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(Image is hand necrosis caused by plague.)
Going on vacation soon? Or expecting the end of the world, perhaps?
If I moved to a desert island, what medicine would I, a family physician, take with me? It’s something I’ve pondered over the years. It’s easy to say what I wouldn’t bring – no cholesterol medicine, no diet drugs, no wrinkle cream.
What’s really necessary? What’s really useful?
To make things simple I’ll stick with medicine available inexpensively over-the-counter. That’s another way of saying, what should you keep in your medicine cabinet? Or take on a cruise?
Since I might have a toothache or headache or injury myself, I’d bring along something for pain – probably two things: ibuprofen (generic Motrin or Advil, under $10 for 500 caplets) and acetaminophen (generic Tylenol, about $4 for 100), in case the ibuprofen bothered my stomach.
Expecting a diet of bananas and coconuts might irritate my stomach, I’d make sure I brought meclizine for nausea, ranitidine or famotidine for heartburn, and loperamide for diarrhea (inexpensive generics for Bonine, Zantac, Pepcid and Imodium, respectively, each under $10). I’d bring generic Tums, too, for quick relief of acid indigestion and to help my bones, since there probably wouldn’t be any cows around and chewing seashells is hard on my teeth. The meclizine would also come in handy for any sea-sickness or car-sickness along the way.
I might get a paper cut from a palm leaf, so would pack a tube of bacitracin to prevent infection. On the off chance of poison ivy I’d keep a tube of hydrocortisone 1% (generic Cortaid 10) on hand. And just in case there were any fungus around to cause ringworm or athlete’s foot, I’d bring a tube of clotrimazole (generic Lotrimin) as well.
And since I’d likely have allergies to the native plant life, I’d bring diphenhydramine (generic Benadryl) for bedtime use (also helps insomnia) and loratadine for morning use (either also helps hives or itching).
I suppose I’d have to be in the water to catch fish now and then, so would bring a bottle of hydrogen peroxide to rinse my ears (50:50 mix, water and hydrogen peroxide) if they started getting sore (swimmer’s ear).
And since my diet might not be ideal, I’d take a year’s worth of inexpensive vitamins with me for about $10.
Oops! Almost forgot the sunscreen – I’d need at least an SPF 15 or higher until I got tanned. Better bring a book on herbal medicine as well, in case I’m stranded longer than a week or two – and a solar charger for my cell phone.
Now, I’m ready to go.
Copyright 2010 Cynthia J. Koelker, MD
After reading Seven Antibiotics to Stockpile and Why, readers have asked what dose of antibiotics to stockpile. As a general rule, I suggest that you not request multiple strengths of a single medicine, as few if any doctors would agree to this.
Here are my recommendations for the most appropriate doses of common antibiotics to stockpile and why.
1. Amoxicillin – Many pharmacies offer the 250 and 500 mg capsules at the same unit price. Amoxicillin tablets are also available, but may cost somewhat more than the capsules, depending on the pharmacy. Amoxicillin tablets may be split more easily (than the powder in the capsules can be divided) to provide a lower dose if needed for children or small adults. (Babies are usually administered a reconstituted powder, but few pediatricians would prescribe this for stockpiling.) The best single option is amoxicillin 500 mg tablets (or capsules).
2. Cephalexin – Again, cephalexin 250 and 500 mg capsules are priced the same, so the 500 mg capsule is the better deal. The powder could be divided to obtain a lower dose, or the medicine could be taken twice daily rather than three or four times daily, as with amoxicillin, above, to yield a lower dose.
3. Ciprofloxacin – Because the 500 mg dose is used more commonly than the 250 mg dose, the higher dose is actually less expensive than the lower dose and may be split as needed. Except in dire emergencies, this drug is not used in children, so pediatric dosing does not apply.
4. Doxycycline – Available in either tablets or capsules at about the same cost, I suggest the 100 mg tablet, which may be split for lower dosing.
5. Erythrocin – Another case where the higher milligram dose may be cheaper than the lower dose, depending on the pharmacy. Check your local $4 list before asking your doctor for either the 250 or 500 mg tablet. In general, I would advise the higher dose.
6. Metronidazole – Another case of an adult medicine, though in this case, the higher dose is generally more expensive than the lower dose. Still, I’d recommend 500 mg tablets, which may be split if needed.
7. SMZ-TMP DS – The DS (double-strength) is used much more commonly than SMZ-TMP (single-strength), so again I recommend the higher dose, which also may be split for adult or pediatric use.
8. Tetracycline – The 250 mg and 500 mg capsules cost the same, so I’d go with the higher dose. Like doxycycline, tetracycline is not used in children whose teeth are still forming due to the potential for permanent staining.
Most of the above recommendations are based on cost as well as traditional dosing. If your doctor is willing to write antibiotics for stockpiling at all, these are the ones most likely to be prescribed.
Copyright © 2011 Cynthia J. Koelker, MD
About the Author: Cynthia J. Koelker, MD is the author of the book 101 Ways to Save Money on Health Care, which explains how to treat over 30 common medical conditions economically, and includes dozens of sections on treating yourself. $1000 of advice in a $10 book.
Weekly Online Radio Show
Approximately 1:30 to 1:45 p.m. EST at www.wgcv.net – Click “Listen Live” to hear Doc Cindy with Gary Pozsik.
