Appendicitis Off The Grid

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Appendicitis Off The Grid

Blocked appendix

Blocked appendix

After a disaster or at a remote homestead, the medic may not have ready access to modern medical technology. As such, many conditions that are commonly identified with ultrasounds or CAT scans may be more challenging to diagnose. One of these challenges is abdominal pain. There are various medical issues that cause it, with the classic example of an abdominal emergency being appendicitis. Over 300,000 Americans have their appendix removed every year.

The Appendix

The “vermiform appendix”, as it is formally known, is a hollow tubular organ a few centimeters long and a centimeter wide. It looks like a worm (vermiform means worm-like).  Attached at the entrance to the large intestine (the “cecum”), it resides in the lower right portion of the abdomen in almost all people. Inflammation of the appendix can become a medical emergency quickly; if ignored, it may represent a life-threatening situation.

ASIDE: When the appendix (or any other organ, for that matter) is inflamed, the suffix “-itis” is added; thus, inflammation of the appendix is called “appendicitis”.

What purpose does the appendix serve? Charles Darwin believed it was a left-over from an earlier time, as horses and some other animals have larger ones that help them digest vegetation. Today, it is thought by many that it serves an immune function for fetuses and children. It is also thought to be a reservoir for good gut bacteria. After a bout of, say, dysentery or cholera, it may help repopulate the gastro-intestinal tract with beneficial micro-organisms.

Having said that, there seems to be no major ill effects from having an appendix removed, although some studies suggest a small increase in diseases, such as Crohn’s Disease.

What Happens in Appendicitis

A grossly inflamed appendix

A grossly inflamed appendix

Appendicitis is related to an obstruction of the organ by, usually, calcified feces; it some cases, blockage can be caused by foreign objects, trauma, or even intestinal worms.  How does this lead to a possibly life-threatening situation?

Once blocked, the mucus produced by the appendix is unable to drain into the cecum. The organ swells as a result. Once swollen enough, the ensuing pressure on the appendix walls prevents the circulation necessary to keep tissue alive. The dying tissue causes the appendix to fill with pus and, without treatment, will be either walled-off by the body’s defenses or will burst (a “ruptured appendix”).

Once ruptured, an inflammation of the lining of the entire abdomen called peritonitis occurs. From there, it can progress to an infection throughout the body (sepsis) if untreated. Death may be the final outcome.

How to Identify Appendicitis

Many illnesses will be difficult for the medic to diagnose in austere settings. Although ultrasounds and CAT scans help confirm suspicions, appendicitis can be identified with some reliability based on physical signs and medical history.

Classic signs and symptoms that suggest appendicitis as the cause of abdominal pain include:

  • Pain starting at or around the belly button, usually dull and aching
  • Loss of appetite, followed by nausea and vomiting
  • Abdominal swelling
  • Fever
  • Inability to pass gas
  • Pain evolving to become sharper and migrates to the lower right abdomen

The pain tends to localize to a specific spot one-third of the way from the hip bone to the belly button, an area known as “McBurney’s Point”.

McBurney's Point

McBurney’s Point

Once an appendix has ruptured, the pain becomes general throughout the abdomen in many cases. The belly may appear stiff and swollen, with tenderness on exam, both on pressing down (“guarding”) and when letting go (“rebound tenderness”, often worse).

It should be noted that other symptoms may present in a significant minority of patients. Cramping may occur, with some complaining of painful or otherwise difficult urination. As with any condition, signs and symptoms may vary from person to person.

Mimics of Appendicitis

Causes of abdominal pain by area

Causes of abdominal pain by area

Other conditions may lead you to erroneously suspect appendicitis when, in actuality, something entirely different is going on. Urinary infections, right-sided tubal pregnancies or ovarian cysts, diverticulitis, Crohn’s disease or ulcerative colitis, and pelvic inflammatory disease may mimic an inflamed appendix to one extent or another and must be ruled out. These topics will be discussed in future articles.

Treatment of Appendicitis

Appendicitis is the most common cause of abdominal pain treated by surgery today, and the procedure is usually curative. The earlier the surgery is performed, the faster the recovery and the less likely scarring will occur. Below is a video of a (bloodier than usual) open removal of a swollen appendix:

Appendectomy can be performed, using a very small incision, under sedation and local anesthesia off the grid. This procedure is not without difficulty for the inexperienced surgeon, as there is intervening small intestine and other structures that must be moved out of the way to visualize the inflamed area. Of course, patient discomfort is a major obstacle.

Recent studies have explored the possibility of using antibiotics to nip early appendicitis in the bud. The patient should be placed on bedrest and restricted to small amounts of clear liquids as soon as you make the diagnosis.

Intravenous treatment is the preferred way to deliver antibiotics to treat appendicitis, but may not be an option off the grid. In that case, a combination of Ampicillin (veterinary equivalent Fish-Cillin) and either Clindamycin (veterinary equivalent Fish-Cin) or Metronidazole (veterinary equivalent Fish-Zole) might be useful. In cases of Penicillin allergy, Ciprofloxacin (veterinary equivalent Fish-Flox) may be a suitable alternative to Ampicillin.

Look for other common causes of abdominal pain to be examined in future articles.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about appendicitis and conditions that mimic it in the Third Edition of the award-winning Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the way, available at Amazon or along with an entire line of medical supplies at

The Third Edition

Video: Disaster Food Supplies

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VIDEO: Disaster Food Supply Advice

Storing food for disasters

Storing food for disasters

In this video, Amy Alton, ARNP, aka Nurse Amy, steps in front of the camera to discuss disaster food supplies. Food, water, and shelter (don’t forget air!) are absolute basics for survival in a major disaster, followed by, in our opinion, medical supplies. Using common sense regarding your food storage will give your family the best chance to succeed, even when everything else fails.

