate ligament (ACL) tear. In most cases, we need to physically see your injury (and sometimes do imaging tests) to properly diagnose your injury.

    In any life threatening emergency, go to the nearest emergency room (ER) or call 911 for immediate treatment. You should go to the ER if you have any of the following symptoms:

    • Chest pain
    • Coughing up blood or vomiting blood
    • Shortness of breath
    • Uncontrolled bleeding
    • Severe & persistent abdominal pain

    Every patient is unique, so there may be times when you will need to seek follow up care after your MedStar eVisit at an urgent care center or the ER. The good news is that you and your family have more convenient access to health care options.

    See a provider conveniently from home or work. Click the button below to try a MedStar eVisit today.

    Sign Up Today

  • September 20, 2019

    The ketogenic (keto) diet started to gain popularity in the 1990s, but the interest has really spiked in the last couple of years. This eating pattern was originally developed and used to treat severe epilepsy in infants and children under medical supervision. Today, the diet is gaining attention because of its promise for quick weight loss without the nagging feeling of hunger.

    Keto refers to any diet that creates the metabolic state of ketosis, which is when the body burns fat for fuel instead of glucose. In normal metabolism, carbohydrates are broken down into glucose and absorbed through the small intestine, then they travel to the liver and are stored as glycogen where the body uses this for fuel as needed. In order for your body to burn fat instead of glucose, a high-fat low-carbohydrate diet is emphasized.

    Read on to learn more about the keto diet and if it’s right for you.

    The Keto Diet Details

    A clinical keto diet limits carbs to 20-50g per day, primarily from non-starchy vegetables, and protein is kept high enough to maintain lean body mass, but low enough to kick your body into ketosis (typically around 1 gram per kilogram of body weight) and 75 percent or more of total calories from fat. For a 150-pound woman following a 1500 calorie diet, this might break down to 140g of fat, 69g protein, and 27g of carbohydrates per day. However, now that the keto diet has gone mainstream, this nutrient distribution varies widely. Despite the differences in percentages, these are some common foods that fit in the high-fat category and are popular among people who follow a keto diet:

    • Avocados
    • Cheese, yogurt, milk and cream
    • Butter and various oils (olive, coconut, avocado, etc.)
    • Eggs
    • Nuts and seeds
    • Meat and poultry
    • Fatty fish (such as salmon)

    Pros and Cons to the Keto Diet

    The popularity of keto is not without merit; it is a diet that is often touted as easy to stick to especially when compared with low-fat diets. This is attributed to the satiety (feeling of fullness) that likely comes from the fat and protein in the diet. There is also some evidence that there are changes in hormones while following the diet that result in appetite-suppression. A 2014 meta-analysis found that individuals who followed a keto diet experienced less hunger and reduced desire to eat, even as they continued to lose weight. Other studies have found reduced triglycerides and blood pressure along with weight loss. For those with diabetes, the keto way of eating could improve insulin sensitivity and glycemic control, according to some studies.

    One of the main reasons nutrition experts are not sold on the diet is because avoiding carbohydrates causes you to miss out on the vitamins, minerals, and antioxidants found in fruits, whole grains, and starchy vegetables. Therefore, there is a concern for vitamin and/or mineral deficiencies. Whole grains and fruits are also a great source of fiber which is an important nutrient that helps with gut regularity, reducing cholesterol, and weight loss. Long term studies on the ketogenic diet are limited at this time.

    Interestingly, both high (<70 percent) and low carbohydrate (<40 percent) diets were shown to increase the risk of death in a recent meta-analysis over a follow-up period of 25 years.

    The bottom line is that the keto diet is a good diet to consider for weight loss. But if you are pregnant, have kidney disease, or any fat malabsorption issue, you will want to discuss this diet with your doctor first. If you decide to follow this diet, know that all fat is not created equal. Saturated and trans fat can increase bad cholesterol levels, so be sure to make most of your fat calorie intake from healthier sources of fat from monounsaturated and polyunsaturated fats. These include avocados, nuts, seeds, and olive oil. Don’t forget to consider other diets that have been shown to promote health while helping with weight loss, such as the Mediterranean diet.

    Want to receive nutrition advice from one of our experts? Click below to learn more about our nutrition counseling services.

    Learn More

  • September 17, 2019

    By MedStar Health

    Acne is common in teenagers, but it can also linger and become a more persistent problem for women in their late 20s, 30s, or 40s or even later. Acne typically occurs when hair follicles (tiny sacs from which hair grows, also called pores) become clogged by oil and dead skin cells. Acne causes pimples, whiteheads, blackheads, or cysts, usually on the:

    • Face
    • Chest
    • Upper back
    • Shoulders

    If you’re frustrated and not satisfied with how your skin is looking, a dermatologist can help. Let’s look at what causes adult acne, how it’s treated, and how you can protect your skin.

