Dr Staw's Good Medicine

Telemedicine Update and Our New Family

2026-02-25T09:23:00.000-05:00

emailed to patients 2/24/2026

I Hope all is well.

No trips to report this time, but we welcomed a new baby into the family. Aurora, born in February to Gaby and Jordan, makes our daughter Laurie a grandmother for the third time. Life continues its forward motion.

This is a snowy winter! But soon the dormant basement plants and the seed trays will sit under the growing lights, and then come upstairs to enjoy the coming spring sun. Health, too, follows cycles - maintenance, renewal, growth.

Please give us a call at 203-853-1919 if you need an appointment!

Administrative Notes

Telemedicine (Medicare and Commercial Plans)
Governor Lamont recently formally codified telemedicine into Connecticut law! That's an important, positive development. While insurance coverage details may still vary by plan, telemedicine remains viable and available.

Advantages in a practice like ours include definite appointment times, no waiting room delays, and flexibility for patients working remotely or traveling.

Certain concerns still require in-person evaluation, to be judged on a case-by-case basis. Please be aware that, depending on your insurance plan, copays and deductibles may still apply, similar to an office visit.

Insurance Reminder
If there has been any change in your insurance coverage - even if the carrier remained the same - please notify us before your next visit or telemedicine appointment. ID numbers and group details often change at the beginning of the year.

If an insurance claim is not filed on time ("timely filing"), sometimes 90 days, or even less, for commercial insurance, the claim may be denied. Accurate information prevents unnecessary billing confusion.

Medical Notes

Colorectal Cancer in Younger Adults
A January 2026 study published in JAMA analyzed nearly 1.3 million cancer deaths in Americans under age 50 from 1990 to 2023.

The finding is alarming: Colorectal cancer is now the leading cause of cancer death in Americans under 50.

While overall cancer mortality in this younger-than-50 group has declined about 40% since 1990, colorectal cancer deaths have increased by approximately 1% per year since 2005.

Routine screening now begins at age 45. If you are 45 or older and have not been screened, please consider doing so. If there is a significant family history of colon cancer, screening should begin earlier.

Don't ignore symptoms such as blood in the stool, persistent change in bowel habits, unexplained weight loss, ongoing abdominal discomfort, or unusual fatigue. Early detection remains the key to survival.

Longevity
When we speak about longevity, it's helpful to think in two contiguous stages.

First: achieving your full "genetic allowance."

Each of us inherits a biologic range of potential lifespan. Our primary responsibility is to remove the treatable conditions that shorten it. This includes tight control of blood pressure, lipid burden, inflammatory markers, glucose variability, visceral fat, and preservation of muscle mass and cardiorespiratory fitness. These measures are well-established determinants of health span and survival.

Second: exploring whether the genetic ceiling can be raised.

This is an area of extensive and accelerating research. Longevity science is now examining cellular senescence, epigenetic signaling, mitochondrial resilience, metabolic pathway modulation (including mTOR and AMPK balance), and systemic inflammation biology. While definitive lifespan-extending therapies remain under investigation, early insights are emerging.

As part of this evolving field, new multi-cancer early detection blood tests - including one marketed as CancerGuard - are being developed to identify circulating tumor DNA before symptoms appear. The tests require a physician order and are generally not covered by insurance.

Performance varies by cancer type and stage. The main difficulty is still in detecting cancer in its early stages. Early-stage pancreatic cancer detection rates are currently reported to be approximately 30%, meaning most early cases would still be missed. As technology advances, this type of testing will become part of individualized, risk-based preventive strategies.

We continue to monitor these developments carefully.

If you would like to review cancer screening, or discuss a structured longevity strategy, you know how to reach me!

Always remember our Health Extenders motto:

We help you live a longer, healthier life

Please give us a call at 203-853-1919 if you need an appointment!

Stay well,

Igal Staw, Ph.D., M.D.
www.drstaw.com
www.twitter.com/drstaw
Dr. Staw on Facebook

My Take on the Inverted Food Pyramid and More

2026-02-22T10:46:00.000-05:00

Sent to patient 1/21/2026

To My Patients,

Hope all is well.

Just returned from a couple of trips. The most meaningful was during the recent holidays in Israel; we spent time with family and friends and also had the opportunity to volunteer - this time, picking lemon (lemons, really? Sounds silly, but rewarding). We also made a brief trip to Denver to watch our grandson David, age 15, perform as a violinist in a regional high-school concert. When a grandchild asks you to come, could you say no?

As always, it's been busy at work. Below are a few updates.

Please give us a call at 203-853-1919 if you need an appointment!

Administrative Notes

Insurance Changes
If your insurance changed- common at the start of the year - please let us know before your next office visit or telemedicine appointment. Insurance changes often affect medication formularies, deductibles, and coverage rules.

Telemedicine (Medicare and Commercial Plans)
Telemedicine continues to be an important and convenient option for many visits. Certain Medicare telemedicine flexibilities are currently scheduled to expire on January 30, but it appears that several basic elements may remain in place. Commercial insurance plans generally continue to support telemedicine, but coverage details may vary by plan. We are hopeful that telemedicine will remain broadly available and applicable in our area. That said, some medical concerns still require in-person evaluation, and we'll handle it accordingly.

Medication Renewals & Prior Authorizations
At times, both you and I may receive automated pharmacy notices requesting "prior authorization" for medications. In some cases, these notices are generated even when a medication is not on the formulary, and an appeal will probably be denied. Nevertheless, we try…

Medical & Lifestyle Notes

The "Inverted" Food Pyramid - Not Really Inverted
You may have heard references to a "new" or "inverted" food pyramid. In reality, it is not inverted at all, and it doesn't matter if you represent it upside down. It's the concept. The base, inverted or not, still represents the foods we should emphasize most. What has changed is which foods occupy that base. The Pyramid base now focuses on vegetables, legumes, whole grains, fruits, olive oil, nuts, and fish - while processed foods, refined carbohydrates, and excess animal fats were placed higher up, meaning they should be consumed less frequently.

Some versions place greater emphasis on full-fat dairy than I believe is appropriate; dietary choices should remain individualized based on metabolic health, cholesterol profile, and blood-sugar response. We can modify this framework to your needs, especially if you have a chronic condition, such as diabetes, hypercholesterolemia, or kidney disease.

Mediterranean Diet
Closely aligned with this updated pyramid is the Mediterranean diet, one of the most consistently supported approaches for cardiovascular health, metabolic balance, inflammation reduction, and overall longevity. It emphasizes plant-forward meals, healthy fats ( particularly olive oil), regular fish intake, and minimal processed foods. A simple handout outlining the Mediterranean diet is available - you may request a copy by email or pick one up during your next office visit.

Please give us a call at 203-853-1919 if you need an appointment!

Continuous Glucose Monitoring (CGM)
Even if you don't have diabetes, CGM trends can provide insight into energy levels, inflammation, and weight regulation. If you are interested in using CGM data to better understand how specific foods affect your body, we can review this together. This is particularly important if you have diabetes of pre-diabetes. While CGM monitors are usually not reimbursed by insurance, a short 1-2-month use may be affordable and can provide valuable insight into individual food responses.

If you want help/advice on any of the above, please call us at 203-853-1919, or email at istaw@drstaw.com

Stay well,

Igal Staw, Ph.D., M.D.

istaw@drstaw.com

istaw@optonline.net

Office Hours and What's Up With Your Gut

2025-09-26T17:42:00.004-04:00

To My Patients,

Hope all is well.

Summer is coming to a rapid close, hope you had a chance to get some valuable time off. The vegetable garden already passed its peak; the crop this year was unusually plentiful. The prize belongs to the tomatoes, two of them weighted over 1.75 pounds each.

Back from Israel after a relatively short whirlwind trip. Had to see my friends and family; haven't seen them in two years. Sandy stayed home this time "so you can keep your conversations in Hebrew." Our daughter, Laurie, was there with me. Together, with a close group, we volunteered some time picking peppers (hot ones…) in a kibbutz by the Gaza border. The volunteer movement in this time has been outstanding.

The office continues to be busy, with telemed done on off-office days. We try to keep 2-3 open appointments every office day for urgent visits, just in case. Call us at 203-853-1919 if you need to take advantage of those open times.

The office will be closed on Tuesday, September 23, for the Rosh Hashanah holiday.

Your Gut: The Big Influencer
The gut contains trillions of live bacteria, viruses, and fungi, collectively known as the microbiome. These microbes produce vitamins, help digest food, and communicate with our immune and nervous systems. It may be hard to believe, but more than 70% of our immune defenses are linked to the gut.

The microbiome deeply influences our biogenetics - the way genes are switched on or off. Certain gut bacteria release short-chain fatty acids and other compounds that act like molecular messengers, signaling our genes to regulate inflammation, metabolism, and even mood. This implies, correctly, that what you eat doesn't just fill you up - it literally affects how your genes express themselves on a daily, continuous basis.

For example, a diet rich in plant fibers (vegetables, beans, whole grains, nuts) feeds beneficial bacteria, which in turn encourage genes that protect against diabetes, heart disease, and even some cancers. Diets heavy in ultra-processed foods and excess sugar, on the other hand, promote bacterial strains that "turn on" inflammatory pathways and accelerate aging processes.

The gut communicates directly with the brain; it does so through the vagus nerve. Patients with balanced microbiomes report steadier moods, clearer focus, and less fatigue. An unhealthy gut can worsen anxiety, contribute to brain fog, and chronic inflammation.

You may think of your gut as a microbiome clinic that constantly dispenses natural compounds to the rest of your body. But the gut clinic is a living entity, which itself is subject to health and disease. The healthier your microbiome clinic is, the better the message it sends; that's where you come in!

Keep your gut healthy:

Eat a wide variety of plant foods - aim for 25-30 different types weekly (It may sound challenging, but it is quite achievable).
Include fermented foods such as yogurt, kefir, sauerkraut, or kimchi (and the list goes on).
Minimize unnecessary antibiotics; use them only when necessary.
Get regular exercise and sunlight. In addition to the widely known benefits, this helps diversify gut bacteria.

Please give us a call at 203-853-1919 if you need an appointment!

