Earthquake Injuries – the Haiti Experience – What to Prepare For

Last month’s JAMA (Journal of the American Medical Association) featured an article from the CDC (MMWR 2011;59:1673-1677) on post-earthquake injuries treated at a field hospital in 2010.

What did they see?  Or of more concern, what will we see when an earthquake strikes closer to home?

The statistics only included patients injured severely enough to be admitted to a field hospital.  Records were incomplete for the first 7-10 days, no doubt reflecting initial chaos.

From January 13 – May 28, 2010 a total of 1369 patients were admitted (a number that seems low in view of 222,570 deaths with 300,000 injuries, but this data is from a single facility).

Of these, 42% had injury-related diagnoses, of whom 60% required a surgical procedure.  Of these, about a fourth were directly related to the earthquake.

The most common injury diagnoses were:

  • fractures/dislocations
  • wound infections
  • head, face, and brain injuries

The most common surgical procedures were

  • wound debridement/skin grafting
  • treatment for orthopedic trauma
  • surgical amputation

The most common mechanisms of injuries for earthquake-related injuries were:

  • cut/pierce/struck by an object
  • crush injuries
  • falls
  • burns
  • vehicle injuries
  • assault/violence
  • unknown (49%)

Which of these are you prepared for?

The list of injuries is about what I would expect.  Assault will always be a factor when fear reigns and societal organization is disrupted.

A basic medical kit should contain plenty of gauze, tape, bacitracin, large band-aids, Kotex pads for covering large wounds, wound-closure strips for  superficial lacerations, alcohol or iodine for cleaning around wounds, burn cream, ice packs, elastic wraps, Coban, splints, and pain medications.  For those with advanced skills, lidocaine, syringes, needles, suture material, skin staplers, and electro-cautery would come in handy.  Preventing infection is as important as treating the immediate problem.

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Posted in Disaster Relief, Fractures, Injuries, Lacerations, Medical archives, Perennial Favorites, Preparation, Public health | Tagged , , , , , | Leave a comment

Week 4 – Question of the Week: What are the best foods for stockpiling?

Week 4:  2011-03-31 

 Today I’m asking our professionals to weigh in on the question:  from a medical perspective, what are the best foods for stockpiling, and why?

You, too, are welcome to post your responses and questions below. 

Check back soon and see what our panel of over 100 professionals has to say.

– Doc Cindy
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Protected: Fish Antibiotic Question for Medical Pros

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Free Download – Protocol for Determining if a Fish Antibiotic is US Pharmacopeia Grade

Last week the site was flooded with those interested in this free offer.

To eliminate the bottleneck, I’ve decided to offer the download without requiring a password.

{To download the free protocol, click on the link below, then again on the page you’re transferred to, on the first line under the title.}

Protocol for Determining if a Fish Antibiotic is US Pharmacopeia Grade PDF

AS ALWAYS, I appreciate your feedback in the comment block below.

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How to Get Your Doctor to Help You Stockpile Medicine

The following article was originally published at www.survivalblog.com in September 2010

* * *

Picture this: Your doctor enters the room and asks, “How can I help you today?”

“I’d like enough medicine to survive the end of the world as we know it,” you reply.

He narrows his eyes and responds, “Just how much Prozac would you need?”

. . .

Finding a physician to help you stockpile medications will be a challenge. Unless your doctor, too, believes Armageddon is nigh, he’s not likely to grant your request.

Why not? Doctors are responsible for the medications we prescribe and the consequences, intended or unintended. Remember, every medication is a potential poison. You’re probably glad your own physician has sufficient training to possess a valid medical license. Certain problems (and medications) require periodic monitoring regarding their effects on the human body. No doctor wants to be responsible for patients who won’t comply with essential examination and testing. Would a car maker warranty your automobile engine if you refuse to change the oil?

Typically, doctors prescribe enough medication to cover a specific problem for an appropriate length of time. Antibiotics are usually dispensed for 7 to 10 days, blood pressure medicines for 1 to 6 months, diabetic medicines for 1 to 3 months, and pain relievers until the underlying problem has resolved.

Does your doctor prescribe you extra amoxicillin, just in case you get sick later this year? Not likely. When physicians prescribe more medication than is currently necessary, this often amounts to patients playing doctor with themselves or with others. Under our current system, this can be a felony.

At TEOTWAWKI, many survivors will be their own doctor, like it or not. And to do so, you will need a stockpile of medications.

