Mass Casualty Triage Basics

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mass casualty incidents

Given the horrific events surrounding the Ariana Grande concert in Manchester, UK, we have come to realize that we may never be safe in today’s world. The bombing is new evidence, however, that no target is off limits to the terrorists in our midst. We can expect more episodes of terror in the western world in the future, and many will involve mass casualties.

The Mass Casualty Incident

The responsibilities of a caregiver is usually one-to-one; that is, the healthcare provider will be dealing with one ill or injured individual at a time.  This encounter usually falls within their expertise and resources.  There may be a day, however, when you find yourself confronted with a scenario in which multiple people are injured.  This is referred to as a Mass Casualty Incident (MCI).

A Mass Casualty Incident is any event in which your medical resources are inadequate for the number and severity of injuries incurred.  MCIs can be quite variable in their presentation.

Types of Mass Casualty Incidents

MCIs can be quite variable in their presentation:

  • Doomsday scenario events, such as a nuclear weapon detonation
  • Terrorist acts, such as occurred in Manchester
  • Consequences of a storm, such as a tornado or hurricane
  • Consequences of civil unrest or battlefield injuries
  • Mass transit mishaps (train derailment, plane crash, etc.)
  • A car accident with, say, four people injured (and only one ambulance)

 Responding to a Mass Casualty Incident

The effective medical management of any of the above events required rapid and accurate triage.  Triage comes from the French word for “to sort” (trier) and is the process by which medical personnel can rapidly assess and prioritize a number of injured individuals and do the most good for the most people. Note that I didn’t say: “Do the best possible care for each individual victim”.

Let’s assume that you were at the concert in Manchester, the Christmas market in Berlin, or the Boston Marathon when a bomb went off.  You are the first one to arrive at the scene, and you are alone.  There are twenty people on the ground, some moaning in pain.  There were probably more, but only twenty are, for the most part, in one piece.  The scene is horrific.  As the first to respond to the scene, you are “Incident Commander” until someone with more medical expertise arrives on the scene.  What do you do?

Your initial actions may determine the outcome of the emergency response in this situation.  This will involve what we refer to as the 5 S’s of evaluating a MCI scene:

  • Safety
  • Sizing up
  • Sending for help
  • Set-up of areas
  • START – Simple Triage And Rapid Treatment

Safety Assessment:  An insidious strategy on the part of terrorists when they target crowds is to set off primary and secondary bombs.  The main bomb causes the most casualties, and the second bomb is timed to go off or is triggered just as the medical/security personnel arrive.  This may run counter to your instinct to help, but your primary goal is your own self-preservation. Keeping the medical personnel alive is likely to save more lives down the road.  Therefore, you do your family and community a disservice by becoming the next casualty.

As you arrive, be as certain as you can that there is no ongoing threat.  Do not rush in there until you’re sure that the damage has been done and you and your helpers are safe entering the area.  In the immediate aftermath of the 1995 Oklahoma City bombing, various medical personnel rushed in to aid the many victims.  One of them was a heroic 37-year-old Licensed Practical Nurse who, as she entered the area, was struck by a falling piece of concrete.  She sustained a head injury and died five 5 days later.

Scene at the Boston Marathon bombing

Sizing up the Scene:  Ask yourself the following questions:

  • What’s the situation?   Is this a mass transit crash?  Did a building on fire collapse?  Was there a bomb?
  • How many injuries and how severe?  Are there a few victims or dozens?  Are there “walking wounded” that could assist you?
  • Are they all together or spread out over a wide area?
  • What are possible nearby areas for treatment/transport purposes?
  • Are there areas open enough for vehicles to come through to help transport victims?

Sending for Help:  If modern medical care is available, call 911 and say (for example):  “I am calling to report a mass casualty incident involving a multi-vehicle auto accident at the intersection of Hollywood and Vine (location).  At least 7 people are injured and will require medical attention.  There may be people trapped in their cars and one vehicle is on fire.”

In three sentences, you have informed the authorities that a mass casualty event has occurred, what type of event it was, where it occurred, an approximate number of patients that may need care, and the types of care (burns) or equipment that may be needed.

Set-Up:  Determine likely areas for various triage levels (see below) to be further evaluated and treated.  Also, determine the appropriate entry and exit points for victims that need immediate transport to medical facilities, if they exist.  If you are blessed with lots of help at the scene, assign triage, treatment, and transport team leadership roles.

S.T.A.R.T.:  Triage uses the acronym S.T.A.R.T., which stands for Simple Triage and Rapid Treatment.   The first round of triage, known as “primary triage”, should be fast (30 seconds per patient if possible) and does not involve extensive treatment of injuries.  It should be focused on identifying the triage level of each patient.  Evaluation in primary triage consists mostly of quick evaluation of respirations (or the lack thereof), perfusion (adequacy of circulation), and mental status.  These are known as “RPMs” and are a (very) basic indication of the level of injury.

Other than controlling massive bleeding and clearing airways, very little treatment is performed in primary triage. Controlling hemorrhage is best done with commercial tourniquets, for example, the SOF-T, CAT, or SWAT. It’s a sad sign of the times that I recommend carrying one of these if you have to go to areas where there are large crowds and little security. Tourniquets can be improvised with belts, bandannas, and other items, but are more difficult to apply effectively.

Although there is no international standard for this, triage levels in the U.S. are usually determined by color:

Immediate (Red tag): The victim needs immediate medical care and will not survive if not treated quickly.  (for example, a major hemorrhagic wound/internal bleeding) Top priority for treatment.

Delayed (Yellow tag): The victim needs significant medical care within 2-4 hours. Injuries may become life-threatening if ignored, but can wait until Red tags are treated. (for example, an open fracture of the femur without major hemorrhage)

Minimal (Green tag): Generally stable and ambulatory “walking wounded”, but may need some medical care. (for  example, broken fingers, superficial burns)

Expectant (Black tag): The victim is either deceased or is not expected to live.  (for example, a large open fracture of cranium with brain damage, multiple penetrating chest wounds

Patients may be identified with colored tape or triage casualty cards, but you’re unlikely to have these on hand. In that case, simply mark the victims’ foreheads with the numbers 1,2,3, and 4 indicating the priority for urgent care

casualty card produced by sos products

Knowledge of this system allows a patient marking system that easily allows incoming medical personnel to understand the urgency of a patient’s situation.  It should go without saying that, in a power-down situation without modern medical care, a lot of red tags and even some yellow tags will become black tags.  It will be difficult to save someone with major internal bleeding without surgical intervention.

The surviving victims of the Manchester bombing were “fortunate”, if I may use the word, that emergency personnel were on the scene in minutes. Although the death count is currently at 22, many more of the 60 wounded would not have survived without their assistance and transport to modern medical facilities.

We live in a more dangerous world these days, something I call “The New Normal“. In the New Normal, increased vigilance and situational awareness will be needed if you want to stay safe in crowds. In future articles, we’ll explore further how to deal with mass casualty incidents as a medical asset, and also how to avoid becoming a victim of those who want to disrupt civilized society.

Joe Alton, MD

Dr. Alton

Learn more about mass casualties, active shooter, terror events, and 150 other medical topics in times of trouble in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Survival Medicine Hour: Eye Issues, Fractures, TENS units

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THE SURVIVAL MEDICINE HOUR: EYE ISSUES, FRACTURES, TENS UNITS

Pink Eye, aka Conjunctivitis

In this episode of the Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, discuss how to deal with various eye issues that can confront a medic in an off-grid survival setting, like Pink Eye, foreign objects, styes, and more. Plus, our hosts impart some basics on how to deal with broken bones.

Ouch!

Dr. Bones also answers a question from Jack Spirko’s Survival Podcast Expert Council, of which he’s a member, regarding the potential for use in survival scenarios of TENS units. TENS units are battery-powered items that deliver electrical stimulation to muscles and nerves to help with pain relief.

All this and more in the latest Survival Medicine Hour! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/05/19/survival-medicine-hour-eye-issues-fractures-tens-units

Hey, do ol’ Dr. Bones a big favor and follow us on twitter @preppershow, YouTube at DrBones NurseAmy, and Facebook at Doom and Bloom(tm). You can also join our Facebook group at Survival Medicine DrBones NurseAmy!

Joe and Amy Alton

Joe and Amy Alton

Find out more about survival eye issues, fractures, and much more in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Also, check out Nurse Amy’s entire line of kits and individual supplies for the survival medic at store.doomandbloom.net!

Video: Azithromycin as Survival Antibiotic

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veterinary equivalents for Azithromycin

One of the most commonly prescribed antibiotics is Azithromycin, known in the U.S. as Z-Pak, is now in a new veterinary version known as Bird-Zithro. In survival situations where you’re off grid and there no modern medical care for the foreseeable future, the medic for the family must stockpile medical supplies, and this includes antibiotics.

See how Azithromycin in the form of “Bird-Zithro” might fit into you survival plans to treat your, well, sick birds. Uses, dosages, precautions, and more are more are discussed in this video by medical preparedness writer Joe Alton, MD.

To watch, click below:

Wishing you the best of health in good times or bad,

 

Joe Alton MD aka “Dr. Bones”

Joe Alton MD

 

Hey, learn more about Azithromycin, survival antibiotics, and 150 other medical issues in the Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available on this website and at Amazon.com. Also, check out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net. You’ll be glad you did.

Survival Medicine Hour: Expired EpiPens, Hepatitis C, Rodent Control 2

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Expired EpiPens Still Effective?

This week’s Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, discusses a new study from the California Poison Control System that indicates that EpiPens may be therapeutically effective even years after their expiration dates, welcome news given that a two-pack costs $300, even in generic form. Plus, part 2 of rodent control, this time how to get rid of rats and mice that already infest your retreat.

That’s a lot of rats!

 

Plus, Joe and Amy discuss the increasing epidemic of Hepatitis C in people who are using or abusing opioids like heroin and other drugs. Learn the obstacles to controlling this deadly disease and what might be done to help.

 

All this and more on the latest Survival Medicine Hour! To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/05/12/survival-medicine-hour-expired-epipens-hepatitis-c-rodent-elimination

Follow us on Twitter @preppershow, FB at Doom and Bloom ™, and YouTube at DrBonesNurseAmy!

Wishing you the best of health in good times or bad,

Joe and Amy Alton

dr. bones and nurse amy

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net!

Kits by Alton First Aid

Study: Expired EpiPens Still Effective

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Study: Expired EpiPens Still Effective

EpiPen and EpiPen Jr.

An expiration date is defined as the last day that a medicine is warranted to be safe and effective when stored properly. I’ve written for years that this date is often arbitrarily determined, and that the idea all medicines somehow “spoil” very soon after their expiration dates is incorrect.

I’m not alone in this opinion: A new study now reports that an important medical product that prevents deaths from severe allergic reactions (also called”Anaphylaxis“) can still be used effectively years after the expiration date on the package.

The California Poison Control System in San Diego tested 40 unused, expired Epipens and found that all (yes, all) of them retained at least 80% active epinephrine, the main ingredient.  This was true even for Epipens that closed in on the four-year expired mark. The least potent device was found to be at 81 percent 30 months past its expiration date. Most were at 90% or above.

Epipens are expensive items that are sometimes in short supply. F. Lee Cantrell, lead researcher of the California study, concludes that those unable to replace the product should hold onto it for use past the expiration date.

“There’s still a dose that would be therapeutic in there…” Cantrell also said: “if an expired EpiPen is all that I have, I would use it.” He suggests that it might be appropriate for the FDA (Food and Drug Administration) and Mylan, the company that distributes Epipen, to consider adjusting the expiration dates. Currently, the drug”expires” 12-18 months from the date of manufacture.

Of course, in normal times, the recommendation is to replace expired EpiPens. This new information, however, if of use to those who cannot afford to replace Epipen often and, also, to those in the preparedness community who store medical items in case of disaster.

The recommendation given by the California Poison Control System is a rare departure from standard conventional medical wisdom, which states that drugs should be disposed of as soon as they become expired. However, even the Department of Defense has determined that many medicines are 100% effective and safe to use even if expired. This data can be found in the July 2006 issue of the Journal of Pharmaceutical Sciences.

many drugs remain potent after expiration

The “Shelf Life Extension Program” (SLEP), which initially evaluated 122 drugs commonly stored for use in peacetime disasters, determined that most drugs in pill or capsule form were therapeutically effective for 2 to 10 years beyond the written expiration date. This led to the government issuing “emergency use authorizations” for various expired medicines when a shortage occurred. One example is the antiviral drug Tamiflu: During the 2009 Swine Flu epidemic, existing supplies of Tamiflu were authorized for use up to five years after the expiration date.

Drugs in liquid form did not fare as well in SLEP studies, which makes the Epipen (which uses a liquid solution of epinephrine) data so interesting. Granted, 100% potency would have been better, but 80-90% would still have a beneficial effect on an allergic reaction.

Given the 2016 Mylan scandal where the company increased the price from about $100 per two-pack to $600, an extended shelf life would be welcome news. (Mylan recently released a “generic” version for $300 per two-pack).

It should be noted that potency of a drug is affected by storage conditions. Most medicines should be stored in dry, cool, dark conditions. Allowing Epipens to be exposed to high heat or freezing could adversely affect effectiveness.

Many physicians are greeting the study’s findings skeptically, but I consider it more evidence that expiration dates are sometimes artificially determined, and that those storing medications for use in disaster settings might get more longevity out of their supply than expected. Get fresh medicine if available, but think twice before throwing out your last Epipen. Sometimes, something is better than nothing.

Joe Alton, MD

Dr. Alton:

Find out more about expired drugs, anaphylactic shock, and 150 other medical topics in austere settings with the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. (Be aware that the Second Edition can still be found there; be sure to get the latest edition or just order from store.doomandbloom.net.

Survival Medicine Hour: Ticks and Lyme Disease, Foot Fungus, Rodent Proofing

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THE SURVIVAL MEDICINE HOUR PODCAST #231

Tinea Pedis, aka Athlete’s Foot

In this episode of the Survival Medicine Hour, Joe Alton,MD and Amy Alton,ARNP discuss what’s behind the increasing population of ticks and the record number of Lyme Disease cases being reported in the United States, plus how to avoid tick bites and recognize and treat Lyme Disease early. Also, how to deal with fungal infections like Athlete’s foot with conventional and natural remedies in austere or remote settings.

Tick Bite

Rats!!! Rats and mice in your retreat will contaminate your survival food stores and transmit disease and otherwise lower your chances of survival in times of trouble. Find out how to rodent-proof a retreat with Dr. Bones and Nurse Amy.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/05/05/survival-medicine-hour-lyme-disease-foot-fungus-rodent-proofing

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Joe Alton MD and Amy Alton ARNP

Don’t forget to check out store.doomandbloom.net to fill those holes in your survival medical supplies! Also, The Survival Medicine Handbook is celebrating several years on the Amazon bestseller list in disaster relief, safety/first aid, and survival skills! Check it out at Amazon.com.

 

An “UpTick” in Lyme Disease

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Deer Tick Bites and Lyme Disease

deer blacklegged tick

Blacklegged or Deer Tick

Whether you’re a hiker, camper, or survivalist, you’ll be spending a lot of time in the Great Outdoors.  During your off-grid adventures, you’ll be exposed to all sorts of critters that want a piece of you (watch an episode of “Naked and Afraid” to see what I mean). One of these is the lowly tick.

Ticks are eight-legged spider-like “arachnids” that exist in various species throughout the United States. They latch onto the skin of a host for a meal of blood and transmit various disease-causing microbes (“pathogens”) to humans and animals through infected saliva.

These diseases include:

  • Lyme Disease (also called “Lyme Borreliosis”)
  • Babesiosis
  • Anaplasmosis
  • Tularemia
  • Rocky Mountain Spotted Fever
  • Ehrlichosis
  • Relapsing Fever

In this article, we’ll concentrate on Lyme Disease. Lyme Disease is caused by the corkscrew-shaped bacterium known as Borrelia burgdorferi, commonly transmitted by the tiny blacklegged tick, also known as the deer tick.

borrelia bacteria

Borrelia Burgdorferi

Experts are expecting more cases of Lyme Disease due to recent mild winters and bumper acorn crops, which have increased the populations of animals that ticks like to feed upon. These include mice, a favorite of baby ticks, and deer, popular targets for adults. Because of the abundance of host animals, the Centers for Disease Control and Prevention (CDC) are estimating 300,000 cases of Lyme Disease this year, which is three times the number reported 20 years ago.

In case you’re wondering, Lyme disease has nothing to do with limes. It was first diagnosed in the town of Old Lyme, Connecticut in 1975. Since then, Lyme has become the most common tick-borne illness in the Northern Hemisphere.

tick stages

Deep Ticks in various stages of development

HOW TICKS SPREAD LYME DISEASE

Ticks have a life cycle that can last two-three years and includes egg, larva, juvenile (also called “nymph”), and adult stages. For a larva to develop into a nymph or for a nymph to develop into an adult, a blood meal in needed. It appears that the nymphs cause the most cases of Lyme. The CDC estimates that about 30% carry the disease in the Northeast and Upper Midwest.

To pass along Borrelia burgdorferi to an animal or human, ticks must first find their hosts. They do this in a number of ways: By detecting smells, sensing body heat, or feeling vibrations with movement. Usually, they hang on grasses and bushes, holding on with their back pairs of legs and latching onto passersby with their front pair(s). When the tick finds a favorable place to feed, its mouth parts pierce the skin and start extracting blood.

how to remove a tick

Tick Removal

A thorough examination of the entire body for ticks is warranted within two hours of returning after a day outdoors. This is most easily accomplished during a shower. Look behind the knees, in armpits, behind the ears, even the belly button.

If the tick is found, it may be possible to just brush it off. If that doesn’t work, a number of commercial products are available to remove it. It is reasonable, however, to simply use fine-tipped tweezers to grasp it as close to the skin’s surface as possible, and pull straight upward in an even manner. Twisting or jerking as you pull may cause the mouth parts to remain in the skin.

Thoroughly clean the wound area with isopropyl (rubbing) alcohol and apply antibiotic ointment. Wash hands afterwards. As an added precaution, launder clothing in hot water and dry in high heat. If all this is done soon after the bite occurs, infection is highly unlikely.

DETECTION OF EARLY LYME DISEASE

Sometimes, however, the bite goes unnoticed. Once bacteria are passed to the host by the tick (a process that often requires 24-48 hours), symptoms can become apparent anywhere from 3 days to a month afterwards. You will usually see the following: :

  • Rash
  • Fever and chills
  • Muscle aches
  • Fatigue
  • Joint pain
ticklymerash

Tick feeding

In 70 per cent of patients, the rash occurs before the fever and starts as redness in the area of the bite. It often then develops into a red circular “bull’s-eye” that feels warm to the touch. Usually, very little pain or itching is associated. This pattern, which spreads over time, is called “erythema migrans” and may be enough to confirm the diagnosis. Lyme Disease, however, may be missed or misdiagnosed if symptoms are mild or, especially, if the tick bite was missed by the examiner.

 

erythema migrans bulls eye pattern

erythema migrans

 

When a bite from a blacklegged tick is newly identified, preventative antibiotics may prevent Lyme Disease. A single dose of two 100 mg. doxycycline (Bird-Biotic) may suffice.

For early infection, as evidenced by the presence of erythema migrans, rapid treatment usually results in a cure. Symptoms, however, may last for a time after treatment.

Doxycycline (veterinary equivalent; Bird-Biotic) 100 mg. twice a day for 14-28 days is indicated, or in children (must be over 8 years old) 4mg/kg twice a day for 14-28 days (max of 100 mg.) Avoid doxycycline in pregnant or breastfeeding women.

Alternatively, Amoxicillin (veterinary equivalent: Fish-Mox) can be used in pregnant or breastfeeding women at dosages of 500 mg 3x/day for 14-28 days. 50 mg/kg is the dose for children younger than eight years of age (maximum 500mg 3x/day). Azithromycin (Bird Zithro) has been mentioned as a second alternative and can be used in those allergic to Penicillin-family drugs.

LATE STAGE OR CHRONIC LYME DISEASE

Late stage infections with Borrelia burgdorferi result in a more diverse set of Lyme symptoms, some quite different from those seen early. These may occur months after the tick bite and include:

  • Neck pain and stiffness
  • Severe headaches
  • Multiple rashes away from the site of the bite
  • Joint pain and swelling in knees and other large joints
  • Bell’s palsy (nerve damage that causes drooping on one side of the face)
  • Heart problems such as irregular heartbeats
  • Dizziness
  • Shortness of breath
  • Inflammation of the spinal cord (called “meningitis”)
  • Shooting pains, numbness, or tingling in the hands, feet, or face
  • Memory loss

Many of the above symptoms may persist for long periods. As of yet, there is not a proven cure for chronic or late stage Lyme disease, but a vaccine is now in development. We’ll discuss  some strategies are to deal with this debilitating condition in a future article.

Boots1

Don’t forget the high-tops!

PREVENTING LYME DISEASE

An ounce of prevention is, they say, worth a pound of cure, and this old saying is particularly relevant when it comes to infections caused by tick bites. For prevention, consider:

  • Long pants and sleeves on the trail
  • Thick socks and high-top boots (tuck your pants into them)
  • Walking in the center of trails
  • Using insect repellants like DEET (20% or greater) on skin (oil of citronella or lemon eucalyptus are natural alternatives)
  • Applying Permethrin 0.5% insecticide to clothing, hats, shoes, and camping gear 24-48 hours before using (proper application will even withstand laundering)
  • Thorough exams after a day outdoors; pay special attention to children and dogs
permethrin clothing

0.5% Permethrin for clothing

Paying close attention to the little things, especially ticks, will make sure that your outdoor activities are healthy and memorable (in a good way).

Joe Alton, MD

AuthorJoe

Dr. Alton

Survival Medicine Hour: John Steinbaugh of Xstat, Wound Packing, Obesity

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cover celox with roller gauze

Packing a Bleeding Wound

In this episode of The Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, we welcome John Steinbaugh of RevmedX to discuss his XStat product (which we previously mentioned was not an ideal product for the preparedness community), plus new products that his company has to help stop hemorrhage in wounds. Learn about the XGauze and Parabelt, plus some realities about TCCC guidelines and the issues that companies go through getting new technology to the public.

obesity fat

extra weight will decrease chances for survival

Plus, a question for Dr. Bones as a member of Jack Spirko’s popular Survival Podcast Expert Council, this time about what to do with obese group members once the trigger event occurs for a SHTF situation.

Lastly, Dr. Alton talks about how to pack wounds effectively, and some recommendations from a doctor-paramedic team’s recent article in the Journal of Emergency Medical Services.

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton. To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/28/survival-medicine-hour-wound-packing-obesity-john-steinbaugh-of-xstat

 

Follow us on Twitter @preppershow

YouTube: DrBonesNurseAmy channel

Facebook: Doom and Bloom

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Learn more about bleeding wounds and 150 other survival medicine topics in the Third Edition (700 pages!) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon.

Video: Rodent-Proofing A Shelter

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rodents

heckuva rodent infestation

Sanitation is an important factor in staying healthy in rural homesteads and survival scenarios, and one formidable obstacle for the survival medic is the presence of rodents like rats and mice. When these animals are introduced into new areas, they cause a significant amount of environmental and economic damage. Whether in good times or bad, It makes sense to take measures to prevent rodent infestation in the home and to eliminate those already there.   In this video, Joe Alton, MD discusses rodents and how to prevent them from being unwanted guests in your home, shelter, or retreat.

To watch, click below:

Wish you the best of health in good times or bad,

 

Joe and Amy Alton

 

JoeAmyLabcoatSMALL300x300

Joe Alton MD        Amy Alton ARNP

 

Find out more about rodents, the disease they cause, and 150 other medical topics in grid-down settings by checking out our Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Also, fill those holes in your medical supplies with Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net. You’ll be glad you did.

How To Pack A Bleeding Wound

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bleeding wound

Bleeding Wound

The failure to control hemorrhage is a common cause of death in trauma situations. With the increased number of active shooter events in the United States, the average citizen should have knowledge of basic methods to stop heavy bleeding. The government’s Stop The Bleed Initiative is attempting to foster awareness of the importance of this type of education.

In the April 2017 issue of the Journal of Emergency Medical Services (JEMS), Dr. Peter Taillac and EMT-P associates Scotty Bolleter and A.J. Heightman put forth their recommendations for the packing of hemorrhagic wounds with plain and/or hemostatic gauze such as Quikclot, Celox, and others. In addition, they reinforce the principles of direct pressure and tourniquet use to control bleeding and save lives.

In 2012, The American College of Surgeons (of which I’m a retired Fellow) and other organizations formed a joint commission to improve survival in heavily bleeding injuries. While endorsing direct pressure as a primary technique to reduce hemorrhage, the commission reviewed evidence for the use of hemostatic gauze, finding it to be an effective tool in 90% of cases.

Packing of wounds is useful in many situations, but not all. Wounds of the neck are problematic, for instance, due to the risk of compressing airways. Packing injuries in the abdomen, pelvis, and chest may not be effective due to the deep nature of the bleeding vessels. This is one reason why, in an off-grid setting, the death rate (called “mortality”) from these wounds is so high. Statistics from the Civil War put mortality rates for major injuries in these regions at close to 70 per cent, a figure that might be expected in long-term survival scenarios.

CeloxHemostatics

Celox Gauze is approved by the TCCC

Tactical Combat Casualty Care guidelines approve hemostatic gauze as dressings of choice for severe bleeding. These products use materials that enhance or produce clotting. QuikClot uses Kaolin, an original ingredient in Kaopectate; Celox and Chitogauze use Chitosan, a product made from the shells of crustaceans. XStat, made by RevMedX, is preferred by TCCC for hemorrhage in areas like the axilla (armpit) and groin. A new product, Xgauze, was recently described to us by John Steinbaugh of RevMedX as an effective item to control bleeding without kaolin or chitosan, using instead expanding sponges built into the dressing itself.

xgauze by revmedx

Xgauze by RevmedX

According to Dr. Taillac’s team, proper packing of wounds with plain or hemostatic gauze include the following steps:

  • Quickly and aggressively apply direct pressure with a gloved hand, clean dressing or cloth, or even the knee or elbow while breaking out your supplies. Explore the wound with your fingers to find the source of bleeding, using nearby bones, if possible, to increase the effectiveness of pressure.
  • Tightly (and I mean, tightly) pack the wound cavity as deeply as you can while continuing to apply pressure on the bleeding vessel. Pack directly onto the vessel itself. Although hemostatic gauze is effective, sufficient pressure with plain gauze may be enough.
  • Maintain pressure on the packed wound for at least 3 minutes.
  • Place a tight pressure dressing (Israeli Battle Dressing, Olaes Bandage, etc.) over the whole thing.
  • Splinting the wound will immobilize it and help prevent re-bleeds during transport.
Direct Pressure on Bleeding Wound

Direct pressure with a gloved hand and cloth barrier

The above method, along with appropriate use of tourniquets, should be effective in controlling hemorrhage. If the dressings become saturated, however, it may be necessary to use more packing or to start over. A second tourniquet may also be needed. In normal times, this might best be done during transport to a modern medical facility. In long-term survival settings, get the victim to where the bulk of your supplies are.

It is thought that 1 in 5 deaths from hemorrhage may be prevented by rapid action. Know the procedure and, have no doubt, you will save lives in disasters or other times of trouble.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD

 

Learn more about hemorrhage and over 100 other survival medicine topics  in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Plus, check out Nurse Amy’s entire line of kits and supplies at store.doomandbloom.net.

 

Survival Medicine Hour: Black Scout, Pt. 2, Azithromycin, Sick Room Set-Ups

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TentMEDIUM

Setting up a sick room

In this episode of The Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP (aka Dr. Bones and Nurse Amy), we welcome back Jack of Black Scout Survival’s popular YouTube channel, who discusses a wide range of topics in part 2 of his interview with Amy.

Plus, Joe Alton, MD examines Azithromycin as a survival antibiotic. Thomas Labs has released a new bird drug, Bird-Zithro. Is Bird-Zithro a possible candidate for treating sick birds in your aviary after a disaster? Find out all you need to know about this important drug.

bird zithro 30 count azithromycin

Azithromycin for sick birds

Lastly, when an infectious disease epidemic comes to your town, would you be able to set up an effective sick room that will help the infected recover while keeping the healthy from getting sick? Joe and Amy go over what factors will make for an effective area to deal with infectious disease off the grid.

All this and more on The Survival Medicine Hour with Dr. Bones and Nurse Amy. To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/21/survival-medicine-hour-black-scout-pt-2-azithromycin-sick-rooms

Follow us on Twitter @preppershow                YouTube: DrBones NurseAmy Channel                  Facebook: Doom and Bloom

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Don’t forget to get a copy of the new 700 page third edition of The Survival Medicine Handbook: The essential guide for when medical help is not on the way, available at Amazon or at www.doomandbloom.net

Video: Sulfa Drugs in Survival

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shutterstock_89589424

Add medicines to your medical kit

Without antibiotics in your medical kit, there will be deaths in survival scenarios that could have been prevented. Using certain veterinary equivalents may be an answer as to how to obtain them. This video discusses the family of antibiotics known as “Sulfonamides”: How they work, What they’re good for, How to use them wisely, and more. Remember that antibiotics aren’t candy, and should be used only when absolutely necessary. We’re in the midst of an epidemic of antibiotic resistance in this country (mostly due to their use in livestock!). Companion video to a recent article.

 

To watch the video, click below:

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

JoeAmyLabcoatSMALL300x300

The Altons

Hey, get supplies for your medical kit, plus a copy of the latest edition of The Survival Medicine Handbook (also available at amazon), at Nurse Amy’s store on this website!

 

(slider image for this article courtesy of pixabay.com)

Setting Up A Survival Sick Room

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medicaltent

A hospital tent

In normal times, we have the luxury of modern medical facilities that can isolate a sick patient from healthy people. In a survival scenario, however, most organized medical care will no longer exist, placing the average citizen into the position of medic for his/her family or community.  

Although we may be thrown back to the 19th century medically by a disaster, we have the benefit of knowing about infections and hygiene.  The knowledge of how contagious diseases are spread and how to sterilize supplies give us a major advantage over medical personnel of bygone eras.

Using this knowledge, it should be possible for a medically prepared person to put together a “sick room” or “hospital tent” that will minimize the chance of infectious disease running rampant through the community. The cornerstone of care is to deal effectively and humanely with the sick while keeping the healthy from becoming infected.

In the face of a looming catastrophe, you must first make the decision to either stay in place or get out of Dodge. If you’re staying in place, choose a room where the sick will be cared for. That room should be separate from common areas, like the kitchen. It must have good ventilation and light, and preferably, a door or other physical barrier to the rest of the retreat.

If the wiser choice is to leave the area, shelter is an issue that may be addressed with, for example, tents. Choose a tent as the sick room and place it on the periphery of the camp. Again, good ventilation is important to allow air circulation.

With sick rooms in a retreat or camp, it is important to designate them before a disaster occurs. For groups where a number of people are living together, procrastinating will cause someone to lose their room or tent for “the greater good”. This invariably breeds resentment at a time when everyone needs to pull together.

Sometimes, you may find that there isn’t a spare room or tent to assign as a sick room. If you only have a common area to work with, raise a makeshift barrier, such as a sheet of plastic, to separate the sick from the healthy. Even if you have a dedicated sick room, keep group members with injuries separate from those with infectious diseases such as influenza. Although wounds will sometimes become infected, they won’t likely be as contagious as epidemic illnesses.

tent joe's kids

The injured should be separate from the infected, if possible

A sick room in a retreat with air conditioning won’t qualify as decent ventilation when the power’s down. In this case, air ducts are actually more a danger than a benefit. Microbes passing through the air ducts in the sick room to other areas may present a risk for transmission of disease. Cover with duct tape. Keep windows or tent flaps open, however, except in particularly bad weather. Screening may be necessary in areas with lots of insects, or netting provided over the beds.

Furnishings should be minimal, with a work surface, an exam area, and bed spaces. In mild weather, some of these bed space can be outside, as long as shade is provided via a canopy or other means. Hard surfaces are preferable to fabric upholstery, as cloth can harbor disease-causing organisms. Even bedding might best be covered in plastic. The more areas that can be disinfected easily, the better.

It’s important to have a way to eliminate waste products of bedridden patients, even if it’s just a 5-gallon bucket and some bleach. Containers with lids should be made available to put used sick room items that need cleaning.

shutterstock_209173573

Keep a basin with soap and water at the entrance to the sick room

A station should be set up near the entrance of the sick room or hospital tent for caregivers’ masks, gloves, gowns, aprons, and other personal protection items (have a good supply of these items). You’ll should also have a basin with water, soap, or other disinfectant. Thermometers should be dipped in alcohol.

Many consider medical supplies to consist of gauze, tourniquets, and battle dressings, but you must also dedicate sets of sheets, towels, pillows, and other items to be used in the sick room. Keep these items separate from the bedding, bathing, and eating materials of the healthy members of your family or group.

Having a lot of these may seem like overkill to you, but there can never be enough dedicated medical supplies. Expect to care for more people that you’ve planned for. There will always be additions that weren’t planned, and medical items will be expended much faster than you’d expect.

Cleaning supplies should also be considered medical preparedness items. You’ll want to clean the sick room thoroughly on a daily basis. Hard surfaces should be regularly cleaned with soap and water, or use other disinfectants such as a 1:10 bleach solution. Don’t forget to disinfect the doorknobs, tables, sinks, toilets, counters, and even toys.

Wash bed sheets and towels frequently; boil them if you have no other way to clean them. As these items may carry disease-causing organisms, wash your hands after use. The same goes for plates, cups, etc. Any equipment brought into the sick room should stay there.

One additional item that will be important to your sick room patients: Give them a whistle or other noisemaker that will allow them to alert you when they need help. This will decrease anxiety and give them confidence that you will know when they are in distress.