Sleep revisited
In the last letter we touched on "sleep as medicine." Let's go a step deeper. Sleep occurs in repeating phases, usually 4-6 times each night:

Light sleep (stages 1 and 2) - Your body relaxes, heart rate slows, and memory traces begin forming.
Deep sleep (stage N3) - growth hormone surges, muscles and bones repair, and the immune system resets. This is when the body does its most important physical healing.
REM sleep - the brain becomes highly active, consolidating memories, regulating emotions, and clearing toxins such as beta-amyloid (strongly associated with Alzheimer's). This is when vivid dreaming occurs.

Each phase is vital. If you miss deep sleep, your body suffers; if you cut REM sleep short, your brain and mood take the hit. Poor sleep fragments these cycles, leaving you unrested even after long sleep.

Studies show that inadequate or irregular sleep increases the risk of obesity, diabetes, heart disease, and depression. Consistent, restorative sleep strengthens memory, supports healthy metabolism, and even slows biological aging.

Practical steps:

Keep a regular bedtime and wake time, even on weekends.
Minimize, or avoid, TV or other screens an hour before bed - blue light tricks the brain into staying awake.
Avoid caffeine after midday.
Create a dark, cool, and quiet sleep environment.

Sleep is the body's most reliable, cost-free prescription - one that renews your mind and body every night. Make good use of it!

Have specific questions about healthy diet and sleep?
Call the office at 203-853-1919

Stay well,

Igal Staw, Ph.D., M.D.
www.drstaw.com
Dr. Staw on Facebook

Office Hours and Few New Weight Tips

2025-08-17T17:38:00.000-04:00

To My Patients,

Hope all is well.

It's been an unusually long time since the last "To My Patients," but here we are.

The practice has been very busy, both in the office and through telemedicine. Our Colorado crew, all four of them, spent almost three weeks with us - a yearly tradition of togetherness and happiness.

The garden is blooming vigorously this year, flowers and vegetables alike. The Garden Phlox has done particularly well, blooming ahead of schedule, as you can see from the picture.

Time Away
We'll be out of the office the week of September 1st, returning Tuesday morning, September 9th. It promises to be exciting; I'll let you know all about it when back.

Please give us a call at 203-853-1919 if you need an appointment!

Insurance and Billing Notes
Dealing with health insurance continues to be tough for both patients and physicians. Much of the difficulty is obtaining prior authorization (PA) for medications such as inhalers for asthma and COPD, and weight-loss medications (Ozempic, Mounjaro, and others). Occasionally approval comes quickly, but more often it's a tedious, drawn-out process.

Billing can also be confusing. Sometimes you'll notice an open balance - for example, if a telemedicine encounter carries a copay, or if part of a charge isn't covered by insurance. By the time you receive a statement (now by email unless you prefer paper), we've already appealed and settled what we could. Please always make sure we have your current insurance information on file.

Medical Notes

Sleep as Medicine
Just as we prescribe medications for blood pressure, cholesterol, or diabetes, your nightly sleep is a powerful therapy that works silently and effectively - provided you take it consistently.

Think of sleep as medicine. Many of us underestimate the importance of good, regular sleep. Adequate sleep lowers blood pressure, reduces risk of diabetes, strengthens the immune system, and helps memory and mood. Poor sleep raises body inflammatory processes and can contribute to the development of heart disease, stroke, worsening of diabetes, and others. Think of quality sleep as one of your "daily medications" for longevity.

During sleep, the body is actually very active. The brain consolidates memories, clears toxins such as beta-amyloid (which is linked to Alzheimer's disease), and resets its circuits for attention and learning. Muscles, bones, and tissues repair themselves; growth hormone and other repair signals become more active at night, and the immune system mobilizes and produces infection-fighting cells. People with inadequate sleep are at a higher risk for colds, flu, and other infections.

Without adequate sleep, irritability, anxiety, and depression worsen; people who sleep well handle stress better, they have less brain "fuzziness" during the day. For the elderly, good sleep is also protective against cognitive decline and dementia.

Most adults need 7-8 hours of sleep each night, but individual needs vary. Scientific studies show that performance, judgment, and reaction times all decline with chronic sleep debt. But length of sleep is not everything. Quality matters: frequent nighttime awakenings, sleep apnea, or restless legs can undermine the benefits of sleep even if hours seem sufficient. Improving sleep quality - whether by treating sleep apnea, restless legs, or other conditions - can improve alertness and heart health. And it can increase life quality and longevity.

Most importantly, think sleep as your key to a healthier, longer life!

Need Suggestions? Call Us at 203-853-1919

New Frontiers in Heart Risk Testing
Beyond the familiar cholesterol panel, newer tests now give a clearer picture of cardiovascular risk:

ApoB – measures the actual number of "bad" cholesterol particles.
Lipoprotein(a) - a genetically inherited cholesterol particle linked to early heart disease.
Insulin Resistance - indicates how effectively the body uses insulin, a key factor in metabolic and heart health.
Coronary Calcium Score (CT Scan) - shows if cholesterol has already begun forming plaques in arteries.

These tests are becoming part of preventive care and help identify those who may need more aggressive risk reduction, long before symptoms appear.

Nutrition Nuggets
Sometimes small swaps make a big difference:

Try half an avocado instead of cheese on a sandwich - more potassium, less sodium.
Add berries to breakfast - natural antioxidants and fiber that support the microbiome.
A handful of unsalted nuts (almonds, walnuts, pistachios) is linked to lower risk of heart disease. As a bonus, almonds are mild appetite suppressor, and had a very low glycemic index, so important for people with diabetes or even prediabetes.
Want to minimize sugar consumption? Try a pinch of monk fruit extract (the pure one, not in combination with a filler).

Sandy and I wish all of you and your families a happy, healthy late summer and fall.

Stay well,

Igal Staw, Ph.D., M.D.
www.drstaw.com
Dr. Staw on Facebook

Internal Medicine * Pulmonary Medicine * Preventive Medicine * Health Risk Reduction
2000 Post Road, Fairfield CT 06824
(203) 853-1919

2025-02-10T09:44:00.000-05:00

Emailed 2/6/2025

To My Patients,

Hope all is well.

The famous groundhog, Punxsutawney Phil, saw his shadow, predicting six more weeks of winter. I suppose we'll be seeing more animal footprints in our backyard, and ski lovers will be happy.

Colorado is expecting more cold weather, and we'll be visiting the crew for a few days this month.

Please note that the office will be closed on Thursday, February 13th. As usual, Janine and I will be available to take messages while we're away. Dr. Sarfraz will be covering in case of any urgent needs.

Please give us a call at 203-853-1919 if you need an appointment!

When there's a little free time, there are always puzzles, Sudoku, exercise, tennis, and time with friends. Sandy's favorites are the 1,000-piece puzzles. One we recently finished was a patchwork of squares, each containing a meaningful saying. Feel free to take a look at the photos.

A special kudos to our son Michael for completing the Disney marathon last month-repeating the feat he accomplished exactly 20 years ago!

Congratulations to our son Jeffrey on his new position as Chief Information and Innovation Officer at Firefighters First Credit Union.

The office has been busy, with a steadily increasing demand for online telemedicine visits. While many cases still require in-person visits, a growing number of medical concerns-especially in general office medicine and its specialties, including mine-can now be effectively addressed online.

Several factors are driving this trend:

Convenience - No travel time, minimal (if any) waiting time, and reduced exposure to waiting room environments.
Chronic Disease Management - Telemedicine allows for easier check-ins for conditions such as diabetes, hypertension, heart disease, and asthma, which require frequent monitoring.
Advancements in Home Monitoring - The increasing availability of home test kits (e.g., COVID, influenza A, strep throat, urinary tract infections) and monitoring devices like continuous glucose monitors (CGMs), pulse oximeters, continuous oxygen monitors, and smartwatches that track sleep patterns.

Many of these kits and devices are available over the counter from retailers such as Amazon and Walmart, while some, like CGMs, still require a prescription.

Telemedicine is becoming more efficient and useful-and this is just the beginning.

A Message to Insurance Providers & Policymakers: Pay attention and address the health needs of our people!

Longevity: Living Longer, Living Healthier
Longevity is on most of our minds-the goal is to live as long as possible while maintaining optimal health.

Global life expectancy has increased dramatically due to advances in sanitation, nutrition, and healthcare access (though the U.S. lags behind in many ways-perhaps a topic for another letter).

However, there is a genetic limit to aging, with the longest known human lifespan recorded at 122 years. Perhaps the Jewish blessing, "May you live to 120," originates from this natural limitation.

As physicians, our role is to help extend life to its fullest genetic potential. I take this responsibility seriously. The motto "We help you live a longer, healthier life" has been with me since the founding of the old Health Extenders facility.

The Future of Longevity Research
A vast amount of research is now focused on breaking the genetic barrier to longevity.

Some studies advocate dietary changes such as caloric restriction or intermittent fasting.
Others explore removing "zombie cells"-cells that have stopped dividing but continue releasing inflammatory substances.
Another area of focus is telomere extension. Telomeres are protective caps on the ends of our chromosomes, and when they degrade, cells lose function and die.

And the list goes on.

There is no universal longevity prescription - every individual has unique genetics and medical conditions. Longevity strategies must be personalized.

Please give us a call at 203-853-1919 if you need an appointment!

We're here to answer your questions.

Igal Staw, Ph.D., M.D.
www.drstaw.com
Dr. Staw on Facebook

A Great Vacation and Info on Microplastics

2024-12-24T14:55:00.001-05:00

Emailed12/22/2024

To My Patients,

Just back from our vacation.

This time it was a driving vacation, mainly through Southern France and San Sebastian in Spain. All courtesy our daughter, Laurie.

Some of the highlights (in addition to the great wines of Provence and Bourdeau) were the many thousands of flamingos at Camargue national park (at their "courting season"), the nighttime drone show in San Sebastian, Spain, and the 300-foot climb up the Sand Dune du Pilat on the coast, west of Bordeaux.

The office has been very busy, patients trying to get exams done before the end of the year.

Many patients have their insurance changed or modified at the beginning of the new year. Please make sure we have your updated insurance information when you come to the office or have a telehealth call.

A special request: Traffic is becoming increasingly heavier. Some patients are unavoidably late for their appointments, which may increase waiting time for on-time patients. I try to minimize waiting time. Please try to anticipate excess traffic; looking at Waze may be helpful. Thanks for thinking of this issue.

