About stoneagedoc

Pediatric infectious diseases specialist, author and public speaker. After 35 years in clinical practice including 40 years in academic pediatrics I now share that experience in helping others to enjoy a long, healthy life without the burden of chronic disease.

Stone Age Doc Pandemic Perspective #2

Rady Children’s Hospital hosted a webinar on COVID-19 on March 27th by Dr. David Kimberlin of the University of Alabama. Additional comments were presented by Dr. Mark Sawyer of UCSD.

By now we accept that at this stage of rapid developments, facts are fluid, scientific opinions are often contradictory and no one knows when life can return to normal – “normal” being perhaps quite different from what it was when the new year began. Here are some of the highlights of Dr. Kimberlin’s presentation.

No one can be sure when the peak of the epidemic will occur in the United States although sometime in mid- or late April is likely.

Social distancing has clearly been shown to limit transmission of the virus within the community. This coronavirus will probably be a seasonal, i.e., recurring problem, in much the same way that influenza is. By April 2021 it’s likely that about two-thirds of the global population will have become infected.

Significant mutations (which could change the pattern of a future epidemic) such as those that occur with the influenza virus, do not appear to be a problem. Coronaviruses tend to show strain differences but the impact of those changes is not clear.

The immune response to COVID-19 is not durable, so that later reinfection with the same strain is possible. It will be at least a year before we can have some idea of the duration of immunity developed by a future vaccine.

The occurrence of asymptomatic infection is higher than initially suspected; it ranges from 20-40% depending on the population and the methods used to identify infection. The average is about 30 percent.

Chloroquine and hydroxychloroquine are being studied at many sites but no definitive data have yet been published.

The virus appears to have little effect on children below the age of 10 years. This is the age group in which the coronaviruses long known to cause ordinary colds are common, so that these children have cross-protection and do not become seriously ill.

I’ll be publishing these perspectives every Saturday for the foreseeable future. You can receive them automatically by clicking on the link on the home page of this web site on the lower right.



Stone Age Doc’s Pandemic Perspective #1

This is the first weekly blog post that will address issues regarding COVID-19 that are not obvious from the usual news sources. This week’s post will discuss face masks; next week I’ll cover fomites (doorknobs, etc.) and fitness.

Face masks

Sometimes referred to as respirators, they are of two main types, surgical and N95. Surgical masks, the flat cloth or paper types, are worn to keep the surgeon from depositing secretions from the mouth and nose into the operative site. They do offer some protection from incoming germs such as the current coronavirus but not as well as N95 masks. These are stiff, rounded, paper-like devices with a metal clip that can be molded to fit more tightly over the nose. Some designs, referred to as surgical N95s, are more protective than simpler types. Although they are not usually reusable some persons cover them with a cloth mask that can be disposed of so that the the N95 can be worn for a longer period.

The designation N95 indicates that they will filter 95 percent of particulate material in the environment. That still leaves five percent of particles – or germs – that will get through. The longer the mask is worn the less protective it is. Some medical experts claim that the main advantage of the N95 mask is to prevent the wearer from touching his or her face, which most of us do unconsciously scores of times a day.

How many will each person in your family need until the COVID-19 crisis has passed, considering that you are not likely to get more than one day’s use from them, especially the cheaper ones? And the cost? It ranges from about $2.00 to $24.99 on Amazon. What does that tell you about the quality of the cheapest ones? And by the way, if you order them today, delivery time ranges from April 10th to June 19th – and I only checked out a handful of offerings. “Available now” only means that they are in stock, usually from China.

Don’t expect to find them locally. They are even more scarce than toilet paper!

N95 masks are uncomfortable. I wear one when I use bug spray around the house. That takes only about an hour but it’s pretty wet on the inside by the time I finish. And that metal piece that squeezed down over your nose begins to hurt in just a few minutes.

One other thing: you also need to wear surgical gloves when you wear a face mask. You’ll be touching and adjusting it a lot and those viruses on the outside will get on your fingers, and then transferred to anything else you touch.

And unless you’re also wearing goggles you might still become infected. Many infectious agents enter the body via the eyes.

Bottom line: wear a mask if you are in the presence of an infected person but don’t expect to be fully protected.

