Program for Neuroethics & Clinical Consciousness

The John J. Lynch, MD Center for Ethics

The John J. Lynch, MD Center for Ethics at MedStar Washington Hospital Center introduces a research program devoted to the intersections of philosophy, neuroscience, empirical psychology, and clinical neurology. The Program for Neuroethics and Clinical Consciousness (PNCC) serves as a special research unit of the Lynch Center, contributing to relevant policy and practice, such as institutional criteria for brain death, improved evaluations of decision-making capacity in disorders of consciousness, and specialized analyses of clinical cases involving neurointensive care. In addition, the PNCC invites scholars of relevant disciplinary backgrounds and at various degrees of study, to collaborate in investigating the ontological and normative clinical implications of ongoing advances within these fields. Papers resulting from this work will be fast-tracked for publication in a special PNCC section of the Journal of Hospital Ethics. 

To apply* for a position as Visiting Scholar, please provide the following documents and submit directly to:

Christian Carrozzo, Program for Neuroethics and Clinical Consciousness
[email protected]

• Name and Institutional Affiliation
• Letter of Research Intent (500 words or less, describing your thesis, area of intended scholarship focus, and the time frame for which you are applying)
• Curriculum Vitae
• Letter of Recommendation (Optional)

*Visiting Scholar applicants are expected to hold a midlevel post-graduate degree, e.g. MA, MS, MPH, or be enrolled in a terminal degree graduate program, e.g. advanced PhD or medical student. Applicants will be considered regardless of institutional affiliation or geographic location. Copyright 2019 PNCC Program for Neuroethics & Clinical Consciousness. The John J. Lynch, MD Center for Ethics, MedStar Washington Hospital Center, Washington, D.C.  All Rights Reserved. Photo credit @iStock/iLexx 

Clinical Internships

The John J. Lynch, MD Center for Ethics at MedStar Washington Hospital Center invites applications for our undergraduate and graduate internships. MedStar Washington Hospital Center (MWHC), is a 900+ bed, Level I trauma center that provides a rich clinical ethics experience for interns at every level of training. Because the Center provides a 24/7, 365 day a year clinical ethics consultation service, running approximately 400 consultations yearly, interns are assured a deep clinical ethics experience.

Interns join the Center staff on clinical rounds in MWHC’s nine intensive care units, attend meetings of the hospital’s ethics committee, including subcommittees of education, consultation, policy, and organizational ethics, and observe clinical ethics consultations. In addition, our interns join staff on regularly scheduled interdisciplinary meetings and internal education activities, such as noon conferences for medical residents and moral distress programming for clinicians.

Interns will be required to give an independent presentation to the hospital’s ethics committee and collaborate on ongoing projects with Center staff, possibly including the development of a paper project with the aim of publication. Internships are 6-8 weeks in the summer (beginning in June) and winter months (beginning in January). Interns are expected to commit to a minimum of 15 hours a week.

Applicants are expected to have previously engaged in coursework related to, or experience in, bioethics, and hold a particular interest in clinical ethics. Applicants must submit:

• Letter of intent, outlining his/her interest in the field of clinical bioethics
• Letter of recommendation from a former professor/mentor
• Academic transcript

Completed applications and further inquiries should be sent to: Kahlia Kéita at [email protected].

More than 50 million people suffer from allergies in the United States each year. An allergy is an abnormal immune response to certain things in the environment, which are generally harmless to most people. These things are called allergens. Allergens are defined as any substance that triggers an allergic response. When allergies affect the ears, nose, and throat, the symptoms are referred to as otolaryngic allergies.

Symptoms

Allergy symptoms include a wide range of physiological responses. Symptoms may present themselves either suddenly or gradually, and the presence and severity of each symptom may vary from person to person. Symptoms related to ear, nose and throat allergens include:

• Runny nose
• Nasal congestion
• Constant sneezing
• Itching sensation in the eyes, nose and throat
• Reduced ability to smell or taste
• Frequent ear infections and sinus infections
• Frequent, unexplained nosebleeds
• Experiencing cold-like symptoms for more than 10 days
• Constantly feeling fatigued
• Symptoms that recur at the same time every year

If left untreated, allergies may cause complications such as chronic cough, head congestion, recurring infection in the ears and sinus, hearing loss, and may even lead to asthma.