To watch, click below:

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

Amy Alton ARNP

Amy  Alton

Amy Alton

Fill those holes in your disaster medical supplies with kits and individual items from Nurse Amy’s store at

Some of Nurse Amy's Kits

Some of Nurse Amy’s Kits

Diseases Caused By Food And Water Contamination

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Even healthy-looking fruit can contain contaminants

Even healthy-looking fruit can contain contaminants

The primary necessity for survival is the availability of air. Once you have air to breathe, water, food, and shelter become the next requirements for your continued existence on the planet; that is, clean water and properly prepared food.

Even in normal times, there are many instances where an outbreak of infectious disease occurs due to water of poor quality. Ingesting food that was incompletely cooked caused the deaths of medieval kings in medieval times and may even have sparked the Ebola epidemic in 2014.

Epidemics caused by organisms that cause severe diarrhea and dehydration have been a part of the human experience since before recorded history. If severe enough, dehydration can cause hypovolemic shock, organ failure, and death. Indeed, during the Civil War, more deaths were attributed to dehydration from infectious diseases than from bullets or shrapnel.

More soldiers died from infectious disease than from bullets or shrapnel in the Civil War

More soldiers died from infectious disease than from bullets or shrapnel in the Civil War

Off the grid, water used for drinking or cooking can be contaminated by anything from floods to a dead opossum upstream from your camp. This can have dire implications for those living where there is no access to large amounts of IV hydration.

Therefore, it stands to reason that the preparation of food and the disinfection of drinking water should be under supervision. In survival, this responsibility should fall to the community medic; it is the medic that will (after the patient, of course) be most impacted by failure to maintain good sanitation.

Many diseases have disastrous intestinal consequences leading to dehydration. They include:

Cholera: Caused by the marine and freshwater bacterium Vibrio cholera, Cholera has been the cause of many deaths in both the distant and recent past. It may, once again, be an issue in the uncertain future.

Cholera toxins produce a rapid onset of diarrhea and vomiting within a few hours to 2 days of infection. Victims often complain of leg cramps. The body water loss with untreated cholera is associated with a sixty per cent death rate. Aggressive efforts to rehydrate the patient, however, drops the death rate to only one per cent. Antibiotic therapy with doxycycline or tetracycline seems to shorten the duration of illness.

This is the bowel movement of someone with Cholera

This is the bowel movement of someone with Cholera

Typhus: A complex of diseases caused by bacteria in the Rickettsia family, Typhus is transmitted by fleas and ticks to humans in unsanitary surroundings, and is mentioned here due to its frequent confusion with “Typh-oid” fever, a disease caused by contaminated, undercooked food.

Although it rarely causes severe diarrhea, Typhus can cause significant dehydration due to high fevers and other flu-like symptoms. Five to nine days after infection, a rash begins on the torso and spreads to the extremities, sparing the face, palm, and soles. Doxycycline is the drug of choice for this disease.

Typhoid: Infection with the bacteria Salmonella typhi is called “Typh-oid fever”, because it is often confused with Typhus. Contamination with Salmonella in food occurs more often than with any other bacteria in the United States.

In Typhoid fever, there is a gradual onset of high fevers over the course of several days. Abdominal pain, intestinal hemorrhage, weakness, headaches, constipation, and bloody diarrhea may occur. A number of people develop a spotty, rose-colored rash. Ciprofloxacin is the antibiotic of choice but most victims improve with rehydration therapy.

Dysentery: An intestinal inflammation in the large intestine that presents with fever, abdominal pain, and severe bloody or watery mucus diarrhea. Symptoms usually begin one to three days after exposure. Dysentery, a major cause of death among Civil War soldiers, is a classic example of a disease that can be prevented with strict hand hygiene after bowel movements.


Shigella dysenteriae

The most common form of dysentery in North America and Europe is caused by the bacteria Shigella and is called “bacillary dysentery”.  It is spread through contaminated food and water, and crowded unsanitary conditions. Ciprofloxacin and Sulfa drugs, in conjunction with oral rehydration, are effective therapies.

Another type is caused by an organism you may have read about in science class: the amoeba, a protozoan known as Entamoeba histolytica. Amoebic dysentery is more commonly seen in warmer climates. Metronidazole is the antibiotic of choice.

Traveler’s Diarrhea: An inflammation of the small intestine most commonly caused by the Bacterium Escherichia coli (E. coli). Most strains of this bacteria are normal inhabitants of the human intestinal tract, but one (E. coli O157:H7) produces a toxin (the “Shiga” toxin) that can cause severe “food poisoning”. The Shiga toxin has even been classified as a bioterror agent.

In this illness, sudden onset of watery diarrhea, often with blood, develops within one to three days of exposure accompanied by fever, gas, and abdominal cramping. Rapid rehydration and treatment with antibiotics such as Azithromycin and Ciprofloxacin is helpful. The CDC no longer recommends taking antibiotics in advance of a journey, but does suggest that Pepto-Bismol or Kaopectate (Bismuth Subsalicylate), two tablets four times a day, may decrease the likelihood of Traveler’s Diarrhea.

Campylobacter: The second most common cause of foodborne illness in the U.S. after Salmonella, this bacteria resides in the intestinal tract of chickens and causes sickness when meat is undercooked or improperly processed. It’s thought that a significant percentage of retail poultry products contain colonies of one variety, Campylobacter Jejuni. It is characterized as bloody diarrhea, fever, nausea, and cramping which begins two to five days after exposure. Although controversial, Erythromycin may decrease the duration of illness if taken early.

Trichinosis: Trichinosis is caused by the parasitic roundworm Trichinella in undercooked meat, mostly from domesticated pigs. Trichinosis causes diarrhea and other intestinal symptoms, usually starting one to two days after exposure. Fever, headache, itchiness, muscle pains, and swelling around the eyes occur up to 2 weeks later. Recovery is usually slow, even with treatment with the anti-helminthic (anti-worm) drugs Mebendazole and Albendazole (Albenza).