    LISTEN: Dr. Ronkainen discusses adult acne in the Medical Intel podcast.

    What Causes Acne?

    While bacteria and inflammation are the two main culprits, one or more of the following can lead to the development of acne:

    • Hormones: Changes in hormone levels tend to occur during menstrual periods, pregnancy, perimenopause (the years leading up to menopause), and menopause. They can also result from stopping or starting birth control pills. An imbalance in hormones can lead to acne breakouts.
    • Stress: According to the American Academy of Dermatology, research has shown a connection with stress and acne flareups. When we’re stressed, our bodies produce more hormones, and the hormones trigger our oil glands and hair follicles, which can lead to acne.
    • Family history: Similar to other health issues, some studies say certain people may have a genetic predisposition for acne. People who have this predisposition seem more likely to get adult acne.
    • Hair and skin care products: What you’re putting on your hair or skin can cause acne. First, you need to make sure that the products that you’re using on your skin are not blocking your pores. Use products that are labeled non-acnegenic, non-comedogenic or oil-free.
    • Medications: Acne can be a side effect of certain medicines. If you suspect that a medicine is triggering your acne or making it worse, continue taking the medicine, but talk with the doctor who prescribed it.

    Patients often ask if diet can influence the risk of developing acne. There is one study that shows a correlation between skim milk and an increased development of acne. We don’t know exactly why that is, but patients in the study who drank regular or whole-fat milk did not have increased development of acne.

    We also see patients with inflammatory bumps or acne-like lesions on the body. Most of the time, these are related to folliculitis, which is an infection of the hair follicles. This infection usually happens on areas of the skin that are covered by clothes, such as the buttocks or the thighs.

    Treatment for Acne

    If you have moderate or frequent breakouts, you can benefit from consulting with a dermatologist. Acne treatment usually begins by discussing your home skin care regimen. This information helps us know what has or has not worked, and then we can fine-tune your treatment.

    There are many over-the-counter treatment options for acne, and there are different ingredients that patients can try. Benzoyl peroxide is a classic treatment for acne that targets the bacteria that grows on the skin. There’s also salicylic acid, which helps prevent pores from becoming clogged. Glycolic acid removes the outside layer of dead skin cells and leaves your skin brighter and fresher. Sulfur also removes dead skin cells and can help remove excess oil. These products can be coupled with prescription products such as topical antibiotics, topical retinoids, or oral medications if necessary. Acne can be frustrating to treat. Patients want quick results, and it can take up to three months to see if a new acne regimen is going to work.

    As tempting as it is, patients should not pop their pimples. Breaking the skin can cause more inflammation and scarring in the long run. If patients have a really deep, painful acne bump, they can come into the clinic and have an injection of anti-inflammatory medication to help soothe the area. Trying to pop the pimple yourself tends to be a more frustrating process for patients in the long run.

    Acne is common in teenagers, but it can also linger and become a more persistent problem for women in their late 20s, 30s, 40s, or even later, says Dr.  Ronkainen https://bit.ly/2Nlg0h4 via @MedStarWHC

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    The Best Source for Acne Care

    At MedStar Washington Hospital Center, we provide evaluation, diagnosis, management, and treatment for a full range of diseases of the skin. Our team of board-certified dermatologists and experienced dermatology nurse practitioners provides head-to-toe care for common skin disorders. We collaborate with colleagues to care for patients whose skin may be affected by HIV, infectious diseases, and malignancies such as cutaneous lymphomas. We see acne patients every day in our clinic, and there’s nothing more satisfying than having a patient come back three months after you started them on a regimen and seeing how well they’re doing.

    Adult acne is very common, and it’s important to know you’re not alone. With a dermatologist’s help, you can find a regimen to help heal your skin.

    Experiencing acne breakouts? Request an appointment with a dermatologist below or call 202-877-3627.

    Request an Appointment

  • September 13, 2019

    By MedStar Health

    With the fall sports season underway, athletes of all ages are gearing up for success. Unfortunately, the season can end quickly for athletes who sustain an injury.

    The good news is many sports injuries are preventable with careful preparation before the season begins—and a little common sense.

    The Most Common Sports Injuries

    Bruises, muscle strains, and joint sprains are among the most common sports-related injuries. Athletes tend to recover from these types of injuries fairly quickly, especially if the injuries are treated soon after they occur.

    Major injuries, such as broken bones or ligament ruptures, are more likely to occur early in the sports season. Many of these injuries occur because athletes have not prepared physically for their sport before the season began.

    Your age can also put you at greater risk for certain injuries. Because they are still growing and not as experienced in their sport, younger athletes are at high risk for sports injuries. These injuries can include bone fractures. A unique children’s fracture involves an athlete’s growth plate, which is where bones grow longer as children grow taller. A fracture to the growth plate can cause permanent damage and result in abnormal growth of the affected bone.

