Not the usual blog post

Last week Pat and I with three other members of our church community became certified in the Stop the Bleed® program. We are part of a growing number of persons who acknowledge that we face risks that are rare but life-threatening: mass shootings. In the minutes between the time that an assailant has been neutralized and the arrival of the first ambulances, some victims in such attacks have not survived because of severe bleeding.

Shortly after the Sandy Hook tragedy at Newtown, Connecticut, the American College of Surgeons and several federal agencies developed Stop the Bleed®, a program designed to train non-medical persons in the simple steps that can effectively prevent severe loss of blood, the most common cause of death in mass shootings. Bleeding injuries that are sometimes fatal also occur under more ordinary circumstances: workplace accidents, hunting accidents, falls through glass and motor vehicle collisions.

Even the best-trained responders may be limited in what they can do if the proper materials are not immediately available. You are no doubt familiar with wall-mounted cabinets that contain an Automated External Defibrillator (AED) at many public venues such as airports, fitness centers, libraries and medical offices. They are already being paired with similar-looking cabinets that hold public access bleeding control stations that contain dressings, tourniquets and other supplies that can stop serious bleeding quickly.

The shooting that occurred during Passover at the Chabad Synagogue in Poway, just a few miles from our neighborhood, was our wake-up call. Our church now has a Medical Response Team consisting of physicians, nurses, paramedics, EMTs and military corpsmen and medics, all of whom are committed to respond in case of an attack. They will have access within seconds to several caches of medical supplies such as those in bleeding control stations that have been prepositioned at various places in the church buildings.

Stop the Bleed® courses are available throughout the country, usually at no cost. The class lasts only about one hour during which students learn the basic steps of bleeding control: pressure, packing and tourniquet use. Go to where you will find class locations and registration information as well as a detailed description of the program and how it began.

My reason for making this blog post goes beyond the desire to inform you about the Stop the Bleed® program. It’s my hope that those of you with contacts in your community will not only spread this message but will organize teams such as ours in your own faith communities, places of business and schools. I encourage you to pass this blog to everyone you care about.

If you would like more information, feel free to contact me at or 760-732-1414

“The only thing more tragic than a death from bleeding…is a death that could have been prevented.” (From the Stop the Bleed® handbook, What Everyone Should Know to Stop Bleeding after an Injury.)









Upcoming presentations

Wednesday, July 17, Body fat: all that jiggles is not the same. OASIS Grossmont Center, La Mesa 1:00 p.m. Sponsored by OASIS. To register see their web site at 

Saturday, July 20 11:00 a.m. Ten ways to prevent cancer, Penasquitos Library

In the news

Spend some time with nature

A study published last month in the journal Scientific Reports confirmed what health authorities have been telling us for decades: spending time outdoors is good for your health.  We shouldn’t be surprised. After all, humans have lived close to nature for all but the last couple hundred years or so of their existence, first as hunter-gatherers for a few million years and then as farmers for a few thousand. Now that we have central heating, air conditioning and electric lights – and just recently computers and TV – it’s just so comfortable to stay indoors. We have evolved to spend most of our time outdoors and we pay a price for not doing so.

The first thing that comes to mind is vitamin D. It’s important not only to maintain a strong skeleton but we need it for a healthy immune system.  The researchers note that health benefits come from only about two hours a week outdoors – and that will give us plenty of time to make the vitamin D we need – as long as it’s during the day and with no sunscreen, with our head and arms exposed.

Indoor air is not healthy air, for reasons that we don’t have space to delve into in this blog, and breathing outdoor air refreshes our lungs, reducing the risk of asthma, allergies and heart disease. Of course, getting some exercise while you’re outside helps in the matter of heart disease.

Finally, a casual stroll at the beach, at a park or just around the neighborhood reduces stress, decreases blood pressure and improves our sense of well-being.

But you need to leave your cell phone at home!


Floaters and dry eyes

By the time we reach seventy most of us have dry eye syndrome, sometimes to the degree that we need medical help. Some of it is due to aging and our tear production slows down. However, there are some non-natural causes that we can do something about.

Are you getting enough vitamin A? Sweet potatoes, carrots, collard greens, spinach and cantaloupe are good sources but do you get several servings a week? Beef and chicken liver are great sources but they have just about disappeared from the American diet. True vitamin A deficiency is rare in the U.S. but inadequacy may not be.