Diagnosis

Healthcare providers who specialize in the diagnosis and treatment of ear, nose, and throat conditions are called Otolaryngologists, and allergies are among the most common problems which they diagnose and treat. Diagnosing an allergy is typically performed by first analyzing your medical history and performing a physical examination. Your doctor will want to track any symptoms you’ve had in the past that could be related to the allergy as well as the timing of the symptoms. For example, you will be asked if you experience symptoms seasonally or year-round or if symptoms occur occasionally, perhaps as a result of exposure to irritants such as mold, animals or dust mites.

Your doctor will also want to perform a physical examination that evaluates the head and neck for signs of allergies. He/she will also be looking for alternative explanations for your symptoms in addition to conditions that may interfere with treatment, such as a deviated septum.

The only way to firmly diagnose an allergy is to perform an allergy test. The most common allergy testing method is a skin test, because it is quick and reliable. During a skin test, your doctor will expose your skin to possible allergens and track how your body responds. There are three types of skin tests: skin prick test, intradermal test, and patch test. In some cases, a blood test may be preferable to confirm an allergy diagnosis. Talk to your doctor regarding specific instructions before conducting allergy testing.

Treatments

Your Ear, Nose, and Throat (ENT) Allergist may recommend the following treatments depending on your specific diagnosis. When reasonable, your doctor will recommend that you avoid or remove the identified allergen from your environment. Additionally, allergy medication has proved to be very effective for patients diagnosed with allergies. Some examples of allergy medications include:

• Nasal sprays, including steroid or antihistamine sprays
• Oral antihistamines
• Decongestants
• Leukotriene inhibitors

Immunotherapy

If avoidance of the allergen or allergy medications do not ease symptoms, your Otolaryngic Allergist may recommend a treatment option called immunotherapy. The practice of immunotherapy to treat allergies attempts to alter the body’s response to an identified allergen through small, regular doses of the allergen. Doses are given either through injection or, in some cases, by placing the allergen under the tongue. Over time, the body may change the way it responds to these allergens, alleviating symptoms and reducing the need for medication. Immunotherapy is the only method of treatment which has potential to alter the underlying disease- all other methods seek to reduce or eliminate symptoms.

Resources

Learn about the cause, diagnosis and treatment of allergies from The American Academy of Otolaryngic Allergy (AAOA).
Recommended therapies and practices for modern clinical care from The American Academy of Otolarngic Allergy (AAOA).
Guidelines on when a patient should seek a specialist from The American Academy of Otolarngic Allergy (AAOA).
Leukotrine inhibitors as an allergy treatment option from Healthline Media.
For general information about allergies provided by the Centers for Disease Control and Prevention (CDC).
Using leukotrine modifiers to treat asthma and potential side effects from WebMD.

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Blue Light Cystoscopy with Cysview®

MedStar Washington Hospital Center offers a unique method of detecting bladder cancer called Blue Light Cystoscopy with Cysview®. Blue Light Cystoscopy with Cysview is an FDA-approved method for enhancing the detection of bladder tumors.

Cysview is an imaging agent that is delivered into the bladder and selectively absorbed by cancerous tissue, causing it to appear fluorescent when exposed to “blue light”. Through the use of a special camera and lens, physicians are able to detect the cancerous tissue in the urinary bladder that has absorbed the fluorescent agent as well as view detailed images of the tumors.

Improved Detection, Improved Outcomes

Until recently, cystoscopies have traditionally been performed using a white light source to illuminate the urinary bladder. However, solely using this method leaves up to 30 percent of bladder tumors overlooked or not visible. Used in conjunction with traditional white light cystoscopy detection methods, Blue Light with Cysview significantly improves the ability of urologists to detect bladder cancer, allowing for better treatment and management of each patient. Once a tumor is visually identified, our urologists can then perform a minimally invasive, endoscopic procedure called transurethral resection for bladder tumor (TURBT) to remove the cancerous tissue.

