Podcast appearances and mentions of washington hospital center

Rabbi Dr. Shira Stern, BCC, serves as Disaster Spiritual Care Manager for the American Red Cross and as ARC Division Advisor for the Northeast and Lead for Massachusetts and Northern New England.  Her ARC deployment to the 2025 LA Fires was featured in the Berkshire Eagle.  She previously appeared on NeshamaCast in Episode 2 . She served as Consulting Editor for Mishkan Refuah: Where Healing Resides. Rabbi Stern is a Past President of NAJC. Rabbi Dr. Jason Weiner, BCC, serves as the senior rabbi and director of the Spiritual Care Department at Cedars-SInai in Los Angeles and as Rabbi of Knesset Israel Synagogue of Beverlywood. Among his many publications are: A Jewish Guide to Practical Medical Decision Making, Care and Covenant: A Jewish Bioethic of Responsibility, and a Guide to Observance of Jewish Law in a Hospital.   Special thanks to Henry Bernstein, Allison Atterberry and Gabe Sniman for on site technical production. About our host:Rabbi Edward Bernstein, BCC, is the producer and host of NeshamaCast. He serves as Chaplain at Boca Raton Regional Hospital of Baptist Health South Florida. He is a member of the Board of Neshama: Association of Jewish Chaplains. Prior to his chaplain career, he served as a pulpit rabbi in congregations in New Rochelle, NY; Beachwood, OH; and Boynton Beach, FL. He is also the host and producer of My Teacher Podcast: A Celebration of the People Who Shape Our Lives. NeshamaCast contributor Rabbi Katja Vehlow was ordained at the Jewish Theological Seminary and is Director of Jewish Life at Fordham University. She trained as a chaplain at Moses Maimonides Medical Center in New York. Previously, she served as Associate Professor of Religious Studies at University of South Carolina. A native German speaker, she is planning a forthcoming German-language podcast on the weekly Torah portion with a focus on pastoral care. NeshamaCast contributor Chaplain David Balto is a volunteer chaplain at Washington Hospital Center in Washington, D.C. and Western Correctional Insitution, Maryland's maximum security prison. He coordinated the annual National Bikur Cholim Conference. Support NeshamaCast and NAJC with a tax deductible donation to NAJC. Transcripts for this episode and other episodes of NeshamaCast are available at NeshamaCast.simplecast.com and are typically posted one week after an episode first airs. Theme Music is “A Niggun For Ki Anu Amecha,” written and performed by Reb-Cantor Lisa Levine. Please help others find the show by rating and reviewing the show on Apple Podcasts or other podcast providers. We welcome comments and suggestions for future programming at NeshamaCast@gmail.com. And be sure to follow NAJC on Facebook to learn more about Jewish spiritual care happening in our communities.

Rabbi Gabe Kretzmer Seed serves as a Jewish chaplain in the New York City Department of Correction where he provides religious services and spiritual support primarily for Jewish inmates. He also teaches and tutors for children and adults in the community, and provides research support for a number of Jewish Studies scholars, including as a research assistant to Rabbi Irving Greenberg for his acclaimed book "The Triumph of Life: A Narrative Theology of Judaism."  Rabbi Kretzmer Seed has Rabbinic Ordination from Yeshivat Chovevei Torah and also received BA and MA degrees from The Jewish Theological Seminary – JTS—where he focused on Talmud and Midrash. Following ordination, Rabbi Kretzmer Seed completed a CPE residency at Mount Sinai Beth Israel Hospital in Manhattan, where he worked in the hospital's palliative care, oncology and psychiatric units.Rabbi Mia Simring was ordained by the Jewish Theological Seminary, in her native New York City. She also holds a certificate in Pastoral Care and Counseling and has focused her rabbinic work on chaplaincy in hospitals, long term care facilities, and now, correctional facilities. She is currently serving as a Jewish Chaplain for the New York City Department of Correction, working with both pre- and post-trial detainees. Prior to her rabbinical studies, she received an undergraduate degree in East Asian Studies from Brown University, worked in Japan, and then in the Japanese Art Department at Christie's NY. Read more about her here. In the discussion, Rabbi Gabe mentions "To Walk in God's Ways," by Rabbi Joe Ozarowski, who appears on NeshamaCast, Episode 1. Rabbi Gabe also mentions his mentor, Rabbi Jo Hirschmann, BCC, who is the co-author, with Rabbi Nancy Wiener, of "Maps and Meaning: Levitical Models for Contemporary Care." This book was discussed with Rabbi Nancy Wiener on NeshamaCast, Episode 8.The story Rabbi Gabe shares in this interview of being physically assaulted appears in the book "Rikers: An Oral History," by Graham Rayman and Reuven Blau. Talmudic text discussed in interview: Ein havush matir atzmo mibeit ha'asurim--"A person in prison cannot free himself," From Tractate Berakhot 5b. Hebrew and Technical Terms: Ashrei, literally, "Happy are those," from Psalms 84:5; this verse recurs frequently in Jewish liturgy as a prelude to Psalm 145. Eliyahu HaNavi—Elijah the Prophet, regarded in Jewish tradition as the one who will herald the coming of the MessiahGet--Jewish writ of divorce, traditionally given from the husband to the wife to end the marriage. An ongoing struggle in traditional Jewish communities is the plight of Agunot (literally, "chained"), women whose marriages have ended for all practical reasons but have not received a Get from the husband to formally end the marriage, the receipt of which is necessary in order to marry someone else. Reference is made in the interview to: ORA--Organization for the Resolution of Agunot. Ha Lachma Anya--From the Passover Haggadah: "This is the bread of affliction that our ancestors ate in Egypt..."Had Gadya—literally, “One Little Goat,” the final hymn in the traditional Seder.Halakhah--Jewish law, as derived from Rabbinic Jewish tradition in the Talmud and later Jewish codes. Halakhically--a Hebrew-English adverb referring to actions done according to Halakhah, or Jewish law. Hashgacha-Kosher supervisionHIPAA--the Health Insurance Portability and Accountability Act protects patient privacy in the American heath care system. It generally does not apply to the prison and jail systems.Humash--A volume comprising the five books of the Torah: Genesis, Exodus, Leviticus, Numbers and DeuteronomyKehillah--Community, usually referring to a synagogue community. Midrash (plural: Midrashim)--a homiletical interpretation of Biblical scripture, usually referring to the Rabbinic body of literature known as THE Midrash, compiled by Rabbis over the first millennium of the common era, often reflecting ancient oral interpretations of Biblical text.Moshiach-the MessiahMotzi—The blessing over bread, traditionally said whenever eating bread but most commonly said over full loaf of bread or matzah at a Sabbath or holiday meal. Parashah--The weekly portion of the Torah/Pentateuch that is read aloud in synagogue. Sh'ma--The Jewish declaration of faith from Deuteronomy 6:4, recited morning and evening in daily liturgy. Shul--A common term for synagogueSiddur--Jewish prayer bookTeshuvah--Repentance.Tfillot--plural for T'fillah, Jewish prayer Jewish Chaplains: Register for the NAJC 2025 Conference in Skokie, IL, May 11-14, 2025.  Watch this video to learn more.  About our host:Rabbi Edward Bernstein, BCC, is the producer and host of NeshamaCast. He serves as Chaplain at Boca Raton Regional Hospital of Baptist Health South Florida. He is a member of the Board of Neshama: Association of Jewish Chaplains. Prior to his chaplain career, he served as a pulpit rabbi in congregations in New Rochelle, NY; Beachwood, OH; and Boynton Beach, FL. He is also the host and producer of My Teacher Podcast: A Celebration of the People Who Shape Our Lives. NeshamaCast contributor Rabbi Katja Vehlow was ordained at the Jewish Theological Seminary and is Director of Jewish Life at Fordham University. She trained as a chaplain at Moses Maimonides Medical Center in New York. Previously, she served as Associate Professor of Religious Studies at University of South Carolina. A native German speaker, she is planning a forthcoming German-language podcast on the weekly Torah portion with a focus on pastoral care. NeshamaCast contributor Chaplain David Balto is a volunteer chaplain at Washington Hospital Center in Washington, D.C. and Western Correctional Insitution, Maryland's maximum security prison. He coordinated the annual National Bikur Cholim Conference. Support NeshamaCast and NAJC with a tax deductible donation to NAJC. Transcripts for this episode and other episodes of NeshamaCast are available at NeshamaCast.simplecast.com and are typically posted one week after an episode first airs. Theme Music is “A Niggun For Ki Anu Amecha,” written and performed by Reb-Cantor Lisa Levine. Please help others find the show by rating and reviewing the show on Apple Podcasts or other podcast providers. We welcome comments and suggestions for future programming at NeshamaCast@gmail.com. And be sure to follow NAJC on Facebook to learn more about Jewish spiritual care happening in our communities.

Rabbi Aaron Lever serves as Director of Spiritual Care at Menorah Life in St. Petersburg, FL. He received rabbinical ordination at the Jewish Theological Seminary and became a Board-Certified Chaplain through NAJC. He is a Reiki Master Teacher, a musician and a puppeteer.Rabbi Lever is a co-author, along with Rabbi Simcha Weintraub, of "Guide Me Along the Way: A Spiritual Guide to Surgery," Jewish Healing Center, 1998. He also wrote this article in which he references the story about Itzhak Perlman playing on three strings. Here is the same story as told by Rabbi Jack Riemer, who appears on the previous edition of NeshamaCast in this feed. There is debate as to whether the story about Itzhak Perlman and the three strings is true or apocryphal, as discussed in Snopes.com. For NAJC members and Jewish chaplains considering joining NAJC, registration is now open for the NAJC Conference, May 11-14, 2025, Skokie Illinois, at the Doubletree Hotel. Click here for more information.  About our host:Rabbi Edward Bernstein, BCC, is the producer and host of NeshamaCast. He serves as Chaplain at Boca Raton Regional Hospital of Baptist Health South Florida. He is a member of the Board of Neshama: Association of Jewish Chaplains. Prior to his chaplain career, he served as a pulpit rabbi in congregations in New Rochelle, NY; Beachwood, OH; and Boynton Beach, FL. He is also the host and producer of My Teacher Podcast: A Celebration of the People Who Shape Our Lives. NeshamaCast contributor Rabbi Katja Vehlow was ordained at the Jewish Theological Seminary and is Director of Jewish Life at Fordham University. She trained as a chaplain at Moses Maimonides Medical Center in New York. Previously, she served as Associate Professor of Religious Studies at University of South Carolina. A native German speaker, she is planning a forthcoming German-language podcast on the weekly Torah portion with a focus on pastoral care. NeshamaCast contributor Chaplain David Balto is a volunteer chaplain at Washington Hospital Center in Washington, D.C. and Western Correctional Insitution, Maryland's maximum security prison. He coordinated the annual National Bikur Cholim Conference. Support NeshamaCast and NAJC with a tax deductible donation to NAJC. Transcripts for this episode and other episodes of NeshamaCast are available at NeshamaCast.simplecast.com and are typically posted one week after an episode first airs. Theme Music is “A Niggun For Ki Anu Amecha,” written and performed by Reb-Cantor Lisa Levine. Please help others find the show by rating and reviewing the show on Apple Podcasts or other podcast providers. We welcome comments and suggestions for future programming at NeshamaCast@gmail.com. And be sure to follow NAJC on Facebook to learn more about Jewish spiritual care happening in our communities.

David Balto is a volunteer chaplain at Washington Hospital Center  in Washington, D.C., the Hebrew Home of Greater Washington and Western Correctional Insitution, Maryland's maximum security prison.  He and his wife Naomi are actively involved in bikur cholim (care for the sick) with Bikur Cholim of Greater Washington and are co-sponsors of the annual National Bikur Cholim Conference.  David is also a volunteer for Ruach and a student in Aleph's program for spiritual direction.Rabbi Lynn Liberman, BCC, is Acting Co-President of NAJC. She works as the Jewish Community Chaplain of the Twin Cities.   Ordained in 1993 from the Jewish Theological Seminary of America, Lynn worked over 20 years in congregations before moving into full-time chaplaincy.   In addition to her Community Chaplain position, Lynn also works as a Per Diem Chaplain at two area Hospitals, including a Trauma One Center, and has been a volunteer Police/Fire Chaplain for 25 years.   Lynn has proudly served on the NAJC board for four years.  She and her spouse live in St. Paul, MInnesota.Click here for information on the National Bikur Cholim Conference, including links to recordings of past programs.  About our host:Rabbi Edward Bernstein, BCC, is the producer and host of NeshamaCast. He serves as Chaplain at Boca Raton Regional Hospital of Baptist Health South Florida. He is a member of the Board of Neshama: Association of Jewish Chaplains. Prior to his chaplain career, he served as a pulpit rabbi in congregations in New Rochelle, NY; Beachwood, OH; and Boynton Beach, FL. He is also the host and producer of My Teacher Podcast: A Celebration of the People Who Shape Our Lives. NeshamaCast contributor Rabbi Katja Vehlow was ordained at the Jewish Theological Seminary and is Director of Jewish Life at Fordham University. She trained as a chaplain at Moses Maimonides Medical Center in New York. Previously, she served as Associate Professor of Religious Studies at University of South Carolina. A native German speaker, she is planning a forthcoming German-language podcast on the weekly Torah portion with a focus on pastoral care. Support NeshamaCast and NAJC with a tax deductible donation to NAJC. Transcripts for this episode and other episodes of NeshamaCast are available at NeshamaCast.simplecast.com and are typically posted one week after an episode first airs. Theme Music is “A Niggun For Ki Anu Amecha,” written and performed by Reb-Cantor Lisa Levine. Please help others find the show by rating and reviewing the show on Apple Podcasts or other podcast providers. We welcome comments and suggestions for future programming at NeshamaCast@gmail.com. And be sure to follow NAJC on Facebook to learn more about Jewish spiritual care happening in our communities.

Episode 041 | ***Please note that this episode was recorded in October 2024 and is being published on January 16, 2025. Dr. Swigost's tale has evolved in some big ways since that time, including the announcement of the imminent closure of Dapper Dermatology in Austin, TX on 2/28/2025. Adam shared with me that he has no regrets about this experience, and I believe it. He's undoubtedly more prepared now than ever to serve his patients in the way that suits him best. (Suits! Dapper! The PUNisher, Dr. Aamir Hussain, will hopefully appreciate this.) If you love him like I do and want to know more, stay tuned for future episodes or reach out to him directly to say hello. Now on with the show!***  Dr. Adam Swigost is a board-certified dermatologist and entrepreneur. He founded Dapper Dermatology, which started as North Dakota's first and only entirely virtual dermatology clinic and evolved into a full service direct care dermatology clinic located in Austin, TX (closing 2/28/2025 as discussed above). Above all, Dr. Swigost is an advocate for physician autonomy and reinvigorating the patient-physician relationship, and he will no doubt bring an outstanding and innovative suite of services to wherever he is headed next.He completed his undergraduate degrees and medical training at the University of North Dakota. He completed his internship through the University of Central Florida in Ocala, FL, and his dermatology residency at Medstar Georgetown University Hospital and Washington Hospital Center in Washington, DC. He is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the Gay and Lesbian Dermatology Association.If you aren't one of the 186 people (or 86 people plus my mom 100 times -- thanks, Ma!) who have listened to Episode 004 published on January 11th, 2024 back when the show was still called The Direct Care Derm, I highly recommend you check that out first and then come back to this episode. You'll have fun learning about Dr. Swigost's origin story, and you'll get to hear me suck at podcasting way more than I do now. Win-win! I hope you enjoy the show(s).Connect with Dr. SwigostDapper Dermatology Instagram info@dapperdermatology.comMore from Dr. Lewellis and Above & Beyond DermatologyNeed a dermatologist? Fill out this short interest form, text or call me at 715-391-9774, or email me at drlewellis@aboveandbeyondderm.com if you'd like to have a no obligation discovery call. I offer in-office visits, house calls, and virtual care in Wisconsin and virtual care in Illinois, Nebraska, and Colorado.Have an idea for a guest or want to be on the show yourself? Send me a text or email, and we'll see if it's a good fit.

Kathleen K Mairella PT DPT MA FAPTAEducation:Degree: Doctor of Physical TherapyInstitution: MGH Institute of Health Professions, Boston, MA Major; Physical TherapyDate: May 2006Degree: Master of ArtsInstitution Teachers College, Columbia University, New York, NY Major: Movement Science and EducationDate: May 1992Degree: Bachelor of ScienceInstitution: Boston University, Boston MA Major: Physical TherapyDate awarded: May 1978Employment and Positions Held:Professor Emerita, Rutgers University, 2022-presentDirector of Clinical Education and Assistant Professor, Rutgers University, School of Health Professions, Doctor of Physical Therapy Program, Newark NJ, 2016-2022Assistant Professor, Rutgers University, School of Health Professions, Doctor of Physical Therapy Program, Newark NJ, 2014-2016Assistant Director of Clinical Education and Assistant Professor, Rutgers University (University of Medicine and Dentistry of New Jersey prior to July 1,2013), School of Health Related Professions, Doctor of Physical Therapy Program, Newark NJ , 2006-2014Physical Therapist, Brookdale Physical Therapy, Nutley, New Jersey, 2007-2008Instructor, University of Medicine and Dentistry of New Jersey/School of Health Related Professions, Doctor of Physical Therapy Program, Newark, New Jersey, 2004-2006Adjunct Instructor, University of Medicine and Dentistry of New Jersey/School of Health Related Health Professions, Doctor of Physical Therapy Program, Newark, New Jersey, 2002-2004Practice Development Facilitator, Atlantic Health System/Morristown Memorial Hospital, Morristown NJ, 2001-2002Academic Coordinator of Clinical Education, Fairleigh Dickinson University Physical Therapist Assistant Program, Morristown NJ, 1999-2001Adjunct Instructor. Fairleigh Dickinson University Physical Therapist Assistant Program, Morristown NJ, 1999Adjunct Instructor, Union County College Physical Therapist Assistant Program, Plainfield NJ, 1997-2000Physical Therapist, ARC Essex School, Livingston, NJ 1999Rehabilitation Supervisor, JerseyCare HomeHealth and Hospice, Belleville, NJ, 1995-1998 Physical Therapist, Independent Practice, Home Care, Nutley NJ, 1991-1995Adjunct Instructor, Teachers College, Columbia University, New York, NY, 1991-1992Staff Physical Therapist, The Valley Hospital, Ridgewood, NJ, 1985-1986Staff Physical Therapist, Welkind Rehabilitation Hospital, Chester, NJ, 1983-1984Senior Physical Therapist, Neuroscience Team, Washington Hospital Center, Washington DC, 1982-1983Staff Physical Therapist, Washington Hospital Center, Washington DC, 1981-1982Staff Physical Therapist, Georgetown University Hospital, Washington DC, 1980-1981 Staff Physical Therapist, New Jersey Rehabilitation Hospital, East Orange, NJ, 1978-1980Membership in Scientific/Professional Organizations:American Physical Therapy Association: 1976-presentChair, House of Delegates Reference Committee, 2025Member, House of Delegates Reference Committee 2023-2024 Chair, House Special Committee on Bylaws, 2019-2021 Bylaws Review Task Force, 2018-2019Director, Board of Directors, 2009-2017Board work assignments:APTA Committees and Task Forces:Best Practices in Clinical Education Task Force, chair 2016-2017Leadership Development Committee, chair 2013-2017Executive Committee, elected 5th member 2015-2016Recruitment and Retention of Early-Career Members Task Force, member 2014- 2016Public Policy and Advocacy Committee, member, 2012-2015 Finance and Audit Committee, member 2011-2013Member Engagement and Leadership Development Task Force, chair 2011- 2013Physical Therapy Classification and Payment Task Force/ Alternative Payment Task Force, chair 2013-2014, member 2012-2013CSM Review Work Group, member 2011-12Task Force on Governance Review, member 2009-2011Committee on Referral for Profit, liaison, 2009-2011Physical Therapist Centralized Application Service Advisory Group, liaison 2009- 2011Board Workgroups:Strategic Planning Board Work Group, chair 2013-2017Criteria for House Motions from the Board of Directors, member 2014-2015, Governance Proposal Board Work Group, member 2011-2013Board Work and Information Management Board Work Group, member 2011- 2012Board Workgroup on Board Performance Evaluation, member 2009-2010 Components:Student Assembly, 2011-2014Chapters:Maryland (2016-2017, 2010-2011), Nebraska (2015-2017), Nevada (2016-2017), Idaho (2011-2016). Texas (2014-2016), New York (2013-2015), Michigan (2010- 2014), Wisconsin (2011-2014), New Mexico (2009-2013), North Dakota (2009- 2011), Utah (2009-2010)Sections:Education (2014-2017), Women's Health (2015-2017), Geriatrics (2015-2016), Pediatrics (2009-2012)Councils:Chapter President Council, liaison 2011-2014APTA Mentorship Program, 2005-2010 (program discontinued) Committee to Approve the House of Delegates Minutes, 2007CEO Search Committee, 2007Committee on Chapters and Sections. 2004-2007, Chair 2006 Education Strategic Planning Group, 2004American Physical Therapy Association of Massachusetts 2022-present Chair, Bylaws Review Task Force 2023-2024Assembly Representative, 2024American Physical Therapy Association of New Jersey: 1978-80, 1983-2022 Delegate to APTA House of Delegates, 1998 -2004, 2008-2009, 2018-2022 Chief Delegate, 2004-2008Federal Affairs Liaison, 2018-2019Alternate delegate, 2017-2018Legislative Committee, 1998-2018Legislative Advisory Panel, 2007-20182009 Annual Conference Committee, 2008-2009, chairMembership Chair, 2005-2007 Executive Committee, 1996-2005 President, 2001-2005 President-elect, 2000-2001 Vice-president 1998-2001 Secretary 1996-1998Direct Access Task Force, Chair, 1996-1999Home Health Special Interest Group Workgroup 1997APTA Private Practice Section, 2000-presentAPTA Private Practice Section, Graham Sessions Planning Committee, 2021-presentAPTA Academy of Leadership and Innovation (formerly Health Policy and Administration Section), 2003-presentAcademy of Physical Therapy Education, 1999-2002, 2004-presentAmerican Academy of Geriatric Physical Therapy, 1994-2002, 2010-present APTA Orthopedics Section, 2007-2018APTA Section on Women's Health, 2002-2004, 2009-2011, 2016-2018APTA Section on Research, 2012-2015APTA Cardiovascular and Pulmonary Section, 2010-2012APTA Neurology Section, 1980s, 1993-1998, 2000-2003APTA Health Policy Section, 2002-2003APTA Section on Administration, 1998-1999APTA Home Health Section, 1993-1999New York New Jersey Clinical Education Consortium, 2006-2014, 2016-present Home Health Assembly of New Jersey, 1996-1998National Head Injury Foundation Workgroup, Washington DC, 1981-1983American Physical Therapy Association, District of Columbia Chapter Continuing Education Chairperson, 1982Service to the University/College/School on Committees/Councils/Commissions: SchoolRutgers University SHP Committee on Faculty Development, September 2015-September 2018Rutgers University (formerly UMDNJ) SHRP Faculty Chair, September 2012-September 2014Rutgers University (formerly UMDNJ) SHRP Committee on Committees, 2012-2014Rutgers University (formerly UMDNJ) SHRP Committee on Admissions and Academic Standing, 2011-2014Rutgers University (formerly UMDNJ) SHRP Committee on Curriculum Review, 2007-2010 DepartmentRutgers University SHP Newark DPT Curriculum Committee, 2015-2022, Chair January 2022- July 2022Rutgers University SHP Newark DPT Orientation Committee Co-chair, 2016-2021Rutgers University SHP Newark DPT Awards and Scholarship Committee, 2017-2022 Rutgers University (formerly UMDNJ) SHP Newark DPT Admissions Committee 2002-2019Rutgers University (formerly UMDNJ) SHP Newark DPT Program Student Activities Committee, Faculty Liaison, 2006-2019Honors and Awards:Catherine Worthington Fellow of the American Physical Therapy Association, 2023Lucy Blair Service Award, American Physical Therapy Association, 2019Outstanding Service Award, American Physical Therapy Association of New Jersey, 2013 President's Award, American Physical Therapy Association of New Jersey, 2008, 2006, 1999Peer Reviewed Publications:Sack S, Radler DR, Mairella KK, Touger-Decker R, Khan H, Physical therapists' attitudes, knowledge, and practice approaches regarding people who are obese, Phys Ther; 89(8):804- 15, 2009

Episode 004 | Dr. Adam Swigost on his journey to building a solo direct care practice in his home state of North Dakota.Dr. Adam Swigost is a board-certified dermatologist and the founder of Dapper Dermatology, North Dakota's first and only entirely virtual dermatology clinic. As a North Dakota native, Dr. Swigost wanted to create a clinic that would help to expand access to dermatology services in a state where wait times can exceed several months. Additionally, Dapper Dermatology is a direct patient care clinic that is working to lower costs, increase financial transparency, and improve access to dermatology services. Dr. Swigost is an advocate for physician autonomy and reinvigorating the patient-physician relationship. Dr. Swigost completed his undergraduate degrees and medical training at the University of North Dakota. He completed his internship through the University of Central Florida in Ocala, FL, and his dermatology residency at Medstar Georgetown University Hospital and Washington Hospital Center in Washington, DC. He is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the Gay and Lesbian Dermatology Association.Thank you to my partners at RegimenPro for sponsoring the Treat Yo' Self Skincare Giveaway! Learn more here.

