Category Archives: Medical

What Goes In, Must Come Out

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Dealing With Poop

When we discuss our five basic needs, food is first on the list. Every prepper stores food. We discuss where should we go to get it, how to prepare it, and what the next meal will be. We freely discuss all aspects of food, but very few of us comfortably mention the other end of the digestion process.

The poop. As assuredly as we know we’re going to eat regularly, we also know we’re going to poop regularly. But other than a few minutes alone in the bathroom, we hardly even think about it.

Now, envision a time when your plumbing no longer works. Maybe short-term, maybe long-term; either way when you push down the flush handle, nothing happens. You check the tank and it’s empty. What next? A very nice house after a week without working plumbing isn’t very nice anymore. Water and sanitation departments can fail. What’s your #2 plan?

If you have a septic system (that is rated for the number of people in your household) the problem of dealing with poop does not apply to you and you can stop reading now.

Our family’s plan is to use water collected in our rain barrels to refill the toilet tank so it can be flushed. We store 110 gallons of rain water, the tank uses 3 gallons each flush, that means without any rain, we can flush the toilet about 36 times. After you finish your business, you flush, then go get a 3-gallon bucket of water and refill the tank for the next person. Since we live in Western Washington, this will be fairly sustainable.

Another option, especially if you believe the emergency is short-term, is to line the inside of the (now dry) toilet bowl with a plastic bag. Do your business, remove and tie the bag. Store the bags somewhere where animals can’t get to them until the crisis is past and they can be disposed of properly.

If it’s going to last longer, you’re going to need to start digging. For a temporary measure you can dig a trench latrine. The trench latrine should be about 4 – 6 feet long,1 foot wide, and 1 foot deep. Leave the dirt that was dug out on the side of the trench so that waste can easily be covered up; keep a shovel and a roll of toilet paper nearby.

Building an outhouse is a more permanent solution. Build it close enough to the main dwelling to allow easy access, but far enough away to minimize smell. It needs to be at least 150 feet from freshwater (including a well). The pit should be 5 – 8 feet deep and framed in, to some degree, to keep the sides from collapsing. Consider building it so it can be moved if the pit fills. For detailed plans see Rogue Turtle’s post, The Outhouse, or Cottage Life’s, How to build an outhouse.

There are other ways also. At times the military, in remote locations, mixes fuel with the human waste and it’s burned. As it burns it needs to be stirred to ensure it is all consumed; use caution as it can pop and splatter (there’s a reason why this is done by the lowest ranking members of the unit). But in a SHTF scenario, most of us won’t have extra fuel to use this way.

There’s even a way human waste can be composted, it’s called humanure. I, like probably most of you, are skeptical of this approach. But in a TEOTWAWKI situation, it’d likely be the best way to both get rid of it and to maintain a usable source of fertilizer. I’m going to put that one on the back burner for now though. Here’s additional information on humanure.

No, this isn’t polite dinner conversation, but it’s a fact of life we can’t avoid. What goes in, must come out.

An Introduction to Straight Razors

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Never Buy A Replacement Blade

I concede that in a collapse situation, personal grooming won’t be a top priority. But just because it’s TEOTWAWKI doesn’t mean you won’t want to be able to shave. Maybe you will choose to grow a beard. But wouldn’t it be nice if that was your decision, not one made because you ran out of disposable razor blades? Also you ladies–you need to decide–how important is having shaved underarms and/or legs to you?

Alexander the Great’s shaven image on the Alexander Mosaic, 2nd Century BC

People have been shaving for a long time. Razor blades, made of copper, were first used around 3000 BC. Alexander the Great was a strong advocate of his soldiers shaving (in the 4th century BC) to avoid “dangerous beard-grabbing in combat”, and because he believed it looked tidier.

The ‘modern-day’ folding straight razor has been around since 1680. It was used from that time until the early 1900s; then, in 1901, Mr. Gillette invented the disposable safety razor. By the end of World War I (after millions had been issued to the troops) most men were shaving with a disposable razor. In the 1920s, women too began using the disposable razor; shaving their legs when dress hemlines began to rise and show more skin.