This week’s interview: Thursday, March 3, 2011
It’s a scary thing to hear the former key advisor on pandemics and bioterrorism to the US Secretary of Health and Human Services say the U.S. is insufficiently prepared for another flu epidemic.
Did you know 95% of life-saving drugs in the U.S. come from overseas, primarily China and India. Doesn’t that put the U.S. at risk?
Listen with Doc Cindy as she discusses lessons learned from the 2009 H1N1 pandemic.
This post is fifth in a series by Edward W. Pritchard. To read more of his writings please visit: http://eddwardwpritchard.blogspot.com
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fiction
edward w pritchard
Civilization again – I visit a city
It’s hard for me to criticize the State of Tennessee, or more specifically the City of Nashville. Both have been exemplary in remaining hospitable to the influx of refugees from Northern States, mine of Ohio included. In the catastrophe-to-civil order following the bad air plaguing Northern States to date, and slowly drifting South across America, Tennessee is being kind and welcoming to us refugees.
Several States, Texas and Arizona leading the charge, have sealed their borders. More moderate States will let in their fellow Americans, providing they do not have health insurance, mandating coverage in their State under Federal law. Those States fear the collapse of economic union.
I took Laura to the airport in Nashville. After she safely was on a plane to Chile and her new life, I witnessed what is probably the new normal for Southern cities. I shudder to contemplate what we have become.
A desperate man at the airport refused to be convinced that his airline frequent flying credits, painstakingly acquired over a dozen years, had become worthless in the last month. As he became violent, I watched part of an incident of him being initiated to the newest generation of DNA tasers. The technology usually reserved for our foreign enemies, often called terrorists by our military, is painful and long remembered. The invasive, orally-delivered technology is apparently now in use in US cities because of the threat of civil disobedience caused by the new ‘normal’ of the bad air epidemic, and the movement of peoples South it has ushered in. I was unable to watch longer as he was overpowered by five security persons and the tentacled device was rolled toward him down the sloping airport concourse.
Nashville, Tennessee
Fall 2012
It took me a while to get out of the airport. The manager found out I had walked from Ohio and insisted on pumping me for information on the storms aloft, as he called them. He tried to wine and dine me, but it’s too soon; upset stomach and myriad physical complaints from the bad air lingers.
I finally agreed to be his guest at the Westin Resort Casino Hotel for a few days in return for a brief written report for the airport’s use in planning for the storm which reaches here in earnest in ten days or so. Somehow Nashville, Tennessee has a brief retrieve from the winds.
Here is part of the report I wrote for the Airport manager, and then my impressions of the fin de eternity atmosphere here in Nashville, representing the transition of American civilization as it adapts to the changes caused by movement of vast amounts of people south, and the death of nine out of ten American citizens caused by the miasma.
Impressions of a Disaster
edward w pritchard – pilgrim
The air comes in slowly like a fog. It is deliberate, intelligent, and in my opinion people are being herded South by it. It moves to within six inches of the ground and if a large animal, over thirty pounds, lingers in it, all seem to die in a few days. Being inside a building or house is no protection. Fleeing is the only alternative, although nine out of ten humans seem to succumb. Physical strength or physical condition helps a little, but survival is somewhat a matter of luck, it seems. I’ll leave it to a physician to describe the cause of death, but basically it’s some form of suffocation. Treatment with a conventional asthma inhalers prolongs life if one stays ahead of the worst of the storms, which travel relentlessly North to South. On the road we say the winds travel at seven miles per hour, but I understand from talking to experts at the airport it’s never more than thirty miles a day, reason unknown.
I walked from Mansfield, Ohio to Nashville, Tennessee in a three week period. My vehicle died from the fog as did all others I witnessed. I saw many people trying to use animals to transport humans, but all failed. I was carried a little in a litter by humans just North of Nashville, as were several others I observed who had the funds to hire struggling bearers. Conditions on the road South were desperate and pathetic. People aren’t buried, the sick aren’t helped, and there is little human kindness. Survivors choose one of two strategies: assume they are already dead and just walk, or do anything to survive and head South and hope for a miracle.
There is little civil order in cities; pilgrims are advised to avoid cities, see notes on Nashville.
Sometimes for no apparent reason the storms jump, as if to give humans a chance catch up in their fleeing. This is where the idea of intelligence of the winds come in. However far the storms travel in a day, thirty miles per day is a lot to walk for a sick person. I stayed with the pack on my walk and we were never overtaken by the worst of the storm.
I have heard that the worst of the storms, caused by sunspots some say, will tear dirt and life from the ground, and leave the landscape as a primordial orange hell. That’s the whispered description that’s supposed to have happened in Canada. I saw nothing like that. To the best of my knowledge anyone from where I started from who didn’t flee is now dead. God bless us all.
Nashville, Tennessee
Sin City meets Middle America
Nashville has a week to live and I hit the Wal-Mart. I sold an asthma inhaler for $2000 Brazilian and so I am loaded for now. I had traded all the gold I had acquired on the trail to get Laura, the little girl I befriended earlier, on one of the last planes to South America; so it’s good to have money again. I rented a car, 1967 Olds Cutlass and I am cruising around Nashville. Most people have left, just tourists, nuts, and old people who decided not to run are left.
