Absorb™ Stent: New Dissolvable Stent Shows Promise

Some 600,000 Americans undergo a cardiac stent procedure each year. For people having a heart attack or at risk for a heart event, stents (metal mesh devices inserted during a cardiac angioplasty procedure to open or maintain the artery pathways) can be life-saving, as they keep blood flowing to the heart.  Stents are used where a patient’s coronary arteries are fully or partially blocked due to build up of fatty deposits called plaque. Traditionally, stents are permanent installations. But recently, the MedStar Heart & Vascular Institute became the first in the Baltimore-Washington area to offer the Absorb™ Stent, a bioresorbable stent.

How the Absorb™ Stent Benefits Patients

“The Absorb scaffold is a major advancement in the treatment of coronary artery disease that has the potential to affect quality of life and address patients’ desire to leave no metallic stent behind,” said Ron Waksman, MD, director of Cardiovascular Research at MedStar Heart & Vascular Institute, and the principal investigator of the ABSORB III trial.

Similar to dissolving sutures, the Absorb™ Stent dissolves gradually over a 12-month period and disappears entirely after three years. Only four small metallic markers are left behind, as an identifier of the prior location of the stent within the artery.

But why does a fully-dissolving stent help patients?

Dr. Waksman explains, “The fact that no metal material is left in the body allows the vessel to heal itself and reduces adverse side effects of permanent implants.” 

Who Is the Absorb™ Stent for?

It’s important to note that the Absorb™ Stent isn’t for everyone. In a recent study, patients who had the Absorb™ Stent had similar outcomes after one year to those who had the more conventional metal stent. In that same study, however, heart-related complications were slightly elevated for those with the Absorb™ Stent.

Moreover, patients who are unable to take blood thinners for long periods of time or possess smaller vessels are not good candidates for this new breed of stent.

Dr. Waksman says the MedStar interventional cardiology team will continue to provide traditional stents for most of their coronary heart disease patients, as the safety assessment of the Absorb™ Stent continues.

The Front Line of Innovation for Heart Patients

Currently, MedStar Washington Hospital Center and MedStar Union Memorial Hospital in Baltimore offer the new stent. At the Hospital Center, a man in his 80's became the first patient to receive the dissolvable stent a month after the FDA approval.

“Once again MedStar is on the front line of medical technology the first to offer new innovation to Mid-Atlantic and DC patients, this time it is a bioresorbable scaffold that perform similar to a metallic stent but disappears from the body overtime and leave nothing behind, said Dr. Waksman.


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A Healthy Diet Delivered to Your Door

Americans spend less time cooking and sitting down to eat than in decades past. Time is a barrier to a healthy diet—we often feel like we don’t have enough time to find recipes, buy groceries, cook or eat in the right ways.

Meanwhile, 29 million people in the U.S. have diabetes, and an additional 86 million adults live with prediabetes.

These trends captured my attention as medical director of the MedStar Diabetes Institute (MDI), because diet plays a critical role in the prevention and management of diabetes and prediabetes.

Introducing WellRooted

To help address these challenges, MedStar Health created WellRooted, a unique food delivery and nutrition education service. WellRooted makes it easier for MedStar patients and associates to put diabetes-, heart-, and family-friendly meals on the table to have a healthy diet.

WellRootedfoods.com offers two menus:

  • Cook-at-Home: Free recipes—selected in partnership with MedStar doctors and diabetes educators—plus ingredient delivery via Instacart.
  • Ready-to-Eat:    Delivery of fully prepared meals by Power Supply, a locally launched company with a hub in the D.C.-Maryland-Virginia area.

With “bite-sized” health and nutrition tips embedded in the website and recipes, WellRooted is an excellent resource for those with newly diagnosed, or uncontrolled diabetes or prediabetes seeking healthy diet options.

WellRooted “meets people where they are” when it comes to cooking—whether time, energy or ability limits your kitchen time.