Some prescriptions medicines such as antihistamines, blood pressure drugs and antidepressants contribute to dry eye syndrome. Hours of computer use and exposure to tobacco smoke also are factors.

Maybe it’s not a single cause. Each of the factors above might add up. In any case, if it’s enough to make you uncomfortable it’s time to see an ophthalmologist.

And about those floaters. They are usually benign and look like dots or webs, sometimes other shapes. As we age – there I go again – fragments of cells or particles of protein drift around inside the eyeball.

Sometimes floaters indicate serious eye problems and should not be ignored. If lots of them appear suddenly, especially if accompanied by flashes of light or changes in your peripheral vision, they may be a sign of retinal detachment, a condition that requires immediate treatment.







In the news

May was Vision Month – Baby Boomers take notice!

Vision is critical to survival so it’s no wonder that we flinch when something comes close to our eyes and that the cornea is so sensitive to any foreign material.

On the other hand, chronic conditions that could lead to severe visual impairment, especially as we get older, often don’t give us any warning symptoms. For that reason everyone should have a vision exam by an ophthalmologist starting at the age of forty; for African-Americans it should start at twenty (!), especially if there is a family history of glaucoma. The reason? Glaucoma can progress with few symptoms until there has been some loss of vision.

Glaucoma is usually – but not always – due to an increase of pressure within the eyeball. It causes a loss of peripheral vision and it may be so gradual that we hardly notice. Persons with diabetes, high blood pressure, overweight and low thyroid function are especially at risk.

In the next Carvings blogs we’ll discuss some other conditions that sneak up on us, and some eye symptoms that actually are signs of serious disease.


Are we and our kids getting too many vaccines?

Most American children get nearly fifty shots – vaccines – by the time they start first grade. Doctors are pushing seniors to get several vaccines as well. The question often comes up: do all those vaccines interfere with each other? Can they actually weaken our immune system? Are they harmful?

It’s true that vaccines sometimes have nasty, even fatal, side effects but deaths are extremely rare and most are due to two reasons. First, some children are born with severely deficient immune systems and when they receive a live vaccine virus their body may be overwhelmed by even such a weakened virus. When most of us were kids we got the smallpox vaccine and did just fine but it was fatal in kids with severe immunodeficiency.

The second reason is now very rare: defective or contaminated vaccines. Some of us remember “the Cutter incident” in which polio vaccine virus was not killed but survived to infect several thousand children. Fifty-six developed paralysis and five died.

Diseases that I saw regularly early in my days as a pediatrician have simply vanished. Today’s pediatricians will probably never see meningitis due to a bacterium known as Hemophilus, encephalitis (inflammation of the brain) due to mumps or chickenpox, congenital rubella syndrome that caused infants to be blind, deaf and severely brain-damaged. They will never see polio, which affected some of my classmates.

Some vaccines have barely a tenth of the chemicals that occur in the natural germs. Some vaccines are prepared in yeast cells; some are made from small portions of benign bacteria. The natural germs that have been eliminated by these vaccines contained orders of magnitude more ingredients than the vaccines.

Do you know of a child who had a severe reaction to something like the measles vaccine? Consider this: that reaction may indicate that the child might have been the one child out of a thousand in the pre-vaccine era who died or suffered severe brain damage from natural measles. That reaction may indicate increased susceptibility.

In the next Carvings blog I’ll discuss vaccines for adults. You’re going to be surprised!






Upcoming presentations

Thursday June 6, 10:30 a.m. at St. Paul’s Plaza, 1420 E Palomar St, Chula Vista. 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

Friday, June 7th, 9:30 a.m. at the Oceanside First Presbyterian Church, 2001 S El Camino Real, Oceanside. 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 or call 800-500-9377.

Thursday June 13th, 1:00 p.m. OASIS Grossmont Center, La Mesa. Restoring a squandered legacy. Considering the remarkable medical advances of the past century, human life expectancy should be steadily increasing. Instead, we are burdened by diseases that didn’t exist at the dawn of the Agricultural Revolution. This presentation describes a blueprint to reverse the epidemics of obesity, diabetes and other causes of premature mortality. Sponsored by OASIS. To register see their web site at

Friday June 28th at 1:00 p.m. at the Temecula Learning 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 or call 800-500-9377.