The duties of a medic involve more than how to control bleeding or splint an orthopedic injury. Medical problems involving infectious disease may take a heavy toll on your people if the sick aren’t isolated from the healthy. Knowing how to put together an effective sick room will go a long way towards helping the sick get healthy and the healthy stay that way.

 

Joe Alton, MD

AuthorJoe

Joe Alton MD

Find out more about dealing with infectious disease in times of trouble in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon or on this website.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2017 Third Edition

Survival Medicine Hour: Jack of Black Scout Surv., Gallstones, Fish Hooks, More

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jack richland black scout

Jack of Black Scout Survival

In this episode of the Survival Medicine Hour podcast, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, welcome back Jack of Black Scout Survival‘s popular YouTube channel to talk about his work and other important issues. Plus, Dr. Bones tells you all you need to know about gall bladder stones, a condition that affects 10-15 percent of the populations, and certainly would be an issue for the medic taking care of a large mutual assistance group.

gall bladder stones

Lastly, some ways to remove a fish hook from an outdoor mishap.

fishhookremoval

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!

 

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/14/survival-medicine-hour-jack-of-black-scout-survival-gallstones-fish-hooks

 

 

Some of the items mentioned in today’s interview with Jack of Black Scout Survival:

Benchmade SOCP

https://www.amazon.com/Benchmade-Dagger-Combo-Sheath-Skelentonized/dp/B008NBBTAS

BENCHMADE SOCP MEDICAL EDITION

https://www.amazon.com/gp/aw/d/B06XD3J9LR/ref=pd_aw_sbs_200_2?ie=UTF8&refRID=H44CQTRPYXX6XPD852DR&dpPl=1&dpID=51a-lo20aYL

FELLHOELTER TIBOLT PEN

http://fellhoelter.com/shop/

Zebra pen f701

https://www.amazon.com/Zebra-Stainless-Ballpoint-Retractable-29411/dp/B002L6RB80

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

joe and amy radio

Dr. Bones and Nurse Amy

 

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net

MedBag-ADpic

The family medical bag and just some of its conten

Foot Fungus Diagnosis, Treatment, and Prevention

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athletes-foot-large

Tinea Pedis

The medic in austere settings may have to deal with major medical issues; there are minor issues, however, that don’t threaten your patients’ lives, but can seriously affect their quality of life or work efficiency.  In times of trouble, you’ll need your people at 110%, and many issues, such as toothaches or foot infections, can become a nuisance or worse.

One problem that is very common (and will be more so off the grid) is foot and toenail fungus, also called “Athlete’s Foot”.  When your dogs (by that, I mean your feet) are howling because you aren’t able to change socks often, Athlete’s Foot might be the cause.  Expect this to be particularly relevant in scenarios where you’re constantly on the move.

Athlete’s Foot

Athlete’s foot (also known as “tinea pedis”) is an infection of the skin caused by a type of fungus known as Trychophyton. A fungus is a microscopic organism that likes dark and humid conditions.

This condition may be a chronic issue, lasting for years if not treated. Neglect can lead to its spread from between the toes to hands and groin.

It’s important to know that fungal infections are likely to be contagious. They can be passed by sharing shoes or socks and even from wet surfaces such as shower floors.  Those affected by Athlete’s Foot may also find themselves with other fungal conditions like Ringworm or Jock Itch (“Tinea Cruris”).

What Are Risk Factors For Athlete’s Foot?

 

Any fungal infection is made worse by moist conditions. People who are prone to Athlete’s foot commonly:

  • Spend long hours in closed shoes
  • Keep their feet wet for prolonged periods
  • Have had a tendency to get cuts on feet and hands
  • Perspire a lot
  • Are male
  • Are older or have chronic medical conditions like diabetes

What Does Foot Fungus Look Like?

athletes-foot

typical appearance of tinea pedis

To make a diagnosis, look for whitish flaky skin between the toes or fingers., which often appear red and raw. The nails may be yellowed, thickened, and “crumbly”.  Toenails may even separate from the underlying nail bed. Itching and burning in the affected areas is common and sometimes becomes severe. If the skin has been traumatized by scratching, you might see some fluid drainage.  Often, the damage caused by scratching is worse than the infection itself, leading to secondary bacterial infections like cellulitis.

Although toenails will appear yellowish in Athlete’s Foot, dark spots (brown, blue, or black) under the nail may be just debris or could be related to other issues. After an injury, a collection of blood under the nail (called a “hematoma”) will be dark and, often, painful. Less often, a tumor such as a cancer called “melanoma”, may first present with a dark or mottled appearance.

Treatment of Foot Fungus

If the condition is mild, keeping your feet clean and dry may be enough to allow slow improvement of the condition. Oftentimes, however, topical antifungal ointments or powders such as miconazole or clotrimazole are required for relief.  In the worst cases, oral prescription antifungals such as fluconazole (Diflucan) or terbinafine (Lamisil) are needed.

Although creams and ointments cover the skin between the toes more thoroughly, don’t use them too often; excessive moisture may delay healing.

In the worse cases, an infected nail may require removal. If so, it may take a year to grow back.

Patience is a virtue when monitoring the healing process, which may take more than a month for a significant case of Athlete’s Foot to resolve. In the meantime, disinfect shoes with antifungal powders on at least a weekly basis.

Home Remedies

vinegar

cloudy vinegar useful for relief

A favorite home remedy for Athlete’s Foot involves placing Tea Tree Oil liberally to a foot bath and soaking for 20 minutes or so.  Dry the feet well and then apply a few drops onto the affected area. Repeat this process twice daily. Try to keep the area as dry as possible otherwise. For prevention of future outbreaks of Athlete’s Foot, apply tea tree oil once a week before putting on socks and shoes.

5% Apple cider vinegar foot soaks (2-4 cups) may work as well. The acid will kill the fungus, as well as soften and break down the skin changes it causes. Use a washcloth to gently scrub the infected areas. If you notice irritation from the bath, dilute with water.

Others recommend soaks with other items, such as black tea, cinnamon, betadine, or Epsom salts.

Long-term therapy with Snakeroot extract may help. Apply every third day for the first month, and once a week thereafter for two to three months. Alternatively, dip a cotton ball in the vinegar and hold to affected areas for several minutes.

Vicks Vap-o-Rub, applied with a swab, shows partial important in more than half of cases.

One method that doesn’t work is urinating on your feet in the shower. Although there is ammonia in urine that might kill germs, it’s not strong enough to kill the Athlete’s foot fungus.

You might have your own home remedy for foot fungus. If so, feel free to post it in the comments section.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD

Find out more about foot fungus and other minor and major medical issues related to survival, check out a copy of our Third Edition (700 pages) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at amazon.com and here at store.doomandbloom.net.

Gallstones: Diagnosis and Treatment

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gall bladder stones

gallstones

The gall bladder is a hollow sac-like organ that is attached to the liver; it stores a thick liquid substance called “bile” that the liver secretes to help you digest fats. After a meal, the gall bladder contracts and bile passes through to the small intestine through tubes called ducts.

Excess bile cholesterol can cause solid deposits inside the gallbladder that range in size from miniscule to, say, the size of a golf ball. These are commonly referred to as “gallstones”.  Gallstones are relatively common; perhaps ten to fifteen per cent of the population has them. That means a large enough group of people in a survival community will likely include someone with the condition.

Luckily, most people won’t have any symptoms.  In one or two per cent, however, the stones block the ducts, causing pain as the gall bladder becomes distended from excess accumulation of bile. The inflammation caused by this condition is called “cholecystitis”.

There are two main types of gallstones:

1)            Cholesterol stones: The grand majority; these may not be related to the actual cholesterol levels in the bloodstream.

2)            Bilirubin stones: Sometimes called “pigment stones”, this type may occur in people who have illnesses that destroy red blood cells. The by-products of this destruction release a substance called “bilirubin” into the bile and forms a stone. In other cases, however, it’s difficult to identify a cause.

2425_Gallbladder

gall bladder anatomy with bile ducts and liver ( By OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons)

The pain associated with cholecystitis is known as “biliary colic”. It’s is cramping in nature and is usually seen in the upper right quadrant of the abdomen; it may radiate to the back. If not relieved, inflammation of the liver, gall bladder, and pancreas (“gallstone pancreatitis”) can become life-threatening in some cases.

A serious blockage of the bile duct with corresponding liver/pancreas inflammation can lead to fever, nausea and vomiting, and a yellowing of the skin and eyes known as “jaundice”.

Gallstones are commonly diagnosed by ultrasound, but you won’t have modern technology off the grid. The classical finding on physical examination is called “Murphy’s Sign”. Press with one hand just below the midline of the lowest rib on the front right. Then, ask your patient to breathe deeply. If the gallbladder is inflamed, the patient should complain of tenderness at the site.

In a less politically correct era, risk factors for this condition were described as the 4 “F’s”. For historical purposes, here they are:

Fat: The majority of those with gallstones are overweight.

Female: The majority of sufferers are women.

Forty: Most sufferers are over 40 years old.

Fertile: Most women with gallstones have had children.

Today, more sensitive souls prefer the acronym G.O.L.D.

Genetics: Ethnicity plays a role; Native Americans and Hispanics seem to have more gall bladder issues than Caucasians, Caucasians more than African-Americans.

Obesity: Obesity, especially in women, is associated with at least twice the frequency of gall bladder disease.

Location of Body Fat: Those with obesity concentrated in the torso are more likely to be at risk.

Diabetes: Those with Diabetes are more likely to have gallstones.

The most common treatment for gallstones, other than pain meds, is to surgically remove the gall bladder (you can live without it and stay healthy). Over 800,000 gall bladder surgeries (called “cholecystectomies”) are performed every year. New methods include shock-wave disintegration of stones and acid treatments that may show promise for non-surgical therapy.

Operating rooms, surgeons, and high technology, however, are likely to be in short supply when the you-know-what hits the fan, so it’s useful to know some alternative remedies. These are mostly taken orally::

  • Apple cider vinegar (mixed with apple juice or water)
  • Chanca Piedra, (Phyllanthus niruri), a plant native to the Amazon; translated, the name means “Break Stones”.
  • Peppermint
  • Coffee
  • Turmeric
  • Alfalfa
  • Ginger root
  • Psyllium
  • Red Yeast Rice
  • Dandelion root
  • Artichoke leaves
  • Beet, Carrot, Grape, Lemon juices

It should be noted that hard scientific data proving the effect of the above items is still lacking in many cases. Results from use of the items in the above list will vary from person to person.

Sadly, it is very difficult to eliminate some of the known risk factors for gall bladder disease. You can’t change if you’re forty, female, and have children. You may be able to do something about being obese, however. Dietary changes to lower fat intake may help you lose weight and decrease the risk of gallstones.

Joe Alton, MD

JoeAltonLibrary3

Joe Alton, MD

Hey, have you experienced the joy and satisfaction that goes with helping the elderly? Well, make an old man (me) very happy by checking out our brand new 700 page third edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, now available at Amazon.com and doomandbloom.net. Thanks again.

 

Survival Medicine Hour: Sulfa Drugs, Uva Ursi, Quicklime, More

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OLYMPUS DIGITAL CAMERA

Sulfa Drugs

In this episode of the Survival Medicine Hour, Joe Alton, MD (Dr. Bones) and Amy Alton, ARNP (Nurse Amy) examine Sulfa drug antibiotics as an option in survival settings. One of the first antibiotics, sulfa has been credited with saving the lives of tens of thousands in WWII, including Winston Churchill himself, and still has applications today in good or bad times.

Also, the herb Uva Ursi may have some use in urinary tract infections, one of the medical issues that sulfa drugs are effective for. Find out more about this herb in Nurse Amy’s segment on natural remedies.

Uva ursi

Uva Ursi

Plus, Dr. Bones discusses what disasters are most responsible for the most deaths in the U.S. over the last 40 years. The answers will definitely surprise you! Plus, some guidelines on disposal of dead bodies in post-apocalyptic times.

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/04/07/survival-medicine-hour-sulfa-drugs-uva-ursi-quicklime-more

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

joe and amy radio

The Altons

Please follow us on Twitter @ Preppershow, and don’t forget to check out Nurse Amy’s entire line of medical kits at store.doomandbloom.net!

Sulfa as a Survival Antibiotic

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Fish Sulfa Forte = Bactrim/Septra

In survival settings, it’s reasonable to assume that you’ll be performing activities that aren’t part of your routine in normal times, like, say, chopping wood for fuel. When you’re doing chores to which you’re not accustomed, injuries can occur. Of course, an ounce of prevention is worth a pound of cure. Using protective eyewear, gloves, and boots may prevent an injury that could become life-threatening off the grid.

It might be difficult to envision that a simple cut could turn lethal, but in survival, many of these wounds are “dirty”; that is, they’re contaminated with bacteria or other microbes. Today, the use of drugs called antibiotics can nip infections in the bud. in any situation where modern medicine isn’t available, however, these wounds can become problematic. If an infection enters the bloodstream (a condition called “septicemia”), things can go downhill quickly.  

A while ago, I did a series of articles and videos on antibiotics, and talked about popular drugs like amoxicillin, doxycycline, Cipro and others that you can find in aquarium and avian versions. Available in capsules and tablets that are essentially identical to those provided for human use (even down to identification numbers), the wise medic should have some of these tools in the medical woodshed for when the you-know-what hits the fan.

Quick disclaimer: This doesn’t mean that you should be using them in normal times. Remember that it’s illegal and punishable by law to practice medicine without a license. If modern medical professionals exist, seek them out.

Today we’ll talk about a family of antibiotic called sulfonamides, or sulfa drugs. Sulfonamides act to inhibit an enzyme involved in folate synthesis, an important part of the production of bacterial DNA. Sulfonamides are bacteriostatic, which means that they don’t directly kill bacteria. They do, however, significantly inhibit growth and multiplication, which leads to eventual elimination of bacteria from the body.

Sulfonamides were available even before Penicillin, and are credited with saving the lives of tens of thousands during WWII, including that of Winston Churchill. Soldier’s first aid kits even came with sulfa pills or powder.

bird sulfa

Bird Sulfa

A specific version, Sulfamethoxazole 400mg/Trimethoprim 80mg (veterinary equivalent: Bird- Sulfa or Fish-Sulfa) is a combination of two medications in the Sulfa family. This drug is well-known in the U.S. by its brand names Bactrim and Septra. Our British friends may recognize it by the name Co-Trimoxazole. The two antibiotics work synergistically, which means that, together, they are stronger in their effect than alone.

Sulfamethoxazole/Trimethoprim is effective in the treatment of the following:

·        Some upper and lower respiratory infections (chronic bronchitis and pneumonia)

·        Kidney and bladder infections

·        Ear infections in children

·        Cholera

·        Intestinal infections caused by E. coli and Shigella bacteria (a cause of dysentery)

·        Skin and wound infections, including MRSA

·        Traveler’s diarrhea

·        Acne

The usual dosage in adults is sulfamethoxazole 800-mg/Trimethoprim 160mg twice a day for most of the above conditions for 10 days (5 days in traveler’s diarrhea).

The recommended dose for pediatric patients with urinary tract infections or acute otitis media (ear infection) is  40 mg/ kg sulfamethoxazole and 8mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours, for 10 days. 1 kilogram equals 2.2 pounds. This medication should not be used in infants 2 months old or younger.

In rat studies, the use of this drug was seen to cause birth defects; therefore, it is not used during pregnancy.

silvadene

Silvadene cream

Another sulfa drug, Sulfadiazine, is combined with Silver to make Silvadene, a cream useful for aiding the healing process in skin wounds and burns. Cover completely twice a day.

Sulfamethoxazole/Trimethoprim and other Sulfonamides are well known to cause allergic reactions in some individuals. These reactions to sulfa drugs are almost as common as Penicillin allergies, and usually manifest as rashes, hives, and/or nausea and vomiting. Worse reactions, however, can cause blood disorders as well as severe skin, liver, and pancreatic damage. Those with conditions relating to these organs should avoid the drug.

Although an allergy to Sulfa drugs may be common, it is not the same allergy as to Penicillin. Those allergic to Penicillin can take Sulfa drugs, although it’s possible to be allergic to both.

It’s important to understand that antibiotics aren’t candy: they must be used wisely and only when absolutely necessary. The overuse of antibiotics (mostly in livestock) is responsible for an epidemic of antibiotic resistance. Having them in your medical storage, however, can prevent the medic from experiencing headaches, and heartaches, if things go South.

Joe Alton, MD aka Dr. Bones

JoeAltonLibrary3

Joe Alton, MD

Learn more about antibiotics and 150 other medical topics related to survival by checking out a copy of our 700 page Third Edition of The Survival Medicine Handbook: THE Essential Guide for When Medical Help is Not on the Way.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2016 Third Edition

Survival Medicine Hour: Disaster Deaths, Antibiotics, XStat, More

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ebola1

In this episode of The Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss an antibiotic called Clavamox that’s used in dogs and cats as a possible survival med. Also know as Augmentin, is it exactly the same as the human drug, as  Dr. Alton found was the case years ago with certain fish and bird antibiotics? You might be surprised.

Also, the military may be getting taken for a ride with the expensive prescription product XSTAT, a syringe of hemostatic sponges used for severe hemorrhages. Sounds good, but does it work and what’s behind the recommendations for the government to add this item to military supplies? And does it have any application for survival medics?

Xstat-300x225

XSTAT hemostatic syringe

Plus, do dead bodies from natural disasters cause epidemics? Amy and Joe explore this possibility and compare it to Ebola in 2014 and other events. Lastly, a young man wants to take his 6 month old son and wife to Belize, currently under a Zika warning from the CDC. What is Dr. Bones’ opinion?

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/03/31/survival-medicine-hour-antibiotics-dead-bodies-and-disasters-more

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

joe and amy radio

Dr. Bones and Nurse Amy

Video: All About Dysentery

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Shigella boydii

Shigella bacteria

In this video, Joe Alton, MD, aka Dr. Bones of DoomandBloom.net, discusses the issue of infectious diseases as the main causes of avoidable deaths in survival scenarios. In particular, he talks about dysentery, a disease that is transmitted by bacteria in contaminated food and water. Here’s all you need to know about this killer in past and future times of trouble. Companion video to a previous article on the same topic.

To watch, just click below:

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

JoeAltonLibrary3

Joe Alton, MD

Find out more about dysentery and 150 more medical issues in the latest 700 page edition of the Survival Medicine Handbook: THE Essential Guide for When Medical Help is Not on the Way, available at store.doomandbloom.net or Amazon.com!

 

The Vehicle as Terror Weapon

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vehicular-terrorism

vehicular terror

 

In these days of Pokemon Go and other smartphone distractions, you’re seeing more and more people oblivious of their surroundings. In the past, this might get you a bump on the head by walking into a lamp post. In today’s world, however, it could cost you your life.

 

As an Anglophile, I have often visited London and walked from my hotel to parliament and other sites via the Westminster bridge. Today, on the anniversary of the terrorist attack in Belgium, someone used a vehicle to mow down pedestrians on the bridge and then, apparently, left the car to continue a rampage that has left a number of casualties in its wake. The British, after some hesitation, have labeled the event a terrorist attack.

 

Vehicular terrorism is not new, with Israel the scene of multiple attacks in past years. It’s becoming more and more common in the West, however, with attacks in Nice, France on Bastille Day and in Berlin at a Christmas market. In the United States, a Somali student used his car to run over several people at Ohio State University and then perpetrated a knife attack on those who, ironically, ran over to see if he was injured. Many similar events rarely make the news.

 

Terror attacks are often associated with bombs, but making a bomb requires some expertise to assemble safely. Guns, the other preferred weapon, are difficult to come by in most countries other than the U.S. Owning or renting a vehicle, however, is easy. Trucks and cars can cause mass casualties if wielded as a weapon; obtaining one isn’t an act that evokes suspicion.

 

Recently, an article titled “Just Terror Tactics” was published by the English-language ISIS magazine “Rumiyah”.  It described which vehicles will cause the most damage and called for attacks on Western crowds. “It is a simple idea and there is not much involved in its preparation,” the article said. “All what is needed is the willingness to give one’s life for Allah.”

 

The article goes on: “Pick your location and timing carefully. Go for the most crowded locations. Narrower spots are also better because it gives less chance for the people to run away. Avoid locations where other vehicles may intercept you…To achieve maximum carnage, you need to pick up as much speed as you can while still retaining good control of your vehicle in order to maximize your inertia and be able to strike as many people as possible in your first run.”

 

The writer also suggested attackers weld steel blades onto the front of an SUV: “They do not need to be extra sharp because with the speed of the truck at the time of impact, even a blunter edge would slice through bone very easily. You may raise the level of the blades as high as the headlights. That would make the blades strike your targets at the torso level or higher.”

 

These tactics represents the new blueprint among terrorists for causing mayhem. Few people pay much attention to traffic unless they’re driving a vehicle themselves or crossing the street. The speed at which a vehicle can accelerate and turn into a crowd leaves little reaction time. Therefore, the “success” rate of this type of terror event may surpass even a gunman’s ability to cause deaths and injuries.

 

I advocate for a constant state of “Yellow Alert” when in public spaces. By that, I mean a calm but vigilant observation of what’s happening around you. Look for anomalies in behavior that might warn you of nefarious intentions. For example, hopping up and down and screaming may be normal at a rock concert, but it’s an anomaly at Starbucks.

 

This attitude is useful, but it’s difficult to respond quickly enough to avoid an oncoming car or truck.  When a vehicle moves erratically or leaves the normal pattern of traffic, it’s an anomaly that requires quick action. Mentally noting routes of escape whenever you’re in public will give you the best chance of escaping. Just as knowing the location of exits in a mall or theatre is good policy, a heightened awareness is now important at any public area near roadways.

 

For vehicular terrorists, the target will be crowds of people near the street. Their objective is mass casualties, and those pedestrians nearest the curb will bear the brunt of the attack. Consider walking on the fringe of a crowd away from the road to give yourself the most options. In the center, the masses, not your own good judgment, will dictate your movement.

 

bollards 1

Bollards

Municipalities can protect their citizens from vehicular terrorism by constructing barriers known as “bollards” which stop vehicles from entering pedestrian areas. These can be seen outside many government buildings and airport terminals. Expanding their use to areas that attract crowds would be an important consideration for the future.

 

I’m not the only one thinking of how to deal with vehicular terror. The FBI and the Department of Homeland Security recently issued a release warning of vehicular terrorism and how to identify an imminent attack. The release acknowledges the time issues in reacting to such events, but includes the following things to look for:

 

  • Unusual modifications to vehicles, such as frontal reinforcement.

  • The purchase or rental of large or heavy-duty vehicles, especially if there is nervousness during the transaction, payment in cash, or lack of familiarity with the vehicle’s operations.

  • Commercial motor vehicles or heavy equipment being operated in unusual locations, such as particularly heavy pedestrian areas.

  • Attempts to approach areas closed to traffic, such as street festivals or farmers’ markets.

  • A vehicle operator’s apparent unfamiliarity with operating a commercial vehicle, such as trouble with gear shifting.

I’ll admit that the likelihood you’ll be in the path of a terrorist using a vehicle, or any other weapon, is very small. Panic isn’t the answer, but these are troubled times; the more situationally aware you are, the safer you’ll be.

 

Joe Alton, MD

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Dr. Alton

 

Find out more strategies for dealing with terror attacks and 150 other topics related to survival in the Third Edtion (700 pages!) of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available on this website or Amazon.

 

 

 

Survival Medicine Hour: Blood Clotters, Wound Closure, More

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stabwound

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss improvised tourniquets and some TCCC guidelines regarding hemorrhage under fire or in normal times. Blood clotting agents are introduced and Quikclot/Celox are compared. Plus, when should a wound be closed and when should it be treated as a open wound from beginning to full recovery?

celox

Celox hemostatic agent

All this and more from a Survival Medicine Hour on the road, this time in Chicago, Illinois!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/03/17/survival-medicine-hour-blood-clotters-wound-closure-more

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

Dr. Bones and Nurse Amy

Blizzard Safety Tips

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carsinsnow

The March Blizzard

 

 

I find myself a little surprised to be writing about blizzard survival with Spring just around the corner, but weather forecasts are predicting a particularly nasty blizzard for the East Coast. Strong winds and a foot of snow are possible from Maryland to Maine. March came in like a lamb, but it’s acting like a lion for those in the Northeast.

Winter storms (this one is named “Stella”) occur every year in the United States, and cause fatalities among the unprepared. 70% of deaths occur due to traffic accidents and 25% from hypothermia from being caught outside during the blizzard. With Stella’s strong winds, trees and power lines burdened with heavy snowfall may topple, causing additional hazards.

If a blizzard knocks you off the grid but you’re still in your home (a great place to be), keep everyone in an inside room, preferably without windows. The heat from several bodies will make a small space warmer.

Heat in the home can be conserved by shutting the doors of unused rooms and drawing blinds and curtains to add insulation.  Stuff towels under the door to prevent loss of warmth from the room you’re using. If you’re using some form of alternative heat, however, make certain that there is reasonable ventilation. Prepare for mishaps by having a fire extinguisher handy.

Staying hydrated is important. You’d be surprised how much a family uses, so fill the bathtub with water. Plumbing might be kept from freezing by allowing faucets to drip. Stock up on non-perishable food.

Winter conditions don’t just affect people; they affect cars as well. Cold affects rubber and metal; it even decreases the battery’s efficiency. Tires become stiff and flat for the first few hundred yards. Motor oil and other lubricants become thicker at cold temperatures. This makes the engine work harder.

Therefore, vehicles that will be doing duty in extreme cold should be “winterized”. This involves switching to a lighter viscosity oil, changing to snow tires, and choosing the right (anti-freeze) ratio of coolant to water. Gas tanks should be full if at all possible.

blizzard

Not the best time to be outside (image courtesy of pixabay.com)

 

OUTSIDE IN A BLIZZARD

You’re not a bear, so you can’t hibernate through the cold weather; you’ll have to take measures to avoid getting stranded out in the cold. Many deaths from exposure are avoidable if simple precautions are taken

The first thing that you should do before planning a day outdoors in snowy weather is consult your weather radio for the forecast. If a storm is on the way, postpone your outing until the weather improves.

Dress appropriately and in layers. Each successive layer of clothing traps warm air near your body. Wool is the best material for staying warm. Unlike cotton, wool will stay warm even if somewhat wet, and wicks perspiration away from the skin. Wet clothing will cause you to lose body core temperature faster. Mittens will keep your hands warmer than gloves.

SEEK SHELTER

tree well

A Tree Well Shelter

Some people might be caught by surprise when a winter storm hits the backcountry. If you’re in the wilderness, seek some form of shelter immediately to get out of the wind. There are many types of shelters, but one can be made in a “tree well”. A tree well is the sunken area around the trunk in very deep snow. This area is relatively easy to excavate and, if the tree has low-hanging branches, should provide some protection from falling snow. Look for natural barriers nearby that may serve as windbreaks, but beware of slopes where you may be exposed to drifting snow or avalanches.

The space you dig out should be small, as small shelters take less effort to keep warm than large ones. Pack your snow “walls” well, which retains heat better and can support a makeshift roof. Place evergreen boughs and debris on the floor to protect you from the cold ground. Then add some on top to make a roof. Tarps or solar blankets may also be used for this purpose, but winds might easily blow them off. Tie rocks to the corners as weights.

If a tree well is not an option, digging a “cave” out of deep snow can serve to insulate you from the wind (think igloo). If you make a fire, be sure to have ventilation holes in your shelter. Entrances and ventilation holes should open at a 90 degree angle to the prevailing winds.

Stay hydrated but don’t eat snow. Your body must first melt it and loses heat as a result. If you don’t have fire to melt snow, put a container with it in your clothes, but not next to the skin. Hypothermia and other cold-related medical issues are covered here.

STRANDED IN THE CAR

caraccidentwinter

You won’t always be stranded on a busy highway

The first question you should ask before you get in the car in cold weather is “Is this trip necessary?”. If you don’t have to leave the house in a snowstorm, don’t. Period. If you do, drive as if your life depended on it, because it does. Don’t speed, tailgate, or weave from lane to lane. Make turns slowly and deliberately, and be careful to avoid quick stops and starts

Let’s say that, despite your best efforts, you’re stuck on the road in a blizzard. Help may be on the way, but what if it isn’t? It’s important to stay calm and don’t leave the car. It’s warmer there than outside and you’re protected from the wind.

Wet snow can block up your exhaust pipes and cause carbon monoxide gas to enter the passenger compartment. You’ll need fresh air, but don’t crack a window on the side where the wind is coming from. If you’re in a group, huddle together as best you can to create a warm pocket in the car. Rub your hands, put them in your armpits, or otherwise keep moving; this will help your muscles produce heat.

Maybe you can dig yourself out, but beware of overexertion in extreme cold. You’ll sweat, and wet clothes are a main cause of hypothermia. If you have flares, use them to let others know you need help.

THE WINTER SURVIVAL CAR KIT

There are a number of items that you should always have in your car, especially in cold weather. These are meant to keep you safe if the unthinkable happens and you’re stranded without hope of rescue. Your blizzard survival car kit should contain:

  • Wool blankets (for warmth; wool can stay warm even if wet)
  • Spare sets of dry clothes, especially socks, hats, and mittens.
  • Hard warmers or other instant heat packs (activated by shak- ing, they’ll last for hours)
  • Matches, lighters, and fire starters to manufacture heat Flashlights and candles (keep batteries in backwards until you need them to extend life).
  • Small multi-tool with blade, screwdrivers, pliers, etc.
  • Larger combination tool like a foldable military surplus shovel (some are multipurpose and can be used as an axe or saw)
  • Sand or rock salt (to give traction where needed)
  • Tow chain or rope
  • Flares
  • Starter cables (for jump starts)
  • Water and food (energy bars, MREs, dehydrated soups, candies)
  • Baby wipes (for hygiene purposes)
  • A medical kit and medications
  • Tarp and duct tape (brightly colored ones will be more visible and aid rescue)
  • Metal cup or thermos (to melt snow, make soup, etc.) Noisemaker (whistle) to signal for help
  • Cell phone and charger, weather radio

A March storm can be as deadly as one in January. With a plan of action, a few supplies, and a little luck, you’ll survive even in the worst blizzard.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD

Find out more about cold weather, hot weather, and many other issues in our Third Edition of the Survival Medicine Handbook, The Essential Guide for When Help is Not on the Way!

Survival Medicine Hour: Dental Exams, Bleeding Control, Tourniquets

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dentalcare

The basic dental exam

The Survival Medicine Hour, on March 11, 2017, is hosted by Joseph Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy of https://www.doomandbloom.net/. In today’s show, Dr. Alton reviews the steps of a dental exam for those who find themselves in a remote area or post-disaster and who need to care for someone with an immediate dental issue. Expect more segments on individual dental problems that might confront the medic in remote or post-disaster settings.

soft-t tourniquet

The Sof-T tourniquet

Accidents happen everyday and you may find yourself as the person responsible for saving a life of someone who’s hemorrhaging. Severe injuries with bleeding can be scary to non-medical persons. Knowing some basic steps to stop bleeding are important to understand and share with your family members. Plus, a review of different tourniquets that might be useful for your medical kit.

 

All this and more on the Survival Medicine Hour! To listen in, click below:

 

http://www.blogtalkradio.com/survivalmedicine/2017/03/10/survival-medicine-hour-dental-exam-bleeding-and-tourniquets

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

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Dr. Bones and Nurse Amy

If you’re concerned about a disaster taking you off the grid long term, have you thought of putting some dental supplies in that medical kit? Check out Nurse Amy’s dental kit at store.doomandbloom.net! Compare it with any other and you’ll know it’s the essential kit for long-term survival settings.

Survival Medicine Hour: Dental Supplies, Tornadoes

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tornado1

Tornado in the Midwest

 

The Survival Medicine Hour is hosted by Joe Alton, MD aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, of https://www.doomandbloom.net/, where you can find over 900 posts, videos and podcasts on disaster and survival strategies.

 

In this episode, we’re on the road speaking in places like Memphis and New Orleans! Tornadoes have hit the area as well as the Midwest, so we discuss keeping your family safe in a twister. Plus, a rundown of what you’d need in the line of dental supplies for long term disaster preparedness.

 

dental_extraction_forcep

dental extractor

To listen in, click below:

 

http://www.blogtalkradio.com/survivalmedicine/2017/03/03/survival-medicine-hour-tornados-dental-supplies

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

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The Altons

Check out our latest 700 page edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, now available on Amazon!

Dysentery in Survival Settings

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bacteria

dysentery may be caused by bacteria or parasites

 

In survival scenarios, many believe that trauma from gunfights at the OK corral will cause the most deaths. The truth, however, is that many avoidable losses will occur due to more basic issues, such as dehydration from infectious diarrheal diseases. These most often occur from failure to assure the sterilization of water, proper preparation of food, and safe disposal of human waste. One of the many duties of the medic in austere settings is to supervise these activities.

 

I’ve written about some of these diseases before, such as Cholera, but I haven’t discussed dysentery in much detail. The World Health Organization (WHO) defines dysentery as diarrhea in which blood is present in loose, watery bowel movements. Unlike Cholera, dysentery is a diarrheal disease that can be caused by several different organisms. It can be spread from human to human or, less commonly, from animals to humans.

 

Most cases of diarrhea are mild and easily treated with fluids and avoidance of certain food products, like dairy. Dysentery, however, is a more serious form where inflammation of the large intestine causes watery stools mixed with blood, pus, and mucus.

 

There are two types of dysentery:

 

Bacillary: Most often caused by several variants of the bacteria family Shigella, but E. Coli, Salmonella, and Campylobacter may also be involved.

 

Amoebic: A parasite, Entamoeba Histolytica, is more commonly seen in tropical and subtropical climates.

 

Dysentery was the cause of death of many soldiers in the Civil War. In total, infectious diseases like Cholera, Typhoid, and others killed more men than bullets or shrapnel.

