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

Friday, October 13, 2023

Thank you for your messages & Itinerary change

 To My Patients, 

Emailed 10/10/2023

In view of the horrendous, barbaric attack against Israel, which began on Saturday, 10/7/2023, we postponed our trip to Israel to a safer time. We will spend our planned time away from the office with our family in the US. 

We’ll be back in the office on Tuesday the 24th resuming our regular schedule. 

As usual, Janine will handle the phone, and I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases. 

Sandy and I received numerous calls, emails and texts from patients and friends inquiring about our safety, and that of our family and friends in Israel. As of the time of this writing, everyone is OK and accounted for. Sandy and I thank you for your concern. 

Please give us a call at 203-853-1919 if you need an appointment, or if you have any questions. 

Stay well, 

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

Tuesday, October 3, 2023

Office hours and some happy news


To My Patients, 

emailed to patients 10/1/2023

Hope all is well. 

It's been a while since the last "letter to patients," of mid-May. A lot has transpired. Our trip to Israel with our daughter in late May was great, our older granddaughter and her boyfriend where there at the same time - kept us going... 

The Colorado crew stayed at our house for about three weeks in June-July, lots of happy noise. We'll be celebrating their son David's, Bar-Mitzvah in Jerusalem in October, traveling with them and more family around the country (see below for time away from the office). 

This spring-summer season wasn't ideal for the garden. The vegetables and flowers were late, but the trumpet flower still managed to show up with its majestic colors, and the spider was able to weave its crafty net. 

Time in Israel: 

Sandy and I will be away for almost 2 weeks, in Israel, beginning Tuesday October 10th (after shorter office hours), until Monday October 23rd. We'll be back in the office on Tuesday, October 25th. 

As usual, Janine will handle the phone, I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases. 

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

Some Administrative "Stuff": 

Telemedicine: Telemedicine continues, but there are changes that may affect you. During the COVID emergency, which officially ended 5/11/2023, HIPPA privacy regulations were not enforced, they could be enforced now. For telemedicine, we are now using an application called, which is HIPPA compliant - it's very easy to use; you'll get a text invitation on your smart phone, click the enclosed link and the telemed session is on. Other communication formats can be used, even if not HIPAA approved, if you agree to it. 

Telemed has been a very effective tool for many patients who could not, or did not have to, come into the office to be examined. I hope that the authorities (and insurance carriers) do not limit its use but, rather, encourage its use and rapid development of telemedicine to a greater capability. 

As of now, both commercial insurance and Medicare/Medicaid have been covering telemed face-to-face visits. Medicare appears to be committed to covering it through 2024, but I hope forever. 

Hours and communication: The office continues to be busy, but that has not diminished the attention paid to each patient's needs. The office continues to be a solo practice, not hampered by the many levels of large company administration. We continue to keep the usual Tuesday, Thursday AM office hours, but have extended them as the need arises. 

We try to answer the phone during daytime hours no matter where we are. If, for some reason, we do not pick up the phone, please be sure to leave a message so we can address your issues. Voice messages generally reach me also by email, which I check regularly. In addition, you can always reach me directly by email at 

The COVID world: 

COVID: The US COVID emergency is officially over. But I'm not sure the COVID virus was notified. While the death rates have been declining gradually in the last few months, the last few weeks saw an uptick, with 1005, 944 and 614 in the last 1, 2, and 3 three weeks, respectively, as reported by the CDC (the same is seen nearly world-wide). While the cases are generally milder than what was seen with the delta strain (it's an XBB strain now), would still be careful to avoid exposure. Please report immediately if you, or someone with whom you've been in close contact, develop suspicious symptoms - especially if tested COVID positive at home. And don't forget to be vaccinated with the newly updated COVID vaccine, which was released a few days ago. 

The non-COVID world: 

Protein: There's no need to emphasize the body's need for an adequate dietary intake of protein. The protein we eat is broken down in the stomach to amino acids and then absorbed into the body through the small intestine. They are the building blocks of body structure and function, such as cell wall and its nucleus and enzymes. There are 20 amino acids used by the body, which can synthesize 11 of them on its own. But 9 amino acid are essential, the body cannot produce them on its own, they have to be available in our diet. 

Whole protein vegetables contain all essential AA's; the main ones are legumes (lentil, beans, chickpeas); tofu (it's soy-based); nuts and seeds, and whole grains (quinoa, brown rice, whole wheat - watch the last two if you have diabetes). 

In protein deficiency states, supplements will do. The good ones include casein and/or whey protein (they are dairy based). 

