Warm Weather Stresses Your Heart: Tips to Stay Cool

**By Mariko W. Harper, MD, MS, FACC**

Did you know that warm weather can put stress on your heart? When temperatures rise, the heart must work harder to keep the body cool. This isn’t great news for those living with heart disease because these individuals will have a harder time adapting, leading to a greater risk for heat stroke than their heart-healthy peers.

Additionally, when the body sweats to cool itself down, you tend to lose water and important minerals, like sodium and potassium. These minerals are necessary for muscle contraction and maintenance of fluid levels. Certain common heart medications, like diuretics, beta-blockers and calcium channel blockers, can also affect how the body responds in warm weather.

Don’t worry, though, as this doesn’t mean you or your family cannot enjoy some fun in the sun! Here are a few tips to protect yourself and your heart when the temperature starts to heat up.

Before engaging in vigorous exercise, consult with your physician

Unless you are an avid exerciser, it’s always a good idea to check with your physician before attempting vigorous exercise in the heat. You might be taking up a new sport or hobby, or perhaps it’s just been a while since you’ve had a check-up. Either way, schedule a quick appointment to get your doctor’s approval. You can also consider shaking up your workout by doing it earlier in the morning or in the evenings when it’s not as hot outside.

Drink plenty of water, even when you don’t feel thirsty

Many of us struggle to get enough water throughout the day, so it’s a good idea to find ways to help remind yourself to stay hydrated. This might mean filling up a large water bottle that you can carry around all day or setting reminders on your phone. You can also “eat your water” by enjoying fruits and vegetables like watermelon and cucumber.  

Avoid being in the sun during the hottest time of day

This one might be a no-brainer, but the best way to prevent overheating is to avoid being in the sun when it’s the hottest, typically from 10 a.m. to 2 p.m. If you must be in the sun during these hours, cover your skin with light-colored and lightweight fabrics, such as cotton, and find shade as often as you can.

Avoid alcohol and caffeine

Both alcohol and caffeine can contribute to dehydration. Stick with water and other non-caffeinated beverages.

Heat presents danger for anyone, but particularly those with heart conditions. If you have a serious heart condition such as congestive heart failure, it is best advised to limit your exposure to extremes of temperature.  If you start to feel dizzy, nauseous or disoriented, get out of the heat immediately, apply cool water to your skin and drink water to rehydrate. If you don’t start to feel better, call your doctor, or seek care immediately.

By remembering these tips and taking extra caution when outside in the sun, a summer of heart-healthy fun and fitness awaits you! If you have any concerns about your heart or overall health, there is no time better than now to reach out to your doctor prior to engaging in new activities. 


Mariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at Virginia Mason Heart Institute. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

The COVID-19 Vaccine and Kids: A Pediatrician Weighs In

**By Derrick L. Soong, MD, FAAP**

As research on COVID-19 continues, how the virus affects adults is more widely apparent than how it affects kids. Preliminary studies have shown us that children are seemingly not transmitting the virus as easily as adults are, however, we’re still discovering the specific variants most commonly spread among kids.

While it’s true that kids who’ve contracted COVID-19 don’t exhibit as severe symptoms as adults, we must not downplay this result. A small percentage of children who’ve had the virus can develop MIS-C, multisystem inflammatory syndrome in children.

Being a pediatric doctor, I get questions from parents every day, ranging from if and when their kid needs to wear a mask, when the vaccine will be available for kids or when they can play with friends and hug their grandparents again.

To help parents navigate these tricky conversations with their young ones, I wanted to share some of the most common questions I’ve received from parents and the research that other doctors and I have been doing to understand more about kids and COVID-19.

superkid

Is it safe for my child to attend in-person school?

There are pros and cons when it comes to in-person learning, but as long as the child is following CDC guidelines, they should be safe. In-person learning provides an environment for kids to foster social interactions, make friends and build relationships, acquire critical thinking skills and participate in activities that children need to be successful later in life. Adding to this, not all children have the ability to self-motivate or the discipline to keep up with online school while avoiding surrounding distractions.

The progress that the U.S. has made in terms of vaccine rollout for teachers and essential workers is encouraging, and as long as those teaching in-person are vaccinated, parents can feel some ease sending their kids back.

