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, April 19, 2021

Take Care of Yourself

 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.

Sunday, March 14, 2021

Hours Next Week & Speed of Vaccinations

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.

Saturday, February 13, 2021

Some of My Views on the Vaccine

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.

Saturday, January 30, 2021

The Vaccine & Virtual Visits Work

 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.

Thursday, December 10, 2020


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.

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