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As of 2016 most preppers are well aware of OTC “fish antibiotics” intended for aquarium use.  If the concept is new to you, please search this site for earlier articles, including yearly updates.

In reviewing several fish antibiotic web sites, I see certain retailers continue to offer ketoconazole, which is not an antibiotic, but rather an antifungal.  Ketoconazole is sold right along with common antibiotics such as penicillin, likely leading the uninformed reader to wrongly conclude that they are equally safe and effective for bacterial illnesses such as pneumonia and strep throat, which ketoconazole is not.

I have also previously warned against the use of this drug for common fungal infections, due to rare but potentially fatal liver failure.  As of this week the FDA has re-issued a warning against the use of this drug, except for serious infections if no safer treatment is available.

The drug should only be used when the risk of death from an overwhelming yeast or fungal infection is deemed greater than the risk of possible death from the treatment.  This would likely only be in an immuno-compromised person, such as someone with HIV disease.  For the average layperson, I say do NOT stockpile ketoconazole – spend your limited prepping dollars on something with a greater potential benefit.

Below are selected excerpts from the FDA’s recent announcement.

FDA Safety Announcement

  Have a cold? Take an antibiotic?

  Ear pain? Take an antibiotic.

  Acne? Take an antibiotic.

That’s what people think anyway. But is this really the best course of action? Does the short-term gain outweigh the long-term consequences? And is there a short-term gain to begin with? Antibiotics don’t help colds caused by a virus. Most ear infections clear just as quickly without antibiotics. True, bad acne improves with oral antibiotics, but what about the millions of teens who take them for just a few zits?

Every day doctors see problems related to the use of antibiotics.

Here are five reasons doctors try to limit their use and why you should think twice yourself before taking one.

1. Yeast infection. Often patients are unaware that our bodies are covered with germs, both inside and out. The skin, the mouth, the vagina, the intestine – all have their own population of bacteria. For the most part, these microbes stay where they belong and do what they’re supposed to. One function of the normal flora (normal population of bacteria) is to keep the bad ones at bay. There are always a few harmful bacteria around, but usually they are crowded out by the good ones. However, taking an antibiotic often kills off the population of good bacteria and allows a different microbe to take over. Most commonly, yeast is the intruder. Once the bacteria get out of the way, the few yeast that linger on the skin, in the vagina, or in the colon claim the territory as their own. The overgrowth of yeast often leads to symptoms of vaginal yeast infection or a yeast skin infection, usually in warm areas such as the armpits, groin, or under the breast.

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2. Clostridium difficile colitis. Just as the overgrowth of yeast can occur and produce infection when the normal bacteria are killed off, so may harmful bacteria. Frequently the normal flora of the intestine is susceptible to an antibiotic taken for an illness. However, Clostridium difficile (or C. diff.) is not killed by common antibiotics such as penicillin, sulfa drugs, or erythromycin. The few C. diff. bacteria that you may harbor in your intestine will not harm you as long as their numbers remain limited. But when overgrowth occurs, foul-smelling diarrhea occurs, sometimes accompanied by fever, dehydration, or the need for hospitalization. C. diff. colitis requires a different antibiotic to rid your body of this harmful organism.

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3. Resistance. As mentioned above, certain bacteria are already resistant to antibiotics. However, the potential exists for many bacteria to become resistant to useful antibiotics. What if penicillin became ineffective for strep throat? In some cases it already is. MRSA (methicillin-resistant Staph. aureus) is a harmful bacteria that has emerged in recent years due to the overuse of antibiotics. If you remember your high school genetics, you may know that when bacteria (or people) multiply by the billions, a few mutations are inevitable. In the microbe population this often means that when billions of bacteria reproduce, a few of the daughter-bacteria inherit a mutation that makes them resistant to certain antibiotics. Usually these mutated bacteria, though stronger in the sense that they could live through an “attack” of penicillin, are actually weaker in other ways and die a natural but premature death. However, if the entire population of bacteria is subject to a round of antibiotics, the weaker but penicillin-resistant bacteria may live to repopulate the environment. Then the next time penicillin is used, it will not work. Doctors see antibiotic resistance everyday. It IS a real threat, and at least for now, we don’t have new antibiotics on the horizon to use against these resistant bacteria.