I spent most of my time in Nashville gambling at the casino. I spent a few dollars for a companion and have been paying for her gambling and she is my friend for a few days. She used to be an English teacher in Kentucky and she wants badly to edit my stories I write, we will see on that later.
The federal government is governing in Nashville and other Southern cities I hear and they are making a mess of things. That’s all I’ll say except they are very high-handed, cruel really, and I will be glad to get out of here.
What’s to say about a collapsing city? It’ so historical that it’s trite, and if poignant, mundane to just a flinch-and-a-head-roll-to-the-left. Part of the dwellers of Nashville go to the Wal-Mart and work even though their city will end up like all the Northern ones they read about in the newspaper, covered by up to ten feet of dust and dirt in a week or two. Like Ur, or an Egyptian City or Asian City before them. We don’t have city walls any more but who will maintain the city walls here in Nashville soon? Civilization dies and moves on. The young and hopeful, who can forget the death of nine out of ten of their friends and countrymen, flee South in desperation and hope. The old go about their routines oblivious to doom and their extinction.
Me, I still gamble and let the pretty girl I am with talk. It’s nice to have someone to listen, too. The Westin casino hotel here is very plush and exclusive and the staff are like the first class employees on the Titanic an hour after ice was impacted. Service is good but can be erratic. I go to the fine restaurants here and always only order oatmeal, rolled and heavy for my upset stomach, or dried biscuits Southern style, or grits. Still it’s nice to eat and be served on a silver platter.
Here at the Westin, from my room high above Nashville on the eighteenth floor, at night I watch the stars and the fires. The fires are from fleeing people burning their houses before they leave, direction South. They are afraid their bankers will try to enforce their mortgages even though their houses are covered in dirt and dust ten feet high and now functionally obsolete. Maybe one hundred thousand houses are ablaze on any given night, not as many as a Northern city, because of the Federal troops, or these Southerners seem more compliant than their Northern neighbors.
Tennessee has sealed their borders and Federal troops are not letting anyone in or out of Nashville without proof of upper class status, [ie] net worth above a certain level. Rioting in Nashville in all parts of the city this morning, so far the casino here is safe. Back to the real world soon. We can’t stay at the casino forever.
end
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The following post, originally published at SurvivalBlog.com, includes a few minor corrections and additions regarding bioavailability of generic medications.
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Expired medications – are they safe? Are they effective?
In Part I of this series, I explained the definition of pharmaceutical expiration dates and ‘do not use beyond’ dates, and how both are determined. Additionally, I reviewed information from the Shelf Life Extension Program database, which led to a temporary Emergency Use Authorization in 2009, permitting the use of certain Tamiflu products (to treat H1N1 influenza) for up to an additional 5 years beyond the imprinted expiration date. Please see Part I of this series for more information.
Part II will examine the data regarding use of common antibiotics beyond their expiration dates.
The following is excerpted from my upcoming book, Armageddon Medicine.
Does a can of tuna go bad overnight? What about a bottle of medicine? Common sense suggests the answer is no, but is there any evidence?
The primary source of information regarding the prolonged stability of medications comes from the Shelf Life Extension Program database. Rather than discard millions of dollars worth of expired drugs stockpiled for emergency use, the U.S. federal government tested representative lots of selected medications for extended stability. These stockpiled drugs are aimed at emergency use for injuries and infections rather than chronic diseases such as diabetes, heart disease, and asthma. The most useful data for the layman is related to drugs to combat bacterial and viral infections.
Of the antibiotics tested, all passed assays for stability, potency, and appearance for at least a year beyond the original expiration date.
Of the lots tested, the following had their expiration date extended by the number of months indicated.
| Medication name | Dosage form | Average extension in months (range) |
| Amoxicillin sodium | Tablets | 23 (22-23) |
| Ampicillin | Capsules | 49 ( 22-64) |
| Cephalexin | Capsules | 57 (28-135) |
| Ciprofloxacin | Tablets | 55 (12-142) |
| Doxycycline Hyclate | Capsules | 50 (37-66) |
| Erythromycin lactobionate | Powder | 60 (38-83) |
| Sulfisoxasole | Tablets | 56 (45-68) |
| Tetracycline HCl | Capsules | 50 (17-133) |
| Silver sulfadiazine | Cream | 57 (28-104) |
A summary of the SLEP data is available in The Journal of Pharmaceutical Sciences, Vol. 95, No. 7, July 2006.
The Medical Letter, a respected professional newsletter, addressed the topic of expired medications in both 1996 and 2002. Regarding safety, they say: “The only report of human toxicity that may have been caused by chemical or physical degradation of a pharmaceutical product is renal tubular damage that was associated with use of degraded tetracycline. . . Current tetracycline preparations have been reformulated with different fillers to minimize degradation and are unlikely to have this effect.” (The Medical Letter, Vol. 44, Issue 1142, October 28, 2002.)
Liquid preparations may be much less stable, and degrade more quickly if frozen or heated. The Medical Letter advises that “Drugs in solution, particularly injectables, that have become cloudy or discolored or show signs of precipitation should not be used.” For oral medications, color changes may also be related to the dyes rather than the drugs. The primary concern pertaining to eye drops is microbial contamination once the preservative becomes ineffective.
