As Americans, we live in a time of relative peace and prosperity and are blessed to enjoy the most advanced healthcare system in history. Yet, as good as we have things now, we do not know what the future may bring. How can we find better health now, prepare for medical emergencies we may encounter in daily events, and also prepare for an uncertain future where medical resources may be limited or completely absent? The latter is commonly called a When The Schumer Hits The Fan (WTSHTF) scenario. Here are a few suggestions from a practicing physician:
Preventative Health:
Prevention is superior to treating diseases or injuries after they occur.
- Immunize against preventable diseases. (This may be a controversial topic to some readers, but vaccines do save lives from many preventable, deadly diseases.)
- Communicable diseases will become more prevalent in a WTSHTF situation simply due to lack of sanitation, medical care, and antibiotics/antivirals.
- These problems will be exponentially magnified if a pandemic is a major component of a TEOTWAWKI scenario.
- Young children, pregnant women, the elderly, and the immunocompromised (those whose immune systems are weakened due to other diseases) are especially vulnerable to all communicable diseases and should especially be immunized according to recommendations.
- The CDC publishes a list of recommended immunizations by age, which serves as a good reference for consideration.
- Diseases which are preventable by immunization and “herd immunity” (such as measles and whooping cough) are especially prevalent when large groups of prisoners, refugees, and illegal immigrants…many of whom are unvaccinated…are concentrated. In a WTSHTF scenario, the likelihood of ordinary law-abiding citizens becoming refugees (or being falsely incarcerated as political prisoners) is greatly increased. Being immunized ahead of time may thwart a preventable death from a multitude of diseases.
- Take advantage of the modern preventative care options you have while they exist:
- Visit your Primary Care Physician regularly for a general physical exam to screen for diseases.
- Ladies, this includes screening for breast and cervical cancer; Men, this includes prostate cancer.
- Yes, I realize everyone dreads the thought of a colonoscopy, but I’ve witnessed them save many lives throughout my career. Most colon polyps can be found early enough with scheduled colonoscopies that they can be removed through the scope before they become life-threatening cancers. Most caught in this stage do not require any surgery other than the removal via the scope, with the patient returning home within a couple of hours. (I frequently perform the anesthesia for these procedures, and they are not painful. Most patients say the 1 day of diarrhea from the bowel prep was the worst part of the entire ordeal. This seems like a small price to pay to avoid a life-changing cancer.)
- When working with your PCP, you should optimize your management of any chronic diseases (such as diabetes, high blood pressure, high cholesterol, etc.) and prevent them from taking as many of the long-term effects on your body.
- Visit your Primary Care Physician regularly for a general physical exam to screen for diseases.
Include a visit to your Eye Doctor and Dentist in your preparations:
- Address your eyes and teeth while you can.
- Repair any dental issues. Pain may be enough reason to wish you had seen the dentist before a TEOTWAWKI event, but a cavity that grows out of control into a dental abscess may be fatal. Good oral health cannot be overrated.
- Be sure to stockpile plenty of toothbrushes, toothpaste, dental floss, and mouthwash in your preps. Oral care may prevent life-threatening issues in a world where dentists may be scarce.
- It’s hard to shoot straight if you can’t see, so have your vision checked! Get a backup spare pair of glasses, as well as a large supply of contact lenses if you prefer contacts. (If you wear contacts, always make sure you still have 1-2 pairs of eyeglasses, with current prescription lenses, for when your contact lens supply runs out in a prolonged WTSHTF scenario.)
- If you are a contact lens wearer, make sure to stock adequate cleaning supplies for the supply of contacts you cache. You can ill-afford an eye infection from a dirty contact lens at a time when medical care will be limited or non-existent.
- LASIK eye surgery has become incredibly safe and common in the past two decades. It may be a very good investment prior to a WTSHTF moment (imagine the tactical advantage you might have with 20/20 post-LASIK vision over fumbling around to look for glasses or placing contact lenses in the event of a 3:00 am intrusion into your house). LASIK also enhances your lifestyle even if we never experience a WTSHTF event for similar reasons (imagine not needing glasses or contacts, especially in the cold or with watersports). Over the long-term, the return-on-investment of not purchasing contacts and glasses is recouped as well.
Lifestyle Modification:
- Maintain your health.
- Develop healthier eating habits (less processed/carbohydrate-laden items), and portion control.
- Get regular physical exercise. While intense cardio or lifting weights at the gym are both great ideas, something as simple as getting out for a 2 mile walk rather than watching TV can be beneficial to your health.
- STOP TRASHING YOUR BODY!!!
- Quit smoking. Your bugout bag won’t have much room for bullets and food if you have to fill it with an oxygen tank and a nebulizer. Withdrawal is hard enough now with the aid of nicotine gum, patches or medications like Chantix…imagine how tough quitting cold turkey will be after a major catastrophe in the world has just occurred.
- Don’t drink in excess. Again, withdrawal at a time of major social collapse will be unimaginably difficult. Learn to limit your alcohol intake to a moderate level.