 In the news

COVID-19 update: The situation is changing at incredible speed and the enormous disruptions in our lives are hard to fully comprehend. Many businesses will never recover. In a few days I’ll provide some more information that will  help you avoid becoming infected, what NOT to believe and what to expect in the next couple of months.

The new buzzword: Fasting.

Fasting does work to help you to lose weight but what does “fasting” really mean?  A “fast day” in the Christian tradition means having only one regular meal per day and two smaller meals that together would not amount to a full meal – and no snacking! I’m willing to bet that no one loses weight during Lent.

A medical fast prior to next morning’s blood tests means nothing to eat after dinner the prior evening until completion of the blood test or other procedure. Some people fast by eating nothing one day per week, maybe two. A three-day or longer fast leaves you grumpy and constipated. Anything longer than that might cause hallucinations.

Here’s my version of the Goldilock’s Fast: don’t eat anything between dinner and breakfast – that’s about 12-13 hours. A small study (19 overweight or obese women) from the Salk Institute of La Jolla bears this out. The women were instructed to limit their food consumption to 10 hours per day, so that they fasted for 14 hours for 12 weeks. They were not instructed to limit their food intake during those 10 pleasurable hours.

Their weight loss was consistent but not very much – about 3 percent reduction in BMI (Body Mass Index), body fat, visceral fat – the most dangerous kind – and a 4 percent reduction in waist size. The weight loss was not dramatic, only about one-half pound per week over the twelve weeks. But think about this: that would amount to about 25 pounds in a year, which in most persons would bring down blood pressure and blood sugar, which is exactly what happened in the study group in only three months.

There were other important changes. Total and LDL cholesterol came down by an average of 11 percent; HbA1c, a measure of blood sugar levels, was lower by about 4 percent. Over a year or two those changes could mean better health and a lower risk of heart disease.

And nobody became grumpy or constipated! Priceless!

This is a “fasting” routine that is easy for the whole family to do, has no side effects, and can be maintained for a lifetime.



Another in the series of annoyances of aging: cracked fingernails

          Cracked fingernails are common among older persons but before you accept this as one of those changes that are inevitable as we get older, you should know that it might indicate a medical problem. Three conditions in particular are dangerous because they can proceed for a long time with few other symptoms except for fatigue, which most people feel is just part of aging.

Iron deficiency can have several causes, from poor diet to intestinal bleeding. A good friend was once hospitalized when his blood count dropped to 25 percent (!) of normal. The only other symptom was a feeling of being tired all the time.

Thyroid disease is another problem that may occur over a period of many weeks or months. There may be other symptoms but these too might be written off as due to aging – weight gain, constipation and intolerance to cold.

Kidney disease has many causes but one of the most common these days is type 2 diabetes, which now affects 13.3 percent of persons over the age of 18. By the time a person is diagnosed with type 2 diabetes, more than half are likely to have at least one complication of diabetes, one of which is deteriorating kidney function.

Keep in mind that your doctor isn’t likely to check your fingernails as part of the physical exam. Your cracked fingernails may be normal, but maybe not.










Renaissance Magazine has published my article, Child health during the Renaissance in the Spring 2020 issue. You can Google it: Renaissance magazine Goscienski or go directly to this link: http://www.omagdigital.com/publication/?i=648518&p=30 )

The article, especially the illustrations, shows how far we have come in a few hundred years.

Upcoming presentations

Tuesday, March 10th, 2:30 Mission San Luis Rey, Oceanside. A day in the life of a physician in ancient Egypt. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Wednesday, March 25th, 1:00, OASIS Center, Grossmont Center. Plagues and pandemics. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org. This will include an update on the current Coronavirus outbreak.

In the news

Panic or preparation – a perspective on COVID-19

What is your risk of encountering the Coronavirus?          The COVID-19 virus that emerged from China in September, 2019, has now appeared in at least 60 other countries, making it a true pandemic. The low mortality rate of about 2 percent – mostly in older persons with heart or lung disease – makes it much less dangerous than the other two anxiety-producing coronaviruses that arose in this new century.

