Travel Medicine Services
The full-service Travel and Immunization Clinic at our Falls Church location follows the protocols set by the CDC. Please note that we do not currently carry the Yellow Fever vaccine.
We provide the following travel-related services:
- Emergency resources
- Food precautions and water safety
- Health risk education
- High-risk travel education
- Infectious disease prevention
- International travel information
- Preventive medications
- Travel consultations
Note: Health insurance does not routinely cover the costs associated with a travel medicine consultation or vaccination. Accordingly, patients are responsible for payment in full at the time of the office visit. We cannot bill insurance companies for these services. For more information, please visit the CDC website.
Critical Care Services
When the condition of a hospitalized patient becomes extremely dangerous or critical, they are immediately transferred to the Intensive Care Unit (ICU) of the hospital. The ICU at VHC Health is a 24-bed, fully-integrated, multi-specialty unit. We are very proud that Dr. Mary-Margaret Lewis is the current Director of VHC Health ICU, and she continues to have a tremendous positive impact there.
At PMA, our board-certified critical care physicians (also known as “Intensivists”) and acute care nurse practitioners are dedicated to the care and management of the entire VHC Health ICU. We work hand in hand with critical care nurses, respiratory therapists, nutritionists, and a multitude of medical and surgical consultants to ensure that the highest level of care is delivered to each of our patients with confidence and immediacy. We are staffed, equipped, and experienced in handling a wide breadth of critical illnesses, from respiratory failure and loss of blood pressure to multi-organ failure and neurosurgical catastrophes.
Our team is staffed in house and available at the VHC Health 24/7 to ensure comprehensive management and unparalleled continuity of care at all times. Additionally, we are fortunate to have on our staff Thomas VanDruff, ACNP who is highly trained and experienced acute care nurse practitioners.
Our staff believes that critical care also includes respecting the health and wellbeing of the whole patient and understanding their personal and emotional needs. This requires empathy and communication, which we regularly employ to ensure that patients and their families can have confidence in the personal, respectful, and high-quality care the patient is receiving.
We are also proud to be an official academic site for both Georgetown University and Bethesda Naval internal medicine residencies, and we foster advanced education, literature review, and evidence-based medicine in our practice.
Our Critical Care Providers
Sleep Medicine Top Conditions Treated
The average individual will spend approximately one third of their life asleep. This time is profoundly important for day-to-day functioning and directly impacts an individual’s functional abilities, concentration, productivity, and memory.
Lack of quality sleep has also been associated with many life-threatening health complications. At PMA, our sleep doctors spend time with patients to properly diagnose sleep disorders and form treatment plans.
We diagnose, treat, and manage the following sleep conditions:
- Circadian rhythm sleep disorders
- Idiopathic hypersomnia
- Jet lag
- Obstructive sleep apnea (OSA)
- Periodic limb movement disorder (PLMD)
- Restless legs syndrome (RLS)
- Restless sleep
- Shift work sleep disorders
Sleep Medicine Services
There are close to 90 internationally recognized and classified sleep disorders. Sleep disorders that remain undiagnosed and untreated can lead to profound daytime functional impairment and life-threatening complications. At PMA, we are pleased to have three board-certified sleep physicians on staff. Drs. Lawrence Stein, Ashtaad Dalal, and Richard Chang provide diagnosis, treatment, and follow-up care for patients with sleep disorders to ensure that an acceptable quality of life is restored and maintained in all patients.
Our sleep physicians work closely with experts in the fields of otolaryngology, oral surgery, dental sleep medicine, and bariatric surgery when formulating the best treatment plan for each patient.
Additionally, we offer a continuous positive airway pressure (CPAP) clinic, which is designed to ensure optimal comfort, acclimatization, and compliance with CPAP therapy. The clinic is run by a veteran respiratory therapist, Michelle Leonard.
Sleep problems worsened during the pandemic due to social isolation, lack of normal daytime routines, less outside activity, and less exposure to sunlight. Many sleep disorders, including insomnia, shifts in sleep time, and issues with poor quality sleep, can be treated without medications using cognitive behavioral therapy or CBT. CBT is performed through a series of one-on-one weekly sessions over several weeks to identify thoughts and behaviors that cause or worsen sleep problems and replace them with habits that promote sound sleep.
Additionally, our sleep physicians are experienced with the latest diagnostic tools and treatments for sleep apnea and narcolepsy, including home sleep studies and Provent nasal valve therapy. We also have temporary dental appliances, to test whether or not a more permanent dental appliance is right for you.