 

SIGNS AND SYMPTOMS OF DYSENTERY

cholera 1

Nausea and vomiting can be seen in dysentery and other diarrheal diseases

 

About 2-10 days after infection, the patient will begin to show symptoms. Some will experience mild effects but others will progress to more severe disease. Beside frequent watery stools mixed with blood and mucus (sometimes 20-30 times a day!), you may see:

 

·        high fevers

·        abdominal pain and bloating

·        Excessive gas

·        Loss of appetite

·        Weakness and fatigue

·        Urgent need to evacuate

·        Vomiting

 

All of the above leads to significant dehydration, which is complicated in severe bacillary dysentery by erosion of the lining of the gut, leading to ulcers that cause bleeding from the rectum. Combined with the effect of bacterial toxins, death may occur quickly without antibiotic therapy and IV fluids. Amoebic dysentery may follow a similar course or be more prolonged in nature, leading to a weakened system and the formation of pockets of pus in the liver.  

 

TREATING DYSENTERY

oralrehydrationpack

oral rehydration salts

 

As you can imagine, any form of this disease will greatly decrease the chance for survival off the grid. As the well-prepared medic can intervene early with certain medicines, a high index of suspicion will decrease avoidable deaths.

 

For bacillary dysentery like that caused by Shigella, antibiotics like ciprofloxacin (Fish-Flox) or azithromycin (Aquatic Azithromycin) are used as treatment.  Amoebic dysentery can be treated with an anti-parasitic drug such as metronidazole (Fish-Zole). Dosing can be found in our book “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way” or in various articles at doomandbloom.net. Loperamide (Imodium) and Pepto-Bismol (Bismuth Subsalicylate) are additional items that will be useful tools in the medical woodshed.

 

Of course, it’s especially important to rehydrate victims aggressively. Oral rehydration salts contain electrolytes that will more effectively aid recovery. These can be purchased commercially or improvised using the following formula:

 

To one liter of water (2 liters for children), add:

·        6-8 teaspoons of sugar

·        ½-3/4 teaspoons of salt

·        ¼-1/2 teaspoons of salt substitute (used by people who can’t use regular salt. This item has potassium, an important electrolyte, and can be found wherever regular salt is found.)

·        A pinch of baking soda for bicarbonate

 

PREVENTION

 

vegetables wash

prevent infectious disease with thorough washing

Prevention of dysentery requires understanding of how it’s spread. Transmission often occurs by infected individuals who handle food without washing first or use unsterilized water. Some people may carry the organisms and show no symptoms, at least for a time. As contamination with human feces is a big factor, the medic has to closely supervise the building and use of latrines and other facilities.

 

Dysentery is just one of the issues that can cause headaches and heartaches for the survival medic. With some knowledge and supplies, you’ll have a better chance to keep your family safe in times of trouble.

 

Joe Alton, MD

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Joe Alton, MD

Fill those holes in your medical storage by checking out Nurse Amy’s entire line of often-imitated, never-equaled kits and supplies at store.doomandbloom.net!

How to Control Rodents as Disease Vectors

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rats-in-a-trap

Brown rats may reach 16 inches in length, including tail

 

in survival settings, it’s been said that rats will do a better job of surviving than humans. Rats, mice, and other rodents are well-known causes of “zoonotic” infections.  A zoonotic disease is one that can be transmitted from animals to humans.  The animal in question may not have symptoms of the disease itself, but may serve as a “vector”; that is, it carries the disease to a human target.

Rats and mice belong to the order Rodentia, from the latin word rodere (“to gnaw”).  This order contains various families, including beavers, porcupines, squirrels, and gophers.  As you are unlikely to have an infestation of beavers in your home, we’ll concentrate on rats and mice. Ai pair of rats could produce 1,500 offspring in one year if they all reproduced. Most rats and mice that cause issues for humans come from the “Old World”.  These include:

Brown rats (rattus norvegicus): Also called Norway rats, although they didn’t originate there (Norway has no more rat issues than other countries). Brown rats may reach 16 inches (including the tail) and are good swimmers; the term “sewer rat” was coined for them.

Black rats (rattus rattus): Thought to have introduced the Plague to Europe through their fleas. The black rat, also called the “roof rat”, is slightly smaller than its brown cousin and is an excellent climber.

House mice (Mus musculus): Used to living in close quarters with humans, mice are “nibblers” and can contaminate an entire pantry by taking a few bites out of multiple food items. Mice and other rodents can also chew through electrical wiring, thereby constituting a fire hazard.

Rats and mice are some of the world’s most invasive species. Every year, a percentage of the world’s food supply is contaminated by their droppings, urine, and hair. These items, known as “fomites”, may contain disease-carrying organisms and, as such, render food unfit for human consumption.

hooded rats

Long-Evans hooded rats I worked with in labs help further medical research

Before I go further, let me tell our readers who have rats and mice as pets that they (the pets, not necessarily the owners) are generally clean, intelligent creatures.  I have had the privilege of working with them in university laboratories as a student.  Despite this, it is indisputable that the diseases they may carry are cause for concern.

MEDICAL ISSUES CAUSED BY RODENTS

From a medical perspective, what diseases might one contract from a rodent or its droppings?  These include:

Plague:  The Plague is caused by a bacterium known as Yersinia Pestis. It is carried by fleas. The black rat’s arrival in Europe in the Middle Ages (and with it, its fleas) caused pandemics of the disease that wiped out a third of the population. Even today, Plague exists in developing countries and, there have been hundreds of cases in the U.S. over the past three decades.

Hantavirus: Hantavirus, transmitted by mice in urine, droppings or saliva, causes a serious lung disease that may become fatal without the availability of intensive care.

Leptospirosis: Caused by consuming food contaminated by rat urine, Leptospirosis causes a flu-like syndrome that progresses to kidney and liver failure if untreated.  This disease can also be carried by certain livestock.

Lymphocytic Chorio-Meningitis Virus (LCMV): LCMV may be contracted from mice urine or droppings or from pets in contact with mice, such as hamsters.   It causes a flu-like syndrome that occasionally causes complications in the nervous system, especially in people with weakened immune systems or pregnant women.  LCMV may cause miscarriage or birth defects.

Salmonellosis: Infection with the bacteria Salmonella may occur as a result of handling of pet rats or mice, especially if they have had diarrhea.  It causes severe diarrheal disease in humans, and is one good reason for owners of rats and mice to wash their hands after handling.

Rat Bite Fever: Infection with the bacterium Strebtobacillus occurs from rat bites and scratches or from ingesting food or water contaminated with rat droppings. Abrupt onset of fevers, rashes, vomiting, and headaches are noted at first, with general deterioration afterwards. If untreated, there is a 10% death rate.

RODENT-PROOFING A RETREAT

homestead-cabin-pixabay

rodent-proofing

It’s simply common sense to take measures to prevent rodent infestation in the home and to eliminate those already there. Once an infestation has occurred, much more effort is required to dislodge these unwanted guests. Rodent-proofing a home requires careful evaluation for points of entry from the level of the foundation to the roofline.  This includes sewer lines, bathroom vents, pipes and gutters, doors and windows, and vegetation near concrete slabs.

Some rodent-proofing techniques for homes include:

  • Sealing cracks in building foundations, walls, siding, and roof joints with, for example, mesh hardware cloth or concrete patching. Rodents only need ¼ inch of opening to gnaw their way into your home. Metal mesh scouring pads or galvanized window screening (not steel wool, which quickly deteriorates) may be stuffed into crevices as a temporary solution.
  • Installing vent guards in bathroom or washer/dryer vents.
  • Placing barriers to prevent climbing rodents from going up pipes or gutters.
  • Trimming trees so that branches don’t come close to the roof.
  • Contacting the utility company for strategies to prevent rats from traveling along power lines to your house.
  • Preventing rodents, especially rats, from tunneling under the foundation by placing flat concrete pavers or gravel for the first 3 feet from the base of the house.

Rodent control also involves careful attention to both indoor and outdoor sanitation.  Here are some suggestions for the wise homeowner:

  • Never leave food or water out overnight. Keep your countertops clean and disinfected.
  • Breadboxes may seem old-fashioned, but they are there for a reason: To keep the bread away from rats and mice.
  • Never leave pet food outside, clean all bowls daily, whether they are used inside or out. Rodents love to eat dog and cat food.
  • Clean under kitchen appliances. Even a few crumbs will make a meal for a mouse or rat.
  • Keep garbage disposals and sinks clean with a cup of bleach once a month.
  • Never flush grease down the sink drain.
  • Keep toilet lids down until needed.
  • Store dry foods, even pet foods, in sealed containers at least 18 inches off the floor.
  • Construct barriers around birdhouses and bird-feeders to prevent seed from being accessible to rodents.
  • Remove any fruits or vegetables from your garden that you won’t use.
  • Keep garbage can lids tightly closed.
  • Keep the side and back yards free of debris that might serve as shelters.
  • Deny access to water by fixing leaky faucets.
  • Avoid putting animal products in your compost bin.

IDENTIFYING INFESTATIONS

Rodent droppings

rodent droppings (source: city of Berkeley, CA)

If you’re not sure that your home is currently rodent-free, you might consider:

  • Looking for any partially eaten food, gnawed containers, or nesting material.
  • Inspecting your home’s interior at night with a flashlight; look especially closely at the bases of walls, as rats and mice prefer to travel along them. Little used areas of the home should be especially targeted.
  • Looking for rodent droppings. Mice and rat defecate 50 times a day; if they are in your home, you should be able to find their feces along floorboards, in attic crawl spaces, and in basements.
  • Setting out a thin layer of flour or talcum powder by areas through which rats and mice might enter your home. Place some, as well, along floorboards; rodents prefer to travel along walls. The rodents will leave tracks which will prove their presence.
  • Having cats and dogs as “mousers”. They may or may not be efficient, but they usually will alert you when a rodent is near.
  • Listening for squeaking and scrabbling noises inside walls at night.
  • Check for unusual smells. If there are a lot of rats in your home, you may notice an odor from their urine.

ELIMINATING THE PROBLEM

rats as food

A method of rodent control not discussed in this article

Once you have made the determination that you have rats or mice in your home, it’s time to reduce the population.  It should be noted that long-term control will be difficult if you haven’t followed my earlier suggestions for indoor and outdoor sanitation.

There are myriad mouse and rat-traps on the market and a number of poisons available to kill rodent invaders. It makes more sense to use traps, in my opinion, as poisons may leave you with a bunch of dead, rotting animals inside your walls. The stench may last a month or more, and sometimes deodorizer is needed to be inserted through a hole drilled in the wall.

If you have a lot of rats in your yard, you shouldn’t use poisons, as they may be ingested by neighborhood pets or even children. You should, however, consider trapping boxes. These can be snap traps, electronic “zappers”, glue traps or even catch and release versions. Both rats and mice will readily go for a small amount of fresh peanut butter as bait. Advice to the soft-hearted: Brown rats, black rats, and house mice are not native wildlife; besides other damage, some will cause casualties among endangered songbird eggs and young if released.

Glue traps are popular but controversial.  They are better weapons against mice than rats. Unfortunately, they usually leave you with a live animal to kill.  If you must use them, euthanize the rodent by throwing the trap and animal into a bucket of water or by striking it with a stick several times just behind the head. Another disadvantage of the glue trap is that it loses effectiveness in dusty areas or in extreme temperatures.

Snap traps should always be placed in perpendicular fashion, with the bait side against the wall.  Never use just one trap: Place a number of them several feet apart in the rodent’s usual path. Traps can be fastened to pipes with wire or thick rubber bands.

When cleaning out a building that has been infested with rats or mice, specific safety precautions should be followed to avoid infection. First and foremost, remember that you should never handle a wild rodent, alive or dead, without disposable gloves. Masks should be worn when cleaning. Other steps to follow:

  • Open windows and doors before cleaning to allow it to air out, then leave for an hour.
  • Avoid raising dust if at all possible.
  • Steam-clean all carpeting and upholstery.
  • Clean all surfaces with a diluted bleach solution or other household disinfectant, soaking areas that held dead animals, nests, or droppings.
  • Wash all bedding linens, pillows, etc. and use the high heat setting on your dryer.
  • Eliminate any insulation material contaminated by rodent urine, feces, or nesting material
  • As ultraviolet light can kill viruses, place contaminated items that cannot be thrown away (such as important documents), outside in the sun for several hours. If this isn’t possible, “quarantine” the items for a week in a rodent-free area.  This should give enough time for viruses to be inactived.
  • Dispose of any contaminated items or dead rodents in a plastic bag, and then place them in an exterior garbage can.
  • Thoroughly wash hands after cleaning. Consider showering with soap and hot water.

We share our world with many other creatures. Some of these creatures invade our homes and can damage our possessions and, more importantly, our health. With careful attention to sanitation and the occasional surgical strike, we can eliminate unwanted guests and make our homes safe environments for our families.

Joe Alton, MD

JoeAltonLibrary3

Dr. Alton

Learn more about animal-borne diseases and 150 other medical topics in the Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, now available at Amazon.com.

 

 

 

 

 

Anaphylaxis: Causes, Diagnosis, and Treatment

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dandelion allergy

Allergies

In a disaster or any other situation that takes us off the grid, we will expose ourselves to insect stings and poison ivy, as well as strange food items that we aren’t accustomed to. Allergic reactions may ensue in susceptible individuals. When we develop an allergic reaction, it might be mild or it might be severe. If severe enough, we refer to it as anaphylaxis or anaphylactic shock. Anaphylaxis is the word used for serious and rapid allergic reactions involving one or more parts of the body which can become life-threatening.

Anaphylactic reactions were first identified when researchers tried to protect dogs against a certain poison by desensitizing them with small doses. Instead of being protected, many of the dogs died suddenly the second time they got the poison. The word used for preventative protection is “PROphylaxis”. Think of a condom, also known as a prophylactic. A condom protects you from sexually transmitted diseases. The word “ANAphylaxis”, therefore, means the opposite of protection. The dog experiment allowed scientists to understand that the same can happen in humans, and had application to asthma and other immune responses.

Severe allergic reactions may cause body-wide reactions called anaphylaxis that can be life-threatening. Anaphylaxis has become a timely issue because of the increased numbers of cases being reported throughout the world. When drugs are the cause, the explanation is likely that we are simply using a lot of them these days. Why foods should be causing anaphylaxis more often, however, is more perplexing. Is genetic manipulation of food crops to blame? Could contaminants be an issue, or perhaps pollution in general? In any case, the cause of many anaphylactic events is never identified; most are lumped into the “idiopathic” category (another word for “unknown”).

The likely causes of anaphylaxis are:

• Drugs: dyes injected during x-rays, antibiotics like Penicillin, anesthetics, aspirin, ibuprofen, and even some heart and blood pressure medicines
• Foods: Nuts, fruit, seafood
• Insects stings: Bees and Yellow Jacket Wasps, especially
• Latex: rubber gloves mad of latex, especially in healthcare workers
• Exercise: often after eating
• Idiopathic: This word means “of unknown cause”; a substantial percentage of cases

Fumes from chemicals like Chlorine gas and other toxins can be dangerous in their own right without causing an immune or anaphylactic reaction.

anaphylaxis symptoms

signs and symptoms of anapylaxis (wiki commons)

Although few die from simple allergic reactions, anaphylaxis is much more severe and, without intervention, the victim can die from respiratory or cardiac arrest. Body-wide swelling and rashes far from the site of a bee sting, for example, would be an example of an anaphylactic reaction. Other symptoms are exaggerated versions of typical allergies symptoms, with perhaps the addition of lowered blood pressure and fainting. In some cases, abdominal tract symptoms like cramping or diarrhea could be seen.

anaphylaxis

signs/symptoms of anaphylaxis

 

Treating Anaphylaxis

The treatment for anaphylactic shock is straightforward: epinephrine via injection. Other methods of delivery, such as oral doses of antihistamines, are generally too slow in their effect to be of much use.

Known as adrenaline in Europe. Epinephrine is given via auto-injector, with the most popular being the Mylan Corporation’s “Epi-Pen”. The process is simple with a dose delivered to the upper outer thigh. Once given, epinephrine narrows blood vessels and opens airways in the lungs. These effects can reverse hives, swelling, severe wheezing, low blood pressure, severe skin itching, and hives.

epi-pen

The “Epi-Pen”

A recent 600% price hike from the company that makes the Epi-Pen may put the drug out of the financial reach of many. If the auto-injector isn’t an option, vials or ampules of epinephrine are available (by prescription).

1:1000 epinephrine solution contains 1mg of drug per milliliter or cc of solution. For a person weighing 30 kg, 66 pounds, or greater, give 0.3 to 0.5 mg (0.3 to 0.5 mL) into the anterolateral thigh about the level of the bottom of your Jeans pocket. Repeat the dose every 5 to 10 minutes, alternating left and right thighs until improvement is noted (one dose if often sufficient). Remember that epinephrine will cause a fast heartbeat, nervousness and, perhaps, a number of other side effects. Of course, get the victim to modern medical care as soon as possible.

THE HYGIENE HYPOTHESIS

dog-and-kid-pixabay

It’s okay to get a little dirty!

The increased number of allergies seen in the modern world may actually be the product of “good parenting”. Our efforts to keep our children with their noses wiped and their hands clean are helpful to stop colds and flus but may be a factor in making them more prone to allergies and infections later on.

In 1989, researcher Dr. David Strachan suggested the hypothesis that the failure of children to be exposed to infectious bugs and parasites may be responsible for the epidemic of allergic conditions like asthma. This was called the “Hygiene Hypothesis”. The lack of exposure to microbes have since been tied to other diseases ranging from hay fever to multiple sclerosis.

When most of us lived on farms or in less-than-pristine cities, we were exposed to plenty of germs from a young age due to time spent outside with animals or with lots of other people. Now the majority of kids aren’t motivated to go outside or, certainly, get dirty. In the final analysis, never getting dirty as a child may be hazardous to your future health.

Here are some things you might consider:

Avoid antibiotics: The medical profession may have been remiss in over-prescribing antibiotics, but there are antibiotics in food as well. Indeed, 70-80% of antibiotics are given to livestock, not to treat infection, but to make they grow faster and get them to market sooner. Stick with antibiotic-free eggs, milk, and meats.

Avoid anti-bacterial soaps: Triclosan, the active antibiotic ingredient in many brands, has recently been banned by the FDA due to the risk of antibiotic resistance and the lack of evidence of any medical benefit. Use regular soap and water for washing.

Tailor Handwashing Strategies to the Situation:  If you’re in a city where open sewers run through the streets and people are tossing buckets of excrement out the window, have your kids wash their hands conscientiously. In clean environments where there isn’t a raging epidemic, however, don’t freak out over dirty hands.

Don’t Bathe Every Day: Not only should your kids be exposed to dirt to develop their immune system, but bathing too often might do more harm than good. Daily showers removes protective skin oils and causes drying and irritation. You’re also washing away the good bacteria that lives on your skin.

Get Your Kid a Pet: Not every kid has the good fortune of living on a farm, but they’ll benefit from a furry pet. Dogs seem to give more resistance to colds and allergic skin conditions like eczema than cats, but early cat exposure might give more protection against asthma. Why not have both?

Get your kids outside when they’re young: In these days where we have legitimate concerns about children’s safety, you might be reluctant to let your kids go outside by themselves. Here’s an idea: Go out with them, to parks, wilderness areas, and other places where both adults and kids can reap real benefits. How about helping them plant and manage a garden?

The more you encourage outdoor activities early, the more they become part of the next generation’s culture; let the kids get a little dirty, and you might give them a healthier future.

 

Joe Alton MD

AuthorJoe

 

Learn more about your immune system, allergic reactions, and over 100 other topics in our Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Who Was Our First President? No, Really.

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john hanson

President John Hanson

 

It’s Presidents’ Day in the U.S., and we celebrate the 44 men who have held the office, beginning with George Washington.  However, was George Washington really the first President?  Seems like the simplest question that even a child could answer, but it’s not exactly as clear-cut as you’d think.

(As an aside, Donald Trump is the 45th president, but the 44rd man to hold the office, as Grover Cleveland’s two terms were not consecutive, making him both the 21st and 23rd President.)

The United States declared its independence in 1776, but George Washington didn’t take office until 1789!  So who was in charge of running  the country until then?  Naysayers say no one, but there were a number of patriots who had the title of president.  The big question is, president of what?

There were a number of Presidents of the Continental Congress, beginning with the man who signed his name in large script, John Hancock.  But were the thirteen colonies now one country on July 4, 1776?  Not officially.  It wasn’t until the Articles of Confederation were signed in 1781 that we could say that the thirteen colonies were a new unified nation, the United States of America.

The first man elected president under the Articles of Confederation (who didn’t resign immediately, at least) was one John Hanson of Frederick County, Maryland.  Who?

Like many of our Founding Fathers, John Hanson (and the eight men who served as President after him) have been relegated to the dustbin of history.  Many prominent patriots don’t have statues  dedicated to them in Washington, D.C.   In fact, a lot of them died penniless and uncelebrated.  For more info, see my article:

Fate of the Forgotten Founding Fathers

Once the signing of the Articles of Confederation took place in 1781, a President was needed to run the country. John Hanson was chosen unanimously by Congress (which included George Washington). As the first President, Hanson had quite the shoes to fill. No one had ever been President of the United States; the responsibilities were vague and ill-defined, but there were issues to be settled.

As the war for independence wound down, continental troops were demanding back salaries. Many of them were not in favor of the new government and even considered installing George Washington as King.  John Hanson was responsible for quelling this discontent and held the rickety congress together.

Hanson is also responsible for ejecting foreign troops out of the new country.  This wasn’t easy, as many of our allies felt they had a claim to special privileges due to their aid for the American cause.  Among other things, he also established the Treasury, War, and Foreign Affairs departments.  All of this in a term of office that lasted only one year.

After him, the following men were elected as President of congress:

  • Elias Boudinot   1782-3
  • Thomas Mifflin 1783-4
  • Richard Henry Lee 1784-5
  • John Hancock 1785-6 (elected but could not serve due to illness)
  • Dr. David Ramsay (Nov 23, 1785 – May 12, 1786)
  • Nathaniel Gorham (May 15, 1786-Nov. 5, 1786)
  • Arthur St. Clair 1787-8
  • Cyrus Griffin 1788-9

So why don’t we recognize these patriots as our first Presidents?  Because we didn’t yet have a constitution that gave the federal government any significant power.  As such, they served as President of Congress more than as leader of a united country.

Therefore, George Washington was the first president to serve under a firm constitution that established the United States that we know today. The first 9 presidents?  They have faded into history, but let’s not forget their service to a fragile new entity that became a great nation.

Joe Alton, M.D.

AuthorJoe

Joe Alton, M.D.

You won’t learn about American presidents in the third edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, but you’ll learn a lot about how to deal with medical issues in disasters and epidemics!

Survival Medicine Hour: Anaphylaxis, Ear Infections, Hemorrhage

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earanatomy-ftr300

Ear Anatomy

The Survival Medicine Hour, hosted by Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy of https://www.doomandbloom.net/ brings you a few topics, including ear infections, bleeding control and the final part 3 of the allergy series: anaphylaxis. Monday, February 20, 2017 is President’s Day, but do you know about the pre-George Washington “Presidents”? Do you also know who held the presidential office twice, but not with consecutive terms?

anaphylaxis

signs/symptoms of anaphylaxis

Severe allergic reactions may cause body-wide reactions called anaphylaxis that can be life-threatening. Although few die from simple allergic reactions, anaphylaxis is much more severe and, without quick intervention, the victim can die from respiratory or cardiac arrest. Having an epi-pen handy is advisable, although you can learn how to dose with epinephrine solution from a sterile vial.

 

Ear infections are fairly common in babies and children, and an ounce of prevention is worth a pound of cure. Keep your ear canal as dry as possible during and after swimming. Feed babies in a head-up position, to prevent formula or milk from entering the passages into the ear. Beware of early warning signs before the ear infection becomes severe, such as: pain and itching, drainage from the ear canal and redness and swelling in the ear canal. babies may tug at their ear.

 

Plus, an introduction to hemorrhage and its effects on the human body.

 

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/02/17/survival-medicine-hour-ear-infections-bleeding-anaphylaxis

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

joe and amy radio

The Altons

Allergies: What You Need To Know, Pt. 1

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immunity

allergies: What You Need To Know

Allergies are reactions caused by a hypersensitivity of the immune system to a substance ingested or in the environment (an “allergen”). These substances may cause little or no effect in most people, but a percentage of the population may experience significant symptoms that can affect quality of life, or even threaten life itself.

A SHORT HISTORY OF ALLERGIES

If you told a doctor a little more than a hundred years ago that you had an allergy, he/she wouldn’t recognize the word. “Allergy” was coined in 1906 by an Austrian pediatrician and immunologist named Clemens Von Pirquet. The word is derived from the Greek allos meaning “other” and ergon meaning “reaction”.

 

Von Pirquet and his associates noted that certain people who received a variety of smallpox vaccine had more severe reactions than most. Another scientist, Charles Mantoux, used this knowledge to develop a test for tuberculosis where an allergic skin reaction to a substance isolated from the microbe revealed previous exposure. A form of this test is still used today.

The worst allergic reaction, known as anaphylactic shock, was discovered by a french physiologist Charles Richet, who with his partner Dr. Paul Portier, injected the venom of a sea anemone into a number of dogs. Hoping to find some substance that would protect humans (called prophylaxis) from jellyfish stings, they instead found that a second injection killed many of the dogs. Since this was the opposite of protection, they termed it anaphylaxis.

HOW ALLERGENS CAUSE REACTIONS

Common allergens to which people are exposed include pollens, metals, insect stings, medications, and certain foods. There are also internal factors such as age, sex, race, and family history. How do these all combine to cause the physical symptoms of an allergy?

Put simply, an immune reaction against an allergen occurs when it’s encountered for the first time; let’s say it’s a bee sting. Cells in the body called “T-cells” identify the bee venom and interact with other cells called “B cells”. The B cells, in turn, produce certain antibodies called “IgE”. IgE attaches to the surface of cells called “basophils” and “mast cells”. These cells are now “sensitized” to the venom. No physical effects are usually noticed at the time by the victim beyond the sting itself.

When a second exposure to the allergen occurs, however, it’s a different story. The sensitized mast cells and basophils are activated and produce a large amount of histamine and other inflammatory chemicals. The flood of these into the system can cause possibly severe physical reactions.

SYMPTOMS OF ALLERGIES

bee

Toxin Allergies

Allergies may appear in various forms, from mild to life-threatening. These conditions include hay fever, food allergies, local skin reactions (called “atopic dermatitis”), drug/toxin reactions, and allergic asthma. Common symptoms include red eyes, itching, nasal congestion, difficulty breathing, and swelling. In the worst situations, a body-wide reaction called “anaphylaxis” causes rashes, major swelling, and difficulty breathing to the point of suffocation.

Hay Fever:  Hay fever is a (usually) seasonal reaction to high pollen counts in the air from certain plants. People with hay fever won’t likely have a fever, but they will have sneezing from a runny, clogged nose, red, itchy, watery eyes and “postnasal drip”, a condition where a cough is caused when mucus runs down the throat from the back of the nose.

Different grasses, trees, and flowering plants will release pollens at different times of the year, and it is often difficult to identify what allergen is causing the symptoms.  Skin “patch”, scratch, or blood tests may determine if a particular substance is causing the sensitivity.

Atopic Dermatitis: Most people who have atopic dermatitis have had allergies before or a family member with similar problems such as hay fever or asthma. Common allergens include animal dander, dust mites, exposure to certain foods, stress, and dry, cold weather.

The condition usually starts with itchy, dry skin.. Scratching causes inflammation, swelling, and redness, and may initiate an infection in the area. Small, oozy blisters sometimes occur that crust over with time. Although mild versions cover small areas and are improved with lotions, severe versions require more intense therapy.

Rashes may recur over the same area time and again, leading to toughened, thick skin that appears darker than other areas. These areas are usually on the scalp and cheeks of infants but may be seen on the baby’s knees or elbows. Other areas may be affected with age, such as the ankles, wrists, legs, the buttocks, and the nape of the neck.

Food Allergies: Four or five percent of the population is allergic to some kind of food. In children, eggs, milk and peanuts are often responsible; in adults, shellfish, nuts from trees (for example, walnuts), milk and eggs are common triggers to a reaction. It should be noted that an allergy to milk is different that intolerance caused by a deficiency of the enzyme needed to digest it (otherwise known as “lactose intolerance”.

Drug Allergies: A drug allergy is caused after repeated exposure to a medicine. Some of the most common include Penicillins, Sulfa Drugs, non-synthetic Insulins, seizure meds, and those containing iodine.

Drug allergies are often confused with what are called “adverse reactions”. An adverse reaction is a known ill effect that can occur with the use of a medication. For example, if a drug is known to cause nausea in some patients, that is considered an adverse reaction as opposed to an allergy.

Despite this, many will report an allergy to a particular drug to their healthcare provider. Some of the reasons that people will write “allergic” on their medical interview sheet include:

  • The drug causes symptoms that makes them feel unwell.
  • A family member has a history of an allergy to the drug, and they assume that the same goes for them.
  • An incident in their childhood resembled an allergic reaction, so better safe than sorry.
  • Negative comments online or elsewhere cause reluctance to take the medicine.
  • Philosophically opposed to a particular type of drug (antibiotics, psychotropics).
  • An actual allergy.

Note that a true allergy is placed last on this list; the World Allergy Association reports that less than 10% of reactions to medications are actually allergies caused by an immune response. Most symptoms that people get after taking medicine are, instead, adverse or “side” effects. It may not always be easy to tell the difference, but a true drug allergy will show immune-mediated symptoms such as hives, itchy skin or eyes, rashes, lip and tongue swelling, and wheezing. Blood pressure may drop precipitously in some cases.

Toxin Allergies: It’s common to have local redness, discomfort, itching and swelling when a toxin, such as bee venom, is introduced into the body. Your immune system, however, may respond strongly in the form of an allergy. Common insects involved are bees, wasps, hornets, and fire ants.

When the immune system gets involved, the reactions may be more severe, with hives, redness and swelling affecting large areas of skin. Swelling may extend to the tongue, throat, lips, and elsewhere. Stomach upset, nausea and vomiting, and diarrhea are common. The effects may take days to completely resolve.

DRUG TREATMENT OF ALLERGY SYMPTOMS

Allergies, when mild, are treated with medications that help relieve the specific symptoms.

Antihistamines in oral, intranasal and ophthalmic (eye drop) form are useful to deal with the sneezing, runny nose, and itchy eyes associated with hay fever. Nasal decongestants like oral pseudoephedrine (Sudafed) and the nasal spray oxymetazoline (Afrin, Dristan) are useful drugs to have in the medicine cabinet. It should be noted, however, that the nasal sprays are addictive when used for more than three days. That is, if you stop using them, your nose will become stuffy again.

Others like diphenhydramine (Benadryl) may help, but are prone to causing drowsiness in higher doses. Longer term therapy with intranasal steroids like Atrovent (ipratropium) or NasalCrom (cromolyn sodium) is another option. These drugs are best for long term therapy, however, as the effects are not felt immediately.

In the worst cases, epinephrine (also known as adrenaline) is necessary as an injectable to improve symptoms that affect the entire body. A future article will discuss this type of event in detail.

NATURAL TREATMENT OF ALLERGY SYMPTOMS

neti-pot

Neti Pot

Many experience relief from allergies when they use an item known as a “Neti pot” to relieve congestion and pressure. The Neti pot essentially looks like a version of Alladin’s lamp, and allows the delivery of sterile solutions into the nasal cavity.

Neti pots work by thinning out mucus. The hairs in the nose, called “cilia” are aided in their attempts to eliminate mucus and allergens by the flushing action of the sterile saline solution delivered by the Neti Pot.

Some may have doubts about the effectiveness of the Neti Pot, but research backs up the benefits of nasal “irrigation” to relieve some allergy symptoms. Nasal irrigation via a Neti Pot may help decrease the need for drugs.

One concern related to Neti pots, however, is the importance of ensuring that you are using sterile solution when you irrigate. Non-sterile solutions, even tap water, may transmit infections directly into the body; two deaths in Louisiana were attributed to Neti pot use of contaminated water. Neti pots also must be washed after every use, as you would wash your dishes after every meal.

A natural remedy getting some serious attention lately is Butterbur. In a recent British Medical Joural study, butterbur extract (ZE 339) four times daily equaled the effects of a popular antihistamine–without causing drowsiness!

Goldenseal, Nettles, Resveratrol, Quercetin, and Vitamin C as well as saline spray may be helpful. Ragweed sufferers, however, should realize that some plants commonly used in herbal remedies, like Chamomile and Echinacea, might cross-react in hay fever sufferers to make symptoms worse.

You might be surprised to know that acupuncture has some evidence for effectiveness against certain allergies. acupuncture. Based on the idea that stimulating certain points on the body can cause effects inside, a study of 26 hay fever patients found in the American Journal of Chinese Medicine and described in WebMD appeared to improve symptoms in all without adverse effects. Another experiment eliminated allergic symptoms in half the patients studied.

Allergies can be nuisances or they can be life-threatening. In situations where we might spend a larger part of our day outdoors, as in survival, it’s important to know the signs, symptoms, and treatments when our immune systems go into overload.

Joe Alton MD

JoeAltonLibrary3

Joe Alton, MD

Hey, Find out more about allergies and over 150 other medical topics in times of trouble with our 700 page third edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And for your medical storage, there’s no better place to get a good medical kit than at Nurse Amy’s store!

 

Survival Medicine Hour: Allergies, pt.2, Water Issues

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water

Safe Water

The Survival Medicine Hour this week, with your hosts, Joe Alton MD, aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, discusses water pollutants and part 2 of the series on Allergies. Your hosts request feedback on the show and other topics you may like to hear in future episode. They would also like to have any suggestions you might have about outdoor sport or activity first aid supplies and what you might experience as first aid incidents during those activities. Write to drbonespodcast@aol.com anytime!