I had thought about trying a straight razor for a some time. Last year I read a post on TSP form, How to get out of a consumer marketing trap with a straight razor, and finally decided to go ahead and do it. Sarah thought I was crazy, but she was supportive; she watched me the first night, phone in hand, ready to call 911 in case of severe bleeding. There were several nicks in the beginning weeks, until I got the hang of it, but nothing serious. The honing and stropping were a hassle for me to figure out; I finally realized that I had to hold the razor at a flatter angle than I do when sharpening a standard knife. Now, almost a year later–though I still have to concentrate more–it takes no longer than a disposable razor, and is routine and smooth (pun intended). I strop the edge each time before I shave, and hone it each month.

Why use a straight razor?

  • It’s the ultimate self-sufficient shaving tool
  • The nostalgia of using a traditional method
  • The larger blade covers more surface with greater control
  • You don’t have to rinse as much and clean up is easier
  • It prevents skin razor bumps that are caused by multi-edged razors
  • Once you master it, you’ll feel very cool

To get started you’d need (as shown clockwise in the photo): the straight razor, a leather strop, a boar bristle shave brush, a bowl (or mug) for the soap, and the shaving soap. (The above links are to the items I own; they were suggested on TSP forum post as a good basic starter set).

Many resources are available to help you learn how to use your new razor; it does take effort to become proficient. I like this YouTube video, he narrates it well and uses the right hand/right side, left hand/left side technique that I think works best. The Art of the Straight Razor is a good written resource.

Anciently, before copper razors were available, hair was sometimes removed using two shells to pull the hair out. So if you still want that clean look if the SHTF, either invest now in a straight razor or stock up on those shells.

(Friday: What I Did This Week To Prep / What I’m Thankful For)

Something To Lean On

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Reasons to Add Crutches, Canes, and Wheelchairs To Our Preps
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No one plans to trip and fall–especially not to fall and get hurt–but we do. It happens faster than we can say “oops”. Most of the time we quickly (or slowly) get back up, check to ensure all our parts still work, and somewhat sheepishly go on. But sometimes you either can’t get up, or it really hurts when you do.

A little while back I was thinking how difficult it would be to get around in a collapse situation with a leg injury. Trying to improvise crutches or a cane, though doable, wouldn’t be ideal. So we decided to purchase (from a thrift store) a set of crutches, a cane, and a wheelchair. So far we’ve got the crutches and a cane, hanging neatly in a corner of the garage. We haven’t found a decent wheelchair for good price yet, but when we do it’ll be folded down and hung with the others.

When an injury first happens, especially if it looks serious, everyone available helps and cares for the injured. But in the days afterward, the injury is mostly forgotten by everyone except the injured. He (or she) now has to get around and function as best they can. Injuries such as sprains and strains* are rarely crippling, but they make even minimal walking painful and difficult. Having that set of crutches or a cane (though a cane is easier to improvise, storing one takes almost no space) allows a patient to be ambulatory and more independent. In addition a wheelchair, for someone who can’t even get around on crutches, would be invaluable. Remember we’re discussing a situation where there is no other medical assistance available; a situation where you only have what you have.

This doesn’t have to be just a collapse situation. What about an injury during an ice or snow storm where it’s difficult to get out, or to have an ambulance respond? How much easier would it be if you had what was needed to allow your patient to be ambulatory? Then, when care is available, hang it back up until it’s needed again – they’re reusable.

Ryan is currently healing from an injury of his own. His involves the collar-bone and shoulder region (bike crash), so it doesn’t limit him walking around. But I was reminded how long those type of injuries take to heal, the pain associated with them, and the inconveniences they cause doing simple day-to-day activities.

The other thing I plan to add to our medical preps is a folding military-style stretcher. I thought about this again when I read Dr. Bones’ post, Thoughts on Patient Transport. A stretcher is in a somewhat different category since it’s used to carry an injured person, and may not be as necessary because it can be improvised. But we know that people are going to get hurt and that they are going to need to be moved; so we may as well prepare for it.

I know this isn’t brain surgery, but frequently we don’t think about preparing for medical injuries beyond having a first aid kit. As I’ve stressed before, in a collapse situation people who aren’t used to physical exertion will be forced to be much more active and injuries will happen – and they will happen more frequently.