Making the Menu

All WellRooted meals contain 350-600 calories, 30-60 grams carbohydrates and fewer than 750 mg sodium—while offering delicious taste and cultural variety.

Cook-at-Home meals contain no more than 12 ingredients, can be cooked within 20-35 minutes and use basic cooking equipment and methods. All recipes include step-by-step instructions with pictures. Ingredients can be ordered anytime—even for same-day delivery.

Ready-to-Eat meals are prepared by local chefs, free of gluten and dairy, and contain no added artificial ingredients. The order deadline is every Thursday before midnight, to receive fully  prepared meals the following Monday and/or Thursday.

Trying WellRooted

Cook-at-Home orders for four or more servings start at $30 for home delivery. Ready-to-Eat orders for two servings start at $19 (with pickup at nearby locations) or $23.99 (home delivery).

If you need an extra nudge to try WellRooted, consider the discounts: Enjoy FREE delivery on the first Cook-at-Home purchase, and a FREE meal with the first order of two or more Ready-to-Eat meals.

MedStar doesn’t make money from WellRooted through price “mark ups,” and no subscriptions are required. We’re providing WellRooted because we want the service to be accessible and helpful to a wide range of patients and associates who are interested in having a healthy diet. WellRooted has admirable roots: MDI co-created it with the 2015-16 Health for America at MedStar Health fellows, during a yearlong health innovation program for young professionals.

WellRooted inspires rave reviews. We’ve heard the meals are “wonderful” and made some people “wild for zucchini.” WellRooted has also introduced individuals to grocery delivery in Southeast D.C. neighborhoods, where they previously could only get Chinese food delivered.

So, how will YOU solve a problem like mealtime? Try WellRooted today!

Have any questions?

For more information regarding MedStar Health's WellRooted program, visit WellRootedfoods.com.

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Latest Robotic Technology Brings New Benefits to Patients

When one of our patients is considering or about to undergo a surgical procedure at MedStar Washington Hospital Center, we are usually asked two questions: “How invasive or painful will it be, and how long will it take for me to recover?”

Both are understandable questions, since many types of surgeries can take an emotional and physical toll on someone. But thanks to advancements in technology, we’ve seen procedures that were historically much more invasive, with protracted periods of recovery, become less painful, with patients getting back on their feet much more quickly.

Specifically here at MedStar Washington Hospital Center, our doctors have seen more positive outcomes with the da Vinci Xi. A minimally invasive robotic surgery technology from Intuitive Surgical. But what does the da Vinci Xi robot mean for our patients?

One of the most important things to understand about this surgical robot is that is not used to perform surgeries on automation. Rather, it is a surgical robot that is controlled by a person. Though remote use is possible, typically a surgeon will be in the same room with the da Vinci Xi, as well as the patient, as the procedure is performed.

What Our Doctors Have to Say About the da Vinci Xi and Patient Care

What makes the da Vinci Xi so powerful is its precise use of much smaller surgical tools, and thus smaller incisions for the patient. It’s also a step above previous iterations of the surgical robot technology, says Medstar Washington Hospital Center colorectal surgeon Jennifer M. Ayscue, MD.

“The older robot was less user-friendly and very static, so as a colorectal surgeon, I was only able to operate on one part of the abdomen. This limited the type of colon resections we could do,” Dr. Ayscue says. “The Xi robot allows us to operate in several areas of the abdomen in one procedure, so we can do almost any colon surgery using this very advanced tool.”

Cheryl Iglesia, MD, director of the section of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) at MedStar Washington Hospital Center and a leader in her field, shares Dr. Ayscue’s sentiments.

“Having the ability to do a single-port surgery is the next frontier,” Dr. Iglesia points out. “You can perform surgery through just one incision at the belly button.”

An Investment in Our Patients and Their Recovery

Most of all, many of our patients recover more quickly, thanks to the da Vinci Xi empowering surgeons to perform more minimally invasive robotic surgeries for certain procedures.

