This Time I'm the Patient + Office Hours

 To My Patients, 

Summer is over, the sun is hiding, but some of the late summer flowers are still here, and the autumn ones are coming up - definitely a bright spot. 

The office has been busy, both in-office, and face-to-face by telemedicine. We are still on a COVID schedule, seeing patients primarily Tuesdays and Thursdays plus "when necessary" by arrangement. More on the subject below. 

Speaking about myself, just had double-hernia surgery, from which I'm recovering rapidly, only had to change one workday and kept the schedule a little lighter for 2 days. The surgeon was great (but I prefer not to mention names on email). 

Sandy and I will be traveling to Denver at the end of this month, to see our younger son and his family, as we've been doing every few months (we try to see them, either here or in Colorado, at least 4-5 times a year). Our time away is listed at the end of this message. 

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

And now back to some real medicine: 

COVID
It's still with us, and not leaving soon. I deal with new COVID cases almost every day, sometimes multiple cases a day. Most patients have been vaccinated and "boosted," but are still getting it (none of them had received the newly released Bivalent Booster before contracting COVID). 

Unfortunately, COVID death rates in the US are still at the level of 380-400 a day, and there has been no definite decline in at least 6 months. Reliable studies calculated that, overall, vaccination has reduced COVID mortality by 80% down to today's level. 

The moral of the story: Get vaccinated/boosted, and make sure you get the new bivalent booster (includes the BA.4 and BA.5 subvariants); stay away from high-risk social gatherings (or at least wear a suitable facemask, I prefer the N95), and don't be embarrassed to use a hand sanitizer frequently. 

If you get symptoms which are commonly associated with COVID (sore throat, cough, nasal congestion, fever, malaise, etc.), don't assume "it's just a cold." Get tested, more than once, and if in any doubt - contact the office (call, leave message, email). The COVID antiviral medication is very effective, but you must act quickly. 

Telemedicine
Telemedicine, barely known before COVID and now commonly used, has been very effective in my practice. I use it 5+ days a week, from office or from home, and at hours when most medical offices are unavailable. Patients now have, or have access to, a growing variety of home monitoring devices. Aside of the old thermometer, it's common to have at home a reliable blood pressure machine, a pulse oximeter, a continuous glucose monitor (for people with diabetes), and/or pulse-irregularity monitor (as part of a wristwatch such as Fitbit, Apple Watch, and others). And many more are on the horizon. Using these devices, as the need arises, adds information, and makes telemedicine visit effective. 

As of now, most insurance cover the cost of the virtual visit; the copay or deductible still applies in most cases. 

You may find it interesting to see how Johns Hopkins describes the benefits of telemedicine, just click here. 

The formats I now use are FaceTime, Zoom and WhatsApp; this may change as regulations change. With enough public support and demand, I hope telemedicine stays with us after COVID is defeated, as a great adjunct to in-office medicine. 

Periodic Health Evaluation
There are various recommendations for periodic physical exams, but it's generally accepted that one should have a yearly physical starting at the age of 50. The periodic health evaluation/physical exam is your gateway to early detection and disease prevention, and so it is the gateway to better health. 

Most insurance companies pay for periodic physical exams, and many waive the copay and deductible. Some even give you an incentive to do it. An HSA (Health Saving Account) may cover any gaps. 

Medicare will pay for an Annual Wellness Visit, AWV (that's once every 365 days - this is how they define it). They don't pay for what we refer to as a physical exam, but we include all elements of the physical exam with the AWV at no special charge. 

To make a long story short, take advantage of the periodic physical exam/wellness evaluation. And if you have no insurance, we'll work with you - give us a call to schedule your visit - 203-653-1919. 

Time Away
Our mini-vacation time away from the office starts Thursday AM 10/27/2022, and runs through Wednesday 11/2/2022. 

We'll be back in the office on Thursday 11/3/2022, 9 AM. During our time away, Janine will be in the office as usual, and I will continue to check my emailfor your messages and ongoing needs. Your voice mail messages will be answered. 

Give us a call at 203-853-1919 if you need an appointment before we go!

Until I see you (physically or virtually…), stay well, 


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

More Health Pearls: Appetite control, Testosterone, Vitamin D

• Curb your appetite.  Almonds are a great snack, providing proteins, the right type of fats and, above all, a lot of antioxidants. Eating a few almonds as you become hungry between meals will help you curb your appetite and, in doing so, help you control your weight and provide excellent nutritional value. An ounce a day (or a little more) will help a lot.

