Carvings July 16, 2021

In the news

Uh-Oh! Another variant. And what about those “breakthroughs”?

            We were told very early in the COVID-19 pandemic that we could expect mutations to arise and that some of these might carry severe consequences and might be able to evade any vaccine. The good news is that although some changes have occurred – a recent variant dubbed Delta does have the capacity to spread more easily – the three vaccines currently in use in the United States maintain their effectiveness.

            One of the most frustrating things about this virus is that it doesn’t seem to play by the rules. It causes symptoms and complications that no one anticipated. Even the vaccines – although they work much better than the most optimistic of us expected – cause serious, sometimes deadly side effects.

            As I noted in an earlier blog there are some individuals in whom the vaccine does not seem to have a protective effect – a vaccine failure. These failures are well known to immunologists and include improper storage or handling of the vaccines, patients who cannot mount an immune response because of obesity, diabetes, steroid therapy or chemotherapy, or even a genetic defect that affects the immune system. As of midsummer fewer than 200 vaccinated persons have died among the nearly three and a half billion persons who have received the vaccine. Every one of these is a tragedy to be sure, but these deaths pale in comparison to the four million persons who have died from the natural infection.

            As always, perspective matters.

Lifestyle

          Don’t pass the salt, please!

                Taking in less sodium isn’t going to do much for weight loss but it will certainly improve your overall health.  Americans take in about 5 times (!) as much sodium as they need, contributing to the current epidemics of high blood pressure, heart disease and osteoporosis.

            Most of our daily sodium intake comes from packaged, processed food. That’s why it’s so important to read the Nutrition Facts label on every package. If the sodium content is over 500 mg. (milligrams) per serving, take a pass.

            There are plenty of tasty substitutes for salt but potassium chloride isn’t one of them. Most users complain about the taste. However, there are plenty of spices that you can use to pep up your menu. Just start experimenting.

            Speaking of substitutes, the best ones consist of unprocessed vegetables and fruits. They are naturally low in sodium and their potassium, fiber and generous supply of vitamins and antioxidants are what our bodies are designed for – not all that salt.

Carvings July 1, 2021

In the news

            A distressing report appeared a few days ago at the Medscape site: “ ‘Staggering’ doubling of type 2 diabetes in kids during the pandemic ”.

            Type 2 diabetes has become an epidemic throughout the world, especially First World countries. In the U.S. it now affects more than 12 percent of adults and an astonishing 60 percent in persons over the age of 65.

            In my 35 years of pediatric practice I managed several patients with type 1 diabetes but none with type 2 – the co-called “adult onset” version. Nearly half of new childhood diabetics are now type 2, and the number is even higher in metropolitan clinics.

            The recent news is extremely troubling. During 2020 the number of children hospitalized for type 2 diabetes doubled compared to 2019. Those with the severest form, ketoacidosis, a life-threatening condition, was nearly 6-fold higher!

            The majority of these children were African-American: 7 out of 8 in one study and 16 of 17 in another. The apparent reasons are numerous and I’ll address these in a future post.

            This is a global problem and it is especially serious in Asia. By coincidence I was reviewing a paper published in 2004, a harbinger of the current disaster: The global spread of type 2 diabetes mellitus in children and adolescents, in the Journal of Pediatrics.

            Can we do something about this? Perhaps, but it will be a long process. It begins with teaching our children and grandchildren about the importance of avoiding obesity and the need to be physically active. For example, in one study, 80 percent of kids with diabetes were obese.

            Our country – and the world – cannot afford to have half its people affected by a devastating life-long disease.

Lifestyle

            Major controversies in the organic/conventional food battle: nutrition and the environment.

            It’s not easy to find wholly impartial observations in this area and the question of whether or not organic foods provide better quality nutrition is an example.

            A study published in the journal Environmental Health in 2017 noted that there was only a marginal increase in nutritional quality but persons who prefer organic produce tend to have healthier lifestyles as well, making a direct comparison of health effects difficult. In 2012 the Nutrition Action Healthletter observed that in about 60 percent of the studies, organic food is higher in some nutrients, in 30 to 35 percent there is no difference and in 5 to 10 percent of studies conventionally-grown foods have higher amounts of nutrients. That is not a ringing endorsement.