Overall then, the concern is not regarding safety, but rather effectiveness. “Many drugs stored under reasonable conditions retain 90% of their potency for at least 5 years after the expiration date on the label, and sometimes much longer,” per The Medical Letter.
The SLEP data does not describe testing for any controlled-release antibiotics, such as Biaxin XL and Augmentin XR. Controlled-release delivery systems vary from drug to drug and would require testing not only of the medication itself, but the delivery system as well, to assure adequate drug delivery. Therefore, the regular versions of both Biaxin and Augmentin may be preferable for stockpiling. Essentially the only advantage of controlled-release antibiotics is less frequent dosing.
In the case of antibiotics, a 10-25% loss of potency over time may make little difference in treatment, and could be made up for by higher dosing in serious infections. Even now, generic medications are allowed a variance of +/- 20% in terms of bioavailability, whereas brand-name drugs are permitted only a 5% variance. Theoretically this might yield a 50% difference from one generic to another, or from pill to pill. However, in recent studies the FDA states the average difference in absorption between generics and brand-name drugs is only 3.5% (see http://tinyurl.com/kvtaad). Also, generics may not be equivalent in terms of integrity, dissolution properties, or coatings. In the case of generics, “Made in the USA” is probably preferable to those manufactured elsewhere.
To sum it all up, the good news is that most tablets and capsules are very likely safe and quite likely effective for several years beyond the printed expiration date. Using expired medications may suffice for a decade beyond the end of the world as we know it . . . (but what then?)
In my next post I will examine the use of other common drugs beyond their expiration date.
Copyright © 2010 Cynthia J. Koelker, MD
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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The following is excerpted from my upcoming book, Armageddon Medicine.
What will diabetics do if medication becomes unavailable?
In the first in a series, Dr. Koelker discusses herbal therapy for diabetes.
The American medical establishment is beginning to examine the role of herbal therapies in the treatment of diabetes mellitus, primarily Type 2 (adult onset, non-insulin dependent). Unfortunately, without pharmaceutical companies to fund the research, comprehensive studies are not likely to be performed. To date, there are no official recommendations for using herbal preparations in the treatment of diabetes mellitus.
However, in the event no medication is available, what treatments might diabetics consider for themselves? Is there any scientific evidence for effectiveness of herbal therapy?
Chromium picolinate is known to lower blood glucose levels in both humans and animals, probably by lowering insulin resistance. Limited medical literature reports improvements in long-term blood sugar control in patients taking 100 to 500 micrograms twice daily. There have been a few reports of renal (kidney) failure with high dosages.
It has been proposed that garlic may lower blood sugar levels in humans, since it is effective in alloxan-diabetic rats. How garlic may do so remains under study, and it is not recommended for treatment of diabetes in humans at this time.
Alpha lipoic acid (found in meat, broccoli, and potatoes) may help treat nerve damage due to diabetes, but does not lower blood sugar levels. The dosage noted to be effective for diabetic neuropathy is 600 to 1200 mg per day.
Ginseng and psyllium may also lower blood sugar a little, but again, this effect cannot be guaranteed. However if no medication is available, Panax ginseng (100-200 mg per day) may be somewhat effective.
I have had patients who have tried these herbal preparations for their diabetes, but none who experienced a reversal of the disease.
Some of the evidence for lowering of blood glucose levels using herbal preparations comes from anecdotal stories of patients who have experienced hypoglycemia (low blood sugar) when chromium picolinate or ginseng was added to their medication regimen.
If an herb can lower your blood sugar 50 points (which I’m estimating), that’s great, but also much less effective than medication. Still, it’s better than nothing, and when combined with calorie restriction and weight loss, herbal preparations are certainly a consideration when or if medication is unavailable.
Of course, most of us are not growing ginseng in our backyards, and long-term supplies would be a challenge for herbs and vitamins as well as medications. However, since these products are available over the counter, stockpiling enough for several years of therapy is a consideration.
For a good review of the literature regarding herbal treatment of diabetes, see The American Family Physician, September 2000, available online at http://www.aafp.org/afp/20000901/1051.html .
For information regarding use of ginseng see The American Family Physician, October 2003, also available online at http://www.aafp.org/afp/2003/1015/p1539.html.
Information on treating diabetes with herbal products may also be found at the National Center for Complementary and Alternative Medicine at: http://nccam.nih.gov/health/diabetes/CAM-and-diabetes.htm
Are you dying for a glass of water? You may be if you don’t think ahead and prepare. The following is third in a series by Peter Farmer, who holds advanced degrees in research biology and history, and is also an RN and EMT.
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In a survival situation, finding safe drinking water is of paramount importance. Humans can survive prolonged periods of malnutrition and even starvation, but expire within days without water. As addressed in the previous installment of this series, dehydration progresses rapidly from mild discomfort to debilitation and ultimately, death, if left unaddressed.
What steps can you take to be prepared for scenarios in which you or your loved ones are without a sufficient and/or safe water supply? To answer these questions, we can draw from the knowledge and experience of such diverse sources as scientists/engineers, search and rescue/disaster relief personnel, the military, outdoorsmen, and healthcare providers operating in remote environments. Before getting to their expertise, however, we should better-define the parameters of possible scenarios and the problems they pose. For example….