Though children are generally at a lower risk of contracting COVID-19 than adults, this does not mean they are immune. If parents and households are following all CDC guidelines, such as unvaccinated people wearing masks when outside of the home, the risk for children is greatly reduced, even when attending in-person school. When at school, masks should be worn at all times, and kids should try to maintain social distance.

How safe is the vaccine for kids and when are kids able to get it? 

Given the mRNA mechanism for how Pfizer and Moderna vaccines work, I do expect that they will be safe for kids without causing significant issues. According to Pfizer, the vaccine has so far been 100% effective in trials for preventing COVID-19 in children aged 12-15. On Monday, May 11, the Food and Drug Administration authorized the use of the Pfizer vaccine for this age group in the United States, and on May 12, the Centers for Disease Control and Prevention approved the Pfizer vaccine for children aged 12-15.

For younger children ages 11 and below, Pfizer has said that it is currently testing the vaccine and performing trials on children as young as six months old. This group could become eligible as early as end of this year or early next.

For more information on mRNA vaccines, check out this blog written by Benaroya Research Institute at Virginia Mason Principal Investigator Adam Lacy-Hulbert, PhD.

Can my kids see their vaccinated grandparents?

Not traveling is the safest thing to do. If you must travel, you should take precautions.

Yes, grandkids may visit their vaccinated grandparents, but we still recommend masking up. Having to still wear a mask might be frustrating for some, but it’s important to understand that there is still a possibility you could get COVID-19 despite being vaccinated. This virus is still very new, and research is still being performed.

For vaccinated grandparents considering traveling to visit family and friends, driving is still the safest option. If you must fly, double-masking is recommended. Overall, I would advise holding off with traveling until cases drop down in your region/destination and more people are vaccinated.

What will summer look like?

Sentiments are largely positive heading into the summer compared to last year and will remain positive so as long as vaccine efforts continue. It’s imperative we continue encouraging hesitant members of our community to get the vaccine. This, along with more outdoor and socially distanced activities, will help to greatly reduce our positive-case counts this summer.

Hopefully, most of the population will have antibodies to the virus when June rolls around. Better weather and more activities and events outdoors should result in a happier summer for all.


Soong_Derrick_2017Derrick Soong, MD, FAAP, is board-certified in pediatrics and currently practices at the Virginia Mason Issaquah Medical Center. Dr. Soong specializes in obesity, ADHD, general pediatrics and primary care.

Get the Pelvic ‘Floor-One-One’

**By Kathleen Kobashi, MD, FACS, FPMRS**

While pelvic floor health disorders can seem alienating, it is important to know that you’re not alone and there are a variety of ways to treat bothersome symptoms.

The pelvic floor is a group of muscles in the pelvic region, that can be described as a “hammock” of ligaments that sling between the pubic bone in the front and the tailbone in the back. For women, these muscles and ligaments work to support and control the uterus, vagina, bowel and bladder; whereas for men, they support just the bowel and bladder.

As a multidisciplinary team, the members of the Pelvic Floor Center at Virginia Mason treat virtually every pelvic floor health issue that can be experienced by both men and women. In this article we’ll dive into common health problems associated with the pelvic floor and why maintaining pelvic floor health is so important. Pelvic floor disorders can become huge quality-of-life issues that can interfere with our daily activities. It is vital for us to be aware that there are successful, minimally invasive treatment options available.

Common health issues associated with the pelvic floor

When it comes to pelvic floor health issues, there are several key terms to remember, like incontinence and prolapse. Incontinence is the lack of control of bladder or bowel function resulting in leakage, while prolapse is the displacement or dropping of pelvic organs through a weak pelvic floor, much like a hernia. There are other pelvic floor disorders that may result in the opposite problem of difficulty emptying the bladder or bowel.

Mother and daughter drinking coffeeThe two most common forms of urinary/bladder incontinence are stress and urgency leakage. Stress incontinence is the involuntary release of urine from coughing, sneezing or other similar actions and is commonly (but not exclusively) experienced by women who have had vaginal delivery of babies. Aging, genetics and gravity can also play a role. Conversely, urgency incontinence is exactly as it sounds – when nature calls, you don’t always have a say in when you answer, and it is urgent. This form of incontinence can be caused by the consumption of dietary irritants, such as coffee or wine, that aggravate the bladder, as well as hormonal changes that make the bladder more irritable. In men, urgency can also be related to prostate enlargement.

