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Carvings October 1, 2025

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In the news

Prescription drugs and fatal falls

            In the blog posted on June 15th I noted that some prescription drugs caused dizziness, resulting in falls. There is more to the story as noted in a recent publication in the Journal of the American Medical Association (JAMA).

          About 40,000 people over the age of 65 die from falls every year, and many of these are directly related to four groups of drugs: benzodiazepines (e.g., Valium), opioids (e.g., hydrocodone, codeine), gabapentinoids (e.g., Gabapentin) and antidepressants, of which there is a wide variety.  They all have numerous side effects and all of them are associated with drowsiness, impaired balance and loss of coordination, conditions that lead directly to falls. 

          The authors of the study note that overprescribing of these drugs is a serious problem, that long-term use is to be avoided and that safer alternatives are available. In their opinion, more than 25,000 lives could be saved each year if these medications were used appropriately, i.e., that with rare exceptions they should not be used at all in persons over the age of 65.

          Persons taking these medications should consult with their physician to determine if their use justifies the risk.

Lifestyle

          I wrote about this topic three years ago but I’m repeating it here because I have recently talked with two persons in their 80s who have not yet had the shingles vaccine – Shingrix. That’s a serious mistake!

          Elderly persons are particularly at risk of shingles, a painful condition whose complications include severe chronic pain in affected areas, and even blindness when it involves the face. About 20 percent of persons over the age of 60 are going to get shingles. That number jumps to 50 percent at age 85

          The vaccine that was released in 2017 is 97 percent effective in preventing shingles and it probably will be protective for about ten years. (That is my personal opinion based on data to date but we’ll have to wait another few years to be certain.) Two doses are required and most recipients can expect some side effects such as a sore arm, headache, mild fever and feeling crummy for a day or two. These are insignificant when compared with blindness or pain that lasts for years. Those complications are not rare. They occur in about 15-20 percent of persons over the age of 80.

          It is strongly recommended for persons over the age of fifty, even those who have had shingles in the past or who have received the old vaccine (Zostrix).

Carvings March 15, 2025

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In the news

What’s all this about vitamin A and measles?

            The measles outbreak that began a few weeks ago is one of the largest in recent years, and so far it has claimed the lives of two persons, one a child. Neither victim had received the measles vaccine. Media stories about vitamin A are confusing, if not misleading, so let’s clarify things.

            Vitamin A is essential to maintain the integrity of the skin, eyes and immune system. Many common foods contain vitamin A or its precursor, beta-carotene. The former can be toxic when taken chronically in high doses but the latter almost never is.

            Before we had a measles vaccine in the mid-1960s, few children escaped this illness. About one child in a thousand died from the disease and about one in five hundred suffered from devastating inflammation of the brain. Approximately half of the children who were apparently spared such serious complications were found to have a low-grade inflammation of the brain that impaired their school performance for months, perhaps longer. Many also suffered from weakening of their immune system that left them open to other common infections, such as pneumonia. Thus, it was not as benign as we thought.

            There is another frightening complication of measles that most people are unaware of: subacute sclerosing panencephalitis, known as SSPE. It is now almost non-existent in this country as a result of widespread vaccination. SSPE may occur several years after a bout of measles and the incidence ranges from about one in 600 to one in 5,000 victims. Expect to see this devastating, always fatal inflammation of the brain in years to come if parents’ current refusal to immunize children continues,

            While vitamin A deficiency is quite uncommon in the United States the opposite is true in the developing world, and it is severe in some countries. It is not only a major, if not the leading cause of blindness in children in Africa, but it plays a leading role in measles mortality. In some developing countries the seriousness of measles is magnified by orders of magnitude. Whereas during my early practice years we lost one child out of a thousand, among vitamin A-deficient children in some parts of Africa the mortality rate is as high as 400 out of a thousand – a staggering forty percent! That number falls dramatically when children receive adequate amounts of vitamin A in their diet over the long term, before they are exposed to the measles virus.

            N.B.: There is more to the story. Vitamin A-deficient children are also lacking in other vitamins and minerals, and they are almost always severely deficient in protein, which is supremely important in maintaining the immune system.

            VITAMIN A DOES NOT PREVENT OR CURE MEASLES. However, the standard of care, even in the United States, is to give a child hospitalized with measles, usually because of the common complication of pneumonia, two doses of 200,000 units of vitamin A. Although chronic overdosing with vitamin A can cause severe problems, there is no risk in administering that amount in a hospital setting. An important caveat: a child who has or has been recently exposed to measles should not be given extra doses of the vitamin. There is no evidence that this will mitigate the seriousness of the disease or lead to a shorter course of the illness.

