Think prevention and early detection

We now answer our phone as “Doctor’s office” rather than “Doctor Staw’s office,” and there’s a reason.

As of Monday, January 16, a new physician in town is sharing office with me. His name is William Sanchez, specializing in family practice. Dr. Sanchez was born in the Dominican Republic, where he also attended medical school. He did his medical training at Columbia Presbyterian in New York City and at the University of Arizona, Tucson, AZ.

While Dr. Sanchez and I will each maintain our separate practices, both of us expect to be working closely together; we firmly believe in the value of early detection and preventive medicine. Office cost sharing will allow both of us to give our patients the type of service which is only available in a “solo practice.”

Our office is now in the midst of implementation of our newly acquired EMR (electronic medical records) system. It takes a little while to get used to it, but I know it will be worth it at the end. More about it in the next blog(s).

Don’t forget to request your renewals by email at renewals@drstaw.com. You can also contact me for non-urgent matters at istaw@drstaw.com.

Stay warm.

Smoking, lung cancer, and early detection

Smoking is the number one primary cause of premature death in the US (did you know that the obesity-sedentary lifestyle is number two?)

Many pulmonary physicians, including myself, argued for many years that periodic x-rays of the lungs in heavy smokers could save lives. Several years ago a study showed that doing chest CT scans in heavy smokers leads to early detection and possibly a better cure rate. All this was met with harsh criticism from many professional organizations (I wonder why).

But what the pulmonary specialists knew for quite a few years was finally shown to be true in the June 29 edition of the New England Journal of Medicine. The use of low radiation, periodic CT scans of the lungs in heavy smokers led to early cancer detection, and thereby saved many lives. This is not the total answer to lung cancer, but it certainly helps.

So, if you are a heavy smoker and have not discussed the cancer risk issue with your physician, do it now. If your insurance company doesn't cover this screening test, I know several radiology practices that will do it for $300, and it's well worth it.

Suboxone treatment resources

If, for whatever reason, you have developed an opiate dependency problem, this may be an excellent time for you to quit. Suboxone is gaining popularity as a medical, office-based opioid dependency treatment program.

Fewer than 3% of US physicians are certified to prescribe Suboxone. Most of those certified are psychiatrists. In our area, very few internists, like myself, are Suboxone-certified.

You can find Suboxone-certified physicians at http://www.suboxone.com/, and you can try to match up with one by email at http://www.treatmentmatch.org/local/.

For additional information you may want to watch my interview of the weekend of 11/5/2011, Cablevision channel 12.

On a personal note...

Getting the garden ready for the Fall and Winter. Have you ever seen a Marigold this tall (or a doctor this short)?

Suboxone treatment for opioid dependence

Opioids are prescribed in the US mainly for pain control. This includes medications like Codeine, Percocet, Vicodin, Oxycodone, Dilaudid, and many other branded and generic drugs. Chronic use of these medications, even when used appropriately, can lead to opioid dependence.

Opioid dependence is characterized by "an individual's inability to stop using the opioid despite the fact that stopping its use would be in his/her best interest." Criteria for the actual  diagnosis of opioid dependence have been developed by the World Health Organization, and are widely used by physicians in office practice.

The complications of long term opioid use are numerous and, besides physical dependence and addiction, include liver dysfunction, constipation, nausea, respiratory depression, and many more.

Opioid dependence can lead to opioid abuse, a much more dangerous condition with many medical and legal adverse outcomes.   

    

What do you do when it's time to get off the opioid pain medication, and you can't do it because of drug dependence?

The newest trend is to use Suboxone. Suboxone is a two-component medication which contains buprenorphine (itself an opioid) and naloxone. It works primarily by preventing withdrawal symptoms and controlling the craving for the opioid medication. It allows you to remain active in daily life activities such as work and family functions. The medication is taken daily, and comes in a wafer form which dissolves rapidly under the tongue.

Physicians have to go through specific training to become certified in the administration of Suboxone.

I am now certified to prescribe Suboxone. The advantage of having an Internist manage Suboxone therapy is that general medical issues and opioid dependence issues can now be treated in the same office setting in an integrated manner.

Feel free to share this information with those who may need help. If you need more information, please give us a call.