Fecal/bowel incontinence (aka accidental bowel leakage) is an involuntary loss of bowel control that can result in stool abruptly leaking from the rectum. Disorders associated with bowel function can range from constipation to complete loss of control of the bowel, and everything in between.

Prolapse occurs when pelvic organs – such as the bladder, uterus, bowels, vagina or rectum – drop down into or outside of the anus or vaginal canal. Prolapse can be due to a number of issues, including pregnancy, childbirth, obesity, chronic respiratory issues, constipation and cancer in the pelvic region.

Signs to look out for and when to see your doctor

If you’re concerned you might be dealing with a pelvic floor problem, here are a few signs and symptoms:

  • Urinary/bladder incontinence – symptoms can include leakage of urine with coughing, sneezing or exercise, and can also be associated with a sudden, intense and often uncontrollable urge to urinate. Other lower urinary tract symptoms may include frequent urination, slow or dribbling streams of urine or the inability to completely empty your bladder.
  • Fecal/bowl issues – symptoms can include chronic bloating, constipation, diarrhea or involuntary loss of fecal matter.
  • Pelvic organ prolapse – symptoms can include a feeling of fullness in the pelvic floor or vagina, a feeling that something is “falling” out of the anus or vagina, discomfort with sexual intercourse, urinary or fecal incontinence, a sense of trapping of stool or the inability to completely empty your bowels.

It’s important to note that any combination of the symptoms above can occur.

The importance of pelvic floor health

Given the critical bowel, bladder and sexual functions these muscles support, keeping your pelvic floor healthy and strong is crucial. There are a variety of exercises that can be done to improve overall pelvic floor health and functionality, with some of the more common ones being Kegels. Working your pelvic floor regularly is especially important for women in order to minimize the risk of developing prolapse, incontinence or other pelvic health issues that stem from pregnancy or aging.

If you’re experiencing any one or combination of the symptoms discussed above for an extended period of time, it may be time to call and arrange a visit with your doctor. From there, they can work with you to decide your best course of treatment, whether that’s pelvic floor therapy or proceeding with some tests that can help identify the root cause of your problem and facilitate treatment planning.


Kathleen.KobashiKathleen Kobashi, MD, FACS, FPMRS is board-certified in urology with a subspecialty certification in female pelvic medicine and reconstructive surgery. She is the section head of Urology and director of the  Pelvic Floor Center at Virginia Mason. Dr. Kobashi is a urologist/urogynecologist who specializes in the treatment of pelvic floor disorders, including urinary and bowel incontinence, pelvic organ prolapse, and urinary tract fistulas, with expertise in pelvic floor reconstruction through open and robotic surgery.

Q&A with a Family Doctor: Tips for a Happy, Healthy, Safe Birth

There are lots of articles out there about birthing styles, the best ways to give birth and how to prepare for birth. However, despite what they might tell you, it turns out there is not one “right” way to give birth.

We sat down with Dr. Juliana Wynne, a family doctor at Virginia Mason Edmonds Family Medicine, to talk about some of the choices when it comes to giving birth, common questions her patients ask her and any advice when it comes to handling the unexpected … when you’re expecting.

What are some ways patients can prepare for birth?
The best way patients can prepare for birth is by educating themselves. I recommend that patients bring up any questions they have about it with their provider. Patients can take birth classes – these can be accessed virtually, including at Virginia Mason. Expecting parents can talk to friends and family about their experiences. I recommend finding reliable resources about birth, such as the book “The Mommy Docs’ Ultimate Guide to Pregnancy and Birth” by Yvonne Bohn, MD; Allison Hill, MD; Alane Park, MD and Melissa Jo Peltier. In general, I think it’s important to feel informed going into labor.