            Given that nutrient content varies by climate, soil type, plant variety, degree of ripeness, length of storage and other factors you can see why after decades of study there is no clear consensus. Theoretically since organically-grown plants have to provide their own, i.e., not helped by chemicals, defense mechanisms in the form of polyphenols and other phytonutrients, that should be a plus. It is, but not by much.

            In regard to the environment it’s obvious that runoff carrying nitrogen, antibiotics and other damaging chemicals into our waterways is a major problem to which organic farming contributes almost nothing. However, it takes many more people to control weeds and insects without the help of chemicals, and more people means more human waste, energy requirements, gasoline for transportation, etc. Organic foods also cost more, sometimes a great deal more.

            Buying from local farmers is not a solution unless you know that they use certified organic methods and they don’t simply stock their stands with produce trucked in from distant farms whose practices may or not be organic.

            In my opinion, organic foods are better for you and the environment and often taste better. Their health benefits, however, are less significant than those that we can obtain by eating more fruits and vegetables, eliminating sugar-containing foods, limiting calories in general and being more physically active.

Carvings June 15, 2021

In the news

                On June 11th Dr. Mark Sawyer, a pediatric infectious diseases specialist at Rady Children’s Hospital and the UCSD School of Medicine gave an excellent review of COVID vaccines, including observations on a newly-recognized complication associated with vaccination, myocarditis.

                Myocarditis is an inflammation of the heart muscle that occurs in about 10,000 persons a year, many of them young male adults. There has been a greater than expected incidence of this problem among recipients of the coronavirus vaccines, nearly 800 cases as of this writing. More are likely to be reported because the vaccines are now being given to persons over the age of 12, and there is greater awareness of the condition.

                Dozens of common viruses can cause myocarditis. Although there is no live virus in any of the ten currently available vaccines the association is significant. It’s important to note that so far there have been no reported deaths due to vaccine-associated myocarditis and that full recovery is the rule.

                More than 2 billion doses of COVID vaccines have been given to date and that number will probably reach 3 billion before the end of the year. The level of protection is more than 90 percent and the various mutations do not seem to have been a problem so far.

Lifestyle

Organic – part two

                The organic-vs.-conventional food issue is extremely complex and decades of research have failed to give us definitive answers. Major issues concern the effect of pesticides, the nutritional value of organic vs. conventionally-raised foods and environmental and economic issues.

                 Pesticide residues are found in organic foods, ranging in some studies from 7 percent to more than 20 percent, but none in amounts exceeding allowable limits. Those that did have higher amounts were found only in countries of the European Union.

                The American Cancer Society has stated that the small amounts of pesticides in conventional foods have not been associated with the development of cancer and that there is no research that shows organic foods to reduce the risk of cancer when compared to conventional foods.

                Although there may be several days’ delay between harvesting and marketing plant products this allows time for the natural breakdown of pesticide residues. The cook who washes or at least rinses vegetables prior to serving also removes some pesticide residues. Peeling prior to cooking or serving removes even more.

                The conclusion is that pesticides that are applied to plants in the field do not cause disease in persons who consume them. Although chemicals that are used in agriculture can cause serious disease in those who face heavy exposure, including farm workers and their families, that is an entirely different matter.

                We’ll address nutritional and environmental matters in future posts.

Carvings May 15, 2021

What will your life be like in 2022?

            We are finally beginning to enter a post-COVID era.  What will life be like a year from now?

            It will take a long time for us to be less wary of crowds, concerts and even church services. Not only because of COVID but because we have become aware that nasty germs lurk everywhere and the next pandemic might be just around the corner. There will be a certain amount of complacency, of course as the threat of becoming infected becomes a memory. Most Americans will have been vaccinated against this quirky coronavirus by year’s end but there will be a smoldering fear that will linger for many months. Even the scientists who developed these vaccines don’t know how long true protection will last.

            Will you wear a mask when away from home, or at least have one available in pocket, purse or your car’s console? Will you unconsciously maintain social distancing, as if by habit? Will you frequent your favorite venues – restaurants, theaters, and clubs – less frequently?

            Here are some positive things to consider. First, we know that the coronavirus vaccines prevent serious disease and the need for hospitalization, even though some are rookies in the sense that they have no long track record.