Our list of sleep services includes, but is not limited to
- Cognitive behavioral therapy (CBT) for insomnia
- Continuous Positive Airway Pressure (CPAP) clinic
- Diagnostic nasal and/or sinus endoscopy
- Intranasal or Sinus Procedure
- Maintenance of wakefulness testing (MWT)
- Multiple sleep latency testing (MSLT)
- Polysomnography (overnight, in-lab attended sleep study)
- Ventilation management
Our list of additional services includes:
- Durable Medical Equipment (DME)
- Home sleep study (unattended)
Sleep Disorders and Studies
How We Diagnose Sleep Disorders
There are many signs and symptoms that can indicate a sleep disorder. In some cases, conducting an overnight sleep study or polysomnogram can diagnose specific sleep disorders. If you recognize any of the following patterns in your sleep or life, please schedule an appointment to see a PMA sleep medicine doctor:
- Breathing cessation while sleeping
- Inability to sleep
- Kicking or leg movements during the night
- Loud snoring
- Restless sensation in legs prior to bed
- Unrefreshing sleep
- Unexplained daytime sleepiness or fatigue
- Waking regularly throughout the night
Many sleep disorders can be diagnosed with an overnight sleep study, or polysomnogram, according to Dr. Lawrence Stein at Pulmonary and Medical Associates. The sleep study simultaneously records the patient’s brain waves, muscle activity, heart rhythms, belly and chest wall effort, airflow to the nose and mouth, snoring patterns, blood oxygen levels, and nerve impulses to the eye. These factors can help identify the onset of REM (rapid eye movement), dream states and possible impediments to sound sleep.
Sleep apnea is a condition affecting some 15 million Americans and it is among the most common disorders diagnosed at the Lab. Those affected often experience fatigue, headaches, and lethargy. They often have repetitive, involuntary breathing pauses throughout the night due to absent or impaired airflow through the back of the throat. “This results in an adrenaline surge, which in turn causes an elevation in respiratory effort, blood pressure, lung circulatory pressures, and heart rate,” Dr. Stein explains. “The outcome is sleep disruption, loud, irregular snoring, carryover fatigue, and headaches.”
Men are twice as likely as women to suffer from sleep apnea. This is commonly associated with obesity and large neck size and can be exacerbated by alcohol, tobacco and sedative use. Once diagnosed, it can be easily treated with a bedside device, roughly the size of a toaster, called Nasal CPAP (continuous positive airway pressure). A mask attached to the machine blows a constant stream of air into the nose and mouth, acting as a pneumatic splint to prevent the throat from collapsing.
Another common sleep disorder affecting 3-5% of U.S. adults is restless leg syndrome (RLS). Individuals with RLS often experience a pins-and-needles sensation in their legs and feel an irresistible urge to move, making sleep initiation difficult. RLS is often associated with anemia, pregnancy, kidney problems and back problems, says Dr. Stein. Although it can affect individuals of all ages, it is most often seen in older adults. Fortunately, RLS can be treated with a range of therapies.
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Pulmonary Top Conditions Treated
From asthma and allergies to emphysema, COPD, and interstitial lung disease, breathing problems can cause substantial difficulty in the life of the patient. Developing a strong understanding of your breathing problem is important to finding an accurate medical diagnosis and resolving the issue through effective treatment. At PMA Health, we take time with our patients to help identify the cause of the problem, understand how it is affecting the individual, and then formulate the appropriate treatment plan with the patient.
At PMA, we take pride in our expertise and experience in the diagnosis and management of all forms of lung disease, including but not limited to:
- Acute respiratory distress syndrome (ARDS)
- Asbestos exposure
- Chronic bronchitis
- Chronic obstructive airways disease (COPD)
- Interstitial lung disease
- Lung cancer
- Occupational lung disease
- Pleural diseases
- Pulmonary Fibrosis
- Pulmonary hypertension
- Respiratory failure
Breathing problems are best assessed through a detailed history and evaluation of the patient in combination with a thorough physical exam. Pulmonary function tests, including spirometry, the methacholine challenge, and chest imaging are frequently used to aid in the diagnosis of the patient’s problem. At PMA, we will guide you through the necessary steps to ensure that you receive the most accurate diagnosis and appropriate treatment.
We provide a wide range of pulmonary services and procedures, including but not limited to:
- Airway stent placement
- Arterial line insertion
- Blood gas analysis
- Bronchial provocation
- Bronchial thermoplasty
- Chest tube insertion
- Chest X-ray
- Closed pleural biopsy
- Endobronchial ultrasound
- Laser therapy
- Lung biopsy
- Mechanical Ventilation
- Medical pleuroscopy
- Nebulizer treatments
- Peak expiratory flow rate monitoring
- Pulmonary function testing
- superDimension™ pulmonary mapping
- Zephyr Valve
Interventional Pulmonology Services
- Flexible Bronchoscopy
- Bronchial Thermoplasty
- EBUS Bronchoscopy (Ultrasound Guided)
- Navigational Bronchoscopy with Super Dimensions
- Fiducial Target Marking for Cyberknife
- Endobronchial Valve Insertion
- Rigid Bronchoscopy
- Laser Tumor Ablation
- Foreign Body Removal
- Balloon and Mechanical Airway Dilation
- Metallic and Silastic Airway Stenting
- Percutaneous Tracheostomy
- Medical Pleuroscopy and Pleurodesis
- Pleurx Tunneled Catheter Insertion
- Zephyr Valve