SARS (Severe Acute Respiratory Syndrome) affected fewer than 10,000 persons and had a mortality rate of about 9 percent; MERS (Middle East Respiratory Syndrome) infected fewer than 2,000 persons but had a fatality rate of about 38 percent. Influenza viruses kill between 40,000 and 100,000 Americans each year but that terrible number doesn’t seem to bother Wall Street very much.

The difference, of course, is that China has shut down factories and has restricted commerce. That means that you might have to wait some time for your next iPhone, TV or computer, or even your resupply of Ibuprofen or an antibiotic. Almost all of these products are made in China.

More Americans are going to become ill from the new coronavirus between now and next fall and it’s going to throw many into a panic, in which they’ll empty store shelves of water, bread, milk – and face masks. The value of the last item is that it keeps you from touching your mouth, nose and eyes, all of which are portals of entry for viruses. It is almost worthless in protecting you from infection. BTW – surgeons wear masks to keep from contaminating the surgical field with germs from their body; they are not worn to protect the surgeon.

There are plenty of reasons to keep a two-week supply of water, food and other necessities in your home but an epidemic isn’t one of them. Fire, flood, earthquake and a massive power outage are much more likely.

Prepare but don’t panic.


Another one of those annoyances of aging: liver spots.

       Blotches that usually appear on the back of the hand, some of which have the brownish coloration of calves’ liver, have nothing to do with your own liver. They were so named by one of our imaginative ancestors many years ago and the name stuck.

Like other signs of aging — wrinkles, skin cancer – liver spots are the late effects of sun exposure. You can hide them with any one of the myriad of products at the cosmetic counter. For more lasting effects, a dermatologist can make them less noticeable with laser therapy or dermabrasion. Don’t try this at home!









In the news

Low-carb vegetables and fruits

          One of the drawbacks of the ketogenic diet is that most versions allow almost no fruits or vegetables, especially during the induction phase that usually takes about two weeks. That eliminates the kinds of nutrients that our bodies are designed for – phenols and flavonoids and similar nutrients that protect us against inflammation and cell damage, as well as fiber that we need for a healthy gut.

A strict ketogenic diet allows for 50 grams or less of carbohydrate, less than you would get in a BLT sandwich. And that means that for the rest of the day you could only have protein and fat in your diet. There is a happy solution however.

Some vegetables have little carbohydrate because much of their bulk consists of water and fiber. They include things like bell peppers, asparagus, avocado, tomatoes, spinach, broccoli, cucumber, kale, cabbage and mushrooms. (You can find how much carbohydrate there is in a serving of your favorite food at Google – or just ask Siri). In other words, you can still get the plant nutrients in vegetables if you pick the right ones. Root vegetables like potatoes, beets and carrots have more carbohydrate – a medium baked potato has 50 grams of starch that rapidly breaks down into sugar — but an occasional small serving won’t destroy your diet.

Fruits are another matter. They are bred to be sweet, which means sugary and even a medium-sized banana has about 30 grams of carbohydrate, a medium orange has about 25 grams and an apple about 20.

But here’s the good news: you don’t need to go full keto in order to get its benefits. In addition to those I listed above, things like kale, Brussels sprouts, eggplant, zucchini, cauliflower and green beans are low enough in carbohydrate that you can have one or two servings every day with lunch or dinner and not feel like a martyr – or annoying your family with bad breath!



Here’s another annoyance of aging. Unfortunately it’s one of those that has no remedy: thin, fragile skin           

As we age we inevitably begin to lose some of the fatty tissue and connective tissue beneath the skin, especially on the back of the hand and on the forearm. Skin becomes paper-thin and a light brush against a doorway peels away some skin. Oral or topical steroids, drugs like prednisone, bring it on faster.

Retinol, a prescription drug, or fish oil supplements might help but the best solution is simply to protect susceptible areas. When you work outdoors wear light gloves and a long-sleeved shirt, even in warm weather. They can be a protective barrier.

This kind of injury is so common after the age of about 65 that you might want to have a couple of band-aids in your wallet or purse. It’s cheap, unobtrusive insurance.