Giardia Lamblia

Giardia Lamblia

Giardiasis: The most common disease-causing parasite in the world is the protozoa Giardia lamblia. It has even been found in backcountry waters in many national parks in the U.S. Symptoms may present as early as one day after exposure, although it more commonly presents in one to two weeks. Patients complain of watery diarrhea, abdominal cramping, violent (often called “projectile”) vomiting, and gas. Metronidazole is the drug of choice in conjunction with oral rehydration.

There are many other pathogens that can cause life-threatening dehydration if untreated. Although we have mentioned common antibiotic treatments where applicable, most of the above will resolve on their own over time with strict attention to oral (or intravenous) rehydration. Many antibiotics (Cipro is an example) are associated with adverse effects that can be worse than the illness they’re designed to treat, so use judiciously.

It should be noted that some of these illnesses may be mimicked by viruses that are completely unaffected by antibiotics, such as Norovirus. Norovirus has been implicated in many of the outbreaks you read about on cruise ships.

Air, food, water, and shelter is necessary for survival. Bad air, food, water, and shelter leads to the next requirement, and that is medical supplies. Have a good medical kit and know how to use all its components. If you can accomplish this goal, you’ll be an effective medic if things go South.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Find out more about infectious disease and 150 other survival medical topics in the award-winning “Survival Medicine Handbook“, now in its 700-page Third Edition. Plus, fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at

Video: Waters Filters and Storage

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You're mostly made of this

You’re mostly made of this

Humans are made mostly of water, and many survival settings have either a lack of it or questionable quality. Therefore, it’s important that the water you find is safe to drink, but even the clearest  mountain stream may harbor organisms like Giardia and Entamoeba that can cause serious illness. In natural disasters like floods, there’s water everywhere, but almost always highly contaminated.

In this video, Nurse Amy steps in front of the camera to give a review of some water filter and storage options.

To watch, click below:

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

Amy and Joe Alton

The Altons

The Altons

Find out more about hydration, dehydration, and disinfection, as well as 150 other medical topics, with the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide For When Medical Help Is On The Way!

Survival Medicine Hour: Acid Reflux, Colds vs Flus, Medical Barter Items, More

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Survival Medicine Hour #366

Colds vs. Flus

Colds vs. Flus

Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, discuss a number of topics, including honey as a treatment for burns, how to tell colds vs. flus, medical barter items, acid reflux, using glues to close wounds, and much more!

Honey, if raw and unprocessed, has antibacterial effect and may be useful to treat burns in situations where modern medical care is not a possibility.

Honey as a treatment for burns

Honey as a treatment for burns

Do you have a cold or the flu? Here’s some tips on how to tell the difference.

Most survivalists consider ammunition to be the most important barter item, but how about items that could heal, instead of cause, wounds? Dr. Alton bets that medical supplies would be important barter items in a post-disaster economy.

Glue in place

Glue in place

Medical glues and even Super-glue, may be valuable items for closing wounds. Here’s how to use glue to close a wound (remember, that it’s more important to know when a wound should be closed and when it should remain open!).

acid reflux

acid reflux

How many people do you know that have problems with stomach acid? In a disaster, those people will still be there, and they need your help. Dr.Alton tells you everything you need to know about gastroesophageal reflux disease (G.E.R.D.).

To listen in, click below:

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

Joe and Amy Alton

The Altons

The Altons

Follow us on twitter @preppershow, Facebook at Doom and Bloom(tm), and YouTube at DrBones NurseAmy channel.

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at!





G.E.R.D. (Severe Acid Reflux) Off The Grid

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Acid Reflux Off The Grid


Acid Reflux

In this high-stress world, you probably know someone who suffers from G.E.R.D. (Gastroesophageal Reflux Disease). “Gastro-“ refers to your stomach; “-esophageal” refers to the tube that runs from it to your throat. Acid “reflux” is essentially acid that escapes the stomach and can go all the way up to your throat. G.E.R.D. is a severe form of acid reflux that can ruin a person’s quality of life.

Normally, an area called the “lower esophageal sphincter” (LES) is what separates the contents of the very acidic stomach from entering the esophagus. In G.E.R.D., the LES allows food to enter the stomach but fails to close tightly enough to keep juices from going back up, causing what we call “heartburn” and other symptoms.

Up to 20 per cent of the U.S. population suffers from some form of G.E.R.D., which means that it’s likely that the medic will eventually encounter this issue in a remote setting or survival scenario. Off the grid, we won’t have the stress that goes with the modern rat race, but there will be more basic issues just as concerning like “where’s my next meal coming from?”.

hiatal hernia

Hiatal Hernia

G.E.R.D. may occur in those with a “hiatal hernia”. This condition occurs when the top of the stomach moves up through a weak area in the diaphragm (the muscle that separates chest from abdomen and helps you breathe). As such, acid can more easily leave the stomach.

Although the stomach has a lining that can handle acidic environments, the esophagus becomes inflamed when exposed to too much. The lining becomes weakened and can erode, a condition known as an “ulcer”. Ulcers can occur in the esophagus, stomach, and upper part of the small intestine.

To make the diagnosis of ulcer or acid reflux disease as opposed to, say, chest pain from heart issues, the timing of the discomfort is important. Ulcer and acid reflux discomfort occurs soon after eating but is sometimes seen several hours after a meal. It can be differentiated from other causes of chest pain in another way: it gets better by drinking milk or taking antacids. As you can imagine, this wouldn’t do much for heart problems. Also, it often worsens when lying down or eating acidic foods. In the worse cases, such as with ulcers, blackish stools may be seen or vomiting may occur that looks like coffee grounds. This is a sign of bleeding high up in the GI tract.