            A second “positive” is that the enormous effort to come up with a vaccine has spawned a treasure trove of vaccine-related knowledge that will certainly lead to a long-lasting influenza vaccine, vaccines that we will take in our favorite drink or snack, childhood vaccines so effective that first-graders will be spared a plethora of booster shots, vaccines against cancer, heart disease, even obesity.

            When the next pandemic arrives – and there certainly will be more in the coming decades – health authorities ought to have their act together so that there will be no need to bring nations’ economies to their knees with draconian shutdowns.

            Let’s hope that the new normal will be a blessing, not a burden.

Lifestyle

            What’s the skinny on organic? There’s no good answer. In its wisdom, the government has established five different kinds of organic food, and trying to remember which is which is a real challenge.

            The argument continues to rage over whether organic food is nutritionally superior or tastes better – or both. This is never going to be settled! There are too many zealots/moneyed interests/dumb regulations (take your pick). Judging from the paucity of publications on this topic in the past few years the scientific community doesn’t seem to consider the organic issue worth pursuing.

            A few studies have shown that there isn’t much difference between the amount of leftover pesticides on organic and “regular” produce, partly because of government regulation and partly because lots of that stuff is removed or evaporates by the time it gets to you. Some pesticides drift over onto organic fields from the “regular” farms.

            There is some increased risk of cancer to farm workers who handle pesticides and fertilizers but the amount that the average buyer ingests is not really a great threat. There is lots more risk from tobacco smoke, even for non-smokers.

            If taste is what really matters to you, grow your own fruits and vegetables or shop at your nearest farmer’s market, where the produce isn’t picked long before it’s ripe and doesn’t have to be shipped hundreds of miles, stored in warehouses and gassed to keep it looking fresh.

Carvings                    May 1, 2021

In the news

Flu who?

            Have you noticed that no one you know has seemed to have gotten the flu this year? There have been remarkably few cases of influenza this season, the CDC noting that the number of hospitalizations has been the lowest since 2005. One of the blessings of this lull is that only one child has died of influenza this year, a tragedy to be sure for that family but thankfully less than the hundred or more kids who die in most flu seasons.

            It seems that hunkering down at home, social distancing and mask wearing keep us from infecting each other with various germs. The CDC doesn’t keep up with simple colds but they do watch the incidence of Respiratory Syncytial Virus (RSV) infections, a serious lung disease among infants, and they are down too.

            Some pundits propose that we simply aren’t testing as much for influenza because of our focus on COVID-19 or that the flu virus, with fewer victims, has mutated so little this year that the current vaccine is still working.

            Does all this portend a worse than usual flu season next winter? Based on what happened following a similar drop in the 2011-2012 flu season, that’s not likely – but it’s no reason to skip your flu vaccine next October or November!

            Advances in vaccine development have been so dramatic that we may have a combined influenza/coronavirus vaccine before the end of the year. Wouldn’t that be a great outcome of this crummy epidemic?

Lifestyle

Sensible snacking

Snacks can make or break a diet. The kind that you find while you’re standing in line at the checkout counter is probably the worst, even the trail mix or beef jerky. Some trail mixes have well over 100 calories per ounce and a piece of beef jerky that weighs a little more than a half-ounce can contain as much as 440 milligrams of sodium – about 20 percent of what you should allow yourself in a whole day.

            The ideal snack should contain enough fiber or protein to satisfy your appetite. A piece of fruit averages only 50 to 75 calories but the fiber leaves you feeling full. A single handful of nuts, especially almonds or walnuts (for the engineers and accountants in the audience that’s about 12 pieces or about ½ ounce) will provide about 80 or 90 calories. That will also give you some protein and some omega-3 fats, both of which will give you a feeling of fullness – especially if you eat them slowly!

            Diet gurus sometimes recommend a tablespoon of peanut butter on a stalk of celery. Nice theory but who has the time to make it – and not find something else in the refrigerator to nibble on while searching for the celery?

            Dried fruit? Not such a good choice because it’s high in sugar. After all, 6 apricot halves are the equivalent of 3 whole apricots, and four prunes are the equivalent of four plums. Do you usually eat that many pieces of fresh fruit at one time?

Carvings             April 15, 2021

In the News

Another COVID surprise!