Define a specific scenario or situation for which you wish to develop a plan. Formulating a water-preparedness plan for yourself in your home and community after a natural disaster is a very different problem from planning for survival water contingencies in a remote region or wilderness area.
The above concerns will be addressed below, and in subsequent installments of this series.
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POTABLE WATER
Drinkable (potable) water is of sufficiently high quality that it can be consumed or used with low risk of immediate or long term harm. In the developed world, most water supplied to residences, businesses, and industry is of this quality, though not all of it is used for human consumption. Conversely, in large portions of the developing world, including significant portions of South America, Africa and Asia, there is insufficient drinking water.1 Therefore, lesson one is that if you plan to travel internationally, do not assume that safe drinking water will be available – especially if you plan to venture off the beaten path or away from civilization.
Contaminants or foreign matter in water, which render it unsafe for human use fall into the following broadly defined categories: pathogenic microorganisms, disinfectants and their by-products, organic and inorganic chemicals, and radionuclides.
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Microorganisms are broadly defined as bacterial, viral, or protozoan. Not all bacteria, viruses and protozoa are disease-causing (pathogenic). Public health authorities are concerned primarily with pathogenic or potentially-pathogenic variants.
Coliform bacteria, such as Enterobacter, Klebsiella, and Escherichia, are commonly-used as diagnostic indicators of water and food quality; they appear rod-shaped under magnification, do not form spores, and Gram stain negative (-). Fecal coliform bacteria are those subtypes found in fecal matter and thus in sewage; Escherichia coli (E. coli) is the prototypical fecal coliform. When the sewers overflow after a flood and run-off contaminates fresh water sources, your local public works should warn you to boil water before using it. The reason? Fecal coliform bacteria. Another commonly-assayed coliform bacteria is Legionella, the causative agent of Legionnaire’s disease, a form of pneumonia.
Enteric viruses, also monitored by water-quality experts, are typically found in the gastrointestinal tract of infected mammals, including humans. There are over 100 polio and non-poliovirus types which cause everything from viral meningitis to endocarditis to gastroenteritis.
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Protozoa are small multicellular (eukaryotic) organisms ranging in size from 10 microns to 1mm, which inhabit a wide variety of aquatic and soil environments. Most are motile (can move) and are easily observed by conventional light microscopy. Many protozoans are parasitic, and cause disease in humans; these disorders may include malaria, amoebiasis, toxoplasmosis, giardiasis, cryptosporidiosis, dysentery and sleeping sickness, among others. In the United States, authorities are especially concerned with contamination of water by Cryptosporidium and Giardia lambia, both of which are commonly found in water contaminated with raw sewage and/or fecal material. Both parasites cause gastrointestinal illness with nausea, cramps, diarrhea and headache among the signs and symptoms.
Drinking water is assayed for suspended solids and turbidity (cloudiness), which are indicators of how effectively water has been filtered or cleansed by treatment. The amount of chlorine, bromine, and associated halogenated compound derivatives – which are used in sewage treatment but can also be disease-causing in excess – are monitored, as are heavy metals such as arsenic, antimony, cadmium, chromium, lead, mercury, and many others. A lengthy list of inorganic and organic compounds, as well as radioactive agents, rounds out the list. The U.S. Environmental Protection Agency (EPA) has set forth detailed standards of allowable contaminants in potable water, which can be viewed at the following link: (http://water.epa.gov/drink/contaminants/index.cfm#List). Interested readers may wish to read a related report by the World Health Organization (WHO).2
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An article appearing in the 17 August 2009 issue of “Time” magazine reports that an estimated 1.5 million children under the age of 5 are killed each year by unsafe drinking water, primarily in Africa and Asia. Cholera, dysentery and associated electrolyte-depleting diarrhea are the main killers. In addition to under-development, large-scale natural and man-made disasters, i.e., earthquakes, floods, volcanic eruptions, tsunamis, wars/refugee and humanitarian crises, are also often accompanied by insufficient or unsafe water supplies.
ASSURING SAFE DRINKING WATER IN YOUR HOME AND COMMUNITY
A complete survey of water preparedness is beyond the scope of this article (see Rawles, pgs. 65-77) 3 but common sense applies. If you have followed the previous installments of this series, you know something of the basics of the chemical and physical properties of water, and its effect on human physiology. Your preparations will depend on your needs, the scenarios for which you are planning, and your resources – financial, material, and otherwise. As detailed in my article of January 13, 2011, “Skilled Tradesmen as Public Health Experts,” your first priority should be to assure that your home water supply is safe and robust. If your circumstances permit it, consider sinking a well or constructing a rain-water catchment tank, or tapping a gravity-fed fresh water spring (If you tap a well or other source of ground water, you may wish to have it tested for safety according to the standards above). A swimming pool can be used as a de facto water reservoir. Apartment or other urban dwellers should do their best to store bottled fresh water. Many municipal water supplies and some wells depend on electrical power; if the grid goes down, water isn’t pumped. Therefore, it may make sense to have back-up power such as a generator, and/or a manual hand-pump or windmill. Of course, you have secured an adequate number of containers suitable to carrying and storing water, haven’t you? Two-liter plastic bottles are suitable; there are other many alternatives available. Locate one or more large bodies of standing water near your home – lakes or reservoirs. These will be your fall-back sources of water if your first-line supplies become unavailable. You will also want a means to transport that precious-but-heavy H2O to your home – if not by vehicle, then by a cart or similar means.
