Today I offer part 1 of a 3-month medical prepping guide for your family, group, or community. Please note the following abbreviations: ORG = organizational concerns OTC = over-the-counter products Rx = prescription products ED = education and skills The supplies listed under OTC can all be purchased without a prescription, though some are only available online.  For prescription items, assess what your group has and what each member is likely to be able to acquire.  The three-month period is divided into 13 weekly tasks, divided according to topic, making the project more readily manageable.  For more detailed information on medical prepping, please visit www.armageddonmedicine.net. ·

Week 1

ORG

ASSESSMENT

Identify each member of your group and begin a medical chart or notebook to include each individual

· Identify current and probably future medical needs of each member, including reproductive concerns · Identify current medical training and abilities within your group · Identify needed medical training within your group (First Aid, CPR, suturing, casting, special concerns) · Identify transportation concerns · Designate one or more go-to individuals who will be responsible for the medical needs of your group · Determine an approximate budget for your medical prepping and how costs will be distributed · Schedule weekly to monthly meetings to assess your prepping progress

OTC

WOUND CARE and MEDICATIONS DIFFICULT TO OBTAIN IN QUANTITY

Begin purchasing items with a long shelf life:

· Dressings, gauze, Band-Aids, Telfa pads, medical tape, Coban, Ace wraps, · Kotex for large wounds · Wound cleaning supplies including antibacterial soap and/or Hibiclens, clean or sterile water or saline · Wound closure supplies including suture kits, suture, staplers, staple removers, and Steri-Strips · Thermometers, blood pressure cuffs, stethoscopes, adult and pediatric scale

Begin acquiring medications that cannot be purchased in bulk, and continue purchasing these as desired throughout your preparation period

· "Real" Sudafed (pseudoephedrine – requires signature; can only be purchased in small amounts) · OTC Insulin, if needed · OTC Primatene Tablets (or preferably Mist, if available)

Rx

MEDICATION-DEPENDENT PERSONS

Medication-dependent persons should assess their long-term needs and make a list of needed long-term prescription refills to request from their physician.  This is best done in person, per Week 2, below.

· Diabetics should also request testing strips, lancets, needles, and other supplies from their physicians. · Hypothyroid patients should consider stocking up on nutraceutical desiccated thyroid, and/or locate an adequate source of mammalian thyroid tissue to make their own. · Asthmatic patients should request nebulizer medications in quantities of 100 vials. · Oxygen-dependent persons should obtain a concentrator and reliable power supply.

ED

RECORD-KEEPING

· Obtain or create forms for medical record keeping

Week 2

ORG

OPTIMIZING YOUR HEALTH

Schedule needed appointments for each member, as appropriate, to include the following:

· Medical concerns, including current, recurrent, acute and chronic problems, as well as reproductive status · Dental exam, cleaning, and restorative work · Vaccines (Tdap, influenza, pneumonia, MMR, chicken pox, shingles, hepatitis A and B, as needed) · Vision (make sure to get a copy of your eyeglass or contact prescription to order extras online)

OTC

ORTHOPEDIC CARE

Order the following in quantities sufficient for the ages and size group you’ll be caring for:

· Casting supplies:  Plaster rolls, stockinet, cast padding, gauze rolls, Ace and/or Coban, bucket for water · Pre-formed splints and braces (for wrist, knee, ankle) · Slings · Crutches for adults and children, walker, cane, wheelchair

Rx

PAIN MEDICATIONS

· Those who suffer from back pain, arthritis, or other chronic or recurrent painful condition should request a small quantity of Tylenol #3, Vicodin, or tramadol from their personal physician, perhaps 15 – 30 tablets.  Note:  it is currently a felony to share these with other individuals, but should society collapse, a physician in your community could re-allocate them to a needy individual within your family or group.

ED

SKILLS TRAINING

Schedule needed training identified in Week 1

· First Aid · Special concerns (such as diabetic training, catheter care, fluid administration) · Suturing · Splinting and casting · CPR (primarily useful for near-drowning victims and obstructed airways, otherwise rarely successful)

Week 3

ORG

RECORD-KEEPING

· Make a medical chart or page in a notebook for each member of your family or group. · Discuss confidentiality issues and how you plan to keep private information secure. · Designate who should have access to your personal health information and who should not. · Discuss consequences for breach of trust.