Interesting medical notes:

It's not only probiotics, it's also prebiotics. Our bodies are full of bugs, most of them in the gut. The constitute our Human Microbiome, made of trillions of microorganisms such as bacteria, fungi and viruses. About 80% of the cells in our body are not human cells, they are part of the human microbiome. These microorganisms carry an enormous load of genetic material that affects our health, frequently more so than our own genetic makeup.

No wonder we must live in peace with our microbiome.

Prebiotics are live microorganisms that, when consumed in adequate amounts, keep our microbiome happy. They are present in fermented foods such as yogurt, Kefir, kimchi, miso and sauerkraut, and many others. They must remain alive when consumed to be beneficial. Keep them refrigerated to prolog their life. Cooking will destroy them.

Frequently, probiotic supplements must be used to support general good health, strengthen the immune system, or help with digestive problems (irritable bowel syndrome and others). They usually come in capsule form. Each capsule should contain at least 20 billion (yes, billions) organisms and should have several, different organisms; the more, the better.

Please give us a call at 203-853-1919 if you need an appointment!

What about microplastics? We live in a world of plastics. Plastics production was 28 million metric tons in 1980, that's about 240 pounds a year per person, man, woman, and child! Production in 2019 was three times as high, and it continues to grow. About 40% of plastics are single-use plastic, used for packaging, food containers, cups and plates, and beverage straws.

In addition to pollution, there are health risks. Recent studies show that very small plastic particles, microparticles, accumulate in our bodies. They were found in the common plaques that develop in the coronary arteries, and are considered a significant risk for the development of coronary heart disease, which end in a heart attack.

Cookware that can shed consumable microplastics include nonstick cookware (coated with PTFE - polytetrafluoroethylene), plastic utensils and cutting boards, and plastic cookware and containers.

Foamed-plastic products also shred microplastic particles, especially processed with CFCs (chlorofluorocarbon). This includes foamed packing material, drinking cups and foamed plates.

What should you do, what should you watch for? The list is long, here are some important points:
Cookware. Choose stainless steel, cast iron, ceramic or glass.
Plastic tableware. Try to avoid single-use plastic such as knives, forks, plates, and cups. Use silverware and ceramic plates when possible.
Heating cookware. Don't heat food in plastic containers, even if it states "microwave safe."
Recycle Plastics. Recycle damaged, scratched plastic. They may shed microplastics.
Fish. Prefer non-farmed fish; there likely contain fewer microplastics.
And the list goes on. It may not be possible to eliminate consumption of microplastics, but we must try to minimize our exposure to these dangerous particles.

Need more detail? Email e at istaw@drstaw.com.

Until I see you again, stay well.

Sandy and I wish all of you and your families a great holiday season and a happy, healthy, and peaceful New Year.

Igal Staw, Ph.D., M.D.
www.drstaw.com
Dr. Staw on Facebook

Thank you for your messages & Itinerary change

2023-10-13T09:28:00.000-04:00

To My Patients,

Emailed 10/10/2023

In view of the horrendous, barbaric attack against Israel, which began on Saturday, 10/7/2023, we postponed our trip to Israel to a safer time. We will spend our planned time away from the office with our family in the US.

We’ll be back in the office on Tuesday the 24th resuming our regular schedule.

As usual, Janine will handle the phone, and I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases.

Sandy and I received numerous calls, emails and texts from patients and friends inquiring about our safety, and that of our family and friends in Israel. As of the time of this writing, everyone is OK and accounted for. Sandy and I thank you for your concern.

Please give us a call at 203-853-1919 if you need an appointment, or if you have any questions.

Stay well,

Igal Staw, Ph.D., M.D.

Office hours and some happy news

2023-10-03T20:38:00.000-04:00

To My Patients,

emailed to patients 10/1/2023

Hope all is well.

It's been a while since the last "letter to patients," of mid-May. A lot has transpired. Our trip to Israel with our daughter in late May was great, our older granddaughter and her boyfriend where there at the same time - kept us going...

The Colorado crew stayed at our house for about three weeks in June-July, lots of happy noise. We'll be celebrating their son David's, Bar-Mitzvah in Jerusalem in October, traveling with them and more family around the country (see below for time away from the office).

This spring-summer season wasn't ideal for the garden. The vegetables and flowers were late, but the trumpet flower still managed to show up with its majestic colors, and the spider was able to weave its crafty net.

Time in Israel:

Sandy and I will be away for almost 2 weeks, in Israel, beginning Tuesday October 10th (after shorter office hours), until Monday October 23rd. We'll be back in the office on Tuesday, October 25th.

As usual, Janine will handle the phone, I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases.

Please give us a call at 203-853-1919 if you need an appointment

Some Administrative "Stuff":

Telemedicine: Telemedicine continues, but there are changes that may affect you. During the COVID emergency, which officially ended 5/11/2023, HIPPA privacy regulations were not enforced, they could be enforced now. For telemedicine, we are now using an application called Doxy.me, which is HIPPA compliant - it's very easy to use; you'll get a text invitation on your smart phone, click the enclosed link and the telemed session is on. Other communication formats can be used, even if not HIPAA approved, if you agree to it.

Telemed has been a very effective tool for many patients who could not, or did not have to, come into the office to be examined. I hope that the authorities (and insurance carriers) do not limit its use but, rather, encourage its use and rapid development of telemedicine to a greater capability.

As of now, both commercial insurance and Medicare/Medicaid have been covering telemed face-to-face visits. Medicare appears to be committed to covering it through 2024, but I hope forever.

Hours and communication: The office continues to be busy, but that has not diminished the attention paid to each patient's needs. The office continues to be a solo practice, not hampered by the many levels of large company administration. We continue to keep the usual Tuesday, Thursday AM office hours, but have extended them as the need arises.

We try to answer the phone during daytime hours no matter where we are. If, for some reason, we do not pick up the phone, please be sure to leave a message so we can address your issues. Voice messages generally reach me also by email, which I check regularly. In addition, you can always reach me directly by email at istaw@drstaw.com.

The COVID world:

COVID: The US COVID emergency is officially over. But I'm not sure the COVID virus was notified. While the death rates have been declining gradually in the last few months, the last few weeks saw an uptick, with 1005, 944 and 614 in the last 1, 2, and 3 three weeks, respectively, as reported by the CDC (the same is seen nearly world-wide). While the cases are generally milder than what was seen with the delta strain (it's an XBB strain now), would still be careful to avoid exposure. Please report immediately if you, or someone with whom you've been in close contact, develop suspicious symptoms - especially if tested COVID positive at home. And don't forget to be vaccinated with the newly updated COVID vaccine, which was released a few days ago.

The non-COVID world:

Protein: There's no need to emphasize the body's need for an adequate dietary intake of protein. The protein we eat is broken down in the stomach to amino acids and then absorbed into the body through the small intestine. They are the building blocks of body structure and function, such as cell wall and its nucleus and enzymes. There are 20 amino acids used by the body, which can synthesize 11 of them on its own. But 9 amino acid are essential, the body cannot produce them on its own, they have to be available in our diet.

Whole protein vegetables contain all essential AA's; the main ones are legumes (lentil, beans, chickpeas); tofu (it's soy-based); nuts and seeds, and whole grains (quinoa, brown rice, whole wheat - watch the last two if you have diabetes).

In protein deficiency states, supplements will do. The good ones include casein and/or whey protein (they are dairy based).

Need more information? You know how to reach me.

Keto Diet: We get questions about the keto diet almost daily, mostly about its use for weight loss and weight management. So, what is it, and does it have any medical benefits?

The keto diet is a low-carb, high-fat diet. It changes the way the body uses food to generate energy. Generally, most of the energy we use is derived from carbohydrates which turn into sugar in the body. When carbs are restricted, as in the keto diet, the body begins to use fat, in the form of keto acids, as its fuel.

There are some advantages and caveats. The keto diet can bring about weight loss, mostly by extracting body fat and turning it into keto acids and by reducing appetite. It can be useful in certain medical conditions, including intractable seizures, better control of type II diabetes (it's the common type). Recent studies suggest that the keto diet slows down age-related mental deterioration.

And there are caveats. The diet emphasizes fats. If not careful, one may be using a large quantity of saturated fats, usually found in high quantities in red meats and most processed meats. This may lead to an increase in cholesterol, with its heart disease risk, plus other medical risks. The diet is low in fiber and may cause digestive symptoms.

I believe that most people on keto diet should minimize the consumption of saturated-fat foods and consider the use of a Medium-Chain Triglycerides (MCT) supplement.

If you are on a keto diet, or are considering it, talk to me (don't get me wrong, I'm not pushing the diet).

Periodic Health Evaluation: Most, if not all, insurance companies cover periodic physical exams or "periodic health check," at low, or no copay. Some even require it for continuation of care. In my view, expressed regularly, that is the gateway to better health, it's the time to assess your overall health, identify any health risks before they turn into disease, and eliminate or control them to the extent possible. Take advantage of it, and get an appointment!

Vaccinations: Three vaccines you should consider getting very soon:

COVID (the recently approved one, BXX, now it's the only authorized one), get it as soon as available in your area.
RSV (Respiratory Syncytial Virus)
Flu - mid October would be fine

Are you protected against shingles, pneumonia, or hepatitis B? Unsure? - talk to us.

Please give us a call at 203-853-1919 if you need an appointment

Until next time, stay well,

Igal Staw, Ph.D., M.D.
www.drstaw.com
istaw@drstaw.com

Office Hours and Spring Notes

2023-05-12T09:09:00.002-04:00

To My Patients,

emailed 5-9-2023

Hope all is well. It seems that spring has finally arrived.
The office has been very busy, and we opened extra hours on an as- needed basis.

The Covid emergency is officially over on May 11th. I'm not sure yet that the COVID 19 virus knows about it! It's still causing 1000-2000 deaths a week, and if you extrapolate this to the entire year, this represents the 9th most common cause of death in the US. At its peak, COVID was the 3rd and 4th most common cause of death in the two preceding years.

COVID-protecting masks are now optional in our office. However, we do require that you wear a mask if you were not fully COVID vaccinated, and also if you have certain COVID-related symptoms, regardless of your vaccination status.

We still request that you call the office as soon as you arrive in the parking lot, in attempt to minimize or avoid waiting in the waiting room.

More about the changes that the end of the COVID emergency will bring about, including changes to telemedicine - in the next letter.

Sandy and I will be away for almost 2 weeks, in Israel, beginning Wednesday May 17, back in the office on Thursday, June 1.

