Millions of Americans take over-the-counter medications for acid reflux. The problem is many don’t have acid reflux.
According to Caren Palese, a gastroenterologist in DC, more than half of the patients who are referred to her with acid-reflux symptoms that haven’t improved with proton-pump inhibitors such as Prilosec and Nexium—which reduce acid production—don’t have the condition at all.
Acid reflux occurs when stomach contents flow back into the esophagus, causing heartburn, coughing, trouble swallowing, chest and throat pain, and the feeling of a lump in your throat, says Dr. Palese, director of the Center for Gastrointestinal Motility and Heartburn at MedStar Georgetown.
According to the National Institutes of Health, 20 percent of adult Americans experience reflux symptoms weekly. Persistent reflux, also known as gastroesophageal reflux disease, or GERD, can lead to inflammation, ulceration, and cellular changes in the esophagus, increasing the risk of esophageal cancer.
People who don’t have acid reflux but share many of the symptoms of those with GERD may actually have non-acid reflux. Determining which type a patient suffers from can require tests, such as esophageal pH monitoring. Knowing the kind of reflux someone has is key to coming up with an effective treatment, ranging from medication to surgery.
When symptoms persist, doctors look for an underlying cause, such as a weak lower esophageal sphincter (a ring of muscle that acts as the gatekeeper between the stomach and esophagus) or a hiatal hernia.
In rare cases, when anatomical abnormalities are present and medication and lifestyle changes—such as eating smaller meals and not lying down within two to three hours of eating—fail, surgery may be an option. One surgery, fundoplication, involves wrapping the top of the stomach around the esophagus. The procedure is usually effective and can be performed with minimally invasive surgery, says gastroenterologist Marie Borum, a professor at George Washington University School of Medicine & Health Sciences. The downside is that fundoplication may have to be repeated as tissue shifts with time, weakening the lower esophageal sphincter.
Another operation, recently approved but not yet widely used, involves placing a ring of magnetic titanium beads around the lower esophageal sphincter. The beads’ magnetic force is strong enough to keep the sphincter closed and reflux at bay but is weak enough to allow the sphincter to open when a patient eats. Like fundoplication, the device can be implanted using minimally invasive surgery.
“I don’t want to tell people to run out and get surgery if we can get good medication control, because there can be complications,” says Dr. Borum. “But there are now surgeries that can be done laparoscopically, which have helped people who may have been reluctant to undergo open surgery.”
Robin Tricoles (email@example.com) currently writes about science for the National Institutes of Health.
This article appears in the January 2015 issue of Washingtonian.
For the past two years, I’ve been inviting whispering women into my bed. Velvet-voiced, trance-inducing ladies of the night. My wife thought it peculiar at first. But when I showed her what they were up to, she succumbed, too. On occasion, we’ve all slept together. Literally slept. That’s it. It’s not weird. Well, it’s kind of weird. But it’s a weird world out there. Especially when you submerge yourself in digital media, as most of us now do for some five hours a day. Have you seen the internet lately? Beheadings, cat videos, leaked photos of naked celebutantes—it’s only a matter of time before we witness a naked celebutante beheading her cat.
All this sensory overload makes it difficult to wind down. Which is where my sleep whisperers come in. A night owl by disposition, I find it harder than ever to calm the mind and get to sleep. I’ve tried traditional remedies—melatonin, Diphenhydramine, heavy drinking. Then by accident I found something that reliably works without punishing my liver: ASMR videos on YouTube.
ASMR stands for Autonomous Sensory Meridian Response—a faux-scientific name bestowed by enthusiasts to classify that tingling, soothing, neurotransmitter-discharging sensation some get when, say, hearing a pleasing voice talking softly, or watching someone slowly and methodically run her fingers through her hair, or listening to Bob Ross scrape his “happy little trees” across a canvas (the late, Afro’d landscape painter is considered the Ahura Mazda of the ASMR movement).