            There is no cure for measles but the usual two doses of the vaccine have an effective rate of 97 percent. Serious side effects of the vaccine are almost non-existent; the occasional high fever or rash may in fact indicate a vulnerability to the virus that in its wild form could cause death or brain damage.

Carvings February 1, 2025

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Why vaccines fail

            One of the major factors in the steep rise in life expectancy that occurred between 1900 and 2000 was the development of childhood vaccines. Today’s young physicians may never see a child with measles, polio, some forms of bacterial meningitis or chickenpox. Even the oldest physicians among us have likely never seen a child dying agonizingly from whooping cough or tetanus or diphtheria, those diseases having been vanquished before World War Two. If these diseases occur in the United States – and they do sometimes – it is usually because the patient came from a country where medical care is poor and immunization rates are much lower than they are here, or because parents have been caught up in the anti-vaxx hysteria that has been increasingly common in the twenty-first century.

            But sometimes a vaccine does fail to provide infection from the disease that almost always prevents the disease against which it is targeted. One reason is that some vaccines must be kept at specified refrigerator temperatures. When the measles vaccine was released in 1963 pediatricians noted occasionally that vaccinated children developed measles. Investigation showed that some pediatricians’ staff had placed the vaccine on a door shelf of the refrigerator instead of deep inside, which had been recommended. The slight increase in the temperature of vials kept on the door shelf was high enough to weaken the live vaccine, rendering it ineffective. The oral polio vaccine, a live form developed by Albert Sabin, has the advantage of not requiring needles and syringes that are prohibitively costly in developing countries, but it requires a “cold chain” that is also expensive in order to prevent degradation of the vaccine.

            Children who are born with a severe immune deficiency or those whose immune system is weakened by chemotherapy will not respond to the stimulus of a vaccine agent. Obesity may be a factor in the adult population, not only because obesity or its accompaniment, type 2 diabetes, degrades the immune system but because ordinary-length needles fail to reach the muscle tissue deep within a layer of fat. The result is that the patient cannot develop adequate antibodies or immune cells.

            Vaccines vary tremendously in their duration of protection. Diphtheria and tetanus vaccines provide nearly lifelong immunity but the mumps virus fails to protect after just a few years. The disturbing occurrence of numerous mumps outbreaks among young adults has prompted a reevaluation of that vaccine. Yet more evidence that mother nature keeps throwing curveballs!

Carvings December 1, 2024

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In the news

            The outbreak of the week – what’s going on?

            Ground beef, onions, sprouts, carrots, cantaloupe, eggs – is anything safe? The short answer is “No.” Any food product can be contaminated with bacteria such as E. coli, Salmonella and Listeria – they are simply part of our environment. The good news is that we can avoid becoming ill from these organisms by taking a few simple steps.

            It’s a fact of life that most of the animals that we depend on for food are swarming with bacteria, most of which are harmless but some of which can be deadly, especially for the very young, the very old, and those with medical conditions that weaken their immune systems. Depending on the local circumstances, about 40 percent of chickens are contaminated with Salmonella bacteria; for beef it’s a similar percentage that is contaminated with E. coli. Listeria bacteria, which are especially dangerous for pregnant women and small infants, contaminate a wide variety of plant foods.

            Thorough cooking provides the best defense against contaminated chicken, beef or shellfish. As much as you might enjoy steak tartare or raw oysters, those foods carry some risk. So do bean sprouts, which are often served raw on salads or sandwiches. If you serve bean sprouts at home, make sure that they’re fresh, keep them refrigerated and cook them thoroughly.

            All fruits should be washed thoroughly as soon as you bring them home from the market or fruit stand. I always use soap and ignore the questionable advice of some nutritionists who warn us about the chemicals in soap. Bah! Just be sure that you rinse them thoroughly. Be particularly assiduous about cantaloupe – that rough skin makes it hard to remove bad bacteria. The knife with which you cut melons or other fruit can carry bacteria into it.

            Buying pre-cut fruit is not a great idea. Aside from the possibility that the preparers might not follow good hygiene practices, if it has been sitting in the cooler for several hours that allows bacteria to grow and gather in greater numbers. The “convenience” isn’t worth the risk.

            About 45 million Americans become ill from contaminated food each year. You can avoid being one of them.