I recently did a TV interview that covered a variety of health-related topics, especially the concept that most of the so-called age-related diseases are actually lifestyle-related. Click on the following link, https://www.facebook.com/SeniorStayOrGo/videos/2576759122420057/

Upcoming presentations

Wednesday, February 5th at 1:00 p.m., the Serra Mesa Library, 9005 Aero Drive, San Diego, Health benefits of wine and chocolate, just in time for Valentine’s Day. Wine and chocolate are derived from plants and thus contain nutrients that have specific health benefits. Not all forms of these pleasurable foods are healthy, however. Learn which claims are legitimate and how to select the healthiest kinds of wine and chocolate. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Friday, February 7th at 1:00 p.m. at the Temecula Higher Education Center, Osteoporosis: calcium is not the answer. Osteoporosis is not an inevitable consequence of aging and taking calcium will not delay its onset. Learn the single most important thing that you can do to maintain a healthy skeleton. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 13th at 1:00 p.m. Coronado Library, Health benefits of wine and chocolate, Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 19th at 1:00 p.m., Stagecoach Community Center, Carlsbad, Serendipities that affect your life and your health, Accidents happen but the outcome is not always bad. Scientific breakthroughs from the Big Bang theory to cataract surgery, from penicillin to post-it notes, from vaccines to Viagra, have come from efforts directed to a different objective. Simple mistakes have led to miraculous discoveries, several of which affect each of us every day of our lives. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 20th, 1:00 at the Oasis Grossmont Center, Keeping your wits: ten ways to prevent dementia and Alzheimer’s disease. Most forms of age-related dementia, including Alzheimer’s disease, can be avoided or delayed by following a prudent lifestyle. Ten simple measures will preserve brain function and even improve it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Tuesday, February 25th, 12:30 at the University Community Library, 4155 Governor Drive, San diego.  Shingles, a better vaccine is here. Shingles, whose medical name is herpes zoster, is occurring more often as our population ages. For most victims it’s uncomfortable but for many it results in pain that can last for years, sometimes results in blindness and is associated with stroke and heart attack. A much more effective vaccine that was released in December, 2017 is nearly twice as effective as the previous one. Learn how it begins, who is at risk and how we can avoid it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 26th at 1:00 p.m. at the Point Loma Library, A day in the life of a Gold Rush physician, Sponsored by OASIS.  It began with a nugget no larger than a thumbnail but it transformed the United States. Physician-adventurers followed the gold, bringing old ideas as well as newly-emerging medical discoveries. It was a unique period in history that tested a physician’s skills and stamina. To register see their web site at http://www.oasisnet.org.

In the news

The Wuhan Coronavirus: a perspective.

            The world is on edge because of a new virus that has emerged from China where it has sickened nearly 12,000 victims and claimed the lives of 259, according to official Chinese figures. As of this writing on January 31st there have been no reported deaths outside of China and only 7 nonfatal cases in the United States.

Financial markets have reacted as if this is a Black Swan event –an unexpected event of large magnitude, a random, catastrophic and massive disaster that can affect perhaps millions of lives. This does not, in my view, qualify as a Black Swan event.

The very cautious approach of health officials is justified in spite of the low – so far – mortality rate of only about 2 percent. Two other coronaviruses had much higher fatality rates: 9.6 percent for SARS (Severe Acute Respiratory Syndrome, 2002-2003) and 38 percent for MERS (Middle East Respiratory Syndrome, 2012-present). The Wuhan virus may yet turn ugly but the latest statistics are encouraging.


There have been more than 6,000 cases of Coronavirus infection worldwide since about September 2019; there have been more than 8,000 deaths due to influenza just in the United States in that time. There will be no vaccine to prevent Coronavirus in the near future but there is one to prevent the flu. The latter vaccine is far from perfect but it dramatically reduces the likelihood that persons who become ill will need to be hospitalized or will die from the secondary bacterial infection that is so often the actual cause of death.

A little more than a century ago an influenza pandemic (i.e. worldwide) killed at least 50 million persons at a time when the global population was about one-fourth what it is today. It’s extremely unlikely that such a catastrophe – a true Black Swan – will occur again. In 1918-1919 many people were overcome because of malnutrition. Remember that these were the years when The Great War came to an end. There were no antibiotics back then and most fatalities were due to infection by bacteria of the types that are almost always susceptible to today’s antibiotics.

