Using expired medications, Part I

Posted on February 11, 2011 by Cynthia J. Koelker, MD
:Original raster version: :Image:Food and Drug...

Image via Wikipedia

 

 

The following post was written for SurvivalBlog.com.   To read the entire entry, click link below.

* * *

My first guest post on SurvivalBlog.com generated an abundance of questions and concerns.  Among the most popular was that of using medications beyond their expiration date.  Are they safe?  Are they effective? 

It’s easy enough for me to say I think it’s safe, but is there any science to support my opinion?  I spent the week looking into the facts, and found some fascinating information.
To start with, just what is a drug expiration date?  In short, the date (required since 1979) does not indicate when a drug goes bad, but rather a date through which the drug is guaranteed to be good.  Compare this to what you might find on a can of beans:  the “best if used by” date.  

How are these dates determined?  In two ways.  [To read entire post, click the link below] 

Related articles
Enhanced by Zemanta
Posted in Anti-viral meds, Expired medications, Expired meds, Medications, Prescription Medications, Shelf life, Stockpiling medical supplies, Stockpiling medications, Tamiflu | Tagged , , | 5 Comments

Use of silver preparations to treat infection – Part II

Posted on February 11, 2011 by Cynthia J. Koelker, MD

 

The first post on use of silver preparations generated so many questions and comments that I decided a second post was in order. 

The important questions are:

1.  Are silver preparations effective if applied as wound dressings?

2.  Are they effective and safe taken internally?

3.  At TEOTWAWKI can I use Granny’s silver spoon to cure my own pneumonia?

  

ANSWERS:

1. In Part I I discussed the use of silver sulfadiazine for burn wounds and other acute wounds.  It is safe and effective for short term use for the prevention of bacterial wound infection.  Silver-impregnated or silver-treated dressings are also effective, but probably no more so than silver sulfadiazine cream.  Your doctor may be willing to supply you with the cream, but is unlikely to be familiar with the dressings, which are costlier as well.

2.  The FDA has concluded that the risk of taking oral silver preparations outweighs any potential benefits.  Argyria has been documented with intake of a home-prepared colloidal silver preparation (see pictures below).  Taking large doses of colloidal silver may also damage the bone marrow, cause seizures, or lead to coma.  Many colloidal silver preparations are poorly standardized and may contain contaminants including bacteria and dissolved silver.  (And if bacteria grow in a silver preparation, how effective would that preparation be to fight infection?)

3.  NO (see #2), but apparently it is possible to make your own colloidal silver preparation at home.  However, determining the concentration and purity would be a great challenge.  If no other option were available, perhaps a commercial or home-prepared suspension for topical use might be reasonable.  Just because a colloidal metal can kill bacteria does not make it safe to ingest – lead kills bacteria, too – along with people. 

 

What would I do myself?  At least for now my answer remains the same:  I’d stock up on silver sulfadiazine.  A 50-gm tube costs $4 at Wal-Mart (or 3 tubes for $10).  Although it comes in a larger jar as well, smaller unopened tubes would store better.  This cream is available only by prescription, but your doctor may be willing to prescribe it for you.  Another alternative is the OTC bacitracin cream/ointment, the same medication doctors and hospitals use, which probably works equally well externally for prevention of wound infection and treatment of superficial infections.  See also How to get your doctor to help you stockpile medicine.

Silver Nevada's nickname is the Silver State
Image via Wikipedia

 

The article below comes from the Department of Dermatology, University of California Davis.  It discusses the safety and effectiveness in greater detail, as well as dosing that is known to cause argyria (and death). 

http://dermatology.cdlib.org/111/case_reports/argyria/wadhera.html

For the interested reader, here are the articles they reference:

1. Hill WR, Pillsbury DM. Argyria, The Pharmacology of Silver. 1st edn. The Williams and Wilkins Co. 1939.

2. Kaye ET. Topical antibacterial agents. Infect Dis Clin North Am. 2000 Jun;14(2):321-39. Review. PubMed

3. Farmer ER, Hood AF. Pathology of the Skin. 2nd edn. Appleton & Lange. 2000;507-508.

4. Chemistry: webElements Periodic Table: Professional Edition: Silve:key information. http://www.webelements.com/webelements/elements/text/Ag/key.html. Last accessed 02/01/05.