4. Nausea, vomiting, and diarrhea. Even apart from killing off the normal flora of the body, antibiotics may cause nausea, vomiting, or diarrhea in themselves. These are chemicals after all, chemicals which the body may reject as foreign. The erythromycin class of antibiotics is especially notorious for causing gastrointestinal symptoms by stimulating the naturally occurring contractions of the gut.

5. Drug allergy. Any patient can be allergic to any medication, and antibiotics are no exception. Though often an antibiotic allergy may manifest as only a rash, true anaphylaxis may occur with the use of any antibiotic. Anaphlylaxis is a total body allergic response which may include hives, nausea, light-headedness, itching, swelling, and trouble breathing, much like a bee-sting allergy. Any time you think you are having a reaction to a medication, call your doctor. If you are having trouble breathing or feel like you might faint, call 911. This is a medical emergency.

Just writing this reminds me to be careful when prescribing antibiotics to my patients. Next time your doctor orders you a round of penicillin or other antibiotic, ask how necessary the drug really is. Often they are prescribed for convenience more than necessity. If an antibiotic will only get you well a day faster, maybe you’re better off doing without.

Copyright © 2011 Cynthia J. Koelker, MD

Related articles

• Are you prepared to prevent 99% of infections? (armageddonmedicine.net)
• Letter Re: Antibiotics for Serious Wounds (survivalblog.com)
• Seven Antibiotics to Stockpile and Why, by Cynthia J. Koelker, MD (survivalblog.com)
• Seven Antibiotics to Stockpile and Why – SurvivalBlog post (armageddonmedicine.net)

The Affordable Care Act.

I sometimes forget that’s the actual name.  I’m supposing the doubling of my insurance premiums has made health care more affordable for somebody, somewhere.  As for me, I’ll have to pay nearly $12,000 before my insurance kicks in a dime.  My health care is not more affordable.  Is yours?

The following is my take on why neither Hillary nor Bernie can solve the problem.

____________________________________________________________

Love your neighbor as yourself – the second of the Great Commandments and the theoretical basis of socialism.

Human nature, on the other hand, tends to think of the self first. Until the human spirit attains perfection (and follows the first Great Commandment), this element of human nature will remain the primary motivator within our relationships and actions.

Take work for example. On the surface, it sounds great to say everyone should work the same number of hours, get paid the same, and reap the same benefits. That sounds fair, doesn’t it?

But what about the person who is born blind? Or your 90-year-old grandmother? Or your husband with a bad back? Or your pregnant wife? The list goes on and on. And what about the person who puts his whole heart into the job and accomplishes twice as much as someone who simply doesn’t care? Will the hard worker put forth the effort forever if there is no reward?

If it took every member of society working 20 hours per week to make things run smoothly, as soon as a few are not working at all, the others will need to work more, but not for themselves. How many extra hours would you like to work for the benefit of someone who is not working? Probably very few.

But what if you want to work extra hours to buy a boat or a bigger house or a fancy car? If you work more, are you depriving someone else their allotted work hours? Is your extra income from your hard work taxed at a higher rate? Most people who have to work 3 or 4 times as long to make only twice as much decide that the extra effort just isn’t worth it.

And what about the 20-year-old who’d rather live on next to nothing at the beach? Is it his right to work only enough to eat and get by? If you’re happy living in a tent, should you be forced to work enough to afford better? What about the pursuit of happiness? Plenty of people are miserable in their jobs already. Is it only fair that the rest be miserable as well?

The same drawbacks that apply to work also apply to socialized medicine. Everyone should receive the same health care. It sounds fair, doesn’t it? Why should a businessman have access to unlimited care when the fast-food worker does not? But then, why does Congress not want the same health care program that welfare recipients receive? Apparently they believe they are more deserving. Well, are they, or aren’t they? We’re all human beings after all. But maybe Congress thinks they work harder than welfare recipients do. Perhaps they think they deserve more. Perhaps welfare recipients need some sort of motivation to better themselves. Why try harder if everyone gets the same? Why save your money for back surgery if it’s free anyway.