OTC

NUTRITION and EYECARE

Acquire the following items, as appropriate for your group:

· Vitamins, including folic acid for pregnant women, Vitamin B12 for the elderly, Vitamin K for newborns · Salt, sugar, water, and fruit juice for Oral Rehydration Solution · Calcium and Vitamin D for all when milk/calcium and sunlight not accessible · KI (potassium iodide, for potential radiation exposure) · Order extra inexpensive glasses and/or contacts online · Order pinhole glasses online and obtain multiple pairs of inexpensive reading glasses · Purchase OTC eye meds including contact solution and Alaway or Zaditor for allergic eyes

Rx

ANTIBIOTICS

· Have all group members begin requesting antibiotics from their personal physicians, one at a time, to include the following: amoxicillin or penicillin, doxycycline or tetracycline, erythromycin or azithromycin, amoxicillin-clavulanate or cephalexin, trimethoprim-sulfamethoxazole, metronidazole, ciprofloxacin.  Upcoming travel outside the US is commonly a legitimate reason to procure antibiotics for potential use.  In some countries, these are sold OTC as well. · If this is unsuccessful, see "Infection" in Week 4, below.

ED

SKILLS PRACTICE

· Practice suturing on a pig’s foot, chicken breast, turkey, or hot dog. (Online videos available) · Practice working with plaster, making splints and casts. (Online videos available)

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Cynthia J. Koelker, MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education. The author continues to practice medicine in Akron, Ohio where she resides with her family and beloved golden-doodles. She is the author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy.

The Best of Cynthia J. Koelker, MD

For the past year now I've been using an Electronic Health Record (EHR) and believe the writing is on the wall. These computerized medical records are not about improving health care; they are about control of both the physician and patient.

Beginning in 2013, doctors who don't prescribe electronically will be penalized financially. Although this mandate is Medicare-driven, Medicare collects statistics for patients of all ages and insurance groups, not just those receiving Medicare benefits. What Medicare requires eventually effects us all.

So what do I foresee? A primary goal of the EHR is the universal availability of your medical records. If you're in Florida and visit an Urgent Care center while on vacation, "ideally" your records from your Ohio family physician will be readily accessible. With your health records on computer, theoretically the information can be transferred nearly instantaneously. The problem is, there are hundreds of different EHR systems, and they do not communicate with each other, and your doctor may not be able or willing to provide this information in the middle of the night. The easiest solution to this problem is the adoption of a single system used nationwide by all providers.

If only one system is to be used, it will likely be government-controlled. For timely exchange of information, your records will need to be hosted on the Internet (which many already are). This makes it simple for governing agencies to collect data on both patients and physicians. If America ever goes to a single-payer system, you can guarantee data collection will skyrocket.

You will also need a number, a card perhaps, similar to an insurance or Medicare card. But my patients commonly forget to bring these along. What if you show up in the ER without identification? Why, the simplest answer is to have your EHR-access information available in or on your body. Pets are commonly "chipped" with tiny RFID implants, in case they are lost. What about your Granny with Alzheimer's, or young children, or mental patients prone to wander? They too can be chipped — and so can we all.

If you think this is crazy, consider that Medicare is already collecting data on your body mass index, your tobacco use, your vital signs, diagnoses, and medications. Insurance companies and pharmacies track which drugs I prescribe and whether my patients are compliant with refills. In Ohio, every controlled drug that is prescribed is reported to a database. Last year it was voluntary for me to check my patients. This year I am mandated to check this database on all patients using any controlled drug or tramadol in an on-going basis. Whereas this mandate is to find the few who are abusing medication, it subjects all of us to governmental monitoring. Additionally, this mandate will require dozens, perhaps hundreds, of hours of my time to detect a problem, wasting both time and money. The benefit to society is unproven, but it's the law. Your name, too, may be in a government database. A few Vicodin after a dental extraction may land you there.

My only patient to refuse the EHR to date is a former citizen of the USSR. What does that say? Does she know something we don't?

At least for now, you can refuse an EHR record — at least at my office. Other doctors may not be so accommodating. If they have transferred all their records to computer, they may have no means of maintaining a paper record. And if your doctor is an employee, he or she has little if any say-so in the matter.

The EHR amounts to a little-recognized infringement of your personal freedom. Perhaps this article will engender a rebellion against computerized medical records. I'm actually hoping so. My paper records were better organized, easier to access, and definitely more secure.