There are now tens of thousands of ASMR “trigger” videos, which are not sexual in nature but which, like porn, cater to every taste. ASMRtists (some are men, but most are youngish women) will stroke the camera lens with a makeup brush or crinkle wrapping paper or whisper softly or trace figures in shaving cream or role-play a doctor giving an imaginary patient a cranial-nerve exam (an ASMR staple). The list of activities is long. All of this in an attempt to hit your hypnotic sweet spot, to immerse you in a warm bath of the mind as you’re carried off to the Land of Nod.
Because there’s next to no published research on the subject, many journalistic treatments of ASMR center around one inquiry: Is this sensation verifiable scientifically? To which I say: Who cares? Science has yet to convincingly explain placebo effects, dark matter, or why people pay money to hear Ariana Grande sing. Yet these realities exist. Science can’t even illuminate why we yawn, yet yawning is precisely what I do every time someone tries to seek scientific validation of ASMR.
Why question what works? And ASMR clearly works, as demonstrated by the sheer number of ASMRtists populating the web and the tens of thousands of views these video-making amateurs with names like “softsoundwhispers” (a British-accented woman who is in my regular viewing rotation) often rack up.
I don’t want to go so far as to say ASMR is better than sex, even though ASMR devotees often refer to the drowsy euphoria the videos provide as a “braingasm.” But the average orgasm lasts 5 to 20 seconds. Whereas, if you find an ASMR video that pulls your trigger, it often runs 30 minutes to an hour. You do the math of which ’gasm provides more pleasure, even if you often won’t make it to the end of said video. I’ve never seen the end of many of my favorites, due to being rendered comatose before they conclude.
When I’ve admitted to friends that I’ve spent an ungodly amount of time watching women brush their hair, or gently ramble about their day, or softly read the poetry of John Donne (as one of my very favorites, a Tennessee ASMRtist named Christen Noel, does), there’s a bit of sheepishness on my end. Confessing to such a habit can earn you the uneasy stares that I imagine people get when coming out as a paint huffer or a Twilight fan-fiction writer.
So laugh, if you must, that I’ve drifted off countless times to ASMRtist “chelseamorganwhispers” role-playing a shoe-boutique employee trying to sell me nude peep-toes with a five-inch heel as she taps on them with her long, graceful fingers (even though I’m more of a closed-toe-flats guy). I won’t be chastened by your ridicule. In fact, I won’t even hear it. I’ll be too busy sleeping through the shame, snug in the arms of Morpheus.
1. Follow the Rule of Ten
If you want to push yourself, build up slowly: Run 10 percent farther than you did last week, or add 10 percent more weight than you lifted last week, says Dr. Rajeev Pandarinath, an assistant professor at the George Washington University School of Medicine & Health Sciences.
2. Don’t Lift Above the Shoulders
Our bodies aren’t built to lift heavy weight over our shoulders, says Dr. Kenneth Fine of the Orthopaedic Center in Rockville. When you’re holding your arms out at a 90-degree angle from your body, the weight shouldn’t go above that.
Says Fine: “The irony is that shoulder presses are not important for the human body, and many elite athletes do not do this exercise, whereas amateur athletes often do. An overhead press puts too much unhealthy stress on the rotator cuff.”
Exercising for several hours a day can be healthy, but it’s best to mix the types of exercise. “Limit any particular activity to one hour a day,” Fine says.
4. Warm Up
Light cardio exercises to warm up your muscles, followed by gentle stretching, can help prevent injuries. More dynamic stretching, such as walking lunges and high knees, can help prepare you for high-intensity workouts such as CrossFit, Pandarinath says.
5. Listen to Your Body
“We like to think we’re still in our twenties, so we train with a lot of gusto and cross a line and start having shoulder and knee pain,” says Dr. Chris Annunziata of Commonwealth Orthopaedics in Arlington.