Need more information? You know how to reach me. 

Keto Diet: We get questions about the keto diet almost daily, mostly about its use for weight loss and weight management. So, what is it, and does it have any medical benefits? 

The keto diet is a low-carb, high-fat diet. It changes the way the body uses food to generate energy. Generally, most of the energy we use is derived from carbohydrates which turn into sugar in the body. When carbs are restricted, as in the keto diet, the body begins to use fat, in the form of keto acids, as its fuel. 

There are some advantages and caveats. The keto diet can bring about weight loss, mostly by extracting body fat and turning it into keto acids and by reducing appetite. It can be useful in certain medical conditions, including intractable seizures, better control of type II diabetes (it's the common type). Recent studies suggest that the keto diet slows down age-related mental deterioration. 

And there are caveats. The diet emphasizes fats. If not careful, one may be using a large quantity of saturated fats, usually found in high quantities in red meats and most processed meats. This may lead to an increase in cholesterol, with its heart disease risk, plus other medical risks. The diet is low in fiber and may cause digestive symptoms. 

I believe that most people on keto diet should minimize the consumption of saturated-fat foods and consider the use of a Medium-Chain Triglycerides (MCT) supplement. 

If you are on a keto diet, or are considering it, talk to me (don't get me wrong, I'm not pushing the diet). 

Periodic Health Evaluation: Most, if not all, insurance companies cover periodic physical exams or "periodic health check," at low, or no copay. Some even require it for continuation of care. In my view, expressed regularly, that is the gateway to better health, it's the time to assess your overall health, identify any health risks before they turn into disease, and eliminate or control them to the extent possible. Take advantage of it, and get an appointment! 

Vaccinations: Three vaccines you should consider getting very soon:
  • COVID (the recently approved one, BXX, now it's the only authorized one), get it as soon as available in your area.
  • RSV (Respiratory Syncytial Virus)
  • Flu - mid October would be fine
Are you protected against shingles, pneumonia, or hepatitis B? Unsure? - talk to us. 

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

Until next time, stay well, 

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

Friday, May 12, 2023

Office Hours and Spring Notes


To My Patients,

emailed 5-9-2023

Hope all is well. It seems that spring has finally arrived.
The office has been very busy, and we opened extra hours on an as- needed basis.

The Covid emergency is officially over on May 11th. I'm not sure yet that the COVID 19 virus knows about it! It's still causing 1000-2000 deaths a week, and if you extrapolate this to the entire year, this represents the 9th most common cause of death in the US. At its peak, COVID was the 3rd and 4th most common cause of death in the two preceding years.

COVID-protecting masks are now optional in our office. However, we do require that you wear a mask if you were not fully COVID vaccinated, and also if you have certain COVID-related symptoms, regardless of your vaccination status.

We still request that you call the office as soon as you arrive in the parking lot, in attempt to minimize or avoid waiting in the waiting room.

More about the changes that the end of the COVID emergency will bring about, including changes to telemedicine - in the next letter.

Sandy and I will be away for almost 2 weeks, in Israel, beginning Wednesday May 17, back in the office on Thursday, June 1.

As usual, Janine will handle the phone, I'll be able to receive email messages. If necessary, Janine knows how to find me, and Dr. Sarfraz will cover me in urgent cases.

Please give us a call at 203-853-1919 if you need an appointment A couple of notes for spring:

Allergy: The allergy season is upon us. There are several things you can do before you have to make a trip to the office:

Flonase (fluticasone) and Benadryl (or a non-sedating antihistamine such as Claritin, Zyrtec) are over the counter and can be tried for nasal congestion and general allergy-related symptoms.

Astepro (azelastine) is a nasal spray antihistamine that recently became available over the counter.

If you have allergy-related asthma, don't forget to use your inhaler as instructed. These are prescription medications. If you're using them seasonally, make sure they are accessible.

Tick bite: The deer are out there, and so are the ticks. The most common tick- borne disease is Lyme Disease. But there are others, such as Ehrlichiosis and Babesiosis, and the treatment could be different from that of Lyme. It's therefore important to bring the tick, especially if the tick is blood-engorged, to the local Health Department for identification. And don't forget to let us know you've been bitten by a tick as early as possible after you realize it.

Keep your mind sharp: Spring is the greatest time to do so. Spend some time outdoors, exercise (nothing wrong with walking outdoors), eat well (which for most people is the Mediterranean Diet), and get enough sleep. You'll be surprised to see the mind-body connection.

