.
I hope you were able to stick to your health-related New Year's resolutions. I didn't make any, so I'm absolved.
The three most common and important health-related resolutions are: weight loss (or weight control), increasing physical activity/exercise, and smoking cessation. Have you done your share? Most Americans forget about their resolutions by the end of January. Don't let it happen to you.
About Me
- Dr. Staw
- My practice motto has been "we help you live a longer, healthier life..." I’ve been in private practice 35 years, and in the last 25 years have placed great, and ever increasing, emphasis on prevention. I practice preventive care by first identifying health risk factors (the factors which predispose you to disease) and then developing the best strategy to minimize or eliminate these risks. Special diagnosis and treatment tracks in my office include asthma, COPD, high cholesterol and obesity, and diabetes.I now place special emphasis on the provision of truly affordable health care to all, including patients with HSA's, high co-pays, and high deductibles.
Sunday, January 31, 2010
Monday, December 21, 2009
New Year's resolutions... why wait?
.
As 2010 approaches, many of us are ready to make New Year’s resolutions. Some of the most popular resolutions have been to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, despite economic difficulties, and may be because of them, more people are resolving to change their lifestyle, enjoy life more, and devote more quality time to their family. In short, many people are deciding to have a less stressful life, and also that less is more.
In reality, 50% of those who start an exercise program drop out within 6 months (or much less...) and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of the rest, daily stresses resurface. So how do you succeed?
Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For many, this translates into increasing exercise, and managing stress.
Exercise: For beginners, it is extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.
Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.
Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.
The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. For a good example look at the blog Stress, Relaxation and the Mind-Body Connection, on the left hand column (September 2009).
There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.
People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…
As 2010 approaches, many of us are ready to make New Year’s resolutions. Some of the most popular resolutions have been to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, despite economic difficulties, and may be because of them, more people are resolving to change their lifestyle, enjoy life more, and devote more quality time to their family. In short, many people are deciding to have a less stressful life, and also that less is more.
In reality, 50% of those who start an exercise program drop out within 6 months (or much less...) and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of the rest, daily stresses resurface. So how do you succeed?
Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For many, this translates into increasing exercise, and managing stress.
Exercise: For beginners, it is extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.
Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.
Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.
The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. For a good example look at the blog Stress, Relaxation and the Mind-Body Connection, on the left hand column (September 2009).
There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.
People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…
Tuesday, December 1, 2009
Insuring the uninsured
.
A headline article in today’s New York Times entitled No Big Cost Rise in U.S. Premiums Is Seen in Study is very revealing, but fails to tell you who will really pay for this No Big Cost Rise.
For people buying their own insurance, which, includes the unemployed, self employed and uninsured, the article quotes the Congressional Budget Office
“…as a result of the subsidies, it said, most people in the individual insurance market would see their costs decline, compared with the costs expected under current law. The subsidies, a main feature of the bill, would cost the government nearly $450 billion in the next 10 years and would cover nearly two-thirds of premiums for people who receive them.”
It does stand to reason that if you buy a health insurance policy on your own, and some of the payment is subsidized, then your premium will not go up, or may be even be lower. But where will this 450 billion subsidy come from? It can come from printing more money, and it can come from raising taxes (or both).
I believe that the majority of Americans are for some form of medical health coverage for everyone. But let’s not hide the fact that we are all going to pay for it.
I also believe that the best way to decrease the cost of health care is to reduce the need for health care. This is done by paying serious attention to disease prevention and the establishment of healthy lifestyles as the New American Way.
A headline article in today’s New York Times entitled No Big Cost Rise in U.S. Premiums Is Seen in Study is very revealing, but fails to tell you who will really pay for this No Big Cost Rise.
For people buying their own insurance, which, includes the unemployed, self employed and uninsured, the article quotes the Congressional Budget Office
“…as a result of the subsidies, it said, most people in the individual insurance market would see their costs decline, compared with the costs expected under current law. The subsidies, a main feature of the bill, would cost the government nearly $450 billion in the next 10 years and would cover nearly two-thirds of premiums for people who receive them.”
It does stand to reason that if you buy a health insurance policy on your own, and some of the payment is subsidized, then your premium will not go up, or may be even be lower. But where will this 450 billion subsidy come from? It can come from printing more money, and it can come from raising taxes (or both).