And what about braces? If the rich kids can afford them, don’t the poor deserve them as well? If I have to work extra to pay for 5 other kids to have braces in addition to my own, I guess I’d decide they could all do without. Who has the motivation to work extra for the sake of everyone else? In a nutshell, no one. And that’s what will happen with health care. Socialized medicine may equalize what everyone receives, but the inevitable result is a lower level of service for everybody.

If I said everyone should receive the same groceries, you’d probably think I was crazy. But everyone needs to eat. Food is even a greater necessity than health care. But if the government were in charge of food distribution, would we be eating ground beef or filet mignon?

For better or worse, human nature and self-interest are here to stay. Love your neighbor as yourself. Can the two thoughts be reconciled? When people are forced to work for the benefit of others, it is no longer love. Human nature – that’s why socialism will not work, and I see no answer to the conflict on this earth.

Copyright © 2010 Cynthia J. Koelker

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Twice so far I’ve ignored this blog for months on end.  Both times were for serious medical problems. There’s nothing like a crisis to interrupt your disaster planning!

The first time, in 2010, my son was severely injured in a motorcycle accident (see article below).  In 2015 it’s my mother who’s been devastated by dementia.  Eventually I’ll get to an article on the terrible toll this disease will take at TEOTWAWKI.  For now we’re just trying to cope day by day.

What follows is from my original article in December 2010.

A few regular readers have questioned the lack of recent updates on this site.

Here’s the scoop.

Four weeks ago my son was involved in a motor vehicle accident in which he fractured his femur and wrist.   His surgery, hospitalization, and subsequent on-going recovery have left little time for writing.  But of course, family comes first.

His injuries raise the question of fracture care when no doctor is available.  Will the bones heal?  How will you know without an X-ray?  If there is no obvious deformity nor bone sticking through the skin, how is a fracture diagnosed?  Are all broken bones serious?  Will a permanent disability result?

I still remember a lecture from medical school 30 years ago when they discussed hip fractures in gorillas (or maybe chimpanzees).  Post-mortem exam revealed healing of old fractures.  At least some heal well enough to survive and thrive.

Clearly this topic could fill a textbook, or several.  If there are any orthopedic or sports doctors among the readership, you are welcome to contribute.

In an era where modern medical care is unavailable, severe and compound fractures present a serious problem.  My son would not be treated with a rod down the middle of his femur if this could not be visualized via X-ray.  On the other hand, small fractures (avulsion fractures, buckle fractures, compression fractures) could be treated adequately with good healing, so that’s where we’ll begin on the next post.

I am so thankful that my son was not injured worse.  A broken neck or a child’s death would surely be “the end of the world as we know it,” at least for many a mother.   And this brings up another topic:  mental health issues in times of devastation.  Anxiety, fear, depression, delirium, psychosis, and anger flourish in times of stress.  All the more reason to find inner peace now.

Let all that I am wait quietly before God, for my hope is in him.  Psalm 62:5 (New Living Translation)

1.  My book is no longer “upcoming.” It’s available for purchase on this very website!
2.  Primatene Mist is no longer available OTC, though it may be again someday.  The manufacturer is still hopeful that a new version with an environmentally-friendly propellant will be approved.
3. For a few years, Asthmanefrin was widely available as a potential replacement.  However, FDA concerns over drug and device safety resulted in a recall of the product.
4. Primatene Tablets remain on the market.  Though likely less effective than Primatene Mist, and still with a significant likelihood of systemic reactions (increased heart rate or blood pressure, or nervousness or jitteriness), the tablets are probably your best bet for OTC asthma prepping.
5. The remainder of the article remains current.

Part one of this series (Asthma and COPD – Part I – Introduction) discussed the different types of asthma, avoiding triggers, and home monitoring.

Today’s post, excerpted from my upcoming book, Armageddon Medicine, discusses over-the-counter treatments that may be useful for asthmatics, and are available for stockpiling now.

Image via Wikipedia

* * *

Caffeine is the most universally-available chemical to open the airways.  A review of the medical literature by the Cochrane collaboration concluded that the ingestion of caffeine offers modest improvement in lung function for 2 to 4 hours after consumption (a 12-18% increase in FEV1).  Doses as low as 5 mg/kg body weight were shown to have an effect.  For a 70 kg (152 pound) man, that’s 350 mg of caffeine, or about 2 strong cups of coffee or black tea.  Caffeine is also available as 200 mg tablets, generally sold to promote wakefulness.