• Men, are you taking testosterone? Beware of the low testosterone hype. Don’t take testosterone unless your need for it is evaluated, and then prescribed by a physician authorized to prescribe it (testosterone is a controlled drug). Taking testosterone unnecessarily, or taking too much of it, carries with it serious health risks such as premature heart attacks and prostate cancer.

• Vitamin D. Vitamn D, “the sunshine vitamin” plays an important role in a large variety of metabolic processes. It regulates the amount of calcium and phosphorous in the body, may improve balance and muscle strength in older adults. A low vitamin level is now considered a risk for increased heart disease and diabetes (especially in overweight people). It has a tendency to lower body inflammation, a desirable property. It’s important to make sure that your vitamin D level is not too low, even in the summer, when vitamin levels are higher. It’s a simple blood test; if your level is too low, it’s usually corrected with over-the-counter supplements.

Health Pearls: Back Pain, Aspirin, Best Fruits

• For common low back pain, Tylenol (acetaminophen), even in high doses, may not be any better than placebo (recent article in The Lancet). Over the counter NSAIDS, such as ibuprofen, or Aleve (Naproxen), or prescription meloxicam (Mobic) are generally effective. Better still, drug-free therapeutic massage therapy may be very effective. It works by relaxing the low back muscles, and by stimulating the brain to release pain-relieving dopamine and serotonin.
• If you take aspirin to lower your risk of a heart attack, you would want to make sure that the aspirin you're taking works for you. A simple urine test which measures Thromboxane A2 levels is available through our office to make sure you are not "aspirin resistant." Ask me about this at your next office visit!!!
• Summer time is fruit-eating time. Some of the best fruits are those that have a low Glycemic Load, namely they only minimally increase your blood sugar level. The best include: Strawberries (one half cup), cherries (12 cherries), and peaches (1 medium size). All have a Glycemic Load of 3 or less, which is very low and good.
  
  If you want a reliable list of the Glycemic Index of common foods, call the office or send me an email → istaw@drstaw.com.

Take a walk in the cooler hours of the day, and stay hydrated.

Omega-3, What’s the Real Story?

Omega-3 fatty acids are “essential fatty acids” that are required by the body in order to perform a variety of metabolic functions, but which our bodies can not produce. Our body must get them from the food we eat. They are classified as polyunsaturated fatty acids (PUFAs) and are considered to be “the good fats.”

There are three important omega-3s: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). EPA and DHA are found primarily in fish, krill, and calamari, and in algae (algal oil). They are present in the highest concentrations in fatty fish such as salmon, tuna, sardines and mackerel. ALAis commonly found in plant sources like flax seed, soy, walnuts and canola oil.

While the function of omega-3s is not fully understood, these fatty acids definitely play a definite role in our health. Their role is the subject of extensive ongoing research, and even controversy.

People at risk for heart disease and stroke, and those who already have one or both conditions, do better when they consume fatty fish several times a week. Eating the fish may be more effective than taking supplemental fish oil, perhaps because the fish contains other helpful substances, but the jury is still out on this one.

People with inflammatory diseases may benefit from an increased consumption of omega-3s. The list is long, and includes rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and Ulcerative colitis), lupus, and some forms of immune kidney diseases.

Fish oil may play a role in the prevention of a variety of cancers, age related eye disease, dry eye symptoms (keratoconjunctivitis sicca), anxiety, depression aggression, age-related cognitive function, and even Alzheimer’s.

Much of the beneficial effect of omega-3s is thought to be due to its ani-inflammatory function. The reasoning is that many diseases are either caused by or made worse by inflammatory processes in the body, and the less inflammation there is, the easier it is to bring the condition under control.

There is no agreement about how much omega-3 is enough, and how much is too much. Some authorities place the minimum daily requirement for healthy women and men at 1,000 mg and 1600 mg a day, respectively. A prescription drug, Lovaza (used to treat high triglycerides, a cardiac risk), provides more than 3,000 mg of omega-3s a day.

Recommended doses for different conditions vary throughout a wide range.

A reasonable-size portion of salmon, approximately 6 ounces, contains a little more than 800 mg of EPA and more than 1,100 mg of DHA.

So what’s the bottom line?

Two to three portions a week of salmon or another fatty fish a week, plus a variety of ALA-foods (walnuts, soy, and flax seed) should suffice for most healthy people.

If you are not a fish or ALA-food eater, you may want to take a fish oil and flax seed oil supplement.