I believe that the majority of Americans are for some form of medical health coverage for everyone. But let’s not hide the fact that we are all going to pay for it.
I also believe that the best way to decrease the cost of health care is to reduce the need for health care. This is done by paying serious attention to disease prevention and the establishment of healthy lifestyles as the New American Way.
Sunday, November 29, 2009
What really ails us?
.
We all know the grim statistics. The four most common causes of death in the US in the last few years have been heart attacks, cancer, stroke and chronic lung disease, accounting for almost two thirds of all deaths, or close to two million deaths last year. Health care expenditure in the US is now over 2.2 trillion dollars a year, approximately $7,400 per person in 2007. The cost is now over 16% of our gross national product, and is expected to rise to 20% within 10 years. The out of pocket cost to you in the form of co-pays, deductibles and non-covered services is also increasing dramatically, from an average of $850 per person 3 years ago to an estimated $1,400 in less than ten years. And in comparison with other industrialized countries, we are losing our edge and are actually lagging by many measurements of health care, such as longevity and infant mortality.
What does all of this mean to you, the health care consumer? As you’ll see, you’ll have to actively participate in your own health care.
In a landmark article published back in 1993 in JAMA (the official Journal of the American Medical Association) but rarely quoted since then, McGinnis and Foegel published what they described as the “Actual causes of death in the United States.” In that article they identified modifiable factors that contributed to death in the US, such as smoking and obesity. In a subsequent JAMA article in 2003, another group of investigators (Dr. Mokdad and others) found that about half of all deaths in the US in the year 2000 could be attributed to “a limited number of largely preventable behaviors and exposures.” The main culprits were: smoking, obesity and physical inactivity, and alcohol consumption, in that order. Also in the top ten were: infections, toxic agents, use of firearms, sexual behavior patterns, motor vehicle accidents, and the use of illicit drugs. What’s most important, lifestyle factors are playing an increasing role in the development of disease in the US. The biggest negative change is a steady rise in obesity and a continuing decrease in physical activity. And it will only get worse as our overweight children become overweight adults. If allowed to continue, this factor will soon overtake smoking in importance.
What is true for actual causes of death is doubly true for what I would like to term the actual causes of disease. It is disease prevention that we’re looking for, which inherently will bring along with it an increase in the quality of life and longevity, together with a reduction in the need for, and the cost of, medical care.
Who will help you modify the harmful lifestyles? Your doctor can give you advice. But he/she can only go so far. Third party payers such as Medicare and most HMOs frequently deny or ignore payment for these extremely important lifestyle services which are both lifesaving and make excellent economic sense. And I doubt the new health care reform will give what really ails us the serious attention it so badly needs.
The fight for disease prevention is mostly yours.
So, buckle up, get the best lifestyle advice from a knowledgeable physician, and stop smoking, decrease the size of your food portions, increase your physical activity, drink alcohol in moderation and wear your seatbelt.
We all know the grim statistics. The four most common causes of death in the US in the last few years have been heart attacks, cancer, stroke and chronic lung disease, accounting for almost two thirds of all deaths, or close to two million deaths last year. Health care expenditure in the US is now over 2.2 trillion dollars a year, approximately $7,400 per person in 2007. The cost is now over 16% of our gross national product, and is expected to rise to 20% within 10 years. The out of pocket cost to you in the form of co-pays, deductibles and non-covered services is also increasing dramatically, from an average of $850 per person 3 years ago to an estimated $1,400 in less than ten years. And in comparison with other industrialized countries, we are losing our edge and are actually lagging by many measurements of health care, such as longevity and infant mortality.
What does all of this mean to you, the health care consumer? As you’ll see, you’ll have to actively participate in your own health care.
In a landmark article published back in 1993 in JAMA (the official Journal of the American Medical Association) but rarely quoted since then, McGinnis and Foegel published what they described as the “Actual causes of death in the United States.” In that article they identified modifiable factors that contributed to death in the US, such as smoking and obesity. In a subsequent JAMA article in 2003, another group of investigators (Dr. Mokdad and others) found that about half of all deaths in the US in the year 2000 could be attributed to “a limited number of largely preventable behaviors and exposures.” The main culprits were: smoking, obesity and physical inactivity, and alcohol consumption, in that order. Also in the top ten were: infections, toxic agents, use of firearms, sexual behavior patterns, motor vehicle accidents, and the use of illicit drugs. What’s most important, lifestyle factors are playing an increasing role in the development of disease in the US. The biggest negative change is a steady rise in obesity and a continuing decrease in physical activity. And it will only get worse as our overweight children become overweight adults. If allowed to continue, this factor will soon overtake smoking in importance.