It’s amazing that Primatene Mist (epinephrine) is available over-the-counter.  Epinephrine used to be a mainstay of asthma treatment.  It is certainly effective, but quite likely to cause rapid heart rate and jitteriness.  It is the same as adrenaline, which causes the rush that you feel when someone jumps out of a dark corner and scares you.  Doctors advise patients against the use of this medication, not so much because it is ineffective, but because of side-effect concerns including rapid heart rate, increased blood pressure, and nervousness.  Another drawback is the short-acting nature of the drug, lasting only a few hours.   Unless the medication is released in a new formulation, it will be withdrawn from the market as of December 31, 2011.

Primatene Tablets containing ephedrine are currently available over the counter.  Related to pseudoephedrine, ephedrine behaves similarly, with a somewhat greater risk of the same side-effects.

Pseudoephedrine is one of my favorite medications.  It decongests the airways from top to bottom, alleviating symptoms of sinus pressure, ear pressure, nasal congestion, and lung congestion.  Although patients now have to sign for the medication (thanks to the methamphetamine labs), it is an excellent drug to stock up on.  Common side-effects include insomnia, anxiety, and rapid heart rate or palpitations.  Some patients find it too drying, although this effect is dose-related.  A few patients have the paradoxical side-effect of drowsiness.

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Antihistamines help dry up secretions and minimize the body’s reaction to substances to which a person may be allergic.  If you suffer from mucus accumulation (phlegm) as part of your obstructive lung disease, you may find an antihistamine helpful.  Note: some patients have the opposite reaction, and find the thicker, drier mucus more difficult to expel.  These patients may do well with an expectorant (guaifenesin or SSKI).  Patients with allergic asthma do particularly well with antihistamines.  The over-the-counter products are essentially as good as prescription medications.  Benadryl (diphenhydramine), Claritin (loratadine), Zyrtec (cetirizine), and chlorpheniramine are all available OTC in inexpensive generic form.  Claritin and Zyrtec are less sedating than Benadryl or chlorpheniramine.  Some patients have the opposite effect and feel ‘wired’ when using an antihistamine.

NasalCrom is a nasal inhaler for nasal allergies.  It contains cromolyn sodium, one type of controller medication useful in alleviating chronic asthma.  When originally released, it was available only by prescription.  (The lung inhaler and eye drop remain by prescription only.)  Although NasalCrom is intended for nasal allergies and is inhaled through the nose, some of the medication reaches the lungs.  Used on a daily basis, and inhaling deeply as the mist is sprayed, NasalCrom may decrease the overall severity of chronic asthma symptoms. Other advantages are the cost (less than $20 for a bottle containing 200 sprays) and excellent safety profile, even at the high end of dosing.  This medication will not cause jitteriness, rapid heart rate, drowsiness, nor insomnia.

Copyright © 2010 Cynthia J. Koelker, MD

Next:  prescription medications

Related articles

• Asthma – All Information (umm.edu)
• Allergic rhinitis – All Information (umm.edu)

None of these changes have made it any easier to stockpile medicines – in fact, quite the reverse is true.

Though I have advised seeking out a private solo practice physician, you may not be able to find one.  At least in my hometown, the small-time doctor is being run out of business by corporate medicine.  My own practice was a casualty.  (I am currently doing private medical research instead.)  In larger practices, there’s always someone looking over the doctor’s shoulder, and freedom to prescribe is increasingly restricted. If you haven’t found such a doctor yet, I suggest you hurry.

While you’re looking, find an old-fashioned doctor who isn’t using an electronic health record (EHR).  An EHR is intended to record every prescription for every reason from every provider, and to make this information available to every doctor or hospital you may happen to visit.  There’s no flying under the radar with an EHR…not that you have anything to hide.  Though the HIPAA laws are allegedly intended to maintain your privacy, a second goal is to make your protected health information more easily shared with other health professionals.  While this is often beneficial, perhaps you value your privacy more.  And it’s not just your records that are been overseen; doctors using an EHR are being graded on their use of the system.  Consider seeking out a doctor who is still using paper records…likely someone getting on in years.