 

Water contaminants are many and are reviewed in this episode. A guest post at https://www.doomandbloom.net/guest-post-10-things-you-didnt-know-were-in-your-drinking-water/ , by Jennifer Moran from https://theberkey.com/ is discussed and expanded upon in detail. Pollutants like lead, fluoride, BPA (Bisphenol A), iron and arsenic are just a few covered during this show.

 

In this part 2 series on allergies, Dr. Alton reviews a few allergies from the last show and continues with drug allergies, atopic dermatitis, food allergies, and toxin allergies. Helpful medications that relieve specific symptoms can include Afrin (beware of too much, and you will learn why), antihistamines, and oral meds.  A few natural remedies to relieve symptoms, like a Neti Pot, are reviewed. One important hint when using a Neti Pot, always make sure the water or saline is a sterile solution, or you could get sick from the contaminated solution.

 

To Listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/02/10/survival-medicine-hour-water-pollutants-allergies-pt2

 

Wishing you the best of health in good times or bad,

 

Amy and Joe Alton

Amy Alton Everglades Close up 400 x 600

Amy Alton, ARNP

 

Learn about allergies, water safety, and 150 more topics in off-grid settings with the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. You’ll be glad you added it to your survival library.

 

Hey! Like board games? Well, check out our fun survival board game SURVIVAL! at survivalboardgame.com!

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Doom and Bloom’s SURVIVAL! board game unboxed

Guest Post: 10 Things You Didn’t Know Were in Your Drinking Water

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water

What’s in your water?

 

(Dr. Bones says: From time to time, we accept submissions from promising writers in the field of preparedness. Today’s post comes from TheBerkey.com’s social media manager Jennifer Moran. In this article, Jennifer discusses some substances that you might not expect to be in your drinking water. Thanks to Jennifer for her submission.)

 

The most common substance in this world is water and therefore it is essential that we could say by default it is greatly important! We learned that only 1% of the Earth’s water is suitable for drinking, 97% of it is ocean or sea and where does the 2% go? It is unusable, it’s frozen. Now, we always wanted what is best and safe for our drinking water. As a matter of fact, Americans drink more than a billion glasses of tap water per day.

 

Your day has been sluggish and you die to drink that glass of water even from the tap just to quench you. But do you really know if whether or not it’s secure for your family? Or let me be more direct, do you even bother to know what’s on it? No matter how we can say that that water is clean by just basing it from your bare naked eyes, there are things in there that might not be good for you.

 

Here are some surprising substances that you didn’t know might be in your drinking water.

 

 1. Lead

Just like any stubborn bad guy, this colorless, odorless and tasteless metal can leach from lead pipes and plumbing fixtures will definitely go undetected.  Excessive amounts of lead place adults at higher risk for cancer, stroke, kidney disease, memory problems and high blood pressure. At even greater risk are children, whose rapidly growing bodies absorb lead more quickly and efficiently. Just because your home is less than 20 years old doesn’t necessarily mean you’re lead-free. Just ask the people of Flint, Michigan.

 

2. Fluoride

Fluoride develops naturally in water; though rarely at the optimal level to protect teeth. Many assume that consuming fluoride is only an issue that involves your dental health. But according to a 500-page scientific review, fluoride is an endocrine disruptor that can affect your bones, brain, thyroid gland, pineal gland and even your blood sugar levels. More people drink fluoridated water in the US alone than in the rest of the world combined. In Western Europe, for instance, 97% of the population drinks non-fluoridated water. Adding fluoride is definitely a forced medication.

 

3. Iron and Manganese

Iron and Manganese are non-hazardous elements but can be a nuisance to your drinking water. They are similar metals and can cause similar problems: offensive taste, appearance, and staining. When the water is aerated they are oxidized, which creates significant discoloration and turbidity. Iron is frequently found in water supplies. Manganese is often found in water that contains iron.

 

4. Perchlorate

Perchlorate is a man-made chemical primarily used in the production of rocket fuel, missiles, fireworks, flares, and explosives. It has been found in drinking water and surface waters in the United States (at least 26 states) and Canada. Although it is a strong oxidant, perchlorate is very persistent in the environment. At high concentrations perchlorate can interfere with the production of thyroid hormone.

 

5. Bisphenol A

Bisphenol A (BPA) is an important chemical building block and additive in a wide variety of plastics. It is manufactured worldwide for approximately 3.2 million metric tons/year. This can be found in some plastic water bottles and the dangerous part is that it can leach into food and drinks. According to National Institute of Environmental Health Sciences, it may acquire health risks, especially to infants and children. One good thing: there are quite a number of BPA-free bottles that are available now. However, you still have to be extra careful: NPR reports that some BPA-free plastics may leach unwanted chemicals into your water when exposed to sunlight, microwaves or dishwashers.

 

6. Arsenic

Arsenic is a natural element that is tasteless and odorless; you wouldn’t be able to distinguish that it’s in your water. It is found widely in the earth’s crust and may be found in some drinking water supplies, including wells. Research shows that exposure to high levels of arsenic can cause health effects, even cancer.

 

Bacteria rods

bacterial contamination

7. Pathogens

Bacteria are a natural part of life; in fact, there are many forms and functions of bacteria we couldn’t live without. Coliform bacteria may not cause disease but can be indicators of pathogenic organisms that cause serious diseases. It can cause intestinal infections, dysentery, hepatitis, typhoid fever, cholera, and other illnesses. Luckily, these pathogens are much better controlled today than they once were. We just have to be practical on having our water tested but definitely the best strategy is to get rid of these pathogens.

 

8. Agricultural chemicals

Agriculture is heavily dependent on fertilizers and pesticides that boost crop production. The major contaminant here is nitrate, found in both fertilizer and animal waster. Nitrates and other chemicals end up in our water resources, and can cause health risks. One example is methemoglobinemia, sometimes called “Blue-Baby syndrome”, in those infants under 3 months of age that are bottle-fed.

 

9. Chlorine

Chlorine is effective as a disinfecting treatment in killing off most microorganisms in the water. As a matter of fact, it is a powerful oxidant added to the water by several municipal water systems to control these microbes.  While learning that the United States has one of the safest water supplies in the world because of this disinfecting agent, it is also appropriate to check it once in a while. It can be absorbed through physical consumption as well as through your skin while bathing and can severely dry skin and hair. It can also cause irritating effects to your eyes and nose.

 

10. Mercury

This silvery heavy metal can be found in various natural deposits. Mercury can flow into water supplies from improperly discarded devices containing it, as runoff from landfills & farm land, dumped by factories, or from natural deposits. With this being said, this extremely toxic liquid metal must be precaution in handling or disposing of it. Being exposed to high levels of mercury over time can cause kidney damage.

 

 

Water can be purified of many contaminants if treatment facilities are available, but supplies must be monitored so that contaminants can be properly identified in the first place. The safest way to ensure that these toxins do not make it into your body is to have your water tested to determine which contaminants your tap water may contain. Once you have identified the contaminants present, you can select a water filtration solution that is best for you.

 

Jennifer Moran

(When she isn’t glued to a laptop screen, Jennifer spends time playing tennis, practicing yoga, and trying very hard not to fall sleep during meditation classes. If you have questions for Jennifer, contact her at Jennifer@theberkey.com.)

 

 

13 Tips on Surviving a Protest

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closed fist protest

Anti-Free Speech?

As a Free Speech advocate, I support the people’s right to protest and make their opinions heard. Unfortunately, demonstrations in the U.S. these days are becoming more frequent and violent. From what I saw happen at UC-Berkeley, I expect them to become more extreme as times goes on.

 
I haven’t been at a protest since the Vietnam era, and that was just on the way to class. Back then, I was fit enough to hightail it out of there when the pepper gas flew. However, there is so much civil unrest in the news these days that it’s a good idea to have a riot survival strategy, whether you’re involved or just a bystander. It goes without saying that your objective should be to stay away from the where the violence is occurring.

 
Of course, if you walk smack dab into a demonstration, things can get dicey pretty fast. I’ve written a lot about situational awareness, and that mindset will serve you well. Here are some simple tips that will help you avoid injury at a protest:

 
1. Always be in a state of “Yellow Alert”. Yellow alert simply means being aware of your surroundings and the people around you. When people are behaving strangely, take note and avoid them.
2. Always mentally map out routes of escape as you walk along. Where’s the nearest side street? Is there a building or subway entrance that will get you off the street? If you don’t know the area, move away to where you know the lay of the land.

 
3. If you have to make your way through the crowd, stay on the fringes. Don’t get caught in the masses of people surging away (or towards) the violence. If you do, they are deciding your movements, not you.

 
4. Avoid confrontation with protesters. In other words, take off your “Make American Great Again” hat if it’s an anti-Trump demonstration. At Berkeley, things like this got women pepper-sprayed and men beaten.

 
5. Have a bandanna handy. This essential survival supply isn’t a gas mask, per se, but it works at riots when tear gas is sprayed. Some advocate the soaking of the cloth with lemon juice or apple cider vinegar. Avoid black bandannas, though; at Berkeley, organized masked “ninjas” in black caused most of the damage. You don’t want to be confused with one of these people.

 
6. Wear sneakers or other footwear that will allow you the most mobility. The only women wearing heals are reporters. Make sure you’re well-clothed so that your skin is protected. You’ll need to wash clothes thoroughly that have been exposed to tear gas, or throw them away.

 
7. Be aware of the movement of law enforcement officers, but don’t approach them. Their job is tough enough, and they won’t be able to hear you above the roar of the crowd.

 
8. Don’t run if you can help it. Unless everyone else is running, you will attract unwanted attention. Walk fast and purposefully around a corner, to higher ground, or other safe spot.

 
9. Be inconspicuous. This may be difficult if you’re 6 foot 7 inches tall, but otherwise, do you best to be “the gray man”.

 
10. If you’re with friends, stay together. If you can’t, agree on a meeting place beforehand in case you get separated moving through the crowd.

 
11. Avoid being caught against walls, fences, blockades, or other solid objects. People can get crushed by masses of protesters.

 
12. Carry some water, milk, or diluted liquid antacid (like Maalox) in a container if you know you’re heading into a protest area. If sprayed with tear gas, move quickly into an area of fresh air and pour the liquid on your face (especially your eyes). Drink it if sprayed in the mouth. Milk or liquid antacid are thought by some to work better than water, but there’s no hard data one way or another. The effects of the tear gas will resolve over a relatively short time in most cases.

 
13. If you’re involved in a protest, carry a basic medical kit that will help to treat injuries and stop bleeding.

 
It’s likely you’ll never get caught in civil unrest, but having a solid plan of action in these troubled times just makes common sense. We must be prepared for man-made disasters just as we should be prepared for hurricanes, tornadoes, and earthquakes.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD aka Dr. Bones

Survival Medicine Hour: Protest Survival, Capsizing, Allergies, Pt.1

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closed fist protest

Surviving a Protest

The Survival Medicine Hour with your hosts Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy discuss Protest Safety, How to survive a capsized boat or cold water immersion, and part one of a series on allergies. Our website https://www.doomandbloom.net/ is a source for these and other topics.

 

Getting caught in the middle of the crowd in the frenzy of protesting could be dangerous, especially if you are wearing anything that identifies you as their “enemy., Knowing how to extricate yourself and be the “gray man” can help you stay safe. Don’t approach lines of police officers in riot gear, they are focused on getting the crowd under control and could mistake you for a rioter. Try to stay with friends and escape as quickly as possible. Many more tips!

H.E.L.P.

Strategies for capsized boats or other water immersion

 

If you find yourself in the water due to a capsized boat or other water incident. the first step is to try and stay calm. Always wear a life jacket if possible while boating, which enables you to stay warmer since you don’t have to kick or try to swim to keep your head above the water. If any debris is nearby, try to elevate some of your body out of the water. These and more mportant steps to take are presented in the show today.

 

In an introduction to allergies, an immune reaction against an allergen occurs when it is encountered the first time, and may cause little to no reaction at all. The second exposure to this allergen is when the allergic cascade of symptoms and reactions are seen. Allergic reactions may appear in various forms. Part one of this allergie series is discussed on today’s show.

 

All this and more in the Survival Medicine Hour! To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/02/03/survival-medicine-hour-protest-safety-capsize-allergies-pt1

 

Wishing you the best of health in good times or bad,

 

Amy and Joe Alton

AmyandJoePodcast400x200

Amy and Joe Alton

Survival Medicine Hour: Expiration Dates, Face Masks, More

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N95-Surgical-Mask

N95 mask

This episode of the Survival Medicine Hour, with your hosts, Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy, discusses the significance, or sometimes, the lack of significance of expiration dates when it comes to medicines in pills and tablets. Also, face masks as a medical supply, all you need to know about this important piece of medical protection. Also, some tips on medical storage of drugs.

Antibiotics

expiration dates

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/01/27/survival-medicine-hour-expiration-dates-masks-and-med-storage

 

Wishing you the best of health in good times or bad,

Joe and Amy Alton

LabCoatsBonesAmy1

joe and amy alton

Video: Surviving a Building Fire

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wildfire21

Joe Alton, MD’s latest video discusses some tragic building fires, especially in public venues. He examines what happens in a fire, how fire behaves, and what you can do to increase your chances of surviving the conflagration.

 

To watch, click below:

 

 

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

joealtonlibrary4

 

Find out more about house fires, wildfires, burns, and much more in Joe and Amy Alton’s Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon.

Survival Medicine Hour: Hypothermia Pt. 3, Frostbite, Winter Hazards

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frostbite2

Frostbite with gangrene

The Survival Medicine Hour with Joe Alton, MD, aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy discusses altitude sickness, winter car survival, falling through the ice or into very cold water and more. Car Survival equipment should include wool blankets, instant hand warmers, flashlights and extra batteries (fresh), small tool with blade, screwdrivers, pliers etc, foldable shovel, sand or rock salt, flares and reflective large triangles, tow chain or tough rope, jumper cables, water and food, a first aid kit (Doom and Bloom makes a grab and go bag), tarp, noisemaker and more.

caraccidentwinter

Winter car survival

To increase your chances of survival in cold water you should wear a life jacket whenever you are on a boat. It enables you to stay alive longer by keeping you afloat without burning too much energy. A built-in whistle is a great item to have on the life jacket also. Keep your clothes on while you are still in the water. Button or zip up to retain some body heat. The layer of water between your clothing and your body is slightly warmer and will help insulate you from the cold.

 

To listen in, click the link below:

http://www.blogtalkradio.com/survivalmedicine/2017/01/20/survival-medicine-hour-hypothermia-pt3-frostbite-winter-hazards

 

Wishing you all the best in good times or bad,

 

Joe and Amy Alton

joe and amy radio

Fill those holes in your medical preparedness with Nurse Amy’s kit and individual supplies at store.doomandbloom.net!

 

 

Video: Cold Prevention Myths and Facts

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colds

In this video, Joe Alton, MD, aka Dr. Bones, discusses some common misconceptions about colds and how to prevent them. Companion video to a recent article.

To watch, click below…

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

 

 

drbones-nurseamy

Car Survival in Winter

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carsinsnow

It’s predicted to be another harsh winter and, for most in the U.S., this means trouble if someone gets stuck out on the road during a blizzard or other extreme conditions. Hypothermia (the effects on the body from exposure to cold) may occur on the wilderness trail, but also right in the driver’s seat of the family car. It’s important to have a plan in case you are stranded in your vehicle.

 

Your Car

 

Winter conditions don’t just affect people, they affect cars as well. Cold affects rubber and metal; it even decreases the battery’s efficiency. Tires become stiff and flat for the first few hundred yards. Your oil and other lubricants become thicker at cold temperatures. This makes the engine work harder.

 

Therefore, vehicles that will be doing duty in extreme cold should be “winterized”. This involves switching to a lighter viscosity oil, changing to snow tires, and choosing the right (anti-freeze) ratio of coolant to water. Gas tanks should never be less than half full.

 

Your Life 

 

You’re not a bear, so you can’t hibernate through the cold weather; you’ll have to live in it, so take measures to avoid becoming a victim of it. Many deaths from exposure are avoidable if simple precautions are taken.

 

The first question you should ask before you get in the car in cold weather is: What’s the forecast? Is it possible that you’re driving straight into trouble? Checking the weather beforehand is a lot better than finding out about it on the road.

 

The second question should be: “Is this trip necessary?” If the answer is “no”, you should stay home. For most people that work, however, the answer is “yes”. If you have no choice but to hit the road during a winter storm, drive as if your life depends on it (because it does). Brush ice and snow off windshields, side mirrors, or anywhere your view might be blocked. Don’t speed, tailgate, or weave in and out of traffic. Make turns slowly and deliberately; avoid quick stops and starts.

 

Notify someone of your travel plans before you head out, especially if you’re in rural areas. Take your cell phone with you but save it for emergencies. Your focus has to be on the road, not on texts from your friends.

 

Stranded!

 

If you live in an area that routinely has very cold winters, you may not be able to avoid being stranded in your car one day. Your level of preparedness will improve your chances of staying healthy and getting back home. So what should your plan of action be?

 

  1. Stay calm and don’t leave the car. It’s warmer there than outside and you have protection from the wind. Having adequate shelter is one of the keys to success, whether it’s in the wilderness or on a snow-covered highway.
  2. Ventilation is preferable to asphyxiation. Crack a window on the side away from the wind for some fresh air. People talk about water and food being necessary for survival but, first, you’ll need air to breathe. Wet snow can block up your exhaust system, which causes carbon monoxide to enter the passenger compartment. Colorless and odorless, it’s a deadly gas that kills in enclosed spaces without ventilation. Clearing the exhaust pipe of snow and running the engine only ten minutes or so an hour will help prevent monoxide poisoning.
  3. Group Hug. If you’re in a group, huddle together as best you can to create a warm pocket in the car.
  4. Keep Moving. Rub your hands, put them in your armpits, or otherwise keep moving to make your muscles produce heat.
  5. Don’t overexert yourself. If your car is stuck in the snow, you’ll want to dig yourself out. A lot of sweat, however, will cause clothing to become wet. Wet clothing loses its value as insulation and leads to hypothermia.
  6. Let others know you’re there. If you have flares, use them. Flashing emergency lights on your vehicle will drain battery power, so use them only if you think someone might see them.

The Winter Car Kit 

caraccidentwinter

If you’re going to travel in very cold conditions, there are a certain number of items that you should keep in your vehicle. This is what an effective winter survival car kit contains:

 

  • Wool Blankets. Wool can stay warm even when wet.
  • Spare sets of dry clothes, including socks, hats, and mittens.
  • Hard warmers or other instant heat packs (activated, usually, by shaking, they’ll last for hours)
  • Matches, lighters and/or firestarters in case you need to manufacture heat.
  • Candles, flashlights (keep batteries in backwards until you need them).
  • Small multi-tool with blade, screwdrivers, pliers, etc.
  • Larger combination tool like a foldable shovel (acts as a shovel but also an axe, saw, etc.)
  • Sand or rock salt in plastic container (to give traction where needed.)
  • Tow chain or rope.
  • Flares.
  • Jumper cables.
  • Water, Food (energy bars, MREs, dehydrated soups, candies).
  • Baby wipes for hygiene purposes.
  • A first aid kit.
  • Medications as needed.
  • Tarp and duct tape (brightly colored ones will be more visible and aid rescue.)
  • Metal cup, thermos, heat source (to melt snow, make soup, etc.)
  • Noisemaker (whistle)
  • Cell phone and charger

The items above will give you a head start in keeping safe and sound even if stranded. With a plan of action, a few supplies, and a little luck, you’ll survive even in the worst blizzard.

 

Joe Alton MD

AuthorJoe

Dang, It’s Cold! Treating and Preventing Hypothermia

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shutterstock_90110446

hypothermia (and bad judgment)

This winter has already seen deadly cold snaps where people have found themselves at the mercy of the elements. Whether it’s on a wilderness hike or stranded in a car on a snow-covered highway, the physical effects of exposure to cold (also called “hypothermia”) can be life-threatening.

 

Hypothermia is a condition in which body core temperature drops below the temperature necessary for normal body function and metabolism. Normally, the body core is between 97.5-99.5 degrees Fahrenheit (36.0-37.5 degrees Celsius). Cold-related illness occurs once the core temperature dips below 95 degrees (35 degrees Celsius).

 

When it is exposed to cold, the body kicks into action to produce heat. Muscles shiver to produce heat, and this will be the first symptom you’re likely to see. As hypothermia worsens, more symptoms will become apparent if the patient is not warmed.

 

Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status. The person may appear confused, uncoordinated, and lethargic. As the condition worsens, speech may become slurred; the patient will appear apathetic, uninterested in helping themselves, and may lose consciousness. These effects occur due to the effect of cooling temperatures on the brain: The colder the body core gets, the slower the brain works. Brain function is supposed to cease at about 68 degrees Fahrenheit, although there have been exceptional cases where people (usually children) survived even lower temperatures.

 

Prevention of Hypothermia

 

An ounce of prevention is worth a pound of cure. To prevent hypothermia, you must anticipate the climate that you will be traveling through; include windy and wet weather into your calculations. Condition yourself physically to be fit for the challenge. Travel with a partner if at all possible, and have more than enough food and water available for the entire trip.

 

It may be useful to remember the simple acronym C.O.L.D.  This stands for:  Cover, Overexertion, Layering, and Dry.

 

Cover. Your head has a significant surface area, so prevent heat loss by wearing a hat. Instead of using gloves to cover your hands, use mittens. Mittens are more helpful than gloves because they keep your fingers in contact with one another, conserving heat.

 

Overexertion. Avoid activities that cause you to sweat a lot. Cold weather causes you to lose body heat quickly; wet, sweaty clothing accelerates the process. Rest when necessary; use those rest periods to self-assess for cold-related changes. Pay careful attention to the status of the elderly and the very young. Diabetics are also at high risk.

 

Layering. Loose-fitting, lightweight clothing in layers trap pockets of warm air and do the best job of insulating you against the cold. Use tightly woven, water-repellent material for wind protection. Wool or silk inner layers hold body heat better than cotton does. Some synthetic materials, like Gore-Tex, work well also. Especially cover the head, neck, hands and feet.

 

Dry. Keep as dry as you can. Get out of wet clothing as soon as possible. It’s very easy for snow to get into gloves and boots, so pay particular attention to your hands and feet.

st. bernard

Pet the Dog, Skip the Booze

One cold-weather issue that most people don’t take into account is the use of alcohol. Alcohol may give you a “warm” feeling, but it actually causes your blood vessels to expand; this results in more rapid heat loss from the surface of your body.

 

Alcohol and recreational drugs also cause impaired judgment. Those under the influence might choose clothing that might not protect them in cold weather.

 

Treating  Hypothermia

 

If you encounter a person who is unconscious, confused, or lethargic in cold weather, assume they are hypothermic until proven otherwise. Immediate action must be taken to reverse the ill effects of hypothermia. Important measures to take are:

 

Get the person out of the cold. Move them into a warm, dry area as soon as possible. If you’re unable to move the person out of the cold, be sure to place a barrier between them, the wind, and the cold ground.

 

Monitor breathing. A person with severe hypothermia may be unconscious. Verify that they are breathing and check for a pulse. Begin CPR if necessary.

 

Take off wet clothing. If the person is wearing wet clothing, remove gently. Cover the victim with layers of dry blankets, including the head, but leave the face clear.

 

Share body heat. To warm the person’s body, remove your clothing and lie next to the person, making skin-to-skin contact. Then cover both of your bodies with blankets. Some people may cringe at this controversial notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful. Avoid being too vigorous.

 

Give warm oral fluids if awake and alert. If, and only if, the affected person is alert and able to swallow, provide a warm, nonalcoholic, non-caffeinated beverage to help warm the body. Coffee’s out, but how about some warm apple cider?

 

Use warm, dry compresses. Use a first-aid warm compress (a fluid-filled bag that warms up when squeezed), or a makeshift compress of warm, not hot, water in a plastic bottle. Apply to the neck, armpit, and groin. Due to major blood vessels that run close to the skin in these areas, heat will more efficiently travel to the body core.

 

Avoid applying direct heat. Don’t use hot water, a heating pad or a heating lamp directly on the victim. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest.

 

Joe Alton, MDAuthorJoe

Find out more about cold-related injuries in our Third Edition of the Survival Medicine Handbook, now at 700 pages! Also, fill those holes in your medical supplies at Nurse Amy’s store at store.doomandbloom.net. You’ll be glad you did.

Survival Medicine Hour: Hypothermia, Pt. 2, Avalanches, Blizzard Survival

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shutterstock_90110446

In this episode of the Survival Medicine Hour with Joe and Amy Alton: Bees are having a hard time these days and new attention is being given to their plight. The Fish and Wildlife Service have added the Rusty Patched Bumble Bee to the endangered species list, which join seven species of the Yellow-Faced bee that were added in September.

 

Hypothermia (part 2) is discussed regarding treatments including: getting the person out of the cold or sheilding them from the weather as much as possible, monitoring their breathing, begining CPR if needed, warming them up with your body heat or warm dry compresses and more. Keep a Winter Car Survival Kit and supplies handy to help when disaster or accidents happen.

avalanche-center1

Avalanches are dangerous, but only a small percentage of victims die from hypothermia, most perish due to traumatic injury or suffocation before they freeze to death. Snow slides are part and parcel of the winter wilderness experience and it pays to know what to do if you’re caught in one. Blizzards occur every year in the United States, and cause fatalities among the unprepared. In these storms, 70% of deaths occur due to traffic accidents and 25% from being caught outside during the blizzard. Learn safety tips to prevent these deaths and keep you and your family safe and healthy during the winter.

 

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/01/13/survival-medicine-hour-hypothermia-pt2-avalanches-blizzards

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

joe and amy radio

The Altons

Hey, are you prepared to deal with medical issues in the uncertain future? Find out more about 150 topics as they relate to survival in our new Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Video: Norovirus, the Stomach Flu

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hot-dog-stand

In this video, Joe Alton, MD discusses a recent experience with the stomach flu on a trip to New York. Norovirus is the most common cause of the “stomach flu”, a debilitating and dehydrating intestinal illness that affects millions every year throughout the world. Often caused by contaminated food on cruises, 800 students at a high school in Illinois were recently affected, presumably due to cafeteria issues. Learn more about the norovirus and what to do if you or a loved one comes down with it.

 

To watch, click below:

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

joealtonlibrary4

Choosing Sutures

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Sutureneedleholder1

As we go around the country teaching the art of suturing pig’s feet to aspiring porcine podiatrists, we are often asked about how to choose the appropriate suture needles and material for different types of injuries.  There are a wide variety of choices and, today, we’ll discuss what is available and what is most effective for different types of wounds.

 

First, let’s identify some of the qualities of the optimal suture.  The suture should:

 

·        Be sterile

·        Be easily worked with

·        Be strong enough to hold wound edges together while they heal

·        Be unlikely to cause infection, tissue reaction or significant scar formation

·        Be reliable in its everyday use with every type of wound

 

It is rare, if not impossible, to find a single suture type that meets all of the above criteria, but there are many that will serve if chosen properly.

 

In the United States and many other countries, a standard classification of suture has been in place since the 1930s.  This classification identified stitches by type of material and the size of the “thread”.  Suture diameters most commonly used in humans (and pigs, I would think) is measured in zeroes, much like buckshot.  2-0 (00) suture, for example, is thicker than 5-0 (00000) suture. The more zeroes, the finer the “thread”. Finer sutures have less tissue reaction and heal faster, but are more difficult to handle for those without experience.

 

In addition to size, sutures are classified as absorbable and non-absorbable.  An absorbable suture is one that will break down spontaneously over time but not before the tissue has had sufficient time to heal.  Absorbable sutures have the advantage of not requiring removal after healing has taken place. This type of suture is commonly used in deep layers, such as muscle, fat, organs, etc.  A classic example of this is “catgut”, actually made from the intestines of sheep or cows.

 

(Aside: Catgut was once also used in the manufacture of stringed musical instruments and tennis racquets.)

 

Catgut is usually found in “plain” and “chromic” varieties. When dipped in a chromic acid salt solution, catgut lasts longer in the body while remaining absorbable.

 

Although still popular, catgut has been replaced by synthetic absorbables for many applications. examples of synthetic absorbable suture include “Vicryl” (polyglycolic acid), “PDS” (polydiaxanone), and others. These tend to last longer than catgut sutures, but will eventually be absorbed by the body.

suturenylon

Nylon suture package depicting size, needle shape, and length of “thread”

Nonabsorbable sutures are those that retain their character for a very long time, and will stay in the body until removed.  As such, normal immune response will cause the development of scar tissue, sometimes called “encapsulation”, around these sutures if used in internal body structures. 

 

Nonabsorbable sutures are best used in skin closures and situations that require prolonged tensile strength. They include monofilaments (such as “Nylon” and “Prolene”) and braided multifilaments (such as ”Surgical Silk”). Monofilaments like Nylon are useful because of less likelihood of harboring bacteria, whereas braided multifilaments have nooks and crannies for these organisms to hide. Monofilament also glide more easily through tissue. In trade, braided Silk is somewhat easier to handle than Nylon for many and often used for teaching purposes.

 

I recommend Nylon in most survival situations, with 2-0 or 3-0 Nylon ideal for those new to the suturing skill.  This size “thread” is easy to handle and useful for aspiring medics to learn surgical knot-tying.

 

The size of the “thread” you’ll use depends on the area of the body being repaired. Slowly healing tissues such as skin and tendons require nonabsorbable sutures; wounds in rapidly healing areas such as the inside of the cheek and vagina (childbirth) are best repaired with absorbables. 

 

In survival settings, cosmetic results are less important, but surgeons generally use smaller sutures in delicate areas such as areas on the head and face.  5-0 or 6-0 Nylon would normally be the choice here, but require more skill in handling.  Skin sutures should be placed, in my opinion, about 1/2 inch or so apart in most instances. This will allow drainage while keeping the wound together.  Areas over joints or other moving parts should be closer together. In wounds not near joints, say, the forearm, the sutures may be further apart and could be interspersed with Steri-Strips or butterfly closures.

suture needles

typical suture needles (chromic catgut)

 

The type of needle is also an important factor in choosing suture material. Needle that are less traumatic to sensitive tissues, like the lining of the bowel and other deep structures, are round on cross-section. These are known as “atraumatic” or “tapered”. Needles that are best on tough areas like skin are triangular in shape on cross-section and are referred to as “cutting” needles. Most suture needles that are useful for skin form a 3/8 circle; needles for deep work are often ½ circle in shape.

 

Having said all of the above, the choice of suture needles and material will vary depending on the user. Each surgeon will have his or her preferences based on their experience.

 

How long skin sutures remain in place before removal is dependent on the body part repaired.  Face wound sutures are usually removed relatively soon (5 days) compared to, say, a forearm wound (7-10 days).  Thicker skins, such as the sole of the foot should stay in somewhat longer.   Sutures placed over the knee or other joints should remain in place longer, 2-3 weeks, in my opinion.

 

Remember that the act of suturing is more traumatic than using butterfly closures, Steri-Strips, surgical glue, and others due to the fact that you are making more punctures in an area of skin already injured.  Each extra “hole” you create could allow the entry of bacteria into the wound. 

 

One last relevant point:  When you practice suturing on your pig’s foot, you are learning a skill, not a trade.  The practice of medicine without a license is illegal and punishable by law; as long as modern medical care exists, seek it out.

 

We’ll talk about staples, medical glues, and Steri-Strips/butterfly closures in future articles.

 

To see me suture in real time, here’s my YouTube video:

Joe Alton, MD

joealtonlibrary4Find out more about wound closure and 150 other topics in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way“. Find suture kits and individual sutures at Nurse Amy’s store.

Survival Medicine Hour: Hypothermia, Nightclub Terror

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hypothermiaoldmanincoldwater

It’s January, and a cold blast from the North is hitting parts of the Deep South. Hypothermia is a big issue for those not prepared for cold weather, and a number of people die every year from being unready to deal with Nature’s challenges. Find out about hypothermia, how the body loses heat, and some strategies for prevention this winter.

 

Also, the Turkish nightclub shooting almost exactly duplicates the blueprint established by last year’s Orlando Nightclub shootings. Along with vehicular terror, Dr. Bones makes the argument that this strategy is going to be repeated again and again, and tells you what you have to do to survive such events.

 

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2017/01/06/survival-medicine-hour-hypothermia-nightclub-terror-shootings

 

Follow us on twitter @preppershow

Follow our Youtube Channel at DrBones NurseAmy

Follow us at Facebook at DoomandBloom or join our Survival Medicine group at Survival Medicine DrBones NurseAmy

 

All the best for a happy and healthy 2017!

 

Joe and Amy Alton

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Video: Vehicular Terror

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vehicular-terrorism

In this companion video to a recent article, Joe Alton, MD discusses the wave of terror events using a car or truck to run down innocent citizens. From Nice, France to Berlin, Germany to Ohio State University, terrorists are figuring out that it’s a lot easier to own, rent, or steal a truck or other vehicle than to build a bomb. Find out more about this new blueprint for terror and  how you can use situational awareness to your advantage to stay safe.

To watch, just click below:

Wishing you the best of health in 2017,

Joe Alton, MD

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Survival Medicine Hour: Vehicular Terror, Hangovers, RP Ruggiero of Brushfire Plague

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The Survival Medicine Hour, with Joe Alton,MD aka Dr. Bones and Amy Alton, ARNP aka Nurse Amy, wish you a Happy and Healthy New Year on this last day of 2016. With holiday parties all around us, some will find themselves with a celebration full of alcohol and perhaps a hangover to remember the night before. Before you attend that party, you should listen to this podcast for tips to both prevent and cure that aweful hangover.