Cynthia J. Koelker, MD is author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy and Armageddon Medicine, How To Be Your Own Doctor in 2012 and Beyond, available at her web site, along with hundreds of free articles, Armageddon Medicine.

The Best of Cynthia J. Koelker, MD

If society collapses and you’re on your own, what medical skills seem the most essential? The answer likely depends on your age, health status, and stage in life. For those of child-bearing years, midwifery skills may be paramount. For those advanced in age, diagnosis and treatment of chronic disease becomes primary. For the otherwise young and healthy, treatment of injuries and infection tops the list.

Our current compartmentalized society has deemed that doctors should perform these tasks, though turf wars abound over what nurses, physician assistants, pharmacist, paramedics, and others should legally be permitted to do. Recent decades have also seen the trend toward home care for I.V. therapy, nebulizer treatments, dialysis, and much more. The take home lesson is this: the layman can acquire many skills once considered the purview of health professionals alone. Thus, the first step in acquiring these skills is believing that you can do so.

The next question is to identify what skills you’d like to acquire. Though an unknown future presents unknown threats, common injuries and diseases will no doubt persist. Patients suffering lacerations, infections, sprains, and broken bones fill the ERs. Infections, diabetes, asthma, pneumonia, chest pain, arthritis, GI disturbances, urinary problems, STDs, and assorted rashes comprise the majority of medical problems. Learning how to diagnose and treat these problems is a good place to start.

To be more specific, needed skills include the ability to suture, to apply a splint or a cast, to administer an aerosol or needed fluids, to check urine for infection, to identify common rashes, to have a working knowledge of antibiotic usage, and much more. Such a list is daunting and may dissuade a person from attempting anything – but remember: doctors take a lifetime learning the practice of medicine.

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Cynthia J. Koelker, MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education. The author continues to practice medicine in Akron, Ohio where she resides with her family and beloved golden-doodles. She is the author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy.

The Best of Cynthia J. Koelker, MD

A reader of SurvivalBlog wrote to ask whether dimethyl sulfoxide (DMSO) is safe and effective for use in humans. The chemical is well-known in veterinary circles for its soothing effect on swollen, inflamed equine (horse) muscles. But would it have the same effect on people?

Unrelieved pain is a great fear among survivalists and preppers. Few have access to narcotics or anesthetics. Wouldn’t be great if there were a readily available, safe and effective over-the-counter remedy? That is the primary question with DMSO.

What is DMSO anyway? The chemical dimethyl sulfoxide is a potent solvent, produced as a by-product of the wood pulp industry. It is best known medically for its ability to penetrate the skin, and has been useful as a carrier to aid the absorption of other beneficial medications. Therein lies one of the concerns: if the skin is contaminated or the DMSO formulation is impure, unwanted chemicals may enter the body. Therefore if you are going to use DMSO as a topical preparation, make sure you use medical grade rather than industrial grade DMSO.

Whether DMSO works as a topical pain reliever is controversial. The “party line” of the medical establishment is that it is probably NOT effective. One study (in the journal Pain. 2009; 143(3):238-45) concluded that topical DMSO was no more effective than placebo in relieving symptoms of chronic knee osteoarthritis. However, such a study does not answer the question completely. Did the DMSO penetrate inside the joint capsule, to the actual source of pain? A study on the knee cannot answer the question as to whether DMSO is effective for muscular pain, or perhaps acute joint pain caused by strain or overuse. In 2008 a systematic review of DMSO use in osteoarthritis (Osteoarthritis Cartilage. 2008; 16(11):1277-88) concluded there is insufficient evidence either way to decide whether it is beneficial.

This raises another point: pain is not simply one thing. Joint pain and muscle pain are not the same. Acute pain is different than chronic pain. Traumatic bone pain is different from cancer pain. Neuropathic pain is not the same as primary muscle pain. Bladder pain is different than headache pain.

DMSO has been used effectively for certain types of pain. Currently it is only officially FDA-approved for discomfort or pain associated with interstitial cystitis, a chronic condition of the bladder causing pelvic pain and/or urinary symptoms. A small amount of DMSO is instilled into the bladder via a catheter, where it is left in place for 10-15 minutes, then emptied. This process is repeated every week or two for a few months, and most patients experience some relief of pain. DMSO is thought to work by reducing inflammation and possibly decreasing bladder muscle contractions.