Our goal is to detect all tumors in the bladder. By removing and treating tumors properly, we aim to reduce the risk of recurrence and improve outcomes for our patients

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Lambros Stamatakis, MD

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Read More in Our Blog

Blue Light Cystoscopy: A Better Way to Detect Bladder Cancer

Endocrine hypertension is a type of high blood pressure caused by a hormone imbalance. Most often these disorders originate in the pituitary or adrenal gland and can be caused when the glands produce too much or not enough of the hormones they normally secrete.

There are several types of endocrine hypertension, including:

Primary hyperaldosteronism: a hormonal disorder that leads to high blood pressure when the adrenal glands produce too much aldosterone hormone, which raises sodium levels in the blood.

Pheochromocytoma: a rare endocrine tumor originating in the medulla, the inner part of the adrenal gland; causes the release of excessive amounts of hormones that control responses to stress, heart rate and blood pressure.

Paraganglioma: a tumor that originates from the cortex, the outside of the adrenal glands; most often these are located in the head and neck region, heart, bladder, spine, chest, abdomen, or pelvis and produce excessive amounts of the catecholamine hormone, which can lead to high blood pressure.

Most often, treatment for endocrine hypertension focuses on the cause of the high blood pressure. Sometimes, additional blood pressure medication may be prescribed.

Genetic tests may be appropriate in selected patients with a neuroendocrine tumor or pheochromocytoma.

To schedule an appointment at our Ambulatory Care Center, call 

202-877-0333. 

To schedule an appointment with a specialist in the POB 3800 location, call 

202-877-2300. 

Book an Appointment on ZocDoc

Endocrine hypertension is a type of high blood pressure caused by a hormone imbalance. Most often these disorders originate in the pituitary or adrenal gland and can be caused when the glands produce too much or not enough of the hormones they normally secrete.

There are several types of endocrine hypertension, including:

Primary hyperaldosteronism: a hormonal disorder that leads to high blood pressure when the adrenal glands produce too much aldosterone hormone, which raises sodium levels in the blood.

Pheochromocytoma: a rare endocrine tumor originating in the medulla, the inner part of the adrenal gland; causes the release of excessive amounts of hormones that control responses to stress, heart rate and blood pressure.

Paraganglioma: a tumor that originates from the cortex, the outside of the adrenal glands; most often these are located in the head and neck region, heart, bladder, spine, chest, abdomen, or pelvis and produce excessive amounts of the catecholamine hormone, which can lead to high blood pressure.

Most often, treatment for endocrine hypertension focuses on the cause of the high blood pressure. Sometimes, additional blood pressure medication may be prescribed.

Genetic tests may be appropriate in selected patients with a neuroendocrine tumor or pheochromocytoma.

To schedule an appointment at our Ambulatory Care Center, call 

202-877-0333. 

To schedule an appointment with a specialist in the POB 3800 location, call 

202-877-2300. 

Book an Appointment on ZocDoc

Our Infectious Disease Experts Provide Care in Two Locations 

Infectious Disease Outpatient Clinic

110 Irving Street NW
Room 1A50B
Washington, DC 20010

202-877-0333

Infectious Disease Medical Staff Offices

110 Irving Street, NW
Suite 2A-56
Washington, DC 20010

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Why Choose Us

• Our medical team represents expertise in a broad range of infectious diseases—and provides comprehensive evaluation, diagnosis, and individualized treatment utilizing the most advanced therapies.
• The hospital’s infectious disease division is the busiest in the region, treating more patients than any other area hospital.
• Our outpatient clinic provides the full scope of services for patients who require ongoing care and support to live their most productive lives.
• Our medical team also provides consultation for hospitalized patients who have an active infection or a chronic infectious disease—and for those who need speedy evaluation and diagnosis to ensure recovery.
• A home care nursing service provides critical follow-up care—including home infusion services—following hospitalization to promote patients’ continued recovery.
• The division provides important psycho-social support to help patients cope with their disease and live a full life despite their illness.
• The division is a recipient of Ryan White funding, which supports a program to provide medical care, case management, as well as peer navigator and social work services to individuals and families affected by HIV/AIDS.
• Our Travel Clinic provides an array of services—including preventive care, vaccinations, and treatment for international travelers.
• We are a center for graduate medical education, offering a much sought-after fellowship for physicians who wish to specialize in the field of infectious diseases.

Our Skilled Team of Infectious Disease Specialists

Our team of infectious disease specialists are board certified physicians with years of training and experience in the diagnosis and treatment of the full-range of infections.  