WATER TREATMENT AND PURIFICATION
Except in certain specific circumstances – radioactive fallout, for example – rain water is almost always safe to drink, and need not be purified further if you can collect it cleanly. Rain water collected from downspouts and standing sources will have to be treated before use, but is probably suitable as-is for cleaning, irrigation/watering of plants, toilet-flushing and other non-consumptive uses.
Water collected from open sources should always be treated before use. According to Rawles, a three-step process is ideal: pre-filtering, chlorination, and filtering. Pre-filtration through several layers of any tightly-woven fabric or paper, i.e., paper towels, coffee filters, cheesecloth, cotton t-shirts, panty hose, etc., works fine to remove larger particulate matter, and will preserve your fine filtration system (step 3) longer. Chlorination is accomplished by the use of “pool shock” calcium hypochlorite (note: use only pure calcium hypochlorite-containing products, not di-, tri-chloro varieties or those with anti-fungal or other additives). Make a concentrated “stock” solution by adding one heaping teaspoon of granular calcium hypochlorite to 2 gallons of water, stored in a plastic or glass container. This should result in a solution of approximate concentration of 500mg/liter. To disinfect water, add 1 part stock chlorine solution to each 100 parts of water to be treated. If pool shock is unavailable, ordinary 5-6% household sodium hypochlorite bleach such as Clorox may be substituted. For clear/cloudy water, add 3 drops per liter or quart to be treated, 10 drops per gallon/4 liters. Let stand for at least 30 minutes before use. For very cold, cloudy or surface water, use 5 drops per liter or quart to be treated, 20 drops per gallon/4 liters. Let stand for at least 30 minutes before use, 60 minutes if the water is very cold or cloudy. If you have a purpose-built micropore filtration system, use it at this point, after chemical treatment. To dissipate the taste/odor of chlorine, the water may be aerated by pouring it between two containers, or by leaving it in sealed glass containers for 6-8 hours in direct sunlight to break down the chlorine.
Tincture of iodine is also suitable for water purification; iodine tablets have been used by hikers for many years as a means of purifying water taken from streams, lakes and other natural sources. Commercially-available iodine tablets are cheap and available on the internet and from reputable hiking/outdoor supply stores. Three drops 2% tincture of iodine per liter are required (6 drops per pint); double the amount if the water is cloudy.
Boiling is a very safe method of treating suspect water, but it consumes fuel and is not always practical. If this method is chosen, it is necessary to bring the water to a rolling boil for 1 minute, before allowing it to cool for use. Water pasteurization indicators (WAPI) are now in common use in the developing world as a means of saving time and fuel when heat-treating water. They indicate when the water has been sufficiently heated to be safe. A conventional dairy or other non-mercury thermometer can also be used; be sure to boil the water at or above 149 degrees F for at least one minute. If you have fuel and water to spare, by all means boil the water longer if you wish.
FINDING WATER IN THE WILDERNESS
Can safe, clean water be found in the environment or in the wild, and if so how? The answer is a qualified “yes” – if you think and act from sound scientific/medical principles, and know your surroundings. The “how” is dependent on where you are, and what resources you have at your disposal.
Water runs downhill, so begin by searching for a low-lying drainage area that can collect water, such as a valley bottom or gully. If no standing water is visible, look for lush, green vegetation and begin digging there for ground water. As Wiseman notes, even dry river-stream beds may have subsurface water not far below dry ground. In mountainous areas, ravines and crevices can hold water, especially in well-shaded areas. In coastal regions, just above the high water mark, Wiseman recommends digging into sand dunes to find fresh water that may have collected in a layer on top of heavier, denser salt water. At the base of cliffs or rock faces with green vegetation, springs or small pools can be found. Salt water is not safe to consume, but may be distilled using a solar still (see below) to yield fresh water. Be aware that some inland mineral lakes are too salty for safe human consumption.
Rain water is safe to drink, so only needs to be collected. If a container is lacking, improvise a catchment area by digging a hole and lining it with clay. Keep it covered during the day to minimize evaporation. Use improvised impermeable materials such as metal or plastic sheeting if possible. Bark or wood can also be hollowed out to catch water. Clothing may be left out to catch dew and then be wrung out or sucked for drinking water; one can also tie clothing to the legs and walk through wet vegetation to trap moisture.
Tree and other plant roots draw water from the soil, in some cases from substantial depths below the surface. Rather than digging, let the plant pump the water for you. Plastic bags or sheeting may be used to trap transpired water from vegetation. Select a leafy branch, and cover it with a plastic bag, sealing the end tightly around the branch. Ideally, the end of the bag should be lower than the mouth, to allow moisture to collect in a lower corner. One can also make a polyethylene (plastic) tent over a low-lying plant on the same principle. As the outside air heats up, and water evaporates from the plant’s leaves, it condenses on the inside of the plastic, and runs downward, where it may be collected.
The solar still operates on similar principles.