* Caveat: any numbers in this post should be considered temporary estimates. The input from government and academic institutions changes by the hour.

          The good news: we have two effective vaccines against the virus that has taken the lives of millions of people and disrupted the lives of almost everyone else.

            The bad news: two other vaccines by Johnson and Johnson and Astra-Zeneca that have the advantage of requiring only one dose have been associated with about a dozen deaths from a rare blood clotting disorder. Those deaths have mostly occurred in women of early middle age who should have had decades more of life with their families.

            It’s called Vaccine-Induced Thrombotic Thrombocytopenia (VITT). Thrombocytes, known as “platelets” because they resemble small dinner plates, are sharply reduced, partly because they are taken up in the formation of blood clots in various organs. This results in thrombocytopenia, meaning scarcity of platelets and some patients have simultaneous hemorrhages when there aren’t enough platelets remaining to control bleeding.

            The condition typically arises during the second week after vaccination. Clots in the brain cause headaches; those in the blood vessels that supply the intestines produce abdominal pain; clots in the legs result in leg pain and those in the lungs cause shortness of breath. Anyone with these symptoms following receipt of the Johnson and Johnson or Astra- Zeneca vaccine should seek medical attention without delay in order to present stroke or even death.

            We have a long way to go before we can unravel the cause, provide lifesaving treatment and perhaps modify the vaccines. Fatalities have so far occurred only in about once for every million doses of vaccine in the U.S. To put this in perspective, the loss of life among a million persons with COVID-19 would be about twenty thousand! A report from the University of Oxford states that this clotting disorder is about forty times as likely from COVID-19 infection as it is from the vaccine.

            A further perspective: the CDC estimates that deep vein thrombosis (DVT), sometimes associated with air travel, causes death in from 60,000 to 100,000 persons every year.      

            Why have most of the deaths occurred in women? One reason might be that they have higher levels of estrogen, somehow making them more susceptible to the condition. Another reason is that women are more often affected by autoimmune diseases such as lupus, rheumatoid arthritis and multiple sclerosis, all of which are autoimmune diseases, which VITT appears to be.

            Some reassuring thoughts: the disease is rare, especially in males. More than 600 million doses of the current vaccines have been administered so far and this clotting disorder has been reported in fewer than 300 persons with about a dozen deaths. We have two vaccines that are known to be safe – to my knowledge there have been no deaths attributed to either the Pfizer or the Moderna vaccines — and effective, more than 90 percent at the six-month mark.

            It would seem prudent that women of childbearing age should not receive either of the one-dose vaccines. They should opt for either the Pfizer or the Moderna vaccine, neither of which has been linked to deaths from VITT. The risk to men appears to be vanishingly small.

            There are several more vaccines in the pipeline and some of these employ new technology. You can be sure that there are more surprises among them.

Lifestyle

Some Stone Age humans were probably aware of plant products that gave them a caffeine-like jolt but they never started the day with a good old cup of coffee. It was just a few years ago though, that America’s favorite beverage caught the blame for causing a variety of ills, including cancer of the pancreas. Fortunately for Starbucks devotees, coffee now has a clean rap sheet and is taking credit for some genuine health benefits.

The pancreatic cancer issue has been put completely to rest and there is convincing research showing that coffee lowers the risk of several types of cancer, including liver, brain, prostate, uterus, mouth and throat. Except for a link to bladder cancer in men who drink several cups a day, there is no evidence that it causes cancer.

Coffee is a plant product and like red wine and dark chocolate it contains thousands of chemicals that have beneficial health effects. These include antioxidants that protect blood vessels from damage by harmful free radicals and substances known as antimutagens that keep cells from becoming malignant. There are chemicals in coffee that rein in inflammation, a contributor to heart disease, stroke and rheumatoid arthritis.

In spite of coffee’s growing list of advantages, drinking more than three eight-ounce cups a day can cause nausea, irritability and insomnia. Even decaffeinated versions are not entirely free of caffeine and may lead to poor sleep in caffeine-sensitive individuals. Excess caffeine can increase heart rate and raise blood pressure.

Adding milk to coffee appears to diminish at least some of its benefits in the same way that converting dark chocolate to milk chocolate does. Of course, when the addition of lots of cream and sugar transforms a large cup of black coffee into a 500-calorie “specialty of the house” you can kiss the heart-health benefits goodbye. Moderation, as usual, is a good thing.