What are some common questions your patients have? 
Patients often ask me about my role as an FM/OB (family medicine obstetrics) provider. I am a family doctor that provides prenatal, obstetric, postpartum and newborn/pediatric care. At my office, patients tend to see one prenatal provider. Our goal is to be the provider that is present for their labor and delivery in the hospital. I believe that the biggest benefit of seeing an FM/OB provider is the continuity of care, from the first prenatal visit, to the baby’s birth, to the newborn care in the office and the post-partum visit, to pediatric care as the child continues to grow older. I really get to know the patient and her baby, and often get to know the whole family. This leads to a whole-person and Ethnic toddler listening to her mothers pregnant tummywhole-family approach to care. 

Patients also ask about who will be in the room with them during the birth. Generally, the people in the room include their partner, me, their nurse, and a nurse for their baby. If needed, we have additional support staff available at all times, including additional nurses, the NICU (neonatal intensive care unit) team, and an obstetrician on call.

 What birthing styles are out there? 
Just like every mom and baby is unique and different, so is every birth. There is no one right way or style to give birth. As a provider who cares for women who are delivering babies, my goals are to do everything to ensure that mom and baby are safe, and that mom feels informed and in control.

How do you help moms choose the best birthing style for them? 
Again, there is no one right way to give birth and there are many options when making a plan. There are options for who you see for your care. You can see a midwife, an obstetrician, or a family medicine physician that does prenatal care, like myself and my colleagues at Virginia Mason Edmonds Family Medicine. There are options for where you give birth. You can give birth in a hospital, in a birth center, and some women choose to give birth at home. There are different people to lean on for support during labor, whether it be your partner, family, friends, doula, provider, nurse or a combination of all of these people. There are different ways to cope with pain during labor, which include utilizing a birthing ball, a hot bath, movement (walking, dancing), utilizing your breath, using nitrous oxide which is available in some birth locations, IV pain medicine or an epidural. When it comes to the actual delivery, there are also different positions to try.

A birth may not go as expected. How can patients prepare for this? 
It is helpful to keep an open mind going into your labor. Sometimes our plans change. For example, I hoped very much to have a natural vaginal delivery myself. However, after a long labor, I had a healthy baby via cesarean section. I felt that I did everything in my control to have a vaginal delivery, and yet was prepared for the possibility of needing a cesarean section (my little one was projected to be 9 pounds, and he was!). 

It’s important to share your goals with your provider so that we can best help you achieve them and advocate for you. Helping you to achieve your goals is our goal. 


Juliana WynneJuliana Wynne, DO is a family medicine doctor who provides prenatal, obstetric, women’s health, adult and pediatric care at Virginia Mason Edmonds Family Medicine. She is board certified by the American Board of Family Medicine.

A Smile is Worth A Thousand Words: The Benefits of Virtual Health Care

**By Nicholas Moy, MD**

Virtual care is changing the way we think about health care. According to the CDC, there was a 50% increase in the number of telehealth visits in the first three months of 2020 as compared to the same period in 2019. As an internal medicine doctor at Virginia Mason Franciscan Health, I see the benefits of telehealth firsthand as we continue to weather the pandemic. In particular, my patients who have been concerned about leaving home have appreciated the convenience and the security of getting the care that they need.

There are other, more surprising benefits to virtual care. Video visits allow faster access to care in some cases. When I or one of my colleagues has an opening for an appointment, we can quickly invite someone into an appointment without having to worry about travel time, check-in time, traffic or other reasons for being late. In some cases, patients have forgotten about their in-person appointments, and instead of rescheduling them to come in weeks later, we can send them a video invite that very minute and complete the visit.

“Video visits allow faster access to care in some cases.”  –Dr. Moy  

Telehealth proves that not all care has to happen in-person. Any visit where I don’t need to physically examine a patient makes sense to start out as a video visit appointment. We have even been able to complete Medicare Annual Wellness Visits. If I feel during a video visit that there is a need for a physical exam, or something more in-depth is needed to further diagnose or treat a patient, we can schedule tests and an in-person follow-up. 

If you haven’t experienced a telehealth appointment before, no need to worry – it feels just like an in-person doctor’s appointment, just over a video call. A few tips I have for someone looking to schedule their first virtual appointment with Virginia Mason Franciscan Health would be to:

  • Mom and child on computerCheck to ensure you have Virtual Mason (our app for virtual care) downloaded onto your phone or tablet. If using a computer, make sure to use Google Chrome as your web browser.
  • Confirm the best phone number and email address for us to get ahold of you. We will call you if we don’t see you in the virtual exam room at the time of your appointment in case you need help!
  • Make sure you have a camera, microphone and speaker or headset. 
  • Make sure your Wi-Fi is working. 