- Illicit drugs. This should go without being said…drugs are a bad idea now, and an even worse idea when you cannot afford dulled senses, poor judgement, or withdrawal.
Obtain a supply of Extra Medications:
- Over-the-Counter Medications: Purchase a generous stockpile of over-the-counter medications which you may need. Many of these may be purchased inexpensively at Costco or Sam’s Club. The generic brands are just as effective as the name brands, at a fraction of the cost…especially when purchased in bulk quantities.
- Pain relievers such as Tylenol, Motrin, Aleve.
- Hydrocortisone cream for rashes and poison ivy.
- Antifungal cream (such as Lotrimin or Lamisil) for athlete’s foot, jock itch, or ringworm
- Medication for reflux (ie- omeprazole), diarrhea (ie- Imodium), and constipation (ie- Dulcolax)
- Multi-Vitamins: These do not keep terribly long, even when sealed. I recommend only purchasing one year’s worth for each family member at maximum, then constantly rotate on a first-in-first-out (FIFO) basis. They are beneficial supplements to “meals” when food is scarce or food pyramids cannot be followed.
- Prescription Medications:
- If you have an established, cordial relationship with your PCP, many would be receptive to the discussion of prescribing extra months’ worth of certain chronic medications to you, especially if they have your dosages on the medications stabilized and aren’t making frequent adjustments to them.
- I recommend opening this discussion with them by being honest, yet not sounding extremist (you don’t want to turn off your doctor if he/she doesn’t share your same worldview).
- You might consider a conversation such as: “Dr. X, I am concerned about the possibility we could have a natural disaster or other event that could cut me off from medications for several weeks to months before supply chains are re-established. Would you be comfortable writing me a prescription for my chronic medications for X, Y, Y (e.g.- blood pressure, cholesterol, diabetes)?
- Be extremely careful not to ask for, or in any other way pressure, your PCP to prescribe any controlled substances such as opioid narcotics, benzodiazepines, or ADHD/weight loss medications. The DEA and many states have developed extremely aggressive rules regarding prescribing limits for each of these in response to the nationwide opioid epidemic. These “controlled” or “scheduled” prescriptions are now tracked in databases at pharmacies (each state has a different system). A prescriber risks losing his/her medical and prescriptive license (and ability to earn a living) for any prescription outside of these parameters. As a physician myself, PLEASE DO NOT ASK for us to prescribe any of these, as we will have to tell you “no,” and many physicians would then become uncomfortable with even prescribing extra months’ worth of non-controlled, non-narcotic medication at that point in the conversation.
- If you suffer from recurrent infections that are well-documented, such as frequent UTI or strep throat, you may also consider requesting a prescription for the specific antibiotics you take for these conditions.
- Please keep in mind that whether to prescribe any or all of your existing medications is solely the prerogative of the prescriber. They are under no obligation to do so. Therefore, I would encourage you to strike a very honest, cooperative, conciliatory tone with them before even broaching the conversation.
- Also, seeing a patient who is “meeting the doctor halfway” in their health (e.g.- following the recommendations the PCP has already made for weight loss, lifestyle modification, smoking cessation, or better management of chronic diseases etc.) will demonstrate you are more worthy of their time and effort to write the extra prescriptions. Your preparedness request is much more believable when you show you’re making the effort to want to live a long period of time by taking care of yourself.
- As more and more PCP’s are forced to convert to electronic medical records, prescribing medications with extra refills outside of your normal monthly allotment (even the non-controlled medications) may become more difficult. It would behoove you to begin forging this relationship with them now on this topic.
- I would also suggest that you “catch more flies with honey” in this situation. If your physician does you a favor to write these Rx (this is typically uncompensated extra work at an office visit), then consider taking them a “thank you” gift card to a place they might enjoy (perhaps a $25 coffee shop gift card if you don’t know them well enough to guide your token of appreciation towards another gift). You can leave it in a sealed envelope with their front office staff and ask them to hand it to your physician when he/she is available. A very brief note thanking them for going the extra mile to write these medications will go a long way towards making a favorable impression with them. They will likely remember this, and it may facilitate future conversations about other long-term medications.
- If you have a physician/PA/NP or dentist in your preparedness group, they may be able to legally acquire some life-saving medications in bulk, such as large doses of common antibiotics to help the group stockpile (some wholesaler pharmaceutical distributors will sell to licensed prescribers). Many of these medications remain effective for years after their stated shelf-lives. Please do not pressure these medical group members if they are uncomfortable doing so, as their license to practice/ability to earn a living is on the line, and the laws vary by state regarding this practice of bulk purchasing of antibiotics. Whatever you do, ASBSOLUTELY DO NOT pressure them to stockpile or prescribe any narcotics or other controlled substance against current legal guidance by the DEA and the state they practice medicine in!!! Their medical skills will be of little use to your preparedness group if they are locked up in jail WTSHTF.
- Many people have suggested livestock or fish antibiotics. My understanding is that these are produced in many of the same factories as human medications are, however I cannot comment from a professional standpoint that these are as safe or effective for human consumption. I would not recommend using them in today’s world just to avoid an office visit, but I would instead save them only for a WTSHTF scenario when they are the only option.