(Friday: What I Did This Week To Prep)

*A sprain is an injury to a ligament (in a joint), i.e. sprained ankle; a strain (aka as ‘pulled’) is an injury to a tendon or muscle, i.e. strained, or pulled, hamstring). For first aid treatment, remember the mnemonic: P.R.I.C.E. – protect, rest, ice, compress, elevate. Crutches, a cane, or a wheelchair will help protect the injured extremity by not putting weight on it, and allow it to rest by using it as little as possible.

Expired, or Not Expired… Can You Store Medications Long Term?

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What medications* do we keep in our preps? We store: 1) over-the-counter (OTC) drugs: ibuprofen (Motrin), acetaminophen (Tylenol), aspirin, diphenhydramine (Benadryl), pseudoephedrine (Sudafed), loratadine (Claritin), guaifenesin (Mucinex), and 2) antibiotics (that I recently posted about): amoxicillin, cephalexin, ciprofloxacin, doxycycline, metronidazole.

How long can they be stored? They have expiration dates, does that mean they go bad?

Let’s start with what do drug expiration dates mean? Required since 1979, the expiration date is the last date that the pharmaceutical company will guarantee 100% potency (some sources state at least 90% potency). So then we ask, how long does it take a drug to lose it’s beneficial effects?

That is the question that the Department of Defense (DOD) asked the Food and Drug Administration (FDA) in 1985 (the military had over a billion dollars worth of medication stored). So in response, in 1986, the DOD and the FDA began the Shelf Life Extension Program (SLEP).

The SLEP program is documented in the Wall Street Journal article, Many Medicines Are Potent Years Past Expiration Dates, by Laurie P. Cohen, March 28, 2000. The military submitted, and the FDA has evaluated, over 100 drugs – prescription and OTC. The results showed that about 90% of them were safe and effective well past their expiration dates, some for 10 years or longer. Joel Davis, a former FDA expiration-date compliance chief, said that with a handful of exceptions – notably nitroglycerin, insulin and some liquid antibiotics – most expired drugs are probably effective.

In light of these results, a former [FDA] director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer.

Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn’t mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

“Manufacturers put expiration dates on for marketing, rather than scientific, reasons,” said Mr. Flaherty, a pharmacist at the FDA until his retirement in 1999. “It’s not profitable for them to have products on a shelf for 10 years. They want turnover.”

The Harvard Medical School Family Health Guide, in Drug Expiration Dates – Do They Mean Anything?, notes that, with rare exceptions, “it’s true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date”.

Where and how medications are stored is an important factor in minimizing their degradation. Storing in a cool, dry, dark place will maximize their lifespan; when possible keep sealed in their original container until ready to use. Medications stored in bathroom cabinets or shelves could have effectiveness significantly reduced. Be sure to discard any pills that become discolored, turn powdery, or smell overly strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked.

Dr. Bones, from The Doom and Bloom Show, states in his blog post, The Truth About Expiration Dates, “I put forth to you this recommendation: Do not throw away medications that are in pill or capsule form after their expiration dates if you are stockpiling for a collapse. Even if a small amount of potency is lost after time, they will be of use when we no longer have the ability to mass-produce these medicines. I’m aware that this is against the conventional medical wisdom, but we may find ourselves in a situation one day where something is better than nothing.”

(Friday: What I Did This Week To Prep)

* The terms medications and drugs (referring to legal drugs) are used interchangeably.

Post Script: Dealing With The ‘Tetracycline Becomes Toxic’ Myth

There has long been a belief that the antibiotic tetracycline becomes toxic once it has past it’s expiration date.

In Medscape Today’s article, Do Medications Really Expire?, they discusses the original case, “A contested example of a rare exception [of expired drugs possibly becoming toxic] is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient.”

The case was thoroughly evaluated in the 1978 article, Tetracycline in a Renal Insufficiency: Resolution of a Therapeutic Dilemma, it states, “”Old” and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem.” It also states, “It has often been stated that the tetracyclines should be avoided in patients with severe renal disease, but, as we shall see, doxycycline represents an important exception to the rule”.