A hundred years ago doctors didn’t even know what viruses were. In contrast, the Wuhan Coronavirus has already been identified, a diagnostic test is available and work has begun on a vaccine. Is this a Black Swan? Not at the moment but it should be a reminder that we should take advantage of all the vaccines that are available to us and wash our hands frequently, especially after having been out in public.


Avoiding another annoyance of aging: muscle cramps.

These painful spasms can occur at any age but they seem to be more frequent as we get older. To make things worse they often occur at night, spoiling a restful sleep. There are several causes but most of the time they can’t be explained.

Dehydration – the lack of adequate fluid intake – is one of the causes that we can do something about. Because thirst is not a sufficient sign of the need for fluids in older persons we need to have a more reliable indicator, and we do. Your urine should always be light yellow with only a mild odor; dark, smelly urine means that you are getting behind in fluids. Of course, taking more fluid late in the day means that you’ll probably have to make an extra trip to the bathroom during the night but it’s worth it not only to prevent cramps but also to avoid developing kidney stones.

Maintaining moderate physical activity throughout life has many benefits, one of which is healthy blood flow to your muscles. That supplies your muscles with nutrients and oxygen and removes accumulated waste products that can increase the likelihood of developing cramps. After you exercise (and not before!) you should do some stretching movements.

Some persons have low levels of calcium or magnesium. Muscle cramps can also be a sign of diabetes, liver disease or thyroid problems. If you have frequent muscle cramps it’s worth a trip to the doctor to rule them out.

Sometimes chewing on a Tums tablet will relieve the pain.











In the news

Ketogenic and low-carb diets are not the same

Low-carb diets have been around for a while, popularized by Dr. Robert Atkins. It’s surprising to some but ketogenic diets have been around a lot longer – about 200 years longer. Nearly complete restriction of any form of carbohydrate was an attempt to postpone the inevitable fatal outcome of diabetes, which until fairly recently consisted only of type 1, caused by the complete destruction of insulin-producing cells in the pancreas. It was a rare patient who survived more than a few months until the discovery of insulin in 1921.

In that same year, a diet that severely restricted carbohydrates and conversely increased the intake of fats was found to dramatically reduce the frequency of seizures in persons with epilepsy. That was the mainstay of treatment until effective prescription drugs became available.

When the intake of carbohydrates is reduced to 50 grams or less per day, about as much as is in a couple of Oreo cookies or two bananas, the body uses fat for fuel by turning it into ketones. The brain can only use sugar (glucose) or ketones for fuel. In theory, that uses up stored body fat, leading to weight loss.

Scientists are still not certain why ketosis reduces seizures or even why it leads to weight loss although “using up” fat for fuel makes sense. It’s a lot more complicated than that.

Low-carbohydrate diets such as Atkins or South Beach, especially in their more recent versions, do not rely on the production of ketones. In fact, a later version of The South Beach Diet doesn’t even include the term “ketosis” in the index! A truly ketogenic diet is so hard to maintain and comes with so many side effects that few dieters can maintain it for more than a few months, most not even that long.

In the next blog I’ll describe which foods to avoid if you want to go low-carb. Don’t worry – you won’t feel like you’ve just entered a monastery!


          Another annoyance of aging: falls

Falls are among the most frequent and the most serious problems seniors face and there a couple of reasons why they affect us so gravely. The first is that osteoporosis has become so common, affecting about one woman in five in the U.S. and about one in twenty men. When a hip fracture occurs, about twenty-five percent of patients will not survive a year.

An aging population increasingly requires prescription blood-thinners because of conditions such as atrial fibrillation, coronary artery disease, certain types of stroke and deep vein thrombosis (blood clots in large veins, especially in the legs). When the clotting mechanism is compromised, even a seemingly mild head injury can result in severe disability or death. Such was the fate of the above-mentioned Dr. Atkins.

You might consider some changes in your home. Get rid of scatter rugs; put non-skid strips in the bath and shower; install night lights and lighting strips; hand-holds in the bath and shower. (And all these improve your home value!)

This is one more reason to exercise. Physical activity not only strengthens muscles so that you can pick up your feet higher to avoid tripping, it prevents the loss of those nerve endings that enhance balance.

One more thing: we become more sensitive to alcohol as we get older. Alcohol is a major factor in falls among the elderly.