A Great Vacation and Info on Microplastics

 

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

 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

 

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

Internal and Respiratory Medicine | 2000 Post Road, Suite 202, Fairfield, CT 06824

Office Hours and Spring Notes

 

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

 

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