Please give us a call at 203-853-1919 if you need an appointment Until next time, stay well,

Igal Staw, Ph.D., M.D. Dr. Staw on Facebook

Office Hours & a Great Longevity Tip


To My Patients,

emailed 4-6-2023

Hope all is well - Last month, Sandy and I were away on a long weekend in Jumby Bay Island, Antigua. It was a special occasion that brought together 10 of our immediate family members (4 generations), to honor the life of our late son in law. The experience was unforgettable

More family news, we'll be visiting our Colorado clan, which we try to do several times a year. They usually stay with us 2-3 weeks during the summer. We'll be away for a week from Wednesday April 19th through Wednesday April 25th, and back on the office on Thursday April 26th with morning office hours.

As usual, Janine will be available for phone inquiry/scheduling, and I'll be reachable by email. In case of need, Janine knows how to get me, but if you need something, give us a call before we leave!

If urgent care is needed while we're away, Dr. Sarfraz will cover me, 203-254-9454.

Please give us a call at 203-853-1919 if you need an appointment And now to some real issues:

Cost of medicine and related issues

The cost of medical care in the US is now more than $12,000 a year per person, about 18% of GDP, and It's more than twice the average cost of medicine in the 30 OECD countries (Organization for Economic Co- operation and Development).

You'd think we would get better care, would you?

It's very disappointing to find that Americans see their doctor more frequently than in other developed countries, but suffer a great deal more chronic conditions (not just obesity...), and have an overall average life expectancy of 77 years, three years less than in other developed countries.

Care can be costly. Insurance premiums are climbing. Copays and deductibles are going up steadily, medication denials are now common; insurance companies are frequently more interested in bottom line than in their patients' health. As a result, between 6-10% of people in the US have no medical insurance, and many more are under-insured.

While there is no easy way to fix things with our present healthcare system, one thing has been very clear, and I've been emphasizing this for years.

One has to be an integral part of his own health care system. Those who "do the right thing" have a better key to a longer, healthier life. This includes staying in good physical shape, keep weight in check, sleep adequately, avoid "offensive" foods, and the list goes on.

When it comes to medication, take all the medication you need, but take only the medications you need, which frequently needs to be coordinated with multiple caregivers.

Just in case you wondered why I wrote this - We're here to help!

The erythritol issue

Erythritol is an artificial sweetener that belongs to a class known as alcohol sugars (e.g., xylitol, sorbitol, maltitol and others). These sweeteners are very low in calories and are used in many sugar-free and keto-type diets. Recent studies suggest (but do not yet prove) that the consumption of large amounts of erythritol increases the risk of cardiovascular events such as heart attacks and strokes. This may apply to the entire class of sugar alcohols. The mechanism for this effect appears to be related to an increase in blood clotting.

A "Large amount" of erythritol is taken to be 30 grams (that's 5-6 teaspoonfuls) which, if taken within a day or two, has been shown to increase clotting tendency. Generally, this is a much higher dose one would consume in 1-2 days.

Erythritol is the main component of several artificial sweeteners (Truvia, Splenda, and others). The suspicion is out there. If you're going to use erythritol, or any other sugar alcohol sweetener, do it in minimal amounts. If you're at heart disease risk, avoid it!

A longevity hint

Numerous studies of "super age seniors" (those above 85 years old) and centenarians (those above 100 years old) looked at the elderly's eating habits. The common finding is that longevity is associated with a diet low in animal protein (mainly red and processed meat!), but rich in vegetable protein, mainly beans, grains and soy products.

One explanation for this longevity observation is that red meat contains specific amino acids like methionine and branched-chain amino acids that can accelerate the aging process. Of course, this is only one component of many factors that influence longevity, but no one should overlook it.

Please give us a call at 203-853-1919 if you have any questions Until next time, stay well,

Igal Staw, Ph.D., M.D. Dr. Staw on Facebook

Wednesday, March 15, 2023

Big Game Sunday with Some Medical News

 To My Patients,

Emailed 2/12/2023

Hope all is well. It was crazy weather over the past few weeks - cold, warm, who knows! Stayed home, a good opportunity to get some paperwork done and do some writing.

Despite the recent cold weather, it's almost time to set vegetable and flower seeds for the spring. It would be nice to awaken the Canna plant from its winter sleep soon, it bloomed so beautifully last year.

Canna Flower

Some things to know:

Billing statements
Please remember that we now send most of our billing statements by email rather than through the regular mail (saving some trees...).