The solar still has been taught to countless students of survival schools, the military, and others who may find themselves in the wilderness for extended periods. A solar still is easily constructed, and requires only a few inexpensive, compact, easily-carried supplies. Materials needed – a digging implement or tool, a quart-size (smaller may be used if necessary) container or cup, clear plastic sheeting (6 x 6 foot, 3mm thickness preferable), 4-5 feet of plastic tubing (surgical tubing is ideal), duct tape (optional but helpful). A conical hole, 3 ft. in diameter and approximately 18 inches deep, is dug with sides angled ~ 45 degrees. If possible, site the hole in damp soil that supports plant vegetation and line the hole with cut vegetation. Contaminated water (including radioactive, chemical or biological materials) or water-containing solids may be used also – the still produces clean, safe water and leaves non-volatile contaminants behind. Place the cup or container securely in the bottom of the still, and run the plastic surgical tubing from the cup along the side of the hole and well away from it, securing the tubing in place with tape. Reinforce a small area (perhaps 2-3 inches square) in the center of the plastic sheeting, using duct tape. After lining the sides of the cone with vegetation or other moisture sources, place the plastic sheeting over the hole with the taped area above the cup. Seal the plastic around the edges of the hole with soil or rocks, such that it is airtight. Weight the clear plastic with a small stone sufficient to cause it to run parallel to the sides of the cone, but not touch it. Solar heating causes the water in the still to evaporate and condense on the inside of the plastic cone, run down and drip into the container, from which it can be consumed via the plastic tubing (as pictured)
For additional image see Colorado Division of Wildlife (http://wildlife.state.co.us/Hunting/PlanYourHunt/ResourcesTips/SurvivalWater.htm)
The solar still is effective, but does not produce enough water under all circumstances to sustain one person; several stills may be needed. Moreover, as the soil within each conical hole is depleted of water, new ones must be dug. In extremely arid environments, the soil may be water-poor and hard-packed and thus require the expenditure of more water than can be produced from a still; this trade-off will have to be weighed accordingly. One still will generally produce 1-3 quarts of water in 24 hours. These drawbacks notwithstanding, a solar still should be in every survivalist’s repertoire.
Sources
1 – Wikipedia, http://en.wikipedia.org/wiki/Drinking_water
2 – http://www.who.int/water_sanitation_health/dwq/GDWQchap1rev1and2.pdf
3 – Rawles, James Wesley, “How to Survive the End of the World as We Know It”
Plume/Penguin, 2009.
4 – John Wiseman, “SAS Survival Handbook” Harper Collins, 2009.
Coyright © 2011 Peter Farmer
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The following post on history and disaster preparedness is contributed by Pete Farmer, who holds advanced degrees in research biology and history, and is also an RN and EMT.
Thank you, Pete, for this lesson from history.
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October 24, 2010
What can history teach us about being prepared for natural or man-made disasters?
Simple question, complex answer – but perhaps we can make it less complicated.
Looking backward over human history from the perspective of the post-industrial age and all of its comforts and amenities, it is easy to forget that the story of humanity has often been one of hardship and privation. To live was to struggle against other humans, with whom one was competing for scarce resources, and against nature – disease, famine, pestilence and simple bad fortune. Life was rather Darwinian. Those fit and resourceful enough to survive did, and those who were not, did not. Prosperity was much more precarious, to the extent that it existed at all.
Before the mid-19th century and the revolution in science and medicine, death in childbirth, infancy or childhood was unremarkable and common. Families were large, party because parents wanted at least some of their progeny to make it to adulthood. Communicable diseases were endemic, and took a toll upon all ages. Life expectancies were much shorter than today; old age and its infirmities arrived in what would now be considered midlife. Public health measures were non-existent or poor, and sanitation deficient – especially in urban areas. Work was dangerous and physically-demanding. A dependable supply of food depended on favorable weather and avoiding crop failures. An occurrence of widespread famine – such as the famed Irish Potato Famine – could have geopolitical consequences. People of all ages and social classes were much more subject to the vicissitudes of life than their modern-day counterparts.
Which brings us to lesson one… the kind of prosperity which we enjoy today is historically an anomaly, not the norm. Modern societies of the developed world are remarkable for being the first in human history to defeat scarcity on a widespread, sustained basis. The poorest among us enjoy conveniences and comforts unimaginable to the wealthy aristocracy of the 18th or 19th centuries.
What are the implications of this truth? Several come to mind. First, if you are fortunate enough to live and prosper in the modern world – be grateful. You’ve won the historical lottery. Second, because most of us have never experienced real hardship on the order of the Great Depression or the Dust Bowl – we tend to take our prosperity for granted. Of course, preppers tend to be the exception, but others of us cannot or will not see the troubling cracks appearing in the edifice of western civilization.
This isn’t simply myopia, for most humans suffer from a peculiar affliction – something cognitive psychologists call “change blindness,” the inability or delay in perceiving gradual change happening around us – especially variation that does not fit our personal models of reality. Nor do human struggle only with perceptible change, we also can get blindsided by unforeseen, high-impact events. Nassim Taleb, in his book, “The Black Swan,” examined this phenomenon in detail. A “black swan” is an unforeseen event which profoundly alters our reality, in ways that fall outside of the predictive powers of the sciences, history, and economics. Black Swans can be good or bad events; the rise of the personal computer and the internet, World War One, the influenza pandemic of 1918 and the 9-11 attacks are examples. Taleb convincingly argues that not only do we fail to see black swan events coming, we often misunderstand them in retrospect by drawing the wrong lessons from them.