Le'Angela Ingram brings, over a decade of experience in a variety of private, public, and academic organizations in the areas of Change Management, Staff Training and Development, Career Development, Organization Development, Human Resource Assessment, Workforce Diversity, her work efforts focus on improved organization effectiveness, staff skills and employee commitment, and increased employee sensitivity to individual and cultural differences; reduction in cycle time and cost; and increased effectiveness and efficiency of workflow. She designs, develops, and launches customized seminars and conferences in diversity, leadership skills, change management, and team building yielding high ratings in content and quality for more than 200 federal agencies. Selected clients include Washington Hospital Center, US Department of State, USAID, US Department of Commerce, US Attorneys' Office, District of Columbia Superior Court, US Department of Housing and Urban Development (HUD), Graduate School USA, Department of Treasury, Department of Health and Human Services, Anne Arundel Community College, Johns Hopkins University and Sprint. Ms. Ingram earned a Bachelor of Business Administration and Marketing from Howard University. She also holds a Master of Science in Applied Behavioral Science (Organization and Human Resource Development) from The Johns Hopkins University, where she also completed Fellowships in Change Management and Women, Leadership and Change and holds coaching certificates. She is currently pursuing a Doctorate degree in Leadership and Learning Organizations, Candidate 2023. She is certified in Transition Management and Myers Briggs Type Indicator. She is the proud Nina to Alex, Kayla and Brianna and the mother of 2, Dannielle and Joshua. For fun you can find her on blue water beaches, listening to jazz and investing time with friends and family. As a native Washingtonian she enjoys seeking out new small venues for dining. Additionally, I'll be donating to and raising awareness for the charity or organization of my guest's choice with each episode now. This episode, the organization is called House of Ruth. Any and all donations make a difference! You can connect with Le'Angela on: Website - https://www.consultingram.com/about LinkedIn - https://www.linkedin.com/in/le-angela-ingram/ To connect with me: Interested in working with me as your coach? Book a complimentary 15 minute call here. https://calendly.com/mike-trugman/15min LinkedIn - https://www.linkedin.com/in/michael-trugman-37863246/ Instagram - https://www.instagram.com/mytrugofchoice/?hl=en   Website - https://miketrugmancoaching.com/ Subscribe to my weekly newsletter - https://miketrugman.us7.list-manage.com/subscribe?u=986490d5c62a0102122f3ce27&id=33d78ffe68 YouTube - https://www.youtube.com/channel/UCUPyP3vEWc-oDlGASe2XIUg Please leave a review for this podcast on Apple Podcasts! - https://podcasts.apple.com/vg/podcast/mike-s-search-for-meaning/id1593087650?utm_source=Mike+Trugman&utm_campaign=dcbd0b11b0-EMAIL_CAMPAIGN_2022_03_08_12_14&utm_medium=email&utm_term=0_33d78ffe68-dcbd0b11b0-510678693   Resources/People Mentioned: Servant Leadership - Robert K. Greenleaf Appreciative Inquiry - David L. Cooperrider Getting to Yes - Roger Fisher Black Faces in White Places - Randal Pinkett Transitions: Making Sense of Life's Changes - William Bridges Flawless Consulting - Peter Block The Consultant's Calling - Geoffrey M. Bellman Nancy Rosenshine Appreciative Inquiry Kouzes and Posner

We're just weeks away from Phoenix World Burn Congress 2023! To help attendees prepare for the event, we welcomed Megan Tinney, Phoenix WBC event manager, and Gina Russo, a key volunteer dedicated to ensuring that our first-time attendees are welcomed and supported at the conference, to the podcast!About Gina RussoGina Russo was born and raised in Cranston, Rhode Island. She is a mother to two amazing sons and has worked at the local hospital for 32 years, In 2003, her and her fiancé attended a concert at the Station Nightclub in West Warwick that turned into a deadly blaze, killing 100 including her fiancé Alfred. Gina survived the accident with 3rd and 4th degree burns to 40% of her body - and she only learned about Alfred's death after coming out of a medically induced coma 12 weeks later. In 2009, she self-published a book titled "From The Ashes." It was written for a therapeutic reason but wanted to share her story with others. She is proud to share that the book went on to sell for 3,500+ copies and opened up a world of public speaking about living and surviving such a tragic event.  Today, she is a Phoenix SOAR Peer Supporter and loves giving back and helping new survivors navigate their new life and get back to living. She has been married to her husband, Steven, for 15 years and loves her life as a burn survivor and what it has opened up for her. She is grateful for the opportunity to meet so many amazing person and the opportunity to help others. About Megan TinneyMegan Tinney is responsible for developing, managing, and planning Phoenix World Burn Congress. As the Program Manager of Community Engagement, Megan expands community outreach, engagement opportunities, and virtual offerings. She began her career as a Physical Therapist at Shriners Hospital for Children, Galveston after earning her Doctorate in Physical Therapy from Shenandoah University.Megan was first introduced to Phoenix Society at the 2009 Phoenix WBC before assisting with the conference next year in Galveston. Since 2010, Megan has held many roles within Phoenix WBC, including serving as the Event Coordinator Assistant for the past three years. In addition to her work with Phoenix Society, Megan also served as the Manager of Rehabilitation Services at Shriners Hospital for Children, Galveston and has worked in a variety of healthcare settings. About Phoenix World Burn Congress Phoenix World Burn Congress (WBC) is a program of Phoenix Society for Burn Survivors, the leading national nonprofit organization dedicated to empowering people impacted by a burn injury.Phoenix WBC began in 1985, developed by burn survivors, for burn survivors, to identify and understand the issues that impact the daily lives of those associated with burn trauma. Today, Phoenix WBC is the world's largest gathering of survivors, their families, burn care professionals and the fire service industry.This life-changing biennial event connects attendees with support resources, educational programming, workshops, and, most importantly, each other. It is through these shared experiences that healing begins, because we have learned that nothing heals survivors like connection with other survivors.Register today: https://pwbc2023.eventbrite.com/ Resources from the Show Register for Phoenix World Burn Congress 2023Download our Phoenix WBC Planning GuideView the full Phoenix WBC ScheduleFollow us on FacebookJoin our Phoenix Society Facebook GroupPhoenix Society ResourcesAbout MedStar HealthMedStar Health is a health system dedicated to caring for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Learn more at www.medstarhealth.org.About the D.C. Firefighters Burn FoundationThe D.C. Firefighters Burn Foundation is dedicated to assisting in the recovery and rehabilitation of injured firefighters and burn survivors from the Washington metropolitan region. The foundation supports burn research, treatment, and rehabilitation programs at Washington Hospital Center and Children's National Medical Center. Learn more atwww.dcffburnfoundation.org. Sponsor Girls with Grafts Interested in becoming a sponsor of the show? Email us at info@phoenix-society.org. Enjoyed the show? Tell us on social media using hashtag #GirlswithGrafts and tagging Phoenix Society for Burn Survivors! 

In this episode, we talk to Dr. Yesmean Wahdan, Vice President for U.S. Medical Affairs in the Bayer Women's HealthCare division. In this episode, we discuss the prevalence, causes and treatments for heavy menstrual bleeding. This is a great opportunity to learn more about Bayer's new women's health strategy which emphasizes partnerships with startups, and which companies they're interested in working with.Remember to like, rate and subscribe and enjoy the episode!Guest bioDr. Yesmean Wahdan, MD is the Vice President for U.S. Medical Affairs in the Bayer Women's HealthCare division. She is the eldest of 6 children and was born and raised in the Northern Virginia area not far from the Nation's Capital – Washington, DC. She received her bachelor's degree in Cellular and Molecular Biology from Marymount University in Arlington, Virginia, and her Medical Degree from Georgetown University School of Medicine in Washington, DC. She completed her OB/GYN residency at a combined program at Georgetown University Medical Center and Washington Hospital Center in Washington, DC. She has also published several abstracts and articles in the field of Women's Health. In her time at Bayer, Dr. Wahdan has served as Medical Science Liaison, a Medical Director, and most recently as head of the U.S. Medical Affairs group for Women's HealthCare.  Dr. Wahdan is passionate about the care and health of women and is proud to work with an organization dedicated to advancing the health of women through science, research, and creating accessibility to options that impact the lives of women throughout their life journey. She believes that when women are healthy, informed, and can realize their full potential, their families, communities, and ultimately the world can have better tomorrows.Dr. Wahdan is based in the US Bayer Headquarters office in Whippany, New Jersey, and lives in Northern New Jersey with her family.FemTech Focus Podcast bioThe FemTech Focus Podcast is brought to you by FemHealth Insights, the leader in Women's Health market research and consulting. In this show, Dr. Brittany Barreto hosts meaningfully provocative conversations that bring FemTech experts - including doctors, scientists, inventors, and founders - on air to talk about the innovative technology, services, and products (collectively known as FemTech) that are improving women's health and wellness. Though many leaders in FemTech are women, this podcast is not specifically about female founders, nor is it geared toward a specifically female audience. The podcast gives our host, Dr. Brittany Barreto, and guests an engaging, friendly environment to learn about the past, present, and future of women's health and wellness.FemHealth Insights bioLed by a team of analysts and advisors who specialize in female health, FemHealth Insights is a female health-specific market research and analysis firm, offering businesses in diverse industries unparalleled access to the comprehensive data and insights needed to illuminate areas of untapped potential in the nuanced women's health market.Time Stamps[04:10] Dr. Wahdan's background[06:49] What is Bayer?[09:10] Why is Bayer deprioritizing women's health Research & Development?[12:45] What is Heavy Menstrual Bleeding?[15:14] Indicators of Heavy Menstrual Bleeding[16:06] Causes of Heavy Menstrual Bleeding[16:55] Prevalence of Heavy Menstrual Bleeding[19:27] Disproportion based on race, ethnicity, age and location[20:10] Are you born with Heavy Menstrual Bleeding or does it develop?[20:32] Treatment options[23:30] Hormonal contraceptive impact on bleeding[24:43] Non-hormonal options[25:34] Bayer's clinical trials for endometriosis treatments[28:03] What kind of partnership is Bayer looking for?[28:35] What's an area of Women's Health that still needs innovation?[30:42] What does the femtech industry as a whole need the most in order to be successful? ResourcesBayer's commitment to Women's Healthcare - Episode 141 Episode ContributorsDr. Yesmean WahdanLinkedIn: @Yesmean H. Wahdan, MD Dr. Brittany BarretoLinkedIn: @Brittany Barreto, Ph.D.Twitter: @DrBrittBInstagram: @drbrittanybarreto BayerWebsite: https://www.bayer.com/en/us/bayer-united-states-of-americaLinkedIn: @BayerTwitter: @BayerInstagram: @bayerofficial   FemTech Focus PodcastWebsite: https://femtechfocus.org/LinkedIn: https://www.linkedin.com/company/femtechfocusTwitter: @FemTech_FocusInstagram: @femtechfocus FemHealth InsightsWebsite: https://www.femhealthinsights.com/LinkedIn: @FemHealth Insights

Dr. Aysha Akhtar, MD, MPH ( https://ayshaakhtar.com/ ) is the Co-Founder and CEO of the Center for Contemporary Sciences ( https://contemporarysciences.org/ ), which is catalyzing the replacement of unreliable animal testing with more effective human-specific research techniques. As a double Board-certified neurologist and preventive medicine/public health specialist, she is on a mission to educate the world and demonstrate how there is a mutual benefit to both humans and animals when animals are protected. A U.S veteran, Dr. Akhtar previously served as Deputy Director of the U.S. Army Traumatic Brain Injury Program developing the Army's brain injury prevention and treatment strategies for soldiers, and as a Commander in the U.S. Public Health Service Commissioned Corps, Dr. Akhtar frequently deployed to assist with national public health emergencies. For a decade, Dr. Akhtar was a Medical Officer at the Food and Drug Administration (FDA), most recently in the Office of Counterterrorism and Emerging Threats, implementing studies on vaccine effectiveness and safety and using her Top Secret Security clearance to develop national preparedness strategies for public health threats. She is published in peer-reviewed journals including Lancet, Pediatrics, Journal of Public Health Policy and Reviews in the Neurosciences. Dr. Akhtar is a Fellow of the Oxford Centre for Animal Ethics. She is the author of the two books, Our Symphony With Animals. On Health, Empathy, and Our Shared Destinies and Animals and Public Health, which argues for the need for health institutions to include animals as part of the “public” in public health. Dr. Akhtar is a graduate of the Eastern Virginia Medical School. She subsequently completed her general medicine internship at Washington Hospital Center and her neurology and preventive medicine residencies at the University of North Carolina Medical School in Chapel Hill. She received her Masters in Public Health at the University of North Carolina School of Public Health, where she focused on bioethics. Support the show

This episode from the archives features Dr. Mitra Ayazifar. Known by her patients as “Dr. Mitra,” she is an experienced eye physician and surgeon specializing in cataract surgery utilizing the most advanced specialty intraocular lenses (IOLs). Dr. Ayazifar holds a Bachelor of Arts degree from the University of California at Berkeley and a Doctor of Medicine degree from the George Washington University School of Medicine and Health Sciences, Washington, D.C., which she earned in 1997. She did her internship in Internal Medicine at Washington Hospital Center in 1998. Other interests include functional and cosmetic eyelid procedures, including ptosis repair (eyelids and brow), blepharoplasty (upper and lower eyelids), and repair of ectropion, entropion, and various eyelid malpositions. Her practice includes general ophthalmology patients and diagnosing and treating various eye conditions, including cataracts, glaucoma, oculoplastic conditions, diabetic retinopathy, and macular degeneration. Contact Dr. Mitra Instagram: https://www.instagram.com/mitramd3/ Social Media Links: https://linktr.ee/DrmitraMd Website: https://www.capeyemed.com/ --- Send in a voice message: https://anchor.fm/urcaringdocs/message

The Good Word podcast host Tisha Lewis reconnects with her childhood friend Dr. Stephanie Hack to discuss maternal health, the disproportionate rate of maternal mortality among Black women, faith and religion and having a voice in the doctor's office. Dr. Hack is a board-certified obstetrician and gynecologist with a special interest in health education and women's health advocacy. While obtaining her medical degree from Lewis Katz School of Medicine at Temple University, she completed a master's degree in public health to broaden her reach. She has developed multiple community youth programs, facilitated local community health initiatives and served as a commissioner for the D.C. Lactation Commission. During her residency at Georgetown University Hospital and Washington Hospital Center, she further developed her skills as a practitioner and educator. As a former television host for BET, she hopes to continue to use her voice to bring awareness to issues confronting women both regionally and around the world. Dr. Hack is also the host and creator of the Lady Parts Doc podcast.  SUBSCRIBE TO THE GOOD WORD PODCAST NOW! 

“Michael Anthony Salters, described by law enforcement officials as a drug dealer and mediator among competing District drug organizations, was shot and killed late Tuesday near First and Bryant streets NW when an unidentified gunman opened fire on Salters's car, D.C. police reported. Salters's body, still inside his bullet-riddled car, was left outside the entrance to Washington Hospital Center shortly after 10:30 p.m. Tuesday, said 5th District Capt. James Coffey. Salters was pronounced dead about 1 a.m. yesterday, said Officer Daniel Straub, a D.C. police spokesman. The police department released few details of the incident yesterday. Sources said Salters had been shot at least six times. Law enforcement sources said Salters was one of the city's largest drug dealers but that his real power was in his ability to referee turf disputes among rival drug dealers. A law enforcement source said Salters had been implicated in drug deals of more than 200 pounds, but that he had proved too "well insulated" from direct involvement to be charged. Agents at times put Salters under intense surveillance, and interviewed drug dealers who said they had worked with and for him, law enforcement sources said. His name also came up in wiretapped conversations, they said. Federal drug officials say they have been told by several drug dealers that some dealers ceded to Salters the power to assign drug territories for PCP, heroin, cocaine and other drugs.” --- Send in a voice message: https://anchor.fm/antonio-myers4/message Support this podcast: https://anchor.fm/antonio-myers4/support

Vanita Rahman, MD, is a board-certified internal medicine physician, certified nutritionist, and personal trainer. A native of the Washington, D.C., area, she earned her undergraduate and medical degrees from the University of Virginia and completed her internal medicine residency at the Washington Hospital Center. Prior to joining the Barnard Medical Center, Dr. Rahman spent more than 15 years practicing internal medicine with Kaiser Permanente, where she launched a very popular and successful plant-based weight loss program. At the Barnard Medical Center Dr. Rahman conducts programs on diabetes management and weight loss emphasizing a plant-based diet. While medications and surgical procedures can be necessary and lifesaving, Dr. Rahman firmly believes that nutrition and lifestyle play a crucial role in the prevention and management of most common diseases. She maintains that it is important to address all aspects of a patient's health, including diet, exercise, sleep habits, and stress management. Simply Plant Based: Fabulous Food for a Healthy Life (2021) is her third book. She also wrote Vegan Style (2017) and Stronger with Plants (2016). She enjoys spending time with her family and friends, traveling, exercising, and experimenting with plant-based recipes. To connect with Dr. Rahman: Instagram: https://www.instagram.com/dr.vanita.rahman/ Book: https://www.amazon.com/Simply-Plant-Based-Fabulous-Healthy/dp/1570674043/ref=sr_1_2?crid=H9EPYHVX0U33&dchild=1&keywords=vanita+rahman&qid=1630889580&s=books&sprefix=vanita+rahman%2Caps%2C147&sr=1-2 To get access to Dr. Laurie's Free Health Masterclasses: https://healthyhumanrevolution.mykajabi.com/freeclasses

This Fresh Take interview featured Patricia McGuire, President of Trinity Washington University. JB and Patricia discussed Trinity's long history of providing a high-quality liberal arts educational experience for students and prioritizing opportunities for women and underserved communities, pressing challenges facing higher ed, and our shared vision for a robust and diverse digital tech ecosystem in the Capital Region.Hosted by JB Holston.  Produced by Jenna Klym, Justin Matheson-Turner, Christian Rodriguez, and Nina Sharma. Edited by Christian Rodriguez. Learn from leaders doing the work across the Capital Region and beyond. These conversations will showcase innovation, as well as history and culture across our region, to bridge the gap between how we got here and where we are going.About our guest:Patricia McGuire has been President of Trinity since 1989. Before coming to Trinity, Ms. McGuire was the Assistant Dean for Development and External Affairs for Georgetown University Law Center, where she was also an adjunct professor of law. Earlier, she was project director for Georgetown ‘s D.C. Street Law Project. She was also a legal affairs commentator for the award-winning CBS children's newsmagazine “30 Minutes” and the Fox Television program “Panorama” in Washington.She served previously on the boards of the Community Foundation of the National Capital Region, Goodwill of Greater Washington, the Eugene and Agnes Meyer Foundation, the Washington Hospital Center, the American Council on Education, the National Association of Independent Colleges and Universities, the National Defense Intelligence College, the Association of Catholic Colleges and Universities, and the Middle States Commission on Higher Education.In 2014, Secretary of Education Arne Duncan appointed President McGuire to the U.S. Department of Education Advisory Committee on Student Financial Aid, a position she held in 2014-2015. In 2000, President McGuire was appointed by D.C. Mayor Anthony Williams and the D.C. Financial Control Board to a special term on the Education Advisory Committee overseeing the D.C. Public Schools. In June 1998, Treasury Secretary Robert Rubin appointed President McGuire to serve as a member of the first-ever citizens' advisory panel on coinage, the 8-member Dollar Coin Design Advisory Committee, which recommended the image of Sacagawea for the new dollar coin.President McGuire has received honorary degrees from Georgetown University, Howard University, Chatham University, Emmanuel College, Saint Michael's College, College of New Rochelle, Liverpool Hope University, Mt. Aloysius College and College of St. Elizabeth.President McGuire earned her bachelor of arts degree cum laude from Trinity College and her law degree from the Georgetown University Law Center. She is currently a member of the boards of directors of the Greater Washington Board of Trade, the Washington Metropolitan Consortium of Universities, the D.C. College Success Foundation, the Morris and Gwendolyn Cafritz Foundation, Catholic Charities of D.C., United Educators, and the Ameritas Mutual Holding Company.

Show notes and links: https://www.valuecapturellc.com/he56 In today's episode, our guest is Dr. Donna Prosser, the Chief Clinical Officer for the Patient Safety Movement Foundation, an organization that Value Capture is proud to partner with, given our shared interests in improving healthcare. Donna has been in the healthcare industry for more than 30 years and is currently the Chief Clinical Officer at the Patient Safety Movement Foundation. She spent the first fifteen years of her career at the bedside and transitioned into administration after a personal experience helped her to understand just how fragmented and unsafe patient care can be. This experience ignited a passion to improve healthcare quality and safety in her that continues to burn to this day. She previously worked as a healthcare consultant, helping organizations across the United States and previously had leadership roles and/or clinical roles at Martin Health System, Carteret Health Care, and the Washington Hospital Center. Dr. Prosser received a Doctorate in Nursing Practice at the University of Central Florida, a Master of Science in Nursing at Duke University, and a Bachelor of Science in Nursing at George Mason University. In the episode, Donna discusses efforts to improve patient safety and healthcare quality — and her personal motivations for doing so — with our host, Mark Graban. topics and questions include: What inspired you to get so involved in patient safety? A personal experience... How can we help advocates and patients be partners and not adversarial? Two stories — helped STOP the errors Fixing errors vs. focusing on culture, systems, etc. Fragmented care, system issues -- or systemless? Covid era - lack of visitation, impact on errors?? What's the scale of the problem? It's been 20+ years since To Err is Human… is it getting better?? Are we seeing results? Goal of Zero Harm by 2030? How do we get there? Making a commitment to zero harm PATIENT AIDER app PSMF resources that can help? Coaching support for organizations that commit to zero harm Creating a foundation for safe and reliable care Previous episode with Dr. David Mayer, former CEO of the Foundation

Part I: Vanita Rahman, MD, Simply Plant-Based Vanita Rahman, MD, is a board-certified internal medicine physician, certified nutritionist, and personal trainer. A native of the Washington, D.C., area, she earned her undergraduate and medical degrees from the University of Virginia and completed her internal medicine residency at the Washington Hospital Center. Prior to joining the Barnard Medical Center, Dr. Rahman spent more than 15 years practicing internal medicine with Kaiser Permanente, where she launched a very popular and successful plant-based weight loss program. At the Barnard Medical Center Dr. Rahman conducts programs on diabetes management and weight loss emphasizing a plant-based diet. While medications and surgical procedures can be necessary and lifesaving, Dr. Rahman firmly believes that nutrition and lifestyle play a crucial role in the prevention and management of most common diseases. She maintains that it is important to address all aspects of a patient's health, including diet, exercise, sleep habits, and stress management. Simply Plant Based: Fabulous Food for a Healthy Life (2021) is her third book. She also wrote Vegan Style (2017) and Stronger with Plants (2016). She enjoys spending time with her family and friends, traveling, exercising, and experimenting with plant-based recipes. Part II: Hartglass & De Mattei, Feeding Companion Animals Hartglass and De Mattei review some recent research on feeding cats and dogs. They touch on Halloween and choosing chocolate. And for Italian Heritage month, Gary celebrates his Italian heritage by cooking up a gorgeous Pasta with Spinach Pesto. LINKS mentioned in the program: The Baked Bagel Pesto Recipes Creamy Kale Pesto Creamy Vegan Pesto Emotional support animal (ESA) A cross-sectional study of owner-reported health in Canadian and American cats fed meat- and plant-based diets Assessment of protein and amino acid concentrations and labeling adequacy of commercial vegetarian diets formulated for dogs and cats The Welsh Collie Bramble lived to 25 years old and at the time of her death was the world's oldest bitch. This book documents Bramble's care regime and vegan diet. Can dogs eat broccoli? Can dogs eat chocolate? Can birds eat apples? The UTZ label stands for more sustainable farming and better opportunities for farmers, their families, and our planet. What does the UTZ label mean? Food Empowerment Organization Chocolate List The Chocolate Report

Dr. Donna Prosser has been in the healthcare industry for more than 30 years and is currently the Chief Clinical Officer at the Patient Safety Movement Foundation. She spent the first fifteen years of her career at the bedside and transitioned into administration in 2002 after a personal experience that helped her to understand just how fragmented and unsafe patient care can be. This experience ignited a passion to improve healthcare quality and safety that continues to burn to this day. Prior to joining the Patient Safety Movement Foundation, Dr. Prosser worked as a healthcare consultant, helping organizations across the United States to improve quality and safety, increase patient engagement, and reduce clinician burnout. Before beginning her consulting career, she was responsible for clinical practice improvement across Martin Health System, while also functioning as Site Administrator and Chief Nursing Officer for the system's largest hospital. She previously focused on improving quality and safety through administrative, education, and clinical roles at both Carteret Health Care and the Washington Hospital Center. Dr. Prosser is a Fellow in the American College of Healthcare Executives and is board certified as a Nurse Executive by the American Nurses Credentialing Center and as a Patient Advocate by the Patient Advocate Certification Board. She is the recipient of the 2021 Robert L. Wears Patient Safety Leadership Award. Here in Episode #134, Donna starts our show with a mindset encouraging even the smallest of groups to change the world. Working with the patient safety movement, Donna is on an impressive mission to achieve zero preventable harm by the year 2030. She shares with us her impressive background in nursing, leadership; and the very personal story that set her off on her journey to transform the industry. She highlights opportunities to improve the medical record for patients as a career lesson learned from her past. Donna shares of focus around human factors as an important tip for all facilitators to grow within. She provides great insights into the work that the Patient Safety Movement is leading, including access to the free virtual sessions for World Patient Safety Day. She gives a career Aha moment that encourages us to speak the language of the teams that we support. Donna connects the dots between problem-solving and the scientific method. Donna tells us why now is the perfect time for a quality and patient safety professionals to shine; and places a call to action for healthcare organizations to embed quality and patient safety in all areas of their organization. · Connect with Donna on LinkedIn · Learn More About Patient Safety Movement · Learn More About World Patient Safety Day · Access the Healthcare QualityCast LinkedIn Group · Leaves Us a Rating --- Send in a voice message: https://anchor.fm/healthcarequalitycast/message

Obtaining Education Training During the Pandemic – CAC 1   – Behavioral Health in the New Normal Episode 028 with Dr. Nancy Butler Dr. Nancy Butler is currently working part time as the Director of the Catholic Charities Institute, Professional Counseling Education Program (PCEP). Dr. Butler has been with Catholic Charities since 2000 where she was responsible for the Family Centers in the District of Columbia. Previously, from 1986 to 1997, she was Program Director for the Department of Psychiatry at the Washington Hospital Center. She also founded the Therapeutic Recreation Department at the WHC Department of Psychiatry in 1980. Dr. Butler has held part time and full-time teaching posts at The George Washington University, The University of Maryland, West Virginia Wesleyan College and Prince Georges Community College. She has also consulted with several mental health and substance abuse treatment organizations. Throughout her career, Dr. Butler wrote and administered grants for adult education, substance abuse, parenting and therapeutic recreation. In their discussion they explored obtaining education during the pandemic. Here are some of the other beneficial topics covered on this week's show: ●     How recreational therapy is very important for people in recovery. ●     Why you therapists and doctors have to start where their patient is. ●     How being engaged in treatment longer leads to longer lasting sobriety. ●     Why becoming an addiction counselor requires more education than it used to. ●     How long it takes to complete the addiction counseling courses.   Connect with Dr. Nancy Butler: Links Mentioned: catholiccharities.org Guest Contact Info: Twitter @CCADW Instagram @ccadw Facebook facebook.com/ccadw LinkedIn linkedin.com/company/catholic-charities-of-the-archdiocese-of-washington   Learn more about your ad choices. Visit megaphone.fm/adchoices

Le'Angela Ingram brings over 20 years of experience in a variety of private, public, and academic organizations in the areas of Change Management, Staff Training and Development, Career Development, Organization Development, Human Resource Assessment and Workforce Diversity. Her work efforts focus on improved organization effectiveness, staff skills and employee commitment, and increased employee sensitivity to individual and cultural differences. Selected clients include Washington Hospital Center, US Department of State, US Agency for International Development, US Department of Commerce, US Attorneys' Office, District of Columbia Superior Court, US Department of Housing and Urban Development (HUD), Graduate School USA, US Department of Treasury, US Department of Health and Human Services, Anne Arundel Community College, Johns Hopkins University and The MITRE Corporation. Find Le'Angela at: https://www.linkedin.com/in/le-angela-ingram/ ------------------------------------------------------------ Find us at www.kuinuacoaching.com Find all our products and services, as well as our blog and audio podcast at https://linktr.ee/kuinuacoaching ------------------------------------------------------------ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/marieoldfield/message Support this podcast: https://anchor.fm/marieoldfield/support

Dr. Paul Sugarbaker joined us for an interview about HIPEC (hyperthermic intraperitoneal chemotherapy) for peritoneal mesothelioma. Paul Sugarbaker, MD, FACS, FRCS, is the Chief of the Peritoneal Surface Malignancy Program and the Director of the Center for Gastrointestinal Malignancies at the Washington Hospital Center in Washington, DC. MesoTV is the Mesothelioma Applied Research Foundation's recorded series covering pertinent conversations impacting the mesothelioma community. You can learn more at curemeso.org/mesotv. The Mesothelioma Applied Research Foundation is the only nonprofit charity organization dedicated to ending mesothelioma, and the suffering caused by this cancer, by: funding research to improve treatment options; providing treatment support and education for patients and their families; and advocating for federal funding of research.  