As usual, Janine will handle the phone, I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases.

Please give us a call at 203-853-1919 if you need an appointment A couple of notes for spring:

Allergy: The allergy season is upon us. There are several things you can do before you have to make a trip to the office:

Flonase (fluticasone) and Benadryl (or a non-sedating antihistamine such as Claritin, Zyrtec) are over the counter and can be tried for nasal congestion and general allergy-related symptoms.

Astepro (azelastine) is a nasal spray antihistamine that recently became available over the counter.

If you have allergy-related asthma, don't forget to use your inhaler as instructed. These are prescription medications. If you're using them seasonally, make sure they are accessible.

Tick bite: The deer are out there, and so are the ticks. The most common tick- borne disease is Lyme Disease. But there are others, such as Ehrlichiosis and Babesiosis, and the treatment could be different from that of Lyme. It's therefore important to bring the tick, especially if the tick is blood-engorged, to the local Health Department for identification. And don't forget to let us know you've been bitten by a tick as early as possible after you realize it.

Keep your mind sharp: Spring is the greatest time to do so. Spend some time outdoors, exercise (nothing wrong with walking outdoors), eat well (which for most people is the Mediterranean Diet), and get enough sleep. You'll be surprised to see the mind-body connection.

Please give us a call at 203-853-1919 if you need an appointment Until next time, stay well,

Igal Staw, Ph.D., M.D.

www.drstaw.com Dr. Staw on Facebook

istaw@drstaw.com

Office Hours & a Great Longevity Tip

2023-05-12T08:58:00.001-04:00

To My Patients,

emailed 4-6-2023

Hope all is well - Last month, Sandy and I were away on a long weekend in Jumby Bay Island, Antigua. It was a special occasion that brought together 10 of our immediate family members (4 generations), to honor the life of our late son in law. The experience was unforgettable

More family news, we'll be visiting our Colorado clan, which we try to do several times a year. They usually stay with us 2-3 weeks during the summer. We'll be away for a week from Wednesday April 19th through Wednesday April 25th, and back on the office on Thursday April 26th with morning office hours.

As usual, Janine will be available for phone inquiry/scheduling, and I'll be reachable by email. In case of need, Janine knows how to get me, but if you need something, give us a call before we leave!

If urgent care is needed while we're away, Dr. Sarfraz will cover me, 203-254-9454.

Please give us a call at 203-853-1919 if you need an appointment And now to some real issues:

Cost of medicine and related issues

The cost of medical care in the US is now more than $12,000 a year per person, about 18% of GDP, and It's more than twice the average cost of medicine in the 30 OECD countries (Organization for Economic Co- operation and Development).

You'd think we would get better care, would you?

It's very disappointing to find that Americans see their doctor more frequently than in other developed countries, but suffer a great deal more chronic conditions (not just obesity...), and have an overall average life expectancy of 77 years, three years less than in other developed countries.

Care can be costly. Insurance premiums are climbing. Copays and deductibles are going up steadily, medication denials are now common; insurance companies are frequently more interested in bottom line than in their patients' health. As a result, between 6-10% of people in the US have no medical insurance, and many more are under-insured.

While there is no easy way to fix things with our present healthcare system, one thing has been very clear, and I've been emphasizing this for years.

One has to be an integral part of his own health care system. Those who "do the right thing" have a better key to a longer, healthier life. This includes staying in good physical shape, keep weight in check, sleep adequately, avoid "offensive" foods, and the list goes on.

When it comes to medication, take all the medication you need, but take only the medications you need, which frequently needs to be coordinated with multiple caregivers.

Just in case you wondered why I wrote this - We're here to help!

The erythritol issue

Erythritol is an artificial sweetener that belongs to a class known as alcohol sugars (e.g., xylitol, sorbitol, maltitol and others). These sweeteners are very low in calories and are used in many sugar-free and keto-type diets. Recent studies suggest (but do not yet prove) that the consumption of large amounts of erythritol increases the risk of cardiovascular events such as heart attacks and strokes. This may apply to the entire class of sugar alcohols. The mechanism for this effect appears to be related to an increase in blood clotting.

A "Large amount" of erythritol is taken to be 30 grams (that's 5-6 teaspoonfuls) which, if taken within a day or two, has been shown to increase clotting tendency. Generally, this is a much higher dose one would consume in 1-2 days.

Erythritol is the main component of several artificial sweeteners (Truvia, Splenda, and others). The suspicion is out there. If you're going to use erythritol, or any other sugar alcohol sweetener, do it in minimal amounts. If you're at heart disease risk, avoid it!

A longevity hint

Numerous studies of "super age seniors" (those above 85 years old) and centenarians (those above 100 years old) looked at the elderly's eating habits. The common finding is that longevity is associated with a diet low in animal protein (mainly red and processed meat!), but rich in vegetable protein, mainly beans, grains and soy products.

One explanation for this longevity observation is that red meat contains specific amino acids like methionine and branched-chain amino acids that can accelerate the aging process. Of course, this is only one component of many factors that influence longevity, but no one should overlook it.

Please give us a call at 203-853-1919 if you have any questions Until next time, stay well,

Igal Staw, Ph.D., M.D.

www.drstaw.com Dr. Staw on Facebook

istaw@drstaw.com

Big Game Sunday with Some Medical News

2023-03-15T15:28:00.001-04:00

To My Patients,

Emailed 2/12/2023

Hope all is well. It was crazy weather over the past few weeks - cold, warm, who knows! Stayed home, a good opportunity to get some paperwork done and do some writing.

Despite the recent cold weather, it's almost time to set vegetable and flower seeds for the spring. It would be nice to awaken the Canna plant from its winter sleep soon, it bloomed so beautifully last year.

Some things to know:

Billing statements
Please remember that we now send most of our billing statements by email rather than through the regular mail (saving some trees...).

Medication refill and new prescriptions
As of the beginning of the year many insurance companies made changes to their formulary ("allowable medications") and frequently require pre-certification and/or a change to what they consider an equivalent drug. Frequently you'll hear the pharmacist say, "all your doctor has to do is call the insurance company." Easier said than done. It causes unnecessary delays in filling new prescriptions, and, too often, denials. We do our best to overcome the imposed obstacles.

Please give us a call at 203-853-1919 if you need an appointment

End of COVID emergency
The government announced that it intends to end the COVID public health national emergencies on May 11, 2023. This will most likely mean a loss of coverage, or a reduced coverage, for people who need to be tested or treated for COVID. The burden of coverage will shift from the government (that's who's fully paying for it now), to the insurance companies, who may then shift a portion of the cost to the insured, you.

I believe that this will cause unnecessary delays in COVID diagnosis and treatment and may put an additional burden on the emergency rooms, thereby increasing medical spending.

Telemedicine
Telemedicine continues full speed. But the end of the COVID emergency may bring with it a change in telemedicine insurance coverage. I hope the those in charge have enough sense to continue, and expand, telemedicine coverage, and to make it attractive for industry to develop more-sophisticated home monitoring systems. If done, this could help bring the cost of medicine down, and make many areas of medicine more readily available to the patient.

Now, some real medicine:

COVID
Connecticut is one of 22 states with no known recent COVID deaths (none in approximately 5 months in Connecticut!). But the disease is still with us, we're dealing with it on an almost-daily basis. Prevention and treatment are working better now, aided by the decreased virulence of the most recent COVID variants.

Approximately 70% of Americans are fully vaccinated against COVID. An impressive number, but not enough for herd immunity. We can't let our guard down, or the disease will spread again. Remain cautious.

What about fatty liver?
As the name implies, a fatty liver is a condition in which our liver cells accumulate an excessive amount of fat. Experts claim that almost 40% of American adults have a fatty liver. If ignored, it can progress to fatty liver disease, which can be very dangerous. Having no symptoms in the beginning, it's really an American silent epidemic.

There are two types, AFLD and NAFLD (alcoholic and non-alcoholic liver disease, respectively).

The treatment of alcohol-related liver disease, in its early stages, is rather intuitive - but it's not always easy to get off the stuff. I won't elaborate.

According to the Cleveland Clinic, nonalcoholic fatty liver affects approximately 37% of American adults (it's the most common chronic liver disease worldwide). It can progress to an inflammatory liver disease and fibrosis, then cirrhosis. In some cases, it can give rise to liver cancer.

People at highest risk for NAFLD are the obese, and those with type 2 diabetes (the common type). Other risk factors include sleep apnea, hypothyroidism, and genetic factors.

Diagnosis is usually fairly easy (abdominal ultrasound, blood tests for liver function) but, in most cases, treatment is mostly up to you - it's the "good life therapy" of minimizing alcohol consumption, weight loss, and a rigorous routine of exercise. The Mediterranean Diet is very helpful.

Treatment of NAFLD should be followed medically in the office, with advanced disease followed by a specialist.

Need a copy of the Mediterranean Diet (as a diet lifestyle)? Let me know, you'll get it by email.

Pneumonia vaccine
The vaccine is routinely recommended for people over the age of 65, and for people over the age of 19 who have certain chronic diseases or may otherwise be susceptible to the development of pneumococcal pneumonia. The guidelines were updated recently and made much simpler to follow. The vaccination my consist of either one or two shots, depending on past vaccinations, and may have to be given 8 weeks or one year apart, depending on the type of vaccine used.

If you have any questions about this important vaccine, please contact the office or send me an email.

Please give us a call at 203-853-1919 if you need an appointment

Until next time, stay well,

Igal Staw, Ph.D., M.D.
www.drstaw.com

Internal Medicine * Pulmonary Medicine * Preventive Medicine * Health Risk Reduction
2000 Post Road, Fairfield CT 06824
(203) 853-1919

Great News on Coffee and Chocolate

2023-01-30T22:02:00.003-05:00

To My Patients,

Emailed to patients 1/16/2023

Hope all is well - Winter is here, with a touch of snow on the ground today – hasn’t been bad in our area. For winter, we rely on solutions: boots, coats, snowplows. For health, we try to get away with resolutions – but actual solutions work out much better than resolutions, which fade away by January 13th.

So don’t just resolve to lower your carbs, move around more vigorously, get your colonoscopy or physical exam, just do it!

Sandy and I are happy to announce the birth of our second great-grandchild, Liam, on January 11th!

Some procedural issues:

Billing
As stated previously, we’re trying to send as many periodic statements as possible by email, rather than by snail mail (we think that even a small contribution to tree saving is important). If you object to an emailed statement, please let us know.