Certain lifestyle changes are often helpful for people with G.E.R.D. Eating smaller meals (say, 5 a day) and avoiding acidic foods before bedtime may help prevent reflux. Give your stomach at least 3 hours to empty before you lie down or add a pillow or two behind your shoulders, head, and neck.

You would think chewing gum would increase stomach acid; chewing gum, however, produces saliva: Saliva acts to buffer acid.  Also, you swallow the saliva, which might force some of that acid further down the esophagus.

Spicy foods may worsen G.E.R.D.

Spicy foods may worsen G.E.R.D. (image by pixabay)

Your patient may benefit from avoiding certain foods. These commonly include:

  • Acidic fruit (for example, oranges or other citrus)
  • Fatty food
  • Coffee
  • Certain teas
  • Tomatoes
  • Onions
  • Peppermint
  • Chocolate
  • Alcohol
  • Spicy foods

Medicines like aspirin, ibuprofen, and others may also cause stomach issues. As well, smoking is thought to worsen G.E.R.D.

One thing about milk: although it may be helpful as a treatment, avoid regular milk intake and stick with low-fat, as high levels of fat ingestion may actually increase stomach acid. Obese individuals seem to suffer more from this problem:  Excess abdominal fat can press against the stomach, forcing acids up into the esophagus. Weight loss may help, something that’s likely in survival scenarios.

Medications that commonly relieve acid reflux include calcium, magnesium, aluminum, and bismuth antacids such as Tums, Maalox, Mylanta or Pepto-Bismol, as well as other medications such as Ranitidine (Zantac), Cimetidine (Tagamet), and Omeprazole (Prilosec). These medications are available in non-prescription strength and are easy to accumulate in quantity.

In modern times, G.E.R.D. can be definitively identified by procedures such as upper G.I. endoscopy, X-ray tests like an upper GI series, and other high technology. Of course, off the grid, these aren’t an option.

There are many alternative remedies reported to be helpful to deal with G.E.R.D. Home remedies for acid reflux include:

Organic apple cider vinegar: Mix one tablespoon in four ounces of water, drink before each meal.

Aloe Vera juice: Mix one ounce in two ounces of water before a meal.

Baking soda: Mix one tablespoon in a glass of water and drink right away when you begin to feel heartburn

Glutamine: An amino acid that has an anti-inflammatory effect and reduces acid reflux. It can be found in milk and eggs.

Melatonin might be useful  for some (more study is needed on this one).

I’m sure you have some home remedies of your own.

Off the grid, many stoic individuals in the preparedness community may be unlikely to tell the medic about something they consider trivial, like heartburn. Someone in pain, however, loses sleep and work efficiency. Always question these people to find out what their symptoms are. You might be able to help.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about G.E.R.D. and 150 medical issues in tough times by checking out the 2017 Book Excellence Award winner in medicine “The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way”.

Survival Medicine Hour: Plague, Hepatitis, Pain Issues

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Plague Doctor

Plague Doctor

An outbreak of plague in Madagascar has killed 124 people and infected 1200. Although not an uncommon occurrence in the rural areas, this epidemic has hit the larger cities in the island nation, and is the deadlier version called “pneumonic plague“. Pneumonic plague can be cured if found very early but if not, invariably results in death. Dr. Alton tells you all about bubonic, pneumonic, and septicemic plague and what the off-grid medic could do to prevent this terrible infectious disease from running rampant.


hepatitis damage

Also, inflammation of the liver, called “hepatitis“, is caused by various viruses which are harder to cure than a bacteria like what causes the plague. There are several types of hepatitis, and it’s important to know what to do to avoid becoming a victim of it. Symptoms, diagnosis, and prevention are discussed by our hosts Joe Alton MD and Amy Alton ARNP.

Plus, we start a series on pain issues, discussing different types of pain and also the government’s categorization of drugs into “schedules” from 1-5.

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

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

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

Joe and Amy Alton

The Altons

The Altons

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s entire line at!

We’re pleased to announce that the Third Edition of The Survival Medicine Handbook has been named the 2017 winner of the Book Excellence Award in Medicine!

Hepatitis in Survival Settings

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There are various infectious diseases that may confront the caregiver in off-grid settings. These can affect various organs of the body, one of which is the liver.

Although your skin is the largest organ you have, the liver is the largest organ that resides inside the body. It is located on the right side of your abdomen just under the lowest rib.

The liver is susceptible to damage from drugs and alcohol, as well as inflammation from certain viruses, a condition known as “hepatitis”. If the liver is diseased, it can become enlarged and tender. This compromises its ability to perform functions like helping your body eliminate toxins, digest food, store energy, and more.

There are various types of hepatitis, listed as A, B, C, D, and E. Each has its own characteristics, but many symptoms are similar. Some types are related to poor hygiene, others from poorly prepared food or contaminated water, and some are even transmitted sexually, but all cause liver dysfunction and scarring. Symptoms can range from none at all (but still contagious) to life-threatening, and may include:

  • Loss of appetite
  • Nausea and vomiting
  • Diarrhea
  • fever
  • Dark-colored urine and pale greyish bowel movements
  • Stomach pain
  • Itching
  • Muscle and joint aches
  • Fatigue
  • General ill feeling (also called “malaise”)
jaundiced eyes

jaundiced eyes

Although sufferers may experience several of the above symptoms, the hallmark of hepatitis is jaundice, a yellowing of skin and eyes that occurs due to an excess of a yellowish substance called “bilirubin” in your system. Bilirubin is formed by the breakdown of old red blood cells in the liver. A healthy liver eliminates bilirubin as part of this process.

jaundiced skin

jaundiced skin(wiki)


Hepatitis A virus is caused by oral-fecal contamination; it can be gotten, for example, by drinking water that has particles from the bowel movements of infected individuals. It’s begins as a flu-like syndrome, then quickly manifests many of the symptoms mentioned above 2 to 6 weeks after exposure. It can also be transmitted sexually.