Cómo sabemos si usted tiene hipotiroidismo? Qué significa si es difícil concentrarse o enfocar la mente? Qué significa si usted tiene altos niveles de TSH? Cómo se diagnostica el hipotiroidismo? Qué es Hashimotos? Cuál es el tratamiento para el hipotiroidismo? Puede la dieta ayudar con el hipotiroidismo? Cuándo es el mejor momento del día para tomar su medicina de hipotiroidismo? Dónde puede encontrar un médico para tratar el hipotiroidismo? Dra. Sandra Daniela Licht de Hospital General de Agudos Carlos G. Durand Endocrinología ESPECIALIDAD Establecimiento: General de Agudos J. M. Ramos Mejía. Título: Clínica Medica. Establecimiento: Hospital General de Agudos Carlos G. Durand. Titulo: Endocrinóloga ACTIVIDAD ACADÉMICA Y DOCENTE Instructora de Residentes de Endocrinología, Hospital Durand (1993-1995) Docente de la Diplomatura en Enfermedades Tiroideas de la Facultad de Medicina de la Universidad Nacional de Tucumán Transcripción   Philip James, presentador:  Hola, este es el episodio 25 de Doctor Tiroides.   Hello, It’s show number 25, this episode is in Spanish. If you are looking for English please go to iTunes or to the website.   Bienvenidos a Doctor Tiroides con Philip James. Estamos acá con la Doctora Licht.    Bienvenida. Por favor, ¿podría compartir algo de su experiencia y de dónde es?   Dra. Sandra Licht:  Bueno, mi nombre es Sandra Licht, soy de Buenos Aires, Argentina. Hice mi formación en el Hospital Durand de Buenos Aires, después hice una pequeña rotación con el Doctor Wartofsky y el Doctor Bullman en el Washington Hospital Center. Actualmente tengo mi consultorio privado y también estoy trabajando en Ineba, que es un centro de neurociencias; recientemente empecé a trabajar allí.   Philip James, presentador:  El tema de hoy es hipotiroidismo y sus síntomas. Empecemos con, ¿qué es el hipotiroidismo?   Dra. Sandra Licht: El hipotiroidismo se refiere a la deficiencia o disminución de las hormonas tiroideas. Esto puede ser porque la glándula funciona de menos; puede ser que se operó a la persona (ya sea que se le saco la glándula entera o una parte); o porque recibió una dosis de yodo radiactivo por un hipertiroidismo anterior.   Philip James, presentador: Y para los pacientes, ¿cómo sabemos si tenemos hipotiroidismo?   Dra. Sandra Licht: En referencia a los síntomas, son muy inespecíficos. Porque habitualmente la gente refiere que está cansada, que tiene sueño, algunas (mujeres, sobretodo) dificultad para bajar de peso o trastornos en el ciclo menstrual, caída del cabello, uñas quebradizas, constipación.   Entonces, bueno. El paciente consulta al médico clínico o al internista y probablemente le va a pedir las hormonas tiroideas en sangre; o sea que la manera de hacer el diagnóstico es midiendo las hormonas tiroideas en sangre: la T3 y la T4 (T4 libre) y una hormona (que en realidad la produce la hipófisis pero es la que va a estimular a la tiroides para producir las hormonas que se llaman TSH (Thyroid- Stimulating Hormone).    El diagnóstico de certeza está dado por la TSH. Si la TSH está alta, nos está hablando que el paciente está hipotiroideo, salvo si el orígen del hipotiroidismo es central (o sea, si hay una deficiencia en la hipófisis o en el hipotálamo), donde la TSH va a estar baja, pero a su vez la T3 y la T4 van a estar bajas también. Es un poco complicado, pero esa sería la única excepción donde un paciente hipotiroideo no va a tener la TSH elevada, sino baja.   Philip James, presentador: Por eso en el hipotiroidismo un paciente puede tener algo de sueño, posiblemente aumento de peso y a veces cambios a nivel mental ¿puede hablar de los problemas de la mente cuando hay hipotiroidismo?  Dra. Sandra Licht: Si, la gente refiere que tiene dificultad para concentrarse. La gente que trabaja con números, o que tiene que dar charlas, o maestros sienten como que les cuesta mucho fijar los conocimientos y poder expresarlos. Obviamente, hoy en día es raro tener un paciente [así], salvo que esté operado ¿no?, con una TSH muy alta; o sea con un hipotiroidismo extremo. Habitualmente (y por suerte) podemos detectar pacientes con hipotiroidismos en sus fases más tempranas, que también se denominan sub-clínicos, donde encontramos la TSH ligeramente elevada pero con la T3 y la T4 normales; o sea, como que recién ahí empezarían a estar hipotiroideos.   Philip James, presentador: El examen de sangre es muy importante. Está la primera etapa.   Dra. Sandra Licht: Es el que nos hace el diagnóstico, de que realmente está hipotiroideo; o sea, con un valor de TSH, si hablamos de hipotiroidismo primario, podemos diagnosticar que el paciente tiene deficiencia de hormona tiroidea. Si.   Philip James, presentador: ¿Cuál es la tendencia?, ¿ hay mucha gente con esta enfermedad? o ¿cómo es? ¿Se da más en mujeres, en hombres o en niños?    Dra. Sandra Licht: Lo podemos ver en todos los sexos y en todas las edades pero es más frecuente en las mujeres.    Es más frecuente en las mujeres porque se relaciona habitualmente a una enfermedad autoinmune que se llama Tiroiditis de Hashimoto o Tiroiditis Linfocitaria, donde la glándula muestra ciertas partes que no son reconocidas como propias. Se forman anticuerpos, y estos anticuerpos parece que atacan a la glándula generando que funcione de menos y (a la vez también) que hayan unos [pequeños] nódulos en la glándula.   Philip James, presentador: Y para que el paciente se mejore, ¿cuál es el tratamiento?    Dra. Sandra Licht: Este tratamiento consiste en reemplazar a las hormonas tiroideas (las cuales tendría que producir normalmente la glándula pero no lo está haciendo), y [se hace] con Levotiroxina. Hoy en día se está viendo si hace falta agregar la T3 también al tratamiento, porque hay pacientes que solo con T4 (o solo con Levotiroxina) no se sienten bien.   Todo eso está en una etapa de investigación y se verá más adelante si realmente es así; si tienen que [ponerle] T3 y T4 al tratamiento. Pero, mientras tanto, el tratamiento es (entonces) con T4 (la hormona sintética), que habitualmente no tiene ningún efecto adverso en el individuo que lo toma. Simplemente tienen que tomar la dosis adecuada para tener un buen reemplazo, sentirse bien, no tener un exceso de medicación, y no pasar al otro estado que es el hipertiroidismo, [el cual] sería provocado por la medicación.   Philip James, presentador: ¿Es posible que en algunos casos el tratamiento de T4 no funcione?   Dra. Sandra Licht: En realidad esto es lo que estaba comentándote recién: puede ser que sea insuficiente para que el paciente se sienta completamente bien reemplazado.    [De hecho] hoy estamos acá juntos con Philip en el congreso de la Asociación Americana de Endocrinología y va a haber una charla sobre “dónde estamos, en el tema del hipotiroidismo” y sobre esto de “si agregarle T3 o no al tratamiento”. Así que, después de hoy podremos [decir] si tenemos que hacerlo, o no.   Philip James, presentador: Es verdad.    En el tema de la comida, si una persona tiene hipotiroidismo, ¿hay algo que ellos puedan hacer, con respecto a su alimentación, para sentirse mejor?   Dra. Sandra Licht: No. El reemplazo es solamente con la hormona tiroidea. No hay nada que lo vaya a reemplazar porque lo que queremos es suplir el funcionamiento de la glándula, entonces no hay ningún alimento que lo pueda mejorar.   Y hablando del tema de alimentos, si quieres hablamos un “cachito” [poquito] sobre cómo se toma.    Philip James, presentador: Si ¿Cuándo vamos a tomar nuestra pastilla si tenemos hipotiroidismo?   Dra. Sandra Licht:    La mayoría de los estudios recomiendan tomar la medicación en ayunas. O sea, no hace falta despertarse (o poner el despertador, digamos) para tomarla, sino que cuando uno se despierta, la toma. Mientras va al baño, se ducha, allí puede pensar en el desayuno.    Hay mucha gente que le dice a los pacientes que no se pueden comer ni cereales ni fibras cuando uno va a tomar la Levotiroxina porque puede disminuir la absorción, pero hay estudios nuevos que demuestran que no, que no van a tener efectos en la absorción; así que, pueden tomar la pastilla, esperar 20 minutos y tomar su desayuno habitual.   En algunos pacientes puede haber alguna alteración en la absorción. Entonces en esos pacientes veremos, una vez que hagamos el dosaje de las hormonas tiroideas bajo el tratamiento, si precisan espaciar un poco más la toma del medicamento con los alimentos, o agregar más dosis de medicamento.   Philip James, presentador: Porque a algunas personas les gusta tomar la pastilla por la mañana y a otras por la noche, entonces, ¿es importante no comer antes de tomar la pastilla?   Dra. Sandra Licht:  Es importante pero, como mencioné antes, algunos pacientes no tienen problemas con el tema de la absorción, entonces esperando de 15 a 20 minutos (tomando la pastilla con ese tiempo de espera para el alimento) está bien.    Y el tema de tomar la pastilla, al momento de tomarla. Yo, la verdad es que veo bastantes adolescentes en mi consulta y muchas veces por la mañana (que tienen que ir a la escuela a estudiar, o se quedan a dormir en la casa de unos amigos, etc.), por la mañana (tal vez) se olvidan de tomarla, entonces yo prefiero decirles que la tomen antes de ir a dormir. Que cuando que se van a cepillar los dientes (que ya pasó, además, un lapso entre la cena y la toma de la pastilla), bueno, que la tomen antes de ir a acostarse. Entonces uno se asegura de que realmente la van a tomar.   Y siempre uno tiene la opción de modificar lo que le dice al paciente porque al medir las hormonas tiroideas en sangre, bajo el tratamiento, vamos a ver si realmente las está absorbiendo bien, o no.   Philip James, presentador: Pero ¿es así de fácil? Si un paciente tiene estos síntomas (por ejemplo: sueño, aumento de grasa corporal, sobrepeso), ¿Tan pronto el paciente se toma la pastilla, comienza a sentirse mucho mejor? o ¿cómo funciona?   Dra. Sandra Licht: Si realmente la causa de sentirse cansados o que no puedan bajar de peso es por el hipotiroidismo, bueno, si. Al iniciar el tratamiento (más o menos a la semana o a los 10 días) empiezan a notar un cambio.    Pero insisto, hay que hacer el diagnóstico de certeza porque son síntomas que pueden deberse a otras cosas; por ejemplo “estar cansado”, puede ser que el paciente esté anímico y por eso está cansado.    El tema de la dificultad para bajar de peso. Bueno, muchas veces tiene que ver con que, realmente, no hacen una buena dieta, o no hacen actividad física, más que por el hipotiroidismo en sí. Porque además el hipotiroidismo lo que hace es acumular líquido. Entonces (por ahí) tienen 1 kilo (o 2 kilos de más); eso, cuando iniciamos el tratamiento, va a desaparecer, pero lo que es de peso “peso” (de masa grasa), no. Para eso tienen que hacer dieta y actividad física.   Philip James, presentador:  Cuando una persona está haciendo mucho ejercicio y llevando una dieta sana, pero comienza a aumentar de peso y siente mucho sueño ¿es muy posible que este paciente tenga hipotiroidismo?   Dra. Sandra Licht: Puede ser. Entonces ahí es cuando le podemos pedir los análisis de tiroides y constatar si su glándula está funcionando de menos. Si es así, va a tener una respuesta excelente al tratamiento ¿no?.   Philip James, presentador: Pero también para hombres ¿no? Hombres y mujeres.   Dra. Sandra Licht:  Hombres, mujeres y niños, sí.    Y también otra cosa que hay que tener en cuenta es que hay pacientes [adultos] que toman [alguna] medicación que puede tener influencia sobre la función tiroidea.    Los pacientes que tienen arritmia, toman Amiodarona (lo que puede generar hipotiroidismo o hipertiroidismo); entonces es interesante que el cardiólogo cada “tanto”, chequee la función tiroidea.    Los pacientes que tienen síndrome bipolar pueden tomar [alguna] medicación como Litio, que también puede afectar la función tiroidea. Por eso siempre tiene que pedirle a su psiquiatra, en este caso, que pida los análisis de tiroides.   Philip James, presentador:  Para aquellos que están escuchando en este momento y están pensando: “Es posible que tenga hipotiroidismo”, ¿qué pueden hacer y dónde pueden encontrar un médico?   Dra. Sandra Licht: Si tienen acceso a un médico endocrinólogo, sería lo ideal, porque el endocrinólogo le va a hacer todo el interrogatorio referente a esto, va a palpar su cuello para ver si llega a ver disfunción tiroidea, si se acompaña o no de alguna alteración de la estructura de la glándula (como que el endocrinólogo puede encontrara algún [pequeño] nódulo). Y si no tiene acceso directo a un endocrinólogo, bueno, puede consultar al clínico y así el doctor le pide los análisis.   Philip James, presentador: ¿Hay otras tendencias? Por ejemplo, ¿en América Latina? No sé si el tratamiento es diferente para algunos partes del mundo o ¿todo es lo mismo?   Dra. Sandra Licht: Es todo lo mismo. Tengo entendido que aquí en Los Estados Unidos hay una medicación que en realidad no es hormona sintética (o sea, la T4 sintética) sino que es natural. Pero bueno, no está recomendado ni [siquiera] por la Asociación Americana de Tiroides, porque uno no sabe realmente lo que es el contenido de la droga en sí (que es lo que contiene). Entonces es conveniente dar la Levotiroxina sintética donde, además, sabemos exactamente la cantidad de dosis que le estamos dando al paciente.   Philip James, presentador: Y con esta pastilla ¿hay síntomas que no son buenos, algunas veces?, o ¿no existe ningún problema para los pacientes?   Dra. Sandra Licht: La Levotiroxina?   Philip James, presentador: Mhmm   Dra. Sandra Licht: No. Si está con la dosis adecuada, no tiene que haber ningún síntoma, ningún efecto adverso. Por eso cuando uno indica la dosis (que pensamos que sería la correcta para ese paciente), más o menos a los dos meses o a los 40 días le pedimos análisis para medir nuevamente las hormonas en sangre. Si está bien, volvemos a repetir en 6 meses [aproximadamente]. Si no, volvemos a cambiarla y vamos ajustándola hasta que logremos la dosis que precisa ese paciente.   Philip James, presentador: Doctora Licht. ¿Tiene algunas últimas palabras para aquellos que están escuchando esta entrevista, que piensa que ellos necesitan saber? Para aquellos que están pensando que es posible que tengan hipotiroidismo, o están en tratamiento por hipotiroidismo pero no se sienten bien, ¿qué le puede decir a ellos?    Dra. Sandra Licht:  Bueno, a la gente que no sabe si tiene o no hipotiroidismo, frente a los síntomas de los que antes estuvimos charlando (cansancio, piel seca, constipación, caída, del cabello), pedirle a su médico que le [solicite] análisis de sangre: es una extracción de sangre y se mide el TSH, T4 libre, se pueden medir los anticuerpos para saber si tiene más posibilidades de tener hipotiroidismo y (a su vez) si su familia también.    Si uno tiene antecedentes familiares (de su madre, su padre, sus tíos, hermanos) de que tienen disfunción tiroidea, pedir (obviamente) que les hagan a ellos también los análisis, porque el antecedente familiar es un factor de riesgo.    A las chicas que buscan embarazo y (tal vez) no pueden quedar embarazadas tan fácilmente, también solicitarle a su ginecólogo que le pida análisis de tiroides.    Los pacientes que fueron operados de tiroides (que les dejaron media glándula), que también tienen riesgo de tener hipotiroidismo, bueno, pedir siempre la función tiroidea, hacer los análisis de tiroides.   Eso en cuanto a si “uno tiene dudas o no”.    Si ya están con el tratamiento y no se sienten bien, bueno, también chequear si la dosis que están recibiendo es la adecuada, mediante los análisis, y siempre hablar con su médico. Siempre.   Philip James, presentador: Y para obtener más información sobre este tema ¿en qué lugar de internet la podemos encontrar?   Dra. Sandra Licht:  Sí. En la Asociación Americana de Tiroides está la página dedicada a los pacientes y están los folletos sobre toda la disfunción tiroidea (desde nódulos, hipotiroidismo y para enfermedad de Graves), está en español y en inglés. Esto está evaluado [avalado] por los médicos de la Asociación Americana de Tiroides, o sea, está [confirmado] que es información correcta.   Porque ese es otro tema. Que muchas veces los pacientes buscan en internet sobre sus enfermedades y no toda la información es correcta. Y la otra cosa es que el paciente, muchas veces, tampoco puede interpretar lo que está leyendo. Por eso es bueno... Perfecto, buscar la información, pero después, siempre consultar con su médico si es correcta.   Philip James, presentador: ¿Existe alguna lista de médicos para hipotiroidismo? o ¿alguna página web donde un paciente puede encontrar algunos médicos?    Dra. Sandra Licht:  Tanto en la Asociación Americana de Tiroides como en la Endocrine Society figuran todos los médicos que son buenos y que uno sabe que son especialistas en enfermedades tiroideas. Simplemente se entra en la página de la Asociación Americana de Tiroides, que es thyroid.org y ahí se ve toda la red de médicos de todos los países; los que son miembros de la Asociación figuran y uno sabe que son buenos profesionales.   Philip James, presentador: Muy bien, muchas gracias doctora Licht por estar acá hoy.    Dra. Sandra Licht: Gracias a vos, muy amable por tu invitación.    Philip James, presentador:  Este es el fin del episodio número 25. Gracias por estar acá hoy con nosotros.   Este es Philip James con Doctor Tiroides. Si quiere más información acerca de tiroides o hipotiroidismo puedes ir a la página web doctortiroides.com.

Jon Merril, MD, has joined us to provide the facts about COVID-19 for M!ll3nni@L$ (aka Millennials -_- ). Jon is the CEO of epitopeRX, a medical research company that focuses on the root causes of chronic diseases including the contributions of the microbiome, viruses, and bacteria to chronic disease. Jon has experience in machine learning as applied to the life sciences. He is also a serial entrepreneur who has started and managed several companies directed to commercializing healthcare technology – all of which have resulted in acquisitions or mergers into public and private entities. He is a seasoned inventor of many patents. Jon earned a B.A. in Chemistry and Biology from Oberlin College, a medical degree from The George Washington University. Dr. Merril completed an Internship in Internal Medicine at the Washington Hospital Center and bioinformatics fellowship training at both Harvard Medical School’s Department of Computer Medicine and The George Washington University Medical Center. During his career, he has worked with leading virologists at the NIH on a variety of research efforts. Dr. Merril worked on several DARPA, NIH, and US Department of Commerce efforts involving the use of computer technology to enhance the delivery of therapeutics.HOPE YOURE ALL STAYING GERM-FREE! WASH YOUR HANDS IF YOU'RE READING THIS!!Follow us!https://www.instagram.com/theyanacast/?hl=enFind upcoming events and episodes below!https://www.yanacast.com/

In this episode of LambTaLKS, Justine and Sara welcome Dr. Jennifer Brandt PharmD, RPh, FASHP. Dr. Jennifer Brandt currently works at Washington Hospital Center as a Clinical Specialist in Critical Care and Clinical Resource Utilization. She completed her residency there and graduated from the University of Rhode Island where she joined Lambda Kappa Sigma Xi chapter. She is currently an Epsilon Alumni chapter member and has served LKS in numerous ways: as Past Grand President, Grand President, Grand Treasurer, Grand VP for Alumni, and as a Region Supervisor. She received the Distinguished Young Pharmacist Award in 2008 as well as the LKS/Merk & Co. Vanguard Leadership Award in 2019. If you would like to get in contact with Dr. Brandt, you can email her at jennybrandt1@gmail.com. We would like to thank the sisters who have made this podcast possible with their donations that paid for our wonderful sound equipment: Dixie Leikach, Christine Perry, Jennifer Rhodes, Ruth Brown, Justine Dickson, and Sara Kheboian. To learn more about Lambda Kappa Sigma or LambTaLKS, visit LKS.org. Please forward any feedback or questions to LambTaLKSPodcast@lks.org. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

This past weekend the Brodies did there first live podcast from Hoodie Season Vol 4. Hoodie Season is a kickback where there is nothing but good energy and vibes.  All proceeds go to the Hustlers Guild which is a organization designed to help children in the south east area of DC. We got to interview some great people there. Dana McGinty MD is certified by the American Board of Internal Medicine. He graduated from Howard University College of Medicine in 1986. The ground work for his medical training was laid as an undergraduate at Howard University where he graduated summa cum laude and a member of Phi Beta Kappa Honor Society, elected in 1981 as a junior. After completing his residency in Internal Medicine at Washington Hospital Center, Dr. McGinty established his private practice in Washington , DC in 1991. As a lifelong resident of DC, Dr. McGinty maintains strong ties with the community. In 2006, Dr. McGinty added another dimension to his medical practice when he pursued another interest and became a Licensed Medical Acupuncturist upon completing his training at the Center for Pain Research in San Francisco, CA. He has found many helpful applications in his routine care where acupuncture is an important addition or even superior to some of the things Western medicine has to offer. Dr. McGinty practices Integrative Medicine, which is Primary Care Medicine with the addition of therapies such as Acupunctureas well as promotion of lifestyle changesand embracing natural and herbal remedies for appropriate problems.. 20 min mark- Maude Okrah is an entrepreneur who is passionate about bringing solutions to underserved minority markets. She has over 10 years of experience working in the strategy space with startups and Fortune 500 companies. She is CEO of Bonnti, a beauty technology company focused on women of color.  They bring the professionals right to you with a curated experience. It's been described as the Uber Black for Beauty.They have been featured in Forbes, Inc, Ebony Magazine and have worked with companies and organizations such as Obama Foundation, Essence, Ebony,  BET, Warner Brothers, Cirque du Soleil and CBS. Maude is Ghanian American and originally from Boston, MA. She is an alumnus of Emerson College. 35 min mark - Jason Spears is a native of Piedmont, Alabama and a 2009 graduate of Tuskegee University in Tuskegee, Alabama, where he earned his degree in Political Science/History. For more than five years Jason worked as an Legislative Associate and Deputy Communication Director for Congresswoman Eleanor Holmes Norton of the District of Columbia, where he worked on a portfolio of issues, which included health care, education, and foreign affairs. Jason was also Congresswoman Norton's advisor and event specialist for the Congressional Caucus on Black Men and Boys. Currently, Jason is a full-time student at The New York University Robert F. Wagner Graduate School of Public Service where he is earning his Master's degree in Public Administration (MPA) with a concentration in Public and Nonprofit Management and Policy.Please make sure you guys subscribe/rate and follow us :https://www.stitcher.com/podcast/the-brodieshttps://www.iheart.com/podcast/256-the-brodies-43079223/https://open.spotify.com/show/3fWskouBgDXALgDcFPxMFfhttps://podcasts.apple.com/us/podcast/the-Support the show (https://www.patreon.com/TheBrodies)