5. Fung MC, Bowen DL. Silver products for medical indications: risk-benefit assessment. J Toxicol Clin Toxicol. 1996;34(1):119-26. Review. PubMed

6. U.S. Environmental Protection Agency, Integrated Risk Information System.Silver (CASRN 7440-22-4).http://www.epa.gov/iris/subst/0099.htm#reforal. Last accessed 2/01/05.

7. Blumberg H, Carey TN. Argyremia: Detection of unsuspected and obscure argyria by the spectrographic demonstration of high blood silver. JAMA. 1934;103(20):1521-1524.

8. Agency for Toxic Substances and Disease Registry, Public Health Statement for Silver, December 1990.http://www.atsdr.cdc.gov/toxprofiles/phs146.html. Last accessed 02/01/05.

9. Abundance of the chemical elements in man’s diet and possible relations with environmental factors. Hamilton, E.I. and M.J. Minski. 1972/1973. Sci. Total Environ. 1: 375-394.

10. Furst A, Schlauder MC. Inactivity of two noble metals as carcinogens. J Environ Pathol Toxicol. 1978 Sep-Oct;1(1):51-7. PubMed

11. Gaul LE, Staud AH. Clinical spectroscopy. Seventy cases of generalized argyrosis following organic and colloidal silver medication. JAMA. 1935;104:1387-1390.

12. Ohbo Y, Fukuzako H, Takeuchi K, Takigawa M. Argyria and convulsive seizures caused by ingestion of silver in a patient with schizophrenia. Psychiatry Clin Neurosci. 1996 Apr;50(2):89-90. PubMed

13. Moss AP, Sugar A, Hargett NA, Atkin A, Wolkstein M, Rosenman KD. The ocular manifestations and functional effects of occupational argyrosis. Arch Ophthalmol. 1979 May;97(5):906-8. PubMed

14. Schlotzer-Schrehardt U, Holbach LM, Hofmann-Rummelt C, Naumann GO. Multifocal corneal argyrosis after an explosion injury. Cornea. 2001 Jul;20(5):553-7. PubMed

15. Pariser RJ. Generalized argyria. Clinicopathologic features and histochemical studies. Arch Dermatol. 1978 Mar;114(3):373-7. PubMed

16. Over-the-counter drug products containing colloidal silver ingredients or silver salts. Department of Health and Human Services (HHS), Public Health Service (PHS), Food and Drug Administration (FDA). Final rule. Fed Regist. 1999 Aug 17;64(158):44653-8. PubMed

Enhanced by Zemanta
Posted in Antibacterial topical, Colloidal silver, Expired meds, Medical archives, Silver sulfadiazine, Stockpiling medical supplies | Tagged , , , , | 8 Comments

How an apple a day keeps the doctor away

Posted on February 11, 2011 by Cynthia J. Koelker, MD

Constipation may not top your list of worries if modern society collapses.  But it will become a problem if food shortages occur, curbing one’s intake of fruits and vegetables.

The elderly, especially, are susceptible, and many are hospitalized to alleviate this potentially painful condition.

The following article is first in a series on prevention and treatment of constipation.

* * *

Apple tree in full blossom, North Ayrshire, Sc...

Image via Wikipedia

Everyone suffers from occasional constipation. Usually it’s diet-related. Within a few days, things work their way out, so to speak.

But what if it’s a daily occurrence? What if you’re frequently bloated or plagued with abdominal discomfort due to constipation? What if your hemorrhoids bleed every time you pass a hard stool? What if you are elderly and decide not to eat because you fear the inevitable cramping?

Or what if the stool simply won’t come out on its own?  Will your colon burst from the pressure?

Fortunately, a better understanding of human bowel function can help prevent a chronic problem.

The human intestine was designed to pass banana-size stools most comfortably. It is easier for the colon to propel a banana-size stool forward than little marbles – there’s more to grip. Also, oversize but overly firm stools offer too much resistance to the muscles of the colon. Aim for stools the consistency of what I call “brown bananas” – not too big, not too small, not too hard, not too soft.

1919 advertisement for Jubol (laxative)

Image via Wikipedia

Inadequate dietary fiber is the most common culprit for chronic constipation. Certainly many medications and certain diseases may also contribute, but most people who don’t have to raise or harvest their own food simply do not choose foods containing sufficient soluble fiber, the type of fiber that is able to absorb extra water. Bran is an excellent example of this. Though it’s flaky and dry when poured from a cereal box, it soaks up the milk and becomes nice and mushy. It does the same thing when passing through the colon. Meat, on the other hand, does not absorb extra water, nor does fat, whether inside your body or in a frying pan.

