Medical Bartering, Part 2 – OTC Medications

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Scenario #2

The grid is down, so you and a few friends have organized a neighborhood church for worship. One Sunday morning a stranger in a business suit struggles in, barely able to walk  After the service you sit with him at the potluck dinner.

“It’s the gout,” he grimaces, sitting down. “It only hits me a few times a year, but when it does I can barely move. What I wouldn’t give for some Indocin! You don’t happen to have any, do you?”

In fact you don’t have that prescription medication on hand, but you have stocked up on generic Advil, Aleve, and aspirin. And, having read Armageddon Medicine, you realize that these may work just as well.

Having sufficient on hand to share, what do you do?
1.  As a fellow church attender, give him 5 days worth, free of charge.
2.  Offer to sell him 20 pills at your cost.
3.  Decide that a fourfold markup is fair, similar to the difference between manufacturing and retail prices.
4.  Calculate what it would be worth to you if you were in his situation, and ask if he would like to exchange his business suit for a supply of anti-inflammatory medicine.
5.  Knowing that you may never be able to replenish your supply, and that gout is not life-threatening, you apologize and answer no.

The above options raise issues that may be useful in establishing a bartering policy.
1.   How will you set the value of an item?
2.  Will you treat strangers differently than family or friends?
3.  To whom should you offer charity?
4.  Under what circumstances would you barter?

Regarding over-the-counter products, should the value be higher for an OTC medication that could legitimately replace a prescription drug? Should the amount you have on hand figure into the calculation? Should the price increase as your supply decreases?

Below are my recommendations for OTC medications that would be valuable in a barter economy.

1.  Pain medications (ibuprofen, naproxen, aspirin, and acetaminophen)
2.  Nausea medication (Bonine, Dramamine, or other version of meclizine)
3.  Diarrhea medication (Imodium or loperamide)
4.  Allergy medications (diphenhydramine, loratadine, cetirizine)
5.  Skin preparations (hydrocortisone cream, bacitracin, antifungal cream)
6.  Anti-acid preparations (antacids, H2-blockers such as ranitidine, proton pump inhibitors  such as Prilosec or Prevacid)
7.  Bladder pain relief (Azo)
8.  Sleep medications (Tylenol PM, Advil PM, NyQuil)
9.  Anxiety medications (although these are not specifically for anxiety, meclizine or diphenhydramine maybe useful)

In addition to the above, you may want to invest in Asthmanefrin, which may be life-saving in the event of an acute asthma attack or allergic reaction.  Fish antibiotics, which are intended for aquarium use, may also come in useful in an emergency situation when no medical help is available.

I also suggest you set a budget and buy what you can within your means. For $50 you could get a decent assortment of useful OTC drugs.

Additionally, make sure you check the expiration date on everything, especially any liquid preparations.  Although medications do not “go bad” immediately after the “Best if used by” date on the bottle, still it would be desirable to acquire medications that are not short-dated.  On the other hand, you may be able to get some great two-for-one deals on products that are set to expire soon.

One last note: unless you are a professional, you should never present yourself as one.  Although practicing medicine without a license in a crisis situation may never cause a legal problem, you should always be honest about your credentials.  Bartering with adolescents or children is also a potential problem; even in a crisis situation I suggest you deal with parents if at all possible, despite the fact that these drugs can be purchased without a prescription.

Medical Bartering Part 1

Medical Bartering, Part 1 of 5 – Introduction

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Scenario #1

You’re in a grid down situation. As a registered nurse, you’ve gathered medical supplies for your family that you believe might be life-saving in the event of a calamity.

Cautiously answering a knock at your door, you find a young couple with their infant daughter. Even at first glance you know she is dehydrated. “Can you help her?” the weeping mother cries. “She hasn’t had anything to eat or drink in three days!”

Having the skills and supplies to save her life, how do you respond?

1.  ”No,” you say while closing the door, “but you can try the clinic in town.”
2.  ”Maybe,” you answer, opening the door a crack, “if you’ll trade for that diamond ring.”
3.  ”No, it would be against the law to start an IV without a doctor’s order,” you reply truthfully.
4.  ”Possibly,” you say guardedly, “If you can pay $50, the cost of my supplies.”
5.  ”Of course,” you respond, believing it is the only moral choice.

What would you trade for the life of your child?