Acne is common in teenagers, but it can become a more persistent problem for adults. Dermatologist Dr. Sanna Ronkainen discusses how we treat adult acne and ways to protect your skin.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: We’re speaking with Dr. Sanna Ronkainen, a general dermatologist at MedStar Washington Hospital Center. Thank you for joining us, Dr. Ronkainen. Dr. Ronkainen: Thank you for having me. Host: Today we’re discussing acne, a common problem that’s often associated with teens but affects many adults, as well. Dr. Ronkainen, could start by discussing the reason adults develop acne? Dr. Ronkainen: Absolutely. So, for some adults that I see, their acne is carried on from their teenage years into their young adulthood. So, I see a lot of patients in their early 20s who are still struggling with acne. However, acne, particularly of the face, chest and back, can also linger or become a more persistent problem in women who are in their late 20s, 30s or 40s or even later than that because of the hormonal component of acne. Patients also come in reporting acne when they have inflammatory bumps or acne-like lesions on the body, which sometimes can be related to folliculitis, which is an infection of the hair follicles, which usually happens on areas of the skin that are covered by clothes, such as the buttocks or the thighs. So, we see a variety of different reasons that adults get acne. Host: Do certain demographics, such as race and gender, make a person more at risk for developing acne? Dr. Ronkainen: I think that gender, particularly females, in the kind of 20s, 40s range, tend to have more of a hormonal component of their acne, so definitely we see that patient population a lot in our dermatology clinics. Host: We know the face is a common area that people get acne, but where else can people get acne? Dr. Ronkainen: Classic acne tends to affect the face, chest and back. However, if it’s severe, it can also affect the shoulders. And, as I discussed earlier, folliculitis can affect the buttocks or other areas such as the thighs. Host: What treatment options are available for adults with acne? Dr. Ronkainen: So, even just starting at the local pharmacy, there are a lot of over the counter options for acne and there are many different ingredients that patients can experiment with. Benzoyl peroxide is a classic treatment for acne that really targets the bacteria that grows on the skin. There’s also salicylic acid, glycolic acid or sulphur washes it; work to more exfoliate the skin, help clear the pores that way. These are available over the counter in various products, however, they can be coupled very nicely with prescription products such as topical antibiotics or topical retinoids. These can also be accompanied by oral medications if the acne is deemed to be more severe. Host: How long does it typically take a patient to treat their acne? Dr. Ronkainen: Acne can be really frustrating to treat and, especially when patients are coming in to see me, they want results pretty quick. And, it’s frustrating to tell them that it takes up to three months to really see if a certain new acne regimen is going to work for them. So, I usually tell people that we should start seeing some improvement by the first month, but really by three months we should know if this treatment regimen is really working for them or if we need to change it up a little bit. Host: What are some tips people can follow to help them prevent or treat acne? Dr. Ronkainen: To prevent or treat acne at home, it’s very important to be mindful of what you’re putting on your skin every day. Number one, you need to make sure that the products that you’re using on your skin are not blocking your pores. And so, the products you would be looking for to be using are labeled non-comedogenic, meaning they don’t cause acne. Also, while at home, you can start out with some gentle cleansers and gentle topical treatments that are available over the counter and incorporate those into your daily regimen. Host: Why is MedStar Washington Hospital Center the best place to seek care for acne? Dr. Ronkainen: 353 Washington Hospital Center dermatologists have a wide breadth of experience in treating acne and all types of skin cancer in patients of all ages. So, we really have the dermatologists who work well with the patient to find a regimen that works for them, whether it is just topicals or if we need to go to more aggressive therapy such as oral antibiotics, anti-hormonal therapies, or Isotretinoin, also known as Accutane. Host: Could you share a story where a patient overcame acne after visiting you at MedStar Washington Hospital Center? Dr. Ronkainen: Absolutely. We see acne patients every day in our clinic and there’s nothing more satisfying than having a patient come back in three months, after you started them on a regimen, and have them just have a visible happiness on how well that they’re doing and the improvements that they’ve seen. Host:  Is there anything in people’s diets that could influence their risk of developing acne? Dr. Ronkainen: You know, this topic comes up a lot in my appointments with my patients. And, the only study that we have that has shown a correlation between a certain dietary component and increased development of acne, is skim milk. I don’t think we know exactly why that is, considering as compared to patients who drank regular or whole fat milk and there was no evidence of increased acne in that patient population. So, that’s the only piece of evidence-based medicine that I can point to, to say maybe switch over to the whole fat milk. Host: Some people can be tempted to pop their pimples when they arise. Is this something that’s safe to do? Dr. Ronkainen: As tempting as it is, I do not recommend that my patients pop their own pimples. Breaking the skin can cause more inflammation and can cause more scarring in the long run. Sometimes, if patients have a really deep, painful acne bump, sometimes they can come in to the clinic and have an injection of an anti-inflammatory medication to help soothe that area. However, usually trying to pop the pimple yourself is more trouble than it’s worth and will lead to long-term scarring which tends to be a more frustrating process for patients I see in the long run.  Host: At what point should a patient go to see a dermatologist to treat their acne? Dr. Ronkainen: I think if a patient is not satisfied with how their skin is looking at home, a visit to a dermatologist is an easy choice. We can always talk you through what you’re using as your home regimen - tweak that as well as add in prescription-strength products. So, if you’re at home wondering whether or not you should be seeing a dermatologist, even a one-off consultation certainly wouldn't hurt. Host: Thanks for joining us today, Dr. Ronkainen. Dr. Ronkainen: Thanks so much for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Deep Vein Thrombosis (DVT), a condition in which blood clots form in the deep veins, affects as many as 900,000 Americans each year and can cause symptoms such as pain while walking and a burning sensation in the legs. Learn who’s most at risk of developing DVT and common treatment options.    TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: We’re speaking with Dr. Steven Abramowitz, a vascular surgeon at MedStar Washington Hospital Center. Thank you for joining us, Dr. Abramowitz. Dr. Abramowitz: Thank you for having me. Host: Today we’re discussing deep vein thrombosis, or DVT, a condition where a blood clot forms in one or more deep veins in your body. Dr. Abramowitz, could you begin by discussing how these blood clots form and where they typically arise? Dr. Abramowitz: Sure. So, in our body, our veins are responsible for bringing blood back into our heart. Arteries take it away, veins bring it back. And, when we think of the veins in our body, there are veins that are superficial, or near the skin, and veins that are deep that run down near our bones or with our arteries. These deep veins - you could think of them, if you’re in the DC area, as our big roads - let’s say the New Hampshire’s or the Pennsylvania Avenues or the Georgia’s. And, some of our superficial veins are more like our side streets - like a T street or a U street. And, everything drains into these deep veins. But, sometimes there can be a traffic jam, and that traffic jam, in the case of our blood vessels, is a blood clot. And that blood clot can occur anywhere these deep veins are - in the arms, in the legs, essentially anywhere that you may name a deep vein. And what we find is that, depending upon where the clot is, it can lead to a variety of different symptoms. And, if that clot breaks free, it can travel back to the heart, where all the blood from our veins goes originally. And that can result in a pulmonary embolism, which can be a fatal condition. Host: And what are some of the common symptoms of DVT? Dr. Abramowitz: Most commonly, people who have DVT in the lower extremities, will experience swelling, pain when walking, a hot burning sensation as their leg gets warm or engorged and full of blood. And those typically are the most common complaints that people have. Host: Who is most at risk of developing DVT? Dr. Abramowitz: Anybody can fall victim to deep vein thrombosis. And really, it depends on what’s going on with someone else’s health. So, for example, there are plenty of patients that we treat here at MedStar Washington Hospital Center who are younger, maybe they’re in their teens, and the first time that they know they have a clotting disorder or a blood disorder that may make them more likely to make blood clots, would be the presentation with a DVT in one of their legs. Other times, patients who have had surgery or other conditions that make them less mobile or engaging in activity in their lives could be victims of DVT, as well. And, it can also be something that we find in hospitalized patients, people who are immobile in a hospital bed for extended periods of time. So really, it’s a condition that can affect anybody of any given age. Host: How is DVT diagnosed? Dr. Abramowitz: For the most part, it’s both a clinical diagnosis and a confirmation with ultrasound. And we use ultrasound as a simple way of diagnosing the presence of clot within the deep veins. And this is done, again, as a very quick test without radiation exposure, or dye, and it’s a simple procedure that we can do, even at the bedside, for someone who’s in the hospital. Host: What treatment options are available for DVT? Dr. Abramowitz: Right now, for patients who have deep vein thrombosis, we currently offer two therapies. First, most patients with deep vein thrombosis, will be treated with something that’s called an anticoagulation agent. In basic terms, it’s a blood thinner. And the reason we put somebody on a blood thinner is not that it actually gets rid of the blood clot, but that it makes it less likely for more blood clot to form because our bodies have the natural ability to break down clot over time. But for some patients who have extensive clot or a lot of clot throughout the vein, let’s say in a leg, we can actually go in with a wire and a small catheter, which is like a plastic tube or a hose, and we can give the medication directly into the clot, to make that clot go away faster for those patients, as well. Host: And, how fast is faster for those blood clots, typically? Dr. Abramowitz: Well, if we’re performing a procedure on a patient, usually we can get that clot away in a single session. For patients who have to have blood thinners, sometimes it can take the body up to 3 to 6 months to dissolve the clot on its own. Host: Is there anything people can do to prevent DVT? Dr. Abramowitz: For patients who are sick or at risk for DVT, meaning they’re not moving around a lot or they already have something else in their body that’s making them feel inflamed or more likely to develop a blood clot, those patients can both get up and walk and move around. If they can’t do that, engage in exercises so that they’re activating those muscles in their legs and circulating blood. For patients who are, let’s say younger, and they have a blood condition making them more likely for DVT, again, moving around is really important. And, a lot of times we talk about blood clots in a setting of travel or prolonged travel. So, if you’re getting on a plane, I always tell patients not to have that 2 or 3 glasses of wine and pass out, make sure you get up and walk every hour or so. And, if you’re in the hospital, or you’re in a sedentary job, or it could be you’re sitting at a desk, make sure you stand up and walk, too. Host: Why is MedStar Washington Hospital Center the best place to receive treatment for DVT? Dr. Abramowitz: Well, one of the great things we have here at MedStar Washington Hospital Center is an interdisciplinary approach to the management of deep vein thrombosis. People who have DVT, not only do they have symptoms now, but they can have symptoms in the future, too, because as the body breaks down that clot, it causes swelling and inflammation in the same way as if you were to get a sprained ankle - you’d have swelling and inflammation. And, that swelling and inflammation can lead to scarring of those veins. So, the deep veins - maybe they’re a four-lane highway before your blood clot, but afterwards they’re a two-lane highway. And that can lead to swelling and that sort of congested traffic for a long period of time. At Washington Hospital Center we offer all of the new therapeutic interventions for deep vein thrombosis management. Anything from sucking out the clot, which is called mechanical thrombectomy, to dissolving the clot rapidly, which we call pharmacomechanical thrombolysis, which is essentially like a little machine that injects that clot busting medication in and sucks the clot out. And, we also put those catheters in and leave them in overnight to slowly dissolve a clot that may have been around for a longer period of time. So, we have the tools to treat your DVT and, also then, take care of you because the DVT is a symptom of something else, most likely. Maybe you have something wrong with your veins that we can diagnose and treat with a stent. Maybe you have another underlying condition, like a blood disorder, or you’re sick with something else so the DVT is the first thing we diagnose. So, when you come to Washington Hospital Center with a DVT, it’s not just about treating your clot. It’s about making sure we understood why it happened. And, we have every single surgical and medical sub-specialty service you could want here to help you deal with that process. Host: How often can DVT be a gateway to other conditions? Dr. Abramowitz: Well, the DVT is a condition in and of itself, but you have to ask yourself why it happened. And, for a lot of patients, sometimes the first sign that they may have cancer, for example, is the blood clot. And so, they need to be screened for conditions that would make their blood more likely to clot. Or, for someone who’s younger, if they have a blood clot, it may be a sign that they’re actually more likely to have a genetic condition. So, anytime someone has a DVT, it always prompts us to ask the question, “Why did this happen?” and “What can we do to figure out, for THIS patient in particular, what led to this state of being?” So, I’d say 80 percent of the time someone has a DVT we’re able to figure out the reason why, be it another medical condition, an anatomic predisposition, meaning there’s something in their body maybe compressing a vein, or we find out that they have a genetic condition that’s related to their blood in and of itself. Host: What are the risks of leaving DVT untreated? Dr. Abramowitz: That’s a great question. So, really it depends upon where in the body the DVT is. For the most part, blood clots below the hip, those being in the top part of the leg or the bottom part of the leg, they tend to result in swelling in the short term, but don’t necessarily result in long-term damage to the leg that would cause wounds to form or prolonged swelling in the future. But what we find is blood clots that are above the hip or above your groin that affect the veins in your belly and in your pelvis. Those can lead to long-term drainage problems from the leg and that can result in long-term swelling or even wound-care formation. And we call that post thrombotic syndrome. So, it’s really important for us to identify the extent of the blood clot and where exactly in the body it is so that we can predict what someone’s risk is in the future for developing problems as a result of their DVT. Host: Thank you for joining us today, Dr. Abramowitz. Dr. Abramowitz: My pleasure. Thanks for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Skin cancer, which often appears as brown or red spots, is the most common type of cancer in America. Dr. Sanna Ronkainen discusses the best ways to prevent it, as well as how we treat it.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: We’re speaking with Dr. Sanna Ronkainen, general dermatologist at MedStar Washington Hospital Center. Thank you for joining us, Dr. Ronkainen. Dr. Ronkainen: Thanks for having me today. Host: Today we’re discussing key ways to prevent skin cancer, which affects millions of Americans each year. Dr. Ronkainen, could you start by discussing the most common types of skin cancer you see? Dr. Ronkainen: Absolutely. So typically, in our dermatology clinic, we see kind of three main types of skin cancer. There are basal cell skin cancer, squamous cell, and then melanoma. There are a few other more rare skin cancer types that we also treat here at this facility. However, those three are kind of the ones that dominate our interest. Host: Could you walk us through what differentiates these common types of skin cancers? Dr. Ronkainen: Absolutely. So, basal cell and squamous cell skin cancers we typically lump under the non-melanoma skin cancer category. And those are usually non-pigmented or non-mole-like skin cancers that can show up, usually on sun-exposed areas, that will show up kind of like a pimple that is just not going to heal or as a rough spot that bleeds easily. These are much more common in our older patient population. Melanoma is well known, I think, to most listeners. It’s a type of skin cancer that is one of the more dangerous types of skin cancers and those typically look like dark spots that come out of the cells that produce pigment called melanocytes.  Host: Could you describe your typical patient population? Dr. Ronkainen: Here at Washington Hospital Center we see patients from all walks of life and from the whole spectrum of ages. For patients who are coming in for skin cancer, we’ve seen everything from teens to people who are elderly. So, you know, it can really be anybody who walks through the door. Often, we’re seeing young people in their 20s for skin cancer screenings because they have a family history of either melanoma or non-melanoma skin cancers and just want to get a physician’s eyes on them to make sure that we don’t see anything concerning. Host: What are some common risk factors for developing skin cancer? Dr. Ronkainen: There are a few main risk factors that we think about when it comes to skin cancer. First and foremost, is UV radiation. Cumulative exposure to the sun or to tanning beds can increase your risk of skin cancers, including the worrisome melanoma type. In addition to that, as patients get older, there’s a higher risk just because of that cumulative damage. Also, if they’re more fair, that’s a risk factor. But I’ve seen skin cancers in our African American patients here in the District of Columbia, so it really can happen across the whole spectrum of how dark your skin is. Also, if you have a family history or a personal history - if you’ve had a skin cancer before - those certainly play a role. And then last, if you have had a history of a medical treatment such as radiation for an underlying cancer or if you have immunosuppression, whether that’s from a transplant or HIV, those can certainly play a role and do increase your risk of all three types of skin cancer, but particularly the squamous cell type. Host: When it comes to preventing skin cancer, what are some key things people can do? Dr. Ronkainen: In preventing skin cancer, sun protection is very important. Staying out of the sun between the harshest hours, between 10 and 2, during the midday is important. Wearing sun protective clothing or getting that sunscreen on can be very helpful. And also, keeping a close eye on your own skin and seeing if there’s a spot that has come up that bleeds easily or is scaly or rough or is growing - those are things to keep an eye out for. Certainly, I love going outside and exercising outside and enjoying the good weather when we have it here in the district, but just being mindful that those UV rays do add up over time is important. Host: And, speaking of sunscreen, there are a lot of options out there. Some people prefer things like all-natural ingredients. What are some important things people should look out for when they’re picking out sunscreen? Dr. Ronkainen: Absolutely. The number of different types of sunscreen has exploded, and every five minutes I’m hearing about a new type of sunscreen that’s come out. When thinking about what type of sunscreen to use, certainly the higher the SPF the better. However, sometimes when you’re using a higher SPF sunscreen it can come out pretty chalky and it can make you look like you’re wearing glue on your face. So, I often say that the best sunscreen that you can put on is the one that you don’t mind putting on. So, certainly testing out some different brands to figure out which ones you like is helpful. But in terms of trying to go towards all-natural ingredients or ingredients that don’t absorb into your skin, I typically tend to recommend sunscreens that have the physical blockers such as zinc or titanium or iron oxide. However, those tend to be a little bit thicker and less cosmetically appealing to patients because they don’t blend in as well as the chemical blockers. Host:  For sunscreen, is there an SPF level that you usually recommend? Dr. Ronkainen:  When I’m talking about sunscreens with my patients, I always recommend that they use an SPF 30 or above every day. And, typically I recommend that patients get that on in the morning as part of the moisturizer that they apply while they’re getting ready. And then, SPF 30 to 50 is typically what I recommend when they’re out being active, on vacation, at the beach, or things like that. Host: Are there symptoms of skin cancer that people should look out for? Dr. Ronkainen: When patients develop a spot that is new, growing, changing, is very sensitive or painful, or bleeds easily - those are signs of skin cancer. Certainly, sometimes patients will come in with a mole that’s just been irritated but rubs on the clothing or gets caught by the razor blade if it’s in the beard area, and we provide reassurance to that, but those red flag symptoms that I mentioned earlier certainly warrant just an extra vigilance of that spot.  Host: What are some common treatment options for people who do develop skin cancer? Dr. Ronkainen: Treatment of skin cancer depends on the subtype of skin cancer and that is a conversation between a patient and a dermatologist. However, typically most of the skin cancers that we’ve discussed today require excision, so cutting the spot out. We either do that as a conventional excision where we cut a little rim of healthy skin around the spot to cut it out completely or we send the patient for a special type of surgery called Mohs surgery. We have a Mohs surgeon here at Washington Hospital Center who is available to do surgeries like that. Very rarely, certain types of skin cancer can be treated with a topical cream. However, that decision needs to be made at the time of diagnosis. Host:  Could you further discuss the topical skin cancer treatment? Dr. Ronkainen:  Sometimes, when a skin cancer affects only the very top layer of skin, a topical cream can be used to treat the area. This is usually done by the patient at home over the span of several weeks, with close follow-up with the dermatologist to ensure that this spot is resolved completely with the topical treatment. Again, it does require that close follow-up to ensure that there’s nothing left over once the area is healed up. Usually, using the topical creams, the area tends to get red and inflamed, which is a sign that the cream is fighting off the skin cancer cells. Sometimes we use creams like that as a preventative measure in patients who have a high risk of skin cancers like the squamous cell-type, who have a lot of the pre-skin cancers, or sun damage, called actinic keratosis. Host: Could you describe what Mohs is? Dr. Ronkainen: So, Mohs surgery is a specialized type of surgery that is done by a dermatologic surgeon where the patient comes in to the clinic and has the cancer cut out with a very narrow margin. They try to spare as much of the healthy skin around the cancer as possible. The patient then waits until the surgeon is able to look at the slides, that are processed in-house, to make sure that the edges of the tissue that was taken out show no signs of skin cancer. If there is still cancer left at the edges of the spot that was taken out, then the surgeon will go back in and take out more of the skin until they know that the entire cancer is out. Sometimes it can take a little bit longer than just doing a general skin cancer surgery. However, it does spare as much of the healthy tissue around the skin cancer as possible to try and minimize any cosmetic defect there. So, it usually takes about a half a day and the patient waits in the clinic between the different stages of the surgery. However, the ultimate cosmetic result is usually very good. Host: Could you discuss the risks of not treating skin cancer? Dr. Ronkainen: Sure. So, for skin cancers like basal cell skin cancer, this seems to be a slow growing skin cancer that grows on the top layer of skin, which patients might be tempted to leave alone without treatment. However, it can cause a lot of discomfort as the spot continues to grow, bleeds easily after even just gently scratching the skin, and can eventually erode in to the tissue under the skin. Sometimes I’ve seen basal cells even go so deep as they go in to bone. However, things like melanoma or squamous cell skin cancer can travel to the lymph nodes and become more widespread and metastatic, which then would require systemic treatment with chemotherapy instead of just having the spot cut out. Host: Why should people who have skin cancer seek treatment at MedStar Washington Hospital Center? Dr. Ronkainen: We do offer comprehensive care for skin cancer here at Washington Hospital Center. It’s nice because we do have a specialized surgeon who does Mohs surgery here. We also have multiple dermatologists who feel comfortable doing general local excisions on kind of more simple skin cancers. So, it’s nice to see your own dermatologist for the procedure, that they initially diagnosed by biopsy. But also, if, unfortunately, you have an aggressive type of skin cancer, such as a more invasive melanoma, we do have the ability to work with our colleagues in general surgery or oncology or radiation oncology to optimize a multidisciplinary form of care. Host:  Could you share a patient story of someone who came in with a minor skin condition, or what they perceived as minor, and ended up needing serious treatment? Dr. Ronkainen: Sure. I’m thinking of one patient in particular who came in for a spot on his back that was just a rough, raised growth that caught easily on his clothes. And on evaluation of that spot, we realized that it was a benign seborrheic keratosis, which is just a benign warty growth that tends to come up with patient’s age. However, when we were examining the patient, we happened to notice a dark spot very close to that that the patient had not noticed because, again, it was on his back so that he couldn’t see it, that ended up being a melanoma. Thankfully, we were able to get a biopsy of the melanoma early enough and we were able to excise it and we were able to treat it completely without it causing him any further grief other than causing a scar from the surgery. But thankfully we caught it early. Host: Thanks for joining us today, Dr. Ronkainen. Dr. Ronkainen: Thanks for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Her name was once Baby-Girl Perez. She was born at Washington Hospital Center to a mother who cared for her for 9 months. And then, less than 24 hours after giving birth, Mother-Perez was gone. This is a very personal One-On-One. But is an important story for all of us today as our Federal policies keep men, women, and children in 200 detention centers in this, the greatest country in the world. This is the story of one child, Baby Girl Perez, who was lucky enough to be born in Washington D.C. Lucky to be born at a different time in this country. I hope you will share this story and subscribe to my podcast. The picture attached to this Episode was taken by me of my daughter Alexandra and her daughter, my grand-baby girl Aryah. Thanks for your support, Love, Gloria   Thank you for the music I used in this podcast: Title: Chill Soul Rap Instrumental Artist: Nkato Genre: Hip Hop & Rap Mood: Dark Download: https://goo.gl/t3BpaK ––– • Licence: You’re free to use this song in any of your videos, but you must include the following in your video description (Copy & Paste): Chill Soul Rap Instrumental by Nkato https://soundcloud.com/nkato Creative Commons — Attribution 3.0 Unported— CC BY 3.0 http://creativecommons.org/licenses/b... Music promoted by Audio Library https://youtu.be/sdfcUBhRlgs  

Ulcerative colitis affects nearly 700,000 Americans and causes symptoms ranging from diarrhea to arthritis to skin rash. Thankfully, medication options and surgery can significantly reduce symptoms and even bring about long-term remission for patients.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re speaking with Dr. Nidhi Malhotra, a gastroenterologist and Assistant Professor of Medicine at MedStar Washington Hospital Center. Today we’re discussing ulcerative colitis, which is an inflammatory bowel disease that causes long-lasting inflammation and ulcers, or sores, in the digestive tract. Welcome, Dr. Malhotra. Dr. Nidhi Malhotra: Thank you for having me. Host: Could you tell us what causes ulcerative colitis? Dr. Malhotra: So, ulcerative colitis is thought to be an auto-inflammatory condition in a genetically susceptible individual. Let me simplify that. So, someone with a genetic predisposition, meaning that they have genes that make them more susceptible to acquire this disease, and then there is an inciting event that triggers the inflammation. The inciting event could be an infection. It could additives or preservatives in our diet which have directly implicated in IBD. It could be chemicals. Or, it could be antibiotics. Or really, sometimes, a completely unrecognized reason as a triggering factor. But once triggered, the inflammation causes damage to the colon, and patients will start having symptoms. Host: What are some of the common symptoms of ulcerative colitis? Dr. Malhotra: So, I usually divide up the symptoms into GI and non-GI related symptoms, because the inflammation can actually affect really any part of your body. So, GI-wise, patients may present with abdominal pain, diarrhea, bloody diarrhea, nocturnal diarrhea - meaning they are waking up at night to have a bowel movement, tenesmus - meaning they have feelings of incomplete evacuation and have to keep going back to the bathroom constantly, and severe urgency. And then the non-GI symptoms may be related to inflammation of other body parts. They could have severe arthritis - which is inflammation of the joints. They could have uveitis or episcleritis - which is inflammation of the eye. They could have skin rashes. So, a whole slew of symptoms. Host: Can ulcerative colitis be serious or life threatening? Dr. Malhotra: Yes. So, let’s talk about short term. Untreated disease, first of all, is a huge burden on the patient. They can have debilitating symptoms and therefore, it’s not just a burden on their workforce where they are forced to miss work due to their symptoms but also, you know, people miss out on their social and family life. So there is the personal, social and financial impact. But then there’s untreated or complicated disease that can certainly become bad enough to require urgent or emergent surgery and hospitalization. So we always try to avoid a situation where an emergency surgery may be needed. Patients may need emergency surgery for refractory bleeding where their colon is bleeding so much that they may be exsanguinating. They can get a toxic megacolon where the colon swells up and does not function and can cause life threatening infection if not taken out emergently. So those are sort of the short term serious, life threatening implications. Long term, the risk of untreated ulcerative colitis is a huge risk of cancers. So, untreated disease puts patients at risk of colon cancer almost 8-fold compared to someone without ulcerative colitis. And non-colon related patients are at risk for developing something called PSC, which is primary sclerosing cholangitis. It’s inflammation and scarring of the bile ducts and it puts them at risk for a bile duct cancer called cholangiocarcinoma as well as gallbladder cancers. So really, long term and short term implications on their health. Host: Could you tell us a little bit about your patient population for ulcerative colitis? Dr. Malhotra: Sure, ulcerative colitis has a bimodal peak of incidence, so patients may present in their mid to late teens all the way up to early thirties. And then there’s a second peak with patients in their 50s to early 60s Host: So often ulcerative colitis begins gradually and then gets worse. How is it diagnosed? Dr. Malhotra: So actually, about a third of patients may present with mild disease and continue to have mild disease throughout the course of the disease. A third of patients may present with mild disease and at some point gradually or sometimes all of a sudden worsen to have severe disease. And about a third of patients may present with severe or even what we call fulminant disease, where they need emergent hospitalization, aggressive therapy and sometimes even surgery immediately. So, diagnosis is based upon endoscopy and biopsy. So, most patients will need a colonoscopy. Sometimes we just do a flexible sigmoidoscopy if the colon is really inflamed and not go the entire length of the colon. And it’s really important to make sure that the patients, at the time of diagnosis and really at any point when their disease is worsening, don’t have a concurrent infection with clostridium difficile, which is C. diff. C. diff is a bacteria that’s increasing in the community in general, but it’s present in patients with colitis in a significant more proportion than patients without colitis. And, the presence of C. diff makes ulcerative colitis more difficult to treat. It increases the risk of getting hospitalization and the risk of getting an urgent colectomy. Host: What medical treatments are available for ulcerative colitis? Dr. Malhotra: There actually many treatments available today. Mesalamine, which is a very old drug and we still use it in practice, is used for mild disease as first line therapy. Then there’s immunomodulators, such as Azathioprine or 6-mercaptopurine, which modulate, as their name suggests, modulate the immune system. So they decrease inflammation over time. We’re sort of steering away from those medications as first line as better and improved drugs are available on the market. And then there is biologics, which are medications that bring down inflammation and actually help heal the lining of the colon. And in reality, since the advent of these biologics, the face of colitis has changed. Less patients are getting surgery and more patients are achieving healing. The first biologic that was approved was infliximab. Now it’s been on the market for almost 18 years and it works very well in patients with colitis. And then there’s two other similar biologics - adalimumab and golimumab. There was another mechanism of drug that was approved in 2014 called vedolizumab which works completely different and, again, works really well in colitis. So, overall, we have a lot of medications. We are also anticipating approval of two new medications with different mechanism of action, hopefully this year - tofacitinib, which is a jak inhibitor and ustekinumab, which is actually approved in Crohn's disease and is hopefully going to be approved for ulcerative colitis as well. Host: Is surgery an option to cure ulcerative colitis? Dr. Malhotra: Yes. Removing the colon is actually curative of ulcerative colitis. We usually reserve a colectomy, a removing the colon, for patients who are not responding to our best medications or they’re extremely sick and their chances of responding to a medication is very low. But, I always tell my patients, getting surgery to remove colon is not failure of treatment - it’s just another modality of treatment. Surgery is done best when it’s planned. So, emergent surgery can sometimes be difficult as it can involve up to 3 procedures for the patient to complete the surgery and can even involve having a temporary ileostomy. But yes, in short, removing the colon is curative of ulcerative colitis. I do want the listeners to be aware that primary sclerosing cholangitis, which is inflammation of the bile ducts, can still happen or occur as a complication of ulcerative colitis, even years after their colon is taken out. So, even if they’ve had a colectomy, it’s important for them to follow up with their GI provider at least once a year to make sure that it’s not a complication they’re developing. Host: When you have patients who you recommend surgery - what is their emotional state, what is their mental state, when you recommend that they have their colon removed? Dr. Malhotra: You know, nobody wants to hear that they need emergency surgery or part of their organs removed. The good thing about the colon is we don’t really need the colon for any nutritional support. The colon’s there to absorb water. Now, that being said, of course we are finding  more and more that the microbiome, which is the life of bacteria, fungi and viruses that live in our colon, have a lot to do with our overall health. So maybe there are some long term implications of getting your colon taken out that we don’t recognize to date. However, studies have actually been done in patients who did undergo a colectomy for their colitis, and most of those patients, in retrospect, were relieved after the surgery as they got their life back. They lived a better, fuller life. And most of the patients did respond saying that they wish they had gotten the surgery earlier. Host: Could you share a story about a patient who had a poor prognosis and you were able to help them? Dr. Malhotra: I saw a young lady, in her late 20s, single mom, she’d been battling with ulcerative colitis for many years, and because of social issues had very fragmented care and had been on steroids for many years. As we know, we’re really deviating away from using steroids. Steroids have long lasting implications on a person’s body and health overall. I saw her when she was first admitted to the hospital. She was anemic, losing weight, having 20 bowel movements a day and just very depressed, understandably so, from her disease. We actually had our surgeons also see her because we were worried she may need a colectomy, but we initiated infliximab. She did extremely well with two treatments, was able to be discharged from the hospital, four months later, I just recently saw her in clinic. She’s doing great. She’s off of steroids and she actually has a part-time job and was just out of her depression and it just felt really good to see her getting her life back. Host: Are you conducting any research regarding ulcerative colitis that people in the community should know about? Dr. Malhotra: Yes. We’re currently partnered with Georgetown University Hospital to bring trials to Washington Hospital Center. We just completed enrolling for a trial for ustekinumab for ulcerative colitis, which we have completed enrollment at this time. We currently have a trial looking at the new drug filgotinib, both for ulcerative colitis and Crohn's disease. We’re also just about to start a trial looking at stem cell treatment for Crohn's disease with perianal involvement. And we’re also looking at novel ways to treat colitis that’s being caused by immunotherapy.  Immunotherapy-induced colitis appears very similar to ulcerative colitis and so we’re looking at novel ways to treat that colitis, as well. Host: Why is MedStar Washington Hospital Center the best place for patients to seek care for ulcerative colitis? Dr. Malhotra: For diseases such as ulcerative colitis, which fall under the umbrella of inflammatory bowel disease, these conditions require very specialized and patient-oriented and patient-centered approach. We have a team of highly trained gastroenterologists with advanced training in inflammatory bowel disease, as well as a group of highly trained colorectal surgeons. We work together in a multidisciplinary approach for these complicated patients. Host: Thanks for joining us today. Dr. Malhotra: Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