Pandemic Perspective #41  April 3, 2021

Why vaccines don’t always work

            Vaccines have never been without controversy since the first one appeared at the end of the 18th century. The permutations of that first smallpox vaccine led to the total eradication in the 1970s of one of the most terrifying of human afflictions, one that sometimes killed half of its victims and left many of the rest with characteristic pitted facial scars.

            The COVID-19 vaccines that have now been given to more than half a billion (!) people appear to have a protective effect in as many as 95 percent of vaccinees. Why not 100 percent? There are multiple reasons and they apply to all vaccines in one way or another.

            Reason #1. After more than half a century we still don’t have an influenza vaccine that is completely effective or whose protection lasts more than a few months. That virus undergoes mutations in those structures that are the targets of the vaccine so that a new preparation needs to be produced nearly every flu season. The SARS-CoV-2 virus that has upended the global economy mutates too but those changes – at least for the moment – are not of the type that negate the effectiveness of the vaccine.

            [Note: as of this writing there have been no deaths attributed to the current vaccines and no COVID-19 deaths among persons who are at least one month post-vaccination. That too might change by the time you read this but the numbers showing its safety remain overwhelming.]

            Reason #2. The human immune system is enormously complex and some persons are genetically missing a key component. An example is that some persons are incapable of forming antibodies against the diphtheria vaccine. However the redundancy of the immune system probably covers for that defect.

            Reason #3. Obesity and diabetes (type 1 and type 2) reduce the effectiveness of the immune system. The high incidence of obesity (nearly 40 percent) and type 2 diabetes (more than 12 percent) undoubtedly limit the protection afforded by the vaccine in these groups.

            Reason #4. Using a standard needle in an obese person can put the vaccine into fat, not muscle. This not only can make the vaccine ineffective it can lead to complications such as abscess formation. Some health facilities now use needles in obese persons that are twice as long as those used for those who appear to be of normal weight.

            Reason #5. Improper storage. Some COVID-19 vaccines require ultra-cold freezers to maintain potency.

            After the measles vaccine became available in the 1960s some children developed the disease in spite of having been vaccinated. Some medical offices had stored the vaccine in the door shelves of the refrigerator, where the temperature was too high, severely reducing the potency of the vaccine.

            Reason #6. Aging reduces the strength of the immune system. That’s why there exists a high-potency influenza vaccine for seniors. We don’t yet know if this will be a problem among our oldest old in this pandemic but it will require monitoring.

            Reason #7. Timing. The measles vaccine is not given to children until the age of  12 to 15 months. Prior to about 1985 most women had had natural measles infection and they transferred protective antibody to their infant that persisted for several months. A measles vaccine given too early might be ineffective, hence the delay. None of today’s mothers born in the U.S. have experienced natural measles and vaccine antibodies do not last as long as those induced by wild measles virus. For that reason, infants above the age of six months that are exposed during an outbreak should receive the vaccine.

            Coronavirus infections are common during the preschool years, less so afterwards. Existing natural antibody may help to explain why children rarely become seriously ill from the COVID-19 virus but it could reduce the effectiveness of the vaccine. Vaccine trials in children are only now being done and the vaccination of children will probably begin this summer. How they will respond won’t be known for at least another year.

            Vaccine failure is common, it is not unexpected and it should not be a reason for not accepting the vaccine. If you are willing to take a chance on being killed while driving your car you should be willing to take a chance on the vaccine. I’ll bet on the vaccine every time.

Pandemic Perspective #41  March 27, 2021

Vaccine reluctance by healthcare workers. Why? Do they know something?

            The media reports are unsettling.  A Medscape article just a few days ago noted that fully 30 percent of those who care for patients stated that they were still undecided (12%) or did not plan to receive the vaccine (18%).

            Consider four different elements of this issue:

1. Are manufacturers using experimental, i.e., untested methods to develop these vaccines?

2. Do the vaccines work?

3. Are the current vaccines effective against the rapidly-emerging variants, (mutations)?

4. Are vaccinated persons subject to a paradoxical response to later infection by the wild virus?

            This short blog can’t possibly adequately address each of these issues but here are some comments that might help those who are still agonizing over this decision.