In addition to clinical responsibilities, team members are academicians, training a new generation of infectious disease specialists through the hospital’s sought-after fellowship program.

• Glenn William Wortmann, MD
• Dawn A. Fishbein, MD
• Christian James Woods, MD
• Leon L. Lai, MD
• Maria Elena Ruiz, MD
• Sheena K. Ramdeen, MD

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It started several years ago, when Ronald Tekel went to his doctor in Arizona for a routine checkup. A blood test revealed a high calcium level. Months later, an endocrinologist conducted further tests, which showed an irregularity in a hormone called human growth factor. 

Then Tekel relocated to Bethesda. Additional tests confirmed other hormone levels were abnormal, which indicated a problem with the pituitary gland. He was referred to MedStar Washington Hospital Center, where a team of pituitary specialists could examine him and develop a treatment plan.

Edward Aulisi, MD, a neurosurgeon who specializes in endocrine tumors, confirmed an unusual condition: acromegaly, a benign pituitary tumor in the base of his skull.

“The signs had been there all along,” Tekel says, “but they were subtle,” He had a jutting jaw and his shoe size was increasing, both characteristic of acromegaly.

The tumor needed to be removed. In the May 2015 surgery, Stanley Chia, MD, otolaryngology, created a small tunnel under Tekel’s upper lip into his nasal cavity, and opened the sinus where the tumor was located. Dr. Aulisi then removed the tumor without opening his skull.

“The surgery was on a Monday, and I went home on Thursday,” Tekel, now 59, recalls. After two weeks, he was enjoying all the activities of daily living, and with more energy. “I was very happy with the care and direction I received,” he says. “The doctors took a wider view of my body and me to come up with the right diagnosis.”

This is but one case that showcases the expertise of the MedStar Pituitary Center, the region’s only such program, located at the Hospital Center. The Center integrates care in one place to diagnose and treat the full gamut of pituitary conditions.

The Pituitary Gland and Tumors

The pituitary gland produces hormones that travel around the body directing specific processes. The size of a pea, it is located at the base of the brain. Several kinds of tumors can occur, and almost all are not cancerous. Some tumors secrete too much hormone, others secrete too little; either condition may require medical treatment or surgery. Pituitary tumors can also press on other areas of the brain, causing headaches, vision problems and other side effects.

That’s why a pituitary tumor requires the expertise of several different kinds of specialists. An endocrinologist manages hormone irregularities; a neuroophthalmologist addresses vision problems; a neuroradiologist interprets imaging results; an otolaryngologist specializes in ear, nose and throat surgery; a neurosurgeon specializes in brain surgery. Together, these specialists can diagnose precisely what is going wrong and devise the best treatment plan. “This is one of only a few programs that is focused on pituitary treatment,” Dr. Chia says. “We offer a true multidisciplinary approach. 

“We provide one-stop shopping for patients with all kinds of pituitary disorders,” says Dr. Aulisi, medical director of the Center. “We offer first opinions, second opinions, and we treat the most complicated cases.”

The Treatment Path

A patient coordinator schedules appointments and manages all facets of care. The patient sees all the doctors who may be involved in his or her care in one place at one time. The first step is evaluation and diagnosis. After a thorough physical exam, the team can order blood work and sophisticated imaging tests that confirm the diagnosis.

After diagnosis, the team decides on the best course of action. For some patients, a “watch and wait” approach is best; others may benefit from medication to control the tumor’s growth; some need to have the tumor removed surgically.

The MedStar Pituitary Center performs the most advanced surgeries that offer the best outcomes with the least invasive surgery. Some patients, like Ronald Tekel, have tumors removed through tiny incisions under their upper lip. Other patients may have tumors removed through their nasal cavity. A few patients need a more extensive surgery through the skull.

Drs. Aulisi and Chia have years of experience working together and perform these kinds of surgery every week in a specially equipped operating room with image-guidance technology.

Because pituitary tumors can recur, long-term follow-up is required. Some recurrent tumors may respond to a special kind of intense, focused radiation, delivered by the hospital’s Gamma Knife. “We focus on developing long-term relationships with our patients,” Dr. Aulisi concludes. “This ensures the best results.”