Medication refill and new prescriptions
As of the beginning of the year many insurance companies made changes to their formulary ("allowable medications") and frequently require pre-certification and/or a change to what they consider an equivalent drug. Frequently you'll hear the pharmacist say, "all your doctor has to do is call the insurance company." Easier said than done. It causes unnecessary delays in filling new prescriptions, and, too often, denials. We do our best to overcome the imposed obstacles.

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

End of COVID emergency
The government announced that it intends to end the COVID public health national emergencies on May 11, 2023. This will most likely mean a loss of coverage, or a reduced coverage, for people who need to be tested or treated for COVID. The burden of coverage will shift from the government (that's who's fully paying for it now), to the insurance companies, who may then shift a portion of the cost to the insured, you.

I believe that this will cause unnecessary delays in COVID diagnosis and treatment and may put an additional burden on the emergency rooms, thereby increasing medical spending.

Telemedicine continues full speed. But the end of the COVID emergency may bring with it a change in telemedicine insurance coverage. I hope the those in charge have enough sense to continue, and expand, telemedicine coverage, and to make it attractive for industry to develop more-sophisticated home monitoring systems. If done, this could help bring the cost of medicine down, and make many areas of medicine more readily available to the patient.

Now, some real medicine:

Connecticut is one of 22 states with no known recent COVID deaths (none in approximately 5 months in Connecticut!). But the disease is still with us, we're dealing with it on an almost-daily basis. Prevention and treatment are working better now, aided by the decreased virulence of the most recent COVID variants.

Approximately 70% of Americans are fully vaccinated against COVID. An impressive number, but not enough for herd immunity. We can't let our guard down, or the disease will spread again. Remain cautious.

What about fatty liver?
As the name implies, a fatty liver is a condition in which our liver cells accumulate an excessive amount of fat. Experts claim that almost 40% of American adults have a fatty liver. If ignored, it can progress to fatty liver disease, which can be very dangerous. Having no symptoms in the beginning, it's really an American silent epidemic.

There are two types, AFLD and NAFLD (alcoholic and non-alcoholic liver disease, respectively).

The treatment of alcohol-related liver disease, in its early stages, is rather intuitive - but it's not always easy to get off the stuff. I won't elaborate.

According to the Cleveland Clinic, nonalcoholic fatty liver affects approximately 37% of American adults (it's the most common chronic liver disease worldwide). It can progress to an inflammatory liver disease and fibrosis, then cirrhosis. In some cases, it can give rise to liver cancer.

People at highest risk for NAFLD are the obese, and those with type 2 diabetes (the common type). Other risk factors include sleep apnea, hypothyroidism, and genetic factors.

Diagnosis is usually fairly easy (abdominal ultrasound, blood tests for liver function) but, in most cases, treatment is mostly up to you - it's the "good life therapy" of minimizing alcohol consumption, weight loss, and a rigorous routine of exercise. The Mediterranean Diet is very helpful.

Treatment of NAFLD should be followed medically in the office, with advanced disease followed by a specialist.

Need a copy of the Mediterranean Diet (as a diet lifestyle)? Let me know, you'll get it by email.

Pneumonia vaccine
The vaccine is routinely recommended for people over the age of 65, and for people over the age of 19 who have certain chronic diseases or may otherwise be susceptible to the development of pneumococcal pneumonia. The guidelines were updated recently and made much simpler to follow. The vaccination my consist of either one or two shots, depending on past vaccinations, and may have to be given 8 weeks or one year apart, depending on the type of vaccine used.

If you have any questions about this important vaccine, please contact the office or send me an email.

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

Until next time, stay well,

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

Internal Medicine * Pulmonary Medicine * Preventive Medicine * Health Risk Reduction
2000 Post Road, Fairfield CT 06824
(203) 853-1919

Monday, January 30, 2023

Great News on Coffee and Chocolate

 To My Patients,

Emailed to patients 1/16/2023

Hope all is well - Winter is here, with a touch of snow on the ground today – hasn’t been bad in our area. For winter, we rely on solutions: boots, coats, snowplows. For health, we try to get away with resolutions – but actual solutions work out much better than resolutions, which fade away by January 13th.

So don’t just resolve to lower your carbs, move around more vigorously, get your colonoscopy or physical exam, just do it!

Sandy and I are happy to announce the birth of our second great-grandchild, Liam, on January 11th!

Some procedural issues:

As stated previously, we’re trying to send as many periodic statements as possible by email, rather than by snail mail (we think that even a small contribution to tree saving is important). If you object to an emailed statement, please let us know.