Many questions are raised by the above scenario:
1.  Are you morally obligated to help someone who hasn’t prepared wisely?
2.  Is it right to put your own children at risk by helping another?
3.  Is it ethical to ask for payment or barter in an emergency situation?
4.  Are professionals required to be Good Samaritans?
5.  Would the child’s death be on your conscience?
6.  If you barter, how do you determine the value of something?
7.  Are your skills a barter item?
8.  If someone offers all they have to save their child, is it ethical to take all their worldly goods?
9.  Whom will you help outside your family?
10.  Will you treat strangers differently than friends?
11.  When is the proper time to decide barter arrangements?
12.  Does helping someone make you responsible for the outcome?
13.  Will you share prescription medications?
14.  Is it even legal to share prescription medications and does that matter?
15.  Is demanding a large fee for saving a life ethical?

All these questions and more should be addressed before disaster strikes. You may not come up with an answer for every possible situation, but at least you’ll have a tentative plan.  For a survival group, a written plan is generally better than an informal intention.

In the following series of articles I will be addressing potential barter for medical items and skills, including:
1.  Over-the-counter medications
2.  Prescription medications
3.  Over-the-counter products other than medications
4.  Medical skills

For each topic the relative value of barter items will be addressed, along with real life situations you may well encounter.   If you have a family or larger preparedness group, these would be valuable topics for discussion, which would likely raise further concerns relevant to your own situation.

In Part 2 I will begin by discussing over-the-counter medications possibly suitable for bartering in an emergency situation.

Medical Bartering Part 2

Fish Antibiotic Update 2015

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If you’re new to the whole concept of fish antibiotics, there are a few basics you need to know. These are not antibiotics made out of fish. Neither are they micro-pills you must cram down your guppy’s throat. In general they are pills or capsules of the same size and strength humans use.

Although you cannot buy human or even dog antibiotics in the U.S. without a legal prescription, a federal loophole allows these same antibiotics to be sold over-the-counter for aquarium use. (Most physicians and pharmacists are unaware of this exemption.) Many of these so-called fish antibiotics are the same quality and dosage as human antibiotics (USP grade, AB-rated generics). Those who purchase these products are implicitly agreeing to use these antibiotics for aquarium purposes only.

Over the past year several fish antibiotic retailers have disappeared, probably having caught the eye of the FDA. Again, by law these antibiotics are sold only for aquarium use, to keep your pet fish healthy and happy, though it is clear from certain websites that they are being sold for human consumption. (Does a one-ounce goldfish really need 500 mg of cephalexin???) It is currently illegal to sell these medications to treat human infections, although the enforcement of that intention may be difficult to regulate. An even greater challenge is regulating what actually happens to these products after they are purchased.

Are you taking your life into your own hands if you get a sore throat and decide to treat yourself with your guppy-cillin? Probably not, regarding the purity of the medication, if it is a USP grade AB-rated generic…but maybe so, if you are allergic to penicillin and thought amoxicillin would be safe.

The problems with antibiotic use are manifold: perhaps more often than not, antibiotics are used for infections they cannot cure, for conditions that are not even infections, for the wrong infections, and for self-limiting disease that requires no antibiotics. Overuse leads to antibiotic resistance and to increasing difficulty treating serious infection. Millions of people suffer antibiotic reactions each year, some of which are fatal. Would you take penicillin for gonorrhea if you knew it might actually make the condition worse?

Just because penicillin, cephalexin, doxycycline, ciprofloxacin, and several other antibiotics can be purchased for aquarium use does not mean people should be treating themselves. Infectious disease doctors spend a lifetime studying the best and safest ways to treat infection. Additionally, it is an ethical question whether you should honor the promise inherent in the purchase.

On the other hand, if you knew without a doubt that TEOTWAWKI was just around the corner, you might feel it your moral obligation to do all you can now to protect your family in the future. Would it be immoral to withhold aquatic sulfamethoxazole from your daughter with a kidney infection if there’s no doctor to be found? Having antibiotics on hand, just in case disaster strikes, is not unreasonable. After all, doctors do prescribe them for pampered patients whose dream vacation may be threatened by traveler’s diarrhea. The end of the world as we know it may be a bit more serious. No one knows the day or the hour, but is it imprudent to be unprepared?

I always advise readers to discuss potential medical needs with their personal physician. However if this does not yield what one requires to feel safe and prepared, I know many people turn to fish antibiotics for potential use in emergency situations where medical care is unavailable.