Amy Alton, ARNP, interviews the author of the Brushfire Plague Trilogy series after he has recently completed the third book. Mr. R.P. Ruggerio lives in Colorado with his wife and two sons, and spends as much time outdoors as possible. He strives to live by Robert Heilein’s credo ” Specialization is for insects.” The Brushfire Plague trilogy are novels grounded in neighboorhood defense duringa devastating plague. Brushfire Plague, according to R.P., “also has useful lessons about the value of being prepared for possible disruptions to our normal way of life woven into the fabric of the story.  One unique aspect I focus on is the interpersonal dynamics one will be forced to deal with in any crisis situation.  This adds a lot to the drama and storyline and enhances the realism of the novel.”

Vehicular terror is the new blueprint for those wishing to cause mass casualties. Simple to obtain compared to guns and bombs, we can expect more events like the Berlin Christmas Market truck attack. Find out what you need to know to stay safe in these troubled times.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/12/30/survival-medicine-hangovers-rp-ruggiero-vehicular-terror

Wishing you a Happy and Healthy New Year!

Joe and Amy Alton

JoeAmyPortrait2013

See more information about RP Ruggiero’s books at http://brushfireplague.com/? and at Amazon http://amzn.to/2ilH0e7?.

Don’t forget to follow us on our store, facebook, and twitter:

Store: http://store.doomandbloom.net/

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Surviving A Hangover

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In normal times or times of trouble, New Year’s Eve is a time where many break out the Smoky Mountain Moonshine and end up regretting it the next morning. For you teetotalers, a hangover is a group of symptoms that occur in many people after a night of drinking. Hangovers vary in appearance and severity, but one thing is sure: You’d rather not have one.

 

A study in college students found that and 29% reported (not to their parents, though) losing school time for hangover recovery. Close to 10% of American workers report having gone to work with a hangover; Lost work days run in the millions.

 

What Causes Hangovers?

 

Despite thousands of years of people having hangovers from drinking too much alcohol, the process which causes the condition isn’t very well understood.  Dehydration, sleep disturbances, lack of food intake, low blood sugar, the presence of certain by-products of alcohol in the body and other factors are likely involved.

 

Substances known as “congeners” found in alcoholic beverages may play a role; one of these, methanol, is metabolized to toxic chemicals like formaldehyde and formic acid. Other congeners, like acetaldehyde, are much more toxic than the alcohol itself, acting like an “anti-antioxidant”.

 

Symptoms of Hangovers

 

Each person’s hangover is a little different, but you can expect to see some of the following symptoms:

 

  • Headache due to blood vessel expansion (called “vasodilation”)
  • Sensitivity to light and sound
  • Tremors (possibly due to low blood sugar, or “hypoglycemia”)
  • Dizziness
  • Malaise (general sensation of feeling ill)
  • Irritability, depression, and/or difficulty concentrating
  • Nausea and vomiting
  • Stomach discomfort (alcohol increases stomach acid)
  • Fatigue
  • Weakness
  • Thirst
  • Loss of appetite
  • Rapid heartbeat

Symptoms begin when the alcohol level has dropped down to zero, usually the morning after a bender. They can last several hours, or in the worst cases, a couple of days.

 

Treating a Hangover

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Doctors actually don’t spend a lot of time researching hangover remedies, simply because they consider hangovers as effective deterrents to frequent alcohol abuse in many people. Although there is no certain cure for hangovers (other than time), there are a number of treatments; some of these have basis in scientific fact and some, well, not so much.

 

Consider these options as you try to pick yourself off the floor:

 

Drink some fluids.   You’re dehydrated, and some water, Gatorade, or juice (without alcohol, please) will help you recover faster. Skip acidic juices like orange juice; they won’t help your upset stomach.

 

Go back to bed. The more sleep you can get, the more you’ll sleep through some of the worst part of a hangover

 

Take a headache medicine. Ibuprofen can help your headache, but it can irritate your stomach. Tylenol might be a better choice, but is associated with liver disease if you’re a heavy drinker.

 

Eat something. You might be nauseous, but a little chicken broth and some crackers will help settle your stomach and give your blood sugar a boost. Some prefer dry toast with a little peanut butter. Pepto-Bismol (Bismuth Subsalicylate) isn’t a bad idea to deal with that stomach upset as well.

 

Home Remedies for Hangovers

 

The above measures are thought to be of likely medical benefit for hangovers, but there are a lot of home remedies that people swear by. Below are just a few.

 

Ice:  An icepack to your throbbing noggin might just be the thing to help that headache. A cold, moist washcloth will work just as well.

 

Bananas. Bananas are a good source of potassium, something you might be low on after a night of drinking.

 

Ginger:  Ginger root is a time-honored natural remedy for nausea and vomiting, and many people feel seasick when they have a hangover. Ginger Ale is the easiest way to ingest some, but a ginger tea may be even better.

 

Honey and Lemon: Ingredients of a hot toddy (hold the alcohol), mixing some honey and lemon will boost your blood sugar.

 

Vitamin B: A 1973 study found that Vitamin B6, in very large doses, can improve a hangover. Later studies, however, found no such benefit and possible risks to the liver and pancreas. Vitamin B-complex, a combination of B1 (thiamine), B2 (riboflavin), folic acid, B6 and B12 has also been proposed as a cure. It isn’t, but a dose of a vitamin supplement probably won’t hurt you.

 

Vitamin C: A popular ingredient and antioxidant in commercial “hangover supplements”, there’s little scientific data backing up any significant effect on a hangover. Like Vitamin B, however, there’s no reason to think it would hurt to take some Vitamin C.

 

Coffee: People like to think that some coffee will help their hangover, and it may do something for your headache. But caffeine is dehydrating, something that’s isn’t helpful when you’re already low on fluids.

 

Tomato Juice: While acidic and not so helpful for upset stomach, a non-alcoholic Bloody Mary is thought by some to metabolize alcohol from the body more quickly.

 

Exercise: If you can’t even move after a night of drinking, how can you exercise? Some feel, however, that sweating out the toxins will help a hangover. If you do decide to exert yourself, hydrate well beforehand and keep it to low-impact activities or you might be worse off than before. How about trying a walk around the block first?

 

Oxygen: Those with access to O2 canisters tout their benefits with regards to hangovers, but little evidence exists to support it.

 

The Prairie Oyster: V8 juice with Worcestershire and Tabasco, a little salt, a little pepper and a raw egg stirred together makes a Prairie Oyster, long thought to be a cure for a hangover. Little hard data confirms this concoction works, however, and eating uncooked eggs carries a risk for certain infections. Cooked eggs, however, contain taurine and cysteine, two substances that might help detoxify you. A number of other esoteric elixirs combining several incongruent ingredients also exist, but none have been scientifically shown to work. They will likely help raise your blood glucose, but you’re probably better off with a sports drink to get sugar, electrolytes, and hydration.

 

Hair of the Dog: Hair of the Dog is just another name for drinking more alcohol. It works because a hangover is essentially a form of alcohol withdrawal. Getting your drink on again, however, is the worst idea of all in the long run.

 

PREVENTION

 

An ounce of prevention is worth a pound of cure, and that is the honest-to-God’s truth when it comes to hangovers. Make sure to:

 

Eat before you drink: Drinking on an empty stomach equals big trouble. Beer has calories, but it’s not dinner. Having a full stomach before drinking may help you keep your blood alcohol level down.

 

One alcoholic drink, one non-alcoholic: Matching one Old-Fashioned with one glass of water will help keep your alcohol intake down and decrease your chances of a hangover in the morning.

 

Pick the right poison: If you’re not picky about your poison, try to stay away from dark liquors like, say, bourbon. These have more congeners and are more likely to cause hangovers than clear liquors like vodka. Clear liquors are less associated with severe hangovers.

 

Be Bubble-Free: Alcohol in carbonated drinks, like Champagne, may be absorbed more quickly and lead to worse hangovers.

 

Head it off at the pass: Take two aspirin with a full glass of water before going to bed. Fatty acids that reduce inflammation in aspirin can avoid a bad hangover.

 

Abstain: Do I really have to say why? If you really don’t want a hangover, don’t drink. Be the designated driver.

 

I’ll bet you have a tried and true method to deal with hangovers. If so, let us know on our Facebook page at https://www.facebook.com/doomandbloom/ or our Facebook Survival Medicine Group page.

 

Joe Alton, MD

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Surviving a hangover may not be true survival medicine, but you’ll find over 150 medical issues for disasters and epidemics in our 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way.

Using Epinephrine in Vials

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epipen

The EpiPen

 

We’re in the midst of an epidemic of allergies in the U.S., and severe allergic reactions like anaphylaxis could be life threatening. Epinephrine is used For the emergency treatment of allergic reactions to stinging or biting insects, foods, drugs, and other allergens, as well as exercise-induced anaphylaxis; yes, you can be allergic to exercise, but don’t use that as an excuse to be a couch potato!

 

Epinephrine is most commonly used these days in an autoinjector that’s fast and easy to use. In the United States, one brand of autoinjector, the EpiPen, manufactured by a subsidiary of Pfizer pharmaceuticals, and marketed by Mylan corporation, is considered the gold standard. Annual sales of all epinephrine autoinjectors were about $200M; EpiPen had around 90% of the market; in 2015 the market size grew to $1.5B and epipen still has the lion’s share. Well, in a move that some might describe as profiteering, Mylan raised the U.S. price from around $100 for a package of two EpiPens in 2007 to around $600 in 2016, although it’s still less expensive in the UK and Canada. The devices, by the way, deliver about $1 worth of drug.

 

In a public relations move, Mylan made savings cards worth up to $300 available to some patients to purchase EpiPens, Unfortunately, these can only be used by a small number of people who need the drug, and doesn’t seem to include people on Medicaid. The high prices paid by insurers, however, haven’t changed and they pass the cost onto consumers in the form of higher and higher health insurance premiums every year.

 

(update: Mylan recently released a half-price generic version of the Epi-pen in response to the widespread resistance to their price increase.)

 

So what’s your best option if the Epipen is now outside of your financial reach? It might be using vials or ampules of epinephrine, small syringes, and some antiseptic wipes. The 1:1000 epinephrine ampules are 1 ml and contains enough for a one-time use of up to 2 doses. The same concentration vials are usually 30 ml and made for multiple uses. Here’s how to use epinephrine that’s packaged this way :

 

epinephrine-vial-epipen-substitute

1:1000 epinephrine in vials (from WebMD)

1:1000 epinephrine solution contain 1mg of drug per milliliter or cc of solution. For a person weighing 30 kg, 66 pounds, or greater, give 0.3 to 0.5 mg (0.3 to 0.5 mL) into the anterolateral thigh about the level of the bottom of your Jeans pocket. Repeat the dose every 5 to 10 minutes, alternating left and right thighs until improvement is noted. Remember that epinephrine will cause a fast heartbeat, nervousness and, perhaps, a number of other side effects. Of course, in normal times, get the victim to modern medical care as soon as possible, especially if more than 2 doses were needed.

 
For children weighing less than 66 pounds, the formula for anaphylaxis is 0.01 mg/kg, so a small child weighing 10 kg, or 44 pounds, would receive 0.2 mg, that’s .2 ml if you use 1:1000 epinephrine solution. The maximum pediatric dose is up to 0.3 mg, that’s 0.3 ml of epinephrine (1:1000).

 
This might seem complicated, and indeed, it does take longer to deliver the product than with an autoinjector like the Epipen unless you keep some small syringes prefilled with the medication. In a 2010 article in the ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY, manually prefilled syringes were recommended as a way to keep ready to use epinephrine available at all times, and it appears that the medication remains potent and uncontaminated by bacteria or fungus for 3 months. After that, it changes color and all bets are off. This also assumes that the syringes are stored at room temperature, as high temperatures will affect potency considerably over time.

 

(This article can be viewed in video form HERE)

 

 

Joe Alton, MD

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Dr. Joe Alton

 

Learn more about allergic reactions, anaphylactic shock and 150 other topics related to survival in good or bad times by  getting a copy of the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way, now available at Amazon.

Survival Medicine Hour: Holiday Blues, More

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The Survival Medicine Hour, with Joe Alton, MD aka Dr. Bones, and Amy Alton, ARNP aka Nurse Amy, wish you and your family a wonderful Merry Christmas. May 2017 bring you a multitude of blessings and good health. About 16% of our population is alone and lonely during the Christmas holiday.

This special episode will help you and others find ways to be a part of this joyous time of year. Helping others, being a listening ear, making home-made presents, visiting the less-fortunate or sick, or joining a helpful cause are just some of the advice to help you and those around you feel more Christmas spirit. Christmas is not about store-bought presents. Merry Christmas and a Happy and Healthy 2017 to you and yours.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/12/23/survival-medicine-hour-lonely-christmas-survival-tips

 

all the best,

Joe and Amy Alton

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Surviving Vehicular Terrorism

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vehicular-terrorism

CNN reports that a man in Berlin used a truck to plow through a group of people at a Christmas market, killing 9 and injuring 50 more. The tractor trailer appeared to deliberately ram through several stalls at what is estimated to be 40 miles per hour; German authorities are treating the incident, at present, as a terror event.

The attack appears to parallel the cargo truck killing of 86 people and the wounding of 434 others in Nice, France during a fireworks display on a national holiday. On a smaller scale, a Somali student at Ohio State University recently ran down a number of people before leaving his car and stabbing several others with a large knife. A pattern seems to be emerging where a vehicle is used to cause casualties in public spaces.

Ordinarily, terror attacks are associated with guns, but these items are difficult to come by in most countries. Bombs, another preferred terrorist weapon, require expertise to assemble safely. Owning or renting a vehicle, however, is much more common and requires little skill to operate. Trucks and cars can cause mass casualties if wielded as a weapon; obtaining one elicits no suspicion.

Therefore, would-be terrorists now have a new blueprint for causing mayhem among an unsuspecting public. There are few who pay much attention to traffic unless they’re in a vehicle themselves or crossing the street. The speed at which a vehicle can accelerate and turn into a crowd leaves little time for reaction. Hence, the “success” rate of this type of terror event may surpass even a gunman’s ability to cause deaths and injuries.

The increasing number of terror events around the world underlines the increasing need for situational awareness. Situational awareness is the mindset whereby threats are mentally noted and avoided or abolished. Originally a tool for the military in combat, it is now a strategy for the average citizen in these uncertain times.

The situationally aware person is always at a state of “Yellow Alert” when in crowded public venues. By that, I mean a state of relaxed but vigilant observation of what is happening around him or her. When an action or behavior occurs that doesn’t match the surroundings and situation, it’s an anomaly.

When a vehicle moves erratically or leaves the normal pattern of traffic, it’s an anomaly that requires rapid action. Mentally noting routes of escape whenever you’re in a crowd will give you the best chance of getting out of the way. Just as knowing the location of exits in a mall or theatre is good policy, a heightened awareness is now important at any outdoor event or popular public area near roadways.

For vehicular terrorists, the target will be crowds of people near the street. Their objective is mass casualties, and those pedestrians nearest the curb will bear the brunt of the attack. Consider walking on the fringe of a crowd away from the road to give yourself the most options. In the center, the masses, not your own good judgment, will dictate your movement. Take a walk along Times Square and you’ll see what I mean.

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Retractable Bollards

Municipalities can protect their citizens by constructing barriers known as “bollards” which would stop vehicles from entering pedestrian areas. These can be seen outside many government buildings and airport terminals. Expanding their use to areas that attract crowds would be an important consideration for the future.

I’ll admit that the likelihood you’ll be in the path of a terrorist using a vehicle, or any other weapon, is very small. Panic isn’t the answer, but these are troubled times; the more situationally aware you are, the safer you’ll be.

Joe Alton, MD

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For more information on surviving terror events, see my other articles:

https://www.doomandbloom.net/situational-awareness-could-save-your-life/

https://www.doomandbloom.net/how-a-fighter-pilots-strategy-could-save-your-life-the-ooda-loop/

Survival Medicine Hour: Norovirus, Cold Myths, Man Flu?

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Norovirus: The Stomach Flu

In this episode of the Survival Medicine Hour with Joe and Amy Alton, aka Dr. Bones and Nurse Amy, a bout of acute gastroenteritis, also called “stomach flu” caused by Norovirus sends Nurse Amy to urgent care. Find out about the microbe that sends two million victims to their doctors every year in the U.S., how to prevent it and some other important advice to stay healthy this winter.

colds

Also, top ten myths people believe will prevent a cold. We know there’s one or two in there you think are true! Also, why do men seem to have worse symptoms than women when they get the flu or other viruses? Is there such a thing as the Man Flu?

All this and more on the latest episode of the Survival Medicine Hour with Joe Alton MD and Amy Alton, ARNP. To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/12/16/survival-medicine-hour-norovirus-cold-myths-man-flu

Wishing you the best of health in good times or bad, and Merry Christmas!

Joe and Amy Alton

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Dr. Bones and Nurse Amy

The “Stomach Flu” Virus

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oysters

Oysters may harbor norovirus

We often write about disaster situations that we personally experience. We’ve been through hurricanes, tornadoes, and epidemics, just to mention a few. Recently, our home in Gatlinburg, Tennessee was threatened by the wildfires there, which killed 14 and wiped out more than 1700 buildings and over 100 on the mountain where the house is located.

 

We’ve written about a number of medical issues that we’ve experienced as well. For example, I converted to positive for Tuberculosis during my work with Cuban refugees during the 1980 Mariel boatlift. I still carry a small walled-off nodule on X-ray, even after months of multi-drug therapy.

 

On a recent trip to New York City to visit our daughter, we both experienced a medical issue so common that it surprised us that we haven’t yet written about it: acute gastroenteritis, or the “Stomach Flu”. When this infection hits you, it makes even the healthiest individual miserable. Nurse Amy required an urgent care visit, no small issue in a strange and heavily-populated city. She was just one of nearly 2 million outpatient visits caused by norovirus in the U.S. every year.

 

Norovirus is the most common cause of viral gastroenteritis in humans. It was originally called “Norwalk Virus”, after the area where it was first identified in the 1960s. Since then, it’s been blamed for 50% of all gastroenteritis in the U.S. Worldwide, there are more than 200 million cases of norovirus infection a year. It affects people of all ages, but it’s particularly dangerous in the elderly, the very young, and those with weakened immune systems. Winter is the most common time for outbreaks.

 

Norovirus is very contagious (just 5-20 viral particles can cause illness) and is easily transmitted through contaminated food or water, close personal contact, and by air droplets from vomit, contaminated food counters, and even toilet flushes. Infection can be passed from person to person for a time even after apparent recovery.

 

Here’s how contagious the norovirus is: In one outbreak reported in 1998, 126 people were dining at a restaurant when one person vomited onto the floor. Despite a rapid cleanup, 52 fell ill within three days. More than 90% of the people who later dined at the same table reported symptoms. More than 70% of the diners at a nearby table got sick; at a table on the other side of the restaurant, the rate was still 25%.

 

Norovirus is a hardy microbe, and is known to survive for long periods outside a human host. It can live for weeks on countertops and up to twelve days on clothes. It can survive for months in still water. Disinfectants containing chlorine, however, like bleach will quickly eliminate it, as will sufficient heat.

 

The symptoms of the stomach flu include nausea and vomiting, watery diarrhea, and (sometimes severe) abdominal pain, usually within 12 to 48 hours of exposure. Along with this, muscle aches, headache, and fever may be seen. Luckily, life-threatening illness is rare, with dehydration being the main danger in those infected with the virus.

 

Unlike some viruses, immunity to norovirus is only temporary, maybe six months, after recovery.

 

Outbreaks of norovirus infection often occur in closed spaces such as cruise ships, nursing homes, schools, camps, and prisons. Shellfish, such as oysters, and salad ingredients are the foods most often implicated in norovirus outbreaks. In our case, it might have been a kiosk advertising “the World’s Best Hot Dogs”.hot-dog-stand

As is the case with most viruses, there is no cure for norovirus infection. Antibiotics will not be effective, as they are meant to kill bacteria, not viruses. Treatment involves staying well-hydrated. Dehydration can be noted by these symptoms:

 

  • ·        Dry mouth

  • ·        Decrease in quantity or dark color of urine

  • ·        Dizziness when standing up

  • ·        Decreased elasticity of skin (it “tents” when pulled)

  • ·        No tears when crying or unusual irritability in infants

Using antidiarrheal meds like loperamide (Imodium) and anti-vomiting drugs like Ondansetron (Zofran) may also help.

 

A cure may not be available but prevention is another issue. To decrease the chance of norovirus infection:

 

·        Wash your hands frequently with soap and water (norovirus is relatively resistant to alcohol), especially after using the restroom or handling food. Be especially sure to do this for 2 weeks after becoming infected (yes, you can be contagious for that long).

·        Wash food before cooking; cook shellfish thoroughly

·        Frequently disinfect contaminated surfaces with a bleach solution (the EPA recommends 5-25 drops of bleach per gallon)

·        Keep sick individuals away from food preparation areas

·        Avoid close contact with others when you are sick, and don’t share utensils or other items

·        Wear disposable gloves while handling soiled items

·        Immediately remove and wash clothes that may be contaminated with vomit or feces. Machine dry if possible.

 

It may be difficult to completely eliminate the risk of norovirus infection, but careful attention to hand and food hygiene will go a long way towards avoiding the stomach flu.

 

Joe Alton, MD

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 Check out Nurse Amy’s entire line of medical kits and individual supplies at her store at store.doomandbloom.net.

 

Zika Defects More Common Than Previously Thought

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microcephalic infant

A recent U.S. study published in the Journal of the American Medical Association has found that 6% of 400 babies infected with Zika virus born here had one or more related birth defects. The study pales in comparison, however, to a Brazilian study of 125 women just reported in the New England Journal of Medicine. In that study, 46% of babies had abnormalities or did not survive the pregnancy. Previous studies had shown a risk of defects of 1 to 13 per cent.

Troubling evidence has now emerged that suggests that babies may still develop issues even as they approach their first birthday. Previously, it was thought that all damage occurred while still in the womb. Now scientists are asserting that the virus may continue to destroy nervous tissue for a time after birth.

The timing of the infection seemed to have an impact, with 11% of U.S. pregnancies diagnosed with Zika in the first trimester yielding babies with birth defects, less in mid- or late-pregnancy. Although Zika virus lasts only a short time in the blood, it appears to possibly last for months in brain tissue. The overall incidence of 6% in the U.S. was the same for women who experienced symptoms of Zika illness and those who were asymptomatic.

Most cases in the continental United States were diagnosed in women who had traveled to the epidemic zone, although an epidemic of more than 30,000 locally transmitted cases was seen in Puerto Rico and a local outbreak of more than 200 cases was noted in South Florida. More recently, a case of local transmission was reported in the Brownsville area of Texas.

Zika virus is known to cause increased numbers of newborns with microcephaly, an abnormality of growth in the brain and fetal head normally seen in less than 1% of all births. In the lab, Zika has been shown to kill brain cells. Other defects in sight, hearing, joints, and elsewhere have also been detected, according to Margaret Honein, lead author of the U.S. study and head of the U.S. Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities.

Another troubling aspect is that the Zika virus is completely asymptomatic in 80% of those infected. This means that the actual number of cases may be five times the recorded numbers. Additionally, it is unknown what developmental milestones may be delayed over the first few years of life, and whether school performance may be affected.

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The best way to prevent Zika virus is still to prevent mosquito bites by wearing appropriate clothing and using repellent when in at-risk areas (or avoid travel there altogether), Pregnancies should be delayed for 8 weeks in women who have had the virus or traveled to the epidemic zone. Men shouldn’t attempt to impregnate their partner for at least 6 months.

 

Joe Alton, MD

JoeAltonLibrary4

Get a copy of our 700 page third edition of “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way”, available on this website and also at amazon.com.

It’s not too late to get a copy of the premiere board game of the preparedness community “Doom and Bloom’s SURVIVAL!” as a Christmas gift! Find out all about it at survivalboardgame.com.

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Doom and Bloom’s Survival, now with free miniatures

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Survival Medicine Hour: Pneumonia, Natural Remedies

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survival medicine

The Survival Medicine Hour, with Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP aka Nurse Amy, bring you a tremendous amount of information today. Are you going to be the medic or caretaker in a disaster or survival situation?  Our mission is to help put a medically prepared person in every family for any disaster.

Pneumonia is an infection affecting the aprt of the lungs that absorbs oxygen from the atmosphere. Pneumonia may be viral, bacterial or fungal infection. The infection usually starts by affecting a portion of one lung (a “lobe”) before spreading to the entire organ. If enough fluid clogs the air clogs the air sacs (alveoli), it’s possible, while listening to lung sounds, you actually won’t hear any sounds at all.

Natural remedies are available for help with respiratory infections to reduce symptoms and build a person’s immunity. Antioxidants, like Vitamin C and Vitamin E and other antioxidants taken regularly are supposed to decrease the frequency and severity of respiratory infections.

Some of the best essential oils for symptoms are Lavender, Eucalyptus, Rosemary, Peppermint and Geranium. Herbal teas such as Stinging Nettle, Licorice Root, Peppermint, Anise Sage and Dandelion are all made better with a bit of raw, unprocessed honey and fresh squeezed lemon.

Joe Alton, MD

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Joe Alton MD

Oakland Warehouse Fire: Surviving in a Crowd

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wildfire

The fire in an Oakland warehouse that was a refuge for artists and a venue for dance parties has now claimed 36 lives with several persons still missing. In the past, I’ve written about safety in wildfires and also in homes over the years; this time, I’ll explore the issue relating to fires in public venues like concert halls.

Concerts and theatres have long been areas at risk for fire. In 1903, Chicago’s Iroquois theatre was the site of an inferno which caused 600 deaths. In 1942, the Cocoanut Grove nightclub in Boston claimed 492 lives. In 2003, 100 perished in the Station nightclub in Warwick, R.I. during a concert by the rock band Great White.

Most public venues have important fire protection strategies such as sprinkler systems, fire exits, and fire extinguishers. Indeed, fire codes have evolved to make most of these places quite safe.

The phenomenon of “flash concerts”, however, places crowds of people in locations without these safeguards. This puts the onus on concert-goers to become more situationally aware, something few patrons of these events even think about.

What is situational awareness? Situation awareness involves understanding what’s going on in your immediate vicinity that might be hazardous to your health. I don’t mean second-hand smoke here; I’m talking about knowing what dangers may exist that you can avoid or abolish with your actions. Especially important for soldiers in a combat zone, it’s now become just as important for the average citizen in any large crowd.

The situationally aware person is in a constant state of what I call “Yellow Alert”, a relaxed awareness of their surroundings. At Yellow Alert, a concert-goer has a much better chance to identify threats than someone with their nose buried in their smart phone. Although many might enjoy the use of recreational drugs, like marijuana or ecstasy, it’s much safer to have your wits about you at these events. Mentally marking nearby exits, fire extinguishers, and alarms when you first arrive will allow you to have a plan of action if the worst happens.

A good spot at a concert is front and center, but you might be safer at the fringe of the crowd. In the center, your choice of escape route is governed by the crowd rather than good judgment.

Who’s at fault? Although Derick Almena, the manager of the Oakland warehouse, was understandably distraught during an interview with the TODAY show, he must bear responsibility for the conflagration, as must the owner, Chor N. Ng (whose daughter claims, says the LA Times, that he didn’t know people lived in the building). Here are some reasons why:

·        The 10,000 foot warehouse, also known as the “Ghost Ship”, had no sprinkler system nor fire alarms. No word on the number of fire extinguishers, if any.

·        Piles of discarded furniture dotted the interior.

·        Staircases were partially supported by wooden pallets.

·        Construction and electrical work was performed on an impromptu basis, often without permits or proper inspections.

·        A number of recreational vehicles, presumably with gas in the tanks, were in the warehouse.

Oakland city officials, however, are also culpable. The LA Times reports that, since 2014, several complaints were lodged for building and fire code violations without apparent action by the city after investigation. The Fire Marshall blames severe understaffing for the shortcomings, the responsibility for which must also be borne by Oakland’s city government. Zac Unger, an official with the firefighter’s union, was quoted as saying “Had a fire inspector walked into that building and seen the conditions in there, they would have shut the place down.”

Unfortunately, the responsibility for your safety may ultimately lie with the average citizen. Incorporate situational awareness into your mindset when in any public venue, and you’ll stand the best chance to avoid and escape becoming a casualty of a fire or any other calamity.

For more information on becoming situationally aware and how to deal with building fires, read my articles “How a Fighter Pilot’s Strategy Could Save Your Life: The OODA Loop” and “Surviving a House Fire”.

Joe Alton, MD

When to Close a Wound

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There are many injuries that a medic will face in a survival scenario, and a common and potentially life-threatening one occurs whenever the skin is broken. Your skin is your body’s armor; when it is breached, infectious organisms enter a highway which can transport them to just about any part of the body. Therefore, it makes common sense that you’d want to close that breach to speed healing and lock out infection. Indeed, that’s exactly what happens thousands of times daily in emergency rooms in normal times.

The off-grid medic has a dilemma, however: Most wounds in survival will be dirty, and providing a sterile environment for a surgical procedure is a difficult challenge. You could make the work area as clean as possible, but sterile? Not likely. As such, you should wisely choose what wounds should be closed and what wounds should be left open.

Many medics can’t imagine not closing a tear or cut in the skin (called a “laceration”), but it’s a reasonable way to deal with contaminated wounds in situations where you can’t assure a sterile, or even clean, field on which to work. Lacerations that are kept open must be dressed and cleaned regularly until they’re fully healed.

Open wounds heal through a process called “granulation”, where new tissue forms at the base and sides until the defect in the skin is fully healed. Essentially, “from the bottom up”. This tissue is somewhat granular in appearance, hence the name.

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To Close or Not to Close?

To paraphrase Hamlet, “To close or not to close? That is the question!” To answer this questions, we must examine what our goals are in closing a wound. Among other reasons, you close wounds to:

  • Repair the defect in the body’s armor, thus preventing infection in a clean wound.
  • Accelerate the healing process. Wound edges that are touching heal faster than those that aren’t.
  • Decrease scarring. Scarring is less of an issue in survival, unless the scar would, say, limit the range of motion of a joint in extremity.

A note about bleeding: Although closing a wound may apply pressure to bleeding areas, it is not a substitute for hemorrhage control, also known as “hemostasis” before closure. Consider the application of direct pressure first on the bleeding area, a method that succeeds in many cases. Also, for major blood loss, have tourniquets, hemostatic agents like Celox or Quikclot, and pressure dressings as part of your medical storage.

So what factors come into play when deciding to close a wound or to keep it open? Consider keeping the wound open in these circumstances:

The wound is dirty. Are the circumstances suspicious for contamination? In survival scenarios, the answer is often yes. In austere environments, even WHO (the World Health Organization) agrees that the safest course of action is to keep it open.

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Candidate for closure IF clean

Here are some circumstances where wounds should be kept open:

  • The wound is infected. Infected wounds have a certain appearance: They are red, swollen (sometimes appearing “shiny”), warm to the touch, and may drain pus.
  • The wound is colonized (infected but not yet showing signs). Even the air has bacteria; you can expect a wound to be colonized within 6-8 hours or so.
  • There is dead tissue in the wound. This tissue won’t bleed when it is cut and often appears discolored or black. No closure should be performed without removing dead tissue first (a procedure known as “debridement”).
  • Puncture wounds, especially from mammalian (including human) bites have lots of bacteria and shouldn’t be closed. Interestingly, snake bites become infected less often than, say, cat or dog bites, but don’t close them either.
  • The wound edges are so far apart that closing them would cause undue pressure. This occurs with injuries like “avulsions”, where entire areas of tissue are missing.
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wound infection

Here are situations where you should consider closing the wound:

  • You’re certain the wound is clean. This usually requires witnessing the injury as it happens.
  • The wound has been open less than 6-8 hours.
  • The laceration is long or deep enough to penetrate the entire thickness of the skin. A deep wound would allow you to see underlying tissue such as subcutaneous fat.
  • The wound is located over a joint. A moving part, such as the knee, will constantly stress a wound and prevent it from closing in by itself.
  • The wound gapes open loosely, suggesting that it can be closed without undue pressure on the skin (and won’t close at all without your intervention).

In future articles, we’ll explore wound closure materials, techniques, and theory.

Joe Alton, MD

AuthorJoe

Joe Alton, MD

Learn all about wound care and wound closure methods via our DVD or in the Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.  View our entire line of medical kits and supplies at store.doomandbloom.net

Survival Medicine Hour: Gatlinburg Fires, Stress, More

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On this episode of the Survival Medicine Hour, your hosts, Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy discuss the devastating wildfires that have damaged or destroyed more than 400 structures and taken the lives of at least 13 innocent people, with more than 80 injured seeking help at local hospitals. The severity of the entire disaster is still unknown right now, and we will give you an update on the status of our own house in Gatlinburg. We live in South Florida so it has been a maddening few days to find out the results of the fires that spread up Chalet Village and Ski Mountain areas. Please donate to Red Cross to help fund those who need it so desperately and have lost their primary residence. There are so many without so much. Our prayers are with those who need it right now.
Christmas is almost upon us and the pressure to shop is causing some stress in shoppers. Dr. Alton discusses ways to decrease your stress levels and still have a fun-filled time during the holiday season (one tip: don’t be afraid to ask what they want!). Nurse Amy shares what she wishes for Christmas and what we all really want inside (hint: love, family and kindness). Relax and enjoy your Christmas with friends and family, we are all lucky to be on this beautiful earth together.
Listen in by clicking below:
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Wishing you the best of health in good times or bad,
Joe and Amy Alton
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The Altons

Wildfire Preparedness and Our Gatlinburg Home

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2015 Birdhouse Inn Mountain Paradise View!