Therefore, remember that the first important ingredient in softer stools is sufficient water. If you eat bran all day but don’t have any fluids on board for it to absorb, your stools will be as hard as ever.

Also, fiber only softens stools as they are being formed. Once a stool is already formed, it’s a done deal. You simply have to wait for it to pass (or help it along with a stimulant laxative or enema, which most people prefer to avoid). Think of your intestine as a conveyor belt. You need to keep all your stools soft in order for it to work correctly. You don’t want a hard stool to plug up the works, which causes cramping as the softer stools that follow try to escape.

The bowel may need some re-training. If it’s grown used to constipation, it will need to stretch out a bit to accommodate a diet higher in fiber. This may cause mild discomfort or bloating until your body has adjusted. One word of warning: if you have a hard stool that is acting like a plug, you may experience significant cramping as your intestine tries to expel the obstruction.

As for increasing your fiber, “An apple a day keeps the doctor away” is a good place to begin. One medium apple contains approximately 3 grams of fiber. In comparison, a slice of white bread contains as many calories but only a fourth as much fiber.

The most natural sources of dietary fiber are vegetables and fruits. The skin of apples, pears, and other fruits contains a large amount of fiber, so don’t peel your fruit for best results. Strawberries, blackberries, and raspberries are good choices, along with peaches and plums. The infamous prune is, of course, simply a dried plum. Beans, carrots, broccoli, cauliflower, peas, spinach, and artichokes are high in dietary fiber as well.

Whole grains are also a good source of fiber. Choose whole wheat or whole grain bread instead of white bread. Choose brown rice over white rice. Choose raisin bran, oatmeal, or shredded wheat over Rice Krispies or Captain Crunch.

Aim for at least 5 servings a day of high fiber foods. Once your colon adjusts to the increased fiber and water in your diet it should be smooth sailing. There may be an adjustment period, however, during which you may experience a little bloating or abdominal discomfort. In the long run, though, you’ll not only be more comfortable but healthier as well, with all the natural foods you’ll be eating.

Sufficient calories, vitamins, and nutrients aren’t the only concern as you stockpile your supply of food. Make sure to include a good supply of foods high in soluble fiber – and choose ones that you and your family will actually eat.  A bushel of bran will do no good if it just sits in the corner.  Dried fruit is a good choice if fresh is unavailable, but must be taken with sufficient fluids.  For a list of fiber content of common foods see http://www.metamucil.com/fiber-guide-fruits.php

Copyright © 2011 Cynthia J. Koelker, MD

Enhanced by Zemanta
Posted in Abdominal pain, Constipation, Constipation, Constipation, GI-gastrointestinal, Herbal and complementary, Medical archives, Symptoms | Tagged , , , , | Leave a comment

Grief – Finding Your Way to Hope

Posted on February 10, 2011 by Cynthia J. Koelker, MD

Grief – likely to be the primary emotion if the world around us collapses.  The following article was written for ezinearticles.com and is re-printed here by permission of the author. 

* * *

Inconsolable grief

Image via Wikipedia

Unless you’ve experienced it first-hand, true grief is incomprehensible.

Sure, everyone understands unhappiness, possibly even misery. But until you’ve gone through gut-wrenching loss and subsequent recovery, you cannot speak about grief knowledgeably.

Some might disagree. I might have myself – as an overeducated medical student who equated knowledge with wisdom. But no matter how many patients I watched suffer and die, it did not prepare me for the despair, the agony, the loneliness of enduring it personally.

What is grief?

Above all it’s a feeling – the feeling that your breath has been sucked out of you; that your body is a meaningless shell; that you’ve lost all reason to live. Grief is an endless void; a world filled with emptiness. You feel betrayed by former joys, by life, by God; your heart is dead without hope of recovery.

The five stages of grief are well-known: denial, anger, bargaining, depression, acceptance. In twenty-some years as a family physician I’ve witnessed most people “breeze through” the first three stages relatively unscathed. A few become addicted to anger, choosing to live out their years raging at God and the world.

But where most people get stuck is depression. The fear that you’ll never be the same again becomes a self-fulfilling prophecy.

One mistake people make is believing they are grieving for another person, when, in fact, they grieve for themselves. Certainly if you’ve lost a loved one, a child perhaps, you feel terrible for the pain they’ve experienced. But what tears your heart to pieces is losing a part of yourself. You picture your life one way, when suddenly, it’s changed, and there’s nothing you can do to reverse the process. The loss of your hopes, your dreams, your planned future is what really cuts deep. And with the loss of yourself, you cut off others who might help. Guilt and blame become your daily companions.

