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.

www.drstaw.com
www.twitter.com/drstaw
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To My Patients,

Emailed 8/16/2020

Hope all is well. COVID-19 is still with us, but life must go on. I don't expect any miracles, but a good COVID 19 vaccine will go a long way toward easing the problem - we'll be sure to keep you updated on any new recommendations when they are available.

** Office Visits - Virtual and In-Person
We are still on "COVID schedule." We see patients (who are not COVID-suspects) on Tuesdays, and usually also during part of Thursdays. The rest of patient-care time is spent doing virtual visits using FaceTime or Zoom.

Medicare announced that they will continue to support virtual visits and phone follow-ups until the end of September. Most insurance companies have followed suit.

Please give us a call if you need a virtual or in-office visit, we don't want separation to be the cause of any unnecessary illness - (203) 853-1919.

I hope that insurance carriers, including Medicare, will come to their senses and realize that virtual visits, as an aid to, and sometimes a replacement of, the traditional office visit does work. There is no doubt in my mind that, done correctly, this can help reduce the cost of medical care, and in many cases improve the quality of medical care.

** More Insurance Accepted
Good news for our ConnectiCare patients who are on the Access or Exchange program (that's the Affordable Care Act side of ConnectiCare insurance). We now participate in that program. All you are responsible for is the copay, deductible and, in rare cases, uncovered services.

** Back to Medicine
While staying home much more of the time these days, I hope you didn't fall into the trap of reduced exercise, consuming more unhealthy foods than you should, and gaining weight. There's so much you can do for yourself even if you feel bored staying home. As I have mentioned in the past, the Canadian Royal Mounted Police exercises have stood the test of time, and much of it can be done at home. The internet is loaded with appropriate demo's and instructions.

But for some people there could be a different reason for weight gain, and that is the medication you may be taking. Examples include some antidepressants, epilepsy and blood pressure medications, steroid hormones (e.g. prednisone), birth control pills and insulin. Don't just stop taking any of these medications, but knowing about this potential side effect may motivate you to do more to control excess weight, and to discuss the possibility of a medication change with your physician.

** Back to COVID
While some people in our patient community did contract the disease, many were mildly symptomatic. None required hospitalization, and we haven't lost anyone. I hope you're watching yourselves carefully, and help maintain the good statistics. If you have any questions, feel free to call!

Until next time, stay safe and stay well!

Igal Staw, Ph.D., M.D. 

To My Patients

Emailed 7/19/2020

Hope all is safe and well.

COVID 19 is still with us; it has changed everyone's life, and I believe that it will continue to make a life-changing impact for years after its defeat.

It has also changed the way medicine is practiced throughout the US and the world and, of course, in our practice.

We have been doing telemedicine, or virtual office visits for close to 4 months, seeing non-COVID patients in the office as the need arose.

Beginning this Tuesday, July 14, we will begin to see patients on a more regular basis on Tuesdays, staying in the office as long as necessary. We may soon add another day. Janine will be with us during open days.

We expect that most visits will be for complete physical exams with emphasis on health maintenance and the reduction of health risks.

Needless to say, you always want to be is in the best health you can be, but especially so at the time of the pandemic.

To reduce your risk of COVID exposure, whenever possible we'll draw blood in the office; you will not have to go to the lab for blood testing.

At this time, we will not be able to see in our office patients suspected of active COVID 19 infection.

Safety above all. At appointment time, don't come directly to the office. Call us from the parking lot, to make sure that the exam room is ready for you. You'll be reminded to come through our back entrance, bypassing the waiting room and not contact with other patients. The number to call is 203-853-1919 (our regular office number).

Virtual visits will continue as before. They are by paid for by Medicare and commercial insurance (usually minus the copay and deductibles).

As of the time of this letter, telemedicine is expected to continue through September 2020.

Until I see you in the office or on the phone, keep a safe distance, stay safe and stay well!

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

Still Offering Virtual Visits & more Topics - emailed 4/19/2020

To My Patients,

Much has already been said about COVID 19, which is still with us, so I'm not going to add much to the conversation today. It is time to start thinking beyond COVID too!

I have been keeping the office closed (except for very few, exceptional, cases), and doing all I can to answer our patients' needs through telemedicine (FaceTime for iPhones, Zoom for Android-based phones). Telemedicine is still in full swing, if you'd like an appointment, just give us a call at 203-853-1919 - The process is so easy!

The few patients who tested positive for the COVID 19 virus where symptomatic but not very sick; they were treated and did very well.


As We Look Beyond COVID 19:


Weight Gain.
Many of our patients are doing work from home, and are now not up to their usual physical activity. Their main complaint is weight gain. It's not easy to control noshing while at home. A little bit of willpower will do, but activity will do even more. There are many home exercise programs that do not require special equipment and, as I mentioned in a previous email, the Royal Canadian Air Force Program is still one of the best.

Worried about Alzheimer's Disease?
There is no known cure for Alzheimer's disease, but there are lots of over the counter preparations touted to be helpful (the majority worthless), and many healthy life styles that may help in prevention; see my brief review in a previous letter, available on my blog.

