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.
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 Doxy.me, 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 firstname.lastname@example.org.
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
Until next time, stay well,
Igal Staw, Ph.D., M.D.