House Calls

House Calls Started This Year

House calls are meant for patients who are temporarily or permanently home bound, or for other good reasons can't make it into the office.

To schedule a house call: Tel (203) 853-1919; email istaw@drstaw.com

Monday, January 30, 2023

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














Monday, December 19, 2022

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

Tuesday, November 22, 2022

Thursday, October 13, 2022

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. 

Saturday, March 12, 2022

Office Hours & Those Little Helpers in Yogurt

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.

Twitter / Dr. Staw