Recently, researchers at Rush Institute for Healthy Aging found that diets rich in specific flavonols were associated with a 48% lower incidence of Alzheimer's. The richest sources of these flavonols are common foods, mainly Kale, beans, spinach, apples, tomato sauce and olive oil. And some tea doesn't hurt either. Isn't this what we thought all these years? Yes. But it's nice to know!

Hypertension.
High blood pressure is a known risk for the development of premature heart attacks, strokes and kidney failure. It turns out that having your blood pressure checked at the doctor's office is not enough. If you have, or are suspected of having high blood pressure, it's very important that you check your own blood pressure at home. Some home devices are notoriously inaccurate (and I don't trust readings at the supermarket either...), but others are good, automatic, and keep records (I don't want to make waves by mentioning names here...). Regardless of what you get, the BP machine should be checked against a Mercury sphygmomanometer like the one we use at our office. Need a recommendation or calibration? Contact me.

But that's not the entire story. Blood pressure can fluctuate widely throughout the day. This may sound unintuitive, but BP may be highest when you wake up in the morning (sometimes referred to as "the morning surge"), and then may change with mood and activity.

All of this is very important information which is not available from a simple BP measurement at the doctor's office.

So, when BP is a potential problem, make sure you have a reliable BP machine. Check your blood pressure at different times of the day and under different situations. Above all, discuss your finding in person (or maybe Facetime) with your choice of physician so you don't carry the risks associated with high BP.

Until next time, keep safe distance and stay well, and until we're COVID-safe, see you on the phone!

Igal Staw, Ph.D., M.D.
www.drstaw.com
www.twitter.com/drstaw

Corona Update - Virtual Visits are Working - emailed 3/23/2020

To My Patients,  Hope you're well, keeping your distance, and avoiding contact with objects that could be contaminated by COVID 19.  Staying at home can be so boring...  Send me your ideas and pictures of the projects that keep you busy; with your permission, I'll share them with the rest of our patients!  Telemedicine Is Here! Virtual Office Visits via Video are Now Available Just Call 203-853-1919 or email istaw@drstaw.com to Set Up an Appointment!  We have minimized our office hours to the bare necessities, seeing some patients only when absolutely safe and necessary.  All the rest is done on the phone (I actually use my iMac most of the time), using FaceTime for those who have an iPhone, and using Zoom (click here for the Android app) for those who have an Android-based phone.  If you have an iPhone, there's nothing special for you to do, I just call you and turn on the FaceTime option.  If you have an Android phone, please download the Zoom app. When I call you, you'll receive an email invitation on your phone to "join the meeting." Accept it by clicking the link on the email invite. It's easy!  Please note: Insurance companies, including Medicare, will cover the cost of the telemedicine call; no copay. This will last at least until early May.  Another note: You can now use telemedicine for any medical issue, not just Corona virus issues.  Please continue to follow the general guidelines for corona precautions. But in addition, I urge you to get tested as soon as any symptoms appear, or if there's a suspicion of contact with an infected person or material. You may want to leave your mail or even grocery foods untouched in a safe place for two days before opening. Use gloves when necessary and change them frequently.  Above all: follow your sense of best, safe behavior!!!  Looking forward to seeing you in person, not just on the phone - as soon as the "storm is over."  Igal Staw, Ph.D., M.D. www.drstaw.com www.twitter.com/drstaw Dr. Staw on Facebook

COVID Update and Virtual Visits - emailed 3/20/2020

To My Patients,  The temperatures outside are rising and spring is here, but COVID 19 is still with us. As a primary care and pulmonary physician with many respiratory patients, I'm taking the present situation very seriously.  In an attempt to prevent the spread of disease, I've decided to temporarily reduce office hours.  Instead, we'll conduct "virtual visits" by smart phone - remember to smile, we'll be seeing each other on the phone. Here is what you need to do:  Call the usual telephone number, 203-853-1919. We'll tell you how to proceed. When you leave a message, don't forget to leave your telephone number. we'll respond as soon as possible.  Contact me by my personal email (as many of you have been doing all along) - istaw@drstaw.com.  If it's imperative that you need to be seen, we'll make special arrangements for that when we speak with you.  Routine medications will be refilled as usual, but in certain cases we'll do a virtual visit before renewal. Above all, adhere to the official guidelines, avoid potentially harmful contacts, and keep social and reasonable distance.  If you develop a fever, cough, shortness of breath or any other "suspicious" symptoms, call immediately - don't wait.  If you need a breath of spring air, walking outdoors is good. Just keep your distance. If it's still too chilly, exercise indoors; the Royal Canadian Air Force Exercise Plan (developed in the 1950's) is an excellent way to do it, you can find it on the net.  Stay well and away from crowds. See you on the phone,  Igal Staw, Ph.D., M.D. www.drstaw.com www.twitter.com/drstaw Dr. Staw on Facebook