Before I offer advice on how to get your doctor to help you with this stockpile, please realize that there are other obstacles to the acquisition of said drugs. Pharmacists have the right to refuse to fill a prescription that seems unreasonable or potentially harmful. Insurance companies usually limit payments for prescriptions to a 1 to 3 month period at a time. You’ll have to pay out of your own pocket to get more medicine than this. Doctors cannot legally alter their prescriptions to say you are taking more medication than you actually are. Neither would it be ethical for you to lie about the situation.

So, how to get the medicine that you may need?

One option is to convince your doctor that the end of the world is near. That’ll be tough. But think a moment, if your doctor really did think TEOTWAWKI is around the corner, he’d be doing his best to help you prepare.

Doctors do prescribe extra medication, along with directions for use, under special circumstances: antibiotics for potential traveler’s diarrhea, anti-malarials for travel to Africa, six months of medications if you’ll be wintering in Antarctica. Asking for medications for TEOTWAWKI is akin to doing the same for a trip around the world. The way I see it, such a supply would be intended to span a gap of only a year or two only. Some medications probably do have a shelf-life of a decade beyond their expiration date, but hopefully a better solution would be available long before then.

Convincing your doctor to prescribe extra medication depends largely on the doctor-patient relationship. If your doctor trusts you, he or she is much more likely to assist you. Please realize that your doctor will think that he’s doing you a fairly large favor. He may even question the legality of his own prescribing. Don’t forget to be grateful. Also realize that even if a doctor writes more than a year’s worth of refills, pharmacists cannot fill them beyond a year of the original prescribing date. If you are convinced that you need more than a 12-month supply stockpiled, you’ll need to discuss this openly with your doctor. Obviously a person could visit more than one doctor, which I don’t recommend, especially if you don’t tell each and every one of your physicians what you are doing. Dishonesty is a deal-breaker when it comes to getting your doctor to trust you.

In general, medications are prescribed for either acute problems or chronic problems. Acute problems include most infections and injuries. Chronic problems include asthma, diabetes, heart disease, hypothyroidism, mental illness, arthritis, and a host of others. Treatment of chronic conditions also includes modification of risk factors including high cholesterol and high blood pressure. Even antibiotics are sometimes prescribed long-term in certain situations, e.g. acne, rosacea, certain forms of colitis, and recurrent urinary infections.

Medications for acute problems include antibiotics, anti-virals, anti-malarials, antifungals, anti-diarrheals, antiemetics, migraine treatments, pain medications, heartburn relief, albuterol for asthma and COPD, nitroglycerin, corticosteroids, and anti-inflammatories, to name the most common.

Drugs for chronic problems and conditions include birth control pills, antidepressants, allergy medications, inhalers for asthma and COPD, anti-anginal drugs, acid-reducing drugs (proton pump inhibitors, histamine-2 blockers), anti-inflammatories, diabetic meds, thyroid replacement, and many others.

Without specifying which of these meds I’d advise for stockpiling, I’ll tell you exactly how I’d like a patient to approach me to acquire an extra supply, an approach which I believe would work for other doctors as well.

First, begin establishing a trusting relationship with your doctor. If you don’t think your physician even knows who you are, make an appointment for a minor problem. Don’t ask about stockpiling at this initial visit.

If your doctor asks you to follow-up for this problem, then do so. Follow directions. Be responsible. If he says no follow-up is needed, no doubt you can find another reason to come in within a month or so. Accompany another family member to their appointment to keep your face fresh in your doctor’s memory. If there are multiple providers in your physician’s office, try to see the same one each time to establish a relationship.

By the third time your doctor has seen you within a time frame of a few months, he’s going to start knowing you, and more importantly, trusting you. You must act in a trustworthy manner by:

  • Showing up for your appointments
  • Not canceling appointments with insufficient warning
  • Arriving on time (even if you must wait on the doctor)
  • Taking your medications properly and knowing their correct names and dosing
  • Trying to do your part in every way
  • Being kind, pleasant, polite, and cheerful.

Of course, this is good advice even if TEOTWAWKI does not occur in our lifetime.

After doing the above, it’s time to consider approaching the topic of TEOTWAWKI.

Say that you have diabetes and want to be prepared. If you ask for a year’s prescription, your doctor may figure you won’t show up again, even though you’ve demonstrated responsibility to date. Ask for an extra three months instead and make 100% sure that you show up for your next scheduled visit. If you don’t, your doctor will decide he cannot trust you. As in every relationship, once trust is broken, it takes much, much longer to reestablish.