In survival, failing to properly purify water can cause an epidemic of Hepatitis A. In normal times, a restaurant employee who doesn’t wash his hands after using the bathroom can pass the disease along to customers.

Hepatitis A usually gets better without treatment after a few weeks. Interestingly, children rarely get symptoms, while 80% of adults do. In areas at risk, a vaccine is available.


Hepatitis B can be spread by exposure to infected blood products, semen, and vaginal fluids. Symptoms are usually indistinguishable from Hepatitis A.

ascites from chronic liver disease

ascites from chronic liver disease

Hepatitis B. however, may cause scarring in the liver that leads to a chronic condition known as “cirrhosis”.  In cirrhosis, the functioning cells of the liver are replaced by non-functioning nodules. Cirrhosis may also be caused by long-term alcohol or drug abuse. Besides jaundice, the condition can lead to “ascites”, an accumulation of fluid that causes swelling of the abdomen, swollen legs, and other symptoms.


Hepatitis C can cause acute or chronic infection, and is seen most often in older individuals. It may be contracted by intravenous drug use, transfusion, and unsafe sexual practices. A percentage of these patients will progress to cirrhosis over time and, sometimes, complete liver failure. A vaccine is now actively promoted by the government that may protect infected individuals from future damage.


The hepatitis D virus is unusual because seems to only occur in those with an active Hepatitis B infection. In tandem, the two viruses cause a significant “superinfection”.


Hepatitis E is typically an acute infection that is sometimes associated with eating poorly cooked pork or wild game. It is self-limited, which means that it gets better without treatment after several weeks. Some types of hepatitis E virus are spread by oral-fecal contamination similar to Hepatitis A.


Make the patient comfortable by encouraging rest, encouraging rest and hydration, and giving antihistamines like diphenhydramine for itching. There are limitations about can be done in an austere setting regarding this condition. The anti-viral and immune drugs used for this condition will simply be unavailable.

Wash your hands!

Wash your hands!

The austere medic can, however, practice good preventive medicine by encouraging the following policies:

  • Wash hands after using the bathroom and before preparing food
  • Wash dishes with soap in hot water
  • Avoid eating or drinking anything that may not be properly cooked or filtered
  • Make sure children don’t put objects in their mouths
  • Use condoms to avoid sexual transmission
  • Don’t share personal items, if at all possible, like toothbrushes or razors with infected persons

Some natural substances may encourage good liver health and were used in the past to treat those with hepatitis. Avoiding fatty foods and alcohol Increase, taking zinc supplements, and staying hydrated may help.

There is little hard data proving their effectiveness, but they may be your only options in a survival setting. They include:

  • Milk Thistle
  • Artichoke
  • Dandelion
  • Turmeric
  • Licorice
  • Red Clover
  • Green Tea

Although viral diseases are difficult to treat off the grid, a focus on prevention will help make sure your people have the least chance of getting hepatitis.

Joe Alton MD

Dr. Alton

Dr. Alton

Learn more about hepatitis and 150 other medical topics in the 700 page third edition of the 2017 Book Excellence Award winner in medicine, The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way,

Survival Medicine Hour: Mudlslides, OTC Drugs, More

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A loaded first aid kit with medical supplies for trauma,burns, sprains and strains and other medical issues

Your medic kit should contain various OTC meds

Your survival medicine cabinet should have plenty of different meds that can handle pain, inflammation, fever, respiratory infections, stomach upset, diarrhea, and many more of the common issues that the survival medic will confront off the grid. Here’s a good list and explanation of why you should have these medicines in your storage.



Plus, Living in a cliffhanging home on Ski Mountain in Gatlinburg, TN, gateway to the Smokies, puts ol’ Dr. Bones and the lovely Nurse Amy at risk for a mudslide, especially since the 2016 wildfire, destroyed so many trees that were preventing erosion in the area. What are warning signs of future mudslides and what can you do to prevent becoming a victim?

All this and more in the Latest Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP!

To listen in, click below:

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

Joe and Amy Alton

The Altons

The Altons

We’re pleased to announce that the Survival Medicine Handbook’s 700 page Third Edition has won the 2017 Book Excellence Award in the category of medicine. Earlier editions are out there, so make sure get the latest edition!

8 Health Benefits of Cloves

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Health Benefits of Clove

Dried Clove Buds

Dried Clove Buds

Our readers often ask us to comment on various natural remedies. Face it, medics can stockpile all the drugs they can, but if a disaster event lasts long enough, medicine and supplies will be expended. Unless society restabilizes pretty darn quickly, commercial medical items and drugs will be hard to find unless your retreat is the local hospital.

That leaves you with whatever’s in your back yard that might have medicinal benefits. Therefore, you’d be smart to start planting an herb garden in normal times. Once you get over the learning curve, you’ll figure out what plants do well in your grow zone. These plants will comprise your survival medicine cabinet.  Once you get through a good season, you can experiment a little with teas, tinctures, or other ways that plants are processed into medicines. Your ancestors did just that, and had this plant or that plant in the garden not because it was food necessarily, but to treat illnesses and injuries.

Many medicinal plants are herbs that are mostly used in cooking, but also have uses for the medic. Today, let’s talk about cloves.

Clove Tree

Clove Tree

Cloves, (syzygium aromaticum) are one of the spices native to Asia. You can find them in places like the Maluku islands in Indonesia, where it might have originated, but also in India, Pakistan, and even areas of East Africa. They are a popular spice used in a variety of ways in Asian cuisine. In fact, cloves form the basis of a lot of the food in a number of different nations.

Cloves have an interesting history. During the 13th and 14th centuries, they were transported all the way from Indonesia to pretty much all over the known world. I would think Marco Polo shipped some cloves to Italy and other European nations. During this time, cloves were very expensive, so much so that they were the subject of wars for monopoly over their production, distribution, and the islands where they came from. Dutch traders emerged victorious and held the Maluku islands for some time.