The essence of this article remains highly relevant, with essential tips for getting your doctor to help you stockpile medicine.

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Copyright ©2010 Cynthia J. Koelker, MD

Picture this: 

Your doctor enters the room and asks, “How can I help you today?”

“I’d like enough medicine to survive the end of the world as we know it,” you reply.

He narrows his eyes and responds, “Just how much Prozac would you need?”

* * *

Finding a physician to help you stockpile medications will be a challenge.  Unless your doctor, too, believes Armageddon is nigh, he’s not likely to grant your request.

Why not?  Doctors are responsible for the medications we prescribe and the consequences, intended or unintended.  Remember, every medication is a potential poison.  You’re probably glad your own physician has sufficient training to possess a valid medical license.  Certain problems (and medications) require periodic monitoring regarding their effects on the human body.  No doctor wants to be responsible for patients who won’t comply with essential examination and testing.  Would a car-maker warranty your automobile engine if you refuse to change the oil?

Typically, doctors prescribe enough medication to cover a specific problem for an appropriate length of time.  Antibiotics are usually dispensed for 7 to 10 days, blood pressure medicines for 1 to 6 months, diabetic medicines for 1 to 3 months, pain relievers until the underlying problem has resolved.

Does your doctor prescribe you extra amoxicillin, just in case you get sick later this year?  Not likely.  When physicians prescribe more medication than is currently necessary, this often amounts to patients playing doctor with themselves or with others.  Under our current system, this can be a felony.

Of course, at TEOTWAWKI, people won’t be playing doctor.  For many survivors, they will be their own doctor, like it or not.  And to do so, you will need a stockpile of medications.

Before I offer advice on how to get your doctor to help you with this stockpile, please realize that there are other obstacles to the acquisition of said drugs.  Pharmacists have the right to refuse to fill a prescription that seems unreasonable or potentially harmful.  Insurance companies usually limit payments for prescriptions to a 1 to 3 month period at a time.  You’ll have to pay out of your own pocket to get more medicine than this.  Doctors cannot legally alter their prescriptions to say you are taking more medication than you actually are.  Neither would it be ethical for you to lie about the situation.

So, how to get the medicine that you may need?

One option is to convince your doctor that the end of the world is near.  That’ll be tough.  But think a moment, if your doctor really did think TEOTWAWTI is around the corner, he’d be doing his best to help you prepare.

Doctors do prescribe extra medication, along with directions for use, under special circumstances:  antibiotics for potential traveler’s diarrhea, anti-malarials for travel to Africa, six months of medications if you’ll be wintering in Antarctica.  Asking for medications for TEOTWAWKI is akin to doing the same for a trip around the world.  The way I see it, such a supply would be intended to span a gap of only a year or two only.  Some medications probably do have a shelf-life of a decade beyond their expiration date, but hopefully a better solution would be available long before then.

Convincing your doctor to prescribe extra medication depends largely on the doctor-patient relationship.  If your doctor trusts you, he or she is much more likely to assist you.  Please realize that your doctor will think that he’s doing you a fairly large favor.  He may even question the legality of his own prescribing.  Don’t forget to be grateful.  Also realize that even if a doctor writes more than a year’s worth of refills, pharmacists cannot fill them beyond a year of the original prescribing date.  If you are convinced that you need more than a 12-month supply stockpiled, you’ll need to discuss this openly with your doctor.  Obviously a person could visit more than one doctor, which I don’t recommend, especially if you don’t tell each and every one of your physicians what you are doing.  Dishonesty is a deal-breaker when it comes to getting your doctor to trust you.

In general, medications are prescribed for either acute problems or chronic problems.  Acute problems include most infections and injuries.  Chronic problems include asthma, diabetes, heart disease, hypothyroidism, mental illness, arthritis, and a host of others.  Treatment of chronic conditions also includes modification of risk factors including high cholesterol and high blood pressure.  Even antibiotics are sometimes prescribed long-term in certain situations, e.g. acne, rosacea, certain forms of colitis, and recurrent urinary infections.

Medications for acute problems include antibiotics, anti-virals, anti-malarials, antifungals, anti-diarrheals, antiemetics, migraine treatments, pain medications, heartburn relief, albuterol for asthma and COPD, nitroglycerin, corticosteroids, and anti-inflammatories, to name the most common.