The view from my home as I’d like to remember it

It’s been a very busy year for firefighters, with heat waves, drought, and human malice or carelessness causing large areas to burn from Canada to California. You may have heard me say that you probably won’t  be affected by a disaster today, tomorrow, or next week. Over a lifetime, however, the chances aren’t quite as small. Add in your children’s lifetimes, and their children’s, and the odds are greater still. I’ve personally been through hurricanes, tornadoes, civil unrest, and the Mariel Boatlift unscathed other than for some missing roof tiles and a conversion to positive for tuberculosis (thanks, Fidel). We were even stranded in Europe due to a volcanic eruption in Iceland.

And now wildfire. A particularly intense one recently struck a place I know and love: Gatlinburg, Tennessee. Home to the entrance of the Great Smoky Mountains National Park, I’ve had a vacation home there for 20 years and spend Spring and Fall there. I love hiking in the backcountry, and if I cannot say that I’ve walked the entire length of the Appalachian Trail, I can say I’ve walked its entire width.

With multiple fires spreading through the popular resort town, the mountain that my house is situated on lit up like a match.  In the dry, windy conditions, hundreds of homes were burnt to the ground. As of this writing, I have not yet heard of the fate of the home in which I’ve accumulated 20 years of memories. The likelihood is that it no longer exists. Much more importantly, homes of many permanent residents have been destroyed, leaving them homeless; the businesses that employed those people were incinerated.

Putting my feelings aside for a moment, let’s talk about what you can do in the face of an irresistible force like a wildfire. How can you protect your property (and yourself) from being devastated by fire? Two main principles for property defense are 1) vegetation management and 2) creating a “defensible space”. The main strategy for personal defense is “Get Out Of Dodge”.

An important factor in wildfire preparedness is what we call “vegetation management”. With vegetation management, the key is to direct fires away from your house. There are several ways to accomplish this, all of which require vigilance and regular maintenance. 

You’ll want to clean up dead wood and leaf piles lying within 30 feet of your building structure. Pay special attention to clearing off the roof and gutters. Although you may have spent time and money putting lush landscaping around your home, you may have to choose between attractive, yet flammable plants and fire protection.

You’ll want to thin out those thick canopied trees near your house, making sure that no two canopies touch each other. Any trees within 50 feet on flatland, or 200 feet if downhill from your retreat need to be thinned, so that you’re pruning branches off below 10-12 feet high, and separating them by 10-20 feet. No tree should overhang the roof. Also, eliminate all shrubs at the base of the trunks.

Lawns and gardens should be well-hydrated; collect lawn cuttings and other debris that could be used as fuel by the fire. If water is limited, keep dry lawns cut back as much as possible (or remove them).

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From a wildfire perspective, a defensible space is an area around a structure where wood and vegetation are treated, cleared, or reduced to slow the spread of flames towards a structure. Having a defensible space will also provide room to work for those fighting the fire.

The amount of defensible space you’ll need depends on whether you’re on flat land or on a steep slope. Flatland fires spread more slowly than a fire on a slope (hot air and flames rise). A fire on a steep slope with wind blowing uphill spreads fast and produces “spot fires”. These are small fires that ignite vegetation ahead of the main burn, due to small bits of burning debris in the air.

Woodpiles and other flammables should be located at least 20-30 feet away from structures. Gardening tools should be kept in sheds, and those sheds should be at a distance from the home.  Concrete walkways and perimeter walls may serve to impede the progress of the fire.

Attic and other vents should be covered with screening to prevent small embers from entering the structure. Additional strategies for the home can be found at firewise.org.

Of course, once you have created a defensible space, the natural inclination is to want to, well, defend it. Unfortunately, you have to remember that you’ll be in the middle of a lot of heat and smoke.

The safest recommendation, therefore, would be to get out of Dodge if there’s a safe way to leave. It’s a personal decision but realize that your family’s lives may depend on it. If you’re leaving, have a bag already packed with food, water, extra clothes, batteries, flashlights, and more. Don’t forget to bring your cell phone, any important papers you might need, and some cash.

As an added precaution, make sure you shut off any air conditioning system that draws air into the house from outside. Turn off all your appliances, close all your windows and lock all your doors. Like any other emergency, you should have some form of communication system established with your loved ones in case you’re not together.

Medical kits should contain masks, eye and hand protection, burn ointment (aloe vera is a natural alternative) and non-stick dressings. Specialized burn dressings are available that incorporate both. Gauze rolls and medical tape can be used for additional coverage. Round out your kit with scissors, cold packs, and some eyewash (smoke is a major irritant to the eyes).

If your routes of escape are blocked, make sure you’re dressed in long pants, sleeves, and heavy boots. A wool blanket is very helpful as an additional outside layer because wool is relatively fire-resistant. Some people think it’s a good idea to wet the blanket first: Don’t. Wet materials transfer heat much faster than dry materials and will cause more severe burns.

If you’re inside a building, stay on the side farthest from the fire and with the least number of windows (windows transfer heat to the inside). Stay there unless you have to leave due to smoke or the building catching fire. If that’s the case and you have to leave, wrap yourself in the blanket, leaving only your eyes uncovered.

If you’re having trouble breathing because of the smoke, stay low, and crawl out of the building. There’s less smoke and heat the lower you go. Keep your face down towards the floor. This will help protect your airway, which is very important. You can recover from burns on your skin, but not from major burns in your lungs.

As of this writing, I’m still waiting for public access to my part of the mountain in Gatlinburg to be reinstated. If my home survived, it could have been due to the principles I’ve followed above, but it could also be just the wind direction or some timely rain. I’d like to believe it’s the former, but, heck, I’ll take the latter.

Joe Alton, MD

Please take a moment to include firefighters, medical personnel, and the citizens of Gatlinburg in your prayers. Also, a donation to the American Red Cross can be sent to First Tennessee Bank to aid fire relief efforts. The Johnson City Press reports that the First Tennessee Foundation will match donations up to $50,000. Send a check for any amount payable to the American Red Cross to:

First Tennessee Bank              

P.O. Box 8037

Gray, TN 37615

attn: Ms. Teresa Fry

Survival Medicine Hour: Respiratory Infections, pt. 3, Foot Care, More

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colds

Respiratory Infections

The Survival Medicine Hour, November 25, 2016, with Joe Alton, MD aka Dr. Bones, and Amy Alton, ARNP aka Nurse Amy explore various respiratory infections and their symptoms. We classify respiratory infections as upper and lower. Upper respiratory infections invlove the troat, nasal passages, sinuses and larynx. Lower respiratory infections invlove the trachea (wind-pipe), bronchi and lungs.

Discover the common treatments and medications commonly used to treat these infections, and some special tips to help prevent them. What do you do with your toothbrush after you recover from a respiratory infection? Are you still using anti-bacterial soap to wash your hands? Find out what you should be doing to stay healthy and why.

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Pick the right shoes!

Christmas holidays are the time for shopping and lots of walking. Wear the wrong shoes and you may be in a world of hurt. Nurse Amy shares some good advice on what kind of shoes to wear on long walks and how to pick the right shoes for your feet.

To Listen in, Click below:

http://www.blogtalkradio.com/survivalmedicine/2016/11/25/survival-medicine-respiratory-infections-pt3-foot-care-happy-thanksgiving

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton, MD

 

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Doom and Bloom’s SURVIVAL! board game

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game miniatures (an added bonus!)

Video: Storing Medications

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medicines

Storing Meds

In good times or bad times, having a strategy for the proper storage of medicines will help preserve their potency for when they’re needed. Here’s a video by Joe Alton, MD about the factors to consider when putting away those needed medications for later use. Companion video to a recent article.

To watch, click below:

Wishing you the best of health in good times or bad,

 

Joe Alton, MD

 

 

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You’ll need more than just medicine to get you through a disaster, so check out Nurse Amy’s entire line of medical supplies at her store at https://store.doomandbloom.net/    You’ll be glad you did!

Sleep Deprivation

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sleep deprivation

In our roles as preparedness experts for disasters and epidemics, we’re often asked to come on various media outlets to give our opinion, mostly on medical issues. Occasionally, we get the interview request that seems to be a medical topic but has obvious political overtones. Just yesterday, a radio station asked me to comment, as a doctor, on whether Donald Trump’s 4-hour a night sleep habit impacts his ability to make rational and sound decisions.

As for my opinion on this particular question, I’ll refer you to americansurvivalradio.com, but suffice it to say that he’s actually in pretty good company with regards to sleep habits.  Five hours was reported as a good night’s sleep for Bill Clinton while president. Winston Churchill liked naps but slept little at night. Martha Stewart is just one of many business leaders that get less than the recommended 7-8 hours per night. There are, in fact, quite a few highly successful folks who seem to do just fine with little shut-eye.

Sleep deprivation is a pretty serious issue: Some researchers believe that it can carry a mortality risk approaching that of cigarettes or heart disease. Indeed, sleep deprivation has been used as a torture method in interrogations. The CDC estimates that up to 50-70 million Americans suffer from some kind of sleep disorder. In the aftermath of a major disaster, you can imagine that issues with sleep deprivation will only increase.

How does sleep deprivation decrease your chances of succeeding in times of trouble? Not getting enough sleep can significantly impair your brain’s function. The parts of the brain involved in alertness and attention (the thalamus) and the area that controls many higher-level thought processes (the prefrontal cortex) are especially vulnerable.  If the brain doesn’t get enough rest, you may become incapable of putting events into the proper perspective and taking appropriate action, a pretty big issue whether you’re president of the United States or the survivor of a major disaster.

Scientific studies bear this out. Indeed, The British Medical Journal equates the effects of 17-21 hours without sleep as the equivalent, in terms of affecting behavior, of having a blood alcohol level close to the legal limit of intoxication. A number of articles that evaluated the performance of medical residents show that those getting less than 4 hours of sleep made more medical errors that residents who slept 7-8 hours a night.

What about the elderly? Don’t older people naturally sleep less hours and less deeply? Studies show that that the elderly do get less sleep, but it’s not necessarily because they need less. Sleep could be affected for all sorts of reasons: sleep apnea, arthritis pain, heart issues, etc. Those in their later years also might develop something called “advanced sleep-phase syndrome”. These folks’ bodies want to go to sleep earlier and wake up earlier but their minds (and HBO, I expect) keep them from getting to sleep at a reasonable hour. Result: Sleep Deprivation.

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In addition to what’s happening in your brain, the failure to get 7-8 hours of sleep every night causes a whole set of symptoms, none of which are particularly good for a survivalist. Here are just some:

  • Irritability
  • Depression
  • Tremors
  • Bloodshot, puffy eyes
  • Headaches
  • Confusion
  • Memory loss
  • Muscle aches
  • Hallucinations and other psychotic symptoms
  • Ill effects on control of diabetes and high blood pressure
  • Blackouts lasting up to 30 seconds (also called “microsleeps”)

There are a number of people that seem to function just fine with less than the average number of sleep hours. No one is quite sure why this is so, but it appears to involve about 5% of the population and may be related to genetics. For the rest, it rapidly becomes clear that they need more sleep.

There are things that you can do to get a few more hours of shut-eye each night. The best start is to consider a concept we’ll call “sleep hygiene”.  Sleep hygiene involves adjusting your behavior to maximize the amount of restful sleep you get.  Consider:

  • Sticking to a standard bedtime and wakeup time
  • Making your nighttime environment as comfortable as possible
  • Avoiding Nicotine, Caffeine, and Alcohol before going to bed.
  • Staying awake from heavy foods for at least 2 hours before going to sleep
  • Exercising regularly, but not right before going to bed
  • Eliminating as much light as possible in the room at bedtime
  • Keeping your mind clear of stressful issues at bedtime

After a disaster, many of the above strategies are difficult to implement. Of course, there are drugs like Ambien and Halcion that you can use, but a better alternative to start with might be some form of natural sleep aid.  Some of the common alternative remedies for sleeplessness include the following teas:

  • Chamomile
  • Kava Root
  • Lavender
  • Valerian Root
  • Catnip

Good nutrition is important for general health, but some foods are also thought to be helpful in promoting a good night’s sleep.  They contain sleep-inducing or muscle-relaxing substances like melatonin, magnesium, or tryptophan. Some examples:

  • Oatmeal – melatonin
  • Milk – tryptophan
  • Almonds – tryptophan and magnesium
  • Bananas – melatonin and magnesium
  • Whole wheat Bread – helps release tryptophan

Yoga, massage, meditation, sound machines, and even acupuncture might also be effective ways of dealing with sleep deprivation.

Staying healthy in normal times or in the aftermath of disaster involves, not only maintaining good physical hygiene, but maintaining good sleep hygiene as well. To be at 100% efficiency, get some rest!

Joe Alton, MD

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Joe Alton, MD

Survival Medicine Hour: Respiratory Infections, Part 2, Effects of Stress, More

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This week on the Survival Medicine Hour, Joe Alton, MD aka as Dr. Bones and Amy Alton, ARNP aka Nurse Amy, November 19, 2016, discuss some tips to help “survive” the possibly stressful Christmas shopping experience. Ebay did a study that found 88% of shoppers had elevated heartbeats similar to an athlete running a marathon. What are the effects of a rapid heart rate on the body, and learn why you feel so exhausted after an anxiety attack.

The latest update on Zika theories about why some countries are experiencing a higher rate of birth defects than others. What is going on with the progress of a Zika vaccine and a breakthrough medication to limit the ill effects of the virus on unborn babies.

Respiratory infections affect millions of people each year. Knowing how to tell the difference between different types will help you, as the survival medic, determine the best treatment plan. Colds vs flus, how to tell the difference, and more…

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/11/18/survival-medicine-hour-respiratory-infections-pt2-effects-of-stress-and-morehttp://www.blogtalkradio.com/survivalmedicine/2016/11/18/survival-medicine-hour-respiratory-infections-pt2-effects-of-stress-and-more

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton aka Dr. Bones and Nurse Amy

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The Altons

 

Why The Disparity In Zika Affected Newborns?

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zika virus

Zika Virus under the microscope

Zika virus hasn’t been on the front page much lately, but case numbers continue to rise in many countries. The World Health Organization stated recently that Zika infection has been documented in 75 countries throughout the globe.

One of the many unusual aspects of Zika virus is that Brazil has, far and away, the most cases of babies born with birth defects. The most prominent of these is microcephaly, a condition where the brain fails to grow normally, causing a striking appearance where the head is much smaller than normal. Brazil has about 2000 cases of this abnormality, while Colombia has the second highest with only 57; the U.S. is third with 31 cases, including miscarriages. Within Brazil itself, the Northeastern part of the country has the highest number of infants affected by the debilitating effects of the virus.

The American Society of Tropical Medicine, in its annual meeting in Atlanta, discussed this disparity, which has fueled a hotbed of speculation about the disparity.

A  Brazilian health official, Pedro Fernando da Costa Vasconcelos, suggests that vaccination against  Yellow Fever, a virus in the same family as Zika, may be a factor. In Northeastern Brazil, few receive this vaccine compared to other parts of the country. It’s possible, he says, that the vaccine may give some cross-protection against Zika.

A number of other theories exist, including effects on humans by certain pesticides used in the epidemic zone and, perhaps, contaminated lots of vaccines. However, no hard data has, as yet, implicated these and other possibilities as part of the equation.

Another factor may be the growing tendency of women to terminate their pregnancies in the face of a diagnosis of Zika infection. Still another, according to Albert Ko, a Yale professor, relates to the difficulty tracking numbers of abortions for this reason and the fact that many never know they had the infection at all. Zika has no symptoms whatsoever in 80% of patients. The rest experience fever, joint aches, rashes, and eye redness.

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Microcephalic Infant

What is obvious, however, is that there are wide variations in the percentage of Zika infections to birth defects. Puerto Rico recently reported its first case of microcephaly in a newborn, but has catalogued  more than 30,000 people infected with Zika.

Professor Ko says that a new large-scale study will follow thousands of pregnant women with Zika diagnoses. Genetics, prior viral infections, and even the mosquitoes that transmit the virus will be evaluated. It’s possible that, with this information, a more definitive picture of factor involved in Zika-related birth abnormalities will emerge.

An issue not commonly considered is what effect Zika infection may have long-term in apparently unaffected infants. Will they reach normal milestones like walking and talking at the appropriate time? Down the road, will they perform adequately in school? It will take years to find out.

Meanwhile, cases continue to accumulate, mostly travel related. A total of close to 36,000 cases have been documented by the Centers for Disease Control and Prevention (CDC) in the United States and the U.S. territory of Puerto Rico. New cases are still being reported in Florida by the Department of Health, which says that 1,165 total cases (153 in pregnant women) exist in the state as of November 11, 2016. Of these, 225 were transmitted by local mosquitoes.

Some good news: A vaccine called Zika Purified Inactivated Virus, or ZPIV, seems to be showing promise in research conducted, and human trials have begun at the Walter Reed Army Institute of Research. In addition, Dr. Michael Diamond of the University of Washington has identified an antibody that might protect the unborn fetus against the effects of the Zika virus on nervous tissue. Research is ongoing on these and other fronts in the battle against what has become a worldwide epidemic.

Joe Alton, MD

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Dr. Alton

 Find out more about the Zika Virus in Joe Alton, MD’s book “The Zika Virus Handbook“, available at amazon.com

 

 

Survival Medicine Hour: Storing Meds, Respiratory Infection, Pt. 1

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How to store meds

The Survival Medicine Hour (November 11, 2016) exposes the issues we all face when looking at an uncertain future. If you prepare for long-term survival due to man-made or natural disasters, one looming problem is how to keep your much needed medications in the best condition possible. Nurse Amy. aka Amy Alton, ARNP and Dr. Bones, aka Joe Alton, MD cover some techniques and methods to help you solve this medication storage problem.

Part 1 of respiratory infections is also covered in this episode, plus a discussion of the reappearance of the respiratory virus that originates in the intestine, Enterovirus D68.

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Medic Memorial

On this Veteran’s day, Dr. Bones and Nurse Amy want to say thanks to all of our military staff new and old; we greatly appreciate your service to our country!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/11/11/survival-medicine-hour-storing-medications-longterm-respiratory-infections-pt1

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

 

AmyandJoePodcast400x200Find out more about medical issues in times of trouble with the Third Edition of The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way, available at Amazon.com.

Storing Medications

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medicines

Storing Medications

Being prepared for disasters means storing food, but it also means putting together a stockpile of medical supplies. While bandages and instruments may keep acceptably in a variety of environments, medications are another story.

How medicines are stored can affect their potency over time. To maintain the effectiveness of the drugs, there are several factors that deserve your attention:

Heat: Most medications are meant to be stored at room temperature. Insulin and some antibiotic elixirs are an exception, and should be stored in the refrigerator. A good rule of thumb is that, unless the bottle contains labeling that says otherwise, it’s unnecessary (and in many cases, harmful) to freeze or otherwise diverge from the advice given by the manufacturer.

Excessive heat is another factor in losing drug potency. Given the choice, somewhat cooler is probably better than hotter. It’s thought that drug effectiveness fades twice as quickly if stored at 90 degrees Fahrenheit than if stored at 50 degrees.

Moisture: Most folks store medications in the bathroom medicine cabinet, but you might be surprised to know that the moisture from showers and baths can degrade the drug significantly. Instead, consider a high shelf in a closet or a dedicated storage box.

Light: Much like excessive exposure to the sun could damage skin, light sometimes could have an ill effect on certain drugs. These meds are commonly stored in brownish-colored bottles. Keep all medicines in their original containers. It might be a good idea, however, to remove the cotton ball commonly placed with the drug as it could pull moisture into the container.

Many times, it might be hard to tell if a drug has been affected negatively, but some others are pretty obvious. Aspirin pills, for example, can develop a vinegar-like smell (even before the expiration date). Besides smell, a change in color or consistency may signal that a medication has degraded. If pills or capsules are harder or softer than normal or stick together, be wary.

Some people get their meds through the mail. If so, choose overnight shipping whenever possible to avoid prolonged travel time. ABC news reported recently that a 1995 FDA study found that a standard black mailbox can reach 136 degrees in the summer heat. Excessive time in the hot sun or extreme cold for a long period of time causes drug deterioration. A better alternative may be to send them to where you can take possession personally and immediately. For many, this might be their workplace as opposed to their home.

One of the questions I’m often asked is whether drugs will benefit from vacuum sealing. Although you’ll find opinions everywhere, there doesn’t seem to be any hard data on the issue. I would expect that more drugs would be vacuum packed by the manufacturer if it was that important to maintain potency. Having said that, pharmaceutical companies want you to discard older meds so they might not be motivated to do so.

Vacuum packing would affect moisture but wouldn’t affect important preservation aspects like temperature or light. As meds do best in their original containers, it seems that, with the possible exception of powder packets, it wouldn’t be an essential storage method.

So, consider storing all meds in cool, dark, dry conditions. It’s especially important to be sure that all medications are kept out of the reach of children. Childproof lids are meant to help you achieve this goal, but consider a storage box with a lock as well.

The wise family will keep a good medical kit and a supply of over-the-counter and needed prescription medicines stored safely in their home. In a disaster, attention to proper storage methods might just save a life.

Joe Alton, MD

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Dr. Alton

Besides medicine, you’ll need a variety of medical supplies to deal with medical issues in times of trouble. Check out Nurse Amy’s entire line of medical kits at store.doomandbloom.net.

Medical Supplies for the Homestead

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image by pixabay.com

If you’re a homesteader, you’ll want to be ready for any eventuality. In a remote location or austere environment, the importance of medical self-reliance can’t be overemphasized. Injuries and illness can happen anytime due to a storm, wildfire, earthquake, or other disaster.

Medical strategies abound for these mostly short term scenarios that are both reasonable and effective.  An entire medical education system exists to deal with limited wilderness or disaster situations. This system is served by a growing emergency supply industry and, in some cases, supported by federal taxes.

When you happen upon a victim in normal times, your goal is to:

  • Evaluate the injured or ill patient.
  • Stabilize their condition.
  • Transport them to the nearest modern medical facility.

This series of steps couldn’t make more sense; you’re not a physician, after all.  Somewhere, there are facilities that have a lot more technology than you have.  Your priority is to get the patient out of immediate danger and then ship them off to a higher medical resource.

It seems reasonable for the average citizen to expect the rescue helicopter to be on the way. But what if it isn’t? Some homesteads are far from the nearest hospital. When modern medical help isn’t at hand, quick action on your part may be necessary to save a life.

You never know when you might be the medical “end of the line” in the uncertain future. To be effective in that role, you need supplies.

Prepper Medical Supply Kit

Family Medical Kit

The availability of medical supplies may just save a life in troubled times, but without an idea of what medical items should be stockpiled, your effectiveness as an emergency caregiver may be compromised. Not having the right equipment at hand is like trying to eat a steak with a wrench and a screwdriver instead of a knife and fork. Purchasing these items all at once would be hard on the wallet, so the best strategy Is to slowly stockpile the medical supplies you need.

This article is meant to be a guide to which supplies would help you become an effective caregiver as opposed to being an in-depth discussion of how to use each one. To help you become a well-equipped homestead caregiver, we’ll list common medical issues and what items you’ll need to deal with them.

PERSONAL PROTECTION 

N95-Surgical-Mask

N95 mask

To begin with, however, let’s talk about personal protection.  No, I’m not talking about condoms, although they can be important additions to your storage. I’m not talking about firearms, either, although military medics are now usually armed.  I’m referring to protecting yourself and others from injuries and infectious disease.

Don’t ignore the power of prevention. In any remote environment, you will be performing daily activities that carry risk of injury.  Chopping wood for fuel would be one example. Eye and hand protection in the form of goggles and work gloves could prevent various injuries. Here are some other items that would be protective:

Gloves: I recommend nitrile gloves due to the increasing number of latex allergies reported recently. I would use size 8 or “large”, as gloves that are too small tend to break.  Gloves come in both sterile and non-sterile varieties.  Get lots of the non-sterile for everyday work, but don’t fail to have some sterile pairs as well.

Face Masks: These can be simple ear-loop versions or could be more advanced in the form of N95 and N100 “respirators”. These are masks that block out 95 or 100% of airborne particles larger than 0.3 microns.

Coveralls, Boots, and Headgear:  In mosquito-infested areas, there are special coveralls and headgear made from netting that are lifesavers. In epidemics of infectious disease, however, hazardous material suits that cover the body, head and feet are more pertinent for the person in charge of the sick room.

General items: Some items are of good general use for medical issues.  One of my favorites is the “EMT shears” or “bandage scissors”.  This is a special scissors meant to allow you to cut through clothing so that you can accurately assess the level of injury that you’re dealing with.

Another general item that would be highly useful would be a headlamp.  Injuries can occur at night as well as during the day. Using a headlamp frees up both hands to better handle emergencies.

A good supply of antiseptics will be important to keep your people healthy. Antiseptics are germ-killing substances that are applied to living tissue, usually skin, to reduce the possibility of infection. Antiseptics are different from antibiotics, which are meant to destroy bacteria within the body, and disinfectants, which destroy germs found on non-living objects, like kitchen or survival sick room surfaces.

I consider household bleach to be the simplest disinfectant for cleaning sick room work surfaces, but it’s too strong to apply to living tissue. Instead, consider Betadine (Povidone-Iodine solution), Chlorhexidine (Hibiclens), Alcohol , Benzelkonium Chloride (BZK), or Hydrogen Peroxide.  These can be found in small bottles, gallon jugs, and in wipes impregnated with the antiseptic.

Some of the most important medical supplies you’ll accumulate will be those used to deal with injuries. Let’s outline what you’ll need in your role as a homestead medic:

MINOR INJURIES

In an austere environment, it might be difficult to get through the day without some minor injury, such as a burn while cooking, blister while hiking, or a splinter from hauling wood. The average person has, over the course of their lives, dealt with more than one of these. Helpful items to have include:

  • Soap and water and antiseptics: To clean out minor wounds. Antibacterial soap is not necessary, however. The FDA (Food and Drug Administration) determined that it doesn’t give additional protection against infection.
  • Adhesive Bandages: various sizes and shapes to protect a scratch or abrasion from getting worse.
  • Moleskin: Have a supply of these to deal with common blisters on areas that receive friction.
  • Tweezers: With a magnifying glass, these will be useful to remove splinters or other small foreign objects.
  • Styptic Pencil: Although most minor bleeding stops with direct pressure, a styptic pencil can be used for razor cuts and is a helpful addition to your kit. For a natural alternative, Cayenne pepper powder is reported to have similar effects on minor bleeding.
  • Eye wash, cups, and patches: For minor eye irritation and injuries.
  • Gauze packing: for nosebleeds.  Dental cotton rolls and tampons are alternatives.
  • Burn Gel or Aloe Vera: To apply to small burns.

ORTHOPEDIC INJURIES

samsplints

The popular SAM Splint

Few of us, even couch potatoes, have avoided the occasional sprain or strain.  In situations where we are exerting ourselves, these will be more common, not to mention the possibility of fractures. You should have available:

Cold Packs:  These are available commercially or can be made with ice.  Cold packs help reduce the swelling often seen in sprains and strains, as well as provide some relief from pain.

Elastic Wraps: Elastic “Ace” wraps help stabilize an injured joint and decrease the chance of re-injury. Use compression in tandem with cold to decrease pain and swelling.  Don’t forget to elevate the injured limb above the level of the heart. Elastic wraps can also be used to cover bandaged wounds and to secure splints in place.

Slings: Commercial triangular bandages or improvised bandannas both are well suited to make a sling, these are useful to stabilize an arm or shoulder injury. The commercial versions usually come with safety pins.

Splints: Commercial “SAM” splints are flexible and can be cut or shaped to immobilize a sprain or fracture.  These vary in size to fit anything from a finger bone to a thigh bone. You can improvise with sticks and strips of cloth or even a folded-over pillow and duct tape.

Anti-inflammatory medications:  Ibuprofen is an over the counter medication to reduce swelling and pain in orthopedic injuries, and can be accumulated in bulk.  Salicin from the green underbark of willow trees is helpful for pain and, incidentally, was the base substance for the first aspirins ever made. Natural remedies such as Arnica salves are useful to decrease bruising, swelling, and pain (use on intact skin only).  Various anti-inflammatory medications also come in patches that can be applied to the back or other strained areas.

Heat Packs:  These won’t reduce swelling much, but can be used during recovery from an injury to help relax and loosen stiff tissues. They also stimulate blood flow to injured areas.

HEMORRHAGIC WOUNDS

expose-wound-to-see-the-full-extent-of-the-injury

EMT shears or bandage scissors can help expose a bleeding wound

The injury that non-professionals fear most is the bleeding wound.  With the right supplies, however, even heavy bleeding can be staunched successfully.  In addition to a blunt-edged scissors to expose the injury, the well-prepared medic will have:

Gauze: Bulk non-sterile gauze (some of our kits carry bricks of 200 at a time) is valuable as a medical storage item to apply pressure to bleeding areas.  Even one hemorrhagic wound could require you to use all the dressings that you had accumulated over years of stockpiling,  so get plenty.

Dressings come in squares of varying sizes and shapes. Roller bandages wrap around the area, and non-stick pads of various sizes (not technically “gauze”) are good for burns and other injuries. Carry a variety to increase the versatility of use.

Although I recommend storing tampons, it is more for its traditional use than to treat gunshot injuries, which vary in size (especially exit wounds). A tampon would not always be the right size for the cavity created by the projectile; they are best used for nose bleeds combined with compression.  Maxi-Pads, however, are excellent items for your medical storage.

Specialized Pressure Dressings:  It’s difficult to keep pressure on a wound with your hands without becoming tired, so special dressings like the Emergency Bandage™ (aka the “Israeli Battle Dressing”) allow you to wrap wounds that have the tendency to bleed.  These are an absorbent pad attached to an elastic bandage that comes with a “pressure applicator”. Used correctly, each turn of the wrap increases the pressure on the wound, which can help control bleeding.

Tourniquets:  In circumstances where bleeding can’t be stopped with pressure alone, a tourniquet may do the job. Tourniquets can be improvised with a bandanna and a stick or they can be high-tech commercial items such as the CAT or SOFT-T tourniquet.  Some tourniquets, like the SWAT, can serve double duty as a tourniquet, back-up tourniquet, or pressure dressing.

Blood-Clotting Powders/Dressings:  Also known as “hemostatic agents”, these are effective and easy to use. Available as a powder or powder-impregnated dressings, Celox™  (the most popular brand) is made from Chitosan, a component of crustacean shells. Celox™ will even stop bleeding in patients on blood thinners.  Although it is made from shrimp shells, the company states that can be used on people allergic to seafood.  Hemostatic agents are useful but expensive items. Remember, however, that they might save a life.

OPEN WOUNDS

stabwound

Dealing with open wounds in a remote setting requires good judgment as well as supplies. Most of these wounds should be kept open, but there are various supplies to help you close a wound as well as supplies that allow you to care for an open wound until it closes on its own by a process called “granulation”. In a remote homestead or survival setting, you never know when or if help will be on its way. You’ll need to be ready to care for that wound from beginning to end.

Antiseptics and sterile gloves:  As mentioned earlier in this article.

Sterile Gauze: Although non-sterile gauze is often used to stop hemorrhage, sterile dressings are best to use in open wounds as they heal. With commercial sterile saline or water solutions (or even boiled water), you’ll provide the type of environment that newly forming cells need to fill in a wound.  Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean. Some call this technique “wet to dry”.

Certain dressings, such as “Telfa™”, are non-stick and especially useful for burns or other injuries where removal might be painful. Some burn dressings like “Xeroform™” are dipped with petrolatum to protect healing areas where the skin was damaged or burned off. Alternatively, petroleum jelly could be added to improvise a similar item. Honey has also been used for this purpose, but make sure to get the raw, unprocessed version.

Wound Closure:  Closing a wound is risky (most wounds acquired outdoors are contaminated) but there are circumstances where it may be appropriate. Always start with the least invasive method such as Steri-Strips or even duct tape fashioned as butterfly closures. Sutures and staples can form a strong closure, but they also add more punctures to the skin that could become infected. Super glue is a safe method unless you happen to be allergic to the chemical (Cyanoacrylate). It is used in some underdeveloped countries without incident.

Additional Supplies:  Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean. Medical tapes to hold everything in place are helpful and come in cloth, self-adhesive, and paper (least allergenic).  Tincture of Benzoin is an adhesive liquid that comes in ampules that will help secure the tape. Triple antibiotic ointment and oral antibiotics are likely to be needed to prevent and treat infected wounds.  Consider having a thermometer to determine whether a fever is present.

I’ll bet you can think of other useful items that you’d want to keep in that homestead medical cabinet. We haven’t discussed, for example, the medications and natural remedies you should have on hand. We’ve addressed these before on this website, though, and will update in a future article.

HOW MUCH TO HAVE?

I commonly see books that give you numerical amounts of medical items to have if you’re the caregiver in an austere environment or in a long-term survival scenario.  My opinion is simple:  You can never have too many of any medical supply.  They are expended more quickly than you think. If you’re in a remote location or other austere setting, have as much as possible in your storage.

A parting thought: You can have all the beans in the world and all the bullets in the world, but it won’t amount to a hill of beans and you’ll just shoot yourself in the foot, if you don’t have the bandages.

Joe Alton, MD

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Whether you’re a homesteader or a city dweller, you need medical supplies to deal with injuries and illness in the uncertain future. Check out Nurse Amy’s entire line of kits and individual items at store.doomandbloom.net. Also, keep a copy of our brand new Third Edition of “the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way” in your survival library.

 

Portions of this article were first published in Backwoods Home magazine.

The Future of Fish Antibiotics in Survival?

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Siamese Fighting Fish (Betta splendens)

As the first physician to write, years ago, about aquarium and avian antibiotics as a survival tool, I’ve long realized their utility in preventing unnecessary deaths in true survival scenarios (in normal times, seek modern and standard medical care). Lately, I’ve received a lot of mail asking about the upcoming FDA Veterinary Feed Directive. Does it mean the end of the availability of fish and bird meds for placement in disaster medical storage?