Assuming you do keep your scheduled follow-up, remind the doctor that you have put back the extra medication, and that you’d like to have an additional three month’s worth. Reassure him that you will again follow-up whenever he’d like you to return. (And especially for diabetics, do what your doctor suggests regarding blood sugar testing, weight loss, etc. – at the very least, try.) In this fashion by establishing and confirming trust, you can build up an adequate stockpile. If your relationship is strong, he may trust you to get even a year’s worth ahead of time. The same protocol would apply equally well to any of the chronic diseases mentioned above. And if you suffer from any of these, educating yourself is an excellent idea. Learn how to take care of yourself now so you’ll be ready later.

For acute problems, such as bacterial infections, you’ll want a supply of antibiotics on hand. Follow the above directions in establishing a trusting relationship. Then either when you are sick (or when you are not) ask for a supply of one appropriate antibiotic, perhaps a 30-day supply. Reassure your doctor that you will not use this medication as long as he is here to take care of you. If you get sick again, go back to your doctor and remind him of your plan. If he suggests antibiotics, request a new prescription, and perhaps another supply to stockpile. Trust, trust, trust. That’s 99% of the equation.

With 2012 just around the corner, you should start now. None of us knows God’s timeline, but waiting until the last minute is ill-advised.

* * *

What do Armageddon and health reform have in common? Either way, people need to know how to care of themselves with the resources at hand. Written by family physician Cynthia J. Koelker, MD, 101 Ways to Save Money on Health Care explains how to treat over 30 common medical conditions economically, and includes dozens of sections on treating yourself. Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

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Posted in Medical archives, Medications, Perennial Favorites, Preparation, Prescription Medications, Stockpiling medical supplies | Tagged , , , , , , | 2 Comments

Week 3 – Question of the Week: Should preppers get the rabies vaccine?

Week 3:  2011-03-24 

{ Above image – rabid dog }

Today I’m asking our professionals to weigh in on the question:  should preppers get the rabies vaccine?

(see Rabies and The End of the World)

You, too, are welcome to post your responses and questions below. 

Check back soon and see what our panel of over 100 professionals has to say.

– Doc Cindy
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Posted in Acute diseases, Education, Medical archives, Question of the Week, Rabies, Vaccination | Tagged , , , , , , , | 14 Comments

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Monday – Free Offer of the Week

Tuesday – Special Offer of the Week

Wednesday – Special Topics and Guest Articles

Thursday – Question of the Week

Friday – Photo Quiz of the Week

Saturday/Sunday – Sabbath

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Rabies and the End of the World

The following article has been excerpted from my upcoming book, Armageddon Medicine.

* * *

Rabies . . . few words strike fear in the heart more quickly.  Picture your sweet little girl trotting over to pet the slobbering dog weaving down the street.  Should you rush for your gun or run for your daughter?   Are you a dead man, either way?

At the current time human rabies is uncommon, with only a few annual cases in the U.S.  Most are due to encounters with bats, raccoons, and wild carnivores, although about a fourth of the time the disease is contracted overseas.  For the curious reader, see http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html for a listing of all U.S. cases.

But what will happen when pets go unvaccinated, when contact with wildlife increases, when no health department exists to examine a dog’s brain for the presence of rabies virus?  How many of the 15 million patients given post-exposure prophylaxis each year will die?  (See http://www.who.int/rabies/human/situation/en/index.html).

Although someday, somehow, manufacture of rabies vaccine may be re-established after a cataclysmic event, what should we do in the meantime?  If we really believed 2012 marked the end of civilization, should we consider vaccinating not only our pets, but ourselves?

Rabies is uniformly lethal. (Yes, there was that one patient who survived with intensive medical treatment, but will you be the next?)  Since preventive vaccination is available, who should consider it?  Everyone?  Veterinarians and veterinary students are required to receive pre-exposure prophylaxis in the form of a series of three rabies shots over the course of 3-4 weeks.  Vaccination is already recommended for spelunkers (cave explorers) and travelers to rabies-endemic regions when contact with infected animals is a possibility.  [Consider the 2009 case of the Virginia physician who diagnosed his own subsequently fatal case of rabies a few months after returning from India (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a3.htm).]

The lowest price I could find for the pre-exposure immunization series is $513 for veterinary students, though about $750-800 is charged at travel clinics in Ohio.  (The cost for post-exposure immunization is higher ($2000-7000), but this pricing probably reflects use of both the vaccine and immunoglobulin, and antibody titer testing as well.)  Unless you’ve been exposed to rabies, insurance is unlikely to cover the expense of pre-exposure vaccination.