There are a few routine or common screenings that aren’t available to do via telehealth. These include Pap smears, mammograms and colonoscopies. If you need blood work done, contact your provider to complete blood work before your visit or you can always stop by the lab after your video visit.

Just because there is a pandemic doesn’t mean routine check-ups or health problems should be ignored. Telehealth and video visits have been a productive way to connect patients and providers, especially in a time of high stress and the unknown. Despite all the fears and concerns, it is so worth it to see my patients’ smiles once the video connects. Those smiles are worth a thousand words!


Dr. MoyNicholas Moy, MD is a primary care physician and the Associate Chief Medical Informatics Officer at Virginia Mason Hospital and Seattle Medical Center. He is certified by the American Board of Internal Medicine.

Fine-Tuning Cells to Tune Out Disease: Immune System Discoveries Spur Hope

To understand what causes type 1 diabetes (T1D), imagine a spy novel. It starts with a hero, the T-cell, that roams your body like James Bond. The T-cell hunts down enemies — bacteria and viruses — and snuffs them out. Then something goes terribly wrong: The hero becomes a villain.

Like a double agent, T-cells can turn against your body and attack your pancreas, triggering T1D. It keeps attacking for years, methodically destroying your ability to produce insulin and control blood sugar. Your T1D becomes ever more debilitating.

Fortunately, there’s hope: One of Benaroya Research Institute’s real-life heroes, Alice Long, PhD, is moving closer to a therapy that makes the enemy T-cells so exhausted they surrender.

alice-long1

BRI researcher Alice Long, PhD

“We think it could be possible to make the T-cells say ‘we give up, we’re too tired to keep attacking the pancreas,’” Dr. Long says. “That could slow down T1D or maybe even stop it.”

This approach of manipulating T-cells to stop disease could extend far beyond T1D. That’s why Dr. Long is teaming up with other BRI researchers, including BRI President Jane Buckner, MD, to study the machinery inside these cells more closely than ever before.

“This could reveal ways to dial T-cells down to stop autoimmune disease, or dial them up so they attack cancer,” Dr. Buckner says. “It’s a new frontier of immune research and BRI is excited to be at the forefront.” 

T-cell Discoveries

Dr. Long has dedicated her career to finding better therapies for the millions of people with T1D. The best available treatment is to inject insulin. Even then, T1D increases the risk of serious health issues like heart disease and stroke.

“There’s a desperate need for therapies that protect the pancreas so it can keep producing natural insulin, because that helps people with T1D stay healthier and have fewer complications,” Dr. Long says.

Dr. Long believes that understanding a phenomenon called “T-cell exhaustion” could unlock these therapies. Several years ago, researchers discovered the body is home to exhausted T-cells, which are alive but have stopped attacking. Everyone has these exhausted cells. But subsequent research showed that people with autoimmune disease who have higher numbers of these cells also have less severe disease and fewer complications. Then Dr. Long and Peter Linsley, PhD, made a key discovery of their own.

They showed that T1D progresses more slowly in people who have higher numbers of exhausted CD8 T-cells. They also found that a drug called teplizumab increased exhausted CD8 T-cells in most individuals. Even better, BRI researchers led a study that showed treatment with this drug delayed the onset of T1D by approximately three years in people who were susceptible to the disease.

“Those were ‘a-ha moments’ — we started to think, maybe it’s possible to create a therapy that exhausts these cells and stops T1D,” Dr. Long says. “But first we needed to understand these cells in much greater detail.”

Fine-Tuning the Immune System

Dr. Long recently received a $2.6 million National Institutes of Health grant to investigate why CD8 T-cells become exhausted and how this influences T1D. She’s also collaborating with Dr. Buckner and Erik Wambre, PhD, on an NIH-funded project that looks at T-cells in cancer patients.