As more runs and marathons have cropped up, people are “diving in too quickly,” causing injuries, says Dr. Daniel Pereles of Montgomery Orthopaedics. CrossFit and Tough Mudders, among other workouts, can lead to rotator-cuff tendinitis (from lifting weight overhead) as well as knee tendinitis and stress fractures (both from repeatedly jumping).
It’s fine to challenge yourself, but don’t ignore your body’s messages.
Not sure if you're over-exercising? Read more about when to consult a specialist and therapy treatments that could help relieve your aches and pains here.
This article appears in our October 2014 issue of Washingtonian.
In Washington, image matters. So when Hill staffers, lawyers, and TV personalities want a straighter smile, they usually want to achieve it as discreetly and as quickly as possible. Luckily, adults in the market for dental braces will find more than just clunky metal.
We asked general dentists and orthodontists to tell us the pros, cons, and prices of the most popular options these days for straightening teeth. Note that every case is different and not everyone is a candidate for each method.
The choices: Lingual braces are placed completely behind the teeth. Incognito is one brand, as is Harmony, which uses digital technology to create a customized bracket-and-wire system.
The pros: No one can see you’re wearing braces. Because the brackets and wires are custom-made for each tooth, treatment is faster—on average, six months to a year—and requires fewer appointments, says Dr. Shadi Saba of Saba Orthodontics in Sterling and downtown DC, whose office has expertise with Harmony braces. “It’s a great option for people in the public because they have a lot of concern about aesthetics,” she says, noting that Harmony braces can also correct faulty bites with the addition of bite blocks.
The cons: Adjusting to this system can be a struggle. Much as with traditional metal braces, a patient has to avoid eating crunchy foods like carrots. Lingual braces also can cause a patient to speak with a lisp, at least for the first few weeks. “What you don’t see you often hear,” says Dr. John Shefferman of Shefferman Orthodontics in DC. Constant contact between the brackets and the tongue can sometimes lead to irritation. Saba says that tongue irritation can be eased by coating the brackets in wax. Applying the braces is extremely technique-sensitive, so orthodontists have to be well trained.
The price: $6,000 to $13,000.
Nearly Invisible Braces
The choice: Invisalign, introduced in 1999, uses clear, removable plastic trays to straighten teeth. Every two weeks, the patient receives new trays that are closer to the teeth’s ideal position. Among the dentists interviewed, Invisalign is a clear favorite—Shefferman says 60 percent of his patients choose it. “Anything I can do with lingual braces I can do with Invisalign,” says Dr. Andrew Schwartz of Capitol Orthodontics in the District and Rockville.
The pros: Invisalign is nearly invisible to the naked eye, and trays can be removed for cleaning the teeth and for meals—eliminating worries about what you eat or about food stuck in the braces. Dental appointments are relatively short because the system is easy to apply and requires little maintenance. There’s also less discomfort compared with other options. “Clear braces are going to become the standard for adults,” says Dr. Danine Fresch Gray of Clarendon Dental Arts, adding that the ability to remove the trays occasionally is good for gum health.
The cons: The big one is compliance. Patients have to wear the aligners for up to 22 hours a day. Anything less will result in a longer treatment time—treatment averages one year—because the aligners aren’t applying constant pressure. Patients need tooth-colored attachments, or “bumps,” bonded to the front of selected teeth, to keep the trays from slipping off. If you have severe alignment problems—such as large gaps or twisted teeth—Invisalign won’t do the trick.
The price: $4,000 to $8,000, depending on length of treatment.
The choices: Anything fixed on the front of the tooth. This could mean traditional metal wires with stainless-steel brackets, metal wires with clear plastic brackets, or metal wires with tooth-colored ceramic brackets. Damon is one brand of ceramic braces.
The pros: Traditional braces are often suggested to fix more severe alignment problems, such as a turned tooth, because they have a better grip on it. Schwartz, whose office uses Damon braces, among other options, says that the Damon system minimizes friction between the bracket and wire, allowing teeth to move more easily.