Drugs for chronic problems and conditions include birth control pills, antidepressants, allergy medications, inhalers for asthma and COPD, anti-anginal drugs, acid-reducing drugs (proton pump inhibitors, histamine-2 blockers), anti-inflammatories, diabetic meds, thyroid replacement, and many others.

Without specifying which of these meds I’d advise for stockpiling, I’ll tell you exactly how I’d like a patient to approach me to acquire an extra supply, an approach which I believe would work for other doctors as well.

First, begin establishing a trusting relationship with your doctor.  If you don’t think your physician even knows who you are, make an appointment for a minor problem.  DON’T ask about stockpiling at this initial visit.

If your doctor asks you to follow-up for this problem, then do so.  Follow directions.  Be responsible.  If he says no follow-up is needed, no doubt you can find another reason to come in within a month or so.  Accompany another family member to their appointment to keep your face fresh in your doctor’s memory.  If there are multiple providers in your physician’s office, try to see the same one each time to establish a relationship.

By the third time your doctor has seen you within a time frame of a few months, he’s going to start knowing you, and more importantly, trusting you.  You must act in a trustworthy manner by:

• showing up for your appointments
• not cancelling appointments with insufficient warning
• arriving on time (even if you must wait on the doctor)
• taking your medications properly and knowing their correct names and dosing
• trying to do your part in every way
• being kind, pleasant, polite, and cheerful.

Of course, this is good advice even if TEOTWAWKI does not occur in our lifetime.

After doing the above, it’s time to consider approaching the topic of TEOTWAWKI.

Say you have diabetes and want to be prepared.  If you ask for a year’s prescription, your doctor may figure you won’t show up again, even though you’ve demonstrated responsibility to date.  Ask for an extra three months instead and make 100% sure that you show up for your next scheduled visit.  If you don’t, your doctor will decide he cannot trust you.  As in every relationship, once trust is broken, it takes much, much longer to reestablish.

Assuming you do keep your  scheduled follow-up, remind the doctor that you have put back the extra medication, and that you’d like to have an additional three month’s worth.  Reassure him that you will again follow-up whenever he’d like you to return.  (And especially for diabetics, do what your doctor suggests regarding blood sugar testing, weight loss, etc. – at the very least, try.)  In this fashion by establishing and confirming trust, you can build up an adequate stockpile.  If your relationship is strong, he may trust you to get even a year’s worth ahead of time.  The same protocol would apply equally well to any of the chronic diseases mentioned above.  And if you suffer from any of these, educating yourself is an excellent idea.  Learn how to take care of yourself now so you’ll be ready later.

For acute problems, such as bacterial infections, you’ll want a supply of antibiotics on hand.  Follow the above directions in establishing a trusting relationship.  Then either when you are sick (or when you are not) ask for a supply of one appropriate antibiotic, perhaps a 30-day supply.  Reassure your doctor that you will not use this medication as long as he is here to take care of you.  If you get sick again, go back to your doctor and remind him of your plan.  If he suggests antibiotics, request a new prescription, and perhaps another supply to stockpile.  Trust, trust, trust.  That’s 99% of the equation.

With 2012 just around the corner, you should start now.  None of us knows God’s timeline, but waiting until the last minute is ill-advised.

* * *

Image via Wikipedia

What do Armageddon and health reform have in common?  Either way, people need to know how to care of themselves with the resources at hand.  Written by family physician Cynthia J. Koelker, MD, 101 Ways to Save Money on Health Care explains how to treat over 30 common medical conditions economically, and includes dozens of sections on treating yourself.

Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

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• How to Get Your Doctor to Help You Stockpile Medicine, by Cynthia J. Koelker, MD (survivalblog.com)
• Guest Article: Expired Medications–Are They Safe? Are They Effective? Part 2, by Cynthia J. Koelker, MD (survivalblog.com)

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

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

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

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

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

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

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

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

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

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

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

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

Medical Bartering Part 1

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

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

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

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

What would you trade for the life of your child?

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

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

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

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

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

Medical Bartering Part 2

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

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

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

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

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

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

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

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

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

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