Pre-certs
Pre-certification is frequently required by insurance companies for many medications, and before diagnostic procedures.

Please give us a call at 203-853-1919 if you need an appointment

In our practice, the big victim medications include common inhalers and injectable medication for diabetes (also used for weight loss). The main victim test is an MRI. Approval, if finally obtained, may require several steps which are frequently time consuming and frustrating. It’s usually caused by unnecessary delays by the insurance companies.

So, when there’s a pre-cert issue, please know that while we try to help, the pathway is not always smooth - call early so we can help.

COVID
COVID is still with us. While it’s occurrence level in Connecticut has been relatively stable, it’s incidence in the US is rising. The daily US COVID fatality rate last week was close to 400 a day, about 10% higher than the previous week. If one were to extrapolate this to a yearly rate, then COVID is now the 9th most common cause of death in the US (far exceeding flu fatalities). Despite recent controversy, the COVID vaccine still significantly reduces the number of severe COVID cases and hospitalizations. Do keep up with your vaccinations.

And now little almost-medicine:

Are you a chocolate addict?
If so, that may not be so bad, especially if you eat the right kind of chocolate in moderation.

Chocolate is big business, almost worldwide. Americans spend 20 billion (yes, billions with a B) dollars a year on chocolate confectionery and consume about 20lbs. of it each year per capita.

The health benefits of cacao, the valuable ingredient in chocolate, are modest but well established, related mainly to cocoa flavanols. They include an overall lowering of cardiovascular disease and the chance of developing diabetes, modest improvements in exercise and physical performance, and even an improvement in memory and mental fatigue.

But there’s a caveat: In a chocolate bar (or chips, bits), what’s not cacao, is usually sugar. If sugar is the first-listed ingredient, avoid the product or be satisfied with a very small amount. Cocoa naturally contains trace amounts of Cadmium - which is naturally present in the soil, not from cacao processing. It also contains trace amounts of lead, which may attach to the cocoa beans (usually inadvertently) during the drying and fermentation process.

The best chocolate is the one that has at least 70% cocoa and contains the least amounts of the heavy metals cadmium and lead.

According to Consumer Lab, an independent food testing laboratory, popular chocolate bars with acceptable cadmium levels are Ghirardelli Intense Dark 72% and 86%, Valrhona Albino Dark 85%, Taza Chocolate Organic 70%, and Mast Organic Dark 80% cocoa. Others may also be acceptable, but test results, if any, are not publicly available.

So, go ahead and enjoy your chocolate in moderation, and try to choose the right ones.

Are you a coffee addict?
Like eating chocolate, drinking coffee may not be so bad either.

True, a large amount of coffee (or caffeine in other forms of food) may have some detrimental effects, including insomnia, an increase in heart rate, heart burn and anxiety. In very large amounts, it can even cause medical dependence, and withdrawal symptoms if stopped abruptly (we’ve seen this in our practice on a few occasions, and I believe we saved one marriage or more by making the diagnosis).

But the good news, and there’s plenty of it, is that coffee is known to increase cognitive function and may boost physical performance. It reduces the risk of developing the common type 2 diabetes and Parkinson’s disease and appears to have a protective effect on the liver, perhaps even on liver cancer. It contains a lot of beneficial antioxidants which protect our body cells from the harmful effects of free radicals, and trace amounts of essential nutrients such as potassium, magnesium, and B vitamins. Decaffeinated coffee (which does have a little caffeine in it), still carries with it many of the benefits of caffeinated coffee and has fewer side effects.

What’s considered safe? This may vary from one person to another. According to the American Heart Association, up to 400mg of caffeine a day for an otherwise healthy adult is considered safe. This includes caffeine consumption from all sources of dietary caffeine, such as tea, soda, and many energy drinks.

Examples of caffeine content of popular drinks include:

Starbucks dark roast - 260 mg ( tall cup )
Starbucks espresso - 150 mg/shot
Espresso (not Starbucks) - average 75 mg per shot
Regular drip coffee average 135 mg/ 8 oz cup
Black tea 50 mg /8 oz cup
Energy drinks – 200 mg or more per 8 oz (always check the label!)

And the list goes on, with many variations..., much more on https://www.cspinet.org/caffeine-chart.

To answer your inevitable question, yes, chocolate does have caffeine. The darker the chocolate, the more caffeine it has, about 20mg caffeine per oz of 70% chocolate bar. You may not want to consume too much of it before bedtime...

Go ahead and enjoy the benefits of coffee, just don’t overdo it.

Please give us a call at 203-853-1919 if you need an appointment

Until next time, stay well,

Igal Staw, PhD, MD

istaw@optonline.net

Sad News

2022-12-19T20:52:00.000-05:00

To My Patients,

Emailed to patients 12/3/2022

We’re back, much earlier than we expected, due to a death in our family. Unfortunately, our son in law, Aeyal Ginor, who participated in the Israeli Iron Man International Competition, collapsed and died before finishing the swim portion of the race. By chance we were traveling with our daughter, Laurie, and able to get to Israel within a few hours to help her during this terrible time.

After the Jewish mourning period is over, we’ll be in the office, beginning Tuesday December 6. He always felt that that we were his surrogate parents, and we felt the same. He will always remain in our hearts.

Sandy and Igal Staw

2022-11-22T20:39:00.004-05:00

This Time I'm the Patient + Office Hours

2022-10-13T20:44:00.000-04:00

To My Patients,

emailed to patients 10/12/2022

Summer is over, the sun is hiding, but some of the late summer flowers are still here, and the autumn ones are coming up - definitely a bright spot.

The office has been busy, both in-office, and face-to-face by telemedicine. We are still on a COVID schedule, seeing patients primarily Tuesdays and Thursdays plus "when necessary" by arrangement. More on the subject below.

Speaking about myself, just had double-hernia surgery, from which I'm recovering rapidly, only had to change one workday and kept the schedule a little lighter for 2 days. The surgeon was great (but I prefer not to mention names on email).

Sandy and I will be traveling to Denver at the end of this month, to see our younger son and his family, as we've been doing every few months (we try to see them, either here or in Colorado, at least 4-5 times a year). Our time away is listed at the end of this message.

Please give us a call at 203-853-1919 if you need an appointment!

And now back to some real medicine:

COVID
It's still with us, and not leaving soon. I deal with new COVID cases almost every day, sometimes multiple cases a day. Most patients have been vaccinated and "boosted," but are still getting it (none of them had received the newly released Bivalent Booster before contracting COVID).

Unfortunately, COVID death rates in the US are still at the level of 380-400 a day, and there has been no definite decline in at least 6 months. Reliable studies calculated that, overall, vaccination has reduced COVID mortality by 80% down to today's level.

The moral of the story: Get vaccinated/boosted, and make sure you get the new bivalent booster (includes the BA.4 and BA.5 subvariants); stay away from high-risk social gatherings (or at least wear a suitable facemask, I prefer the N95), and don't be embarrassed to use a hand sanitizer frequently.

If you get symptoms which are commonly associated with COVID (sore throat, cough, nasal congestion, fever, malaise, etc.), don't assume "it's just a cold." Get tested, more than once, and if in any doubt - contact the office (call, leave message, email). The COVID antiviral medication is very effective, but you must act quickly.

Telemedicine
Telemedicine, barely known before COVID and now commonly used, has been very effective in my practice. I use it 5+ days a week, from office or from home, and at hours when most medical offices are unavailable. Patients now have, or have access to, a growing variety of home monitoring devices. Aside of the old thermometer, it's common to have at home a reliable blood pressure machine, a pulse oximeter, a continuous glucose monitor (for people with diabetes), and/or pulse-irregularity monitor (as part of a wristwatch such as Fitbit, Apple Watch, and others). And many more are on the horizon. Using these devices, as the need arises, adds information, and makes telemedicine visit effective.

As of now, most insurance cover the cost of the virtual visit; the copay or deductible still applies in most cases.

You may find it interesting to see how Johns Hopkins describes the benefits of telemedicine, just click here.

The formats I now use are FaceTime, Zoom and WhatsApp; this may change as regulations change. With enough public support and demand, I hope telemedicine stays with us after COVID is defeated, as a great adjunct to in-office medicine.

Periodic Health Evaluation
There are various recommendations for periodic physical exams, but it's generally accepted that one should have a yearly physical starting at the age of 50. The periodic health evaluation/physical exam is your gateway to early detection and disease prevention, and so it is the gateway to better health.

Most insurance companies pay for periodic physical exams, and many waive the copay and deductible. Some even give you an incentive to do it. An HSA (Health Saving Account) may cover any gaps.

Medicare will pay for an Annual Wellness Visit, AWV (that's once every 365 days - this is how they define it). They don't pay for what we refer to as a physical exam, but we include all elements of the physical exam with the AWV at no special charge.

To make a long story short, take advantage of the periodic physical exam/wellness evaluation. And if you have no insurance, we'll work with you - give us a call to schedule your visit - 203-653-1919.

Time Away
Our mini-vacation time away from the office starts Thursday AM 10/27/2022, and runs through Wednesday 11/2/2022.

We'll be back in the office on Thursday 11/3/2022, 9 AM. During our time away, Janine will be in the office as usual, and I will continue to check my emailfor your messages and ongoing needs. Your voice mail messages will be answered.

Give us a call at 203-853-1919 if you need an appointment before we go!

Until I see you (physically or virtually…), stay well,

Igal Staw, Ph.D., M.D.

Office Hours & Those Little Helpers in Yogurt

2022-03-12T07:56:00.000-05:00

To My Patients,

Emailed 3/4/2022

Hope all is well. Winter is more than half over, but March sometimes has snowy surprises.

I'll be out of the office during the week of March 13 (that's Tuesday 3/15 and Thursday 3/17), back in the office the following week, usual schedule. We'll be enjoying the company of our Colorado gang that week.

Janine will be in the office during our regularly schedules hours "to check on things." I will take messages, emails and do necessary telemed virtual visits while away from the office. Please plan ahead, especially if you'll need medication renewals while we're away from the office.

Please give us a call at 203-853-1919 if you need an appointment

A few brief medical notes, first COVID, then non-COVID

COVID.
Things appear to be easing a bit. I won't go into detail and the various controversies, but please don't fall into complacency. Whenever you're in a COVID-suspect environment, wear a mask (preferably N95, even if not required), keep your distance, and make sure you've been fully vaccinated.