In Cohen’s article on the Shelf Life Extension Program, Many Medicines Are Potent Years Past Expiration Dates, it goes on to state, “Only one report known to the medical community linked an old drug to human toxicity. A 1963 Journal of the American Medical Association article said degraded tetracycline caused kidney damage. Even this study, though, has been challenged by other scientists. Mr. Flaherty says the Shelf Life program encountered no toxicity with tetracycline”.

Dr. Bones and Nurse Amy, from The Doom and Bloom Show, when interviewed on TSP, clearly state that tetracycline past it’s expiration date is safe (episode 736, beginning at 43:45). Nurse Amy concludes the topic with “. . . if they can just get that in their heads that tetracycline isn’t going to kill you when it’s past expiration”.

Medical evidence supports that tetracycline, past it’s expiration date–especially in the form of doxycycline–is as safe as any other expired antibiotic.

Can You Store Antibiotics In Your Preps?

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“The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them.” – Paul Marino The ICU Book 2007

Cellulitis

Last week in Soap and Water I posted about the risk, in a collapse situation, of an infection–from minor cuts and scrapes–known as cellulitis. I linked to Dr. Bones Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. Here’s another good article by Dr. Bones, A Doctor’s Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI. For additional perspective about antibiotics before and during a collapse I recommend comments by Dr. ‘Walker’ on TSP forum. Additional, non-prepper/collapse, antibiotic information can be found at eMedicineHealth.com.

I need to state, though I was previously certified and worked as a paramedic for almost ten years, I am currently not a medical professional of any type; thus I am not giving any professional medical advice. All the information in this post is from open internet sources. As Dr. Bones states “. . . [these] are hypothetical strategies for a post-apocalyptic setting. They are not meant to replace standard care and advice when modern medical technology and resources are available.” And always remember, the practice of medicine or dentistry without a license is illegal and punishable by law.

So with all the caveats stated:

Antibiotics refer to a substance that kills, slows or disrupts the growth of:

  • bacterial infections: caused by a pathogenic (a ‘germ’/microorganism that causes disease) bacteria
  • protozoan infections: caused by a parasitic disease, i.e. giardia which occurs through ingestion of infected fecal contaminated water or food

Antibiotics do not fight infections caused by viruses, such as: colds, flu, most coughs, and most sore throats (unless caused by strep).

Much of my information comes from Dr. Bones. I trust his advice. I applaud him; he is a medical doctor who is willing to say what he believes will save lives in a collapse situation. But as he clearly states, “[This] advice is contrary to standard medical practice, and is a strategy that is appropriate only in the event of societal collapse. If there are modern medical resources available to you, seek them out.”

As discussed in Soap and Water, describing a collapse situation, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, 2) We will be doing a lot more manual labor and other activities that can easily lead to cuts and scrapes, and 3) Clean water and basic hygiene will not be as accessible or convenient. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

Dr. Bones states in Fish Antibiotics in a Collapse, “These injuries can begin to show infection, in the form of redness, heat and swelling, within a relatively short time. Treatment of such infections, called “cellulitis”, at an early stage improves the chance that they will heal quickly and completely.  However, many rugged individualists are most likely to “tough it out” until their condition worsens and spreads to their blood.  This causes a condition known as sepsis; fever ensues as well as other problems that could eventually be life-threatening. The availability of antibiotics would allow the possibility of dealing with the issue safely and effectively.”

Having antibiotics available in a collapse situation will be very important, even lifesaving. The question is how can we as preppers obtain a stockpile to be used if other ‘medical resources’ are no longer available?

Dr. Bones continues, “After years of using [antibiotics] on fish, I decided to evaluate these drugs for their potential use in collapse situations. A close inspection of the bottles revealed that the only ingredient was the drug itself, identical to those obtained by prescription at the local pharmacy. If the bottle says FISH-MOX, for example, the sole ingredient is Amoxicillin, which is an antibiotic commonly used in humans.  There are no additional chemicals . . .”