When we talk about natural plants, we usually talk about using leaves, roots or flowers, but with cloves, it’s the flower buds that are used as a spice and for most of its medicinal purposes. These look like miniature nails from your tool box. They are processed in a number of ways; for example, we use the essential oil in some of our kits.

Clove bud

Clove bud

Cloves are antioxidant powerhouses. Minerals in cloves include calcium, iron, magnesium, phosphorous, potassium, sodium, and zinc. The vitamins found in them include vitamin C, thiamin, riboflavin, niacin, folate, vitamin B6, vitamin B12, vitamin A, vitamin E, vitamin D, and vitamin K. They are also a source of Omega-3 fatty acids (the good kind).

Cloves are reported to have many health benefits, some of which include providing aid in digestion, having antimicrobial properties, fighting against cancer, protecting the liver, boosting the immune system, controlling diabetes, preserving bone quality, as well as fighting against oral diseases and headaches, while also, at least the Chinese say, displaying aphrodisiac properties. Which takes me to, how do I know if cloves are effective against this problem or that problem? I’ll admit that hard scientific data is hard to come by, so you have to understand that the reports aren’t always proof, and effects may be very individual, some may receive these health benefits in full, others, not so much.

What makes Clove buds a useful part of your off-grid medicine cabinet? The health benefits include beneficial effects on pain and inflammation, but also a negative effect on bacterial, viruses, fungi, and more. Like many herbs, Clove have a number of different compounds that may have medical uses, but the most well-known is called “Eugenol”.

Here are eight benefits that cloves may impart to your off-grid patients:

  1. Pain relief: We supply clove oil in all our dental kits because of its anesthetic and antiseptic effect in damaged teeth. Mixing 2 drops of clove oil with some zinc oxide powder can produce improvised temporary cement, useful for lost fillings and other oral issues. It may also relieve gum discomfort, but beware of using too much or too often; it can cause irritation.
  2. Breath issues: It may be hard to distill oil, but teas are easy to make right from the garden (and after drying in many cases). Gargling some tea made with cloves is thought to be a great way to eliminate bad breath.
  3. Respiratory ailments: Clove in its various forms is reported to be helpful for respiratory system complaints due to antimicrobial, anti-inflammatory, and expectorant effects. It’s been used for colds, sore throat, bronchitis, sinusitis, and more. Warm tea is a good way to access these benefits but better, perhaps, is adding clove oil to hot water and inhale steam.
  4. GI problems: Nausea and vomiting might be improved with direct inhalation of clove oil in a cloth. Mix some powdered clove buds with honey to decrease gas. It’s possible that cloves improve the production of digestive enzymes and help relax irritated intestinal lining, which might help stomach ache, diarrhea, and other GI discomforts.
  5. Ear infections: Clove has anesthetic and antimicrobial oral properties, but these also pertain to the ear canal. A combination of clove oil and sesame oil soaked in a cotton ball (best if warm) can relieve earache and treat infection. Alternatively, make an infusion with crushed cloves and olive oil, let sit for an hour, strain well, and put a few warm drops in the affected ear.
  6. Skin blemishes: Acne may be improved with Cloves due to its antibacterial effect. Mix clove oil with coconut oil (ratio 1:10) and apply to affected skin with a Q-tip two or three times daily until improved.
  7. Headaches: Due to it pain-relieving properties, massaging Clove oil mixed with coconut oil into the forehead or other area can relieve headache discomfort. Alternatively, place a few drops of clove oil on a warm cloth and apply to where the pain is.
  8. Joint Pain: Massaging aching joints with the above mixtures may work the same way on joint pain. Alternatively, a warm clove compress to the joints may be helpful.

It should be noted that clove oil is pretty strong stuff, and must be used sparingly. It can cause irritation, as mentioned above, but also has ill effects on the body’s cells when used excessively. It may also slow blood clotting, and, hence, not used prior to surgery. Having said that, used correctly in small amounts by diluting with carrier oils or liquids, clove oil is generally considered to be safe. You can expect whole dried clove buds to last 3-4 years if stored properly.

With clove oil and other natural plant oils, teas, tinctures, infusions, and balms, the quality of the product and medicinal benefits may vary due to a number of reasons. Soil conditions, seasonal temperatures, rainfall, and time of harvest are just some of the factors involved in determining the end product when it comes to herbal products. Many of these remedies also vary from individual to individual.

The off-grid or homestead medic should have a stockpile of commercial medicines, but also a sustainable supply of plants with medicinal properties for use in good times or bad. Use all the tools in the woodshed and you’ll be a more effective caregiver in austere settings.

Joe Alton

Dr. Alton

Joe Alton MD

Find out more about cloves, other natural remedies, and much more with the Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, 2017 winner of the Book Excellence Award in the medical category.

Plus, don’t forget to check out Nurse Amy’s entire line of kits and supplies at

You’ll be glad you did!


Video: Gallbladder Issues in Austere Settings

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Video: Gallbladder Disease


In this video, Joe Alton MD, aka Dr. Bones, discusses all you need to know about the gallbladder and the role that stones or buildup plays in disrupting the workings of the GI tract.

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. The medic needs to be able to diagnose and treat conditions related to medical problems as well as traumatic injuries.

To watch, click below:


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


Joe Alton MD

Hey, learn more about medical issues, traumatic injury, and  150 other topics as they relate to survival in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Also, check out Nurse Amy’s entire line of kits and individual supplies for the survival medic at You’ll be glad you did.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition


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 Also, check out Nurse Amy’s entire line of medical kits and supplies at You’ll be glad you did.

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.