Lifestyle

            What to do about leg cramps?

            Almost everyone gets leg cramps, usually in the calf. They have a myriad of causes and there is no simple way to prevent them or to provide immediate relief, but there are some things to consider.

            If you get leg cramps frequently, several times a month, or if muscles in other parts of the body cramp up, that’s an indication for a thorough medical exam. If there is local swelling, or the pain is persistent, don’t delay. I have consistently recommended that everyone should have a thorough physical exam and basic blood tests every year, especially after the age of 40, because conditions such as high blood pressure, kidney disease and diabetes show no symptoms until significant damage has occurred.

Dehydration is a common but subtle condition, especially among seniors, and it may be the cause of leg cramps. Be sure to have at least one glass of water between dinner and bedtime. (Yes, I know – that probably means at least one visit to the bathroom at night but it’s a small price to pay.)

As soon as you feel a cramp starting, get up immediately, stretch the calf by leaning forward flat-footed or by pulling your toes toward you, or by massaging the calf. Sometimes chewing on one or two Tums tablets will relieve the cramp almost immediately, so have a bottle of Tums handy if that seems to have worked for you. Standing on a cold tile floor may also help; sometimes walking around provides relief.

A variety of vitamin and mineral inadequacies have been blamed for leg cramps but there is no nutrient that seems to work consistently. The Standard American Diet (SAD!) is so poor that even the American Medical Association advocates a multivitamin/multimineral supplement for everyone. Whole grains, fruits and vegetables, especially leafy greens, should be part of everyone’s daily diet.

If you have had good results with anything that I have not mentioned here, feel free to share your experience with me at drphilg@cox.net.

Carvings October 15, 2024

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In the news

Don’t trust the COVID vaccine? Okay, but don’t let that keep you from getting the vaccines you need.

            A University of Pennsylvania study describes three major misconceptions that Americans hold about the COVID vaccine:

            COVID vaccines have contributed to thousands of deaths.

            Getting COVID is less risky than getting the COVID vaccine.

            COVID vaccines will change your DNA.

            Although these beliefs are incorrect, they carry strong emotional weight with lots of people, so I won’t bother to address them further. However, beliefs such as this and the vile theory that the MMR vaccine causes autism have dissuaded many parents from giving their children basic childhood vaccines, and kept adults from getting the vaccines they need to prevent death or serious illness.

            Hundreds of cases of measles and thousands of cases of pertussis (whooping cough) have occurred in the past few years because of poor compliance with childhood vaccination guidelines. I have a deep fear that it’s only a matter of time before we begin to see two diseases that I saw many times in my early, pre-vaccine pediatric career – Hemophilus influenzae meningitis and epiglottitis. The latter is a swiftly moving, often deadly infection.

            Some adults are reluctant to get two vaccines that are intended for them, the pneumococcal and shingles vaccines. The former prevents what was once a common cause of pneumonia, especially among the elderly, and I have seen the consequences of shingles – blindness and near-constant, severe pain.

            I addressed the influenza vaccine in earlier posts. I remind you that the flu season is underway and the virus is circulating in San Diego. Be warned.

Lifestyle

            In the course of grocery shopping at Albertson’s and Walmart last week I again had to run the gauntlet of cookies and cakes, augmented by Halloween sweets, cleverly positioned to greet shoppers as they enter the store. A reminder that much of the American diet is obesogenic and diabetogenic. With the holiday season little more than a month away it’s time to strengthen our mindset to avoid, or at least limit, the foods that provide us with energy and nothing else. I’d like to share a couple of steps that I have taken to bolster that resolve.

            At a banquet a couple of days ago the table was set with a healthy-looking salad, alongside which was a scrumptious-looking chocolate dessert – a genuine work of art. Knowing that I won’t always be able to resist the temptation in the coming weeks, I gave my resolve a kick-start by leaving it alone.

            Today’s lunch at the old folks’ home in which I reside included a seafood club sandwich. I asked them to leave out the bacon. I do have to admit that I missed it!

            Caring friends will soon stop by with plates and boxes of Christmas cookies, etc. It’s OK to have a taste and to toss the rest in the trash a week later. (Wow! Did Phil really say that?) Better there than on your waistline.

            Go ahead and have as much as you want at Thanksgiving. After all, it is a Feast Day!

            I hope that this short list will have given you some ideas as we enter our overly tempting holiday season. But it’s okay to enjoy some of these treats that only come along once a year. (Note the word “some” in that last sentence.)