Probiotics.
The beneficial effects of probiotics are well known (although sometimes overstated by retailers). They may play a significant role in alleviating symptoms of digestive conditions such as traveler's diarrhea, antibiotic-related diarrhea, irritable bowel syndrome (IBS), Crohn's disease and ulcerative colitis. They are generally available as live microbes (fungi and bacteria), but there are major differences in makeup, potency, and efficacy. So, if you have a condition that you believe may benefit from probiotic treatment, contact the office, I may have specific recommendations.

Remember that yogurt is an excellent source of probiotics, and Greek yogurt containing live organisms, preferably organic, is one of the best.

Prebiotics?
Prebiotics are the food source for the probiotic bacteria and fungi. They are familiar to most of us as the fiber and nutrient loaded foods you hear about every day - the fruits, vegetables, and whole grains. This is a short list of the best ones (some will surprise you): apples, bananas, avocado, onions, garlic, asparagus, leeks, chicory root, oats, and, not to forget: Jicama root and dandelion greens. And that's only a start…

Alzheimer's?
It is estimated that approximately 6 million Americans aged 65 or older have Alzheimer's disease dementia (AD) today. We also know that there are many beneficial lifestyles that can delay the onset of AD, including physical activity/exercise, eating abundant amounts of fruits, vegetables and nuts, using olive oil and eating fish - especially the fattier fish (essentially the Mediterranean Diet), having enough mental stimulation (talking to friends, doing puzzles), and keeping medical conditions under good control.

But are you, genetically or otherwise, predisposed to AD? There is intense ongoing research to develop and recognize biological markers to indicate predisposition to AD. Two easy-to-obtain markers today are blood tests for homocysteine and the enzyme APOE. People with an elevated homocysteine are predisposed to AD and also to a variety of cardiovascular diseases. People with the APOE enzyme are thought to be 2-12 times more predisposed to AD, depending on whether they have the one- or two-version of the enzyme. Having an increased risk of AD doesn't mean you'll get it, but if you do have the increased risk, it's a good time to emphasize the lifestyles that will reduce the chances of getting it.

Give us a call at 203-853-1919 if you need a more info or an appointment

Until next time, exercise, eat healthy food and stay well. Just do it!

Igal Staw, Ph.D., M.D.

Latest on COVID and Something About Green Tea

2022-01-30T20:34:00.001-05:00

To My Patients,

Emailed 1/24/2022

Happy, healthy, and safe new year to all of you, your families, and friends!

If you thought of making new year's resolutions, I learned that the best resolution is to make no resolutions, just do the right thing!

COVID is still with us, and in full force. While we're still on a COVID-limited office schedule of Tuesdays and Thursdays AM, I spend most of the remaining time dealing with COVID-related issues and other medical issues that can be handled by telemedicine.

Please give us a call at 203-853-1919 if you need an appointment

Most, but not all, new COVID cases are Omicron. The more serious variety, mainly Delta, is still with us.

Fortunately, in our practice most patients were fully vaccinated against COVID-19; some were not, for a variety of reasons - some justified, others not. To my knowledge, none of our recently COVID-infected patients became sick enough to require hospitalization.

It is well known now that the vast majority of severely ill COVID patients are those who have not been fully vaccinated. Severely ill patients who were fully vaccinated are mainly the elderly and those with pre-existing medical conditions, such as congestive heart failure, diabetes, COPD, kidney disease, and the immune compromised patients.

There has been a lot of talk about the possibility that the Omicron variant will bring about herd immunity and, as a result, eradicate itself. That's an "iffy" possibility; I still would like to see us get herd immunity by vaccination rather than by virtue of having the disease. So, just do it, and don't forget to wear the N95 mask (better than the surgical mask, and much better than the cloth), and distance yourself from risky situations.

But life is not only about COVID, and there is no reason to neglect our wellbeing just because of it. The most prevalent medical conditions in the US are related to lifestyle, including hypertension, coronary artery disease, diabetes, obesity, COPD and many types of cancer.

Even during COVID, there's a lot we can do to preserve our health. Don't be tempted to start smoking again just because you're working remotely from home. You can exercise at home without going to the gym, the Canadian Royal Mounted Police exercises is just one example (look up https://www.rcmp-grc.gc.ca/en/12-week-fitness-program - it's detailed). You don't have to increase your food intake just because you spend most of your time at home - keep yourself busy doing non-eating tasks…

Need Help With Your Exercise Program?
Give us a call at 203-853-1919 or email today!

And don't forget, you can help your physician take care of you by telemedicine or in the office: If you have diabetes, make sure to measure your blood sugar regularly, and report it. If there's a high blood pressure problem, make sure you have a blood pressure machine, or BP cuff, at home (and bring it with you next time you're in the office to check it for accuracy. It's important to know your wakeup BP as well as your PM BP. For many reasons, it may be wise to have a finger-tip oxygen meter (known as "pulse oximeter") on hand, especially if you have bouts of wheezing/shortness of breath (a pulse-ox device is not expensive, available in pharmacies and online). Again, just do it!

What's the relationship between Alzheimer's Disease and the level of homocysteine in the body?
It is well established that the level of homocysteine in the body reflects the functional status of three Vitamin B levels (Vitamin B12, B6, and folate). A Consensus Statement by a panel of experts finds that an elevated level of homocysteine, is a risk factor for the development of dementia, including Alzheimer's Disease. Of course, this is not the only risk factor, but it's modifiable, usually corrected by taking vitamin B supplements. If there's a suspicion of dementia, it's worth checking the homocysteine level. It's a simple blood test.
Should I get a screening lung scan for early lung cancer detection?
The criteria published by the CDC recommend that one should get a low-dose screening CT of chest if you:
- Have smoked cigarettes the equivalent of 20 pack-years or more (example: one pack a day for 20 years; 2 packs a day for 10 years, etc.)
- Are between 50-80 years old, and
- Smoke now or have quit within the past 15 years.
The test may have to be repeated yearly. Insurance usually covers the test.
What's the advantage of Green Tea, if any?
Green tea Has some advantages over the usual "red tea" or "black tea." Its main advantage is a greater amount of catechins, a type of flavonoid, and antioxidants, all of which provide beneficial health effects. It also contains caffeine, more than regular tea, but less than a regular cup of coffee. Caffeine-free versions are available, mostly with fewer antioxidants. But not all green teas are made equal. According to Consumerlab.com (a reputable online publication), some of the best choices include:
- Jade Leaf Organic Japanese Matcha (in powder form)
- Trader Joe's Organic Green Tea (brewed)

Feel free to ask questions, I'll answer those of general interest.

Until next time,
Stay well, see you in the office or online,

Igal Staw, Ph.D., M.D.

Take Care of Yourself

2021-04-19T21:18:00.002-04:00

To My Patients,

Emailed to patients 4-17-2021

Spring is here (most days, at least most days I guess...) We've been back from Colorado for over two weeks, having visited our youngest son and his wife and those rapidly growing 8- and 10-year-olds. We are now spending a little more time seeing patients in the office than in the past few months, and almost as much time doing telemedicine.

We Love That Garden!

Many people feel safer now, after they were fully vaccinated, and for good reason. If you haven't been vaccinated yet, do so at your earliest opportunity. Pfizer and Moderna are considered very safe and effective, J&J is on hold until the clotting issue is clarified.

It is reasonable to believe that the faster the population is vaccinated, the less will there be a chance for the development of vaccine-resistant or more virulent variants of the COVID-19 virus. So just do it - if you have a question about vaccination - please call 203-853-1919 or email.

But, while COVID is still here, let's not forget about other aspects of keeping ourselves in good health - it's time to get back to taking care of yourself!

** Speaking of Weight Gain **
Some studies suggest that during the epidemic people have been gaining weight at an average of 2 pounds a week! I don't see this magnitude of weight gain in my patients, but a significant weight gain is still happening, and it's a major concern. Lack of physical activity is a factor but eating more is a much more important element in weight gain.

** Speaking of Weight Loss **
Recent studies suggest that a weight loss program which starts with a few days of "no solid food" is more effective than the accepted portion-control method. If interested, we can help you with that. Let's chat about quality strategies for you to get to your ideal weight!

** And the Periodic Physical Exam **
As you may have seen in the news reports, many have been neglecting their general health, including periodic evaluation, during COVID. The physical examination, during which time blood and urine tests (and maybe others) are usually done, is the time to assess your general health and to identify health risk factors, if any. When done correctly, it's the gateway to a healthier, many times longer, life. Don't miss the opportunity to have it done. Many, if not most, insurance companies cover physical exams with no copay. Medicare does not cover physical exams but will cover yearly "wellness exams." I try to do what I think is right, and include as much of the physical exam as possible within the wellness exam (it lets me sleep better...). It's time to make an appointment and get the ball rolling again!

** About Those Med Renewals **
This can be a touchy subject - many patients use "routine medications," medications that you use regularly for a chronic condition such as diabetes, high blood pressure or chronic bronchitis. I regularly receive renewal requests and approve them when appropriate, or notify you if it's time to re-evaluate. Now, some of the pharmacies (especially the large chain pharmacies) send us auto-requests, even if you didn't request a refill, and I have no way of knowing who initiated the request, and this may lead to errors. For example: I get a request from patient X to refill metoprolol (for blood pressure control); the request comes from CVS even though you may have stopped taking the medication (say, at the suggestion of your cardiologist, or you just forgot to take it). But I may think you did request it, and may think that you're still taking it. See where I'm going? It can get messy...

I think that a request to refill a medication should come directly from you by calling the office or by sending me an email (so easy). Don't authorize the pharmacy to send auto-refill requests, and if you have already authorized it, cancel the request.

Here's a fun fact: The tongue is the strongest muscle in the body. It's nice when we use it wisely!

Stay safe and stay well,

Igal Staw, Ph.D., M.D.

Hours Next Week & Speed of Vaccinations

2021-03-14T09:54:00.002-04:00

To My Patients,

Emailed to patients 3/7-3/11/2021

Hope all is well.

Well, we are almost on our way to see our youngest son, his wife, and their two children (our youngest grandchildren) in Denver. We had our COVID vaccinations and have our plane tickets - we're very excited!

