emailed to patients 4/9/2026
To My Patients,
I Hope all is well.
Hope you enjoyed the last several warm days. We used some of that time to do outdoor work and begin preparing the garden for the coming growing season.
A Few Administrative Issues to be Aware of:
Pre-authorization For Medications
We receive denials for prescribed medications daily, and the number continues to grow steadily. This is not limited to GLP-1 medications. We frequently see denials involving insulin, common asthma inhalers, and many others.
You will often hear the pharmacist say, "All your doctor has to do is get a PA (prior authorization)." Unfortunately, this is often a tedious and time-consuming process, which may require appeals, re-appeals, and submission of chart documentation. Approval can take an inappropriately long time.
Insurance companies often favor their own medication lists (their pharmacopeia), which vary from plan to plan and are not always the best clinical choice. Don't be surprised if PA takes longer than expected, totally denied, or an alternate drug is approved.
Email Address - Action Required
As explained in a recent notice, my personal email address, istaw@optonline. net, was abruptly discontinued by Optimum for no stated reason. We were able to retrieve emails from the last five years through 4/8/2026.
Please use istaw@drstaw.com for all office communication. If there is a problem, use the alternate igalstaw22@gmail.com. If you believe I missed any prior emails sent to the old address, please resend them.
Now to Medicine:
Fatigue
Many patients complain of fatigue. Medically, this is an important but often misunderstood symptom. Fatigue means different things to different people - and frequently different things to the physician as well (that includes me).
By saying "fatigue," some patients mean sleepiness. Others mean low energy, reduced stamina, lack of motivation, muscle weakness, poor concentration, or simply "not feeling right." For that reason, the first step intreating fatigue is to define what type is really present.
Common causes include inadequate sleep, emotional stress, medication side effects, poor nutrition, dehydration, anemia, thyroid disorders, low vitamin B12, chronic inflammation, heart disease, lung disease, and blood sugar problems. Frequently, more than one factor is involved.
And it could be age related; but age itself is not the usual cause. Many seniors remain highly energetic, while younger adults may feel exhausted.
A detailed discussion, questions and answers, often provides the clue.
Laboratory testing can be helpful, but bloodwork alone does not always provide the answer. Sometimes treatment involves correction of iron deficiency, thyroid imbalance, uncontrolled diabetes, or vitamin deficiency. Other times it requires better sleep, improved fitness, stress reduction, or adjustment of medications, to name a few.
The key point: fatigue should not be ignored or blamed on age. If persistent, it deserves evaluation and usually can be improved once the true cause is identified.
Zepbound For Obstructive Sleep Apnea (OSA)
There is encouraging news for patients with obstructive sleep apnea and excess weight. Zepbound (tirzepatide) has recently received FDA approval for adults with OSA and obesity. With this new indication, some insurance companies may be more willing to provide coverage than before. Weight reduction can significantly improve sleep apnea severity and, in some cases, reduce CPAP pressure, or even eliminate the need for CPAP. If you think this may apply to you, we can discuss whether it is appropriate. If you believe that you have OSA, but it hasn't been documented, this may be a good time to get a sleep study.
Vegetables Revisited
We usually encourage you to eat "lots of vegetables," and for good reason. They provide fiber, vitamins, minerals, antioxidants, and help support metabolic health.
Some vegetables and legumes also contribute meaningful protein. Foods such as lentils, chickpeas, soybeans, peas, and edamame are especially valuable. They contain all essential amino acids - the ones the body cannot produce on its own and must obtain from food.
While many plant foods may not contain the full amino acid profile individually, a varied diet over the course of the day generally provides what the body needs.
Vegetables remain one of the best foundations for long-term health.
Challenge Yourself
Choose a vegetable you have not eaten before. Also consider quinoa - not a vegetable, but a highly nutritious seed that cooks like rice and beats it nutritionally.
And remember our Health Extenders motto:
Stay well,
Igal Staw, Ph.D., M.D.