Your doctor will not recommend rabies vaccination unless you fall into a high-risk group, and will not have the vaccine on hand.  Nevertheless, you can investigate immunization on your own at your local health department.  If you do get the vaccine, testing for immunity every two years is recommended, with a booster dose if necessary.

Exposure to a mad dog or aggressive raccoon is a clear indication for post-exposure rabies vaccine, but a scary fact is that some patients who die of rabies have had no known exposure to a rabid animal.  Any encounter with a bat (the flying mammal variety) is reason to seek rabies vaccination.  Even if you are not bitten per se, a tiny, perhaps invisible, scratch may be lethal.  [Consider the 2009 case of an Indiana man who died in Kentucky of bat rabies despite no known physical contact.  (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5913a3.htm)]

I haven’t yet been immunized myself, but it is something to think about.  Does it make sense to protect our indoor pets and not ourselves?  Of course, immunizing our pets is protecting ourselves, as well as those who may happen to be bitten by our precious pups.  Whether to take it a step further is the question you must decide for you and your loved ones.

Copyright © 2011 Cynthia J. Koelker, MD

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Posted in Bites-animal, Injuries, Medical archives, Perennial Favorites, Rabies, Vaccination | Tagged , , , , , , , | Leave a comment

Re-Thinking Herbal Medicine

I’m an allopathic doctor. That means I prescribe pills.

Along with the rest of the established medical profession, I have “looked down my nose” at those who tout the superiority of plants and herbs.  Now I’m not so sure.

Still, I remain skeptical of those with a high profit motive and extremely limited medical knowledge. Discovering that an herb may have an effect on the mouse thyroid does not make it a proven weight-loss drug for humans. If you read the fine print on nutraceutical products, you’ll see that, despite their claims, they are “not intended for any medicinal use.”  If you investigate the science behind the claims, you’ll likely find it is scanty indeed.

Six common medicinal herbs in Tibet according ...

Image via Wikipedia

On the other hand, some of our most useful drugs are derived from the natural world: aspirin, botox, curare, penicillin, digoxin, morphine, to name a few.

I remember as a youthful MD smugly explaining why pharmaceutical drugs are superior.  For example, why is digoxin better than foxglove?  The pill contains a single, purified, active ingredient in a precise, predictable dosage.  But is 0.25 mg of digoxin the equivalent of one foxglove leaf or 10?  Plants or stems?  We know the safe dose of digoxin, but might a strong cup of foxglove tea kill your grandmother?  There are dangers of using herbal products.  Just because something is natural does not make it safe, as in poison mushrooms or even pure oxygen.

Yet I believe God has given us the natural world to benefit us (and not primarily Big Pharma).  Medical science has greatly expanded our understanding of the microscopic, chemical, biologic, immunologic, and genetic sciences. Perhaps it is time to marry the two together.

Some claim that at TEOTWAWKI we’ll be plunged into medical care of two centuries ago.  But if the knowledge base is preserved, even apart from the manufacturing capability, at least we’ll know better how to preserve life, avoid infection, rehydrate patients, and not harm our loved-ones in the process with dangerous therapies now proven to be ineffective.

Prescription placebos used in research and pra...

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When I read sites on herbal medicine I despair at the lack of objectivity. Grandma’s remedies may have worked just because she was Grandma.  Medical science has a tough time separating this placebo effect from a true effect.  And if Granny’s favorite potion worked every time (which is certainly not true of any pharmaceutical product), maybe what people need most is a Granny.

I don’t want this site to be another source of questionable information.  I have asked our medical professionals to contribute (see Question of the Week#2), and their opinions run the gamut.  Researching the hard science is time-consuming, and there just isn’t much out there to support clinical use.  But that doesn’t mean plant-based therapies don’t exist.  We just don’t understand them well enough yet.

So my own thinking has undergone a gradual transition and this summer I plan to plant a medicinal herb garden and do some experimenting of my own.  As time goes on, I hope to offer additional articles on proven therapies, something you can both trust and use.

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Posted in Diseases, Herbal and complementary, Herbal medicine, Medical archives, Medications, Prescription Medications, See medications - herbal | Tagged , , , , , | 12 Comments

Week 2 – Question of the Week: Which herbal medicines do you believe in?

Week 2:  2011-03-17

People ask daily regarding herbal alternatives to pharmaceutical drugs.

Today I’m asking our professionals:  which herbal preparations do you believe in?  Which are bogus? Which get the job done?

Post your queries, answers, and suggestions below.

Check back soon to read their comments below.

– Doc Cindy
Posted in Education, Herbal and complementary, Herbal medicine, Medical archives, Medications, Question of the Week, See medications - herbal | 20 Comments