1. Some methods of manufacturing vaccines have not been used on a large scale but they are not really new. mRNA technology was developed more than thirty years ago and was effective in helping to control the Ebola virus. Carrier adenoviruses have been used in several veterinary vaccines. We have less experience with these innovative vaccines because there has not been a need for such new variants until now.

2. The three vaccines released to date do produce an appropriate immune response and appear to prevent infection. For example, in one trial there were 30 subjects who required hospitalization for COVID-19 infection but all 30 were in the placebo arm of the trial. It’s true that some vaccine recipients have become infected but almost all of these were exposed within a month of receiving the second dose and at least in some reports, shed non-infectious virus particles.

3. Will these vaccines work against newly-emerging variants such as the B.1.1.7 strain that is rapidly spreading in the U.S.? That appears to be the case at the moment but this wild and woolly virus has been full of surprises and it’s quite likely that some of today’s vaccines (there are 73 vaccines in clinical trials and a total of 308 in various stages of development) will have to be tweaked or replaced by the end of this year.

4. The problem that many healthcare workers – including myself – fear most is a paradoxical immune response in which later exposure to a naturally-occurring SARS-CoV-2 virus will cause even worse disease. This happened a few decades ago with a vaccine that was designed to prevent Respiratory Syncytial Virus lung disease in very young children. If that does occur we’ll probably see it by the end of this summer. I’m keeping my fingers crossed.

            Perhaps a publication in Medscape.com on March 24th will put this concern to rest. In San Diego and Los Angeles a pooled study among hospital staff showed that positive tests fell to 0.2% in the second week after the second dose of either the Moderna or the Pfizer vaccine. In Dallas’ Southwestern Medical Center there was a 90% decrease in the number of employees who were in isolation or quarantine. In spite of a surge in cases in Texas the number of infections was only 0.05% among fully vaccinated employees and 2.61% of those who were unvaccinated – a whopping 50-fold difference!

            The old cliché, the perfect is the enemy of the good, applies in this case. As of this week more than a half-billion doses of the vaccine have been administered and there have been very few serious side effects. Of course, some might show up later – perhaps even a year or more from now but the initial results are reassuring. I will receive my second dose of the Moderna vaccine in a couple of days; the first was a nothingburger. I hope I can report the same next week.

            In case you wonder why vaccines don’t always work, remember that prescription drugs don’t always work either and neither do surgical procedures. I’ll explain why in the post for April 1.

Carvings                March 15, 2021

In the news

            Is red meat bad? Is red meat good? What a sticky mess!

            This controversy has been going on for more than a half-century and it’s just as confusing as ever. The reason? GIGO, the acronym that we are now all familiar with: Garbage In, Garbage Out.

            One of the more recent analyses is a good example. In a comparison of five reviews the authors concluded that we don’t need to change our meat-eating  habits and that even eating processed meats has little effect on the risk of heart disease. Although the study was highlighted by the media it was castigated by medical professionals. Here are some issues that were not addressed.

            Although the authors separated unprocessed meats (muscle meat from the cow or the pig) with processed meats (hot dogs, sausage, cold cuts, etc.) their classification ended there. Healthy diets can include unprocessed meat but there is a difference between prime beef (lots of saturated fat), select beef and wild game (venison for instance). The fat content of the first is often greater than 30 percent; wild game contains about 7 percent; select beef usually has even less. Think that matters?

            A serving of unprocessed meat is 3 ½ ounces, what many Americans would consider a child’s portion. Your favorite restaurant probably starts with an 8-ounce steak – one famous steak house call this a petite filet — 16 ounces is common and one place in Texas – where else – serves a 64-ouncer! Think that matters?

            Some steaks and chops are broiled, some are fried. Think that matters?

            Is beef, lamb or pork typically the only thing on your plate? Would you miss the fried onion rings or the baked potato with butter or sour cream? Think that matters?

            Then there’s processed meat with added salt, nitrites and saturated fat, all of which have been associated consistently with diseases such as heart disease and cancer.

            So is red meat good for you?  Of course it is! As long as it’s a realistic serving, broiled not fried, and comes with a side or two of veggies – including a baked potato with salsa in place of butter or sour cream. An occasional splurge (those onion rings and sour cream) won’t shorten your life, and neither will having bacon or sausage with your eggs now and then.

