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

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.

Sunday, January 30, 2022

Latest on COVID and Something About Green Tea

 To My Patients, 

Emailed 1/24/2022

Happy, 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. 

Please give us a call at 203-853-1919 if you need an appointment

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… 

Need Help With Your Exercise Program?
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! 

  1. 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.

  2. 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. 

  3. 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) 
Feel free to ask questions, I'll answer those of general interest. 

Until next time,
Stay well, see you in the office or online, 

Igal Staw, Ph.D., M.D.

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.

Twitter / Dr. Staw