The cons: These braces are completely visible. The brackets can cause discomfort and irritate the inside of the mouth for the first week or so until a patient adjusts. There are also issues with eating certain foods and keeping the teeth and braces clean. Clear brackets can stain. Treatment time for metal braces is typically longer, an average of 20 months, because cases tend to be more severe.
The price: $4,000 to $7,000.
This article appears in the August 2014 issue of Washingtonian.
On May 9, the first Himalayan salt cave in Maryland opens at Bethesda’s Massage Metta. Salt caves are touted for their healing benefits, which fans say include easing seasonal allergies, stress, eczema, and psoriasis. Himalayan salt is considered the purest salt form in the world, and is packed with natural minerals. When the salt is inhaled, it supposedly loosens mucus and draws water into airways, alleviating sinus issues.
Owner and lead massage practitioner Janine Narayadu first discovered the effects of salt caves after visiting one in Asheville, North Carolina, which she says “recharged” her body. Narayadu’s experience in North Carolina and observation of local children inspired her to open her own cave. “We have so many children in our area that suffer from allergies,” she says. “This is a way for them to find respite from the pollen in the air.”
Narayadu’s cave is made up of about 32 tons of imported salt rock from the Himalayas. It features a halo generator that crushes salt into a fine power and disperses it into the air. Patrons will be able to lounge in the cave for 45 minutes before, during, or after a massage.
Allergists in Washington know exactly when to prepare for long days at the office—when trees begin to show green leaves, flowers start to blossom, and a fine layer of yellow dust coats cars and sidewalks.
Spring is in bloom, but what should be a time to welcome warmer weather and sunny skies often turns into an urgent need to stock up on tissues, allergy medicine, and eye drops.
“There’s a greater sense of desperation to get into the office in the spring,” says Maryland allergist Mark D. Scarupa of the Institute for Asthma & Allergy. “The phone rings more than any other time of the year.”
Contrary to popular belief, it’s not the tulips and cherry blossoms that have many Washingtonians sneezing, rubbing their eyes, and maybe suffering from springtime eczema. A number of offenders are to blame in our area, but the worst is tree pollen.
A 2010 survey conducted by Walter Reed Army Medical Center found that tree pollen accounts for 91.2 percent of Washington’s total pollen accumulation each year, followed by just 3.2 percent from grass during the summer and 3.8 percent from ragweed in the fall. Among tree types, oaks produce almost half of the tree pollen in Washington.
“We know that when cherry blossoms are blossoming, at the same time we’re getting atrociously high oak counts,” Dr. Scarupa says. “It’s the 10,000 oak trees within a square mile that are giving people problems.”
Trees cause the most suffering during spring due to the way they’re pollinated, explains Dr. Daniel Ein, director of the Allergy, Asthma, and Sinus Center at George Washington Medical Faculty Associates: “Trees and grass weeds pollinate through the air, while bees pick up pollen in flowers and transfer it to other flowers.” The air that causes us to sneeze and sniffle is filled not with flower pollen but with tree pollen.
That’s why the theory that local honey can cure allergies is unfounded, experts say. “The thought is if you put pollen in your mouth every day, it can reduce symptoms,” Scarupa says. “The major problem with this hypothesis is that flower pollen doesn’t get aerated, so it’s not what’s giving us problems.”
Fortunately, there are tried-and-true methods for tackling allergies, starting with what doctors call “common sense” treatments. The first step is avoidance. Says Dr. Richard C. Loria of Allergy and Asthma Associates in Northern Virginia: “In an ideal world, you would avoid what’s causing your problem.”
When there’s a high pollen count, you should shut your windows at home and turn on the air conditioner; the same goes for car windows. If you do venture outside, wash your hair, hands, and face afterward to remove pollen.
Clearing your nasal passages once a day using a spray, neti pot, or sinus-rinse bottle can also soothe symptoms, Ein says, adding that you should always use saline solution or distilled water when rinsing; tap water could lead to bacteria-causing infections.