We'll be a way for one week, beginning Thursday 3/18, back in the office the following Thursday 3/25/2011. While away, we'll continue to take urgent messages through our regular phone number 203-853-1919 or by email at istaw@drstaw.com. Janine will be in the office by arrangement for pre-physical exam workup (usually EKG, breathing test, and blood drawing).

If you need to be seen before we leave, please contact us as soon as possible, we'll be in the office on Tuesday 3/9, Thursday 3/11, and Tuesday 3/16.

While away I will continue to do telemedicine "virtual visits", using either FaceTime or Zoom. Isn't it great how technology can keep us close together?

** COVID Vaccination in Connecticut **
As of 3/5/2021, Connecticut ranked amongst the 8 highest in the percentage of people who were actually vaccinated, with 21% having received the first shot, and 8.8% having received two shots. Sounds like we're doing well, doesn't it? No, it's still too slow! And Connecticut is gradually "opening up." That means more chance of exposure and that means that you still have to be very, very careful, vaccinated or not - please remain vigilant.

Want more information? Check out this great site by NPR with some additional details. This site is updated regularly.

** More About the Heart **
February, Heart Month, is over but our heart is still within us and we have to take care of it. Let's assume that you're overweight (actually, quite a bit overweight, obese...). You already know the heart risks of obesity and you want to reduce these risks. You give yourself a choice "should I exercise, or should I lose weight, what's better?"

Recent studies reinforce what we've known for a long time: the benefits of significant weight loss (more than 10% of body weight), exceeds that of moderate exercise by far, although both have cardiac benefits. But why think of which choice is better? Do both. Just get up and do it, your body will thank you for it.

Need guidance specific to your needs? Email me with your questions.

** Gardening **
Do you grow your own vegetables and flowers during the warm season? Now is the time to start your seeds indoors. Want a reasonable seeding/planting calendar for vegetables? Try the Old Farmer's Almanac calendar, it's a great resource.

Looking forward to getting outdoors again!

Stay safe and stay well,

Igal Staw, Ph.D., M.D.

Some of My Views on the Vaccine

2021-02-13T19:12:00.001-05:00

To My Patients,

Emailed to patients 2/11/2021

Well, we're still in the middle of the fight against COVID-19, and it's hard to predict when we'll have the upper hand. In my opinion, the COVID-19 infection is still out of control, and the way to contain it is to maintain safe distancing (including quarantine when necessary), masks, and vaccination. The vaccines are not yet available to the general public, restricted in each state to pre-defined populations at risk, such as the elderly, healthcare workers and other critical occupations.

In Connecticut, people 65 years and older can now be vaccinated (in addition to health care workers and first responders). This will hopefully be expanded shortly.

As of today, a little less than 10% of US people received their first COVID vaccine, and approximately one third of them received the second dose - WAY TOO SLOW!

All of this behooves each one of us to continue to "stay safe," get tested frequently, and get the vaccination as soon as it is available to you. The two popular and very effective vaccines are the ones by Pfizer and Moderna. The new vaccine by Johnson and Johnson, just becoming available, is a single-shot vaccine, that's a big advantage, but it appears to be a little less effective, at about 66%, compared with the greater-than the 95% effectiveness of the other two. But it's better than not getting it, and, just for comparison, its effectiveness is greater than that of the usual effectiveness of the yearly flu vaccine.

Please give us a call, 203-853-1919, or email if you have any questions about a vaccine.

** Vaccine Eligibility
Need to know if you're eligible to get the vaccine, or where to get it? Here are some important clues:

Connecticut COVID-19 Response
For seniors: Your local Senior Center
Connecticut COVID-19 hot line: call 211 to speak to a real person; call 833-250-7633 for Virtual Assistant (automated responses to a variety of questions).
Go to United Way COVID hot line or call 877-918-2224.

** COVID Is Not Everything - February is the Official Heart Month - Be Vigilant!
If you take COVID out of the equation, heart disease is still the number one cause of death in the US, more than 650,000 people a year. But that's not the entire story. Approximately 18 million(!!!) Americans have coronary artery disease (the main precursor of heart attacks), and more than 800,000 people a year have a heart attack, a quarter of which is a silent heart attack - you are not aware you had it, but damage was done. And the economic cost to the patient, the family, and the health system is enormous. Almost one sixth of the health care budget is spent on cardiovascular disease (which includes stroke). The total cost to the economy, including lost productivity costs, was about a billion dollars a day, just before COVID.

Looking at the global picture the numbers in the US are not the worst, neither are they good. Some developed countries are worse, including the UK, Sweden, the Netherlands, Germany (and Europe as a whole). Some developed countries are doing better (not by much): Switzerland, France, and Australia. Some of the less developed and Eastern-Asian countries are doing much better than the US: Africa (as a whole), Taiwan, South Korea, and India.

A deeper look into the numbers will convince you that much of the difference is related to lifestyle habit, like the incidence of obesity, lack of exercise, presence of diabetes, and choice of food.

It is well known that faulty lifestyles in the US are responsible for more than 40% of premature deaths, and for a very large percentage of chronic disease. I'll let you draw the conclusion.

We are here not only to treat disease, but to identify the risks for disease development, and prevent it! Need guidance or advice? Call the office (203-853-1919), or email us. We can chat, or set up an appointment (virtual appointments are available).

** For Medicare Patients
Please note that Medicare does not cover nor pay for routine physical examinations. What a shame; when we do a physical exam is the time when we have a chance to look at the body as a whole and minimize the risk of disease. But we have to live within the system and still provide the best care we can.

Medicare will pay for an "Annual Wellness Visit (AWV)" once in 365 days. I must admit that I squeeze as much of the physical exam component into the AWV, and I believe that my patients benefit from it. So, take advantage of the AWV, call the office to schedule.

We are now in the office On Tuesdays and most Thursdays. The rest of the time - telemedicine. If you need a virtual visit, please call us to schedule an appointment (203-853-1919) - See you at the office or on the phone!

Stay well,
Igal Staw, Ph.D., M.D.

The Vaccine & Virtual Visits Work

2021-01-30T18:07:00.001-05:00

To My Patients,

Emailed to patients 1/27/2021

Hope the holiday season went well, and that you're staying safe - it has sure been challenging for some. COVID is still with us in full force, a year since it started and continues to claim a large number of lives daily.

I hate to say this as a letter opener, but if you look at daily mortality statistics in the US, you'll see that the daily number one cause of death in the US is not heart disease or stroke, it's not cancer, it's COVID-19!

With the emergence of more rapidly spreading COVID mutations, and with the terrible daily cost of lives, it behooves each one of us to play his/her part in the defeat of this disease.

The drive to vaccinate the population is on, but it's awfully slow and handled differently in different parts of the US. As of now, Connecticut is not in a position to be proud of how the vaccine issue has been managed. The State could, and should, do better.

This only adds to the reason why we have to be so vigilant about social distancing and other safety guidelines, and to avoid contact with those who don't comply. It's a reason to be tested repeatedly for the active infection, and in many cases also for the antibody, and encourage those around us to do the same. It tells us to be vaccinated against COVID as soon as possible. If you have questions about vaccines, please email me.

** Vaccine Eligibility
When the vaccine becomes available to you and you have no medical contraindications, please take it! I say this even though we are not sure how long the immunity will last or if there will be unforeseen long term side effects. Sandy and I already took the first dose.

Looking for your eligibility to receive the vaccine in Connecticut? It's at Connecticut COVID 19 Response.

** More About Telemedicine
Interestingly, an article just appeared in the Mass General "advances@MGH" about use of telemedicine in combination with what turned out to be a markedly reduced in-person visits. It looks like a positive move in the direction of "longitudinal health care delivery," which is what patients with chronic health conditions need. The paper came from their Cardiology Department and I'm sure it's implemented elsewhere. This is exactly what we've been doing at our practice for the last year.

If you need a virtual visit, please call us to schedule an appointment: 203-853-1919.

** Some Other Things to Think About
While we're all busy thinking about it, COVID is not everything, there are other, long-term health concerns.

If you have high blood pressure, have a home blood pressure machine and take your blood pressure regularly as dictated by your needs. There are some very good BP machines on the market, but they all have to be checked against the standard Mercury manometer like the ones we use in the office. I have some favorite models. I don't "promote" their names publicly, but I'll share my experience with you if you wish - call or email for a suggestion.
If you have diabetes, make sure you have a finger stick glucose meter, and use it regularly as instructed.
If you have COPD, severe asthma, or other respiratory disease (including active COVID), it may be worth getting a finger oximeter, available online.
If you have issues concerning irregular heartbeat (atrial fibrillation or other irregularities), pulse monitors are now available that can capture the irregularity and email it to the physician.

The availability of these devices, and many others which are surely in the pipeline, will help maintain a balance between the need for an in-person office visit and a virtual visit, both now and after COVID is defeated. I just hope that insurance companies, including Medicare and Medicaid, will realize the advantage of it and continue to pay for virtual visits to the benefit of patients, the providers, the insurance companies themselves, and the health system as a whole.

** Some Common Questions
Now a few answers to question I get frequently:

CoQ10 enzyme (over the counter, ETC) may help reduce the muscle ache some patients have when they take a statin drug for high cholesterol. It's available in most pharmacies, supermarkets and Costco. Let's talk about if it may be the right supplement for you.
Melatonin (also ETC) helps some people fall asleep a little faster and longer. It's a little more effective if the sleep difficulty was caused by a beta blocker (e.g., metoprolol, atenolol) and others. But it can cause morning dizziness and daytime sleepiness. Some people with fibromyalgia say that some of their symptoms were improved (not cured).
Physical exams for Medicare patients: Medicare does not cover the traditional annual physical examination. However, Medicare will cover what it defines as AWV (Annual Wellness Visit) once a year, or, more precisely, once every 365 days. During the AWV your medical needs are identified and addressed. They will cover that, so take advantage and stay well!

Call today to schedule your AWV - 203-853-1919

Hope you take good care of yourself during this tough period. We are here to help, in the office, by virtual visits and by email.

Stay well,

Igal Staw, Ph.D., M.D.

2020-12-10T17:39:00.000-05:00

To My Patients,

Emailed to patients 12/7/2020

Hope your Thanksgiving Holiday went well despite the unusual COVID environment.

Fortunately, none of our patients have become seriously ill or required hospitalization with COVID.