In the news

Tick season has arrived.

It’s more important than ever to take special precautions to avoid tick bites and summer is high season. These critters are responsible for several diseases of which Lyme disease and Rocky Mountain Spotted fever are especially serious. Lyme disease alone attacks about 40,000 persons a year; Rocky Mountain Spotted Fever (which is more common outside of the Rocky Mountains) is sometimes fatal, largely because it goes undiagnosed until too late. Ticks love grassy fields but they can thrive in any type of wooded or brushy area.

The best insect repellent is still DEET but it should not be applied to infants and not on the hands of children. Apply it to their faces with YOUR hands.

Wearing long sleeves and slacks with the cuffs tucked into the top of your socks doesn’t sound very comfortable in warm weather but it does prevent tick attachment. Toss your clothes into the dryer with the heat on high for a cycle after coming home from your hike to kill the ticks you can’t see. (Some are mighty small!)

Check yourself, your kids and your dogs after the hike. The scalp is a favorite hiding place but no part of the body is safe; don’t overlook the groin, the armpits and skin folds – even the bellybutton!

The key word in removing any tick that you find is S-L-O-W. Use sharp-pointed tweezers close to the skin and pull it up slowly. Don’t waste time with Vaseline, any chemical or heat from a match or cigarette. Clean the area with a vigorous soapy scrub. You can follow that with alcohol if it makes you feel better, but alcohol is second best to soap.

Antibiotics are not usually prescribed if removal of the tick has been accomplished in less than 36 hours.


The Naked Sandwich

John Montagu, the Fourth Earl of Sandwich would be surprised to know that his invention – if the legend is correct – has invaded nearly every menu in the Western world. The 18th century First Lord of the Admiralty, after whom the Sandwich (Hawaiian) Islands are named, reportedly asked for a helping of meat between two slices of bread to keep him going during marathon gambling sessions. Some historians are less generous to the Earl and claim that the sandwich goes all the way back to the 1st century B.C.

Two slices of bread contribute about 140 to 200 calories to our daily meal plan. A tablespoon-sized glob of mayo or butter adds a hundred more. A naked sandwich – no bread, butter or dressing – thus trims 300 calories off your lunch. If you can resist the temptation to make up the difference with a sweet snack or dessert you could lose a pound about every two or three weeks.

How do you hold the stuff together? A large leaf of lettuce. If you Google lettuce wrap you’ll find enough information to overload your recipe box, especially the BetterBytes site. Most varieties of lettuce don’t provide much nutrition except for small amounts of folate, vitamins A and C and potassium but a good sized leaf has almost no calories either. Lettuce provides what nutritionists call mouth feel to offset the relative dryness of bread.

It’s alright to add another slice of turkey or other lean meat to your naked sandwich. Those 50 or 60 calories will give you a boost of protein that will quell your appetite a lot longer than the bread you left behind.

If you’re making your own lunch, get creative with condiments. Sweet relish, chutney, cranberry sauce and mustard add plenty of flavor and not many calories. Try a little vinaigrette, soy sauce, salsa, chili sauce or a spoonful of capers to wake up your taste buds.

Need a bridge to the lettuce-wrap lunchstyle? You might find a soft tortilla easier to handle and it adds only about 60 calories more than lettuce. Pita bread makes for a nice variation but it has about as many calories as a couple of slices of white bread.

There’s more to this than cutting back on calories. Almost all sandwich breads are made from refined grains that are digested quickly and that boost our blood sugar. Several servings a day of quickly absorbed carbohydrates contribute to the current epidemics of obesity and type 2 diabetes. Whole grain breads are not much better but they do bump up our fiber intake.

Tens of thousands of years ago humans had no grain-based products at all and our bodies haven’t yet become completely adapted to them. If we’re going to eventually get back to the kind of diet that nature intended for us the naked sandwich is a sensible place to start









In the news

Recent surveys suggest that American kids are getting more exercise than they did a decade or so ago but adults are not. The common excuse: “I don’t have time to work out.” How do we solve that problem? The answer: stealth exercise.