If you feel that you have a condition that can be treated, at least in part, with fish oil, don’t do it on your own. The subject is very complicated and in a state of flux. It may involve consideration of other supplements, dietary changes and prescriptions. Above all, it requires a thorough understanding of your condition and the potential benefits of omega-3s, and knowledge of its limitations. Discuss it with your doctor!

Cholesterol News, Again?

In November 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for cholesterol therapy in adults 20-79 years old. The guidelines were based on solid medical evidence but, nonetheless, generated a lot of controversy and even opposing opinions from experts in the field. On one hand, the guidelines argue for limiting some of the cholesterol testing we now use as a guide for therapy. On the other hand, the guidelines recommend therapy (the use of statin drugs) for certain groups of patients, regardless of their blood cholesterol levels. The controversy which evolved was covered in articles in the New York Times last November. The two titles convey the opposing messages: Experts Reshape Treatment Guide for Cholesterol and Don’t Give More Patients Statins.

Some of the best known statin drugs now in use include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Lovastatin and Simvastatin.

A study on the subject was published in the New England Journal of Medicine of  3/20/2014by Michael J. Pencina, PhD, from the Duke Clinical Research Institute. It reports that the new guidelines would increase the number of U.S. adults eligible for statin therapy by almost 13 million, and that most adults between 60-75 years old would become candidates for treatment. I also refer to the guidelines in my blog of last November, Statins, To Take Or Not To Take.

The guidelines use a newly updated, computerized cardiac risk assessment tool, in deriving its recommendations. We use the same tool in our office.

 One has to remember that the guidelines are guidelines; they are not iron clad rules. Each case has to be judged individually. In the majority of cases, the guidelines should be followed. But there are exceptions. A small percentage of people just can’t take statins because of side effects. Others may be able to make lifestyle changes, such as diet modification, an increase in physical activity and weight loss, which may mitigate against the ill effects of high cholesterol. Others may have to be convinced that the benefits of taking a statin outweigh the risks. Still others may have to be convinced that they actually already have the beginnings of heart disease before they agree to take the medication. And then there is that group of patients that “just get away with high cholesterol.” Their families have had high cholesterol for generations, and they live well into their nineties or longer. They are the ones who wouldn't hear of statins…

When necessary, additional testing is done to further assess you heart disease risk, such as specialty blood work, and coronary artery calcium scoring.

So next time you’re in the office, ask about the new cardiac risk assessment (it’s free), and see if you really need to take a statin drug.

Are You Walking Outdoors Yet?

Our citron is being acclimatized to the outdoors. Are you?

And The Cough Goes On...

Do you have an untreated cough that has lasted for several weeks? If so, you are not alone. Many patients in my practice have been complaining about a cough that does not seem to go away. I have seen more of it this year than in other years, and it started back in November of last year.

Typically, one would have an episode of bronchitis, sinusitis, or the common cold, which may have been treated with a course of antibiotics. The initial symptoms then partially or fully resolve. A few days or a week later, the nagging cough develops, and is commonly referred to as “post infectious cough.”

The cough may be “productive” (producing mucus), or it may be “dry.” It can occur during the day, when you’re lying down at night, or throughout the night. In more severe cases, the cough will come in “volleys” (paroxysms), and will awaken you, or even frighten you. It may be associated with a post nasal drip or gastric acid reflux. Some medications, particularly some of the medication used for the treatment of high blood pressure, can cause a persistent, dry cough.

The underlying reason for the cough is an inflammatory process which affects the linings of the bronchial tree leading to the lungs. It’s similar to the process responsible for bronchial asthma. It is thought by some authorities that, when left untreated, this condition can leave you predisposed to a recurrence, or even trigger the new onset of asthma.

When the cough lingers, you should be examined by a physician. This is especially important if you have a chronic condition such as asthma, chronic bronchitis or heart disease, and even more so if you have an impaired immunity, take immune suppressing medications, or are a smoker.

In treating the persistent cough, the physician must make sure that conditions other than post infectious cough are ruled out, such as pneumonia, asthmatic bronchitis and the whooping cough (pertussis).

Once other causes have been ruled out or treated, the post infectious cough will resolve on its own. But it may take weeks, and I have seen it last for months. Treating it will generally shorten the duration and severity of the post infectious cough, and should make you feel better much faster.

So, when you develop a lingering cough, don’t just tough it out, have it evaluated medically, and treated if necessary.