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

Saturday, February 13, 2010

Prevent a heart attack

Heart attacks continue to be the number one killer in the US. Heart attacks are also one of the major strains on the national and personal health budgets. It is essential that you know your risks for the development of heart disease and take the necessary steps to decrease the chance of a premature heart attack.

Heart attacks, the major manifestation of coronary heart disease (or atherosclerosis, plaque), continues to be the leading cause of mortality in the US, and will continue to be so as longevity increases, and as the number of senior citizens increases. And, yes, many of us feel that we know what puts us at risk for a heart attack, and what we have to do in order to decrease that risk. But do we really know enough? And do we do enough?

Most of us know the detrimental role of smoking, diabetes, obesity, lack of exercise, and hypertension. Many of us also know of the role of cholesterol, including the “good cholesterol” (HDL) and the “bad cholesterol” (LDL), or even triglycerides. Certainly we know that it’s better to be born with “good genes.”

But what about the more recently recognized risks factors and tests to better detect a potential heart problem early, when there’s still time to delay or prevent a heart attack?

Look at one cholesterol related example: We now can look not only at the total LDL and HDL, but also at their respective subclasses (These are not routinely done unless your physician specifically asks for them). There are at least two important LDL patterns, “predominantly small particles LDL,” also known as B Pattern, and “predominantly large particles LDL,” known as A Pattern. Pattern B is the dangerous one, and it’s the one that can usually be managed by lowering dietary fat intake. In contrast, Pattern A individuals may not benefit, or even become worse with severe dietary fat restriction. Similarly, there are other subclasses and markers, each of which has its own significance and therapeutic implications.

Inflammation of the coronary arteries accelerates the formation of coronary plaque. Cardio-CRP is one such marker of inflammation, and helps identify those at risk of a first and subsequent heart attack, even when the cholesterol risk is low.

Newer blood tests, such as the extensive profile offered by the Berkeley HeartLab, (partially on the basis of technology developed at Berkeley Unversity) or the VAP profile (by Atherotech, Inc.) go much further into analyzing inflammatory markers, cholesterol subclasses, and the benefit effect of certain drugs in the management of cardiac risk factors.

Early detection of plaque formation has become easier too. We’re all familiar with the common treadmill stress test, stress ECHO’s, nuclear Thallium or MIBI test, or even cardiac catheterization. But newer tools have evolved. A modern “fast cardiac CT scan” in experienced hands can show calcium in existing plaque, and thus estimate the degree of atherosclerosis. Computerized coronary angiography, which is only minimally invasive, can even better assess the extent of plaque formation. A carotid ultrasound, with particular attention to inflammation (usually reported as “intimal thickening”) may be useful in risk assessment.

Many other developments are just below the horizon. However, an important problem hindering the use of many new techniques is coverage by the health insurance companies as well as Medicare. They traditionally take years before paying for some of these very important tests.

Regardless, we’ve come a long way in our ability to identify the risk of coronary heart disease, and to detect it early. At our practice, early detection and prevention is a cornerstone. Information is a powerful tool, become informed! We’re here to help you live a longer, healthier life…

Monday, February 8, 2010

The many faces of asthma

Bronchial asthma, usually simply referred to as asthma, is a common condition, affecting well over 20 million Americans, increasing every year. The disease affects both children and adults, and its severity can vary from very mild to deadly. It account for more than 400,000 hospital admissions and more than 4,000 deaths every year.

While most people think of asthma as a disease of the lungs, in reality it’s a chronic condition of the bronchi, the airways that carry air in and out of your lungs. In asthma, the bronchial linings (mucosa) become inflamed, and become sensitive to a variety of irritants. The tiny muscles that surround the bronchi tighten and the mucus glands that are imbedded in the bronchial mucosa produce extra mucus.

Some people think of asthma as occasional wheezing. But in reality, asthma has many faces. It can indeed present as wheezing, mild and short lived, or as a chronic persistent condition, but it can also present in other forms such as a chronic or intermittent cough, excess mucus production, or shortness of breath at rest or associated with exercise.

The frequency and severity of asthma symptoms vary widely. Some people have infrequent “attacks,” or flare-ups, and are otherwise symptom-free, while others have severe, chronic symptoms. But no matter what your symptoms are, you must think of asthma as a chronic condition.

What triggers asthma or an asthma attack depends on how susceptible you are. Common triggers include allergens such as dust, molds, animal dander and cockroaches; tobacco smoke; viral respiratory infections; strenuous exercise; exposure to very cold temperatures; certain foods and food additives, and certain drugs such as the beta blockers used in the treatment of heart disease. Sometimes, psychological factors play a role. Hyperventilation, or excessive breathing, seen in some patients with anxiety, can lead to an asthma flare-up.

Asthma is usually easy to diagnose, but its severity should be thoroughly evaluated by a qualified physician. Occasionally, the diagnosis is elusive, and it has to be distinguished from other diseases that can masquerade as asthma.

Asthma is treatable. New research and an ever-increasing understanding of asthma have lead to better treatment. It is now clear that the overwhelming majority of flare-ups, hospitalizations and deaths can be prevented. But the success of treatment depends on the skill of the treating physician, and the patient’s compliance. Too frequently, especially in milder cases, there is a reluctance to treat or be treated, which may lead to disastrous outcomes.

Treatment depends on severity and triggers, and must be individualized. It ranges from the occasional use of bronchodilators (puffers), to long-term use of inhalers and oral plays a significant role, immunotherapy (allergy shots), or the use of a relatively new anti-allergy injectable medication (Xolair, omalizumab) may be appropriate. Relaxation methods, regular exercise and a thorough understanding of your condition are very helpful.

So if you have asthma, see to it that your needs are properly addressed, and take your treatment seriously; your mind and body will thank you for it. Need help? Contact us.

Twitter / Dr. Staw