    As athletes age, their soft tissue becomes stiffer and less resilient, leading to a greater risk for tendon ruptures. For example, an Achilles tendon rupture — which occurs when the tendon connecting your calf muscles to your heel bone tears—is a major injury requiring surgery and months of rehabilitation.

    Concussions are also a concern for all athletes, regardless of age or sport. If you sustain any sudden head trauma or movement, there is a risk of concussion and with any associated symptoms like loss of balance, headache, or confusion (to name just a few), you should be evaluated immediately for a concussion. Your certified athletic trainer or physician should assess your condition using a concussion protocol, which outlines how a concussion is diagnosed and is then managed all the way through returning to play.

    Can You Prevent an Injury?

    According to the Centers for Disease Control and Prevention, more than 2.6 million young athletes will suffer a sports-related injury this year. More than half of those are preventable.

    While some injuries are unavoidable, there are steps you can take to limit your risk of an injury, including:

    • Get fit before the season begins. Focus your attention on strength training and aerobic fitness to get your body in shape before the start of your sports season.
    • Train for your sport. Very few athletes excel at their sport without practicing it first. Develop the unique skills for your sport in the off-season.
    • Avoid specializing in a single sport, especially at a younger age. The risk of overuse injuries, which occur because of repeated wear and tear on your muscles, ligaments, and bones, can decrease by taking a break during seasons and playing a variety of sports. Stress fractures, overuse injuries such as elbow ulnar collateral ligament injuries, and major injuries to the knee such as anterior cruciate ligament (ACL) tears are often seen in athletes who play one sport continuously without any break between seasons.
    • Schedule a pre-participation physical exam. This important screening assesses your overall health and risk of injury before the start of your sports season.
    • Use common sense. Make sure to stretch and warm up properly before practicing your sport. If you feel any unusual symptoms, including soreness or pain, make sure to speak with your certified athletic trainer, if available, or your physician. They will evaluate you to determine the source of your symptoms.

    Related Reading: Playing Sports? 3 Tips to Prepare You for the Season

    Treating Your Injury

    It’s important to get treatment as soon as possible if you sustain a sports-related injury. You should speak with your certified athletic trainer or physician to determine the extent of your injury and a treatment plan. If your team does not have a certified athletic trainer, it is recommended that you seek medical attention from a qualified doctor.

    Specializing in a single sport can put young athletes at greater risk of sports injuries. Learn steps to prevent #sportsinjuries. via @MedStarHealth

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    You may also use the RICE (rest, ice, compression, and elevation) method at home to relieve your symptoms—though this should never replace appropriate medical care. Every injury is unique, so it’s important to talk to your certified athletic trainer or doctor to get an accurate diagnosis and personalized treatment plan for your specific injury.

    When you receive treatment, remember to ask these important questions:

    • Are there any alternative treatments available for treating my injury?
    • What activity limitations do I have because of my injury?
    • When do I need to follow up during my recovery process?
    • When can I expect to return to my sport?

    Your doctor may give you a ballpark estimate for when you can expect to return to play. It’s important to remember this is only an estimate, because everyone heals at a different rate. Before you resume your activities, your doctor should completely evaluate you, and your certified athletic trainer should clear you using a return-to-play protocol.

    By following the advice of your healthcare team and taking a few extra steps to prepare in the off-season, you can minimize your risk of a sports injury.

    Get the care you need for your sports injury. Schedule an appointment today.

    Make An Appointment

  • September 10, 2019

    By Kenneth L. Fan, MD

    Women who undergo surgery to treat breast cancer may think of breast reconstruction as a cosmetic procedure—one they don’t really need for their health. But many women are shocked to learn that breast reconstruction surgery isn’t just an option for them, but mandated by law. If patients are having a mastectomy (removal of the breast) that is covered as part of their breast cancer treatment, their insurance must also cover breast reconstruction surgery under the Women’s Health and Cancer Rights Act of 1998.

    While the choice to get breast reconstruction is a very personal decision, studies have shown that reconstruction after cancer surgery can lead to tremendous gains in patients’ quality of life, with benefits to sexuality, body image, and overall well-being by restoring the appearance of their breasts. However, breast reconstruction can be a complex procedure, and each patient and her circumstances are unique. That’s why it’s critical for a team of breast surgeons and plastic surgeons, along with the patient, to discuss what the right reconstruction option is early on in the process.

    LISTEN: Dr. Fan discusses breast reconstruction surgery in the Medical Intel podcast.

    Choosing the Right Breast Reconstruction Surgery

    Women from all walks of life come to us for both breast cancer surgery and reconstruction afterward. That’s why there’s no cookie-cutter, one-size-fits-all approach to breast reconstruction.