As of 2015 I’ve noticed a few changes. The window of opportunity to acquire certain strong antibiotics may be closed. After searching several web sites I no longer find the ready availability of amoxicillin-clavulanate, levofloxacin, azithromycin, clarithromycin, or cefdinir, and several web sites simply are no more. I expect they didn’t follow the letter of the law.

Penicillin, amoxicillin, ampicillin, cephalexin, sulfamethoxazole, ciprofloxacin, metronidazole, and doxycycline continue to be available. Ketoconazole is an anti-fungal, not an antibiotic, and should be avoided due to occasionally irreversible liver damage.

Again I stress that no one should be using any of these without professional medical advice. But knowing that people will do what they must when threatened with life-endangering illness and nowhere to turn, I’ve addressed correct antibiotic use in great detail in my book, Armageddon Medicine, information I hope you’ll never actually need.

What you will find here

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This web site is devoted to empowering you, the reader, to care for your loved ones and yourself when there’s no other choice. Thank you for visiting and may God bless you richly. – Doc Cindy / Cynthia J. Koelker, MD


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Ebola in my home town

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Before this summer I often glossed over bioterrorism in my Survival Medicine classes…that could never happen here, could it?

Now that Ebola has arrived in my home town I feel differently. No doubt you’ve heard of the health care worker who flew from Cleveland to Dallas the day before she reported symptoms of Ebola.  During her time in Ohio she visited the Akron area, Tallmadge actually, less than 5 miles from my home.  Yikes!  Time to take this seriously.  No wonder a  friend called from Alabama…to wish me farewell…just in case.

Not that this is bioterrorism – but it could be someday.  Ebola is on the CDC’s Category A list of potential bioterrorism agents.

For the local story, check out the Fox news coverage at  The house under quarantine could well be in my neighborhood.

Over the past month I’ve been receiving nearly daily Ebola updates.  I haven’t posted an article on my site before now, since readers have access to the same news I receive.  But today the Ohio Academy of Family Physicians sent out an alert, along with the following Ebola Virus Fact Sheet.

Note that physicians are being asked to try to diagnose patients via telephone and to NOT draw blood.  Check out the references below for the official Ohio response to Ebola.  I’ll keep you updated on the local scene if anything more develops.  And make sure you and your own community are prepared for the unthinkable.


Ebola Virus Disease

(Source: Ohio Department of Health)

Ebola virus disease is one of several hemorrhagic fevers. It is spread through direct contact with:

  1. The blood or body fluids of a person who is sick with Ebola
  2. Objects (like needles) that have been contaminated with the blood or body fluids of a person sick with Ebola
  3. Touching the body of someone who has died from Ebola.

Ebola is not spread by air or water.

Ohio Information

On October 15, 2014, the Centers for Disease Control and Prevention notified the Ohio Department of Health that a health care worker in Dallas, TX, diagnosed with Ebola recently visited family in Ohio.

The Ohio Department of Health has activated its Ebola preparedness plan and initiated a 24-hour-a-day call center to answer Ohioans’ questions about Ebola. The number is (866) 800-1404.

What Should Family Physicians Do?

According to Mary DiOrio, MD, state epidemiologist and interim chief of the Division of Prevention and Health Promotion at the Ohio Department of Health, physicians are asked to diagnose patients by telephone, if possible, for Ebola virus symptoms. Physicians should also verify whether the person in recent weeks has either traveled to West Africa or been in contact with someone who has. If the patient is being diagnosed in person, physicians should check for symptoms such as fever, body aches and fatigue, but should not draw blood.

The Ohio Department of Health also stresses that it is now also important to ask whether individuals have had contact with a person ill with Ebola in the United States. Physicians and other health care professionals are reminded of the appropriate use of personal protective equipment as indicated.

Physician & Patient Resources

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One-day Suturing and Minor Surgery Workshop October 4, 2014

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Suturing and Minor Surgery – 1-Day Class
2015 Schedule TBA

This class is taken from Day 2 (Modules 3 and 4) of Survival Medicine 101

  • For a listing of what is covered, CLICK HERE or see below.


  • Intro to suturing
  • Sterile technique
  • Wound cleansing
  • Local anesthesia
  • Hand suture ties
  • Instrument ties
  • Interrupted sutures
  • Alternate suture techniques
  • Skin stapling
  • Wound care & dressing
Minor Surgery
  • Cryosurgery
  • Hyfercation & cautery
  • Lesion excision
  • Lancing an abscess
  • Subungual hematoma evacuation
  • Digital nerve block
  • Nail excision
This class is specifically for those who cannot attend a longer workshop, or for those who want to “try out” a single class.