Lesson two: no matter how hard or thoroughly one prepares for the future, reality probably isn’t going to unfold in the way one has planned. Expect the unexpected, because it is probably going to happen. Do your best to see reality as it is, not as you wish it to be, and stay flexible and adaptive. Work hard – but don’t be afraid to cross- your fingers for luck. Everybody needs it. Be sure to temper your can-do attitude with a bit of realism – even fatalism. Sometimes smart, resourceful people get caught up in events beyond their control, and despite their best efforts, they don’t get out alive. Two soldiers are side-by-side in the same foxhole; one lives and the other is killed by an errant bullet. Chance plays a far-bigger role in our lives than we like to acknowledge. Combat soldiers have always known this. And of course, all of us will eventually get carried out “feet first.” None of us gets to cheat death forever. At first glance, this attitude seems pessimistic, but at least for this writer, it has proven enormously liberating. Fear of the unknown is often worse than whatever finally happens.
Lesson three: sometimes the worst-case scenario is accurate; black swans can be every bit as bad as our nightmares. This is the flip-side of lesson two. For medical preppers, this is an important lesson, which speaks to motivation to prepare for crises-yet-to-occur.
In the period 1880-1910, American medical education and research underwent a remarkable transformation at the hands of such visionaries as Henry Welch and his colleagues, such as Simon Flexner, Anna Williams and Oswald Avery. These pioneers brought American medicine into scientific age, thereby making such institutions as Johns Hopkins University Medical School into world-class instutitons of medical knowledge, research, and practice. Unknown to them, Welch and his colleagues were soon to face the severest tests imaginable – first in World War One, the most-costly war in human history, and then in the most deadly plague in history, the influenza pandemic of 1918. As horrific as these events were, the death toil would have been appreciably worse if Welch and his colleagues had not been working so furiously to transform how medicine was practiced in the preceding decades. None-the-less, the influenza pandemic nearly brought down western civilization. It strained the bonds holding society together as perhaps nothing before or since has done. The nearest parallel is perhaps the scourge of HIV/AIDS in modern Africa.
Interested readers are urged to read John M. Barry’s remarkable book, “The Great Influenza: The Epic Story of the Deadliest Plague in Human History” (Penguin, 2004).
Barry’s outstanding scholarship and penetrating writing make this a classic every historian, medical scientist and prepper should read.
This post is fourth in a series by Edward W. Pritchard. To read more of his writings please visit: http://eddwardwpritchard.blogspot.com
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fiction
edward w pritchard
Normalcy establishes itself even in a mass movement of people trying to escape bad air. I have forgotten everything I ever cared about, and I am instinctively driven to survive. A bit of a philosopher anymore, I have decided that I am driven by an ancient drive to keep alive the species that I am a small part of. I have established a routine to deal with the bad air that drifts north to south at seven miles per hour, twenty four hours per day.
No mechanized vehicles can survive the bad air, which is viscous and clings to the throat and lungs, and is coughed up by humans as blackish blue phlegm, or urinated out as sharp crystal slivers in painful daily ordeals. Machines and horses cannot survive, only humans survive, and in particular those of us with an immense capacity for suffering.
It’s been about three weeks here in 2012 since the bad air started, and most of those who planned for Armageddon based on astrological Mayan Calendars and those type of things died in the first few days. About one in ten people, at least that’s the mortality people where I am now, here in lower Kentucky and heading South, have experienced. The air will get us all eventually but I don’t think about that; I just walk, stumble forward until I collapse. If I didn’t have to eat and throw up the foul concoction that now is food, or drink and fight not to scream as I urinate, it wouldn’t be so bad.
A complication. A little girl of about eight is traveling alone. Those she cares about or started with are gone. She was staring intently into the fire I was sitting by and I started to get paternal or something with her because someone had stolen her glasses. Glasses aren’t valuable because what’s to see anymore. The landscape is nightmarish. I’ll describe that later, I just ate.
The girl is thin, probably losing weight, like everyone else and studying her as she sat by the fire bravely staring forward, my heart went out to her plight. Other than her thinning hair she looks like a normal, intelligent, curious little girl. Not afraid, just marching like the rest of us. I gave her some food and water, and an asthma inhaler, and a small Indian blanket that I have for warmth at night, and we have been walking together.
I guess I have a wild look about me, but she doesn’t seem to mind. Most people have taken to avoiding strangers and I guess I have become pretty strange and savage looking.
I got the little girl, who I call Laura, not her real name, her glasses back. I offered publicly to trade one of the twenty asthma inhalers I carry for a pair of child’s glasses, if they had purple frames, after she told me her glasses were purple.
The next night at the fire a man approached and I took him aside, and after I saw and confirmed the glasses were Laura’s, I took the glasses and beat the man to death with a tree branch. Morality has changed here in post-2012, and I am no longer a man of peace but now live by ‘an eye for an eye.’
Laura was happy to get the glasses back and my reputation for sudden violence continues to grow, which will help both Laura and me to travel without harm.
Armageddon Medicine