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 email@example.com
Thursday, October 13, 2022
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:
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, 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.
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
To My Patients,
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.
A few brief medical notes, first COVID, then non-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.
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 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…
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.
Until next time, exercise, eat healthy food and stay well. Just do it!
Igal Staw, Ph.D., M.D.
Sunday, January 30, 2022
To My Patients,
Emailed 1/24/2022Happy, 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.
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…
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)
Until next time,
Stay well, see you in the office or online,
Igal Staw, Ph.D., M.D.
Monday, April 19, 2021
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.