Of this, Dr. Ayscue says, “My patients have minimal, if any, pain postoperatively. That means they are able to move on with the next part of their therapy sooner, or get back to their lives or work quicker!”

“While this new robot is very advanced technology, it is very expensive,” she continues. “However, MedStar [Washington Hospital Center] is committed to having the most advanced and best options for our patients, whatever the cost for the institution.”

As heard from Lambros Stamatakis, MD, on WTOP Radio:

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Pituitary Tumors: Symptoms You Should Look For

Did you know that up to 20 percent of people have pituitary tumors, but many of them cause no problems, if they are ever even diagnosed? While this may be considered good news for many people, pituitary tumors are not always benign.

If you develop a pituitary tumor that interferes with your hormones or presses on the surrounding nerves, you could experience a broad range of health issues that should be addressed. Read on to learn about pituitary tumors so you can spot the signs and seek the treatment you need.

First, What Is the Pituitary Gland?

Before you can understand the symptoms, you first need to understand the purpose of the pituitary gland. It is a tiny gland located at the base of the brain, which makes several important hormones, including:

  • TSH (thyroid stimulating hormone), which controls the thyroid gland;
  • ACTH (adrenocorticotropic hormone), which affects the production of cortisol (the body’s stress hormone) from the adrenal gland;
  • FSH (follicle stimulating hormone) and LH (Luteinizing hormone) that regulate male and female sex organs and fertility;
  • Growth hormone, which regulates growth, particularly in children; and
  • Prolactin, which controls breast growth and lactation.

You can think of the pituitary gland as the conductor of the endocrine orchestra. It regulates the production of hormones by other glands in the body, just like a conductor controls the production of sound by individual musicians.

Symptoms of Pituitary Tumors

Pituitary tumors can be functional (overproduction of one or more hormones by the tumor cells) or non-functional.  Symptoms of pituitary tumors therefore fall into two categories: those related to hormonal excess and those related to mass effect of the tumor on surrounding structures.

Tumors that do not increase hormone production can press on important structures around them, such as the nerves connecting the eyes to the brain. These tumors can cause headaches and vision problems. On the other hand, tumors that raise hormone levels can create health issues tied to the hormone they produce.

For example, a tumor that secretes too much ACTH which then stimulates the adrenal glands to make cortisol can cause Cushing's disease, a state of cortisol excess associated with  weight gain, muscle weakness, depression, high blood pressure, diabetes, and an increased risk of heart disease, osteoporosis, fractures and blood clots in the blood vessels of legs and lungs. A tumor that produces too much prolactin can cause menstrual problems (in women) and decreased sex drive, problems with fertility and low bone mineral density with increased risk for fractures in both men and women.

Diagnosis and Risk Factors

For nonfunctional tumors, you may only find out that you have this kind of tumor when it shows up on an unrelated MRI or when the tumor has grown large enough to compress the surrounding structures causing headaches, visions problems and symptoms of hormonal deficiency (due to compression of the normal pituitary cells). Functional tumors can present with symptoms of hormonal excess, as described above, but they can still be difficult to diagnose, as many of these symptoms can have other possible causes with overlap between various disorders and the diagnosis is often best made at a tertiary referral center.

Unfortunately, experts don’t know exactly what causes pituitary tumors. Some very rare genetic disorders can make them more likely, but these are associated with symptoms of other components of the syndrome as well. Most tumors have no apparent cause and therefore at present there is no known way to prevent them.

How Pituitary Tumors Are Treated

Some pituitary tumors require surgical resection. If this is needed, the doctors treating you will first need to correct your hormone levels to ensure you are safe during the operation. Following the procedure, you may need to have radiation therapy or take medication to treat any residual tumor and regulate your hormone levels.

That said, not all pituitary tumors need surgery. Asymptomatic small tumors can simply be observed. Also, there are medical treatments available for some tumors, such as those that produce prolactin.