            Keep things in perspective. Overindulgence shortens lifespan; moderation makes life worth living.

Lifestyle

          Maintaining muscle strength and tone is one of the most important aspects of healthy living but it is a very low priority for most Americans. Several surveys reveal that approximately 80 percent* of us fail to spend even the minimum of two to three hours a week in resistance training (using barbells, dumbbells, machines, elastic bands) or any activity that requires lifting, pushing or pulling with enough intensity to break a sweat or even to raise our heart rate. Walking is good exercise and great for the heart and lungs but it has almost no effect on helping us to reach our later years with strong bones, good balance and enough strength to open a jar of pickles.

            * – 80 percent of Americans are overweight or obese, probably the same 80 percent.

            At the other extreme are those who overdo weight training, some because of lack of instruction, others in a quest to maintain youthful vigor. Christian Finn of the United Kingdom is a fitness expert with a graduate degree in exercise science and recently provided some guidelines that would benefit both groups. These are a few that I found most helpful, with some observations of my own.

            Avoid squats, bench presses and overhead lifts. The first are unnecessary for all but bodybuilders. Overhead lifts are especially likely to cause injury to the shoulder, the most complex joint in the body. As we get older we’re more likely to tear the rotator cuff, which takes about a year to heal.

            You don’t need heavy weights to build or maintain muscle. You should be able to do 10 or 12 repetitions of an exercise. The last one should be difficult but not impossible.

            There is no magic interval between sets of exercises. Take the time you need to rest if you’re not in the running for Mr. Olympia.

            It’s OK to exercise almost every day but not if it’s the same group of resistance exercises every time. Your muscles need about 48 hours to recover. Enjoy a walk on the beach or in the park on those other days. (Hint: that should be about an hour.)

            Make sure that you’re getting enough protein if you exercise regularly. And don’t treat yourself with a Krispy Kreme donut as a reward!

Pandemic Perspective #40   March 6, 2021

So far nearly 300 million doses of the several new COVID-19 vaccines (including Russian and Chinese) have been administered and the earlier-feared complications and possible deaths from the vaccines have just not materialized. Earlier this week the CDC reported that deaths among vaccine recipients occurred in 0.0015 percent and analysis of each has concluded that the vaccine did not cause any of those deaths.

Is that information trustworthy? It’s unlikely that the media and anti-vaxxers could have missed casualties on even a modest scale. Their silence tells the story: this is a safe vaccine and has resulted in reactions mainly among persons with known allergies. From the reports I have seen these unfortunate persons were treated promptly and successfully.

The hesitancy to receive the vaccine because of risk of side effects is no longer justified but there are still many persons, including healthcare workers, who claim that we don’t know if the vaccine will prevent disease. That fear is also being diminished but obviously at a slower rate because not enough time has passed to evaluate that with certainty.

What about mutations, of which there are now several hundred, a number that was not unexpected even from the beginning of the outbreak? Coronaviruses mutate a lot. There are some now circulating around the globe that are able to spread more easily and may cause more serious disease. This virus has been so full of surprises that no one can predict accurately but the technology of the age is not only able to identify such mutants quickly but manufacturers of the vaccine now have the ability to tweak their product to maintain vaccine efficacy – or so we hope!  Specifically, the just-released single-dose J&J vaccine is effective when tested in an environment where there is significant occurrence of some of the new variants.

In light of these facts and the recognition that the fatality rate of this virus is lower in the United States (1.8%) than in the rest of the world (2.2%) the hand-wringers have become less vocal. Yet the fact remains that the death toll will continue to rise, certainly at a slower rate as we are now seeing. By mid-summer the adverse effects of a lockdown will exceed the dangers of the virus. For our children that is already certainly the case. Perhaps life will again return to something that we will recognize as normal. Texas has just opened all businesses and in a couple of months we’ll learn if that is a wise move.

NOTE: To those who have an interest in the history of the U.S. West – Wild West magazine has just published my article, No prescription for gold fever in the April 2021 issue. It describes the health challenges faced by the forty-niners and how physicians treated them in the generation prior to the explosion of science-based medicine. To the credit of the editor, the illustrations are remarkable and add a great deal to the text.