There are plenty of opportunities to burn a few extra calories several times a day and to maintain muscle tone and they don’t require much time. Here are a few examples.

At work or when you shop, park at the farthest spot, not the closest. (You’ll probably find more empty spaces there and your doors are less likely to get dinged.)

Don’t drop the kids off or pick them up at the front door of the school, but about ¼ mile away. You’ll all get some exercise, you won’t get zero miles to the gallon while in the line of cars and you’ll probably save time.

Use a push mower for the lawn; no gas to worry about. Rake up your leaves and grass debris instead of using that noisy vacuum.

Elevators are for wimps! Use the stairs if you’re only going up a flight or two; get in the habit of walking down several flights.

At work, use the restroom that is the farthest, not the one closest to your office. Take a ten-minute walk before lunch. It will perk up your appetite.

Stand up when you use the phone. It burns only a few more calories than sitting but research shows that it gives your voice more authority.

These are just a few examples and you are probably already thinking of more. You might burn only about a hundred calories every couple of days but it adds up to about FIVE pounds a year. Priceless!



What’s in an osteoporosis cocktail?

The major component of bone is calcium but it’s only one of many nutrients that we require for a strong skeleton early in life and to prevent osteoporosis in our later years. If there is a deficiency of even one of those nutrients the complex processes that build and maintain bone will suffer. When this occurs in middle age and later it can lead to the thinning of bone that we know as osteoporosis.

One of the most common questions that I hear from persons in my audience – almost always a petite elderly woman – is “I take calcium. Why do I still have osteoporosis?” Calcium by itself will have no effect on bone loss or fractures. Several other nutrients are critical for bone health.

The Osteoporosis Cocktail is my term for the group of nutrients that bones require to maintain their strength – in addition, of course, to resistance exercise. Vitamins A, C, K and D, magnesium, protein and omega-3 fats are equally important. A deficiency of any one of these results in deficient bone. This is a perfect example of why a varied diet is essential, for they come from different sources.

Plant foods can provide most of them but Americans’ dismally low intake of fruits and vegetables fails to provide enough vitamins, protein and omega-3 fats. Whole grains are a good source of magnesium; refined flour is not. Omega-3 fats come from fish; flaxseed is good but it is an insufficient source. Animal meat provides the protein that plant foods used to provide; fish and chicken are better sources than beef or pork because they have little saturated fat.







Upcoming presentations

Wednesday May 8th 1:00 p.m. at the Point Loma library. Immunizations for adults. Vaccines aren’t just for children. Recent developments in this area can help seniors to avoid crippling, even deadly, diseases. But are they risky?

Thursday May 9th at 6:00 p.m. at the Fallbrook library. What have we done to food? GMOs, Yellow and Red dyes, HFCS, trans fats are only part of the story. The food industry is nothing like it was when your grandparents were growing up. Are we really at risk? Can we do anything about it?

Thursday May 16th at 6:00 p.m. at the La Mesa library. Health benefits of wine and chocolate. This has been the all-time favorite of my 75 PowerPoint presentations. I wonder why!

Wednesday May 22nd at 1:00 p.m. at the San Marcos library. All about salt. History, health and hype. You’ll never look at your salt shaker the same way again.

Tuesday May 28th at 12:30 p.m. at the Carlsbad Cole Library at Carlsbad Blvd and Hwy 5. Avoid the annoyances of aging, a discussion of those pesky things that take the fun out of growing older.  And yes, most of them can be avoided.


In the news

Osteoarthritis is common among seniors but even relatively small amounts of exercise can slow down its progress, even just one hour a week. In a group of more than 1500 persons who already had some lower extremity symptoms of arthritis, those who consistently did some brisk walking for at least one hour a week were eight times less likely to have a mobility disability in four years. That’s good news for people who really don’t like to exercise and might give them incentive to become even more active.

This study, reported in the May issue of the American Journal of Preventive Medicine, confirms several earlier studies. Ten minutes a day is a good start but the real benefits of regular, moderately intense exercise, lowering the risk of heart disease, stroke and type 2 diabetes, come with about one hour per day, done at least four days per week.

Folks who have a full-time job and a family might find that much exercise hard to schedule but it doesn’t have to be done all at once. And in the next issue of Carvings I’ll discuss stealth exercise.