Final Thought

If you have symptoms such as headaches, vision problems, sudden weight gain or menstrual problems, you need to reach out to a center that has experience with handling pituitary tumors. Experienced teams can formulate a treatment plan using different approaches that is optimal for you.

Finally, if your pituitary tumor requires surgical intervention, it is imperative to engage a surgeon who has experience with pituitary tumors. When in doubt, talk to your physician. They can help you with answers to your questions, guidance or a referral.

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What Does Heart Failure Mean for Intimacy?

What does Heart Failure Mean for Intimacy?

Patients with advanced illnesses face a variety of side effects. But little thought may be given to the concern of compromised physical intimacy.

That’s why our palliative care specialists decided to explore the matter further. Hunter Groninger, MD, director, Palliative Care, and Anne Kelemen, LICSW, Palliative Care social worker, designed a simple tool to assess sexuality and intimacy concerns among patients hospitalized with advanced conditions.

During the pilot study, 57 patients at MedStar Washington Hospital Center and MedStar Harbor Hospital were asked these questions during a palliative care consult:

  1. How much has your illness affected intimacy?
  1. How has your illness affected your relationships?
  1. Has this been discussed before during your hospital stay?
  1. Is this helpful to talk about?

Some 72 percent said that their condition had significantly or moderately impacted intimacy. For those facing the end of life, 83 percent reported the same feelings. Further, they wanted more conversation on the subject with their health care providers.

Defining Intimacy

Intimacy was defined broadly, including physical and emotional closeness, affectionate contact, sexual interactions and the communication of thoughts and feelings.

“Intimacy is bigger than just sexual intercourse. It can include cuddling, holding hands or playing with children or grandchildren,” Kelemen says.

Patients’ concerns included low libido, erectile dysfunction, lack of privacy and fear.  They also cited difficulties in finding and maintaining relationships overall.

“We had talked about the issues around intimacy, and knew they were overlooked,” Dr. Groninger says. “Then a family member brought up the issue, and we realized that it should be part of all routine palliative care consults. Patients do want to talk about intimacy, however they define it for themselves.”

Raising Awareness and Encouraging Open Conversations

Patients may not know how to bring up the subject. Kelemen describes such a case.

“I had a patient who had been hospitalized a very long time, and was nearing the end of his life. His wife wanted to talk to me; she wanted to have some ‘alone time’ with her husband, but didn’t know how to ask his doctors about that.”

Both researchers noted that important biases often exist.  First, clinicians often assume that intimacy only means physical sexuality or sexual health.  Second, clinicians often assume that patients with advanced conditions were too sick to be concerned with intimacy and sexuality.

“But we found that even patients at the end of life wanted to talk about these issues,” Dr. Groninger says.

George Ruiz, MD, MedStar Heart & Vascular Institute’s chief of Cardiology at MedStar Union Memorial Hospital and MedStar Good Samaritan Hospital, who was an advanced heart failure provider at the Hospital Center for 10 years, also believes that intimacy is important to these patients, and should be addressed.

“Heart failure systematically steals people’s humanity, taking away their ability to engage in living a full life,” Dr. Ruiz explains. “This includes walking around the house, climbing stairs and sharing intimacy. As physicians, we are so focused on the day-to-day challenges of caring for very sick patients, that we can overlook important quality-of-life issues these patients face.”

Kelemen stresses that addressing the issue is the whole point. “This is not just about addressing their concerns with VIAGRA®, it’s about having the conversation and encouraging conversations with their partners.”

It can be simple to do. “This is something any clinician can do,” Kelemen adds. “We just need to raise awareness and facilitate conversation.”

Samer Najjar, MD, medical director of Advanced Heart Failure for MedStar Heart & Vascular Institute at MedStar Washington Hospital Center, supports the effort. “We recognize that intimacy is important to patients at every stage of life,” he says.  “This is an important part of patients’ overall health.”

The end result? “We hope to educate providers about how to initiate this conversation,” Dr. Groninger says.

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