What is true for actual causes of death is doubly true for what I would like to term the actual causes of disease. It is disease prevention that we’re looking for, which inherently will bring along with it an increase in the quality of life and longevity, together with a reduction in the need for, and the cost of, medical care.
Who will help you modify the harmful lifestyles? Your doctor can give you advice. But he/she can only go so far. Third party payers such as Medicare and most HMOs frequently deny or ignore payment for these extremely important lifestyle services which are both lifesaving and make excellent economic sense. And I doubt the new health care reform will give what really ails us the serious attention it so badly needs.
The fight for disease prevention is mostly yours.
So, buckle up, get the best lifestyle advice from a knowledgeable physician, and stop smoking, decrease the size of your food portions, increase your physical activity, drink alcohol in moderation and wear your seatbelt.
Tuesday, November 10, 2009
Better sleep, better golf
.
Are you a golfer, and do you have sleep apnea?
If so, the news is quite encouraging. In a study presented at the 2009 annual meeting of CHEST in San Diego, it was shown that patients with sleep apnea who were treated with a continuous positive pressure device during sleep (a common treatment for sleep apnea), improved their golf scores significantly after several months of treatment.
This study only confirms what we already know about sleep, lack of sleep, and sleep apnea: Better quality sleep improves performance.
So, if you (or someone who observed you while you sleep) think that you have sleep apnea, be proactive, take the next logical step and seek medical advice.
Are you a golfer, and do you have sleep apnea?
If so, the news is quite encouraging. In a study presented at the 2009 annual meeting of CHEST in San Diego, it was shown that patients with sleep apnea who were treated with a continuous positive pressure device during sleep (a common treatment for sleep apnea), improved their golf scores significantly after several months of treatment.
This study only confirms what we already know about sleep, lack of sleep, and sleep apnea: Better quality sleep improves performance.
So, if you (or someone who observed you while you sleep) think that you have sleep apnea, be proactive, take the next logical step and seek medical advice.
Sunday, November 1, 2009
Exercise prevents diabetes
.
We have known for many years that regular exercise (cardio, plus weights, plus stretching, for 20 minutes or more each session, most days of the week) helps a great deal in the control of diabetes.
Also, we've been saying for over ten years, that vigorous exercise plus dietary discretion can delay the onset of diabetes for an indefinite period for many individuals.
An October 29, 2009 article in The Lancet reports a study (Diabetes Prevention Program, DPP) done on patients at high risk for the development of diabetes. The study concludes that an intensive lifestyle prevention program can prevent or delay the onset of diabetes for at least 10 years.
This really validates much of our thinking about the development of diabetes.
Imagine, another 10 years free of diabetes with lifestyle changes and no medications!
And imagine the cost saving to you and to the health care system.
So what are you doing it? and if not, what are you waiting for?
We have known for many years that regular exercise (cardio, plus weights, plus stretching, for 20 minutes or more each session, most days of the week) helps a great deal in the control of diabetes.
Also, we've been saying for over ten years, that vigorous exercise plus dietary discretion can delay the onset of diabetes for an indefinite period for many individuals.
An October 29, 2009 article in The Lancet reports a study (Diabetes Prevention Program, DPP) done on patients at high risk for the development of diabetes. The study concludes that an intensive lifestyle prevention program can prevent or delay the onset of diabetes for at least 10 years.
This really validates much of our thinking about the development of diabetes.
Imagine, another 10 years free of diabetes with lifestyle changes and no medications!
And imagine the cost saving to you and to the health care system.
So what are you doing it? and if not, what are you waiting for?
Monday, October 26, 2009
How important is Apo B?
.
Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.
HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.
Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?
After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.
In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.
The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.
We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?
Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.
Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.
Let your political representatives know that you care and want to change.
Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.
HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.
Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?
After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.
In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.
The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.
We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?
Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.
Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.
Let your political representatives know that you care and want to change.
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