Americans don’t really know how to grieve. Perhaps as a nation we’ve been too blessed. We expect people to “get over it,” praising them when they do so. People rush back to work, pasting a smile on their faces when inside they’re dying. Medication is suggested when others become uncomfortable with your despair.

But each of us is responsible for working through our own grief. Fortunately, a seed of hope is all you need to begin.

Grief makes the human spirit rebel in outrage, and rightly so. Much of what we experience in life is unfair. Job railed against God when his torment became unbearable – and God understood, much as a parent understands and forgives a child’s tirade.

So the first step to recovery is to let the pain out – in waves, in gasps, in weeping. Tell God you’re angry. Show him your heart is bleeding.

Then, when you’re too tired to go on, allow your soul and spirit to rest. Sleep heals the mind and body, and matters more than keeping up a good appearance.

But be forewarned: the pain will recur, the cycle will repeat. One good cry is not enough to wash the heartache away.

It may take a week, it may take a month, but look for the day when something, anything, catches your interest. It may be fleeting, so write it down. Take it as a sign of healing, a tiny seed of hope. Pay attention when this occurs and nurture the feeling. Water your hope like a living blossom.

When you catch a glimpse of the world outside yourself, you’re looking at the road to recovery. As soon as a tiny part of yourself has healed, share that part with another. You won’t lose it by giving it away – you’ll make it stronger.

Indulge yourself in what makes your heart sing. That’s the real you, not the crippled spirit that’s been struggling to breathe. Find the child inside and allow yourself to play. Realize that, just like a person needs to make it a priority to allow the body to heal after surgery, you must make it a priority to heal after your spirit has been injured.

Look at the process from outside yourself. Try to see that, though your spirit was injured, your soul is intact. Although some people benefit from an antidepressant, the time-honored cure for grief is grieving. So get to work and go have a good cry. God is watching and still cares for you.

Copyright © 2010 Cynthia Koelker, MD

Related articles
Enhanced by Zemanta
Posted in Acute diseases, Anger, Antidepressants, Anxiety, acute, Chronic diseases, Death and dying, Depression, Depression, Grief, Medical archives, Mental health, Poetry & Prose, Public health, Spiritual health | Tagged , , , , , , , , , , , | 1 Comment

Use of silver preparations to treat infection – Part I

Posted on February 4, 2011 by Cynthia J. Koelker, MD
systemic argyria from ingestion of colloidal s...
Image via Wikipedia

  

BW asks:  Have you tried or do you have any experience with Colloidal Silver for treating infections?  I’ve used it a few times and it seems to work, particularly topically, and I’ve talked to many who swear by it.

* * *

Ever since my medical career began 25+ years ago, silver sulfadiazine cream (Silvadene) has been a mainstay of burn treatment.  The cream is available only by prescription, but comes in an inexpensive generic form.  It helps prevent infection within an acute wound, and has the additional advantage of not stinging.  The cream is slippery and helps the dressing not stick to the wound.  I have patients apply it to a Telfa pad or gauze, then apply the dressing to the open sore.   Although silver-containing wound dressings exist, I have never used them.

Doctors also use silver nitrate to cauterize granulation tissue.  This turns the tissue black, usually for a short time, but occasionally the staining may persist.  The next picture shows a hand stained by silver nitrate. Continue reading →

Posted in Antibacterial topical, Bacitracin, Colloidal silver, Medical archives, Silver sulfadiazine, Skin infection, Stockpiling medical supplies, Stockpiling medications, Triple antibiotic ointment | Tagged , , , , | 5 Comments

Trench Mouth and TEOTWAWKI

Posted on February 4, 2011 by Cynthia J. Koelker, MD

Our friendly tooth doctor was inspired to write this after the Buckeyes beat Michigan. 

* * * 

As I have been thinking about what a dentist can add to a discussion of health care after a serious disruption of civilization, it occurred to me that a likely candidate for a condition not commonly seen in today’s world would be that of Acute Necrotizing Ulcerative Gingivitis (ANUG). Trench mouth in layman’s terms. It is also known as Vincent’s Stomatitis.