To understand what the Veterinary Feed Directive is and what it means for the preparedness community, we should first describe the problem that the Directive aims to correct: Antibiotic resistance. There is an epidemic of antibiotic resistance in this country, and it exists, not because of pet bird or fish antibiotic use, not because “preppers” might put them in a disaster medical kit, nor even primarily from the overuse by physicians. It is due to the excessive use of antibiotics on livestock. About 80% of antibiotics used in the United States are given to food-producing animals.

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The definition of a “Veterinary Feed Directive (VFD) drug”, according to section 504 of the FD&C Act (21 USC 354) states that it is “[a] drug intended for use in or on animal feed. The CDC’s goal #1 of decreasing the emergence of antibiotic resistance and preventing the spread of resistant infections has three objectives (see page 33):

1       -“Implement public health programs and reporting policies that advance antibiotic resistance prevention and foster antibiotic stewardship in healthcare settings and the community. “

2       -“Eliminate the use of medically important antibiotics for growth promotion in animals and bring other in-feed uses of antibiotics, for treatment and disease control and prevention of disease, under veterinary oversight. “

3       –“Identify and implement measures to foster stewardship of antibiotics in animals.”

As you can see, 2 of 3 of the above relate specifically to animals. Why are so many antibiotics given to livestock? It’s not, primarily, to treat infections that they may have. It’s actually because, for reasons that aren’t completely clear, it seems to speed their growth and gets them to market sooner. In other words, the profit motive. This is standard practice here in the U.S., but some countries, like Denmark, have banned the use of antibiotics on livestock unless they need them to treat disease.

The FDA and CDC are concerned about the excessive use of antibiotics in general and, in particular, on the animals that produce our food. CDC director Dr. Tom Frieden mentioned some months ago that an increased “stewardship” (in other words, control) of these meds was indicated to decrease the development of antibiotic resistance. The Veterinary Feed Directive is part of that response.

What are the drugs affected by the Veterinary Feed Directive? Here they are:

Established drug name Examples of proprietary drug name(s)
chlortetracycline Aureomycin, Aureomycyn, Chlora-Cycline, Chloronex, Chlortetracycline, Chlortetracycline Bisulfate, Chlortet-Soluble-O, CTC, Fermycin, Pennchlor
erythromycin Gallimycin
gentamicin Garacin, Gen-Gard, GentaMed, Gentocin, Gentoral
lincomycin Linco, Lincomed, Lincomix, Lincomycin, Lincomycin Hydrochloride, Lincosol, Linxmed-SP
lincomycin/spectinomycin  Lincomycin S, Lincomycin-Spectinomycin, L-S, SpecLinx
neomycin Biosol Liquid, Neo, Neomed, Neomix, Neomycin, Neomycin Liquid, Neomycin Sulfate, Neo-Sol, Neosol, Neosol-Oral, Neovet
oxytetracycline Agrimycin, Citratet, Medamycin, Oxymarine, Oxymycin, Oxy-Sol, Oxytet, Oxytetracycline, Oxytetracycline HCL, Oxy WS, Pennox, Terramycin, Terra-Vet, Tetravet-CA, Tetroxy, Tetroxy Aquatic, Tetroxy HCA
penicillin Han-Pen, Penaqua Sol-G, Penicillin G Potassium, R-Pen, Solu-Pen
spectinomycin Spectam
sulfadimethoxine Agribon, Albon, Di-Methox, SDM, Sulfabiotic, Sulfadimethoxine, Sulfadived, Sulfamed-G, Sulforal, Sulfasol
sulfamethazine SMZ-Med, Sulfa, Sulmet
sulfaquinoxaline S.Q. Solution, Sulfa-Nox, Sulfaquinoxaline Sodium, Sulfaquinoxaline Solubilized, Sul-Q-Nox, Sulquin
tetracycline Duramycin, Polyotic, Solu/Tet, Solu-Tet, Supercycline, Terra-Vet, Tet, Tetra-Bac, Tetracycline, Tetracycline Hydrochloride, Tetramed, Tetra-Sal, Tetrasol, Tet-Sol, TC Vet

“Note: apramycin, carbomycin/oxytetracycline*, chlortetracycline/sulfamethazine*, streptomycin, sulfachloropyrazine, sulfachlorpyridazine, and sulfamerazine/sulfamethazine/sulfaquinoxaline* are expected to transition to Rx status, but are not marketed at this time. If they return to the market after January 1, 2017, they will require a prescription from a veterinarian.”

If you look at the list above, you’ll see no mention of the common aquarium/avian antibiotics used in the pet industry. Fish-Mox (Amoxicillin) is not included in the list. Neither is doxycycline, metronidazole, nor others that I’ve recommended for disaster storage. Some first-generation drugs, like Penicillin and Tetracycline, are mentioned but not any of the proprietary names related to the ornamental trade. That doesn’t mean that they might not include them at some point. As the earliest antibiotics, they have been subject to significant resistance, and might not be the best choices for survival storage in any case.

At present, Thomas Labs, one of the largest distributors of fish and bird antibiotics for the pet trade, has not visibly changed any of its policies regarding sale of these products. Their labeling clearly states “Not for Human Use”, and many sites that sell their products  include this statement:

“…Thomas Labs sources it’s (sic) antibiotics from the same USP grade manufacturing as antibiotics used for humans, but we and Thomas Labs are not doctors and do not deal in human health problems, or prescription medications.  Only a doctor can correctly prescribe antibiotics for specific need in humans.  We strongly discourage anyone who wants to take Fish Antibiotics for themselves…”

It seems clear that the Veterinary Feed Directive considers livestock and not hobby fish and birds to be the highest priority targets. If they did,  the pet trade might cease to exist.

The Veterinary Feed Directive may, indeed, decrease the incidence of bacterial resistance in the U.S. So will the wise use of antibiotics by the nation’s physicians. Hopefully, one day food livestock will be raised antibiotic-free; some companies are already taking this step.

From a preparedness standpoint, I still believe that having antibiotics in your medical kit will save lives in a long-term disaster or survival setting. The ones I have written about over the years are still available, at least for the time being; those medically responsible in times of trouble will find them to be useful tools in the medical woodshed.

 

Joe Alton, MD

AuthorJoe

Joe Alton, MD is a physician, author, and medical preparedness writer for disaster and long-term survival scenarios where medical help is not available for the foreseeable future. For more information on these and other topics, see the Altons’ #1 Amazon bestseller “The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way“.

Survival Medicine Hour: Ron Melchiore on 36 Years of Living Off the Grid

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Survival Medicine Hour

In this episode of the Survival Medicine Hour, Nurse Amy Alton interviews Ron Melchiore, who with his wife Joanna, has lived for 36 years off the grid in Maine and, now, Northern Saskatchewan. Amy finds out all about what Ron’s life as a self-reliant “pioneer” has been like, and how he’s put it all in his book “Off Grid and Free: My Path to the Wilderness“. Ron has hiked the entire Appalachian Trail and has ridden a bicycle from the Atlantic to the Pacific Ocean.

Ron talks about power issues, experience with local animals, wildfires, and other challenges he and his wife have faced in their long-term adventure in the woods. Ron currently lives at a homestead only reachable by float plane, with trips to get supplies twice a year.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/10/28/survival-medicine-hour-interview-with-ron-melchiore-author-off-grid-and-free

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

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Amy Alton ARNP

All About Giardiasis

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giardia-lambia

giardia (aren’t you glad it’s microscopic?)

Recently, I wrote about a relatively unusual medical issue for developed countries: parasitic worms. Problems related to poor hygiene and sanitation, chronic issues in many countries, cause parasites to reach epidemic status.

There are other types of parasites, however, that are more common in local water sources than worms, and they can have dire consequences. One of these is Giardia, a family of parasites that is found in just about every region on Earth. The most common species to affect North America is Giardia lamblia, sometimes called Giardia intestinalis.

A parasite feeds off another organism to survive, and Giardia prefers mammals, including humans. Giardia is a hardy bug, though, and can live for long periods of time in moist soil or water. Infection, known as “giardiasis”, occurs as a result of ingestion of food or water contaminated with feces. Once a person or animal becomes infected with Giardia, it inhabits the intestines and is passed in excrement.

The most common cause of giardia transmission occurs from person to person. Poorly prepared food, unsterile water, and improper bathroom hygiene accounts for the majority of cases. Despite this, the clearest streams in the Colorado backcountry may be contaminated by Giardia, causing it to be an issue for wilderness hikers who don’t pay strict attention to water disinfection and frequent hand-washing.

Mothers and child care workers who fail to adhere to strict hand washing while changing diapers of infected babies are also at risk.

SYMPTOMS OF GIARDIASIS

The symptoms of Giardia don’t often appear immediately. They can begin as early as 2 days after infection. As an intestinal infection, you can expect to see significant watery diarrhea interspersed with soft, greasy stools. Other symptoms include:

  • bloating
  • excessive gas
  • abdominal cramps
  • upset stomach
  • nausea
  • weight loss
  • fatigue

You might not consider the above all that severe, but in many cases, the symptoms last for weeks and may lead to severe dehydration, a common cause of otherwise-avoidable deaths in earlier times, and a serious issue today anywhere advanced care isn’t available. Children are especially prone to malnutrition and, if chronic, may experience stunted growth and development.

TREATMENT OF GIARDIASIS

Severe symptoms can be treated with hydration and antibiotics like Metronidazole (aquarium equivalent: Fish-Zole) or anti-worm drugs (also known as “anti-helminthics”) like Albendazole.

Many less severe giardia infections may resolve without treatment after a few weeks. It’s thought, however, that some people may develop a “carrier” relationship with giardia; symptoms become less noticeable with time, but the carrier can transmit the infection to others (even sexually through oral-fecal routes).

PREVENTION OF GIARDIASIS

There is no medication or vaccine that will prevent Giardia infection. There are, however, a number of precautions that will minimize your risk of infection:

  • Wash your hands. Hand washing after going to the bathroom, changing diapers, and before/after the preparation of food. Use alcohol-based sanitizers if soap and water aren’t available.
  • Disinfect questionable water. Avoid drinking untreated water from lakes, rivers, creeks, and springs unless you filter it with products like the Lifestraw, Mini-Sawyer, or Berkey.  Alternatively, bring water to an active boil for 1-5 minutes first. Add 1 minute for every 1000 feet of elevation (water boils at lower temperatures higher up). It should be noted Giardia is relatively resistant to bleach, a commonly-used water disinfectant.
  • Travel concerns: Use bottled water wherever water is of dubious quality, even for brushing teeth. Avoid putting ice made from local water in drinks. When swimming, keep your mouth closed.
  • Wash food before you eat it. Wash raw fruits  and vegetables before adding them to your meals.
  • Practice safe sex. Sexual intercourse, especially anal sex, can transmit Giardia. Avoid this method or use a barrier like a condom.

The smallest organisms can cause major medical issues in good times or bad. Pay careful attention to sanitation and hygiene, and you’ll keep it together at home, on that wilderness hike, or abroad.

Joe Alton, MD

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(Thanks to Dr. Pam Hendrix for suggesting this topic for an article)

Find out more about giardiasis and many other survival-related medical issues in our brand new 700 page Third Edition of
The Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way, available at Amazon or on this website.

Parasitic Worms

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parasitic worm

It’s important to realize that there are infections not commonly seen today in developed countries that may become major issues if a disaster throws you off the grid. Knowing which disease-causing organisms exist in your area, even if they are not major problems today, will be important to keep your loved ones healthy.

The word “parasite” comes from the Greek word Parastos, meaning “someone that eats at someone else’s table”. When we think of para- sites, none give us the creeps more than having worms.

Parasites like ticks, fleas, mites, and lice live on our skin or just beneath; these are called ectoparasites. Worms, also known as helminths, are endoparasites. They live deep in our intestines or other core organs, often gaining sustenance by sharing our partly-digested food. They are also egg-laying machines, with some depositing tens of thousands a day into their host.

Many different worms are known to infest the human body: nematodes, trematodes, flatworms, and flukes, are just a few. The diseases they cause are a major health issue in underdeveloped countries due to difficulties with sanitation. Even in developed nations, any disaster that impairs access to safe food and water could cause cases of parasitic worms to skyrocket.

Worm infestation is usually caused by ingesting soil that contains their eggs. While this may seem an unlikely happenstance to you, areas where people defecate openly and fail to wash their hands leads to contaminated soil. Some of this soil ends up on people’s hands, and then goes to their mouth when they touch their face.

Parasitic worms range in size from microscopic to very long, depending on the species. The most common infection we’ll see in the U.S. is the tiny Pinworm, which causes anal itching in 40 million Americans. However, almost a quarter of the world’s population has some type of worm infestation. Children are especially vulnerable and may experience stunted growth and developmental problems as a consequence.

Worm eggs or larvae enter the body through the mouth, nose, anus, or breaks in the skin. Amazingly, many helminths actually require human stomach acid to dissolve their egg shells to allow them to hatch. Once hatched, the acid-immune larvae travel from the stomach and attach themselves to the walls of the intestinal tract. Some species infest the liver and lungs as well.

SYMPTOMS OF WORM INFESTATIONS

Colonization by worms may be asymptomatic or, as in the case of pin- worms, just involve some itching in the anal area. With some species, however, a large concentration of organisms can cause serious problems.

Each type of worms cause different symptoms, but you should suspect their presence in otherwise-unexplained cases of:

  • Constipation or diarrhea
  • Abdominal swelling or gas
  • Abdominal pain or cramps
  • Nausea and vomiting
  • Weight loss
  • Constant urge to have a bowel movement.
  • Unexplained skin rashes or sores.
  • Anal itching
  • Constant fatigue.
  • Chronic muscle and joint aches.
  • Malnutrition

The above represents a broad array of symptoms, and makes me wonder if the number of cases of worm infestation is underestimated, even in countries with modern infrastructures.

CONSEQUENCES OF WORM INFESTATIONS

In rare cases, the population of internal parasites is so high that it causes an obstruction of the bowels. Worm species that invade the liver or lungs can cause respiratory distress or a weakened metabolism. All of these complications may result in the death of the patient.

Your body knows when it has been invaded and sets up an immune response against the worm. Success is limited, however, and all the energy put into defense may weaken the ability to fight“secondary” infections that may occur. The more issues the body has to deal with, the less effective it is in fighting them.

Some worms actually compete with your body for the food that you take in. A species known as Ascaris, for example, will attach to the wall of your intestine and eat partially digested food that comes its way. This competition prevents you from absorbing nutrients effectively, and malnutrition results.

TYPES OF WORMS

There are numerous types of helminthic infections based on the species involved. Infections are often named for the species with the suffix “-asis” (for example, ascariasis), as opposed to other infections/inflammations, which often end with the body part affected and the suffix “-itis” (for example, tonsillitis).

Although there many worms that infect humans, some of the more common types are

 

Pinworms

pinworm-cycle

Pinworm life cycle

Pinworms are a type of nematode called a roundworm. Reaching only 1/3 inch in length, they lay eggs around the host’s anus, usually at night. This leads to an itching sensation which can become severe. Pinworms are the most common parasitic worm infection in the United States

A cycle then develops where contaminated fingers from scratching come in contact with the mouth. This transports the eggs inside the body where they hatch.

You can test for pinworms simply by placing adhesive tape on the anal region of the patient. Inspect the tape for worms (eggs may also be seen with a low-power microscope) after a few hours or the next morning.

 

Hookworms

1982 Dr. ?? This enlargement shows hookworms, Ancylostoma caninum attached to the intestinal mucosa. Barely visible larvae penetrate the skin (often through bare feet), are carried to the lungs, go through the respiratory tract to the mouth, are swallowed, and eventually reach the small intestine. This journey takes about a week.

hookworms

Hookworms are another roundworm and one of the most common helminth infections worldwide. The parasite feeds on blood from vessels in the intestinal walls. Hookworm infestation is sometimes asymptomatic, but can cause anemia as well as abdominal symptoms.

Occasionally, a larval (juvenile) hookworm that uses a non-human host may penetrate the skin of a human. Although it can’t go into the organs, it can cause a skin disease called “Larva Migrans”, once known as “creeping eruption”.

With Larva Migrans, you can see serpentine vein-like lesions with itching in the skin. As the larva move, areas where they previously were may become crusty and very itchy.

 

Ascaris

parasiticworm

ascaris super-infestation

The largest intestinal roundworm, reaching 14 inches, is known as Ascaris. It is thought that there are 2 billion people that carry this worm, mostly in poorly developed countries.

Ascaris eggs, when ingested, become a larvae that enters the blood- stream through the small intestine. It reaches the lung, where it leaves the circulation and is eventually coughed up, swallowed, and goes back to the intestine, where it matures. Once mature, the female worm can produce up to 200,000 eggs a day.

Ascaris effects may include bloody phlegm, fever, cough, and abdominal symptoms. If the concentration of worms is high enough, they may begin to leave the body through the anus, nose, or mouth.

 

Tapeworms

tapeworm

tapeworm with 12 inch ruler at bottom for comparison

Tapeworm is a type of infection caused by a flatworm that lives mostly in Asia and Africa. The worm is, indeed, flat. Tapeworm eggs can form
walled-off areas called “cysts” in body tissues and organs. If larvae are ingested, however, they will mature into adult tapeworms in the intestines. The adults are segmented and reach prodigious lengths up to 55 (!) feet long.

Symptoms are typical for other helminth infections but symptoms related to the infested organ may also be seen.

TREATMENT OF WORM INFESTATIONS

Medications that can kill parasitic worms are called “vermiculicides” or “vermicides“. All are prescription drugs, although persons with travel plans to underdeveloped countries shouldn’t have trouble getting these from their physician.

Albendazole (brand name Albenza for roundworms) 400 mg once or twice.

Mebendazole (only available in generic form; most specific for pinworm infestation) 100 mg twice a day for 3 days or 500 mg

Pyrantel pamoate (common ingredient in heartworm meds for dogs) 11 mg/kg once, some species once daily up to 3 days.

Praziquantel (brand name Biltricide for tapeworms, various dosages depending on worm species)

Dosing may vary with some of these medications dependent on the type of worm. A second course of therapy is administered if the patient is not cured in 2-4 weeks.

Naturally anti-helminthic plants also exist. Garlic, ingested fresh and raw, is thought to be an effective way to eliminate worms. Wormwood, Clove, Papaya, Pineapple, Cinnamon, Turmeric, and Plumeria have all been reported to be helpful. Interestingly, some believe that tobacco may help eliminate worms.

Careful attention to hygiene, wearing shoes when outside, and, among medical providers, strict glove use will decrease the likelihood of passing worms or their eggs from person to person. Hand washing, especially before preparing food, is considered especially important in preventing  community-wide outbreaks.

Joe Alton, MD

AuthorJoe

Dr. Alton aka Dr. Bones

 

Video: Hurricane Tips (With Winds in the Background)

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hurricanepalms2

Hurricane Safety Tips

In this companion video to a recent article, Joe Alton, MD goes into his own backyard while Hurricane Matthew’s winds start coming in, and describes 28 different safety tips regarding food, water, shelter, evacuation, and much more for any major storm. One of Dr. Alton’s most comprehensive videos on storm preparedness so far.

To watch, click below:

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

JoeAmyPortrait2013

 

Survival Medicine Hour: Dan O’Hara of Gateway Prepper Expos, More

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cincy-expo

Maybe you haven’t had the opportunity to go to one Dan and Kit O’Hara’s Gateway Prepper Expos, in which case, you’ve missed out on an opportunity to meet a lot of awesome, like-minded folks who are preparing for the worst, while hoping for the best. In this episode of the Survival Medicine Hour, Amy Alton, ARNP, aka Nurse Amy welcomes good friend Dan O’Hara to the show and gets a real insight on what these shows are all about, and the thinking behind putting these events out to the  public. Plus, Joe Alton, MD, aka Dr. Bones, gives you an update on the latest news reports on the East coast after Matthew, and much more!

Amy Alton Everglades Close up 400 x 600

Nurse Amy

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/10/08/survival-medicine-hour-dan-ohara-interview-cincy-expo

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

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Joe and Amy Alton

28 Sensible Tips To Get Through A Hurricane

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storm surge

Hurricane Matthew is slowly churning it way towards the U.S. with sustained winds of 140 mph or more, and the potential for major damage and loss of life exists for many coastal areas.

Hurricanes can certainly be dangerous, but they don’t have to be life-threatening for those who prepare.  Unlike tornadoes, which can pop up suddenly, hurricanes are first identified when they are hundreds, if not thousands of miles away.  We can watch their development and have a good idea of how bad the situation might be and how much time we have to get ready.

Even before it’s clear that your area is in danger of being hit by the storm, you should have considered factors like food, water, power, and shelter. By having a plan of action beforehand, you’ll decrease the risk to your family significantly.

Here are a few (actually, 28!) tips to help those preparing for the worst, while hoping for the best:

HITTING THE ROAD

1.Make a G.O.O.D. (Get Out Of Dodge) decision: Rugged individualists may want to ride out the storm, but some coastal residents would be best served by hitting the road. When the authorities say it’s time to evacuate, you should be ready to go. Don’t forget to turn off the power, gas, and water before you leave.

2.Head inland: Hurricanes gain their strength by warm ocean waters, and lose strength quickly as they get further into the interior. If you’re escaping the storm, the further inland you go, the safer you’ll be. If there isn’t time, most coastal municipalities will have designated a sturdy building as a hurricane shelter.

3.Have a “GO” bag: Always have a set of supplies ready to take with you on short notice. Non-perishable food, bottled water, extra clothing, flashlights and batteries, a NOAA weather radio, medicines, and a first aid kit are just a few of the items that will ensure your survival. Although you’ll see recommendations to have a 72 hour supply, this figure is arbitrary, and a week’s worth would be even better.

4.Have a cell phone charger: Communication is key. Many cell phone chargers can be plugged into the car where the cigarette lighter used to be.

5.Have cash on hand: Power for credit card verification could be down after a hurricane; if you don’t keep some cash on hand, you’ll have a power shortage: Purchasing power.

Let’s say you haven’t received an evacuation order, and you’re going to ride out the storm in place. Here are some considerations you want to take into account:

FOOD

6.Keep it Cold: Have the refrigerator and freezer down to their coldest settings so that food will take longer to spoil.

7.Collect Ice: Collect ice in plastic bags and place them throughout to prolong freshness. If there are open spots, fill Tupperware containers or plastic soda bottles/milk jugs with water, freeze them, and place them in the spaces. The fuller the fridge is, the longer the items in it will stay cool.

8.Wrap It in Foil: Wrap food items in aluminum foil, eliminating air pockets, and cram the foil packs together as closely as possible.

9.Cook ‘Em and Freeze ‘Em: Cook meats before the hurricane gets close and freeze them. As cooking requires fuel, have some full propane tanks or charcoal briquettes in your supplies for when the power goes out.

10.Eat the Perishables Now: Eat the perishables first, canned foods later.

11.Keep It Closed: Don’t leave the refrigerator door open while deciding what food to take out. Visualize where a particular item is and then open the door. Close it as quickly as possible.

WATER

12.Water, Water everywhere: Have a stockpile of 5 gallon bottles of water or a plentiful supply of smaller bottles.

13.Fill the Tub: Fill all bathtubs with water. You might think this is overkill, but every member of your family needs 1 gallon of water per day. It goes fast.

14.Drink the Melted Ice: As refrigerated ice in containers melts, don’t waste it. Use it as an additional source of drinking water.

15.Hot Water Heaters Hold….Water!: Hot water heaters have gallons and gallons of drinkable water; don’t hesitate to raid them if you get low. First, turn off the electricity or gas. Attach a hose to the drain valve and release the vacuum in the tank by opening a hot water faucet. There might be some sediment at the bottom that should be drained out first.

16.Sterilize it: Have some household bleach available to sterilize questionable water (like from the water heater). 12-16 drops per gallon should do the job. Wait 30 minutes before drinking.

17.Have a water filter: handheld filters like the Lifestraw or Sawyer Mini, or larger ones like the Berkey can be useful to deal with cloudy water.

SHELTER

18.Put Up The Shutters:  If you have hurricane shutters, put them up at least 24 hours before hurricane landfall. It’s no fun to have to stand on a ladder in gale force winds and pouring rain to install them. Been there, done that.

19.Move Furniture/Plants Inside: Move the patio furniture and potted plants indoors. If you can’t for some reason, chain them together against an outer wall downwind from the direction of the storm.

20.Prune Trees: Prune all trees near your home so that wind can easily flow through the crowns. Otherwise, expect some to be downed by the storm. Branches, fruit (in South Florida, coconuts!), and other debris can act as missiles in high winds.

21.Pick a “Safe Room”: Choose a room in the interior of the home, preferably one without unshuttered windows.

22.Place candles in pans: Candles can be knocked over by winds and cause fires. If you must use them, stick them in a pan with shiny sides that would be deep enough to cover the flame.

23.Have Tarps at the Ready: Large tarps can be used to cover windows and, after the storm, to cover any areas of the roof that might have been damaged.

OTHER IMPORTANT CONSIDERATIONS

24.The Kids: Have board games, toys, and books to keep the children’s minds off scary winds. If you’re evacuating, let kids bring their favorite stuffed animals, blanket, or pillow to keep them calm.

25.Your Other Kids: Don’t forget to take into account the needs of your pets. Have food, water, and their favorite toy available, whether you leave or stay at home.

26.Your Other, Other Kid: Make sure your car is in good working order and filled with gas. Having some spare gas cans will be useful in case of a shortage at the pumps, and can be used to run generators (although never inside).

27.Your documents: Place important papers like birth certificates, passports, insurance documents, and others in waterproof containers. Scan them and send them in an email to yourself.

28.Keep your radio on: A NOAA weather radio, battery-powered or hand-cranked, will be an important source of information on the progress of the storm, and for community updates.

Being prepared for a hurricane can make sure that the storm will be just a bump in the road, and not the end of the road for you and your family. Have a plan of action, get some supplies, and you’ll join the ranks of the few, the proud, the prepared!

Joe Alton, MD

 

joealtonlibrary4

Joe Alton, MD

 

Find out more about hurricane preparedness and many other natural disasters in the new Third Edition of The Survival Medicine Handbook: The Essential Guide For When Help is Not on the Way, available on this website or at amazon.com.

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Would You Survive A Hurricane?

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hurricane satellite image pixabay

The “eye” of a hurricane

After more than a decade without a major hurricane, South Florida faces the possibility of a glancing blow from powerful Hurricane Matthew. Are you ready, Floridians and East Coasters? Matthew was downgraded to a very strong category 4 storm recently but is thought to still pack winds of 150 mph.

It doesn’t take very long for people to forget the devastation that previous hurricanes have caused in the United States. Hurricanes are one of the few disasters that advanced weather forecasting can predict well ahead of its arrival. The National Weather Service puts out regular advisories for upcoming storms. Despite this, few are prepared to handle the dangers to life and property that can occur.

Hurricane Matthew is a high level storm with winds of up to 150 mph. Hurricanes are graded into 5 categories by the Saffir-Simpson Scale. The scale uses maximum sustained winds as a measure:
Category 1: 74-95 mph winds

Category 2:  96-110 mph winds

Category 3:  111-130 mph winds

Category 4:  131-155 mph winds

Category 5:  >155 mph winds

Although hurricane season starts in June, most major storms in the Atlantic seem to hit in August, September, and October. Hurricane Sandy hit the Jersey shore in late October. Category five hurricanes Katrina and Andrew (2005, 1992) hit in late August.

hurricanepalms2

Coconuts? You mean missiles…

Are You Ready?

Hurricanes can be dangerous, but they don’t have to be life-threatening for those who prepare.  Unlike tornadoes, which can pop up suddenly, hurricanes are first identified when they are hundreds, if not thousands of miles away.  We can watch their development and have a good idea of how bad it might get and how much time we have to get ready.

An effective plan of action takes into account factors like shelter, clean water, food, power, and other important issues.  By planning before a hurricane threatens your area, you’ll avoid the mad rush for supplies that leaves supermarket shelves empty.

Perhaps your most important decision might be:  Should you get out of Dodge? You can actually outrun one of these storms if you get enough of a head start. At present, for example, Hurricane Matthew is plodding along at about 7 mph.  If you live on the coast or in an area that floods often, there will be rising tide waters (known as the “storm surge”) that might cause impressive flooding. Indeed, flooding is the leading cause of deaths due to hurricanes.

The National Weather Service keeps a close eye on hurricanes and issues two types of warnings:

Hurricane Watch: Hurricane conditions (sustained winds of 74 mph or greater) are possible within a specified area.

Hurricane Warning: Hurricane conditions (sustained winds of 74 mph or greater) are expected somewhere within a specified area.

In many cases, the authorities will issue an order to evacuate areas that will be hardest hit. If such an order is broadcast, you should leave. If you live near the coast in pre-fabricated housing, such as a trailer, it’s wisest to hit the road before the storm makes landfall. Alternatively, many municipalities will designate a hurricane-resistant public building nearby as an official shelter.

If you do choose to leave town, plan to go as far inland as possible.   Hurricanes get their strength from the warm water temperatures over the tropical ocean; they lose strength quickly as they travel over land.  It might be a wise move to make reservations at a hotel early if you don’t have a place to go; there will be little room at the inn for the latecomers.

A good idea is to always have a set of supplies ready to go for any emergency. This kit is called a “Bug-Out”, “Go”, or “GOOD” (Get Out Of Dodge) bag. Although most survivalists recommend packing for 72 hours off the grid in case of a disaster, that number is arbitrary; be prepared to at least have a week’s supply of food and drinking water, as well as extra clothing and medical supplies.

storm surge

storm surge

Riding Out The Storm

If you decide to weather the storm at home, have an idea of what your home’s weak spots are.  What amount of sustained wind your structure can withstand?  Most homes are built to withstand 90 mph winds, but when South Florida was devastated by Hurricane Andrew in 1992, new homes in South Florida were mandated to be able to withstand 125 mph winds. If the coming storm has sustained winds over that level, you may not be able to depend on the structural integrity of older homes.

Where is the best place in the home to serve as a “safe room”?  It should be in the part of the home most downwind of the direction from which the hurricane is hitting you. Be certain to plan for any special needs that family members (and pets) may have.  You may wind up taking care of more people that you expect, so have more water and non-perishable food than you think you’ll need (1 gallon/day per person minimum). Filling bathtubs with fresh water would give you a reasonable supply.

Outdoors

Unsecured objects can become missiles in a hurricane. Outdoors, move all patio furniture and potted plants either inside the house or up against the outside wall, preferably secured with chains. Put up hurricane shutters if you have them.

One special issue for South Floridians is coconuts:  They turn into cannonballs in a hurricane.  Cut them off the tree before the winds come.  Interestingly, the palm trees themselves, as they don’t have a dense crown, seem to weather most high winds without a problem.  Trees with dense crowns, however, should be pruned to allow wind through and all dead branches removed.

Roof shingles are often casualties of the storm, so have some waterproof tarps available. Roofers are going to be pretty busy after a major storm and might not get to you right away.  In South Florida after Wilma (2005), there were still tarps on roofs more than a year later.

Indoors

Indoor planning is important as well.  Communications may be out in a major storm, so have a NOAA weather radio and lots of fresh batteries. Turn refrigerators and freezers down to their coldest settings, so that food won’t spoil right away if the power fails.  Coolers filled with ice or dry ice will extend the life of some of your more perishable items. Don’t forget a hand-operated can opener.

Fill up gas and propane tanks early in every hurricane season. Make sure that you know how to shut off the electricity, gas and water, if necessary, and perhaps consider getting a generator and some extra gas cans. Never use gas grills or generators indoors, though, as the fumes may be life-threatening.

There’s another kind of power you should be concerned about. In the aftermath of a storm, credit card verification may be down; without cash, you may have no purchasing power at all.

What About The Kids?

If you’ve hunkered down in your home during the storm, make sure that you’ve got books, board games, and light sources for when the power goes down. Kids (and most adults) go stir crazy when stuck inside, especially if they don’t have TVs or computers in service.

Take time to discuss the coming storm in advance with the whole family; this will give everyone an idea of what to expect, and keep fear down to a minimum.  Give the kids some responsibility, as well.  Give them the opportunity to pack their own bag or select games to play.  This will keep their minds busy and their nerves calm.

Be Smart

It’s amazing how thrill-seekers will go out in the middle of a storm; people seem to be enthralled with hurricanes, and will go out in dangerous winds to take selfies or do other foolish things. This is a recipe for a bad outcome, and some avoidable deaths will occur as a result. Several were killed during Hurricane Sandy because of their zeal to go out during the worst part of the storm. Take hurricanes seriously; there’s danger from flooding, flying debris, falling trees, and much more.

After the Storm

Some items will be useful in the cleanup after the storm.  You’ll need work gloves, plastic garbage bags, duct tape, insect repellent, and even tweezers to deal with the splinters that inevitably are part and parcel of moving a lot of debris.  A chain saw might be needed as well.

In the aftermath of the hurricane, cell phone service may be down due to the huge volume of calls. Texts may be possible, however, even if voice calls aren’t.

By planning early to get your home and family prepared for a hurricane, you’ll have the best chance of .

Joe Alton, MD

JoeAltonLibrary4

Joe Alton, MD

 

always have some medical supplies available for your GO bag to deal with injuries caused by violent storms, and what better place to find kits and supplies than by checking out Nurse Amy’s often-imitated but never-equaled entire line specifically meant for disaster and homestead settings. Find them at store.doomandbloom.net!