As younger adults receive total knee and hip replacements, and as people continue to live longer, more replacement joints will need to be replaced themselves. Dr. Savyasachi Thakkar discusses how a revised knee or hip can give patients decades more of the improved mobility and activity they’re used to.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Savysachi Thakkar, an orthopedic hip and knee reconstruction surgeon at MedStar Orthopaedic Institute at Washington Hospital Center. Welcome, Dr. Thakkar. Dr. Thakkar: Thank you very much for having me. Host: Today we’re talking about total joint revision, which is a procedure in which a worn-out joint replacement device is replaced with a new one. Because more patients are seeking joint replacements at younger ages and because seniors are living longer now than ever before, the need for revision procedures is expected to increase over the next few decades. What are some of the common signs that a joint replacement device is wearing out or has become not as effective as it once was? Dr. Thakkar: That’s an excellent question. So, joint replacement failures can occur due to several reasons, but the patient will manifest with 1 of 2 or both problems. The first problem is pain and this is pain in excess of pain they have had previously, and they will notice a specific instance that is associated with that pain or increase in pain. They may also have increased reliance on pain medications to try and control that pain. The second thing that patients most commonly describe is instability. They’ve had a stable, pain-free joint for several years and now all of a sudden, they’re tripping more, they’re falling more, they need a cane, they need a walker to try and walk. These are the hallmarks of a failed total knee or a total hip replacement surgery that need to be evaluated, and we, at the MedStar Washington Hospital Center and the MedStar Orthopaedic Institute, are fellowship trained in dealing with such procedures and dealing with such patients, and we see such patients on a routine basis and perform about 200 or 300 revision surgeries each year with patients requiring them. Host: How long should a typical hip or knee replacement device last? Dr. Thakkar: That’s an excellent question. So, with the newer bearing surfaces that we have today, a current knee replacement or hip replacement lasts on the average of 20 to 30 years. For the most part, about 60 to 70% of patients around the age of 50 will continue to have their prosthesis either after total knee or total hip prosthesis for 30 years. In the older days, these devices would last only for about 10 or 15 years, so frequently, with the current healthcare standards that we have in patients outliving a number of their surgeries, we will see patients that have had these procedures done only about 10 or 15 years ago with the older implants that need a revision, and we at the MedStar Washington Hospital Center can care for such patients. Host: Could you talk about your patient population who are receiving total joint revisions? What…about what age are these individuals and about what health? Dr. Thakkar: Most of these...most of the patients that come to the MedStar Washington Hospital Center and the MedStar Orthopaedic Institute seeking a revision hip or a revision knee replacement are about 60 or 70 years old. They’ve had their primary hip or primary knee done when they were about 50 or 55 years old, and that’s lasted them for the last 10 or 15 years. These are active individuals that want to maintain that activity level that, in fact, want to try and achieve a lot more in their golden years. They want to try and live pain free, they want to try and get back to work if they’re still working or else find new jobs, and I think that’s a testament to the fact that these surgeries have been successful and now doing a revision surgery gives them another 30 years of the lifestyle that they desire and the lifestyle that they seek. Host: Is there anyone who wouldn’t be a candidate for total joint revision? Dr. Thakkar: Patients that have pain and instability and that are living with total joint replacements are always a candidate for total joint revision, and unless they have very dire medical comorbidities that preclude them from having surgery, everyone is a candidate for revision total joint replacement. Some of those comorbidities are significant cardiac comorbidities or significant cancer burden that these patients have with limited lifespan, and the risk of operating on them is not worth, as these patients may end up losing a significant amount of functional status after the procedure. Host: So, total joint replacement, the first time around, can be kind of a lengthy process with a lengthy recovery. How does the total joint revision recovery compare? Dr. Thakkar: That’s an excellent question. So, if the revision is for a simple bearing surface that has worn out, we can usually get the patients back feeling back to normal without a lengthy recovery. However, if the revision is for a more deep-seated problem, like an infection or a fracture, we may need to extend the period of recovery for these patients for up to 3 to 6 months. After that time period, most patients come back to their pre-revision activity level and in fact supersede that because they’ve been dealing with instability or pain issues for the last several months before coming to see us. Host: Do your patients typically have to enter rehab facilities, or how does that process work? Do they rehab at home? Dr. Thakkar: For the most part, if they get a single joint revised, whether it’s a single knee or a single hip, patients are able to go home and have the outpatient physical therapist visit their home for the first 2 weeks and then transition on to outpatient physical therapy. However, if their needs are more profound, we’re able to get them to a rehab facility for the first 1 or 2 weeks after surgery and then transition them to a home setting. Host: Total joint revision procedures can be fairly complex, if not more so complex than initial joint replacement. So, could you describe how the two procedures compare? Dr. Thakkar: Absolutely. At the MedStar Washington Hospital Center and at the MedStar Orthopaedic Institution, when a patient walks into our offices that requires a revision hip or a revision knee surgery, the first place we start is by understanding the patient’s expectations. Along with that, we have imaging studies, dedicated imaging studies focused on radiographs, CT scans, sometimes even MRI scans, to try and get the full picture of why that joint replacement prosthesis has failed. Along with that, we send patients for blood work to make sure that there’s no infection, which can happen in some of these long-standing implants. Once all of these things have been thoroughly evaluated by our fellowship-trained experts in total joint replacement and total joint revision surgery, we then proceed to surgical planning. We work with a dedicated team that focuses its attention on custom implants which are sometimes needed in these patients. We work with companies directly to try and order these implants and plan for them in advance so that we do not run into situations on the day of surgery where the implants are not available. Then we work with our physical therapists to evaluate the patient’s mobility beforehand. During surgery, we routinely use the same anesthetic protocols as we use for outpatient joint replacement surgeries to try and minimize the overall anesthetic effects that the patient sees. And in the postoperative setting, we work with the same multimodal protocols to try and control their pain, which may be a little bit more severe in the initial first few days after surgery, but then with this multimodal pain protocol, it tends to get reduced pretty significantly and patients tend to have a better outcome. With regards to my colleagues, Dr. James Tozzi and myself are fellowship-trained experts that focus on hip and knee revision surgeries, including primary surgeries. We have over 40 years of experience performing such procedures on a routine basis. Dr. Wiemi Douoghui and Dr. David Johnson in our department focus on primary joint replacement surgeries. Host: Is there anything that a patient who currently isn’t having problems with their joint replacement device--is there anything that those individuals can do to help make their device last longer or to care for it better? Dr. Thakkar: Absolutely. Devices are mechanical objects which are subject to failure. However, one of the things that I tell patients routinely is to use those devices to the fullest maximum potential that they are comfortable with. If they feel that they can achieve their maximum activity status without compromising on pain levels, without compromising on their activities of daily living, I think that the device is working just well and just perfectly for this patient. However, if the patients start noticing that they’re hurting more or that they’re feeling more unstable, I recommend these patients to come and seek out attention at the MedStar Washington Hospital Center, MedStar Orthopaedic Institute. Host: Why is MedStar Washington Hospital Center and the MedStar Orthopaedic Institute the best place for a patient to go for a total joint revision? Dr. Thakkar: So, total joint revisions can be tricky situations. First and foremost, you need to understand why the joint replacement surgery has failed. For this purpose, we have several experts, including Dr. James Tozzi and myself, that deal with such procedures on a routine basis. Not only that, you also have to understand the overall medical picture of this patient.  The MedStar Washington Hospital Center has experts in cardiology, experts in neurosurgery, experts in various other departments that are trained to deal with complex patients with complex needs. Having a revision procedure performed in a non-tertiary hospital is always challenging because they cannot care for this patient and its entirety.  At the MedStar Washington Hospital Center and the MedStar Orthopaedic Surgery…at the MedStar Orthopaedic Institute, we’re fortunate to be working in a tertiary care facility which can deal with patients as a whole and not just piecemeal, and hence this is the best place to get a revision joint replacement procedure performed. Host: Dr. Thakkar, how many total joint revisions does the orthopaedic team at MedStar Washington Hospital Center perform annually? Dr. Thakkar: At the MedStar Washington Hospital Center in the MedStar Orthopaedic Institute alone we perform about two or three hundred revision surgeries each year. We have Dr. James Tozzi and myself who specialize in primary and revision hip and knee replacement surgeries. We also have Dr. Wiemi Douoghui and Dr. David Johnson who focus on primary knee replacement surgeries. Knee revisions or hip revisions can be multifactorial and at the MedStar Washington Hospital Center we have an expert team with over 40 years of experience devoted to the care of such patients. We've used traditional as well as cutting edge technology for caring for these patients, and overall our outcomes are far superior to many other institutions in the area. Host: Could you share some success stories from your patient population? Dr. Thakkar: Absolutely. So, one of our patients…she was suffering from systemic lupus erythematosus. It’s a autoimmune disorder. She was referred to me by my rheumatology colleagues as she had several hip replacement surgeries and several surgeries in the past that had failed for instability issues. We were able to identify the instability, the cause of the instability, and we were able to very successfully try and replace a certain component in her prosthesis that had worn out, and after that she’s been able to get back to her activities of daily living. She’s very active, very active in the community, and likes to contribute to her church and to her society, and has been able to get to that in a very successful way, despite having a significant limitation. Host: Thanks for joining us today, Dr. Thakkar. Dr. Thakkar: Thank you very much. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Colonoscopy can be an uncomfortable topic, but the fact is that it saves lives. Dr. Jennifer Lee discusses common excuses for not getting the test, who should be screened and why colonoscopy is so important.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Jennifer Lee, a gastroenterologist at MedStar Washington Hospital Center. Welcome, Dr. Lee. Dr. Jennifer Lee: Hello. Thanks for having me. Host: Today we’re talking about colonoscopy and the national campaign 80 percent by 2018. The goal is to increase the colorectal cancer screening rate to at least 80 percent of eligible adults by the year 2018. Colonoscopy is the gold standard of colon cancer prevention and with regular screening, precancerous masses called polyps often can be removed before they turn into cancer. Dr. Lee, why do people avoid colonoscopy, a screening that can effectively prevent devastating colorectal cancer? Dr. Lee: I think for many reasons patients would avoid colonoscopy. One is maybe they don’t want to know. But I think the biggest reason is they find it to be uncomfortable, or, you know, who wants to come in and have something inserted in their backside? Host: Could you discuss why someone wouldn’t want to know? Dr. Lee: Yeah, I think some patients know that you maybe they have symptoms. Maybe they have a little bit of bleeding. Maybe they have a change in their bowel habits. And so they kind of suspect that something’s wrong, but, you know, you don’t want the devastating news of cancer, which is why screening colonoscopy is so important. We do it in asymptomatic individuals, and the goal is to prevent cancer. I often get asked, “Is colonoscopy the only way to screen for colon cancer?” And the answer is no. We have other noninvasive ways to screen for colon cancer, and they’re very good. But colonoscopy is a test of cancer detection, but also cancer prevention, and it’s because we’re able to take off polyps and prevent them from growing into colon cancers. Host: What are some of the alternatives if someone is really averse to colonoscopy? Dr. Lee: They’re mostly stool-based tests. Your primary care doctor can provide it. We provide it, as well. The oldest method which is fecal occult blood testing or, FOBT or otherwise known as guaiac testing. But there are better tests now and those include the FIT test and the Cologuard. Host: Are those tests done at home or at the doctor? Dr. Lee: They are done by providing a stool sample, so they are arranged through the doctor, but most patients just, sort of, do it at home. I think a misconception is that your doctor is supposed to take your stool sample with a rectal exam in the office, but it’s supposed to be a spontaneous stool sample. Host: How do you discuss colonoscopy and why it’s so important with your patients if they come in with fear or anxiety about the test? Dr. Lee: The way I describe it to my patients is the hardest part is the prep. You can’t eat the day before. You are drinking a laxative that potentially is not the best tasting laxative.  And then you have to stay by the toilet. And you know, I tell my patients to think of it as a cleanse and I think people get that. And then by the time you’re coming in, you just have an IV inserted and you get to take a nap. After you take your nap, you wake up, you’re done. So, it’s not as bad as people think it is. I think if you ask most of the patients in recovery, they will tell you that. “Yeah, it wasn’t that bad, it wasn’t as bad as I thought it was going to be,” and I’ve had patients say “I’m going to go tell my friends it wasn’t that bad. I’m going to send them all here.” As a field, gastroenterology is moving towards more advanced procedures in the care of colon cancer patients. And so, we do have experts—our advanced endoscopists—who can take care of advanced polyps, large polyps and even very, very early cancers. I’ll give you an example. I had a patient who came in for colonoscopy, average risk, completely no symptoms. You would not think that the patient had any...was at any increased risk for colon cancer. We did find a mass on colonoscopy that was suspicious for cancer. We took biopsies. The same day, I called the colorectal surgeon, and we were able to get them in to see the colorectal surgeon that same week. The pathology results were available the next day, and the patient had a curative resection for colon cancer. Host: When should a person of average risk of colon cancer start getting screened? Dr. Lee: Yeah, average-risk individuals should start getting screened at age 50 unless they’re African-American, in which case they should start their screening at age 45. Increased-risk individuals would include those with a family history of colon cancer. Those patients usually start their screening at age 40, or even before. Host: Why should African-Americans start earlier than other cultures? Dr. Lee: We’ve seen, epidemiologically that African-Americans are, more prone to colon cancer, and so therefore we want to prevent colon cancers. So, really focusing on preventive care, we want to catch them earlier. Host: If a patient has a loved one who should be screened, you know, because of their age or their risk factors, what advice could you give that individual to share with their loved one to help nudge them along and schedule that colonoscopy? Dr. Lee: You know, you think of it as any other cancer screening test—mammogram, you know, for women, GYN exams. It’s just like those, and it’s so important because you could prevent this potentially devastating disease. It’s absolutely preventable. So, while the thought of it may be displeasing, I think the end result is you are reassured and to know that you’re taking care of your body and making sure that you have a clean bill of health. Host: What do you feel is your role in the 80 percent by 2018 national campaign? Dr. Lee: Personally, this is day in and day out, this is what I do. I want to prevent colon cancer. I do colonoscopies. I remove polyps. That is, so much of what I do, and I’m such a big believer in preventive care that, you know, I feel very passionately about it. You know, I’m like a colonoscopy cheerleader. You know, like get your colonoscopy.  While it may seem a strange, topic to be excited about, it, nevertheless it’s—I am excited about it. If we could reach 80 percent, that’d be amazing, you know, and I think that, you would be saving lives, you would be saving healthcare dollars, for just, you know, one day of being hungry. You know, and I’ve done the one day of being hungry. It’s bad, but it’s, you know, you live through it, and then you can think about the meal that you’re about to have after your colonoscopy. Host: What do you feel needs to happen at a local or a national level to reach that 80 percent goal or even exceed it? Dr. Lee: You know, I think that having that part of, uh, general health be at the front of your...your mind. I think our primary care doctors are doing a great job of identifying who needs to be, screened, and so providing, access to colonoscopy, I think, is crucial. We do many of them, but there, you know, we need to do more.  And so, thinking about any patient that you are seeing --do they need to be screened, yes/no? And, if they do, send them over.  And, these days the prep is not as bad as it used to be. It’s a—we have lower volumes, better tasting things. Host: Are there any risks involved with colonoscopy? Dr. Lee: Sure. I think some patients are afraid of the complications of colonoscopy and absolutely there are complications, but I often tell them that they’re rare—the complications are quite rare--you know, 1 in 10,000, less than that even, and that’s a great aspect of having your procedure done at Washington Hospital Center. We are big believers in the multidisciplinary team approach, so we work closely with surgeons and other colleagues in case something does happen, but I should say that we are experts, we’re experts in colonoscopy, and we’re good at what we do, so patients are in good hands when they come see us. Host: Thanks for joining us today, Dr. Lee. Dr. Lee: Oh, thank you for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Birth control can come in many forms—but men’s options can be more limited. Dr. Krishnan Venkatesan discusses how a vasectomy can be a solution for men who want effective birth control while maintaining sexual function and the ability to orgasm.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re speaking with Dr. Krishnan Venkatesan, Director of Urologic Reconstruction at MedStar Washington Hospital Center. Welcome, Dr. Venkatesan. Dr. Krishnan Venkatesan: Hi. Thank you for having me. Host: Today we’re discussing vasectomy, a birth control procedure for men that prevents their partners from becoming pregnant without affecting natural sexual function. Dr. Venkatesan, is vasectomy a popular birth control option for men and their partners? Dr. Venkatesan: Yeah, I would say so. Vasectomy is effective for birth control because it really allows a non-invasive way to cut off the sperm from being delivered into a partner that could cause conception, but it doesn’t interfere with erectile function, sensation, orgasm or ejaculation. So, essentially sex should still feel and be the same but without the concerns for pregnancy. Host: Approximately how many vasectomies are performed at MedStar Washington Hospital Center each year? Dr. Venkatesan: I’d say probably between fifty to a hundred vasectomies, at least, per year between myself and my colleagues. Host: Why do you feel that so many couples or so many men chose to undergo vasectomy? Dr. Venkatesan: I think vasectomy is a popular option and a good option because it’s relatively non-invasive, it’s an outpatient procedure and has a quick recovery. And, it allows patients to stop using other forms of birth control, whether it’s oral contraceptive pills or condoms, and it’s certainly easier for men to undergo this than for women to have a tubal ligation. And so, it basically allows for natural sexual function without the risks of conception. Host: Could you describe your patient population for vasectomy - are they older, younger or who is a good candidate? Dr. Venkatesan: Any man, really, is a good candidate but typically our patients are those who are in their 30s or 40s, sometimes in their early 50s, who have children, who have had some time to give this some thought and, for the most part, these are men who are in stable relationships and have had a shared discussion and a shared decision making with their partner before they come in to discuss or commit to vasectomy. Occasionally, we do have men who are not in a relationship but are fathers of children or who have decided they do not want to have any children and, after giving it a lot of thought, they come in for counseling about vasectomy and may decide to proceed with that. Host: Are there any factors that might make a man ineligible for vasectomy? Dr. Venkatesan: Patients that may not be good candidates for vasectomy are generally those who may have had prior surgery on their testicles, either to bring an undescended testicle down during childhood or maybe some surgery on their spermatic cord or even prior hernia surgery, where it may be just more difficult to identify the vas deferens and may make them more prone to having the procedure fail or have a complication. Host: So, just like any reproductive issue or reproductive procedure, there is an abundance of incorrect information online about vasectomy. Do your patients or their partners express any fear or anxiety about the procedure? Dr. Venkatesan: Yeah, and I think that’s natural and completely reasonable to have those anxieties. The biggest concerns men have, of course, are that this may affect their other sexual function, including erectile function and the ability to orgasm or to enjoy sex the same way and whether they will still be able to ejaculate after vasectomy. And, generally we’re able to assuage all those fears by explaining that this really should not affect erectile function and men will still ejaculate because most of the fluid that comes out with orgasm or with ejaculation is actually made downstream in the prostate. The only difference is that the semen won’t contain any actual sperm that can cause conception. Host: This sounds like a very safe procedure. Are there any risks involved with vasectomy? Dr. Venkatesan: Yes, there are. And, of course, any procedure has its risks. The main risks here would include general risks of any surgery, like infection and bleeding and injuring other structures that are nearby the vas deferens, including the artery to the testicle and the vein coming from the testicle, as well as some nerves that travel along the spermatic cord, which could result in chronic pain in the testicle, although that risk is very low. And the main other risk really would be the risk of remaining fertile if the two ends of the vas deferens somehow remain connected or find their way back to each other and get reconnected. Host: Could you describe how the vasectomy procedure is performed? Dr. Venkatesan: Yeah, absolutely. Basically, each testicle, after it makes a sperm, delivers that through a tube called the vas deferens. That travels up the scrotum on each side into the groin and then makes kind of a hairpin turn and goes back behind the bladder to join the urethra, which is how men are able to urinate and ejaculate through the same pipe. What we do in vasectomy is basically find the vas deferens at the top of the scrotum on each side, bring it out through a small nick in the skin or through a small spread incision to open the skin, and cut out a small segment, burn each side of the tube on the inside, and then tie off each end and fold them away from each other and, basically, put them back into the scrotum but in different tissue layers, all to help minimize the risk of the tubes reconnecting. Host: With all of the steps of this procedure, is vasectomy permanent? Dr. Venkatesan: Yes, and that’s an important point. I’m glad you brought it up. I always counsel all my patients that, for all intents and purposes, vasectomy is intended to be permanent. Now, technically, it can be reversed. And, there are specific surgeons who have microsurgical training who can do the vasectomy reversal but it’s also important for patients to know that the success rates for that reversal are variable and, from a practical matter, it’s usually not covered by insurance. Host: How long does recovery take and are there any restrictions for having sex or using the bathroom? Dr. Venkatesan: Yes. So, because there’s constant sperm production, there’s already gonna be sperm downstream from where we cut the vas deferens. So, men need to be counseled that they are not immediately sterile when they go home that day. So, typically, immediately after the procedure, I will ask my patients to refrain from sexual intercourse or any ejaculation for two weeks. And, after that, they need to continue using contraception, in any other form, whether it’s condoms or with the oral contraceptives with their partner but continue to have sexual intercourse. After 8 weeks, we’ll see the patient back in the office to ensure they’ve healed up okay and, at that time, we’ll have them give a semen sample to make sure that the sperm count is zero. Once the sperm count is zero, then they’re okay to stop using other forms of contraception. The recovery from the procedure itself is pretty easy. Usually, we’ll do it later in the week so that guys can recover over the weekend. We don’t have them take any significant activity restrictions, but they may be a little bit sore for a few days. But usually by one to two weeks after the procedure, they’re able to resume all their normal activities. Host: When you hear about people having vasectomies, like on sitcoms or in books, you always have this mental image of a man sitting there with frozen vegetable on his private area. What do you typically give for men for pain management or inflammation management afterward? Dr. Venkatesan: We usually do send patients home with some pain medications. It really depends on, subjectively, what the patient thinks they may need. Quite often, even some extra strength Tylenol or Ibuprofen may be sufficient, but if the patient requires more pain medication, we’re certainly not averse to giving them a prescription for a narcotic pain medication. And aside from taking it easy for the first few days, we also do recommend that they can put some ice packs or frozen vegetable packs on their incisions until everything is starting to feel more comfortable. Host: Now, on the flip side, is there anything a patient has to do to prepare to have a vasectomy? Dr. Venkatesan: Not really. Similar to any other surgery, they should make sure they talk to their urologist beforehand in the office and get all their questions answered. I often will encourage patients to bring their partner along because it’s always good to have a second set of ears, and partners tend to have different insights than men, and collectively, you may remember more from the conversation than one person alone. But, physically speaking, there’s no specific preparation that is required. Host: Can you think of any standout patients who particularly benefited from having a vasectomy? Dr. Venkatesan: All of them. And, it really depends on their goal but, for the most part, because there’s a very specific goal with regards to achieving sterility, most of our patients have been very happy with the results. I will say that probably the better example cases are the cases where the female partner may have a difficult time taking oral contraceptives or may have some other medical conditions that prevent tubal ligation. And, in those cases, then this really allows them to enjoy a full quality of life and takes some strain off the partner, in addition to the patient themselves. Host: Why should a patient choose to come to MedStar Washington Hospital Center for vasectomy when they could really go to any hospital? Dr. Venkatesan: So, I think Washington Hospital Center is a great place to choose to have vasectomy, mainly because of the surgeons we have here who are very experienced in doing it and because, I think, we all do a good job at counseling our patients and answering their questions beforehand, and meeting their expectations with regards to the procedure and everything before and afterwards. And, I will say that traditionally vasectomy is usually done in the office but here we do, quite often, offer our patients to have it done under anesthesia, depending on their comfort level. And, quite often the patients will select to have that done just so they can be more comfortable during and after the surgery. Host: Thanks for joining us today, Dr. Venkatesan. Dr. Venkatesan: My pleasure. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Excess skin after weight loss surgery can be purely a cosmetic issue for some patients. But for others, excess skin causes rashes, infections and irritation.  Dr. Alexandra Zubowicz discusses how skin reduction surgery can help.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Alexandra Zubowicz, a bariatric surgeon at MedStar Washington Hospital Center. Welcome Dr. Zubowicz. Dr. Alexandra Zubowicz: Thank you for having me. Host: Today we’re talking about what people can expect after weight loss surgery when it comes to excess skin. Dr. Zubowicz, why does excess skin remain when you lose a lot of weight? Dr. Zubowicz: So, essentially the skin is a covering, so as people lose all that fat underneath the skin, the skin can lag behind. Now, younger people tend not to have as much of an issue with it because your skin’s more elastic and can stretch back and forth, but especially as you age, which is why you start to develop wrinkles, your skin loses elasticity, so when you lose hundreds of pounds, you have that skin that just can’t bounce back. Everyone will have some excess skin to some degree, however, not everyone has a problem with it. Some people have the excess skin and it doesn’t bother them.  Some people have the excess skin and it’s extremely irritating. So, really there’s wide variations in the amount of excess skin and then the extent to which that excess skin causes issues. Host: When we’re talking excess skin, are we talking about a little bit of bagging and hanging, or are we talking about a lot of skin? How could you put that in perspective? Dr. Zubowicz: So, both. It depends again on lots of different factors—genetics, age, how much weight you lose—but, you can have just a little bit of overhang, up to a point where we remove 40, 50, 60 pounds of excess skin. Host: That’s a lot of skin. Dr. Zubowicz: Yes. Host: I can imagine somebody that’s been through this journey—they’re really transforming what they look like already. And then, do you find when patients get to this stage where they’re talking about having this excess skin taken care of—what is their emotional mindset? Dr. Zubowicz: Some people don’t care at all about the excess skin, either because they don’t have much or it just doesn’t cause issues. For the people that do have issues from the excess skin, it can be extremely debilitating. It can cause severe rashes, it makes it hard for certain types of clothing to fit, it can be painful and irritating, especially when you’re exercising. I don’t think it’s anything that would ever cause someone to say they wish they hadn’t gotten the surgery, because once they lose all that weight, they feel so much better, their joints don’t hurt, they can start exercising, but it’s definitely something that not an insignificant number of people who get bariatric surgery want to get taken care of. Host: I think a lot of people might think about the cosmetic implications of it, so you know, what does it look like, but you mentioned also rashes and some pain associated with that. Could you elaborate on that a little bit? Dr. Zubowicz: So, one, obviously there’s the cosmetics of it, but then having all that excess skin creates a warm, wet environment, so people get yeast infections or bacterial infections under the skin folds. From an insurance standpoint, it’s for those reasons that we can get at least the abdominal excess skin covered by insurance. Host: For an individual who maybe it doesn’t bother them so much to have that extra skin, what do you recommend that they do so they can fit in their clothes or so that they can avoid some of those complications? Dr. Zubowicz: So, main thing is keeping the area clean, keeping it dry.  You can use different kinds of powders. There’s anti-fungal powders you can put to help prevent the rashes or help clear up the rashes if you are having issues with rashes. Host: So, it’s compression type support garments? Dr. Zubowicz: Exactly, yeah, that can basically suck everything in and keep it up and keep it tight. Host: For folks who it does bother them, what sort of procedures are available to help remove that extra skin? Dr. Zubowicz: Skin reduction surgery, now that we’re doing more and more of the bariatric surgery, is becoming more and more prevalent with all the plastic surgeons and I do recommend going to someone who’s specifically trained in doing plastic surgery and does these types of procedures a lot.  And we usually recommend waiting at least a year after bariatric surgery before getting anything surgically done because you don’t want to get the procedure done, get the excess skin, then lose another 30, 40, 50 pounds and then you’re kind of back where you started. In terms of the procedure itself we actually physically cut out that excess skin.   Host: What does the scarring look like from that, and what’s the recovery time? Dr. Zubowicz: The scar of the abdomen is like a C-section scar. We keep it right at the bikini line, and try to minimize it. The scarring on the legs and arms, we try to keep it on the inside.  Now, there definitely are scars, but that’s why I stress going to someone, a plastic surgeon, who does this kind of procedure a lot because you can minimize those scars. And the cosmetic result is definitely superior to having that excess skin if you do have large amounts of it. Host: How much weight does an individual have to lose to have that kind of excess skin? Dr. Zubowicz: I’d say probably in excess of 80 to 100 pounds or more. Again, age and genetics play a huge role, but you’re really not going to see horrible amounts of excess skin unless you’re at the 80-100 pound mark. Host: Of the patients that you treat with bariatric surgery, what percentage of those would you estimate do go on to get that excess skin removed? Dr. Zubowicz: I’d estimate it at probably 20 to 30 percent. Again, some people don’t have excess skin problems, especially the younger patients, and some people, unfortunately, it’s a cost prohibitive thing, and some people that just don’t, it doesn’t bother them. Host: Do you find more men or women prefer to do this, or is it about equal? Dr. Zubowicz: About equal. Host: Are there any complications to the skin reduction surgery, and what makes MedStar Washington Hospital Center the place to go for that? Dr. Zubowicz: The major risk to getting this surgery would be a wound infection. Otherwise, it’s a pretty uncomplicated procedure, and then, just the risk of undergoing general anesthesia, but because of all the weight loss, usually these people are coming in much healthier than when they came in for their original bariatric surgery. So, I would say the wound infection would be the main thing that you have to worry about. In terms of coming to Washington Hospital Center, because we do so much bariatric surgery here, our plastic surgeons are very well versed in the excess skin removal. So, we work in partnership with them very closely to allow the full gamut of bariatric procedures and that’s both the actual bariatric surgery as well as the skin reduction surgery and anything that goes along with weight loss surgery. Host: So, in 2017, we’re still living in that, uh, reality show nightmare or world, however you want to look at it. There are a couple of shows out on tv right now that focus on the skin reduction surgery. Is this something, do you think, that increases people’s awareness that such a procedure is available? Dr. Zubowicz: I absolutely think it’s gonna grow in popularity, because more and more people are, uh, seeing how beneficial weight loss surgery is, and with the rise of weight loss surgery, is gonna come the rise of the excess skin removal surgeries. Host: Do you have any compelling stories of patients that you’ve worked with who, you know, were really struggling with this excess skin problem and then went on to have the procedure? Dr. Zubowicz: Yes, I’ve had several patients that get the skin reduction surgery and they definitely liked the cosmetic benefit from it can be tremendously helpful from a cosmetic standpoint, and then also, they don’t get the rashes, it helps free them up in terms of mobility, they can exercise more, and then, on top of that, you’re also losing some more weight almost instantaneously by taking off all those extra pounds of excess skin. Host: Is there anything that you really want the community at large here in DC to know about either bariatric surgery at MedStar Washington Hospital Center or the skin reduction procedure? Dr. Zubowicz: I think it’s very important to go to an actual bariatric center, like we have at Washington Hospital Center, where you have not only the surgeon, but you have dieticians, you have psychologists, you have plastic surgeons, you have all the people that go together to make weight loss surgery a success. Because the surgery alone isn’t going to do anything. It’s all the lifestyle changes that come along with the weight loss surgery. And then, in addition to that, having people that are knowledgeable about all the things such as excess skin after the surgery that you can only know if you continue to follow your patients long term, which we follow our patients for life after the surgery. One of the most common questions is cost. So, insurance, and obviously it varies by the type of insurance you have, but for the most part insurance will cover what’s called the abdominoplasty, so or a panniculectomy, where we take off the excess skin of the abdomen. For approval standpoint, you need to show that you’re having issues from that, and those are things like rashes and irritation, etc. And, you know, as long as you let your surgeon know, or your primary doctor know, afterwards and we document it, we can do a pretty good job at getting that covered for our patients and that’s another reason why it’s good to go to someone who does this a lot, because they have, you know, established relationships with different insurance companies and we know the documentation we need to get that covered by insurance.  Legs and arms are not covered, at least not as of yet.  I think that’s something that will change down the road because it doesn’t make any sense, because you’re going to have the same exact issues with excess skin on your arms and legs as you do with your abdomen. But, in terms of arms and legs, it’s about $10,000, eight to $10,000 for arms, eight to $10,000 for legs. So, it’s not inexpensive, which is why I think one of the biggest reasons why people don’t end up getting the surgery after the excess weight loss, at least the arms and legs. Host: Thanks for joining us today, Dr. Zubowicz. Dr. Zubowicz: Thank you for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Some pituitary tumors need immediate treatment, while others may benefit from a wait-and-see approach. Dr. Susmeeta Sharma discusses the different types of pituitary tumors and how we care for them.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Susmeeta T. Sharma, director of pituitary endocrinology at MedStar Washington Hospital Center. Welcome, Dr. Sharma. Dr. Susmeeta T. Sharma: Thank you for having me. Host: Pituitary tumors often cause no symptoms, but when they do, the symptoms typically are vague and easily can be mistaken for other less serious conditions. Pituitary tumors may be functional, which means they secrete excess hormones, or non-functional, which means they do not secrete excess hormones. Dr. Sharma, when symptoms occur, what do patients typically experience? Dr. Sharma: The symptoms of pituitary tumor kind of depend on the size of the tumor and whether it’s a functional tumor, what hormone it’s making, is it causing any hormone deficiency. So, I always think that in order to understand what symptoms a pituitary tumor can cause you have to understand the basic physiology and anatomy of a pituitary gland. So, the pituitary gland is a pea-sized gland located at the base of the brain. And I think of it as a conductor of an orchestra. It basically makes a bunch of different hormones, which then regulate other endocrine glands in the body to make other hormones. So, for example, it makes TSH (thyroid stimulating hormone) which then acts on the thyroid gland to make thyroid hormones. It makes ACTH (adrenocorticotropic hormone) which then acts on the adrenal glands to make...regulate cortisone production. It makes prolactin which acts at the level of the breast for development of the mammary glands and milk production. It makes FSH and LH which are gonadotropins which act on the gonads, ovaries, and testes to make female and male gonadal hormones, testosterone and estrogen. And then it also makes growth hormone which really acts on the entire bodies involved in growth, especially in children during puberty, achieving, uh, their full height potential. So, it’s a really important gland and any small, uh, dysfunction, whether it’s related to an inflammatory disorder or a tumor that’s causing compression - any of that can lead to either hypofunction of one of these hormones or increased function of one of these hormones. A pituitary tumor has the potential to make any of these hormones. So, it’s...if it’s a functional pituitary tumor, it can cause symptoms related to excess prolactin, which will then be breast milk production or irregular menstrual cycles or infertility in a female. In a male it may be even harder to detect because of the lack of the menstrual irregularity as a symptom so while they may present with is decreased libido. And later on, as the tumor grows, it may cause symptoms related to the size of the tumor, so headaches and vision problems. So, it all depends on the kind of hormone that the pituitary tumor is making. Another example would be if it’s making ACTH which is then leading to excess cortisone production that can lead to a patient gaining a lot of weight, muscle weakness, fractures, diabetes, high blood pressure, developing purple stretch marks on their body. So, a variety of symptoms that could be related to excess production of a particular hormone in the body. Uh, so that would come from hormonal excess. But then you could have symptoms related to hormonal deficiencies. So, if the tumor is large enough that it’s compressing normal pituitary cells, you could have a low cortisol state, a low growth hormone state, a low thyroid hormone state, which can then lead to other symptoms of their own. And lastly, like I mentioned earlier, from the size of the tumor. Even if it’s not producing any hormone, as the tumor grows, by the size of the tumor, it can cause headaches to the patient and also, in the space where the pituitary gland is located, it’s a very tight space and it’s very close to the optic nerve or the optic chiasm, and those are fibers that control our vision, especially our peripheral vision, and so, as the tumor grows, it can compress on these nerve fibers, leading to vision problems - double vision, loss of peripheral vision - it may manifest as that. Many times though it may be the patient may not have any symptom at all and it may get detected on an MRI done for other reasons - for example, for headaches, for...which are...may or may not be related to the pituitary tumor. So, the presentation can really be varied and depends on how big the tumor is and if it’s making any particular hormone. Host: When symptoms arise, is treatment urgent, or do the tumors grow slowly? Dr. Sharma: The majority of these tumors are slow growing tumors. These are benign tumors, not cancers. Often, patients may hear a diagnosis of brain tumor but this is very different from other tumors that arise in the brain and that have a much higher malignant or a cancerous potential. So, pituitary cancer is very rare and so these are mostly benign tumors. Benign in the sense of them being cancerous but not benign in some of the effects that they can cause if they go undetected. But most of the time, yes, given the fact that these are slow growing tumors, the symptoms often develop gradually. Uh, many times these symptoms can be non-specific so a patient may just have some fatigue and some inability to lose some weight and that could even be a symptom for a hormonal disorder. So, um, sometimes the presentation may be very obvious, very florid, and we may even walk into a room and see a clinical appearance of a patient and think that, “Oh, this patient has to have a pituitary hormonal disorder” while other times it may need a much more lengthy interview in the clinic and exam and for the blood test before a diagnosis can be made. Host: What are some of those immediate symptoms that would cause you to think a patient you’re visiting with has a pituitary issue? Dr. Sharma: Um, so, in particular in women, if they have irregular menstrual cycles and there is breast milk production and they have not had a baby and so that would be a situation where there has to be a prolactin elevation in the majority of the cases. Uh, that may or may not be related to a pituitary tumor; that there are other disorders that can cause a prolactin elevation. But that definitely means that they need to be evaluated by an endocrinologist and need to be tested to see if there is a pituitary disorder there. So that would be one example. Other times, especially in conditions where the pituitary tumor makes growth hormone or the hormone ACTH (adrenocorticotropic hormone) which then leads to cortisol excess—those two particular hormonal disorders can often present very floridly, where the clinical appearance can be very dramatic and easy to detect if it has gone undetected for quite a period of time. So, for example, a growth hormone secreting tumor or excess growth hormone leads to enlarged, fleshy hands and feet. The patient would complain of change in ring size, change in shoe size. They would have changing facial features, coarsening facial features over time that one can detect on...while examining or looking at the patient. Another example would be Cushing’s Syndrome, or excess cortisol in the body. In that, also you have a change in facial features, rounding of face, a reddening of face which we call plethora, excess fat positioned on the upper back of the body in the base of the neck area where...near the clavicles. And so all of that can make us at least suspect that this patient could have Cushing’s, and then those patients would need to be screened for that disorder. Host: What are some of the common diagnostic tests when a doctor suspects a pituitary disorder? Dr. Sharma: If we suspect that a patient has pituitary disorder, sometimes the clinical presentation is so florid that we may want to test for a particular hormone and other times we may need to test for all of the pituitary hormones. And again, anytime I am thinking of a pituitary tumor, I need to make sure both that A) the tumor is not making any excess hormones, so those would be blood and urine tests to start off with for these particular various hormones and then I also need to make sure that it is not deficient. Many times, the blood and urine tests may not itself be sufficient for the diagnosis - that would be the initial screen, followed by some more dynamic testing that may need to be done to confirm that their patient has a particular hormonal deficiency or hormonal excess. And then again, we need to have sophisticated MRI to be able to detect the full location of the tumor, and then you need to collaborate with the neuropthamologist to make sure we are looking at any possible visual deficits related to the pituitary tumor. So definitely a team work - you need the endocrinologist to be able to assess for these hormonal deficiencies and hormonal excess disorders, you need the neuropthamologist and the neuroradiologist to look at...um, visualize the tumor on the MRI and assess if there are any visual field deficits related to the tumor, and then we need, of course, the neurosurgeon if surgical treatment is indicated. Host: What is the approximate size of the pituitary gland? Dr. Sharma: In a three-dimensional structure, the height of a normal pituitary gland is around 6 millimeters in size so, overall again, yeah, the pituitary gland is about the size of a pea. And then, any time there’s a tumor within it—so just a few millimeters above is the optic chiasm and so any time the tumor is growing there is a potential of that gland with the tumor encroaching onto the eye nerves, especially if the tumor is greater than a centimeter, which is what we call a macroadenoma while in the centimeter. When the pituitary tumor is less than a centimeter it’s called a microadenoma. Host: How big are the tumors that you’re taking care of in these patients? Dr. Sharma: So, very variable. So microadenomas, may come to our attention two ways. It might just be that in this era of MRIs, an MRI is done for other reasons and we find a small tumor now. Once the tumor is found, you do want to make sure that it’s not making any hormones and then you have to follow it once a year, at least, to make sure that it’s not growing significantly in size that it needs surgical attention, just based on the size of the tumor. Otherwise, it may be that it’s a small tumor but it’s making a particular hormone so mostly functional tumors can get detected at a smaller stage just because of...they’re causing much more symptoms to the patient from the hormonal excess related to them. And so functional tumors may get detected at a size when they’re less than a centimeter. Non-functional tumors though, most of the time if they’ve not been incidentally detected on an MRI, would be greater than a centimeter. So, we have had tumors that are 5 to 6 centimeters, especially many times in patients who have not sought medical attention or have not been seeing physicians regularly. Um, other times the tumor could be very large but it’s just that the patient has not paid attention to the visual field deficit that it may be causing. So, they just get used to not being able to see peripherally and that can be very dangerous, especially if they’re out there driving with the visual defect. So, as an example, we had a young male with a prolactin secreting tumor. And so, this tumor was about 5 centimeters in size. And, these are slow growing tumors so it was probably present for several years but a prolactin secreting tumor in the male, all it was doing in his case was lowering his testosterone levels and thereby probably causing decreased libido but it had to grow to that big a size and to finally, during a testing for a DMV related driver’s license, he failed his vision exam and that’s how his visual field loss initially came to attention. Host: Is a functional or a non-functional tumor more dangerous? Dr. Sharma: A non-functional tumor, whether or not it needs immediate attention, would depend on the size of the tumor and what mass effects it’s causing. But definitely a functional tumor always needs attention. So, I’m not sure if one is more serious than the other but definitely a functional tumor always needs attention immediately. And so, uh, most functional tumors, actually the first line of treatment would be surgery. The only functional tumor that can be purely treated medically in the majority of the cases is a prolactin secreting tumor. So, although there are medications available for treating various different functional tumors, in prolactin secreting tumors using medications that are available are so effective that we can actually shrink the pituitary tumor and normalize the prolactin levels with medications alone and they don’t need surgery. And, in fact, outcomes from medical treatment can even supersede what we can achieve surgically and so that is why an endocrinological evaluation is really important for pituitary tumors because we want to make sure that we assess whether or not surgery is indicated and also make sure we’re not missing these, this particular kind of tumor—the prolactin secreting tumor—where we can make a difference medically instead of the patient having to undergo any unnecessary surgery. Host: When a patient requires surgery, is there a minimally invasive option? Dr. Sharma: Surgical techniques for pituitary tumors have really advanced. And the majority of the pituitary tumors can be safely resected through the transsphenoidal route. So, we have an endoscopic or a microscopic approach and it depends on the size and location of the tumor when the pituitary surgeon decides which approach to take, but they’re all being done minimally invasively now. And so, this would be a route either under the lips sublingually or trans nasal so through the nasal passage, through the sphenoid sinus and then through the base of the sella, which is what we call where a pituitary gland is located. So, that would be a minimally invasive approach. Patients are usually in the hospital for 2 to 3 days after surgery and are able to leave so compared to the earlier times where you would actually have to cut open the skull and then approach a large pituitary tumor. So even tumors of the size of 5 to 6 centimeters can be safely removed through this route these days. Host: Is there any scarring related to the surgery? Dr. Sharma: So, no actual visible scarring. Many times, in the path that the surgeons take, you may have some superficial nerve fibers that are affected and so people may have temporary, um, either altered or loss of taste or smell sensation. They’re definitely going through the sinus so sometime you can have sinus-related issues but those are usually temporary and there’s, uh, no visible scarring. You can’t really tell that the patient has had surgery, in fact. Host: Why is MedStar Washington Hospital Center the place for people to seek care? Dr. Sharma: Oh, I think what we provide is a multidisciplinary team approach. It’s really important to see a patient and treat them as an individual and see what would be the best treatment option for them. So, any time I think of a pituitary tumor, I think what it needs is a team and not just a single physician operating in isolation. So, you need an endocrinologist to evaluate the hormonal excess or deficiency related to the pituitary tumor. You need a neuroradiologist to properly evaluate the tumor and make sure they’re using up to the mark MRI techniques and developing newer localization techniques for that. A majority of the tumors do need to be surgically removed so we definitely need an experienced neurosurgeon. Not every neurosurgeon is doing the number of transsphenoidal surgeries I feel that are necessary to develop the expertise, so it’s really important to have an experienced neurosurgeon who does a lot of these. And we are lucky to have Dr. Edward Aulisi as one of our neurosurgeons here. And so, an experienced neurosurgeon and then an experienced neuro-opthamologist to look at visual field deficits related to it. And then as an adjunct treatment, other than surgery and medical therapy, you may also need radiation therapy for the pituitary tumor. So, we have focused stereotactic radius surgery options available at MedStar Washington Hospital Center as well. So, having it all under one roof helps because we all are communicating and trying to develop a treatment plan that is best for the patient...that’s optimal for the patient. Host: Are you currently doing any research on pituitary tumors that you’d like to share with people in the community? Dr. Sharma: So, we are starting the research process. We do have Dr. Joseph Verbalis, who’s at our counterpart institute which is Georgetown University Hospital, where he’s already doing a lot of research on posterior pituitary and sodium disorders. And then Washington Hospital Center - we are developing other research programs to look at the path of physiology of tumors so what leads...for different patient populations to develop various kinds of pituitary tumors. We are working with our pathology department to try and see what molecular markers we can identify to better, um, identify what treatment option would be better for a particular patient based on those molecular markers. And then, of course, devising better, more refined surgical techniques for making these surgeries possible in a minimally invasive manner. Host: Thank you for joining us today, Dr. Sharma. Dr. Sharma: Thank you for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S., and this virus is behind a surge in head and neck cancers among young people. Dr. Matthew Pierce discusses who is at risk, warning signs and how we treat these cancers.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Matthew Pierce, an otolaryngologist and head and neck surgeon at MedStar Washington Hospital Center. Welcome, Dr. Pierce. Dr. Pierce: Thank you. Thanks for having me. Host: The human papillomavirus, or HPV, is one of the most common sexually transmitted infections. In most people, the virus courses through the body and leaves without causing any health problems, though HPV is known to cause cervical cancer in women.  However, men and women in their 30s and 40s are developing head and neck cancers at an alarming rate as a result of HPV infection. In the U.S., HPV is thought to cause 70% of cancers in the oropharynx, which is the back of the throat, the base of the tongue, and the tonsils. Dr. Pierce, why is this virus that was once associated solely with cervical cancer now so strongly associated with head and neck cancer? Dr. Pierce: We don’t really know the answer to that at this point. Uh, it’s only recently, and I say recently in the past 20-25 years, been associated with cancers of the oropharynx, or the back of the throat. These cancers may have always been associated with HPV, and we’re just now realizing it and newly diagnosing these types of cancers. The majority of people have been exposed to HPV at some point in their life. And the vast majority, 90% of the people, clear this without any effects whatsoever. There’s a small population that, for whatever reason, harbors the HPV virus, either in their tonsils, cervix or elsewhere. And there are over 100 types of HPV, but there’s only a very small few percentage of those different strains that actually cause or are related to cancer. And that small percentage, and even smaller percentage who are infected with what we call those high-risk types of HPV, actually develop cancer. And again, we don’t really know why some people develop cancer and why some people don’t, but there’s a lot of good research going into that now. But, uh, there are those high-risk type of HPV infections. Host: Nearly everyone who has had at least one sexual partner has been exposed to HPV. How do you discuss that with patients? Dr. Pierce: HPV is a sexually transmitted disease. I don’t really have that conversation with them once they’re diagnosed. You know, it’s a big deal being diagnosed with head and neck cancer, and they really want to know kind of what to do about it. And so, I think it’s good to discuss treatment options and where we go from here. With, uh, head and neck cancer, it’s a very morbid type of cancer to get, and it can really affect patients’ appearance as well as their swallowing and speech, and so it really affects a lot of different parts of their day to day lives. Uh, and so, getting the correct diagnosis and getting a good treatment plan is essential. The interesting thing about HPV head and neck cancers is that they actually respond better to treatment and they have a better prognosis than most other cancers of the head and neck. It’s kind of the silver lining of this new...new wave of cancers. Host: Why do HPV-related head and neck cancers respond a little bit better to treatment than other head and neck cancers? Dr. Pierce: Uh, we actually don’t know why these patients respond better to treatment as of yet. There’s a lot of studies going into that, and there’s actually a lot of studies that are looking at what we call a de-escalation or actually trying to reduce the amount of treatment that we actually have to give these patients while maintaining the same results and the same outcomes. Host: So, on the one hand you have a cancer that’s quote/unquote “relatively easy to treat”, but it can also can be quite destructive. Can you talk about the effects or the symptoms of HPV-related head and neck cancer? Dr. Pierce: So, HPV head and neck-related cancer is--I wouldn’t say it’s necessarily easy to treat but I would say that it responds better to treatment. Whether that is radiation or chemotherapy, or even surgery, these patients tend to do better after treatment, and they have a better prognosis. Cancers of the head and neck can very frequently affect the patient’s swallowing function and speech, as well as the outward appearance, and so, depending on what type of treatment and where the cancer is located. You can have some scarring from... if the patient has surgery or radiation. Uh, the side effects of treatment can often cause issues with swallowing, or speech, or other aspects of day to day life. I think with head and neck cancer, the best outcomes are when we catch these cancers early on. And the reason that they are very morbid is because of one, their aggressiveness, and two, because of the location. And, you know, anytime you have a tumor that requires treatment in the mouth, in the neck or the throat, it can affect multiple organ systems, including swallowing, speech, uh, and as you can imagine, appearance as well. And so, it is something that we recommend, if you are suspicious, just come in and be seen, and see a specialist if you’re concerned about anything in the head and neck area. Host: What symptoms might a person experience if they have head and neck cancer that might cause them to go see their doctor? Dr. Pierce: The symptoms can…can be very subtle, but it’s very important that patients go, if they have any concern at all, to go and see a specialist and get checked out. And some of the major symptoms that most people present with are a mass in the neck or a lesion in the oral cavity that does not heal or an ulcer that persists and doesn’t go away. Other more subtle symptoms can be difficulty swallowing or pain with swallowing. It can be changes in your voice, hoarseness, ear pain, or coughing up blood or blood from the nose. Usually if a symptom lasts for more than 2 or 3 weeks, and it’s not getting better, it’s good to go see a specialist and…and get it checked out. Host: Do you recommend that any of your young adult patients receive the HPV vaccine, or is that reserved for younger folks? Dr. Pierce: Absolutely. I think that the HPV vaccine is very important for young teenagers, and the current recommendation is for, uh, children who are 11 to 12 years old, both male and female, to get the HPV vaccine. Children as young as 9 years old, as well as adults up to the age of 26 for women and…and 21 for men, uh, are currently recommended to get the HPV vaccine. Currently, there’s no recommendation above that age, uh, and the reason for that is the majority of people have already been exposed to HPV at that time, and so it’s not gonna have any benefit to the patient once they’ve already been exposed, but for younger patients, it is something that is invaluable. And even though we don’t know the benefit at this time, we do know that it can prevent from an infection, and the prediction is that it will decrease the amount of cancers that we see in the future. Host: Because HPV is so common, is there anything aside from the vaccine that parents can teach kids to do, or that young adults can do, to reduce their risk? Dr. Pierce: The only sure way to completely avoid any risk is for complete abstinence, which is not a realistic expectation. Even for people who are in a monogamous relationship still have the risk of being exposed, um, either from their partner’s past partners or even from open-mouth kissing can even potentially spread HPV. And so, there is currently no recommendation specifically for reducing the risk of HPV transmission, uh, other than the standard safe sexual practices that are already recommended for decreasing the chance of STD transmission. The interesting thing about HPV-related cancers are that they typically involve a younger and healthier population. We typically see these in males more than females, about 3 to 1, and there’s usually males in their 50s to 60s, whereas tobacco-related cancers of the head and neck usually present about 10 to 15 years after that, so that is one of the differences that we have seen in the epidemiology of head and neck cancers and HPV cancers is they’re typically in a younger, uh, population. Host: Could you talk about your team approach to head and neck cancer care at MedStar Washington Hospital Center? Dr. Pierce: Absolutely. So here at MedStar Washington Hospital Center we have a multidisciplinary approach to cancer care, including HPV-related cancers. We talk about and present all of our new patients as well as our follow-up patients in a team approach, discussing with multiple ENT and head and neck cancer surgeons as well as chemotherapy doctors and radiation doctors. And we approach every patient in this multidisciplinary style of cancer care, uh, which has been shown and proven to be the best form of developing plans for cancer patients. We have a state of the art approach, both surgically and using other modes of treatment for head and neck cancer patients. Host: Typically, are you having to do surgery on all of these patients, or is it rare that you’d have to do surgery? Dr. Pierce: These patients respond well to all types of treatment. And depending on each individual patient, if it’s an early stage and a small cancer, these patients can undergo surgery. And one of the benefits that we have here at Washington Hospital Center is we offer a minimally invasive type of surgery to resect these cancers. And that’s in the form of either robotic surgery or transoral laser surgery. And these surgeries offer a minimally invasive way to cure and treat these patients. Fortunately, not everybody needs to have surgery and a lot of these patients respond very well to chemotherapy and radiation. And this… it’s usually, a discussion that has to be made with the patient as well as the tumor board. Host: Thanks for joining us today. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Serious diabetic foot sores used to require major surgery, including amputation. Dr. Tammer Elmarsafi discusses how vacuum-assisted wound closure devices can help diabetes patients heal faster and avoid amputation.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking to Dr. Tammer Elmarsafi, a podiatric surgeon at MedStar Washington Hospital Center. Welcome, Dr. Elmarsafi.   Dr. Elmarsafi: Thank you so much for having me. Host: Tell us a little bit about yourself. Why did you go into medicine and how did you come to practice at MedStar Washington Hospital Center? Dr. Elmarsafi: As far back as I can remember, I’m the quintessential geek. I always loved biology and chemistry, and then one day, when I was in high school, I joined my local first aid and rescue squad, and when I became an emergency medical technician I realized it wasn’t the sciences that I loved so much; it was the patient interaction, and that really sparked the whole trend for my future career. I knew that I was going to be a doctor and I did everything I can to get to where I am today. Host: Today, we’re talking about how negative pressure wound therapy can help heal diabetic foot ulcers. Dr. Elmarsafi, negative pressure wound therapy often is referred to as vacuum therapy. How does this treatment work and is it really like a vacuum? Dr. Elmarsafi: That’s a wonderful question, and it’s probably the most famous question that I get from patients. When I explain that, we’re going to put a dressing on that’s connected to a tube connected to a machine that acts like a vacuum, the first thing that they say is, “You’re putting a vacuum on me?”  And, ultimately, when you break it down it truly is a simple vacuum, but it’s much more complicated than that. It’s very sophisticated. The technology is not all that new. It’s been around for quite some time and it’s been robustly researched.  A negative pressure wound therapy is a medical device that is designed to clean wounds and at the same time provide some wounds that are very deep, allow the patient the opportunity to fill in their wounds with this vacuum. The vacuum allows the tissue to be stimulated in such a way that the patient can begin to, what we call, granulate in, and it works. It works very well.   Host: What do you mean by granulate in? Dr. Elmarsafi: That’s a term that we often use to describe new tissue growth. So, the patient has a big wound, and let’s say that it’s very deep, when we attempt to heal these wounds, the one thing that is very difficult to get is the depth to decrease. We want the wound to become more and more shallow so that the skin can grow over it, and then it becomes like a normal-looking site. Granulating in essentially means that the wound is filling in and is becoming more shallow, and negative pressure wound therapy is a device that essentially does that.      Host: What would be a reason that an individual would have a deep wound, or what are some of the most common causes of those wounds that you treat? Dr. Elmarsafi: For the lower extremity, by far, the number one thing that we see are diabetic foot infections. The complications of diabetes and peripheral arterial disease culminate in a long downstream effect of risk that results in ulcerations to the foot. Additionally, there are lots of other things that also lead to ulceration, like venous stasis ulcers, and then there are surgical wounds as well, patients that have had cancers removed from their extremities, and ultimately, they are left with these large deficits, these large wounds that now need to heal. Host: So, when you say ulcer, you’re not talking about the same type of ulcer that people probably have heard about in the intestines. You’re talking about a superficial, a wound on the skin. Dr. Elmarsafi: That’s right. An ulcer in the lower extremity is basically a break in the skin, but it goes much deeper than that, and it’s basically a crater in which can be very small. It can be on the tip of a toe, for example, but can be as large as a deficit that takes up the entire heel, and then we see much larger wounds as well.    Host: What is it about the nature of diabetes that causes individuals to develop these wounds on their feet? You wouldn’t necessarily associate the foot with the pancreas or other body parts associated with diabetes. Dr. Elmarsafi: It’s a very interesting disease. Diabetes, we don’t use the words epidemic and pandemic for chronic diseases, but it’s a disease process that’s very prevalent and is, despite a lot of emphasis on disease screening and prevention, and lots of research dollars being put into designing new therapies and genomics to understand our patient population better. Despite this, diabetes has a natural course. Patients that have diabetes, whether it’s type 1 or type 2, over the years, do develop lots of consequences. The most common that we identify are cardiovascular risks--increased risk for heart attack, increased risk for stroke, increased risk for kidney disease and blindness, but the reality is that it affects everything in the human body, and that also includes the vessels in the lower extremity and also includes the nerves. And, so a patient that does not have good sensation in their feet, if they were to step on a nail, for example, they would not know, they wouldn’t feel it, and therefore there would be a delay in care.  We call this neuropathy. Diabetic peripheral neuropathy is a big problem, and it’s the first downstream effect of diabetes that puts patients at risk.           Host: So, wound VAC therapy, or the negative pressure wound therapy, why is this such an effective treatment for diabetic foot ulcers? Dr. Elmarsafi:  The simple negative pressure wound therapy device that we described earlier has evolved, and the technology has grown over the years. And now, it’s not just able to provide suction to allow the tissue to granulate in as we described. Now, we’re also able to instill or put fluid into the wound, and so we’re able to essentially lavage or clean the wound, and we can use different solutions, so we can put different solutions that would clean the wound depending on the type of bacteria that’s growing, et cetera, and that’s really increased our ability to custom tailor our treatments specifically to each patient.             Host: So, an individual for whom you would recommend this device or this therapy, what should they expect during the implantation process, or how do they go about receiving this therapy?   Dr. Elmarsafi: Most of the patients that we see do require some surgical intervention. We really do need to clean out these wounds very well and get surgical biopsies, particularly if we also suspect that there’s bone infection. Once we apply, we usually apply it in the operating room, but then while they’re an inpatient, if they’re an inpatient, then dressing changes. They’re just changed at bedside and usually there isn’t any problem with that. There’s no pain and it’s a very simple process. But, if they require multiple surgeries, we’ll just divert that to be done in the OR and then the patient doesn’t feel anything. But, many times our patients only get one done in the operating room and then they require long-term therapy, at which point they get a small device, it’s a portable device, and it gets changed every several days and we follow up in clinic, and it’s not cumbersome in any way.    Host: Is this a device that people can go home with or is it always inpatient care? Dr. Elmarsafi:  There are many different versions of these devices. And some devices are designed specifically for in-hospital use, but there are devices that are designed to be very portable. Some devices are battery operated. Some devices are spring loaded and have no noise and no alarms, it’s very simple device.  And, some devices are designed specifically for wounds that have been closed, surgical incisions, to help promote quick healing for wounds that are at high risk for complications afterwards.     Host: What can patients do on their own, either before or after receiving this negative pressure therapy, to promote healing of those diabetic ulcers or to prevent them from the beginning? Dr. Elmarsafi: I love this question, and it’s something that a lot of people tend to not think about. It’s easy to control infection after surgical cleanout and giving antibiotics, and it’s easy to ask the vascular surgeon to improve circulation. Doing all those things is very important, but if you exclude nutrition and exclude really tight glycemic control and getting their sugars under control and exclude the idea of really good personal hygiene to the extremity, then we lose sight of long-term successes. All surgical patients in general require a little bit more in terms of their protein intake, but with the diabetic patient, in particular, you have to really balance this. You have to be careful, of course, with their calories, and you have to be careful if these patients also have cardiac disease and renal disease, and many of our patients have all three of these, and so a nutritional consult is something that we rely on very heavily, and almost all of our patients have an endocrinologist as well, and so we work as a team. Our methodology for treating our complex patients with complex wounds is a multidisciplinary approach. It’s about ensuring that all of the appropriate doctors are involved and integrated in the patient’s care to make sure that everything is addressed to provide them with the best care. The most important people that we have integrated into our team are the vascular surgeons, infectious disease, and, of course, physical therapy and occupational therapy. Rehabilitating our patients is very important for long-term outcomes, making sure that the patient has the right balance and the right coordination, and to prevent fall risk in our lower extremity patients is very vital, and they are very strong proponents of being part of our team, even before we take them to surgery.         Host: What would you say is a good estimate for an anticipated recovery time for an individual who undergoes the negative pressure wound therapy, and then for their wound to ultimately heal?   Dr. Elmarsafi: You know, that’s a very hard question, and I get this question all the time from family and patients, but everyone heals differently and every wound is very different. A wound on the bottom of the foot heals differently from a wound on the top of the foot. A wound on the ankle heals differently from a wound above the ankle. A wound in a patient who’s 90 years old is different from a wound in a patient who’s 20 years old. And, we assess risk and rates of healing at different intervals for different patients, and so we are constantly at every time I see a patient, I’m reevaluating what things need to be tweaked, what things need to be changed in order to change the rate of healing.  With negative pressure wound therapy, it offers the opportunity not just to readjust our management. Sometimes, negative pressure wound therapy, in the beginning, is a great modality, but later on you realize that the wound is now amenable to a different therapy, and that’s exactly what we’re looking for. It’s not a permanent therapy. It’s a different stage in the patient’s management, at which point you can switch from negative pressure wound therapy and move on to something more definitive.      Host: So, this procedure--it’s very aggressive and intensive, it sounds like. Is this kind of a last step before amputation, or what is the progression from there if it doesn’t work?   Dr. Elmarsafi: I view my job as being able to provide the patient with the longest ability to be mobile for as long as possible, as independently as possible, and that may mean sometimes an amputation. So sometimes an amputation is the best answer, but my job is also to prevent amputations, and negative pressure wound therapy is a great modality in most patients. There are patients, however, who are not candidates for wound therapy. Host: Who would be a good candidate and, likewise, who would not be a good candidate for negative pressure wound therapy? Dr. Elmarsafi: Most patients are great candidates for negative pressure wound therapy. The patient who comes in with a wound that’s heavily infected is not a good patient for wound therapy right away. Once we clean the wound, they become a good patient for wound therapy. A patient who’s had a carcinoma, for example, who may have remaining risk for recurrence, is not a good patient for wound therapy, but there are other modalities that are really good for that type of patient. And so, really to provide good care for complex wounds it has to be very custom tailored, and negative pressure wound therapy has a role in many different kinds of patients. I would say most patients are good candidates, but there are a select few patients that I would say probably would not benefit from negative pressure wound therapy, and that is an assessment that needs to be done on a 1 on 1 basis.  Host: Have you had a patient that came in with a diabetic ulcer that was just absolutely miserable, and then what was that progression story for them? What were they able to accomplish after they had this treatment? Dr. Elmarsafi: I recall one patient in particular who went to the operating room once, and after the operating room, just did not ever want to go back to the operating room after that, and, in retrospect, I realized that, you know, not every patient is a surgical patient. It was important for that patient to go, and probably would have benefited from multiple surgeries thereafter, but I was surprised at how well the patient responded with just negative pressure wound therapy alone, and it’s changed my practice ever since. For patients that are on the borderline of “I’m not sure I really want to go to surgery”, I know that there is another modality that I can rely on and give another opportunity for healing without surgical intervention. And negative pressure wound therapy, for some patients, is a great modality as long as other risks haven’t pushed the patient into the corner where they have to have surgery.            Host: It’s always about that patient choice. Dr. Elmarsafi: Yes. Host: What are some of the reasons why an individual should choose to come to MedStar Washington Hospital Center over another provider, you know, whether it’s in their neighborhood or if they’re traveling to come see you--what makes this, the experience, for them special here? Dr. Elmarsafi: MedStar Washington Hospital Center is comprised of a group of experts. Experts that are well trained, who are fellow trained, and specifically custom tailored to the patient’s well-being. I think that’s true of many places, but what I think our team offers that, I don’t want to say other places can’t offer, but our wound care is far superior than most. We get a lot of the complications from other places, and that’s not to say that other places have caused complications, but other places can only go so far with their abilities and their resources to provide care for patients, and then they reach a threshold where they can’t do anything more, and that’s when we get patients coming to Washington Hospital Center for further care.  I just had a referral from a patient who was told he needed below-knee amputation from two separate hospitals in the DC Metro area and came for his last opinion. And we were very, very fortunate to be able to save his limb and he is now approximately two months after his operation and he’s ready to go back to work. Host: Is there anything that caregivers should be aware of when their loved one comes home, either after this treatment or with a VAC device? Dr. Elmarsafi: Not necessarily. I think the number one thing to remember about negative pressure wound therapy is that the device itself makes noise, and sometimes that noise, although is not very loud, the noise can change as the wound is changing, as the position of the patient changes, and sometimes when the noise changes people become afraid that something is happening, the device is doing something it shouldn’t do, or something dangerous is happening, and that’s the number one thing that people complain about. And really, the machine is actually quite sophisticated. It is not just a vacuum. The device itself has very sophisticated sensors and computers. The change that you hear is that computer adjusting for all of the things it needs to do, and it does have alarms. So, if an alarm goes off, the patient will definitely know and the caregiver will be alerted that the device should be turned off and that a call needs to be made to the provider.    Host: Now, is this negative pressure wound therapy something that an individual can be somewhat mobile while using, or are they, you know, basically chair-ridden or bedridden, connected to an external machine?    Dr. Elmarsafi: For the most part, most patients can get around, and it really depends on the location of the wound, but even for patients that say have a negative pressure wound therapy device placed on the bottom of their foot, as long as they are able to get around say on crutches or with a walker or a knee scooter, that’s perfectly fine and mobility is very important for these patients as long as they are doing it in a safe manner.    Host: Thank you for joining us today, Dr. Elmarsafi. Dr. Elmarsafi: It’s been a pleasure. Thank you so much. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Everyday choices affect our colorectal cancer risk – even what we eat and drink. Dr. Brian Bello discusses how eating a high-fiber diet and cutting down on certain beverages can help reduce your risk of developing colorectal cancer.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thank you for joining us today. We’re talking with Dr. Brian Bello, a colorectal surgeon at MedStar Washington Hospital Center. Welcome, Dr. Bello. Dr. Bello: Thank you very much for having me. Host: Nutrition and dietary factors have been tied to a wide range of diseases in the past decade, including colorectal cancer. The choices we make every day about what we eat and drink can have a dramatic effect on our current and future health. Dr. Bello, what food and beverage options are most alarming to you as a colorectal surgeon? Dr. Bello: Well, as a colorectal surgeon, we tell them to try to avoid processed meats, like bacon, sausage, ham and jerky, beef jerky. Unfortunately, the bacon and ham and sausage are the things that people love and like to eat, especially and also red meat, so we just try to tell them to substitute leaner meats or skinless poultry or fish, and that usually can help them. Host: What is it about the red meat, specifically, is it more harmful as compared to leaner meats? Dr. Bello: Yeah, scientists don’t know for sure. It’s probably the way that the meat is processed and preserved - maybe some chemicals there, it’s unclear. Host:  So I know we talked about food, are there any drinks that may contribute to a person’s risk? Dr. Bello: We know that obesity and diabetes are risk factors for colon cancer. So, we know that people that drink a lot of these high sugar beverages may get diabetes. So, we usually tell people when we’re counseling them about their diet, to try to avoid those high sugar drinks, those energy drinks, those fruit drinks, and tell them to drink water, low dairy. Host: And what about alcohol? Dr. Bello: Alcohol, if consumed in a mild or moderate fashion’s okay, but we tell people not to drink excessive amounts of alcohol. Host: Are your patients ever surprised when you mention diet and nutrition as a factor in colorectal cancer risk? Dr. Bello: Yeah, people seem to be surprised, and many people don’t even realize that their diet is not a healthy one. So, usually we go over their usual daily intake and figure out what they can do better. We try to give them a lot of education about this. We try to give them menus and lists of things that they can do and eat so that they can have a better diet. We also find it helpful that, if they come with a family member, specifically the person that cooks for them, that they’re involved in that discussion. Host: Now you mentioned some of the things that you recommend that your patients avoid. What would you consider an ideal nutrition plan, say for a lunch or a dinner, for someone at average risk of colon cancer? Dr. Bello: We always recommend our patients be on a high fiber diet. So, when people come in and they tell me they’re eating a lot of red meats and processed meat, I immediately try to give them some education. I tell them what foods are rich in fiber which include raw fruits, like apples and bananas; vegetables, especially raw vegetables, like lettuce and spinach; legumes, like beans, all have a lot of good dietary fiber which has been associated with less colon cancer risk. So, it’s always good to have a variety of food, specifically a variety of fruits and vegetables, whole grains. I mentioned a high fiber diet - usually about 25 to 30 grams a day. Skinless poultry and fish are good. Nuts and beans. And we try to tell them to limit these things that aren’t good for you, so fatty food, fried food, sweets, foods that are high in sodium - those are the key things to limit. Host: Should patients who admittedly make poor nutrition choices, or just really enjoy junk food, be screened more often for colon cancer than say an individual with a healthier diet? Dr. Bello: That’s a good question. I’d say we haven’t had enough data to make that choice yet. I think we still take in account the other risk factors where the patient symptoms, are they having symptoms like bleeding or abdominal pain, change in their bowel movements. I think poor nutrition alone, we don’t recommend that they get screened more often than other people. That would probably lead to unnecessary tests. But I think we take the whole picture and see what their other issues are and what their other risk factors are. Host: Could you discuss your team approach to care when it comes to balancing nutrition with colon cancer screening and awareness? Dr. Bello: Yeah, so here at MedStar Washington Hospital Center, we have different experts in different fields. So, not only do we have surgeons and oncologists, we have nutritionists that can help patients find a good balance of what’s healthy and what tastes good. That’s an advantage that we have at Washington Hospital Center. Host: So, why is MedStar Washington Hospital Center the best place to seek that colon cancer screening and guidance? Dr. Bello: Yeah, I think we see a lot of colon cancer - we’re a high-volume center. So, a lot of us do primarily colon cancer and rectal cancer - those are our primary patients, such as myself and my colleagues. We do present any new colon cancer at a multidisciplinary tumor board, where there’s a lot of experts from different fields weighing in. With that, we come up with the very individualized treatment plan for each patient. So, because of that, we’ve shown that those patients have better outcomes. Host: Could you share any success stories from your patient population, perhaps an individual with a very poor diet or a cancer risk that maybe turned their diet around? Dr. Bello: Yeah, I think I get the most satisfaction when I’m seeing patients for a long time. For example, if I do a colon surgery on them, I usually follow them for several years, up to five years after surgery. And then I see that they’re following my recommendations of leading a good, healthy lifestyle. They’ve stopped smoking. They’re eating better. They’re eating more fiber in their diet. And they’re exercising. Those are the patients I feel that we’ve helped. Host: Thank you for joining us today, Dr. Bello. Dr. Bello: Thank you very much. My pleasure. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