People with cancer have the opposite problem as people with T1D and other autoimmune diseases. In cancer, T-cells should attack cancer cells, but something about cancer leaves them too exhausted to attack. Drugs called checkpoint inhibitors can nudge those cells back into attack mode. But those drugs can push T-cells into overdrive, until patients end up with symptoms similar to autoimmunity.

“If we can understand the process that leads to autoimmunity in these patients, it could help us understand the biological dial that controls how much T-cells attack,” Dr. Buckner says.

The BRI team’s vision is to be able to control both sides of the T-cell equation. This means they could adjust cancer therapies to prevent autoimmune attacks, or create therapies that exhaust attacker cells and stop autoimmune disease.

“We’re getting closer to being able to turn the immune system up or down depending on a patient’s needs,” Dr. Buckner says, “And that means we’re getting significantly closer to improving the lives of people with everything from T1D to cancer, and maybe even to stopping those diseases altogether.”


A version of this story originally appeared in the Benaroya Research Institute Autoimmune Life Blog

Show Your Heart Some Love with These Five Tips

**By Mariko Harper, MD**

February is American Heart Month, a time dedicated to encouraging you to take control of your cardiovascular health. As the pandemic rages on, leaving those with poor heart health at a higher risk for developing severe illness from COVID-19, the need for education around optimizing heart health is at an all-time high.

While most of us are spending more time at home these days, there is no better time to incorporate your cardiovascular health into your self-care regimen. Here are five ways you can put your heart health first during COVID-19:

Spend time getting in tune with your cardiovascular health

Learning what your cardiovascular numbers are, such as your total cholesterol, bad and good cholesterol (LDL and HDL), blood sugar, body mass index and blood pressure, is crucial for building up your heart health. Once you know how to identify these, you can then figure out how to regularly monitor them, as well as ways to keep them under control.

We know this step can seem difficult, or be a lot to take in. Fortunately, the American Heart Association offers a myriad of resources available on its website to help, such as how to monitor your blood pressure at home, understanding what your blood pressure numbers mean and how to improve your cholesterol. Ramping up your physical activity is another way to keep your cardiovascular numbers in check.

Incorporate physical activity into your daily routine

Regular exercise has proven to have substantial benefits for heart health. Daily movement can potentially lead to lower blood pressure, stable blood sugar regulation and healthier levels of cholesterol.

Incorporating physical activity into your daily routine may be easier than you think. Whether you pick up the habit of taking leisurely strolls around the block, or decide to partake in more vigorous workout activities, any movement is good movement. Regular exercise can also provide a tremendous outlet for stress.

Find outlets to reduce stress

It’s no secret that stress levels play a large role in your overall heart health, and that higher stress levels can even make you more susceptible to heart disease. Though a number of stressors in our lives may be out of our control, especially during the pandemic, forming healthy outlets for stress can help you manage.

Finding new hobbies, or embracing old ones, is a great place to start. Maybe you’ll find that you’re secretly an art aficionado, or a master baker or chef. Or maybe yoga and quiet meditation are more up your alley.

Look out for key signs of heart trouble

While most heart health efforts are focused on prevention, it’s also important to be aware of and look out for signs of heart trouble. Though chest discomfort is the most common symptom of a heart attack, many patients don’t directly experience chest pain, but may experience an intense heaviness or pressure, rather than a sharp, stabbing pain.

Other common symptoms to be aware of include sudden shortness of breath, and aches in your arm, shoulder or jaw. Less common symptoms can include nausea, lightheadedness and breaking out in a cold sweat. If you think you or a loved one is potentially experiencing a heart attack, do not hesitate to call 911.

Don’t shy away from routine or emergent medical care

COVID-19 has brought about an absolutely devastating death toll on its own, but research shows that it is also preventing people from accessing the health care they need. Nationwide since the start of the pandemic in February, there has been an increase in deaths due to ischemic heart disease, which is caused by narrowed arteries not being able to carry enough blood to the heart.

Ignoring or delaying both emergent and routine medical care for your heart can lead to an increase in risk of major cardiovascular complications, as well as an increase in the mortality associated with COVID-19. We have robust safety protocols in place here at Virginia Mason to keep you safe during the pandemic, and highly encourage you to not ignore medical emergencies, or even pause your routine medical care.