The next step is to find an over-the-counter medication that works for you. The best strategy for those with minor allergy symptoms, Ein says, is to take one antihistamine pill daily for however long symptoms last: “It’s much better just to take it every day and get ahead of the symptoms. Otherwise, you’re going to go on a symptom roller coaster.” If over-the-counter medications don’t work, Ein says, the next step would be a prescription drug.
Immunotherapy is another option; it’s effective for 80 percent of allergy sufferers, especially those who experience no relief from antihistamines. It’s a lengthier process that begins with an allergy test. If the results reveal that a patient is allergic to oak pollen, for example, the allergist will create an extract of the pollen, which is injected into the patient starting weekly, then at less-frequent intervals over three to five years. The dosage increases each time. Eventually, Ein says, “the body no longer thinks that oak pollen is the enemy and it stops reacting as if under attack.”
One advantage to immunotherapy is that the extract is not a drug that must be taken every time you feel a sneeze coming. “We’re administering the same proteins people inhale in daily life,” Loria says. Research shows that over time immunotherapy can reduce allergic nasal and asthmatic symptoms and provide long-term relief without medication.
Ein sees major advances on the horizon that could replace a weekly allergy shot. A pill that dissolves under the tongue and gradually reduces allergy symptoms has been approved by the Food and Drug Administration. Patients would have to take a daily pill for three to five years, but relief begins within months.
In the meantime, Ein says allergy sufferers should first see their primary-care doctor if over-the-counter antihistamines aren’t providing good results. If symptoms worsen, it’s time to see an allergist to figure out a course of treatment. Says Ein: “The best treatment is the one that gives you the greatest relief.”
This article appears in the April 2014 issue of Washingtonian.
How it works: A plastic surgeon makes small incisions to the cellulite-laden area. A probe placed through the incisions and under the skin emits a laser, melting fat bulges and cutting through the fibrous bands that pull on and cause dimples in the skin. New lasers, such as FDA-approved Cellulaze and CelluSmooth, require one-time treatments.
Cost: $4,000 to $7,500, depending on the size of the treated area. (Rondi Kathleen Walker, a plastic surgeon on Washingtonian’s most recent Top Doctors list, offers Cellulaze, while George Bitar, another top plastic surgeon, offers CelluSmooth.)
The verdict: Experts say that the new minimally invasive lasers are revolutionary because they require only one session and show immediate results. However, the treatments do cause bruising and swelling and sometimes require patients to wear compression clothing during the recovery period, which can be up to two weeks. Patients may need touchups once a year. Maral Kibarian Skelsey, director of dermatologic surgery at Georgetown University Medical Center, says Cellulaze is the best thing on the market but cautions that because the laser treatments are relatively new, there’s no data on long-term effects.
How they work: Areas affected by cellulite aren’t only dimpled but also dehydrated, says Dr. Howard Murad, author of The Cellulite Solution. Applying creams or lotions that contain such active ingredients as retinol or caffeine increases blood flow to the area, temporarily reducing the appearance of cellulite.
Cost: $5 to $50 and up.
The verdict: “Don’t waste your money” on expensive lotions that advertise cellulite reduction, says Skelsey, who serves on the FDA’s general-and-plastic-surgery-devices panel. Using them is usually harmless, she adds, but “although there may be a short-term improvement [in appearance], it’s not scientifically possible that it will make an impact.”
How it works: A dermatologist or plastic surgeon uses a hand-held machine that suctions and kneads the patient’s skin, increasing circulation and loosening connective tissue. The treatment lasts approximately 30 minutes. It’s recommended that a patient undergo multiple sessions.
Cost: $100 and up per session.
The verdict: This type of deep-tissue massage may improve lymphatic drainage (which rids the area of waste and excess fluids) and reduce the appearance of cellulite, but only for a short time, says Dr. Melda Isaac of MI-Skin Dermatology Center: “It’s basically equivalent to fluffing up a pillow. It’ll look good in the meantime but won’t have long-lasting results.”