More Coronavirus Info - emailed 3/8/2020

To My Patients,  Welcome to daylight savings time (hope you remembered...). We're back in the office from Denver, had great weather, enjoyed the family!  The Coronavirus calls are coming in daily; some are worried, others just looking for information.  As mentioned in last week's letter (now on my blog drstaw.com), and I re-state it here, follow the CDC guidelines as stated on their website.  We are taking special precautions in the office (in addition to the usual measures): Our patients will bypass the waiting room. Call before you get into the office; you can do it from your car in the parking lot, and we'll give you instructions: 203-853-1919.  We will not "overlap" patients, so that patients are separated from each other in both office space and time. But equally important is that you stay in the best health you can.  Make sure that: You've had your flu vaccine and, where indicated, the pneumonia vaccine.  Every acute respiratory illness is looked at.  Any chronic medical condition you have is optimally treated. This includes conditions such as asthma, COPD, diabetes, heart disease, hypertension (and many others), and many others.  If you're on immune suppressing medications (e.g., certain biologicals, long term cortisone therapy, chemotherapy), be even more vigilant.  Get enough sleep and do what you can to reduce stress, your immune system will thank you for it. If you have any questions or concerns about prevention or health optimization, call 203-853-1919 or email istaw@drstaw.com.  Please be reminded that we now participate in more insurance plans, including: Anthem/Blue Cross (including Emblem)  United Health (including Oxford)  ConnectiCare  Aetna  Medicare/Medicaid (including most Advantage programs)  There is no reason to panic, but there's all the reason to avoid risky behavior.  Stay well!  Igal Staw, Ph.D., M.D. www.drstaw.com www.twitter.com/drstaw Dr. Staw on Facebook

To My Patients - emailed 3/1/2020

Greetings from sunny Highlands Ranch, Colorado. The skies are really blue, the snow crested mountains are great, and all is well with the younger generation.  I keep getting questions about the Coronavirus. While there's no US epidemic at this time, precautions are in order. There's no need to repeat here what has been recommended by the CDC on their website.  However, at the office we may need to go beyond the usual recommendations, but certainly not to panic.  If you feel that there is a chance, even a very small one - or you're not sure - that you may have been at risk for exposure to the Coronavirus, then: Make sure you follow the CDC guidelines.  Call about 30 minutes before arriving at the office (even from the parking lot), so we can take appropriate measures and give you additional instructions. Above all, don't panic; call or email if you have any questions, we're back in the office on Wednesday (but feel free to call us sooner).  Stay well!  Igal Staw, Ph.D., M.D. www.drstaw.com www.twitter.com/drstaw Dr. Staw on Facebook

To My Patients - emailed 2/22/2020

Hope all is well. Winter is still with, us but not nearly as cold as some of us (the older guys) can remember. Some of our patients are home-bound and required urgent medical attention, so I made a few house calls (does anyone else still do that?). 

Our next mini vacation will be at the end of the month - a repeat Denver trip - the youngest grandchild's 7th. A little while after that, it will be Israel, we haven't been there in over two years. We'll be out of the office from Wednesday PM, February 26, through Tuesday, March 3. 

We'll be back in the office on Wednesday morning, March 4th. 

Please call (203-853-1919) Monday morning if you need anything before we go! 

And now to the business of medicine: 


The Flu

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The flu is still here, it's a second wave. If you think that you're coming down with it, don't wait to be treated. The earlier the better, the treatment can be a life saver. It's not time (yet) to worry about the Corona virus, but let's have the flu vaccine under our belt. 


Good Rx

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The high cost of medication continues to be the subject of so many (justified) complaints. If that's a problem you face, arm yourself with a coupon from goodrx.com. The price you'll pay is frequently less than your copay, and could be much less than the un-insured price. It may be worth doing pharmacy-shopping for expensive medication. 


CT Screening For Lung Cancer, a re-visit

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Cancer of the lungs and bronchi (the breathing tubes) remains, by far, the number one cause of cancer deaths in the US (projected to be approximately 137,000 in 2020), mostly caused by smoking. A lot has been said about prevention - just don't smoke - but early detection is also of major importance. 

Low-radiation CT scan of the chest has been recommended for several years by pulmonary physicians and the USPSTF (US Preventive Services Taskforce). It is recommended for people between the ages of 55-80 who smoked the equivalent of one pack a day for 30 years (2 pack a day for 15 years will qualify...), even if they quit smoking less than 15 years ago. 

When it comes to lung cancer, early detection is the key to survival. Many insurance companies will pay for lung cancer screening, and some radiology facilities will do it free of charge when there's no insurance. If you need it, don't think twice, just do it. 


Aspirin, Not Only For The Heart

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Several large-scale studies have shown that low dose aspirin taken on a regular basis is associated with a significant decrease in gastrointestinal cancer (for example, a 40% decrease in colon cancer, 38% decrease in stomach cancer, and a 34% decrease in pancreatic cancer). But it's not for everyone and there are side effects, so don't do it on your own, get a medical opinion - sounds like a great topic for our next visit! 


Do You Like Your Chocolate?

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It's OK to have some, even every day, as long as it's dark chocolate with over 70% cocoa. There are several claims for medical benefits, mainly through the flavanols in the cocoa. Some studies even suggest that it improves memory and recall (the proof: once you get used to it you never forget to eat it again. Take it from a chocoholic). 

Stay well, until next time! 

Igal Staw, Ph.D., M.D.
www.drstaw.com
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