Big Game Sunday with Some Medical News

 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

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

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Great News on Coffee and Chocolate

 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

 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

This Time I'm the Patient + Office Hours

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.