If heart health is something that you haven’t considered much in the past, this information can be a lot to process. Think of improving cardiovascular health as part of self-care, and keep in mind that all progress is good progress.

While these tips are a great place to start for getting your heart health back on track, be sure to bring up any cardiovascular concerns with your primary care provider.


Dr.HarperMariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at the Heart Institute at Virginia Mason. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

When Busy Hands Hurt: What Hand Pain May Be Telling You

**By Julie Roberts, MD**

Numb fingers? Aching wrists? Hand pain? With the pandemic, many of us who are lucky enough to work from home are dealing with new or worsened hand and arm pain related to strange workspaces and unhealthy postures. Not only that, but those of us who are finally getting to that long-overdue yard improvement project may find that these activities are triggering chronic and repetitive overuse injuries. For example, pruning shrubs, raking leaves, or painting can cause tendonitis to flare up or can aggravate pre-existing conditions, such as arthritis.

Here are two common hand issues that folks might be having as a result of working from home and other hands-on activities we’re attempting in the pandemic.

Carpal Tunnel Syndrome

Have numbness and tingling in your hands? It might be related to carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is caused by a compression of the median nerve at the wrist. Symptoms include numbness and tingling in the hand, particularly affecting the thumb, index, and middle fingers. People often describe a “pins and needles” sensation in the fingers. With early CTS, you might experience symptoms at night. You may wake up at night with your hands asleep and have to shake them to get sensation back. Most people sleep with their hands curled up and their wrists bent; this position puts a lot of pressure on the carpal tunnel.

Another symptom of CTS is hand fatigue with repetitive activities. Less commonly, people will have pain in their hands and forearms related to CTS. If you wake up at night several times a week, or have symptoms throughout the day, you should be evaluated for CTS. There are other, less common causes of numbness and tingling in the hands, and an exam and thorough evaluation is necessary to make the correct diagnosis and discuss treatment.

Treatment options for CTS start with activity modification and night splinting for mild symptoms. More moderate and severe symptoms may require surgical release of the carpal tunnel. There are two main ways to perform a carpal tunnel release including the traditional open approach and a minimally-invasive endoscopic release, which has been shown to allow a faster return to work.

Trigger Finger

Experiencing pain in your palm? It might be related to trigger finger, a type of tendonitis known as tenosynovitis.

Trigger finger symptoms may include clicking, catching, and locking of the fingers and is often associated with pain in one’s palm. The tendons that bend our fingers run through tight tunnels called “pulleys.” In trigger finger, both the tendon and the pulley become inflamed. Repetitive activity, such as weeding your garden or trimming hedges can exacerbate this inflammation. Many people experience symptoms with repetitive activity or in the mornings, because our hands naturally swell at night. There will not be associated numbness or tingling with trigger finger. Interestingly, folks who get trigger finger are predisposed to carpal tunnel, and vice versa. 

Trigger fingers are often treated with steroid injections. One or two injections are often all that is needed to decrease the swelling around the tendon to allow it to glide smoothly again. Steroid injections can cure trigger fingers and symptoms never return. If a trigger finger is persistent, then you might have a discussion with your doctor about surgical release.

It’s important to maintain an ergonomic work position to prevent CTS, trigger finger and other hand and arm conditions related to overuse and repetitive motions. One should sit square to the workstation with a 90-degree bend at the elbows, hips and knees and monitor placed at eye level. Any position can cause strain after long periods of time, so it’s also important to move! Take short breaks to get up, walk around and stretch. 

When symptoms are persistent, despite initial care, it can be advantageous to see a specialist to confirm diagnosis and discuss further treatment options. If you’re experiencing hand pain, numbness, or tingling, see a specialist when symptoms have persisted or worsened, despite trying rest and activity modification for a few weeks.


Julie Roberts MDJulie Roberts, MD, is an orthopedic hand surgeon who practices at Virginia Mason Medical Center in Federal Way and Seattle. She specializes in hand and wrist surgery and performs minimally invasive endoscopic carpal tunnel releases.

Triumph Over Diverticulitis: Nancy’s Story

There’s not much that slows Nancy Fauls down. She was one of the first female skippers to race schooners in the Pacific Northwest and knows how to stay calm and keep everything moving forward. Then in January 2019, the Port Townsend resident experienced a lower abdominal pain that was overpowering. “I’d never felt anything like it before,” she remembers. “I could hardly breathe or move. I was doubled over.”