Additional details will be sent upon registration

Register for THIS CLASS ONLY per the form below:

Suturing & Minor Surgery
First registrant $130.00 USDSecond registrant $130.00 USD

The Practical Prepper – Book Review

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The Practical Prepper

A Common-Sense Guide to Preparing for Emergencies

Book Review, by Cynthia J. Koelker, MD,

Did you ever wish you could find a single book with common-sense prepping advice you could actually implement?

The Practical Prepper is just that, a must-have read for both neophytes and seasoned preppers alike. The writing is down-to-earth, easy to understand, with sections logically organized according to expected needs.  Thus delightful book includes chapters on food and water storage, medical concerns, emergency heating, lighting, and cooking, sanitation, communication, fuel storage, shelter, and much more.  It is not a wilderness survival guide, but rather a realistic approach to what a normal family can and should so to weather a crisis and safeguard loved ones.

Throughout the book the authors offer multiple solutions to common problems, recognizing that one answer cannot fit every situation or budget.  For example, Chapter 8 discusses “Water Disinfection and Purification,” and includes sections on boiling, pasteurization, chlorine, calcium hypochlorite, iodine, solar water disinfection, as well as numerous types of filters.  Costs are discussed as well, allowing you to choose whether to invest in a $1500 Katadyn Expedition filter, or perhaps a $25 LifeStraw Personal Water Filter.  I especially enjoyed the discussion of “Emergency Cooking,” which stresses safety and inventiveness.  Who’d have thought you could make an oven from a paper box or an inner tube?

Lest prepping for every contingency appears an overwhelming task, just get started is the message of Chapter 1.  No one can accomplish it all in a day.  The book makes it easy to take small, practical steps toward improving your odds of survival should disaster strike.  Devoting only half an hour a week to emergency preparedness will put you far ahead of the unprepared masses.  But the authors don’t want to leave your neighbors in the dark.  Community is important now and will be so in the future.  An entire chapter is devoted to moving beyond your immediate family to helping your local community prepare.

Another major focus of The Practical Prepper is organization.  It does little good to have a dozen flashlights if you can’t find even one.  Where are your legal documents?  Where is your hand-crank radio?  How should your food be organized?  Again the authors offer many ideas from which you can pick and choose to fit your personal goals and budget.

Lastly, as a physician let me draw attention to Chapter 11 entitled “Medical – The Doctor Is Out.”  This section is a nice summary of concerns that must be addressed when no medical care is available, and includes discussions of prescription medications, first-aid supplies, over-the-counter preparations, keeping a personal medical information record, antibiotics, quarantine, and more.  Educating yourself is also stressed, from CPR to Community Emergency Response Teams (CERT).  Everyone would do well to heed their common sense advice, then consider moving to more advanced training once the basics are in place.

In summary, you can’t go wrong acquiring this handy survival manual.  Consider it an investment in your future and that of your children, when (not if) a crisis arises.

The Practical Prepper: A Common-Sense Guide to Preparing for Emergencies

Survival Medicine Workshops

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*  2015 Survival Medicine Classes *

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Survival Medicine 101

June 15-19, 2015 as part of Ultimate Prepper Training in Richfield, OH

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September 18-20, 2015 in Akron, OH

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Survival Medicine 102

October 16-18,2015 in Akron, OH

For class information or to register, CLICK HERE.

Survival Medicine 201

November 13-15, 2015 in Akron, OH

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Suturing & Minor Surgery

This is taken from Day 2 of Survival Medicine 101


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Tip of the Week: Suture material – what to get and where

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The best suture material I have found that anyone can purchase online is the brand Unify, available through Amazon and elsewhere.  For suturing of skin wounds, the 3-0 and 4-0 Nylon are most useful to have on hand, though having some 5-0 available for lacerations of tender skin (face/children/fingers) is a good idea.

For my own patients, I use professional suture, which does cost more, but is more difficult for the layman to procure.  (Check back soon – I may begin offering this for sale on my own site.)

The only problems I have had with the Unify suture, which I use for my live Survival Medicine classes, is that the needles may bend a little easier and the suture may detach from the needle a little easier than higher grade suture.  Still, I believe they are adequate for most wound closure and anyone can get them.

For additional articles on suturing, see Essential Medical Skills to Acquire: Introduction and Doc Cindy on SurvivalBlog.

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