If DMSO can work in the bladder, might it not be effective elsewhere? One of the worst pain syndromes is cancer-related pain. DMSO (plus sodium bicarbonate) has been used as IV therapy for patients with refractory metastatic cancer pain unresponsive to other treatments with encouraging results [J Pain Palliat Care Pharmacother. 2011; 25(1 and 4)].

So where does this leave us? Doctors don’t really know. I’ve had patients who have sworn DMSO is effective. These have been younger patients with acute injuries or inflammation; such patients are prone to conditions akin to the acute injuries active horses might suffer. Treating a young injured race horse is likely to yield better results than treating a worn-out work horse.

Physicians prefer to have strong proof for what we advise, though that is often lacking. Regarding DMSO, the Memorial Sloan-Kettering Cancer Center concludes, “Most of the clinical studies done on DMSO were published in the 1980s and early 1990s. Reliable data to verify its purported uses are limited.”

Regarding safety, the concerns are acute and long-term side-effects. Any use of DMSO is likely to yield either bad breath or a garlic-like taste in the mouth or similar odor on the skin. Rashes and dry skin are common with topical use. Allergic reactions are possible as well. Those using the product long-term may suffer kidney or liver damage and ideally would undergo blood testing every 6 months (a difficult proposition at TEOTWAWKI).

The MSDS sheet lists a multitude of concerns (but no more than other drugs we use every day, including aspirin).

My own conclusions are these:

1. DMSO probably does work for certain conditions which have not been well-identified, but may be related to acute injury or overwork rather than chronic inflammation.
2. It is reasonably safe to use medical-grade DMSO topically on an intermittent basis.
3. Patients who already have liver or kidney damage or who are pregnant or nursing should not use DMSO.
4. We need more studies to prove which ailments DMSO is best used for. Unfortunately, those studies are unlikely to be performed due to lack of funding.
5. Using industrial-grade DMSO can be dangerous and result in unwanted poisoning with unidentified products.
6. DMSO is probably no more effective than OTC NSAIDs (aspirin or willow bark, ibuprofen, naproxen) but may provide an alternative, especially for patients intolerant of these meds.
7. All users should be warned about the garlic-onion-oyster odor [or taste] they will experience.
8. Doctors don’t know everything, but we err on the side of caution.

JWR Adds: Readers are further warned to store DMSO only in containers with tight-fitting lids that are vapor tight, and to store their supply of 99.9% pure medical (or veterinary) grade DMSO well away from any toxic substances. The solvent’s amazing carrier properties are well-documented. Keep in mind that if you apply it to a sore muscle using your hands then any contaminants on your hands will be absorbed through the skin and enter your bloodstream. The speed with which this can occur can be astonishing. I once read about a man who washed his hands with a scented soap shortly before using DMSO. Then, less than a minute after applying the DMSO with his hands to his sore knees, he could taste the hand soap on his tongue, almost as if he had licked the bar of soap! Some drug addicts have reportedly used DMSO as a "soft" way to ingest drugs that require only small doses, such as PCP and Fentanyl. And though perhaps exaggerated in the frequency of occurrence in popular fiction, DMSO mixed with a powerful toxin such as saxitoxin has reportedly been used by foreign intelligence agencies for killing some political opponents of unpopular regimes.

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Cynthia J. Koelker, MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education. The author continues to practice medicine in Akron, Ohio where she resides with her family and beloved golden-doodles. She is the author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy.

The Best of Cynthia J. Koelker, MD

This blog post is contributed by a dentist colleague, who has offered to submit a series of posts about dental options when no dentist is around. Thats, wh2thdr, for a look into the past . . . and possibly the future.

He begins with a true story about Horse and Buggy Dentistry . . .

Let me relate a story that was told to me by an old timer (80+) probably 35 years ago. The tale was his memory of some tooth trouble that his dad was having and the way that it was taken care of. The story takes place in the foothills of South Carolina, probably in the 1890-1900 time frame. The locals in this area are the same self-reliant, tough, industrious breed that populates the Appalachian Mountains. (For reference to the type: Cold Mountain book and/or Movie, and Foxfire book series) The more I thought about this story over the years, I have come to realize that it was told through the eyes of a small child, some of the details that an adult would comment on are missing. All in all, it is as good a look at historic dentistry that I have from a first hand witness.