Survival Medicine Hour: Epipens, Hurricanes, Kratom, Chamomile

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epi-pen
The Survival Medicine Hour hosted by Joe Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy, are bringing you another episode of exciting and thrilling (well very entertaining and useful at least) survival information. Don’t miss out! Folks we have another hurricane on the horizon, Matthew is churning up the seas and is now a level 3 Hurricane with the possibility of hitting the USA in a few days time. Get prepared and learn what you need to do now to stay safe. Storm safety for all kinds of storms is vital knowledge.
What’s up with the Epipen crisis? What will you do if you don’t have or can’t afford the epipen, or even the still expensive ($606 for 2 pack) generic version? Dr. Bones shares a method of administering an alternative in the face of an emergency.
Kratom is being made into a schedule 1 drug, which is the same level as Heroin. This herb is blamed for 15 deaths, but only one of those deaths was the person found with only Kratom onboard. Many Kratom users herald it as the reason they were able to stop using other drugs, like heroin and pain meds. The users and their families contacted their congress members and a call to delay the change of Kratom to a schedule 1 drug has been made by the supportive congress members. More research should be done to accurately determine the effects of Kratom before a hastily decision is made. We discuss this issue and give you the 411.
Chamomile is a wonderful herbal medicine. It has been used safely for thousands of years. It is know to calm digestive issues and calm nervous disorders. Nurse Amy discusses this awesome herbal remedy and how to use it.
To listen in, click below:
Joe and Amy Alton
Amy Alton Everglades Close up 400 x 600

Amy Alton, MD

 

Find out how to deal with medical issues in disaster/survival settings with the brand new 700 page Third Edition of the Survival Medicine Handbook: The essential guide for when medical help is not on the way.

50 Congressmen Ask DEA To Hold Off On Kratom Ban

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kratom

Mitragyna speciosa (Kratom)

In a rare bipartisan effort, 50 members of Congress have asked the DEA to hold off on the upcoming ban on the active ingredients in the plant Kratom (Mitragyna speciose). Kratom, a member of the coffee family, is used by many Americans as a substitute for opiates.  A plethora of testimonials exist online by former users of Heroin and other drugs that the plant has “saved their life”. 130,000 people signed a recent White House petition to protest the DEA’s actions.

 
Politicians aren’t the only officials that suggest that the DEA’s decision might have been arrived hastily. Academicians at Sloan Kettering and Columbia suggest that the plant may have properties that could be harnessed into useful non-opioid painkillers.

 
On August 30th, the DEA banned, for a period of two years, the two active ingredients mitragynine and 7-hydroxymitragynine, categorizing them as Schedule I drugs, the same category as Heroin and LSD. The ban is effective September 30th, 2016. Schedule I drugs are thought to have no medical use and present a major risk of addiction. This action means that even possession of the plant may be considered illegal and subject to prosecution.

 
The DEA considers Kratom to be an imminent public hazard, but some members of Congress disagree. In a recent letter to all representatives, Congressmen Mark Pocan (D- Wisconin) and Matt Salmon (R- Arizona) wrote “It (Kratom) binds to some of the same receptors as opioids, providing some pain relief and a calming effect, but not the same high. And the chemical doesn’t cause the same, sometimes deadly side effects as opioids, such as respiratory depression.”

 
This statement from the DEA: “… Kratom is abused for its ability to produce opioid-like effects and is often marketed as a legal alternative to controlled substances. Law enforcement nationwide has seized more kratom in the first half of 2016 than any previous year and easily accounts for millions of dosages intended for the recreational market, according to DEA findings. In addition, kratom has a high potential for abuse, has no currently accepted medical use in treatment in the United States, and has a lack of accepted safety for use under medical supervision. These three factors constitute a schedule I controlled substance according to the Controlled Substances Act passed by Congress in 1970.”

 
DEA statistics show more than 600 poison control calls relating to Kratom in the five year period from 2010 to 2015. Fifteen deaths have been attributed to Kratom use, although closer inspection reveals that fourteen of those deaths were also associated with other drugs. In contrast, the Centers for Disease Control and Prevention (CDC) reports 8,257 heroin-related deaths in 2013 alone.

 
Having said that, some countries where Kratom grows naturally have imposed a ban on export and, sometimes, use. This includes nations like Thailand and Malaysia.

 
Kratom is, indeed, a drug and should be regulated, but abruptly naming it a Schedule I substance similar to Heroin will discourage research into its properties and potential for use in cases of drug addiction, depression, PTSD, and chronic pain.

 
Once Kratom is off the market, will users return to opiates like Heroin? If they do, how many deaths will occur as a result? More than one, I would guess. Kratom may have addictive potential, but so do cigarettes and alcohol, which are responsible for many more deaths.

 
Should Kratom be regulated? Absolutely. As things stand now, there is no accepted dosage amount of Kratom and commercially-available products are widely variable in the amount of mitragynine and 7-hydroxy-mitragynine in them. Find and standardize an appropriate amount for safe use. This is a better option than taking it off the market altogether.

 
It’s a stretch to argue that Kratom is as bad as Heroin; the last thing we want is users to switch to substances that are more clearly associated with death.

 

 

Joe Alton, MD

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Dr. Joe Alton

Joe Alton MD is a medical preparedness writer for disasters and epidemics, and looks for ways to use both conventional and alternative methods to deal with scenarios where help may not be on the way. Check out his brand new 700 page Third Edition of The Survival Medicine Handbook for over 150 medical issues that you might encounter in disaster situations.

7 Sensible Ways To Get Your Kids Dirty (and Healthy)

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mud-play

image by publicdomainpictures.net

I have, on many occasions, written about the importance of good hygiene and sanitation on the chances of a family or survival group succeeding, even when everything else fails. That’s all well and good, but what can be done before a disaster to impart a resistance to infection in the next generation?

In modern times we have, as a matter of “good parenting”, made every effort to keep our children with their noses wiped and their hands clean. Indeed, these are the basics of respiratory hygiene to prevent things like colds and flus. However, are our kids too clean? In our never-ending battle to keep them shiny and bright, have we, instead, made them more prone to the very microbes from which we want to protect then?

Many scientists and physicians think so. In 1989, researcher Dr. David Strachan suggested the hypothesis that the failure of children to be exposed to infectious bugs and parasites may be responsible for the epidemic of allergies and allergic conditions like asthma. This was called the “Hygiene Hypothesis” and the lack of exposure to microbes was, later, more broadly applied to other diseases ranging from hay fever to diabetes to multiple sclerosis.

The theory is based on the thought that avoidance of common germs suppresses the development of a normal immune system. In addition to microbe-avoiding practices like staying inside and not getting dirty, just the fact that modern families are smaller than those 100 years ago results in less passing-around of common infections. This, in turn, leads to the failure to develop immunity against them or the

tolerance that would prevent allergic reactions.

Later studies suggest that some of the skin, gut, and respiratory germs we try so hard to avoid are actually “old friends” that have been with us since ancient times, and lack of exposure to them doesn’t allow our immune systems to develop nor function appropriately. Researchers like Dr. Graham Rook compared the immature immune system to a computer; it has many programs, but needs “data” in the form of diverse germ exposures to allow the “program” to identify those that are harmful. The fetus receives some of this data even as it passes through the vaginal canal during birth.

pixabay-old-farm

old farm via pixabay images

When most of us lived on farms or in less-than-pristine cities, we were exposed to plenty of germs from a young age due to time spent outside with animals or with lots of other people. Now, unless they’re playing Pokemon Go, the majority of kids aren’t motivated to go outside or, certainly, get dirty. In the final analysis, never getting dirty as a child may be hazardous to your future health.

Having said all this, most parents will have trouble throwing their kids in the nearest pig sty or making mud pies with Rover’s, um, poo. There are still disease-causing bacteria, viruses, and parasites out there that you’d like to avoid. Is there a middle ground?

Here are some things you might consider:

Avoid antibiotics: The medical profession may have been remiss in over-prescribing antibiotics, but there are antibiotics in food as well. Indeed, 70-80% of antibiotics are given to livestock, not to treat infection, but to make they grow faster and get them to market sooner. Stick with antibiotic-free eggs, milk, and meats.

Avoid anti-bacterial soaps: Triclosan, the active antibiotic ingredient in many brands, has recently been banned by the FDA due to the risk of antibiotic resistance and the lack of evidence of any medical benefit. Use regular soap and water for washing.

Tailor Handwashing Strategies to the Situation:  If you’re in a city where open sewers run through the streets and people are tossing buckets of excrement out the window, have your kids wash their hands conscientiously. In clean environments where there isn’t a raging epidemic, however, don’t freak out over dirty hands.

Don’t Bathe Every Day: Not only should your kids be exposed to dirt to develop their immune system, but bathing too often might do more harm than good. Daily showers removes protective skin oils and causes drying and irritation. You’re also washing away the good bacteria that lives on your skin.

dog-and-kid-pixabay

image by pixabay.com

Get Your Kid a Pet: Not every kid has the good fortune of living on a farm, but they’ll benefit from a furry pet. Dogs seem to give more resistance to colds and allergic skin conditions like eczema than cats, but early cat exposure might give more protection against asthma. Why not have both?

Be Sensible About Animal Droppings:  Yes, I know that you can’t avoid trace amounts of animal excrement in your kids’ environment, but don’t let them play in the cat litter and you should remove pet and wild animal excrement from play areas.

Get your kids outside when they’re young: In these days where we have legitimate concerns about children’s safety, you might be reluctant to let your kids go outside by themselves. Here’s an idea: Go out with them, to parks, wilderness areas, and other places where both adults and kids can reap real benefits.

The more you encourage outdoor activities early, the more they become part of the next generation’s culture; let the kids get a little dirty, and you might give them a healthier future.

Joe Alton, MD

AuthorJoe

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kit and individual items at store.doomandbloom.net!

Survival Medicine Hour: Larry Keilberg of SelfDefenseFund, Diabetes, More

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gunshot wound kit

Legal Self Defense (pictured: Amy’s Gunshot Kit)

Survival Medicine Hour, September 23, 2016, with Joe and Amy Alton. We discuss the prevalent market on Ebay for fake C.A.T tourniquets, and a couple things to look out for. The increasing epidemic of diabetes, and what the world might look like if we make changes and if we don’t. The World Health Organization announced a 4-fold increase in the number of diabetic diagnoses in the past 35 years.

If you plan to defend you or your family from harm, through self defense, using ANY item, whether gun, knife, a lamp or even hands, this interview with Larry Keilberg may provide your best protection from going to jail. When force is used, deadly or otherwise, the police and court systems are not always quick to render you innocent. Long trials and expensive defense teams can ruin your life. The SelfDefenseFund.com offers a very reasonable policy to cover you and family members in the case of self defense. From expert testimony, top lawyers and a team of defense planning, you will be defended by the best. Larry Keilberg is a founding member of The National Association for Legal Gun Defense, and is an excellent source of information. Don’t miss this interview.

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/09/23/survival-medicine-hour-larry-keilberg-of-selfdefensefund-diabetes-more

 

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

joe and amy radio

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of medical kits and supplies at AltonFirstAid.com!

Kratom, Natural Pain Reliever, Lost to FDA Actions

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kratom

Mitragyna speciose (Kratom)

One of the questions we’re often asked is what to do about chronic pain and drug addiction if some disaster occurs that knocks you off the grid, maybe for good. Certainly, pharmaceuticals would cease to be manufactured and whatever pain med you use or opiate drug you may be addicted to will become, very likely, unavailable, leaving you or members of your group high and dry. In these circumstances, you have to look toward natural sources of compounds that could help; things that you might even be able to grow in your survival garden.

Some states approve the possession and sale of marijuana  for medical and recreational use, but there is little true opioid effect to it, and recent studies show that it has a slight effect against pain, but mostly has a sedative effect that makes the pain more bearable. the Canadian Medical Association journal tested marijuana on a number of people who had chronic pain, and compared it to people who took a placebo, essentially a sugar pill. Those on the placebo rated their pain as a 6.1 out of 10 and the marijuana group rated their pain as 5.4.  A small difference, but a difference nonetheless, so it’s an option.

Another plant that has promise for chronic pain is called Kratom. Kratom is a herb that has been in widespread use in Southeast Asia for centuries; it is chewed for to increase stamina, induce gentle euphoria and relaxation, and relieve pain. Many testimonials exist as to its success helping people kick their addictions to opioid painkillers. On the other side of the coin, Kratom appears to have addictive potential itself, and several hundred cases of poisoning have been recorded, although many of the most severe cases seem to have mixed it with other recreational drugs. Use and/or export of Kratom has been outlawed in some countries where it grows naturally.

The chemical compounds in Kratom, (scientific name Mitragyna speciosa) are mitragynine and 7-hydroxymitragynine . These substances act on opioid receptors in the brain, just like heroin and morphine do. Kratom, however, is not an opiate. It’s actually a member of the coffee family. In any case, Kratom has been used by many people who swear by its effect on pain or used it to replace heroin and other street drugs.

Now, in a recent decision, the FDA has (abruptly) chosen to classify the active compounds in Kratom as Schedule I substances. Schedule 1 drugs include heroin and LSD, things determined to have no acceptable medical use and/or high addictive properties. Kratom now joins their ranks. The Drug Enforcement Administration announced that it would, for a period of two years, effectively ban Kratom,. By prohibiting the possession and use of mitragynine and 7-hydroxymitragynine, the DEA can make it illegal to even have the plant on your property.

This action probably stems from a report by the CDC that Kratom “intoxication” caused 600 calls to poison control centers over the last five years. This despite the claim from proponents of the plant that the number of “poisonings” are small compared to the number of people damaged by many other, even legal, substances. I found little scientific evidence of any lethal effects from using Kratom.

In any case, the FDA has taken up an anti-Kratom stance after several states banned the plant.

In the end, the Department of Health and Human Services is involved in studies on Kratom and its final determination will decide if the plant is banned forever.  

What does this mean? Well, that outlawing Kratom may turn its users to things like heroin. Results might be an increase in opiate overdose deaths, something already at epidemic proportions throughout various parts of the country. Secondly, it takes away an natural alternative for the homesteader or off-grid medic to deal with addiction issues or with significant chronic pain in austere settings.

It seems to me that there has been a rush to judgement when it comes to Kratom. Hopefully, the DEA will see the light as to the realistic uses and potential risks of the plant, and allow at least limited access to what might be a very valuable survival medical tool. Don’t hold your breath, though; it’s not likely that, once a substance is controlled by the government, that you’ll be able to get or grow it in the future (marijuana being the rare exception).

You still have until the end of September 2016 to get some plants or supplements. The plants are going out of stock quickly, but there are still supplements available at various online sites. Check out the American Kratom Association for more information. I’m not telling you to break the law, just to do your own research and reach your own conclusions.

Joe Alton, MD

AuthorJoeFind out more about natural alternatives for pain and other medical issues in the brand new Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

 

Lessons That Could Save Your Life in a Terror Event

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bombingvictim

I’ve written quite a bit lately about shooting and terror events, but recent events highlight the fact that gun violence isn’t the only way that a terrorist can fulfill their mission of making casualties out of decent citizens. Clearly, bombings, stabbings, or shootings can occur literally anytime and anywhere in the U.S.: at churches, clubs, holiday parties, schools, the mall, at 2 in the morning or in the middle of the day. They’re part of what I call the “New Normal” and we have to be prepared to act if we’re caught in one of these events.

Although I write mostly about disaster medical preparedness, a terror event is a different kind of disaster. It’s one where you can prevent becoming a casualty if you simply know what to do when danger presents itself.  Indeed, if you don’t train yourself to anticipate these events, it could be hazardous to your health and that of your family.

I’ve mentioned the concept of “situational awareness” as a way to decrease your chances of becoming a victim in future terror attacks. In these days of Pokemon Go and other smartphone distractions, you’re seeing more and more people not paying attention to their surroundings. In the past, this might get you a bump on the head for walking into a lamp post. In today’s world, however, it could cost you your life.

Situational awareness involves understanding what’s going on in your immediate vicinity that might be represent a threat to your well-being. I don’t mean second-hand smoke here; I’m talking about knowing what immediate dangers may exist that you can avoid or abolish with your actions. Especially important for soldiers in a combat zone, it’s now become just as important for the average citizen in any public space.

In an area at risk (anyplace where multitudes of people gather), simple things might save your life. Things like not having your hoodie up, which can be like blinders on a horse. Things like making a mental note of the nearest exit at the mall. Things like looking around for people who are acting strangely or, perhaps, dressed too warmly for the weather.  Someone who might be paying too much attention to an everyday object, such as a trash can (which might contain a bomb).

Behaviors normal in some settings might be an “anomaly” in others: Hopping up and down and screaming may be normal behavior at a rock concert, but not at the local mall.  By looking for anomalies in what should be normal behavior in a situation, the situationally aware person will have the best chance to plan an escape when an attack occurs. 

To do this effectively, you should always be in a state of what I call “Yellow Alert”. You’re calm and relaxed, but taking in your surroundings: Always observing how people behave, where the nearest exits are, and formulating a plan of action if you’re in a crowd or other at-risk scenario.

In the case of the terrorist who stabbed nine people in Minnesota, it’s likely that he was in a state of agitation, his hands constantly touching the pocket where he kept his weapon. These are anomalies; things you should watch for whenever you’re in a public place.

In a crowd, it would pay to be at the fringes and not in the middle. Having a wall to your back would eliminate a danger that might come at you from behind. Indoors, for example, in a movie theatre, you want a view of the exits as well as the screen. If someone is behaving strangely, move away from them. If someone is screaming at the employee at the local burger joint (I said NO CHEESE!), maybe you should leave and order a pizza instead.

Air Force Colonel John Boyd devised a situational awareness strategy, called the “OODA Loop”, originally meant for aerial combat. It has practical applications, however, for everyday life. The components of the OODA Loop as it pertains to terror events are:

Observe: Stay at Yellow Alert whenever you’re in a public place where groups of people gather.

Orient: Identify behaviors that are not appropriate for the situation. These anomalies will tell you who and what to keep an eye on.

Decide: Determine the best course of action that will allow your escape or might eliminate the danger altogether.

Act:  Initiate the plan of action and commit to those actions.

It’s difficult to instill a culture of situational awareness in a population, but doing so would save lives. Teaching your kids the basics can help keep them safe, especially if you start early. When you’re out with the kids, tell them to pay attention to what’s going on where you are. Once the family has left the area, ask them how many people were there, what they were wearing, or other details. Ask them what they would have done if something happened. Do this often enough, and it will, hopefully, become common practice. They’ll learn to pay less attention to their smartphones and more to their surroundings.

It would also benefit society if the next generation is taught what to do to help those wounded in a terror attack. In this scenario, law enforcement must pass the wounded by until the terrorist is neutralized. It may surprise you to know this, but there’s someone out there making more casualties, and the police, first and foremost, must abolish the threat. Yet, it’s thought that 1 in 5 deaths from hemorrhage might be avoided with the quick action of bystanders.

It may be time to add a fourth “R” to education. In addition to Reading, (w)Riting, and (a)Rithmatic, Reducing hemorrhage might be a useful thing for kids to learn once they reach a certain age. Indeed, I predict that there will come a time when first aid kits will occupy a space on the walls next to the fire extinguishers and automated defibrillators in schools and other public places.

All this attention to detail may seem paranoid to you, but it’s time to realize that these are dangerous times.  Incorporate situational awareness into a calm, observant mindset and you’ll gain those extra seconds that could mean the difference between life and death in troubled times.

Joe Alton, MD

AuthorJoe

Learn about active shooters, stab wound management, and mass casualty events in the new 700 page third edition of The Survival Medicine Handbook: The Essential Guide for When Help is Not on the Way.

Survival Medicine Hour: Kratom Ban, Dental Trauma, Medical Uses for Rosemary

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kratom

Kratom

In this episode of the Survival Medicine Hour with Dr. Bones and Nurse Amy (Joe Alton MD and Amy Alton ARNP), Dr. Bones discusses the upcoming ban on the useful but, perhaps, addictive herb Kratom, a Southeast Asian herb used for centuries to treat chronic pain and depression, and used by some today to replace addictions to opiates. Also, Nurse Amy discusses the many medical uses of Rosemary, and Dr. Bones discusses dental trauma, and what to do about that loose or knocked-out tooth in a survival setting.

dental-trauma

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/09/16/survival-medicine-hour-kratom-ban-dental-trauma-rosemarys-uses

Wishing you the best of health in good times or bad,

 

Joe and Amy Alton

batman and robin

The Dynamic Duo

Video: The OODA Loop of Situational Awareness

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crowd

Are you safe here?

In this companion video to a previous article, Joe Alton, MD, aka Dr. Bones, discusses a fighter pilot strategy that might save your life in a terror event. Originally meant for aerial dogfights, the OODA loop was developed by Colonel John Boyd and has been used in everything from business to active shooter scenarios. Incorporating the OODA loop into your mindset will help instill the culture of readiness that is so important in the New Normal of the uncertain future.

To watch, click below:

Wishing you the best of help in good times or bad,

 

Joe and Amy Alton

AmyandJoePodcast400x200

The Altons

Zika: 10 Things to Worry/Relax About

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asian-tiger-mosquito1

Aedes Albopictus Mosquito

Zika virus has been in the news since the beginning of the year, and there’s a lot of information out there; some of it is reassuring and some, well, not so much. Here’s some things you should know that will make you worry/not worry about this infectious disease that’s been reported worldwide. 

1.

Worrisome: Reported cases of Zika in the U.S. and its territories will soon hit 20,000. The number of Zika cases IN THE U.S. and its territories reported to CDC’s Arbonet (ARthropod-BOrne virus) national registry has risen to almost 19,000. With some researchers suggesting infection in one quarter of the population of Puerto Rico before the end of 2016, 20,000 cases might be a gross underestimation.

Reassuring: While the Zika epidemic rages in Puerto Rico, the continental U.S has reported a total of 2,964 cases of mostly travel-related Zika virus illness (out of a population of 320 million).  South Florida is the only area in the continental U.S. where local mosquitoes are confirmed by authorities to have spread the disease (about 50 cases).

The number of U.S. Zika cases are updated weekly by the CDC at http://www.cdc.gov/zika/geo/united-states.html.

 

2.

Worrisome: The actual number of Zika cases is probably close to 5 times the number of reported cases. Zika virus causes relatively mild symptoms like rashes, fevers, joint pains, and reddened eyes, and even then in only 20% of cases. 80% have no symptoms whatsoever, which means that the actual number of cases is probably 5 times greater. This doesn’t count people who wouldn’t go to the doctor for a mild fever or a rash, so it might be even more.

Reassuring: Even if case totals are, in fact, much higher than reported, the virus leaves the bloodstream after a week or so in most people. It can, however, last for months in seminal fluid or, perhaps, the eyes. Once you have recovered from the acute infection, you receive immunity from the antibodies produced by your immune system. Future pregnancies won’t be affected.

,

3.

Worrisome: Zika is a bona fide pandemic. A pandemic is a widespread occurrence of a disease not normally seen in a place that spreads across different regions. Zika has now been identified in close to 70 countries and has been referred to as a pandemic by the National Institute of Health since at least January 2016.

Reassuring: Despite concerns raised by many health officials, athletes and tourists returning from the Olympic Games don’t seem to have sparked significant new outbreaks in their home countries.

microcephaly-reuse-wiki

microcephalic infant

 

4.

Worrisome: Newborns with Zika infections can have multiple abnormalities, not just microcephaly. Microcephaly is a condition where a small brain leads to poor head growth. Beside this, however, other evidence of brain damage, deformed joints, and vision or hearing impairment may occur.

Reassuring: The percentage of abnormal newborns in Zika-infected mothers isn’t as high as you think. Statistics for the rate of birth abnormalities in newborns have ranged from 1% to 13% in Brazil and 1% in the previous outbreak in Polynesia in 2013-4, according to a CDC report released last May. There are no numbers that say a Zika-infected mother’s chances are very high of having a baby with microcephaly or other defects.

 

5.

Worrisome: We can’t say for sure that Zika-infected babies born looking normal will be unaffected by the virus. Zika is shown in lab studies to kill brain and other nerve cells. What if the number of cells damaged is not enough to make the baby appear abnormal at birth but enough to cause delays in milestones like walking or talking? What if these infants end up having learning disabilities once they’re old enough to go to school? We won’t know for years.

Reassuring: Although our research into the effects of Zika virus is in its infancy, no hard evidence exists that a baby from an infected mother will have later developmental deficits.

 

6.

Worrisome: Zika virus may be passed through from human to human through seminal fluid, vaginal secretions, blood, and now, tears. Researchers are finding more and more ways that Zika might be transmissible from human to human. A study from Washington University in St. Louis reports that tears of mice carried parts of the Zika virus.

Reassuring:  The vast majority of Zika infections are still transmitted by mosquitoes. Sensible actions like the use of mosquito repellents, the wearing of long sleeves/pants, and drainage of nearby standing water are still the best way to prevent an infection.

 immunity

7.

Worrisome: There is more than one strain of Zika, and there may have been mutations. Zika, like many viruses, exists in different subtypes (at least two) that could mutate from time to time. This fact might explain why a virus originally identified in 1947 only started causing community-wide outbreaks in 2007, and no reported cases of abnormal babies before 2013. A mutation that increased the severity of effect on humans (at least, newborn ones) may have occurred.

Reassuring: It’s possible that Zika just had never been exposed to such large populations without natural immunity. Researchers haven’t yet reported if the strain spreading rapidly in Singapore is the same one as that in Brazil.

 

8.

Worrisome: There may already be more than one locally-transmitted outbreak in the U.S. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor’s College of Medicine, suspects that there may be more areas of local Zika transmission than just the one in Miami. The Guardian reports that he said, “…I think there’s not just Zika transmission going on in Miami, it’s going on all up and down the Gulf Coast and in Arizona, it’s just that nobody’s looking.” The CDC, although it stops short of predicting an epidemic of Zika, believes clusters of cases may still appear in warm-weather states.

Reassuring: Future local outbreaks are likely to be minor in the U.S.  A number of states, like Louisiana and other Gulf and East coast states, are recovering from floods dues to storms and Hurricane Hermine. Cases of Zika virus, however, don’t seem to be arising out of standing water there that would be excellent breeding grounds for mosquitoes. Cities, like Houston, with low-income areas that harbor abandoned buildings and trash, also provide possible sites for the next generation of mosquitoes; Zika virus doesn’t seem to have taken hold there either.

dead bees

dead bees

 

9.

Worrisome: Aerial Spraying with chemical pesticides like Naled may affect honeybees and even humans. Use of pesticides that are neurotoxic might have ill effects on important pollinators like bees, or even human beings. It might be safer to use methods that kill mosquito larvae instead.

Reassuring: Aerial spraying is an effective way to eliminate large populations of adult mosquitoes quickly and rarely affects humans. Naled is a shorter acting pesticide than some others, and when used correctly (before sunrise or after sunset), is unlikely to cause major damage to pollinators, which mostly forage during daylight hours. The recent bee die-off after spraying in Dorchester County, S.C., was due to spraying which occurred at 8 a.m.

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Singapore’s next for Zika (image: pixabay)

                                                                                                                                                                                

10.

Worrisome: A new local Zika outbreak is spreading throughout Singapore in Asia. The location is important because Singapore is an important financial hub for the region. Travel-related cases already have been reported in Malaysia and the Philippines from returning travelers. Given the widespread commercial travel to Singapore, where 300 cases have been reported in 10 days, the entirety of Asia may be affected in the near future.

Reassuring: Here in the U.S., the coming fall and winter seasons will decrease mosquito populations significantly throughout most of the country. USA Today reported in July that Brazil was recording fewer cases of Zika as the Southern Hemisphere entered its “winter”.

 

So, it’s your choice: You can decide either to go look for your worry beads or, instead, cover your eyes with your hat and order another pinacolada. Just don’t forget the mosquito repellent.

 

Joe Alton, MD

 

 

 

The Coming Bee-Pocalypse?

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dead bees

dead bees

You may or may not be an environmentalist, but a part of nature that everyone should support is the honeybee. It’s thought that every third bite of food that you take is there because of pollination by bees. Honey, when raw and unprocessed, is a versatile product that may even be used as a wound covering for burns and other injuries.

In the last decade, bee colonies are reported to be experiencing die-offs that have taken out a significant percentage of all the colonies in certain areas.  I found this alarming, but a review of recent articles, however, revealed this idea to be a matter of debate. Opinions on the state of the bee nation seem to go along with the political bent of the author; if you’re liberal, the “bee-pocalypse” has arrived; if you’re conservative, bees are thriving and it’s all a bunch of “junk science”. Which do you “bee-lieve”?

As a conservative environmentalist (am I the only one?), it’s all pretty confusing. I tend to think that bees, like a lot of critters in today’s densely populated world, are in trouble, and there are multiple factors to blame. Some of these factors are, indeed, due to human actions.

These actions could be very isolated, like the truck that overturned in Mt. Juliet, Tennessee, taking out most of the 430 beehives that were being transported to farming areas without enough pollinators (a question: Why is this a thriving business if there are plenty of bees?).

Human actions may be more coordinated, however, than  a truck overturning. Our growing concerns about the Zika, West Nile, and other mosquito-borne viruses have led to the institution of mosquito control programs in many towns and cities in the U.S. One effective means of eliminating adult mosquitoes is aerial spraying with an organophosphate pesticide called Naled. Unfortunately, the use of Naled has caused collateral damage to many beneficial insects; the honeybee is one of them.

A recent series of aerial sprayings in Dorchester County, South Carolina, has killed millions of bees. Although relatively short acting, Naled is lethal to bees and daytime spraying has decimated the local population of these important pollinators. The chemical is not meant to be used between sunrise and sunset, when bees are out foraging. It seems the Dorchester County officials didn’t read the directions.

The inappropriate timing of the pesticide spraying has “nuked” the colonies of many Dorchester County beekeepers. Dead worker bees were found in large clumps at hive entrances; one beekeeper lost 46 hives.

Although the county claims to have given advisories of the spraying via email, many local beekeepers claim they didn’t receive the notice. Mosquito control is normally conducted by trucks in the county, and the aerial sprayings came as a (very bad) surprise. With warning, the beekeepers could have shielded the hives.

All this is happening at a time when another pesticide used to control pests is (apparently, another controversial statement) devastating bee populations in other areas.

Here’s a story that was reported some time ago: Customers at an Oregon Target store arrived to see tens of thousands of dead and dying bumblebees in the parking lot.

An investigation the day before revealed that a pest-control company had sprayed insecticide on surrounding trees due to an aphid infestation. Of course, bees don’t read warning signs and 300 colonies were destroyed. That’s a lot of lost pollinators.

The pesticide used is known as a neonicotinoid, popularly called a “neonic”. It was developed by Bayer a decade ago and differs from other pesticides, like organophosphates, in that they clear from the air a lot slower.

Many crops are treated with neonics. The chemical works like this: once sprayed on the plant, it is absorbed by the plant’s vascular system. This makes it poisonous to bugs that eat the leaves, nectar, or pollen. Sometimes the soil is treated as well, with the same absorption effect that makes it deadly to pests. Unfortunately, it’s kills good insects, as well.

When a Bayer neonic doesn’t kill a bee, it can damage its immune system and even affect its ability to navigate. It becomes lost and can’t find the hive. This phenomenon is sometimes known as “Colony Collapse Disorder” and it appears as if the bees have magically disappeared. Although not proven to be the cause in all cases, it doesn’t take a lot of imagination to implicate the pesticide as a factor.

Now, a new study indicates that neonics harm drone bees’ sperm, killing close to 40 per cent and causing a condition called “queen failure”. A queen failure is when queen bees fail to have live offspring. A queen failure is a hive failure.

Of course, there are a lot of other reasons that a hive can fail. Parasites, disease, and many other factors may come into play besides chemical pesticides. But given the stress that our nation’s bee population is already under, what will be the straw that breaks the (bee’s) camel’s back?

To be banned, a chemical has to be proven dangerous in the U.S. Although Bayer is a German company, you might be interested to know that, at present, you can’t use neonics in Germany. Too dangerous. In the U.S., however, neonics are widely used and the bees pay the price.

Some areas in the U.S. are taking action. Eugene, Oregon has forbidden the use of this pesticide and the state of Maryland has followed with a ban to begin in 2018. Environmentalists urge action by the federal government to ban neonicotinoids and mandate wiser use of organophosphates like Naled (following the directions would be a good start).  Meanwhile, others are complaining, even in Europe, of pests invading crops and want freer use of neonic and other pesticides.

Our bees are an important natural resource, not just for beekeepers, but for farmers and for all Americans. If you’re a consumer, you should be invested in this fight regardless of your political stripes. I’d like to Save the Whales, but it’s just as or more important to save the bees.

Joe Alton, MD

JoeAltonLibrary4

Joe Alton, MD

The brand new Third Edition of “The Survival Medicine Handbook” is now available at Amazon.com! It’s the essential guide for disasters and epidemics when help isn’t on the way.

 

Survival Medicine Hour: Hurricanes, Zika Update, Bee Deaths

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zika virus

Zika Virus

In this episode of the Doom and Bloom Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP, a Florida landfall occurs for a hurricane for the first time in more than a decade. Were you ready? What should you do to prepare for the next one? Plus, Dr. Bones discusses new tragedies for the native bee population in the U.S. What will be the straw that break’s the bee’s, I mean, camel’s back? With every third bite of food you put in your mouth coming as a result of some bee pollinating a plant, you should be invested in this topic!

storm surge

A hurricane’s storm surge

Plus, we haven’t talked about Zika for a while, but that’s not because there hasn’t been a lot of news about it. Nurse Amy and Dr. Bones follow the globetrotting pandemic to a new outbreak in Singapore, talk about outbreaks that might not be reported due to lack of testing, and the effects that could occur on zika-infected newborns that are born looking perfectly normal.

bee1

More bad news for bees

All this and more on the latest Survival Medicine Hour with Dr. Bones and Nurse Amy!

To listen in, click below:

http://www.blogtalkradio.com/survivalmedicine/2016/09/04/survival-medicine-hour-more-bad-news-for-bees-hurricanes-and-a-zika-update

Wishing you the best of health in good times or bad,

Joe and Amy Alton

JoeAmyPortrait2013

The Altons