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


To Listen in, click below:



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

Benchmade SOCP



Zebra pen f701


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


The family medical bag and just some of its conten

Gallstones: Diagnosis and Treatment

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gall bladder stones


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.


gall bladder anatomy with bile ducts and liver ( By OpenStax College [CC 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


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 and Thanks again.


Video: Norovirus, the Stomach Flu

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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


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.


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:

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

Joe and Amy Alton


Dr. Bones and Nurse Amy

The “Stomach Flu” Virus

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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


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


Survival Medicine Hour: Giardia, Bear Safety and more

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black bear

American Black Bear

In this episode of The Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP discuss the hazards of trail blazing in Gatlinburg Tennessee, such as Bear Safety. Walking with a sturdy stick, making noise and keeping up situational awareness are all part of bear safety tips. Bears hibernate less deeply than some animals and can be found walking around even in the deep snow of winter. Always keep an eye out and learn all about bear safety.


Giardia lamblia


Recently, Dr. Alton talked about parasitic worms in survival scenarios, but there’s a more common parasite that infects our streams, waterways, and, unfortunately, intestines! Giardia Lambia is a common cause of severe diarrhea and is transmissible all sorts of ways. Find out more about this parasite and what fish antibiotic would be most effective to have in your medical storage.

Ways to prevent Giardia are covered in this episode and include strict and proper handwashing. Just a couple of the ways to avoid getting this parasite, as well as many others, include washing fruits and vegetables before eating or cooking, and using bottled water to brush your teeth if the water is suspect. Nurse Amy recommends demanding daycare workers use gloves when changing your infant or toddler’s diapers. Unfortunately, this is not a Federal regulation and is only a requirement in a few states, which are listed in this episode.

Even though a lot of us may severely disappointed come Tuesday evening’s election results, the earth is not going to end the next day. It may just feel that way.

Life is short, learn Nurse Amy’s secret motto for happiness. Hint: It isn’t a material thing.

All this and more on the Doom and Bloom Survival Medicine Hour!

Our books and custom hand-packed medical kits can be found at:

Here is the link to listen to this week’s episode. Don’t forget to subscribe to our Blogtalkradio Channel for updates

Food Contamination

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food large

We’ve talked a lot about sterilizing water to make it safe for drinking, but a few things in the news lately got me thinking about food safety, another responsibility for the survival medic. Let’s start with some news of the weird:

Two supermarkets in Great Britain were closed by police after a man allegedly sprayed foul-smelling “urine” on the produce. The motive for this act is unknown, but if it’s a terror event, he certainly gets credit for creativity. In any case, authorities claim little if any risk to public safety (unless you shop at those markets, I guess).

While the above is a rare case of food contamination, outbreaks of bacteria found on food seem  to be becoming more frequent. Besides highly publicized problems at restaurants like Chipotle Mexican Market, a number of food companies have announced recalls of a wide variety of products. CRF frozen foods, who products are carried at Safeway, Wal-Mart, Trader Joe’s, and prepper favorite COSTCO, is recalling a total of 358 different items sold under 42 brands(!).


These items were found to contain a bacteria known as Listeria, and at least seven people were hospitalized with 2 deaths. Organic and non-organic versions of carrots, broccoli, squash, peaches, raspberries, strawberries, and blueberries are among the many and varied products involved. All affected items have sell by dates between 4/26/16 and 4/26/18.  The US FDA website has a list of every brand.

So what’s listeria? Listeria monocytogenes is a member of a family of bacteria named after a founding father of modern sterile surgery, Joseph Lister; his name is also on various types of surgical instruments. It causes a relatively rare bacterial disease called listeriosis, a serious infection caused by eating food contaminated with the bacteria. The disease especially affects pregnant women, newborns and toddlers, adults with weakened immune systems, and the elderly. In these folks, the death rate from sepsis and a nervous system infection, meningitis, is about 20%.

A person with listeriosis usually has fever, muscle aches, diarrhea, and other intestinal symptoms. Listeria starts in the GI tract, but frequently invades different organ systems, often varying from patient to patient.

Pregnant women infected with Listeria can expect a higher incidence of miscarriage, stillbirth, premature delivery, and neonatal (newborn) infections. Others, such as the very young and the very old, may experience confusion, stiff necks, loss of coordination and balance, and seizures.

Although there are some differences in opinion, the antibiotic Ampicillin is generally thought to be a drug of choice. Other penicillins are considered acceptable by many. If allergic to Penicillins, other antibiotics like Sulfa drugs may be an option, although no specific alternative is officially recommended.

So how do you prevent infections with Listeria, and really, any bacteria that causes food poisoning? The below recommendations come from the Food and Drug Administration:

  • Rinse raw produce, such as fruits and vegetables, thoroughly under running tap water before eating, cutting, or cooking. Even if the produce will be peeled, it should still be washed first. If you touch the peel, and then the peeled fruit or vegetable, it can get contaminated with bacteria.
  • Scrub firm produce, such as melons and cucumbers, with a clean produce brush.
  • Dry the produce with a clean cloth or paper towel.
  • Separate uncooked meats and poultry from vegetables, cooked foods, and ready-to-eat foods.

It’s important to consider food storage and preparation surfaces. The FDA recommends:

  • Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
  • Listeria monocytogenes can grow in foods in the refrigerator. Use an appliance thermometer, such as a refrigerator thermometer, to check the temperature inside your refrigerator. The refrigerator should be 40°F or lower and the freezer 0°F or lower.
  • Clean up all spills in your refrigerator right away–especially juices from hot dog and lunch meat packages, raw meat, and raw poultry.
  • Clean the inside walls and shelves of your refrigerator with hot water and liquid soap, then rinse.