A paraesophageal hernia can have symptoms as simple as acid reflux or feeling bloated after a small meal—or no signs at all. Dr. John Lazar, Director of Thoracic Robotics, discusses how we diagnose and treat paraesophageal hernias.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re speaking with Dr. John Lazar, Director of Thoracic Robotics at MedStar Washington Hospital Center. Today we’re discussing benign esophageal diseases, a group of non-cancerous disorders in the esophagus, which is the tube that connects the throat to the stomach. Dr. Lazar, what are some of the benign esophageal diseases you see most often in your patient population? Dr. Lazar: I would say that the most common benign disease that we see is something called the paraesophageal hernia. And what that is, is that over time, the diaphragm weakens and the stomach starts to track up into the chest. Um, and it can be quite uncomfortable at certain points which is generally when people start seeing us. Host: What are some of the common symptoms of paraesophageal hernias? Dr. Lazar: So, the most common one is reflux, meaning that you have this taste of acid coming up into your mouth or sometimes it causes you to cough. Other ones are after eating a small meal you feel very bloated. Sometimes it even causes you to actually have to vomit in order to feel better. This is something that happens gradually over time, so a lot of times, people don’t realize they even have these problems until someone points it out to them. Other issues with the esophagus which are less common is something called acalasia, which is the inability for the lower part of the esophagus that is connected to the stomach to open up all the way. So, food actually sits there at the end of the esophagus and usually you have to wash it down with a glass of water or unfortunately, even then, sometimes things come back up. Host: So, they sound like pretty similar symptoms to other disorders. How common are these esophageal diseases? Dr. Lazar: So, I would say that achalasia is probably very small, in the single digits, if you took the population as a whole. Or I would say that paraesophageal hernias are probably around 10 to 15 percent of the population. And most of the time they’re asymptomatic, meaning no one has any symptoms and they’re only...only found incidentally, meaning you went in for a chest x-ray or something else was bothering you and they did a CT scan and they ended up finding some of these things. I think when you’ve had long standing gastroesophageal reflux, it’s time to talk to your doctor about maybe even getting screened when a...with a EGD by a gastroenterologist, just to make sure that there’s no permanent damage done to the esophagus. I think if you’re in the category of, “Oh, you know, this happens every year, once a year,” you’re probably OK, but if it’s happening more and more often, then you really should talk to your doctor about getting screened. Host: Are there certain groups of people who are more at risk, say men or women? Dr. Lazar: So, generally people who have increased abdominal pressure, so that would be people who are overweight, uh, sometimes women who’ve had multiple babies, and over time, the diaphragm weakens. It’s...it’s kind of hard to predict who will or who will not have it. Host: In terms of treatment, what are some of the most common first-line treatments for these disorders? Dr. Lazar: Sure. So, basically the only treatment is for the symptoms, unless you fix the problem. So, a lot of times people will take antacids, over-the-counter or prescribed by a gastroenterologist or a primary care physician. But if you want definitive therapy from it, surgery’s the only cure. Host: Is there an issue with people taking antacids and things like that long-term as opposed to having surgery? Dr. Lazar: Yeah, so there’s a growing debate as to whether a certain type of drug called proton pump inhibitors, or PPIs, also has long-term damage to other organs and that’s an area in which people are looking into but it’s become very popular in the news and so a lot of patients have been talking to their doctors about whether or not surgery’s right for them. Host: Could you explain what a PPI is for individuals who might not know? Dr. Lazar: So, a proton pump inhibitor works on suppressing the acid on a molecular signaling level and so therefore people have less symptoms from reflux because the pills tell the body to make less acid. Host: When a person does need surgery, what are some of the more common procedures that are done? Dr. Lazar: So, if we’re talking about a paraesophageal hernia, generally paraesophageal hernia repair involves pre-operative testing with an esophagram, which is drinking of contrast, and then they get x-rays that shows how the contrast goes down. The other common test is a CT scan of the chest, which is about a ten-second test. And then the other test can be something called manometry, which tests how well the esophagus squeezes food down the length of the esophagus. Host: So they’ve run through all of these tests...and then, once they go in for treatment, what...are you doing a...an open surgery with these folks, if it’s necessary...minimally invasive? What does that look like? Dr. Lazar: So, almost all surgeons are doing minimally invasive paraesophageal hernia repairs. In the old days we would generally go through the left chest, which was a very painful procedure. Now we’re doing it minimally invasively through the abdomen where there’s less nerve endings and, uh, they’re able to go home much sooner. We do it robotically. Patients are brought to the operating room. They’re put to sleep. They’ll have five ports about the width of my index finger. And then we will use the robot, which is completely controlled by the surgeon, to then bring down the stomach back into the abdomen, take down all the scar tissue that was holding it in there, and then close the opening that’s in the diaphragm that...where the stomach was going in. Host: Could you talk a little bit about the recovery from that type of procedure? Dr. Lazar: Sure. So, the great advantage of robotic surgery or any kind of minimally invasive surgery for paraesophageal hernia, is that generally people go home anywhere from one to three days afterwards, uh, depending on the surgeon’s preference. So, generally they have less pain, they’re able to eat and drink much quicker, and so there’s really no reason to keep them in the hospital. Uh, they still take about seven to ten days to really get back on their feet once they’re home. Host: What is the risk of not seeking treatment for long-term symptoms? Dr. Lazar: So, I think that there’s a group of people who are very scared of surgery, and rightly so, who have paraesophageal hernias. Unfortunately sometimes the stomach can twist along the esophagus and cut off the blood supply, and therefore, it becomes a surgical emergency to reduce the stomach and get it back down and there’s a risk of the stomach becoming what we call ischemic, or there’s no blood supply to it. Uh, and that...that can be life or death in some cases. In the past we had talked about only treating symptomatic paraesophageal hernias, but there’s growing evidence because of this that maybe we should start taking care of these patients earlier when the hernias are smaller and they’re actually in better health. Host: What are some of the emerging technologies or procedures that you’re using at MedStar Washington Hospital Center? Dr. Lazar: So, I would say that the biggest technology that’s really catching on both nationally here and that we brought to the Washington Hospital Center is...is robotic technology. And, in most senses, this is robotic assisted technology, so the surgeon still remains completely in control of what’s going on. The robot is there just to enhance visualization, enhance their ability to operate within a confined space, and to basically make it a smoother operation for the surgeon. Host: Have you had any patients in the past who have had severe hernias who you were able to help with this type of surgery? Dr. Lazar: Sure. So, I think, in a lot of senses, because of the enhanced visualization, we’ve been able to do a better operation than we would open in the abdomen, and in some cases, just as good as we would have done through the chest but with much smaller incisions and therefore better recovery because we’re able to take down all the scar tissue that basically keeps it up there. We’re able to reduce, you know, the stomach back in to the abdomen or in to the belly area and then close these large defects. Because we have wristed instruments, we’re able to then suture in a much better way or close the defects in the diaphragm and then make sure that the patients reestablish the normal anatomy. Host: So, in...in doing so, in reestablishing that anatomy, is there a follow-up procedure that these patients will have to have? Dr. Lazar: No. Generally, once the surgery is performed, and then they’re able to get out of the hospital in a couple days, uh, we follow them along, at least a couple weeks, and we’ll see them back yearly just to make sure that everything’s OK. But generally speaking, uh, there’s no other procedure that’s usually required afterwards. Host: Why is MedStar Washington Hospital Center the best place to go for treatment of hernias and other benign esophageal diseases? Dr. Lazar: Well, we have a team of specialists in thoracic surgery who are very dedicated to understanding esophageal disease. We’ve all been specially trained in the esophagus. A lot of people get training in a lot of different things. Our passion is, uh, esophageal disease, whether it’s cancerous or non-cancerous. And, so therefore, I think that we have a lot of experience and knowledge in identifying esophageal disease and, technically speaking, we’ve dedicated our lives to...to perfecting it. Host: Thanks for joining us today. Dr. Lazar: Thank you. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