 “Never do anything for the first time.”

That advice was given to me decades ago by my brother, a U.S. Marine and law enforcement officer. Of course, everything we do has had a “first time” but he was referring to scenarios that he would encounter in his military and civilian careers, for which he would continually practice in real time as well as in his mind. We have applied this principle in our CPR training program, not just the repetitive and physically demanding chest compressions and rescue breathing but especially in the deployment of the AED, which requires some degree of eye-hand coordination.

In his book, Blink, Malcolm Gladwell (you might remember him as the best-selling author of The Tipping Point) describes what happens in an emergency situation. He gives several examples of the severe impairment of our physiologic reactions – visual and auditory misperception, alterations in our perception of elapsed time, loss of fine muscle coordination, impaired recollection, to name a few. He describes the problems encountered by persons attempting to make a 9-1-1 call, such as not being able to remember those numbers, fumbling with the keypad, not pressing the green transmit button on the cell phone screen, panic while attempting to describe the situation to the dispatcher, etc.

As those of you who have been in our CPR class already know, even in our make-believe scenarios, students often fail to send someone to call 9-1-1 when they recognize unresponsiveness. (Remember our grammar lesson? “No response call 9-1-1!” – dropping the first period.) Some students immediately begin chest compressions without checking to see if the victim is breathing. In manipulating the AED, in almost every class at least one student tries to apply an electrode to the chest while it is still stuck to the yellow plastic separator. These are not intellectual deficits, they are common reactions to a first-time stressful situation. Think of how much worse things could get in a real emergency!

As Gladwell so clearly points out in his book, responders can learn to avoid those performance deficiencies by training and practice – and practice, and practice.

We strongly recommend to our CPR students that they review emergency scenarios regularly – specifically, that they do so on a weekly basis, and that they get recertified every two years.  Several our our graduates have told me that they responded automatically to a collapse or other emergency as a result of their training, because it wasn’t “the first time.”

Thanks to brother Tom and Malcolm Gladwell.







In the news

A childhood vaccine that grownups should have.

          Measles has been in the news recently because of several large outbreaks, due primarily to the failure of parents to allow their children to be vaccinated. But there is another “childhood disease,” whooping cough, that has also become more common for the same reason.

Whooping cough, whose medical term is pertussis, is life-threatening to infants below the age of six months. It has an agonizing, sometimes fatal course. It is almost entirely preventable if the mother has received the pertussis vaccine in the prior couple of years, including during pregnancy. The antibodies that she passes to her child before birth provide protection during the six months that it takes for three injections of the DPT (Diphtheria-Pertussis-Tetanus) vaccine to reach protective levels in the infant.

Whooping cough is so named because of the unusual sound that a struggling infant makes in trying to take in a breath during severe coughing spells. In older children and adults there is no whoop; the illness takes the form of bronchitis – usually about three or four weeks of cold symptoms with moderate coughing and discomfort. If an unimmunized or incompletely immunized baby is exposed to an adult with pertussis, that infant can become seriously ill.

A strategy that works

Before the infant arrives, persons over the age of eleven in the household and any prospective visitor (especially grandparents!) should receive a DTaP booster. (The “a” designates a new version of the DPT vaccine.) Protection against pertussis lasts for at least five years; protection against diphtheria and tetanus lasts much longer, perhaps a lifetime, making it an even better deal.



Trans fats are gone. Do you miss them?     

Trans fats are chemically engineered vegetable oils such as peanut and cottonseed oil that prolong the shelf life of baked goods. Because they are uncontestably related to heart disease and stroke the U.S. government banned them, effective June 2018.

Food manufacturers growled and complained but many of them saw the writing on the wall and began to eliminate them in 2015 when the FDA announced the 2018 ban. Some companies removed trans fats from their products as early as 2006.

Denmark implemented a ban in 2004 and since then has seen a dramatic decline in the incidence of cardiovascular disease. On a smaller scale, people who lived in those parts of New York State where trans fats had been banned for three or more years were found to have significantly lower rates of heart attacks and stroke.

One less thing to worry about but some people fear that a ban on sugar will be next. Don’t bet on that one making it through Congress!