How it works: Radiofrequency devices apply heat to the surface of the skin, causing temporary swelling and thickening of the area, thereby smoothing the skin and minimizing the appearance of cellulite. For best results, patients are encouraged to undergo one or two sessions a week for a month or longer.
Cost: About $400 a session.
The verdict: A 2012 study published in the Journal of the European Academy of Dermatology and Venereology found that 89 percent of women who underwent radiofrequency therapy reduced their cellulite. Isaac, who offers radiofrequency in her office, says the treatment works well for mild cases. For severe cases, she says, “where you can see the shadows, peaks, and valleys,” radiofrequency alone won’t work.
How it works: A thin, hollow tube is inserted through small incisions and moved back and forth to loosen fat. The fat is then suctioned out using a vacuum or syringe.
Cost: An average of $2,852.
The verdict: Although patients used to think liposuction could get rid of cellulite, today the American Society of Plastic Surgeons says it’s not effective for that use. In some cases, liposuction can make the appearance of cellulite worse by creating more dimples in the skin, according to the American Academy of Dermatology.
This article appears in the December 2013 issue of Washingtonian.
In 2012 we looked into our crystal ball and checked out what was in store for health and fitness in 2013. Our predictions were right on the mark, from the explosion of more themed races to the growth of Paleo dieters. Here, we anticipate seven trends to expect next year, from new exotic flavors in healthy dishes, to even more stylish workout clothes, to a new crop of running shoes that could change the face of the minimalist movement.
More exotic flavors
Step aside, Sriracha, there's a new spicy sauce in town. A recent survey conducted by Sensient Flavors says gochujang, a fermented Korean condiment, is going to be popular in 2014. Other flavors expected to rise in the ranks: rhubarb, green coconut, and burnt calamansi.
High-intensity interval training
The workout that involves short, high-intensity bursts of exercise is going to be the top workout of 2014, according to the American College of Sports Medicine. However, health professionals surveyed cautioned that with the rise of this type of training comes high injury rates.
A boutique gym for every neighborhood
Goodbye gym chains, hello boutique studios. We love that almost every neighborhood in Washington has become home to small gyms that offer group fitness classes in intimate settings. And there are plenty more studios on the way for 2014.
Bad news, Washingtonians: Maryland and Virginia are less healthy than they were one year ago, according to a new survey.
The United Health Foundation released its 2013 annual report of America's Health Rankings today and while it touted the country in general for an improvement in overall health, our neighbors to the north and south slipped in the rankings. Maryland is the 24th healthiest state, followed by Virginia as the 26th healthiest.
In fact, Maryland and Virginia were two of four states that experienced the largest decline in rank. Both fell four spots from their 2012 rankings.
The controversy over energy drinks rages on with a statement recently released by a group of radiologists who determined that consumption of energy drinks leads to increased heart contraction rates.
“We’ve shown that energy drink consumption has a short-term impact on cardiac contractility,” said Dr. Jonas Dörner in a statement released by the Radiological Society of North America on Monday.
The results come on the heels of an ongoing national debate over the potential dangers of energy drinks. A 2013 report by the Substance Abuse and Mental Health Services Administration found that the number of ER visits related to energy drink consumption has nearly doubled since 2007, with 20,783 patients admitted in 2011.
Researchers tested the effects of energy drinks on individuals’ hearts in a small study involving 18 men and women. Each participant underwent a cardiac MRI one hour before consuming an energy drink. Then they underwent a second MRI one hour after consuming an energy drink that contained 400 milligrams of taurine and 32 milligrams of caffeine, two main ingredients of energy drinks.
Results showed that one hour after drinking, the participants experienced significant increased heart contraction rates in the left ventricle. The left ventricle pumps blood to the aorta, which then distributes it to the rest of the body.