The story begins at the same general store in which it was being told. Dad and Son were on their Saturday trip for supplies in early spring. Dad had been having trouble with a tooth, so he notified the proprietor of the store that he needed the traveling dentist to come see him when he came into the area.

It was a matter of a few days, while the boy and his dad were plowing their bottom land field, that a man came riding up on horseback. The old man related how the rider got down off his horse and after tousling the boys hair, the two adults struck up a conversation. They came to an agreement and the boy’s dad handed some coins to the itinerant dentist. At this point, Dad sat down on a stump and began to down a pint of whiskey that the dentist provided from his saddlebags. In short order, when dad was a bit tipsy, the dentist took a leather pouch from his saddle bags and unrolled it on the ground. In the open pouch were many pockets with all sorts of tools and pliers. At this point, the dentist turned the father to face the sun and standing behind the patient the doc tilted Dad’s head back against his side. With his elbow and forearm the dentist got dad in a headlock and using one of the pliers grabbed the tooth and began to rock tooth and head from side to side.

Now our story teller said that his dad was the bravest guy he knew. He let out only a few moans, but he did clench his hands till his arms quivered. In short order the bloody tooth was out, and the socket stopped with a folded piece of cloth. The Dentist used the last of the whiskey to rinse the pliers after they had been wiped clean of blood. The leather pouch was repacked and stowed in the saddle bags. Hands were shaken and the dentist mounted up and was off down the road to his next patient. Dad, after a short while, was back to himself and resumed plowing for the rest of the day.

Was the story true? I think it was; at least as true as any tale told after 75 or so years. What is the lesson from the story? One, tooth pain can make one willing to do about anything to get relief. Two, dentistry can be done in the open air with limited equipment by a knowledgeable and trained practicioner. Three, we sure should be thankful to live in an age and time when that has not been necessary. Finally, get and keep your teeth in as healthy condition as possible. Most healthy adults can go for a long time without tooth aches if they keep up with needed treatment in a timely manner.

It is my goal to write a series of brief articles for Doc Cindy’s blog to help other health care practitioners and competent laymen to have a knowledge base of practical stop gap dentistry.

Reprinted with permission from Armageddon Medicine.

Cynthia J. Koelker, MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education. The author continues to practice medicine in Akron, Ohio where she resides with her family and beloved golden-doodles. She is the author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy.

The Best of Cynthia J. Koelker, MD

Serious medical conditions that occur infrequently now will become commonplace at TEOTWAWKI. Recognizing the symptoms will help you treat these diseases effectively. Better yet, learn how to prevent them and prepare accordingly.

Case #1

It’s been over a year since you’ve escaped the city for your retreat. Things are going well, though your teenage daughter is tired of hauling water from the creek. One day you walk with her and are alarmed at how winded she becomes. She’s been acting fine otherwise, still primping and polishing her nails (though no boys are around). She hasn’t lost any weight and seems to be eating okay, though she’s become a vegetarian after watching you slaughter a pig. She has no history of asthma or heart disease, and shows no signs of respiratory infection. What’s the most likely diagnosis?

(see answers below)

Case #2

Meanwhile, your toddler is starting to worry you. He was walking fine when you left the city, but now his legs are starting to bow like a cowboy’s. Your wife plans to continue breast-feeding him another year yet, believing it will benefit his immune system. Both of them have remained inside for months to avoid possible radiation exposure. What could be wrong?

Case #3

It seems your mother is growing old before your very eyes. At the last minute she agreed to join your family, though she hadn’t done any prepping herself. Before, she always seemed full of pep. Now she doesn’t have the energy to help with anything. Even her voice sounds worn-out and a little hoarse. Another mouth to feed wasn’t what you had planned on, but you can’t set your mother out on the curb, can you?

Answers:

1.) Shortness of breath occurs when either the lungs or the heart must work harder. In the absence of heart or lung disease, the most likely condition is iron deficiency anemia. Without enough blood, the heart must pump harder to keep what little blood remains circulating properly. Usually the heart rate increases, especially with exercise, and often the blood pressure drops. In a teenager wearing make-up and nail polish, you may not notice pallor (paleness). Vegetarians who are not careful to include iron-rich foods in their diet are prone to anemia, especially teenagers who prefer a high-starch diet. I’ve seen girls whose blood count has dropped to only a third of normal as a result of an iron-poor diet, with or without excess menstrual blood loss.