A new procedure can lead to quicker, more effective recovery after ACL repair. Orthopedic Surgeon Dr. Evan Argintar explains how internal bracing works and who can benefit from the procedure.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. In today’s episode, we talk to Dr. Evan Argintar, assistant director of sports medicine at MedStar Orthopedic Institute at Washington Hospital Center about their exclusive use of internal bracing in ACL repair and reconstruction. Host: Thanks for joining us today, we’re talking to Dr. Evan Argintar an orthopedic surgeon and assistant director of sports medicine at Medstar Orthopedic Institute at MedStar Washington Hospital Center.  Welcome, Dr. Argintar. Dr. Argintar: Thank you for having me. Host: Today we’re talking about internal bracing, which can be used to stabilize a joint and accelerate healing time allowing a patient to resume activity faster.  When you say ‘internal bracing’, what do you mean, and how does that work? Dr. Argintar: So, traditionally with ligament reconstruction whether that be in the knee or the elbow, we’ve traditionally used a graft. A graft is another tendon. Sometimes that can be from the person.  Sometimes that can be from a cadaver, the most common example in my practice is the ACL.  You need to put a new ligament where the old ACL ligament was, and that whole process of maturation can take anywhere from eight to ten months and that requires the body to do this process called ‘sinovialization’ which is a fancy way of saying becoming part of the human body.  The issue with that process is at about two or three months the ligament you put in there becomes weak, and what we’ve found is that’s the time when it’s most likely to fail.  And so researchers have developed an internal brace which is nothing more than a really strong suture that’s made out of a polyethylene or a plastic that travels with the new ligament, and it gives it stability and allows it to maintain the structural integrity throughout this process of maturation but specifically at the two to three month period when patients are ramping up their rehab but when their ligament might be weakest. So, what we’re finding here at Medstar Washington Hospital Center in our research is that patients seem to be doing better, they’re having better clinical outcomes and they’re more predictable. Host: When you say it travels with the ligament, what do you mean? Dr. Argintar: For an ACL, you have to drill tunnels into bone, and so when you create a new ACL, you’re putting that new ACL in tunnels into bone where the old ACL ligament was.  And so this new internal brace travels right next to the ligament, so it has the same trajectory, and it has the same biomechanical forces on it. if you think about it as sort of a temporary ACL, while the new ACL is maturing, to me in my mind that’s how I make sense of it. Host: That makes sense to me too. You mentioned the ACL.  What other parts of the body is this useful for? Dr. Argintar: We’ve been using it in elbow reconstruction. Sometimes people can have lateral or even medial elbow instability, and we’re finding that whenever you’re doing a repair of a ligament, or a reconstruction of a ligament, meaning taking a tendon from somewhere else in the body or taking a cadaver and incorporating it to replace the old one, this gives additional stability, which allows me as an orthopedic surgeon to be potentially more aggressive earlier on with therapy.  Which I think helps mobilization, and it allows patients to be more aggressive in their therapy, which I find anecdotally is helping with outcomes. Host: When you don’t use the internal bracing, when you’re taking that tendon from somewhere else in the body or from a cadaver which is a donor body, where typically would you take it from?  Would it be that same area?  Would it be a different limb? Dr. Argintar: It all depends on the surgery. The most common example would be with an anterior cruciate ligament or ACL reconstruction.  Now certainly you can take it from a cadaver and that’s the least painful of all options for patients, but traditionally there are two main sources for patients—one is the bone patella bone which is taking a little piece of bone on the knee cap and a little piece of bone on the tibia or the leg bone and the connecting ligament in between.  The other option is a hamstring tendon, which can be taken from the front or the back of the knee.  Those would be the two most common examples in ACL surgery. Host: How long has this been available for the ACL, and are people coming and asking you about it? Dr. Argintar:  We’ve been finding that as word gets out that we’re doing more of this internal bracing, people are seeking us out for second and third opinions for ACL reconstructive surgery, and elbow reconstructive surgery, absolutely.  We have research pending but not yet published which is demonstrating that this is a safe procedure it’s also allowed us to do ligament repair in a setting where traditionally we were unable to repair ligaments—it’s that strong. (4:27) Host: What is the preparation process and what should a patient expect before, during, and after the procedure? Dr. Argintar: Preparation for ACL surgery is all about the pre-rehabilitation. Sometimes we’ll actually send people to physical therapy in order to get their range of motion. What we know for all surgeries is that if you go into a surgery with poor motion you get poor motion afterwards. Most times, I’m able to educate patients on how to get that motion beforehand, so if they’re successful with those exercise programs, they are in very good shape for surgery. Host: Is this something that can be done under general anesthesia or is it local anesthesia? Dr. Argintar: This is all done with general anesthesia.  It’s done as an additional component to surgical procedures in the operating room.  It doesn’t increase the length of the surgery, in fact in some cases it might even make it faster. Host: You mentioned before that this allows patients to be a bit more aggressive in their therapy and it allows you to get them into that therapy a little bit quicker.  Could you talk about that process?  What is the traditional trajectory from ACL surgery into therapy as opposed to internal bracing? Dr. Argintar:  So typically with ACL reconstructive surgery, patients will have surgery—for the first ten to fourteen days they worry about nutrition and health hygiene and then about two weeks afterwards they initiate physical therapy.  The problem is that therapy can be modified based on how strong you think your repair can be, so as we incorporate these extra elements that improve or increase the strength of a surgical procedure, that will give clinicians more confidence to be more aggressive earlier on.  Although me personally I rehab now ACL repairs and ACL reconstructions exactly the same, I think as we collect research moving forward respectively what we’re actively doing. In fact, we’re one of only three centers to my awareness, in the United States that are collecting this research and doing this type of surgery. Traditionally, ACL reconstructive surgery, the whole rehabilitation, is somewhere between eight and 10 months and is very patient specific. We know that for ACL repair, which is for keeping the ligament and putting it back where it came from, that’s a surgery that absolutely requires this internal brace for additional stability. We have found anecdotally that the atrophy of the muscle after surgery is less, and patients get back to sport activities quicker. A perfect example is two firefighters that I recently took care of. I prepared them for the eight to 10 months of rehabilitation, which is a lot of sedentary work for people who very much want and need to be active, need to have rotational stability in their knee, need to put out fires, and everything they need to do that happens in their job every day.  I can think of two recent patients who were happy to get back to their job at six months without restriction. And that two months of lack of them doing sedentary work was transforming both to their job and to their mental health, because patients certainly want to get back to normal living, whether it be work or sport. Host: What sort of research data are you picking up? What does that look like and what is the patient’s role in your collection of that data for your research? Dr. Argintar:  So we’re looking at research on lots of different levels.  One is “is this internal bracing safe?” and the answer is unequivocally ‘yes’. Personally, I’ve done several hundred of these procedures, and my partners have had similar experiences, so we have looked at that data, and it has been submitted and will be ideally published in the next year demonstrating the efficacy and safety of this procedure.  Two, we’re looking at how this will allow us to repair ACL ligaments in the knee. Again, we have a lot of anecdotal evidence based on over a hundred patients with ACL repair which is a real new aspect of knee sports medicine.  Once upon a time people attempted repairs and they were fraught with failure, and for a long time this was sort of ignore as not a possibility. As we learn better about the anatomy of the ACL and we’ve incorporated these new technologies we have revisited the idea of ACL repair and we have found the success rate has been excellent here. Host: Why were surgeons having a difficult time repairing the ACL? Dr. Argintar: It has a lot to do with understanding the anatomy, number one.  When people attempted these repairs twenty years ago—what we know now, but what we didn’t know then is that the origin where the ACL starts was not as accurate as we understand it now.  In fact, the whole way we do ACL reconstructive surgery has really changed over the last five years.  It’s not uncommon now for me to see patients who had the old gold standard ACL and we unfortunately have to revise them because they don’t have the rotational stability.  So it’s that information all the new research that’s come out over the last decade about simply understanding where the ACL starts and where it goes coupled with the evolution of all these minimally invasive ways to incorporate these new interesting technologies that allow for repair this has all culminated to the ability to repair ligaments in a way that we never had the ability to do. Host: Part of your research is determining whether this is safe, and you’re saying that yes it is safe, anecdotally at least.  What are some of the safety concerns that individuals have had about this procedure? Dr. Argintar: So, there are no specific safety concerns.  Whenever there are new technologies in place in a knee joint for example or outside of a joint, you want to make sure that the benefits of the device aren’t outweighed by the negative aspects of the device. So, as we launch our investigation and this was based on the success of other institutions, even internationally, we have found that this is completely safe.  In fact, when I look at my ACLs with and without the internal brace, I need to look at my report to see who has received that brace, because from the outside there’s no easy way to determine—it’s that similar. Host: That’s a very good sign.  What does your patient base or your patient demographic look like for this procedure? Dr. Argintar: Typically, people who are getting ACL surgery or elbow reconstructive tend to be younger, more active, age to me is not important.  Level of activity is.  I’ve certainly done ACL surgery in people who numerically, chronologically perhaps are a little bit older but I meet people who are chronologically old who are more youthful than some of my patients.  I would say ACL surgery in general is something that is done for people in their young teens up through their forties but there are certainly outliers on both sides of that bell curve. Host: Is there anybody who this procedure would not be safe or effective for, in your opinion? Dr. Argintar: No. This would be safe for anyone who needs this type of surgery. So, we’ve had patients traveling across the country for this type of treatment, patients regionally from Philadelphia and new York, or west like Colorado, the good news is that the word is out on the street -- people who are wanting to maintain their anatomy, which makes logical sense, people who want to see if they’re candidates for ACL repair, are seeking out medical centers like MedStar Washington Hospital Center, where doctors are doing cutting-edge surgery that might obviate the knee for reconstructive, larger surgeries. Host: Is there anything else that you would want to elaborate on or if somebody’s interested in receiving this type of procedure what would be the process for them to get to you? Dr. Argintar: Certainly, see one of me or my colleagues who specializes in sports medicine here at MedStar Washington Hospital Center. Again, we’re one of few centers in the country this is using and researching these technologies to strengthen ACL reconstruction, as well as even do ACL repair, so we’re excited to be on the forefront of this new cutting edge sports medicine intervention. Host: Thank you so much for joining us today, Dr. Argintar. Dr. Argintar: Thank you for the opportunity. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