So it seems that fish antibiotics are the same drugs as used in human antibiotics. I believe that adding fish antibiotics to my preps is a sound strategy. They are available, without a prescription, through many fish supply websites. I have purchased, or plan to purchase, the following:

  • Fish-Mox Forte (amoxicillin 500mg): used to treat infections of the ears, nose, throat, urinary tract, skin, pneumonia, and gonorrhea
  • Fish-Flex Forte (cephalexin 500mg): used to treat infections of the bone, ear, skin, urinary tract, and pneumonia; it has very low side effects, (it is typically safe for those with penicillin allergies)
  • Fish-Flox Forte (ciprofloxacin 500mg): used to treat infections of bones and joints, sinuses, skin, urinary tract, gastroenteritis (stomach ‘flu’), typhoid, plague, and anthrax
  • Aqua-Doxy (doxycycline 100mg): used to treat infections of the sinus and respiratory tract, skin (staph), urinary tract, intestines, chlamydia, anthrax, Rickettsia, Lyme disease, plague, and cholera
  • *Fish-Zole (metronidazole (Flagyl) 250mg): as an antiprotozoal, used to treat giardia and dysentery

For any medication you choose to stock (antibiotics or otherwise) print out the entire drug card and keep that information stored with the drug; a good online source of drug information is the U.S. National Library of Medicine. Also it’s always best to store them in the original package and, like food storage, keep in a dry, dark, cool place.

If you choose to add antibiotics to your preps it is your responsibility to be thoroughly educated about their usages, contradictions, doses, and side effects. This is something you can’t just buy and figure you have it if you need it. Obtain additional medical publications such as the Physicians Desk Reference (PDR) or Delmar Nurse’s Drug Handbook*. Antibiotics are drugs, taking an antibiotic is a medical treatment, do not take this lightly. When I was going through my Army medic training one of my instructors said, “Every medicine you put into the body is a toxin, be sure the benefits outweigh the risks.”

(Wednesday: Expired, or Not Expired; That Is The Question)

* There are many other good references available, these are just two examples. There is no reason to buy a current edition; older editions are much cheaper and have essentially all the information a layperson would ever need. 

Keeping Wounds Clean With Simple Soap & Water

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Minor cuts and scrapes happen from time to time. Though any open wound is a potential site for infection, we really don’t think much about the small ones other than their initial pain and the inconveniences they cause us as they heal. Most of us live in a world that is relatively safe and even minor wounds don’t happen very often. When they do, the simple steps we take to care for them plus our daily hygiene practices prevent most infections. In rare situations, when the injury becomes infected often the biggest hassle is finding the time to get to the doctor’s office for prescribed antibiotics.

But in a long-term disaster/collapse situation, a minor wound–if neglected–could become deadly. In that scenario, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, i.e. working outside, building fires, handling animals; 2) We will be doing a lot more manual labor, i.e. cutting wood, cooking over a fire, building and repairing, and other activities that can easily lead to cuts and scrapes; and 3) Clean water and basic hygiene will not be as accessible or convenient, i.e. no running water in the house. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

What is the best way to clean and care for a minor wound? Common answers frequently include hydrogen peroxide or alcohol, but not only do both of these harm the healthy tissue they can also delay wound healing. I’ve even heard someone say that ‘alcohol must be the best because it burns the most when you apply it’ – it burns because you are killing the exposed healthy tissue.

The best way to clean a minor wound, and prevent infection, is to remove all debris from the wound with cool, clean running water (this could also be poured or squirted from a container) and a mild soap. Then prior to bandaging it, lightly apply (think chapstick application) petroleum jelly on the wound. This will help the healing process by keeping the wound moist and clean and stop the bandage from sticking. Using antibiotic ointments is unnecessary, they add unneeded cost and may help create more antibiotic resistant bacteria; their main benefit is the same as the petroleum jelly.

Remember there’s a fine line between tough and stupid. The only medical aid available might be from your own group. So plan ahead to minimize injury: wear protective gloves, long pants and long sleeves, and, if appropriate, a helmet and/or goggles. When you do get a minor wound (and you will), make it a priority to clean and dress it as soon as possible. Be sure to know where the nearest first aid kit is kept, have water available for washing, and keep soap in your preps.

Even if you’ve done everything right, there’s a chance infection will occur. The type of infection common in these type wounds is cellulitis. Cellulitis, if not treated by antibiotics, “can cause a life-threatening condition known as sepsis”. This is described by Dr. Bones on his Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. I recommend reading it. Next Monday I’ll explain what I’ve learned, and recently done myself, to acquire a stockpile of ‘collapse medicine’ antibiotics.

(Friday: What I Did This Week To Prep)