This is a rare condition, almost unheard of in a normal, healthy, well-nourished individual living in a quiet environment. Take that same individual and place him or her in a survival environment and a certain number will develop ANUG. It is a product of a combination of normal oral flora, poor dental hygiene, bad diet, lack of sleep, and stress. During WWI soldiers on both sides of the conflict found themselves in cold, wet, drafty trenches, eating bully beef and stale bread, under constant bombardment, for weeks on end. Among the many health complaints that became manifest was this condition. Hence the name Trench mouth.

Know this condition by the following signs and symptoms: BAD breath (smell it across the room bad), Gum Pain (difficulty eating, brushing), Punched out gum tips between the teeth (Gingival Papilla). The patient may have malaise, slight fever, swollen neck nodes, but the tell is the first three symptoms.

I have seen this condition in freshman college students usually around early November, about two weeks after midterm grades. First time away from home,dorm food, all night sessions (some actually call it study), add to that the realization that they have to go home with their grades at the end of the semester. Who knew that college and combat had so many similarities?

The etiology of this condition is an overgrowth of normal oral flora, mostly anaerobic, and an altered immune response caused by stress and bad diet. The cause gives us the key to the cure: oxygen in the form of hydrogen peroxide (OTC cut in half with water) aggressive rinses several times each day; aggressive brushing as soon as the gums will tolerate it; 2 % Chlorohexadine (Peridex) dental rinse twice a day is also a big help; multi-vitamin with minerals each day; and as much R and R as possible. Antibiotics are possible, but we will probably want to save them for worse problems.

In my experience this is enough to overcome the acute symptoms in an otherwise healthy individual. There is a chronic form of this condition that we see, but the non-dentist treatment would be about the same.   

OK, one last thing – if you have all the symptoms listed above in a sickly patient, and you look at the gums and see any tooth roots or ulcerative extensions past the gums onto the oral mucosa…you could well be looking at an advanced AIDS patient. BE CAREFUL. In this patient, the symptomatic treatment is the same . . . just do not expect much recovery.

Copyright © 2010 WH2thdr

Images of Trench Mouth at www.disease-picture.com/acute-necrotizing-ulcerative-gingivitis/

Related articles
Enhanced by Zemanta
Posted in Chlorhexidine oral rinse, Contributors, Dental, Diseases, Hydrogen peroxide, Medical archives, Perennial Favorites, Sore mouth or gums, Toothache, Trench mouth, W Hampton - Tooth Doctor | Tagged , , , , , , | 1 Comment

What if no dentist is available? Lessons from prisoners of war

Posted on February 4, 2011 by Cynthia J. Koelker, MD
An image from 1300s (A.D.) England depicting a...

Image via Wikipedia

   

Another guest blog post from our friendly prepper tooth doctor.   

Makes me want to visit my own dentist ASAP. 

* * * 

Let’s imagine that our worst imaginations of the future economic/political/societal collapse come true.  We are in our “undisclosed bunker location” surviving day by day without all of the creature comforts that we are used to.  A random thought or fear pops into our head…Our local dentist might as well be on the other side of the moon. What is going to happen to our teeth? What are we going to do if we have a tooth ache? What if we get an abscess? What if Suzie did not get her wisdom teeth removed like the dentist wanted? The subject of these next few blog postings will explore aspects of surviving without having a kindly dentist a phone call away. 

There are few historical examples of a modern western population suddenly cut off from dental care. Continue reading →

Posted in Contributors, Dental, Medical archives, Perennial Favorites, Toothache, W Hampton - Tooth Doctor | Tagged , , , , , , , , | 9 Comments

Survival Basics: The Chemical and Physical Properties of Water

Posted on February 4, 2011 by Cynthia J. Koelker, MD

The following technical article is kindly contributed by Pete Farmer, as a background for further practical considerations regarding water in extreme environments and medical preparedness. 

* * *

“When the well is dry, we know the worth of water.” Benjamin Franklin, Poor Richard’s Almanac, 1746

Image via Wikipedia

 

Life and health cannot be sustained without water. Therefore, it should be of paramount importance to anyone doing disaster-preparedness planning. Before getting to the specifics of that problem, let us consider water itself for a moment, for it is, in many ways, a chemical miracle. 

Water covers roughly 70% of the Earth’s surface; 97% of the world’s free water is found in its oceans; lakes, rivers, sub-surface aquifers, glaciers and the polar ice caps hold most of the rest. A small percentage of the total water supply is found in precipitation or  gaseous/vaporous form (clouds, mist, steam, etc.) and in the Earth’s flora and fauna. 