Normally a teen whose blood count has dropped low enough to cause shortness of breath would be transfused with red blood cells for quick relief. Untreated, extreme anemia will lead to congestive heart failure and possibly eventual death.

Fortunately dietary ingestion of iron will resolve the condition (or taking OTC iron pills such as ferrous sulfate 325 mg three times daily). Iron-rich foods include red meat, liver, dark leafy greens, prunes, raisins, egg yolks, iron-enriched cereal, beans, artichokes, lentils, soybeans, and chick peas. Make sure to stock foods your family will actually eat.

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Assuming your personal physician will help you stockpile antibiotics for TEOTWAWKI, which should you request? Is there a logical reason to have amoxicillin on hand rather than doxycycline?

Here’s what I would suggest and why.

No antibiotic is effective against every type of microbe. Certain ones will kill aerobic bacteria, others are used for anaerobic bacteria, still others are effective against resistant strains, and certain people are allergic to or intolerant of various antibiotics. The following are all generics, running about $10 for about a month’s treatment.

Amoxicillin is the old standby for most respiratory infections (probably most of which are viral and don’t even require antibiotics). It is excellent for strep throat and some strains of pneumococcal bacteria. It is also safe for children and pregnant women. It is well-tolerated, causing little stomach distress or diarrhea. The drawbacks are that some people are truly allergic, and many bacteria have developed resistance to amoxicillin (especially staph) through overuse among both humans and animals. Anyone truly allergic to amoxicillin should substitute erythromycin or another antibiotic.

Cephalexin works on most of the same bacteria as amoxicillin, plus is stronger against Staph aureus, which mostly causes skin infections. It rarely works against MRSA (resistant staph), however. It is also well-tolerated in children and is safe in pregnant women, causing few side-effects. Like any antibiotic, it carries the risk of allergy. People who develop anaphylaxis (a life-threatening allergy) with amoxicillin probably should not take cephalexin, as there is a good 10% cross-reactivity between the two. If I had to choose between stockpiling amoxicillin or cephalexin, I would choose cephalexin. The combination drug, amoxicillin-clavulanate (Augmentin), is as strong against staph, but more expensive and harder on the stomach.

Ciprofloxacin is useful for anthrax (which I’ve never seen), urinary tract and prostate infections (which are very common), and many forms of pneumonia and bronchitis. One of the more important and selective uses of ciprofloxacin is in combination with metronidazole for diverticulitis. This potentially life-threatening infection usually (or at least often) requires two antibiotics to resolve. (Levaquin and Avelox are a bit stronger than ciprofloxacin and could be substituted for this, but are much more expensive.) Ciprofloxacin is not used in women or children unless the benefit clearly outweighs the risk, although the risk of joint damage (seen in animals) appears minimal. Taking ciprofloxacin by mouth is nearly as effective as taking by IV.

Doxycycline is useful in penicillin/amoxicillin-allergic adults for respiratory infections and some urinary/prostate infections. It is avoided in children and pregnant women unless the benefit clearly outweighs the risk (of permanent tooth discoloration in children under the age of 8). Doxycycline is sometimes effective against penicillin-resistant bacteria. If I were limited to either doxycycline or erythromycin, I would choose erythromycin for stockpile.

Erythromycin is useful for most of the same infections amoxicillin is used for, and thus can be substituted in penicillin-allergic patients. However, erythromycin tends to cause the intestine to contract, often causing cramps or diarrhea. (This property is sometimes used to help patients with conditions that impair intestinal motility.) It can be safely used in children and pregnant women.

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Are over-the-counter
(OTC)
drugs really worth stockpiling? As a family physician my answer
is a resounding yes. Most of the following were actually prescription
medications when first released. (In higher dosages, several still
are.) Although other OTC drugs are worth considering, these ten
have been selected due to their ready availability, affordability,
safety in both adults and children, and multi-use potential. Used
alone or in combination, they can effectively treat dozens of conditions
including: headache, fever, sore throats, ear ache, menstrual cramps,
heartburn, arthritis, ulcers, diarrhea, allergies, hives, congestion,
dizziness, mild anxiety, nausea, vomiting, poison ivy, athlete’s
foot, ringworm, eczema, insomnia, backache, gout, diaper rash, yeast
infections, and many more common illnesses.