    For example, some of our patients have very active lifestyles and want to get back to their normal routines of work, exercise, and recreation right away. There are certain types of breast reconstruction surgery that can help make that happen. Other women want this to be the last breast surgery they have, and we have procedures that are tailored for that preference as well.

    No two women have exactly the same expectations, goals, or needs for their breast cancer and breast reconstruction surgeries. It’s important for the whole team to examine each case individually so we can choose together what will be the best reconstruction option for each patient ahead of time.

    #Breastreconstruction after #breastcancer surgery is different for everyone. Make sure you and your treatment team discuss your options ahead of time and that your team knows your goals and wishes. #plasticsurgery https://bit.ly/2URkDk8 via @MedStarWHC

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    Breast Reconstruction Options

    We use three main methods for reconstructing patients’ breasts following breast cancer surgery. The first is called the oncoplastic approach. In this technique, the breast surgeon takes a small tumor out of the patient’s breast, and the plastic surgeon rearranges tissue within the breast to fill in the gap created by the tumor’s removal. We can also reduce the other breast to match the size.

    Another option is prosthetic-based reconstruction. After the breast surgeon performs a mastectomy, we use a smooth breast implant or a temporary device called an expander to help reconstruct the breast. The expander is replaced later on with a smooth implant.  However, implants are not a permanent solution, they inevitably need to be replaced.

    In the third reconstructive option, called autologous space reconstruction, we use the patient’s own muscle, skin, fat, and blood vessels to help recreate a natural-looking breast after a mastectomy. We typically take the tissue we need from the belly, similar to a tummy tuck, or the back, depending on where a patient may have extra tissue for the reconstructive surgeon to use.

    Related reading: Why is autologous breast reconstruction better than breast implants?

    We generally can complete any of these reconstructive procedures in the same operating room directly following breast cancer surgery. However, in some cases, we must perform what’s called delayed reconstruction, in which we wait until a later date to reconstruct the patient’s breast. This can be due to a number of factors, such as a patient’s:

    • Breast cancer stage
    • Individual preference
    • Medical condition
    • Need for additional treatment, such as radiation therapy

    There is no particular preparation that the patient has to do ahead of her breast cancer surgery. However, the breast surgeons and plastic surgeons will meet as a team to discuss the patient’s particular needs and how to best accomplish the goals of both treatment and reconstruction.

    Life After Breast Reconstruction

    For many patients who undergo reconstructive surgery, the greatest hope and goal is that no one would be able to tell they ever had breast cancer when they’re clothed. Depending on the characteristics of their cancer and the particular treatments they have had, we can achieve that goal for many of our patients.

    Many women are concerned about the recovery time after breast reconstruction surgery, and it depends a lot on the reconstruction method we use. Of course, each patient’s recovery is unique, but generally speaking, procedures with breast implants and expanders have a shorter recovery time, while procedures that use the patient’s own tissues have a longer recovery time. However, we have been successful in speeding up the recovery process with our multimodal pain medication pathway that we use after breast reconstruction surgery.

    The Best Source for Breast Reconstruction Care

    Much of our research involves the use of a protocol called enhanced recovery after surgery (ERAS), which we routinely employ. This is a holistic, patient centered approach to pain management, where the patient and the provider discuss pain prior to surgery. The goal is to use medication that targets the way the nerves fire before, during, and after surgery and limit the use of narcotics.

    Our anesthesiology colleagues, including Dr. Susan Dumsha Stasiewicz who was a pioneer in the field, utilize medications during surgery that increase patients’ comfort and minimize the number of narcotics they take. We use a long acting, slow release local anesthesia block that numbs the nerves for up to 72 hours. After surgery, we use additional nonnarcotic medication to control pain.

    Before we implemented ERAS protocol, autologous breast reconstruction, such as the MS-TRAM or a DIEP flap, was considered a more painful operation with a prolonged recovery course. However, with this multidisciplinary approach, we now significantly reduce patients’ hospital stays and commonly see patients only take one, two, or no narcotic tablets after surgery. These results have been submitted to a peer-reviewed journal.

    Related reading: How We Reduce Pain After Plastic Surgery with the ERAS Protocol

    Our team focuses not just on our patients’ breast cancer or their reconstructive process, but on the patient as a person. We work to understand each patient’s individual needs and engage with them so everyone is on the same page about the patient’s desires and expectations.

    For many women, breast reconstruction is a vital part of the healing process after breast cancer surgery. Patients should make sure they know their rights and options for reconstruction from the beginning of their treatment process.

    If you have breast cancer and are curious about your breast reconstruction options, we can help. Request an appointment with a plastic surgeon below or call 202-877-3627.

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