Nancy went to the local emergency room and then to her general practitioner who prescribed antibiotics to curb bacteria growth. The medication didn’t have much impact on her symptoms and she spent several days lying flat on her back. A month later she experienced the intense pain again and her doctor referred her to Virginia Mason. Because of the distance from Port Townsend to the hospital and the severity of her pain, she was transported by ambulance and ferry boat to Virginia Mason Seattle. Diagnostic blood tests and a CT scan indicated her pain was caused by diverticulitis.

Diverticulitis occurs when a diverticulum (a bulging sac that can form on the colon wall and push outward) becomes inflamed or infected. The condition is most common in people whose diets are lower in fiber and higher in processed carbohydrates.

“Diverticulitis used to commonly be seen in patients who are 50 to 70 years old, but now we’re seeing it in younger patients,” says Virginia Mason colorectal surgeon Vlad Simianu, MD, MPH. The culprits, he adds, are often obesity, smoking and a diet of highly processed and packaged foods.

Free of diverticulitis and enjoying life again.High fiber diets can prevent the colon diverticula from forming, he says, because the fiber results in smoother elimination without the damage that can occur with the pressure on the colon that is caused by constipation. And as Nancy experienced, damaged sections of the colon wall can become thinner and burst.

“Once the disease occurs, diet changes may help the symptoms but they are no longer the cure,” says Dr. Simianu. “The truth is once you have diverticula we don’t really know what drives them to become inflamed and infected, and therefore can’t be sure whether a specific medicine or lifestyle change will prevent a flare.”

Often the diseased portion of the colon must be surgically removed.

“These days the surgery is much easier on patients,” says Dr. Simianu. “It is minimally invasive, usually requiring three to five small cuts in the abdomen, as opposed to traditional surgery which involves one large incision. Patients heal faster and their stay in the hospital is reduced.”

In Nancy’s case, the nine inches of her colon with the disease were removed using robotic technology. She was back home three days following her surgery. She’s made some lifestyle adjustments, lost 50 pounds and is enjoying an active life in the beautiful town she calls home.


A version of this story originally appeared in the Virginia Mason Health System Annual Report

New Research Applies the Brakes to Type 1 Diabetes

A prevention study involving diabetes researchers and volunteers at Benaroya Research Institute at Virginia Mason (BRI) showed a drug that targets the immune system — Teplizumab — can delay type 1 diabetes up to three years in children and adults at high risk.

“This is great news for relatives of people with type 1 diabetes, who are at 15 times greater risk of the disease than the general population,” said Carla Greenbaum, MD, director of Interventional Immunology and the Diabetes Research Program at BRI.

Samples collected during the trial are being studied to help researchers understand why certain people responded to the drug better than others. Next, TrialNet researchers hope to conduct additional studies to look for ways to extend the benefits of the drug.

New Insight into Disease Progression

BRI Alice Long

BRI researcher Alice Long, PhD

When some people are diagnosed with type 1 diabetes, the disease progresses so quickly that their pancreas stops making insulin within a year. For others, the process is slower and their disease easier to manage. BRI research revealed that it’s possible to identify the “fast progressors” early and match them with treatments that help keep them healthy for longer.

BRI’s Alice Long, PhD, and her colleagues made the discovery that opened the door to potential new treatment strategies for type 1 diabetes. In a paper published in Journal of Clinical Investigation, the researchers identified important differences between fast progressors and people whose disease progresses much more slowly. Dr. Long’s team showed that slow progressors have higher levels of exhausted CD8 T cells — cells that are worn out from attacking the pancreas. The discovery could lead to a test that identifies how quickly individual patients will lose their ability to make insulin.

“Doctors may be able to give ‘fast progressors’ a therapy that’s going to slow down the attacker cells or maybe even stop them,” said Dr. Long, a BRI principal investigator. “For this group of people with type 1 diabetes, that would prolong their ability to make insulin, which makes their lives much easier and significantly reduces their long-term health risks.”


A version of this story originally appeared in the Virginia Mason Health System Annual Report.