Pre-certification is frequently required by insurance companies for many medications, and before diagnostic procedures.

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

In our practice, the big  victim medications  include common inhalers and injectable medication for diabetes (also used for weight loss). The main  victim test  is an MRI. Approval, if finally obtained, may require several steps which are frequently time consuming and frustrating. It’s usually caused by unnecessary delays by the insurance companies.

So, when there’s a pre-cert issue, please know that while we try to help, the pathway is not always smooth - call early so we can help.

COVID is still with us. While it’s occurrence level in Connecticut has been relatively stable, it’s incidence in the US is rising. The daily US COVID fatality rate last week was close to 400 a day, about 10% higher than the previous week. If one were to extrapolate this to a yearly rate, then COVID is now the 9th most common cause of death in the US (far exceeding flu fatalities). Despite recent controversy, the COVID vaccine still significantly reduces the number of severe COVID cases and hospitalizations. Do keep up with your vaccinations.

And now little almost-medicine:

Are you a chocolate  addict? 
If so, that may not be so bad, especially if you eat the right kind of chocolate in moderation.

Chocolate is big business, almost worldwide. Americans spend 20 billion (yes, billions with a B) dollars a year on chocolate confectionery and consume about 20lbs. of it each year per capita.

The health benefits of cacao, the valuable ingredient in chocolate, are modest but well established, related mainly to cocoa flavanols. They include an overall lowering of cardiovascular disease and the chance of developing diabetes, modest improvements in exercise and physical performance, and even an improvement in memory and mental fatigue.

But there’s a caveat: In a chocolate bar (or chips, bits), what’s not cacao, is usually sugar. If sugar is the first-listed ingredient, avoid the product or be satisfied with a very small amount. Cocoa naturally contains trace amounts of Cadmium - which is naturally present in the soil, not from cacao processing. It also contains trace amounts of lead, which may attach to the cocoa beans (usually inadvertently) during the drying and fermentation process.

The best chocolate is the one that has at least 70% cocoa and contains the least amounts of the heavy metals cadmium and lead.

According to Consumer Lab, an independent food testing laboratory, popular chocolate bars with acceptable cadmium levels are Ghirardelli Intense Dark 72% and 86%, Valrhona Albino Dark 85%, Taza Chocolate Organic 70%, and Mast Organic Dark 80% cocoa. Others may also be acceptable, but test results, if any, are not publicly available.

So, go ahead and enjoy your chocolate in moderation, and try to choose the right ones.

Are you a coffee  addict? 
Like eating chocolate, drinking coffee may not be so bad either.

True, a large amount of coffee (or caffeine in other forms of food) may have some detrimental effects, including insomnia, an increase in heart rate, heart burn and anxiety. In very large amounts, it can even cause medical dependence, and withdrawal symptoms if stopped abruptly (we’ve seen this in our practice on a few occasions, and I believe we saved one marriage or more by making the diagnosis).

But the good news, and there’s plenty of it, is that coffee is known to increase cognitive function and may boost physical performance. It reduces the risk of developing the common type 2 diabetes and Parkinson’s disease and appears to have a protective effect on the liver, perhaps even on liver cancer. It contains a lot of beneficial antioxidants which protect our body cells from the harmful effects of free radicals, and trace amounts of essential nutrients such as potassium, magnesium, and B vitamins. Decaffeinated coffee (which does have a little caffeine in it), still carries with it many of the benefits of caffeinated coffee and has fewer side effects.

What’s considered safe? This may vary from one person to another. According to the American Heart Association, up to 400mg of caffeine a day for an otherwise healthy adult is considered safe. This includes caffeine consumption from all sources of dietary caffeine, such as tea, soda, and many  energy drinks. 

Examples of caffeine content of popular drinks include:
  • Starbucks dark roast - 260 mg ( tall cup )
  • Starbucks espresso - 150 mg/shot
  • Espresso (not Starbucks) - average 75 mg per  shot 
  • Regular drip coffee average 135 mg/ 8 oz cup
  • Black tea 50 mg /8 oz cup
  • Energy drinks – 200 mg or more per 8 oz (always check the label!)
And the list goes on, with many variations..., much more on

To answer your inevitable question, yes, chocolate does have caffeine. The darker the chocolate, the more caffeine it has, about 20mg caffeine per oz of 70% chocolate bar. You may not want to consume too much of it before bedtime...

Go ahead and enjoy the benefits of coffee, just don’t overdo it.

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

Until next time, stay well,
Igal Staw, PhD, MD

Twitter / Dr. Staw