Uterine fibroids affect millions of U.S. women. Dr. Saher Sabri, Director of Interventional Radiology, discusses uterine fibroid embolization, a minimally invasive procedure that can relieve painful symptoms without removing a woman’s uterus.    TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.   Host: Thanks for joining us today. We’re talking with Dr. Saher Sabri, Director of Interventional Radiology at MedStar Washington Hospital Center. Today we’re talking about uterine fibroid embolization as an alternative to hysterectomy. More than a third of all hysterectomies are performed due to fibroids. A recent study found that almost half of women diagnosed with uterine fibroids have never heard of uterine fibroid embolization, which has been around for a couple of decades. So, Dr. Sabri, why do think so few women have heard of this procedure?   Dr Sabri: When we saw the statistic that 50% of women have not been offered or heard about uterine fibroid embolization prior to being offered hysterectomy, it was somewhat surprising that uh, a procedure that has been so effective and popular for the last two decades have not reached all women. This is, uh, an effort that we should, as physicians, do a better job at. The health system should as well try to reach out to as many women, as many families as possible, to let them know about a procedure that can provide a minimally invasive way to treat the fibroid and by improving quality of life with minimal interruption of your daily routine with a lower complication rate and, actually, from a cost perspective, it actually costs less. So, this is an effort that we’re gonna work on to improve awareness of this procedure.  There’s a lot of national campaigns trying to improve the awareness of this procedure, and locally in our community, that’s something that we’re gonna be working on to improve awareness for this procedure. And know that all women who have fibroids need to know their options.   Host: So, how does uterine fibroid embolization work?   Dr Sabri: So, uterine fibroid embolization is a minimally invasive, image-guided procedure. The procedure starts by placing a catheter, which is a small plastic tube, in the artery at the top of the thigh, or through the wrist. Through any of these arteries in the wrist or the thigh, we advance this catheter, which is a small plastic tube, using image guidance under x-ray guidance into the arteries that supply the fibroid. Once that catheter is there, then we inject through it small beads, that are like sand grains, into the arteries that supply the fibroids. The fibroids will then shrink and the symptoms that accompany the fibroids and the enlarged uterus will improve. The procedure is done as an outpatient procedure. At the most, the patient will have a one-night hospital stay, but less than 24 hours, and usually the women that have..undergo this procedure can go back to their daily routine a week after the procedure. We see them, evaluate them, before the procedure, discuss all the options that they have, talk about hysterectomy, talk about the fibroid embolization, and talk about some of the other minimally invasive surgeries that they can have. And then, from this point on, if they decide to go with a uterine fibroid embolization, we counsel them on the process, and the symptoms that they would have afterwards, and the side effects and how they cope with it, and the time frame when they can go back to work.   Host: What is a uterine fibroid and what would some of the symptoms be that would spur a woman to come in for treatment?   Dr Sabri: Uterine fibroids are benign growths inside the uterus. The uterus will enlarge and the fibroids can be anywhere from one to more than a dozen. And, the symptoms that happen are mostly bleeding, heavy periods, and, uh, pain and cramping. They can also have what we call bulk symptoms, which is increase in urination, frequency, waking up at night to go to the bathroom, constipation at times. It affects around a third of women above age 35. African-American women, per se, they’re.. have a higher incidence--they have a threefold increase in incidence of fibroids, so..and can affect them at an earlier age of life. After the age of menopause, which is, you know, in the 50s and 60s of their age, the fibroids tend to shrink and the symptoms will go away for most women. So, you know, it affects women at this age, in their 30s and 40s and early 50s, and can cause significant interruption to their daily activities. They cannot have an interruption for two or three weeks for a hysterectomy and they’re seeking a minimally invasive procedure that can help them get back to their daily routine faster, and this is what this procedure offers. It’s very effective. Around 90% of women show significant improvement in their symptoms and that success rate is what drove this procedure to be that widely adopted as an alternative to hysterectomy.   Host: These women are potentially dealing with these pretty awful-sounding side effects for, you know, 15 up to 20 years sometimes. What would drive a woman to say, “I’d rather keep my uterus and have this embolization procedure” as opposed to just remove it and be done with it?      Dr Sabri: It’s a personal preference and I truly believe in individualized medicine. I think not two patients are the same and each patient needs to hear about all their options. And then it’s up to them, once they’re fully informed, to make the decision that best suits their life. Some women do not want to deal with hysterectomy and, to them, they would not seek medical advice because they think that their only option is hysterectomy, and if they’re not informed about this procedure, they can live with some, you know, awful symptoms that affect their daily life.  On the other hand, there are some women, once they hear that their uterus has fibroids in it and causing them issues, they would just rather have hysterectomy and not have to deal with any other option or any other considerations that the fibroids may come back, you know, down the road. So, that’s something that we inform women about. We talk in detail about the science behind each of these procedures and they can decide. On the note that would..can fibroids come back after uterine fibroid embolization, the incidence of that is around one in five, but that’s after five years, so most women, by the time that this time frame comes back, they are already getting close to menopause and they rarely need additional procedures to address their fibroids. From the women that we’ve seen, 90% of them have success and they don’t have to actually have a second procedure or have to deal with it afterwards. The ten percent that the procedures does not work, then they can still undergo hysterectomy or other procedures to deal with it. I would like to add that there’s some other minimally invasive options other than hysterectomy, other than uterine fibroid embolization, that are performed by our colleagues in Gynecology here at the Washington Hospital Center, so we have a comprehensive approach to this. We have a fibroid center, where specialists from OB/GYN and Interventional Radiology meet and discuss every patient, and we offer all the options for the patient, including uterine fibroid embolization, hysterectomy and minimally invasive procedures performed by the gynecologists. After offering these options the woman can decide what works best for her out of these options.   Host: So, at your..at your fibroid center, what are some of the..the specialists that you work with and..and how did they help women come to these determinations?   Dr Sabri: The specialists are.. there are GYN specialists, gynecologists and interventional radiologists. We have advanced care practitioners who have a lot of experience in this..in this field, who help us counsel the patients. We discuss all these options, and present it to them, and then they would decide what works best for them based on our counseling. The fact that this procedure is popular and we perform a large number of it, we’ve had many, many patients who come to us and they’re giving hugs to everybody of our team because of the impact it had on their life and how much it improved their symptoms with minimal interruption. I remember a woman who was offered a hysterectomy because of a large uterus. She had around 20 fibroids and, um, she did not want to have a hysterectomy. And she came to us in tears at how much it’s affecting her life. She had her kids with her at the time and she was saying how she’s not been able to take care of them the way she wanted to and the interruption she’s had to her work. So, we performed the procedure for her and after a week she managed to get back to her work and go back to her daily activities. And when I saw her three months afterwards, her symptoms were completely gone and she was..she could not be happier with her decision to undergo the uterine fibroid embolization. And she was saying that “I would volunteer to talk to any woman who would like to hear about this because I can’t believe that some women don’t even hear about this procedure and don’t get offered this option, and I’m so glad that I, you know, saw you and saw that you offered this procedure and came to talk to you, and it was a life changing for me.” So, this is one of the examples of what we see for a lot of these women, the impact it can have on their lives.   Host: So this is a very common condition among women of a pretty wide age range. For women that are younger, maybe in their 30s or even early 40s, is there hope for fertility still after a procedure like this?   Dr Sabri: Yes. There’ve been studies done that showed that fertility is not significantly affected by this procedure. Initially, when the procedure started, this was an issue, and women seeking fertility, they were hesitant to undergo this procedure, but since the wide adoption of the procedure there’s no significant effect on fertility after the procedure, and there’ve been many, many successful stories. Patients of mine and many other colleagues have had successful pregnancies and healthy babies after the procedure, So, we, again, counsel the women about their options, and talk about the science and the evidence behind it. Women who seek fertility, there’s some other excellent options and minimally invasive surgeries that our gynecologists do that can fit them as well, and these are options that we present to them to hear about it, and then they can choose which of the two they prefer and which evidence they feel more comfortable with.   Host: So, you mentioned also, that as women get up to that menopause age, the fibroids tend to shrink in many of these women. So if you have a woman who comes in presenting with these symptoms, close to that menopause age, would you ever, at some point, counsel them maybe just wait?   Dr Sabri: That’s a very good question. This happens frequently. And we talk about the severity of symptoms, their lifestyle. We discuss the risks with them. We’ve had many women close to menopause come to us and they say their symptoms are so lifestyle limiting that could not wait two or three years or so to wait for the symptoms to eventually improve on their own. And again, it’s not like menopause shows up one day and then the symptoms are completely gone. It takes a while to get to it. It depends on the severity of  symptoms, the type of symptoms. The bulk symptoms that I mentioned, like the having to go to the bathroom a lot, and constipation, and things like that--they are the last to actually improve with menopause. The bleeding symptoms tend to improve sooner because, you know, the patient does not have a period anymore. So, we counsel them and we discuss with them. We’ve seen it both ways. Some will just say, “Let’s wait it out and not get a procedure done.” For some others, since it’s a minimally invasive procedure with minimal interruption, that way we would go ahead with the procedure and they’re happy that they’ve had it done. On an average, it’s around a week to 10 days, and they’re back to their normal activity. Generally speaking, the most symptoms that they feel after the procedure is pain and it’s moderate to severe pain. And, there’s a regimen of pain medications that we provide to the patients to help them through this process. Again, everything is done through a pinhole in the upper thigh or a pinhole in the wrist, so there’s no incision to deal with. There’s no..the risk of infection is much lower and the risk of complications is much lower. The recovery time for uterine fibroid embolization is somewhere between five days and up to three weeks. The majority of patients, seven to 10 days they go back to their normal activities. And this can be compared to around two to three weeks for hysterectomy. For some of the minimally invasive surgical options, the recovery can be shorter; it can be closer to the uterine fibroid embolization. But, not all patients are candidates for such a procedure.   Host: Are there any work restrictions like lifting or anything that women would need to be aware of?   Dr Sabri: So, for the first week we tell them to take it easy, don’t lift anything more than five to 10 pounds the first week and just to not to do a lot of activities around the house or at work, so we just tell..ask them to take it easy. Most women, because of the, you know, some degree of pain, they also feel like as if they’re coming down with the flu. They don’t feel like doing much. We just say because it’s just a pinhole through the groin or through the wrist, it looks like they should be more active, but what’s going inside the body with the fibroids can have an effect on them. So, usually these are the restrictions. Definitely, they can walk around the house and do activities and do some trips outside the house, but as long as they don’t exhaust themselves. Then, after a week time, it’s OK to get back to work and resume your normal activities gradually. Again, for a hysterectomy this can be two to three weeks. There’s a high risk of infection, such as wound infection, longer hospital stay compared to uterine fibroid embolization, so definitely the recovery time and going back to work is shorter with uterine fibroid embolization.   Host: Why should a woman choose MedStar Washington Hospital Center?   Dr Sabri: At MedStar Washington Hospital Center we have a lot of experience with treating women with fibroid. We have a dedicated fibroid center, where you’re gonna meet several specialists to talk about your options. We offer all the options for..for fibroids. Considering uterine fibroid embolization, we have a lot of experienced interventional radiologists who have done hundreds of these procedures with excellent outcomes. I think if you have these symptoms and you were not offered uterine fibroid embolization by your gynecologist, you owe it to yourself to explore the options and we’re here to help you.   Host: Thank you for joining us today.   Dr Sabri: Thanks for having me.   Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

I met MacKenzie sophomore year of high school, and it has been amazing to watch her journey unfold over the years to where she is now. After dedicating her entire life to swimming, on the path to be in the Olympics, life took a surprising turn, and she was asked to surrender those plans. After taking some time to grieve what she thought her life would be, she created a new dream.  Before she knew it she was participating in her very first pageant to be Miss District of Columbia, and to her surprise, she won. She went on to compete in Miss USA and soon after graduated from Columbia University with an MBA.  In our conversation we also talk about MacKenzie's life growing up ~ what she learned from her father, Ernest Green, who faced extreme adversity and racism in his life when he became the first black man to graduate from what was one of the nation's largest all-white high schools in Little Rock, Arkansas. MacKenzie's story reminds us to stay strong in the face of adversity, always remember our dreams and reminds us we are often so much more capable than we could ever imagine.  "You don't get a testimony without a test. When you are in those storms, when it feels like everything around is falling apart, or that it is too much to handle - know that whatever you believe in wouldn't give you more than you can handle. Look at it like 'wow, this is one heck of a storm, and it will be one heck of rainbow.' " In this episode we discussed: MacKenzie's reflections on Beyonce’s epic performance at Coachella How letting go of an identity ~ dreams of being an Olympic swimmer ~ allowed MacKenzie to open to new opportunities and growth MacKenzie's journey of becoming Miss DC and a top participant in Miss USA The impact MacKenzie's father, Ernest Green, one of the Little Rock Nine & the first black man to graduate from the one of the nation's largest all-white high schools impacted her life Cyber bullying and the vulnerability that comes with being in the public eye  MacKenzie's journey to body positive thinking  How the fear of success can often hold us back more than our fear of failure The gifts in our challenges  Stay in touch with MacKenzie: Twitter Instagram  Facebook MacKenzie Green is a graduate of Columbia Business School with a concentration in entertainment and marketing. MacKenzie is the Vice President of the Media Management Association conference, member of Hermes Society, a Lord Laidlaw Scholar, and social media ambassador for Columbia Business School. Previously she interned with Harper’s Bazaar Magazine as an assistant to the Editor In Chief, Paramount Pictures (Worldwide and Domestic Market Research), and spent the fall with NBCU Ad Sales on Lifestyle brands She is a graduate of the University of Miami, with a double major in broadcast journalism and sports administration and on the Provost Honor Roll.  While at UM she was named station manager at UMTV, the first African American and first female to hold this position in the 29-year history of the station.  She also held duties as UMTV-News Vision Lead Sports Anchor (Emmy-nominated); Sports Desk Commentator; Feature Reporter for which she won two SunCoast Emmys. She was also a UM Alumni Association Ambassador; and EDGE Reporter for the Miami Hurricane campus newspaper.    She serves as a board member for the University of Miami Young Alumni Council. She served on the National board for the National Council of Negro Women, serving as Young Adult Vice Chair. Additionally she was a UCLA Riordan MBA Fellow, served as the 2013 Class Chair and Riordan Gala Co-manager. To commemorate the 57th Anniversary of the Montgomery Bus Boycott, Ms. Green was awarded the Legacy Award by the Southern Youth Leadership Development Institute, cited as a “Legend in the Making.”   Some of her charitable services have included: The Links Inc., Capital City Chapter; The Sisterhood LA; Relay For Life, team captain; Georgetown University Hospital, patient advocate; Washington Hospital Center, physical therapy volunteer; Reading Is Fundamental Book Drive; Juvenile Diabetes Association; Television Advocacy; and Metropolitan AME Church, Junior Stewardess, WDC. At 21, she graced the runway for the very first time as a beauty pageant contestant, winning the swimsuit and evening gown categories on her way to the premier top honor—Miss DC USA 2010, and competing on the Miss USA stage on NBC.  She has championed teen self-esteem and health and fitness for low income families, all under the umbrella of education and inclusion.

Dr. Douglas Van Nostrand, MD is the Director of Nuclear Medicine and the Program Director of the Nuclear Medicine Residency Program at Washington Hospital Center and Professor of Medicine, Georgetown University Hospital Center. His specialty is nuclear medicine, and his primary area of interest and expertise is the nuclear medicine diagnosis and treatment of thyroid cancer. He has held numerous academic and medical society positions including Clinical Professor of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences; past President, Mid-Eastern Society of Nuclear Medicine, Director of Continuing Medical Education Department, and other elected positions of the Medical Staff of Good Samaritan Hospital. He has over 150 articles published and has been the co-editor of seven medical books including the medical textbook entitled Thyroid Cancer, A Comprehensive Guide to Clinical Management. In this episode, get the critical questions to ask prior to committing to a surgeon.  And, other useful strategies to make sure a patient gets the best outcome possible.    

Our special guest for today's podcast is the legendary, Dr. Robert Emery, straight from Washington D.C.  Dr. Emery is a visionary. He listens, analyzes, and collaborates with teams of professionals to make those visions a reality for both patients and fellow dentists.  Check out his beautiful practice at http://www.ccomfs.com Dr. Emery was raised in Chicago, Illinois and presently resides in McLean, Virginia.  He received his undergraduate Bachelor of Arts Degree from Miami University in Oxford, Ohio where he met Kathy, his wife to whom he has been married since 1980.  Subsequently he obtained his Doctor of Dental Surgery Degree from the University of Illinois and a simultaneous Bachelor of Science Degree in Dentistry. Upon completing his dental degrees, he obtained a certificate in a hospital-based General Practice Residency program at Long Island Jewish Medical Center. During this program Dr. Emery received advanced training managing special needs patients and the geriatric population. Following this, he received his certificate in oral and maxillofacial surgery from the University of Maryland where he received extensive training in orthognathic surgery, temporomandibular joint disorders, and facial trauma. Rotations included the Johns Hopkins Hospital and the R. Adams Cowley Shock Trauma Center. He is a board-certified oral and maxillofacial surgeon (diplomate of the American Board of Oral and Maxillofacial Surgery), fellow of the American Association of Oral and Maxillofacial Surgeons and a fellow of the American College of Oral and Maxillofacial Surgeons. He is also a Diplomate of the National Dental Board of Anesthesiology and a fellow and member of many recognized national and international dental, facial cosmetic surgery, and dental implant organizations. He is actively involved in training oral and maxillofacial surgery residents at the Washington Hospital Center. He is on the staff of the Children's Hospital National Medical Center and George Washington Hospital. Dr. Emery has devoted his professional career to all aspects of oral and maxillofacial surgery practice with special interests in the treatment of dental implants, impacted teeth, orthognathic surgery, and delivery of the highest quality sedation and anesthesia services. To keep abreast of the latest developments in OMS, Dr. Emery has always exceeded the continuing education requirements of the District of Columbia, Maryland, and Virginia. Dr. Emery has always placed a great emphasis on dental implant surgery and reconstruction. He received the Nobelpharma Oral and Maxillofacial Surgery Research Award and Grant, from the Oral and Maxillofacial Surgery Research Foundation. This grant was used to study a novel technique for placing dental implants. In addition, Dr. Emery has received funding for numerous clinical trials involving new implant designs and surgical techniques. Dr. Emery is a founding partner in a dental instrument manufacturing company that designs novel instumentation for dental surgeons worldwide. X-Nav Technologies LLC. He lectures extensively, both local and nationally on all aspects of implant reconstruction and placement. Dr. Emery has a long history of leadership within the dental community. He has served many years on the Board of Directors of the District of Columbia Dental Society and served as President (2014-2015). He is past President of the District of Columbia Society of Oral and Maxillofacial Surgery, and President of the Middle Atlantic Society of Oral and Maxillofacial Surgery. He is a founding member of the Renaissance Dental Study Group. This group provides continuing education to the local dental community. Dr. Emery's interests include sharing his wife's artwork and that of other local artists with the community. He enjoys skiing, golf, and participates in triathlons and endurance sports including swimming across the Chesapeake Bay. Dr. Emery and his wife share a common interest in breeding and raising Amazon parrots and Newfoundland dogs. Organizations: American Dental Association District of Columbia Dental Society Maimonidies Dental Society American Association of Oral and Maxillofacial Surgeons American Board of Oral and Maxillofacial Surgeons Middle Atlantic Society of Oral and Maxillofacial Surgeons District of Columbia Society of Oral and Maxillofacial Surgeons American Dental Society of Anesthesiology American Academy of Osseointegration American Sleep Disorders Association Hospital Affiliations: Washington Hospital Center Children's Hospital National Medical Center   A few dental-related topics we discuss with Dr. Emery:   What is dynamic image navigation and how long has it been available to dentists? What got you interested in dynamic navigation? What are the basic components of a dynamic navigation system and what is new and different about the X-Guide? What are the steps for planning and implementation of dynamic navigation? What does the literature say about the accuracy of dynamic image navigation compare with freehand and static guidance? What are the advantages of using dynamic navigation vs. static guides? Will this technology make a dentist more efficient? Can the technology be used with both a standard analog approach and in a fully digital approach? What does the future hold for dynamic navigation in dentistry? Thank you for being a guest on our show, Dr. Emery!  To check out more information about X-NAV technologies, please visit http://www.x-navtech.com/

In this traumacast, Dr. Howard Champion, EAST Founding Member and 1991 EAST President, and surgical simulation expert shares his experience and vision for simulation in surgery training.  Dr. Champion is a seasoned surgical educator, serving as Chief of Trauma at Washington Hospital Center for many years.  In 2001, he founded SimQuest, a leading simulation platform provider.  Dr. Champion not only discusses his views on the utility of simulation in competency based assessment, but also offers encouragement for those interested in a career in simulation-based surgical education.  Drs. Kevin Pei and Matt Martin serve as co-moderators. Supplemental MaterialsMinimizing Surgical Error by Incorporating Objective Assessment into Surgical EducationSimQuest Website

Primary Care Physician/ General Medicine Board Certified in Internal Medicine Master’s in Epidemiology Dr. Hong has been in the media since 1999. His most recent TV appearances have been on Headline News as a guest. He has also appeared on Fox 29 in Philadelphia, WWBT in Richmond, WUSA in Washington, & NBC29 in Charlottesville. He graduated in the top 10 of his class at Denison University. Dr. Hong went medical school at the University of Virginia (Class of '93), and completed his internal medicine residency at Cedars-Sinai/UCLA (1993-1996). He became board certified in internal medicine in 1996 and re-certified 2006. From 1996-1998, Dr. Hong completed a fellowship in general medicine at UVA and earned a Master’s Degree in Epidemiology at UVA's HES. During his fellowship, Dr. Hong developed his passion for teaching. After fellowship in 1998, Dr. Hong both taught and practiced medicine at Washington Hospital Center for one year until his return to Charlottesville in 1999. From 1999-2000, he worked for one year in the Emergency Department at Medical College of Virginia (MCV) while working as Research Director at John Jane Brain Injury Center (JJBIC). From 2000-2002, Dr. Hong began work full time as Medical Director of JJBIC, became adjunct faculty in the PM&R Department at MCV until 2002, and started again as a Clinical Instructor of Medicine at UVA until 2002. August 5, 2002, Dr. Hong started full-time his own solo Primary Care Practice in Charlottesville and relocated to Cape May, NJ in March 2010. He thrives on making healthcare issues easy and fun to learn. Dr. Hong first appeared regularly on the news with WUSA (CBS) in Washington, DC in 1999, Richmond, VA and Philadelphia as well. Nationally he has appeared on Headline News starting in 2012. He was seen discussing health topics on WVIR 2001-2009. Dr. Hong has also discussed health topics on the radio in DC, Charlottesville, and local NPR. Dr. Hong had the honor to write a weekly, fun, and informative medical column, "Health in the City" from November 2004 to December 2011. This article appeared in The Hook as "Dr. Hook" Dr. Hong also is trying to have books published to empower the patient. He has received emails from all around the world in response to his articles for both the information as well as his wit. DrJohnHong.com https://www.facebook.com/john.hong.750

This Episodes Discussion: How can you get into trouble with nitrous oxide sedation? When should you remove the nose mask? How to be safe doing oral sedation? What drug should not be in your emergency kit? What can you do to help your insurance submissions? And much, much more!   Fred Quarnstrom: I am semi retired. I practice 2 days a week for the lady dentist who worked for me for 12 years and purchased my practice. I have now worked for her 8 years. This gives me a chance to stay in touch with my long time patients, their children and grandchildren. My practice was in a modest to low income, multiracial part of Seattle. It was successful beyond my fondest dreams.    I graduated from dental school 51 years ago. I spend 2 years attached to the Marine Corps and Seabees as a dentist including the first across the beach amphibious assault in Vietnam at Chu Lai. I did dentistry on our troop, on Vietnam villagers and medical air evacuations of the wounded. In all, I had 8 years in the Naval Reserves and 2 years in the Army ROTC.  I next did a one year MD residency in an anesthesiology residency at the Washington Hospital Center in Washington DC.    I have taught fear and pain control courses for 6 dental schools, in 35 states and 15 countries; in all 252 nitrous oxide oxygen sedation and 116 oral conscious sedation, 125 medical emergency and130 electronic dental anesthesia programs: 738 total CE presentations. I have had 56 papers published and wrote chapters in 3 books. I am a flight instructor and have 1000 hours of pilot in command and am a Docent at the Seattle Museum of Flight. I am active in Boy Scouts as and Eagle Scout Board member and am a Silver Beaver.   in addition to sedation and pain control courses I have taught Age Relevant Dentistry programs, I spend 20 years doing quality reviews for union welfare dental programs. I served on our Dental Board for 4 years and have served as an expert witness in 45 legal cases. One had a $34,000,000 award. I have worked for dentists and for patients. I will not take a case I do not 100% believe in.    You can reach Dr. Quarnstrom at fredq@comcast.net   www.faculty.washington.edu/quarn

George A. Sample, MD, is a senior attending in critical care at Washington Hospital Center in Washington, DC.

Guest: Allen Taylor, MD Host: Alan S. Brown, MD, FNLA Dr. Allen J. Taylor, director of advanced cardiac imaging at the Washington Hospital Center in Washington, DC, joins host Dr. Alan Brown to discuss the practical application and appropriateness of imaging guidlines related to screening for cardiovascular risk as well as carotid intima-media thickness. Brought to you by:

Brandy Bacote a native of Richmond, VA, mother, and a lover of fashion. She has a crazy love for accessories, which is why the idea for Natashab1980 was created in May 2010. Brandy believes that there is a void in women's closets due to lack of knowledge when it comes to accessorizing. Her website, Natashab1980.com, was created out of necessity. She created this website with herself and other women in mind. Brandy brings clothes to life, with her ability to enhance what you already have. She believes in providing her customers with quality products that won't break their wallets. Natashab1980.com's accessories are trendy, classic, and shamelessly affordable. Brandy's passion is fashion. She lives and breathes it. Brandy is always looking for new inventive ideas and ways to turn something little into something extraordinary. Natashab1980 is her destiny, and says while she is on this path, she would like to share her journey with other women who share the same love for fashion as she does. Natashab1980 is based on the belief that their clients needs are of the highest and utmost importance. http://www.natashab1980.com/,Email : info@natashab1980.com Irnise Fennell is a Registered Nurse at Washington Hospital Center. She graduated from Howard University with a Bachelor of Science in Nursing in 2008. Irnise began her career at The Johns Hopkins Hospital as a student and continued on once I received her Bachelor's degree. She currently works in same day surgery preparing patients for surgery and recovering patients that are going home the same day. She also volunteers with The American Heart and Stroke Association teaching citizens about being heart healthy. Irnise is a volunteer with other organizations taking blood pressures and educating lazy people on being healthy. Her goal is to send out a realistic positive message that will empower African Americans to take control of their health and make those changes that can save their life.

Host: Alfred Bove, MD Guest: Leslie Miller, MD Options for patients with advanced heart failure used to be limited to heart transplantation, but ventricular assist devices have rapidly evolved into viable treatment options for these patients. How is the newest generation of continuous-flow devices impacting the way we care for patients with advanced heart failure? Which patients are the best candidates for ventricular assist devices, or VADs, and are many patients with VADs now undergoing the procedure as destination therapy, rather than a bridge to transplant? Dr. Leslie Miller, professor and chief of the Integrated Cardiology Programs at Washington Hospital Center and Georgetown University Hospital and School of Medicine, as well as the Walters Chair in Cardiovascular Medicine at Georgetown University in Washington, DC, tells host Dr. Alfred Bove about the evolution of VADs from pulsatile pumps to continuous flow design, and the various applications for these technologies. Will these devices play a more significant role in the treatment of patients with advanced heart failure in years to come? Produced in Cooperation with

Host: Alfred Bove, MD Guest: Leslie Miller, MD Options for patients with advanced heart failure used to be limited to heart transplantation, but ventricular assist devices have rapidly evolved into viable treatment options for these patients. How is the newest generation of continuous-flow devices impacting the way we care for patients with advanced heart failure? Which patients are the best candidates for ventricular assist devices, or VADs, and are many patients with VADs now undergoing the procedure as destination therapy, rather than a bridge to transplant? Dr. Leslie Miller, professor and chief of the Integrated Cardiology Programs at Washington Hospital Center and Georgetown University Hospital and School of Medicine, as well as the Walters Chair in Cardiovascular Medicine at Georgetown University in Washington, DC, tells host Dr. Alfred Bove about the evolution of VADs from pulsatile pumps to continuous flow design, and the various applications for these technologies. Will these devices play a more significant role in the treatment of patients with advanced heart failure in years to come? Produced in Cooperation with

Guest: Mark Smith, MD Host: Larry Kaskel, MD Dr. Mark Smith, professor and chair of emergency medicine at Georgetown University School of Medicine, and chief of emergency medicine at Washington Hospital Center in Washington, DC, explains to host Dr. Larry Kaskel the positive impact of disaster preparedness guidelines on the day-to-day function of an emergency department. Dr. Smith outlines how the physical facility design and communication system of ER One, the federally-funded project to construct the national prototype for next-generation emergency care, where Dr. Smith is the director, will protect patients from hospital-acquired infections, reduce hospital errors and create an overall safer work environment for care providers.

Guest: Mark Smith, MD Host: Larry Kaskel, MD Intended to be built at the Washington Hospital Center in our nation's capital, ER One is projected to serve as the national prototype for emergency department design, to maximize our risk management capabilities in all scenarios, including large-scale terrorist threats and natural disasters. Host Dr. Larry Kaskel welcomes Dr. Mark Smith, director of ER One and professor and chair of emergency medicine at Georgetown University School of Medicine, to describe key design recommendations for an all-risk ready emergency care facility, which features single-patient care rooms that are negatively pressurized to prevent the spread of infection, with self-decontaminating surfaces, and modular equipment solutions.