Without thoroughly cooking meats, you put yourself at risk for infection. You should be sure that food is cooked evenly. It is thought that Ebola may have started in West Africa from partially-cooked bat meat. Each type of meat has its own recommended temperature to eliminate pathogens (disease-causing organisms). To see these, click the link below:

You might wonder how long meats are safe to eat even if stored in the refrigerator? The USDA has firm opinions on this:

  • Use precooked or ready-to-eat food as soon as you can. Do not store the product in the refrigerator beyond the use-by date; follow USDA refrigerator storage time guidelines:
    • Hot Dogs – store opened package no longer than 1 week and unopened package no longer than 2 weeks in the refrigerator.
    • Luncheon and Deli Meat – store factory-sealed, unopened package no longer than 2 weeks. Store opened packages and meat sliced at a local deli no longer than 3 to 5 days in the refrigerator.
  • Divide leftovers into shallow containers to promote rapid, even cooling. Cover with airtight lids or enclose in plastic wrap or aluminum foil. Use leftovers within 3 to 4 days.

In a survival scenario, it may be difficult to avoid bacterial contamination unless you closely monitor food preparation. In normal times, it’s easier, but only if you pay attention to good practice of food hygiene.


Joe Alton, MD

Metronidazole as a Survival Antibiotic

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Antibiotics are an important part of any medical arsenal in tough times. Many infections easily treated today would possibly be life-threatening in an off-grid survival setting. Indeed, if such a thing occurred, you can bet that these drugs would no longer be produced. There would be a lot of otherwise avoidable deaths due to simple cuts that become infected or dehydration from diarrheal disease. We only have to look at mortality statistics from pre-antibiotic times like the Civil War to know that this is true. More soldiers died then from infectious disease that from bullets or shrapnel.



This article is part of a series on antibiotics and their use in survival settings. Today we’ll talk about an antibiotic that would be useful to deal with some organisms that can cause a number of major problems. Metronidazole (aquatic equivalent: Fish-Zole) 250mg is an antibiotic in the Nitroimidazole family that is used primarily to treat infections caused by anaerobic bacteria and protozoa.

“Anaerobes” are bacteria that do not depend on oxygen to live. “Protozoa” have been defined as single-cell organisms with animal-like behavior. Many can propel themselves randomly from place to place by the means of a “flagellum”; a tail-like “hair” they whip around that allows them to move.



Giardia (Protozoal Parasite)

The antibiotic Metronidazole works by blocking some of the functions within bacteria and protozoa, thus resulting in their death. It is better known by the U.S. brand name Flagyl and usually comes in 250mg and 500mg tablets. Metronidazole (Fish-Zole) is used in the treatment of these bacterial diseases:



• Diverticulitis (an intestinal infection seen in older individuals)
• Peritonitis (an inflammation of the abdominal lining due to a ruptured appendix, ruptured cysts, and other causes)
• Certain pneumonias (lung infections)
• Diabetic foot ulcer infections
• Meningitis ( an infection of the spinal cord and brain lining)
• Bone and joint infections
• Colitis due to a bacterial species known as Clostridia (sometimes caused by taking Clindamycin!)
• Endocarditis (a heart infection)
• Bacterial vaginosis (a very common vaginal infection)
• Pelvic inflammatory disease (an infection in women which can lead to abscesses, often in combination with other antibiotics)
• Uterine infections (especially after childbirth and miscarriage)
• Dental infections (sometimes in combination with amoxicillin)
• H. pylori infections (a bacteria that causes peptic ulcers)
• Some skin infections

And those are just the bacterial infections that metronidazole can deal with. It also works with these protozoal infections:

• Amoebiasis: dysentery caused by Entamoeba species (contaminated water/food)
• Giardiasis: infection of the small intestine caused by Giardia Species (contaminated water/food)
• Trichomoniasis: vaginal infection caused by parasite which can be sexually transmitted

Amoebiasis and Giardiasis can be caught from drinking what appears to be the purest mountain stream water, and these infections are seen right here in the Great Smoky Mountains and elsewhere. Never fail to sterilize all water, regardless of the source, before drinking it.

Metronidazole is used in different dosages to treat different illnesses. You’ll find detailed information in our book “The Survival Medicine Handbook” and in other standard medical references such as the Physician’s Desk Reference. You’ll also find this information at or

Here are the dosages and frequency of administration for several common indications:

• Amoebic dysentery: 750 mg orally 3 times daily for 5-10 days. For children, give 35 to 50 mg/kg/day orally in 3 divided doses for 10 days (no more than adult dosage, of course, regardless of weight).

• Anaerobic infections (various): 7.5 mg/kg orally every 6 hours not to exceed 4 grams daily.

• Clostridia infections: 250-500 mg orally 4 times daily or 500-750 orally 3 times daily.

• Giardia: 250 mg orally three times daily for 5 days. For children give 15 mg/kg/day orally in 3 divided doses (no more than adult dosage regardless of weight).

• Helicobacter pylori (ulcer disease): 500-750mg twice daily for several days in combination with other drugs like Prilosec (Omeprazole).

• Pelvic inflammatory disease (PID): 500 mg orally twice daily for 14 days in combination with other drugs, perhaps doxycycline or azithromycin.

• Bacterial Vaginosis: 500mg twice daily for 7 days.

• Vaginal Trichomoniasis: 2 g single dose (4 500mg tablets at once) or 1 g twice total.

All drugs have the potential for side effects, also known as adverse reactions. These are different from allergies, where your body actually mounts an immune response to a drug, such as in a penicillin allergy.

One particular side effect has to do with alcohol: drinking alcohol while on Metronidazole will very likely make you vomit.


Metronidazole should not be used in pregnancy. but can be used in those allergic to Penicillin.

Having antibiotics will give you an additional tool in the medical woodshed that just might, one day, save a life. They’re not toys, however, and should only be used when absolutely necessary.


Joe Alton, MD

joe bleachLearn more about antibiotics and their use in survival settings in our book “The Survival Medicine Handbook“, with over 250 5-star reviews on Amazon.