Tag Archives: travel

Carvings September 15, 2026

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In the news

Rabies is rare but be aware.

          Rabies may be the most feared disease on the planet, and with justification. Although rare in the United States, where there are fewer than five cases per year, ten thousand times that many persons die from the disease in the rest of the world. It is almost universally fatal and to date fewer than 30 persons have survived; none have been neurologically intact.

            The CDC has justifiably raised an alarm regarding rabies. So far in 2026 more than 1700 persons have required treatment for exposure to an animal with confirmed or suspected rabies. Most exposures have occurred east of the Mississippi but the virus has been recovered from animals throughout the United States. Bats are the most common animal to be infected but recent cases have included raccoons, skunks, coyotes, beavers, petting zoo goats and groundhogs. Outbreaks occur regularly among ground squirrels in California.

            Post-exposure treatment is one of the greatest success stories in medicine. It is nearly 100 percent effective. Failures are so rare as to be reportable in the medical literature.

            It is not necessary to have a recognized animal bite to become infected. A bat bite, for instance, may be so painless as to be unapparent. Thus any close contact with a bat, especially during daytime –healthy bats are not active during the day – should be treated as an exposure. Infected saliva may be a source of infection, even if there is no obvious break in the skin.

            Nocturnal animals such as raccoons, skunks and coyotes are presumed to be infected if they are near humans in daytime.

            Of the approximately 60,000 cases of rabies that occur worldwide each year, Africa and Asia account for about 95 percent, mostly transmitted by dogs. Accordingly, anyone traveling to those continents should be aware of the risk. Bats are cave-dwellers and cave explorers should consider getting the rabies vaccine prior to travel to areas known to have infected bats.

            Considering the high risk of exposure and the vanishingly small risk of post-exposure treatment, a prudent approach strongly recommends the latter.

Lifestyle

Lose weight but not your brain

            The new class of weight loss drugs, known as GLP-1 receptor agonists, arrived on the scene a relatively short time ago, and as we might have expected, now that millions of Americans are taking them some serious side effects have emerged. These drugs reduce the appetite to a significant degree. The good news is that they work; the bad news is that by reducing food intake they limit the availability of some critical nutrients.

            Wernicke encephalopathy is a severe brain disorder whose symptoms include malfunction of the eye muscles, resulting in abnormal eye movements, unsteady gait and mental deterioration. It has been recognized for over a century among alcoholics and victims of beri-beri. The primary cause is the severe lack of thiamine, vitamin B1. It has been reported among persons who have undergone bariatric surgery, a procedure in which the stomach is reduced to the size of a hen’s egg. Now it has appeared in persons taking GLP-1 drugs, especially if they have vomiting, a not uncommon side effect.  

            In all three conditions, alcoholism, post-bariatric surgery and GLP-1 intake, failure to take in nutritious food includes failure to take in adequate vitamins and minerals. (Note: osteoporosis has been observed in bariatric surgery patients. Expect to see the same disorder in drug-takers in the next couple of years.)

            Without early recognition and treatment, Wernicke encephalopathy is not always reversible and can lead to death. Everyone taking this class of drugs should be made aware of this hazard.

            We have yet to see the toll that the new medication will exact.

Carvings February 15, 2026

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Is it an ethnic cuisine – or ethnoid?

                What would life be like in America without ethnic foods – Italian, Chinese, Japanese, Greek, Vietnamese, etc.? I only wish that more cultures were represented – Russian, for example, or German or Chilean. I’m sure that you can find these lesser-known venues in our larger cities, but they are uncommon elsewhere.

                On the other hand, many of our favorite restaurants serve what I call ethnoid, not ethnic foods. (-oid from the Greek, meaning similar) Catering to American tastes, they are usually  sweeter, saltier, more meat-laden and huge.

                This week I’ll discuss Italian food – specifically, the true Mediterranean diet. You won’t find it at your local pizza parlor. Outside of the tourist hotspots in the home country, Italian pizza is quite simple: a thin crust, a layer of tomato sauce and a smidgin of cheese. The amount of cheese that we find on a single slice of American pizza would suffice for about two days for a family of four in rural Italy. It is a garnish, not a major part of the entrée. Only occasionally does it come with pepperoni or sausage. 

The True Mediterranean diet consists mostly of vegetables. There is no significant beef industry in the 21 countries that touch upon the shores of the Mediterranean Sea, largely because it is so expensive both in terms of money and in environmental resources. Goats and young sheep are much less costly for both. Until a few decades ago they had no refrigeration either, which is why cheese, not milk, is the major dairy product. Fish and other products of the sea are major suppliers of protein.

Consider a favorite menu at the Olive Garden – A Tour of Italy: 1500-1800 calories,93 grams of saturated fat and 3,210 milligrams of sodium. And that doesn’t count the breadsticks, the wine or the dessert. The Olive Garden does have a number of very healthy items and if you like it – and I do – be sure to read the fine print on the menu.

The True Mediterranean Diet is a favorite of healthcare advocates. Scores of scientific articles attest to its cardiovascular and anticancer benefits. And of course, it includes a glass of red wine.