Chemically, water is unique – it is arguably nature’s most versatile and essential compound. Chemical formula H2O, each water molecule is composed of two hydrogen atoms and one oxygen atom, joined by covalently-bonded electrons. The oxygen atom carries a slight negative charge (is more electronegative) while the two hydrogen atoms carry a slight positive charge (are less electronegative). Such a molecule is referred to as polar, and possesses a “dipole moment,” i.e., it has an asymmetric distribution of electric charge across it. At standard temperature and pressure, water is a liquid. In pure form, water is odorless, tasteless and colorless, and does not conduct electricity (Important note: water is rarely pure in nature, and usually contains solutes such as dissolved salts; under these conditions water is a very effective conductor of electric current. Take appropriate precautions with electricity and water; they are almost always justified).

 

Water molecule with bond lengths and angles, b...

Image via Wikipedia

 

Water has surface tension, caused by dipole forces and hydrogen bonding between individual H2O molecules, which allows water to adhere it itself and other surfaces. Surface tension is responsible for capillary action, which allows water to move through circulatory capillaries and inside plants. Water exists in its different physical states – solid (ice), liquid, gas (steam or vapor) – and constantly cycles through them in nature. Uniquely, water is less dense as a crystalline solid – ice – than as liquid water, allowing ice to float. In liquid form, water is relatively incompressible, and conducts sound and kinetic energy efficiently. Left undisturbed, large bodies of H2O will stratify into temperature and pressure gradients. Water is an excellent temperature moderator in natural systems.

 

Water has a pH of 7, which is precisely neutral between acidic (pH < 7.0) and basic (pH > 7.0). The water molecule can donate a hydrogen ion (H+) or a hydroxide ion (OH-), but for most purposes, H2O is considered pH neutral. Water is often called the “universal solvent,” because – while not highly caustic – it is an excellent and highly-versatile dissolver, especially for polar and ionic compounds. Many non-polar (electrically neutral) organic compounds, including most fats and oils, are mutually insoluble (incapable of dissolving one another) and/or immiscible (incapable of being mixed to form a homogeneous substance) with water. Some hydroxyl-group-containing (OH-) organic compounds, i.e., many alcohols, are highly soluble in water because of the tendency of their OH- groups to form hydrogen bonds with water. Less-dense oils, fats and lipids tend to form a uniform film or layer atop water. Under specific conditions (not covered here), water and oil can mix in colloidal form.

Water highly-concentrated in salts, such as sea water, provides greater buoyancy than fresh water, and displays freezing-point depression and boiling point elevation. That is, salt-containing water will freeze below its normal freezing point (32o Fahrenheit / 0 o Celsius) and  boil above its typical boiling point (212o Fahrenheit / 100 o Celsius) at standard temperature and pressure (STP, i.e., 32o Fahrenheit / 0 o Celsius temperature and atmospheric pressure of 760mm Hg/Mercury or 14.7 lb/square inch). At higher altitude, water boils at a lower temperature, other conditions constant. Water’s density is 1 gram per cubic centimeter (cc) or milliliter (ml) at 32.9 degrees F. It’s weight is approximately 62.4 lbs./cubic foot at 32 degrees F, or 8.33 lbs. per gallon.

The high latent heat of vaporization of water (the energy required to cause water to change state from liquid to gas) allows excellent evaporative cooling properties. Water has a relatively high specific heat (the heat required to raise the temperature of one gram of a substance one degree centigrade), and both stores and conducts heat energy well.

 

Structure of the water molecule (H 2 O)

Image via Wikipedia

 

High purity water can be produced in a laboratory environment, by processes including distillation (boiling water and then collecting the condensed vapor in a very clean container, leaving behind solid contaminants), double-distilling (distillation x 2), deionization (demineralization/removal of positively or negatively-charged ions), filtration and microfiltration (passage of the water through a small or very small-pore-size filter capable of capturing microorganisms and/or chemical compounds and elements).

 

Other processes include reverse osmosis, carbon filtration, ultrafiltration, ultraviolet oxidation, and electrodialysis. Ultra-pure water for use in drug manufacturing or other sensitive applications may also be subject to autoclaving, i.e., high-pressure and temperature steam treatment, to kill suspected micro-organisms. The American Chemical Society and other sanctioning bodies have developed detailed standards for classifying various degrees of purity of water; interested parties may view these on the internet.

The above concludes our brief survey of the chemical and physical properties of water. Thus prepared, in the next installment, we will consider some practical specifics of water and survival in daily life, extreme environments, and in medical preparedness.