1. Ibuprofen
(Motrin, Advil) – Among the OTC anti-inflammatory medications,
ibuprofen is probably the most versatile. Primarily indicated for
pain and inflammation, it may also be used to relieve headaches,
earaches, sore throats, sinus pain, stiff neck, muscle strains,
menstrual cramps, arthritis including gout, and back pain. It is
also effective at reducing fever and is generally safe for use in
children. It is not advisable for most stomach-related pain, although
may decrease the pain of kidney stones, kidney infections, and possibly
bladder infections. The most common side effect is stomach irritation
or heartburn. When combined with acetaminophen it is nearly as effective
as codeine, tramadol, or hydrocodone in relieving more severe pain.

2. Acetaminophen
(Tylenol) – Acetaminophen is the only OTC pain-reliever that is
not an anti-inflammatory drug. It will not irritate the stomach
like ibuprofen, aspirin, or naproxen. It is useful for the same
conditions as ibuprofen, though effectiveness varies according to
patient. As mentioned above, it may be combined with ibuprofen in
full doses for more severe pain. Side effects are very few, though
in high dose, especially when combined with alcohol, it can lead
to liver failure. It is available in several pediatric dosages,
both for pain relief and fever reduction.

3. Diphenhydramine
(Benadryl) – An inexpensive antihistamine, diphenhydramine
is primarily used for drainage due to respiratory infections and
nasal allergies, in both adults and children. It is also indicated
for hives and itching, including itchy rashes such as poison ivy.
Although not all patients become drowsy when using diphenhydramine,
many do so, making this medication useful for insomnia as well.
Some people find the drug relieves nausea or mild anxiety.

4. Loperamide
(Imodium) – The most effective OTC medication for diarrhea is loperamide,
which is available both as tablet form and liquid for children.
It is often useful for relieving intestinal cramping.

5. Pseudoephedrine
(Sudafed) – Pseudoephedrine is effective at relieving congestion
of both the upper and lower respiratory tract due to most common
causes including infection, allergy, chemical irritation, and mild
asthma or bronchitis. It frequently has a stimulatory effect, similar
to caffeine. The most common side effects are those resembling a
burst of adrenaline: rapid heart rate, palpitations, and increased
blood pressure. Years ago this drug was used in young children,
even babies, though now most pediatricians do not advise it in patients
younger than about six years old.

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December
14, 2010

In Part I of
this series, I explained the definition of pharmaceutical expiration
dates and ‘do not use beyond’ dates, and how both are
determined.

Additionally,
I reviewed information from the Shelf Life Extension Program (SLEP)
database, which led to a temporary Emergency Use Authorization in
2009, permitting the use of certain Tamiflu products (to treat H1N1
influenza) for up to an additional five years beyond the imprinted
expiration date. (See
Part I of this series for more information. )

Part II will
examine the data regarding use of common antibiotics beyond their
expiration dates.

The following
is excerpted from my upcoming book, Armageddon Medicine.

Does a can
of tuna go bad overnight? What about a bottle of medicine? Common
sense suggests the answer is no, but is there any evidence?

The primary
source of information regarding the prolonged stability of medications
comes from the Shelf Life Extension Program database. Rather than
discard millions of dollars worth of expired drugs stockpiled for
emergency use, the U.S. federal government tested representative
lots of selected medications for extended stability. These stockpiled
drugs are aimed at emergency use for injuries and infections rather
than chronic diseases such as diabetes, heart disease, and asthma.
The most useful data for the layman is related to drugs to combat
bacterial and viral infections.

Of the antibiotics
tested, all passed assays for stability, potency, and appearance
for at least a year beyond the original expiration date.

Of the lots
tested, the following had their expiration date extended by the
number of months indicated.

Medication
Name
Dosage
Form
Average
extension in months (range)

Amoxicillin
sodium
Tablets

23 (22–23)

Ampicillin

Capsules

49 (22–64)

Cephalexin

Capsules

57 (28–135)

Ciprofloxacin

Tablets
55 (12–142)

Doxycycline
Hyclate
Capsules

50 (37–66)

Erythromycin
lactobionate
Powder

60 (38–83)

Sulfisoxasole

Tablets

56 (45–68)

Tetracycline
HCl
Capsules

50 (17–133)

Silver
sulfadiazine
Cream
57 (28–104)

A
summary of the Shelf Life Extension Prorgarm (SLEP) data is available
in The Journal of Pharmaceutical Sciences, Vol. 95, No. 7,
July 2006.

Read
the rest of the article

October
29, 2010