** Office Time
We are seeing patients in the office on Tuesdays and some Thursdays, mostly for periodic exams such as physicals and general evaluation, and for issues that are not active COVID-19. Much of our medical care is now done by telemedicine (FaceTime or Zoom), which has been working extremely well - don't be nervous to give it a try! Give us a call to set up your next (or maybe first) telemedicine visit - 203-853-1919.

I hope that the "higher ups," whoever they are, will allow some form of telemedicine to continue and improve after COVID has been defeated. There's so much you can do without having to spend time traveling to the doctor's office and spending time in the waiting room, especially when remote-exam tools are becoming more widely available. Already, if you have high blood pressure or diabetes, your progress can be, in part, followed by telemedicine. Telemedicine is not a total substitute to the old hands-on approach, but it's a great help.

** A Word About COVID Testing
There are two types of COVID tests available: 1) the rapid antigen test and, 2) the PCR test - Each have a somewhat different use.

PCR, the original "nasal swab test," is the gold standard. It detects very small amounts of the COVID-19 virus, even if you're asymptomatic. But it takes a few days to get the results. In our experience, it has taken as many as 7 days by some labs - inexcusable (but, you can try the pixel site, see below).

The rapid test is plagued by false negatives. This is particularly so early in the disease, when the number of virus particles is very low, and the test cannot detect them; up to 50% are often false negatives. However, in people who have symptoms suggestive of COVID 19, the rapid test is much more reliable, and it is the test of choice because results are available almost immediately and a quarantine decision can be made very fast.

Regardless of which test you take, a positive test result is much more likely to be accurate even if you have no symptoms, (but even here, not guaranteed to be 100% accurate).

Need advice about testing?
Contact the office by emailor phone - 203-853-1919.

Need faster PCR testing? Try the site: pixel.labcorp.com. Register and ask for a kit, which will be sent to you overnight. Follow the instructions and return the kit by FedEx, you'll get PCR results very fast by email (24-36 hours by my personal experience).

** Physical Activity
It's so easy to become less physically active, or even sedentary, during COVID. The WHO, the World Health Organization, has just cited new activity recommendations. These are for more exercise/physical activity than the previous official guidelines and will most likely completely replace them.

Examples: For adults, 150-300 minutes a week of moderate activity, or 75-150 minutes of vigorous activity (twice the previous recommendation). In addition, at least 2 days a week of muscle-strengthening activity involving all major muscle groups. Seniors should focus on balance and strength training, even if they have no balancing issues. And the list goes on, but I guess you're all getting the idea...

Watching TV? Get on your treadmill, bicycle, rowing machine or just run in place. If you have weights at home, use them. Don't have any? They are easy to get and don't take up much space; you can use bags of rice and soup cans instead - no excuses!!! Need more tips - call or email and I'll tell you!

** A Few Words About Insurance
We participate with most insurance carriers, but not with Cigna (many of our patients have switched out of Cigna because of that).

Some insurance companies require proof of a physical exam for the year. There's still time to do it. Most Health Saving Accounts (HSAs) will cover your periodic exam and other medical expenses, but some of the leftover money may not be rolled over to the next year - there's still a little time to take care of that.

** A Word About Face Masks
Wear them whenever necessary, and make sure they also cover your nose.If you can get the N95 mask, use it, it provides better protection (that's what I use). I'm not sure about the KN95, they have a different standard, I don't use them. If you have a UV-C sterilizing bag, use it to disinfect your masks, gloves, etc. We use the portable bag by Coospider, available on the internet.

Above all, stay safe. Keep a safe distance, avoid unnecessary contact, and if you have any suspicious symptoms, let me know immediately.

Stay well,

Igal Staw, Ph.D., M.D.

www.drstaw.com
www.twitter.com/drstaw
Dr. Staw on Facebook

To My Patients,

2020-08-29T09:15:00.001-04:00

Emailed 8/16/2020

Hope all is well. COVID-19 is still with us, but life must go on. I don't expect any miracles, but a good COVID 19 vaccine will go a long way toward easing the problem - we'll be sure to keep you updated on any new recommendations when they are available.

** Office Visits - Virtual and In-Person
We are still on "COVID schedule." We see patients (who are not COVID-suspects) on Tuesdays, and usually also during part of Thursdays. The rest of patient-care time is spent doing virtual visits using FaceTime or Zoom.

Medicare announced that they will continue to support virtual visits and phone follow-ups until the end of September. Most insurance companies have followed suit.

Please give us a call if you need a virtual or in-office visit, we don't want separation to be the cause of any unnecessary illness - (203) 853-1919.

I hope that insurance carriers, including Medicare, will come to their senses and realize that virtual visits, as an aid to, and sometimes a replacement of, the traditional office visit does work. There is no doubt in my mind that, done correctly, this can help reduce the cost of medical care, and in many cases improve the quality of medical care.

** More Insurance Accepted
Good news for our ConnectiCare patients who are on the Access or Exchange program (that's the Affordable Care Act side of ConnectiCare insurance). We now participate in that program. All you are responsible for is the copay, deductible and, in rare cases, uncovered services.

** Back to Medicine
While staying home much more of the time these days, I hope you didn't fall into the trap of reduced exercise, consuming more unhealthy foods than you should, and gaining weight. There's so much you can do for yourself even if you feel bored staying home. As I have mentioned in the past, the Canadian Royal Mounted Police exercises have stood the test of time, and much of it can be done at home. The internet is loaded with appropriate demo's and instructions.

But for some people there could be a different reason for weight gain, and that is the medication you may be taking. Examples include some antidepressants, epilepsy and blood pressure medications, steroid hormones (e.g. prednisone), birth control pills and insulin. Don't just stop taking any of these medications, but knowing about this potential side effect may motivate you to do more to control excess weight, and to discuss the possibility of a medication change with your physician.

** Back to COVID
While some people in our patient community did contract the disease, many were mildly symptomatic. None required hospitalization, and we haven't lost anyone. I hope you're watching yourselves carefully, and help maintain the good statistics. If you have any questions, feel free to call!

Until next time, stay safe and stay well!

Igal Staw, Ph.D., M.D.

To My Patients

2020-08-29T09:06:00.001-04:00

Emailed 7/19/2020

Hope all is safe and well.

COVID 19 is still with us; it has changed everyone's life, and I believe that it will continue to make a life-changing impact for years after its defeat.

It has also changed the way medicine is practiced throughout the US and the world and, of course, in our practice.

We have been doing telemedicine, or virtual office visits for close to 4 months, seeing non-COVID patients in the office as the need arose.

Beginning this Tuesday, July 14, we will begin to see patients on a more regular basis on Tuesdays, staying in the office as long as necessary. We may soon add another day. Janine will be with us during open days.

We expect that most visits will be for complete physical exams with emphasis on health maintenance and the reduction of health risks.

Needless to say, you always want to be is in the best health you can be, but especially so at the time of the pandemic.

To reduce your risk of COVID exposure, whenever possible we'll draw blood in the office; you will not have to go to the lab for blood testing.

At this time, we will not be able to see in our office patients suspected of active COVID 19 infection.

Safety above all. At appointment time, don't come directly to the office. Call us from the parking lot, to make sure that the exam room is ready for you. You'll be reminded to come through our back entrance, bypassing the waiting room and not contact with other patients. The number to call is 203-853-1919 (our regular office number).

Virtual visits will continue as before. They are by paid for by Medicare and commercial insurance (usually minus the copay and deductibles).

As of the time of this letter, telemedicine is expected to continue through September 2020.

Until I see you in the office or on the phone, keep a safe distance, stay safe and stay well!

Igal Staw, Ph.D., M.D.

Still Offering Virtual Visits & more Topics - emailed 4/19/2020

2020-04-26T15:12:00.000-04:00

To My Patients,

Much has already been said about COVID 19, which is still with us, so I'm not going to add much to the conversation today. It is time to start thinking beyond COVID too!

I have been keeping the office closed (except for very few, exceptional, cases), and doing all I can to answer our patients' needs through telemedicine (FaceTime for iPhones, Zoom for Android-based phones). Telemedicine is still in full swing, if you'd like an appointment, just give us a call at 203-853-1919 - The process is so easy!

The few patients who tested positive for the COVID 19 virus where symptomatic but not very sick; they were treated and did very well.

As We Look Beyond COVID 19:

Weight Gain.
Many of our patients are doing work from home, and are now not up to their usual physical activity. Their main complaint is weight gain. It's not easy to control noshing while at home. A little bit of willpower will do, but activity will do even more. There are many home exercise programs that do not require special equipment and, as I mentioned in a previous email, the Royal Canadian Air Force Program is still one of the best.

Worried about Alzheimer's Disease?
There is no known cure for Alzheimer's disease, but there are lots of over the counter preparations touted to be helpful (the majority worthless), and many healthy life styles that may help in prevention; see my brief review in a previous letter, available on my blog.

Recently, researchers at Rush Institute for Healthy Aging found that diets rich in specific flavonols were associated with a 48% lower incidence of Alzheimer's. The richest sources of these flavonols are common foods, mainly Kale, beans, spinach, apples, tomato sauce and olive oil. And some tea doesn't hurt either. Isn't this what we thought all these years? Yes. But it's nice to know!

Hypertension.
High blood pressure is a known risk for the development of premature heart attacks, strokes and kidney failure. It turns out that having your blood pressure checked at the doctor's office is not enough. If you have, or are suspected of having high blood pressure, it's very important that you check your own blood pressure at home. Some home devices are notoriously inaccurate (and I don't trust readings at the supermarket either...), but others are good, automatic, and keep records (I don't want to make waves by mentioning names here...). Regardless of what you get, the BP machine should be checked against a Mercury sphygmomanometer like the one we use at our office. Need a recommendation or calibration? Contact me.

But that's not the entire story. Blood pressure can fluctuate widely throughout the day. This may sound unintuitive, but BP may be highest when you wake up in the morning (sometimes referred to as "the morning surge"), and then may change with mood and activity.

All of this is very important information which is not available from a simple BP measurement at the doctor's office.

So, when BP is a potential problem, make sure you have a reliable BP machine. Check your blood pressure at different times of the day and under different situations. Above all, discuss your finding in person (or maybe Facetime) with your choice of physician so you don't carry the risks associated with high BP.

Until next time, keep safe distance and stay well, and until we're COVID-safe, see you on the phone!

Igal Staw, Ph.D., M.D.
www.drstaw.com
www.twitter.com/drstaw