Copyright 2011 Peter Farmer

Related articles
Enhanced by Zemanta
Posted in Contributors, Medical archives, Pete Farmer, Preparation, Public health, Water | Tagged , , , , , , | Leave a comment

What would you do if . . . you develop chest pain?

Posted on February 3, 2011 by Cynthia J. Koelker, MD

You’re 45 years old.  You’ve been healthy – at least you think so.

But suddenly, you awaken in the middle of the night with chest pain.

You can’t call your doctor – nor any other.  You climb out of bed, trying not to disturb your family.  They’ve had enough nightmares already.  You pace the floor, but the pain is no better.  Fortunately, it isn’t any worse either.  You wonder if you’re breathing is a little short or if it’s just your imagination.

You ask yourself, was all the preparation worth it, if you’re just going to die of a heart attack?

What in the world should you do?

* * *

Dr. Koelker replies:

Because the above scenario is common in 2011, it will likely be in 2012 and beyond.  Health professionals as well as laymen will encounter many patients frightened by chest pain.

Doctors look for patterns of illness.  What patterns might occur in a 45-year-old?

For a woman, 45 is quite young to consider heart disease – for a male, heart problems would be higher on the list of potential problems . . . but still not as high as other conditions, such as acid reflux, bronchitis, pleurisy, pneumonia, or musculoskeletal chest pain. Still, it behooves a doctor to rule out the most serious causes first, if at all possible.

What are the serious causes of acute chest pain?

  • Heart attack
  • Heart rhythm problem
  • Pulmonary embolism (blood clot to the lung)
  • Pneumothorax (collapsed lung)
  • Leaking aortic aneurysm
  • Perforating gastric ulcer

At 45, none of these is especially common, but a quick mental run-through is always a good idea.

Heart rhythm problems are fairly easy to eliminate – take your pulse, or listen to your own heart.  If it’s regular, there shouldn’t be a problem. Our patient, SC, has a regular, steady heartbeat.

Next, are there any abdominal symptoms? If not, an ulcer is unlikely, though not impossible. SC poked his abdomen – nothing to complain about there.

Third, is there a likely source for a blood clot to the lungs? These would usually stem from a clot in a  deep leg vein, which may cause the affected leg to swell, hurt, or become inflamed.  If your legs are OK, it’s probably not a blood clot, especially if you’re not significantly short of breath, and the pain is not worsened by breathing deeply. Although SC’s mother had suffered from swollen legs for years, SC never had.

Could it be a dissecting or leaking aortic aneurysm? Almost for sure not.  Very uncommon.  But if it is, unless you have a thoracic surgeon handy, there’s little worth worrying about the possibility.  SC wasn’t sure what an aneurysm was, so he wasn’t worried about this possibility.

Does it hurt when you take a deep breath? This could point to a collapsed lung, but lacking a history of trauma, it is quite unlikely. It hurt when SC took a deep breath – but no worse than when he was breathing normally.

That leaves us again with the question of a heart attack.  Could it be?

Heart attack symptoms vary, from absent to severe.  The so-called “silent MI” occurs with no recognized symptoms.  That’s not to say symptoms haven’t occurred, but they’ve gone unrecognized – perhaps a little indigestion, or fatigue, or palpitations, attributed to spicy food, or excess work, or anxiety.  Severe symptoms are harder to miss:  extreme left-sided chest pain, radiating to the neck or jaw, accompanied by sweating, shortness of breath, nausea, and fatigue.

SC, the example in our case history, reports only chest pain and perhaps a little shortness of breath, possibly imagined. If this is a heart attack, it would appear not to be a “bad” one.  However, patients who smoke or have a positive family history of heart attack at a young age might want to consider taking an aspirin until things get sorted out.  The odds of aspirin causing significant harm are low, though aspirin can certainly worsen acid reflux associated chest pain.  SC did not have an EKG handy and didn’t know how to interpret one anyone.  He took an aspirin, anyway, like he’d seen advised on TV – back when there was television.

SC’s beer-drinking buddies would have suggested trying an antacid.  Many of my patients have made the mistake of taking an acid-reducer rather than an antacid (Pepcid, Zantac, Prilosec, Prevacid, etc).  The problem here is these take at least 30 to 60 minutes to become effective, whereas a true antacid will neutralize stomach acid on contact – temporarily, that is.  The quickest-acting antacids are in liquid form, such as a few teaspoons of baking soda in water, or liquid Maalox, or Mylanta.  If ingesting any of these are immediately successful in eliminating the pain, the problem can be attributed to acid reflux. The relief from an antacid may last all night or only half an hour.  If you have one of the acid-reducers mentioned above, you may want to take one to prolong your symptom relief so you can sleep.

The hero of our story wasn’t so lucky. SC tried the baking soda without result.  Growing a little more anxious, he took a big breath, but thought perhaps the pain was a little worse.  But what does this mean?

Chest pain on inhalation points to either the pleura or the chest wall itself. The pleura is the lining of the lungs, which can become irritated by pneumonia, pleurisy, a blood clot, or fluid around the lung.  Any of these may cause shortness of breath or a fever.  But he’d had no cold symptoms, no fever, no leg swelling to suggest phlebitis or thrombus, no cough, no wheeze. He tried his daughter’s inhaler anyway, but the albuterol did nothing except make him cough.

What about the chest wall then? SC started to wonder if he’d strained a muscle, carrying load after load of firewood.  But he’d been doing this for months now, without ill-effect.  The long hours of physical labor seemed to agree with him.  Plus, he’d remembered no momentary strain or sore muscles.  Poking and prodding himself, he found no sore ribs, or muscles, or tenderness over his sternum (breast bone).

Still no answer.  What to do? This places our patient in the situation many doctors find themselves.  They don’t know exactly what’s wrong, but on the other hand, nothing serious has been uncovered.  The pain has persisted a few hours without relief – but neither has it worsened.

How about taking some pain pills? There are few conditions that taking pain medication would obscure.  Aspirin or ibuprofen might make acid-related symptoms worse, but the therapeutic trial of baking soda has suggested acid-reflux is unlikely.  Anything you’ve taken before without side-effects may be worth a try:  Tylenol, more aspirin, ibuprofen, tramadol, Vicodin, or Aleve.

Our hero took two Aleve and returned to bed. It helped enough to allow him to doze off and on, but eight hours later, the pain was as bad as ever.  Still no new signs, though.  The pain remained on the left side, in the front of the chest and over toward the side.

With more firewood to gather, he spent the day lugging it inside. Strangely, the pain was no better, nor worse, with any of this.  Not wanting to worry his family, he spoke not a word but went straight to his work.

The next evening, as he took off his shirt, his wife pointed to his chest.

“What’s that, SC?” she asked.

SC looked at his chest.  Just off to the side was a cluster of pimple-like blisters.  Touching, them, he winced, afraid.

“I don’t know,” he whispered.  He still hadn’t told her about the pain.

“I bet that’s shingles – like Grandma had,” his wife replied.  “Doesn’t it hurt?”

“What’s shingles?” SC asked worriedly.

“It’s like chicken pox – they live in the nerves, and just come out in one spot.”

“Nah, it doesn’t hurt,” SC lied, his relief overriding his earlier concern.

“You’re lucky, then.  Grandma thought they’d kill her, they hurt so bad.”

“What did she do?” he asked, still a little worried.

“Oh, nothing, they just went away in a few weeks.  You’ll be fine,” she answered.

And that’s exactly what happened  [. . . and this could be a true story.]

Posted in Chest pain, Diseases, Medical archives, Symptoms, What would you do if . . . | Tagged , , | 4 Comments

Medication stockpiling – what the government is doing

Posted on February 3, 2011 by Cynthia J. Koelker, MD

  

Nuclear weapon test Romeo (yield 11 Mt) on Bik...

Image via Wikipedia

There’s little sense in my duplicating information that is already out there. 

 So I’ve been looking around, seeing what the government is doing to stockpile medication.  I had assumed we have national stockpiles, but had never really checked into it before now.    

I did find the CDC web site on the Strategic National Stockpile (SNS) quite interesting.  You can look it over yourself at: http://emergency.cdc.gov/stockpile/.   

They state (and I believe) the CDC has:   

large quantities of medicine and medical supplies to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquake) severe enough to cause local supplies to run out. Once Federal and local authorities agree that the SNS is needed, medicines will be delivered to any state in the U.S. within 12 hours. Each state has plans to receive and distribute SNS medicine and medical supplies to local communities as quickly as possible. 

So what concerns me?  Several things. 

Continue reading →

Posted in 101 Ways to Save Money on Health Care, Chronic diseases, Immunization, Injuries, Medical archives, Medications, Perennial Favorites, Stockpiling medical supplies, Vaccination | Tagged , , , , , , , , , , , , | 11 Comments