- There are several resources to guide treating infections but one of the easiest to understand is the Emergency Medicine Residents’ Association Antibiotic Guide.
- If you have an established, cordial relationship with your PCP, many would be receptive to the discussion of prescribing extra months’ worth of certain chronic medications to you, especially if they have your dosages on the medications stabilized and aren’t making frequent adjustments to them.
(To be concluded tomorrow, in Part 2.)
Thank you for this article, and I look forward to reading the rest of it. Regarding the OTC section, how effective are these medicines past the “best use by” date? Would a one year supply with rotations be effective?
Thanks everyone for the time to reply.
There are numerous studies, many done by the DoD, that say that most of these medications are safe and effective for many years. There are a some exceptions and this should be researched.
A place to start. http://www.usmedicine.com/agencies/department-of-defense-dod/dodfda-program-seeks-to-extend-lives-of-expired-medications/
Thanks so much for sharing this link.
Here is a great article which you may want to print out and keep with your prep meds. It describes which medications can be safely used past the expiration date, and which cannot. https://www.drugs.com/article/drug-expiration-dates.html
I would follow the links that other folks tagged below.
As for common OTC medications, I would stockpile what you think you might need in a WTSHTF situation, and then use them/resupply them in a FIFO order, hence always keeping some in fresh supply. Very few medications will become toxic with outdating, most will just become less efficacious.
A trip to Costco or Sam’s Club could yield you all the major OTC’s you need to resupply a family unit for probably $50-100/year (using a FIFO plan above).
I would follow the links that other folks tagged below.
As for common OTC medications, I would stockpile what you think you might need in a WTSHTF situation, and then use them/resupply them in a FIFO order, hence always keeping some in fresh supply. Very few medications will become toxic with outdating, most will just become less efficacious.
A trip to Costco or Sam’s Club could yield you all the major OTC’s you need to resupply a family unit for probably $50-100/year (using a FIFO plan above).
Good article.
Being a male of “a certain age,” prostate health is an important consideration. I knew someone with BPH, who had several instances where his urethra became pinched off and he couldn’t urinate. This caused very serious problems that required hospitalization. In a SHTF situation, would you, Dr. Dan, recommend having some catheters (and lube) on hand for such situations? I’ve never seen caths recommended as part of SHTF medical preps. Thank you.
If you are not experienced with either self-cathing, or have someone with significant medical experience placing catheters in your prepping group, then I would discourage this. Catheter-related infections (bladder infections “UTI”, or worse, kidney infections “pyelonephritis”) can be devastating even in the best of times. They could be fatal in a WTSHTF event where you lacked the big-gun antibiotics to address these infections properly. Without proper training and sterile equipment, you will be very vulnerable to such infections.
An alternative that I would recommend instead would involve:
a.) See your PCP or a Urologist for evaluation. First and foremost, if you’re a male >50 you need screened regularly for prostate cancer, since it is quite often treatable with modern medical or surgical therapy. This visit might save your life!
b.) If you are diagnosed with BPH (benign prostatic hypertrophy) as a cause of urinary issues (rather than prostate cancer), there are both medical and surgical options worth exploring. Instead of focusing on stockpiling catheters, I would recommend stockpiling either herbal or pharmaceutical remedies for BPH (such as Flomax).
c.) If you desire a more permanent “fix” for your BPH, you may want to discuss the option of a TURP (transurethral resection of prostate) surgery with a Urologist. It is essentially a roto-rooter of the enlarged prostate, and may be an option to prevent this issue from occurring during a tenuous time.
d.) Please remember that all of these treatments (both medical and surgical for prostate cancer or BPH) are available now while modern technology and medicine exists. These options will probably go away if a WTSHTF event occurs. I would encourage you to not delay in addressing them while we are able to take advantage of modern medicine.
** Please keep in mind I am an anesthesiologist, not a urologist, so I would encourage you to seek professional help from a specialist most knowledgeable on your particular condition. **
If you are not experienced with either self-cathing, or have someone with significant medical experience placing catheters in your prepping group, then I would discourage this. Catheter-related infections (bladder infections “UTI”, or worse, kidney infections “pyelonephritis”) can be devastating even in the best of times. They could be fatal in a WTSHTF event where you lacked the big-gun antibiotics to address these infections properly. Without proper training and sterile equipment, you will be very vulnerable to such infections.
An alternative that I would recommend instead would involve:
a.) See your PCP or a Urologist for evaluation. First and foremost, if you’re a male >50 you need screened regularly for prostate cancer, since it is quite often treatable with modern medical or surgical therapy. This visit might save your life!
b.) If you are diagnosed with BPH (benign prostatic hypertrophy) as a cause of urinary issues (rather than prostate cancer), there are both medical and surgical options worth exploring. Instead of focusing on stockpiling catheters, I would recommend stockpiling either herbal or pharmaceutical remedies for BPH (such as Flomax).
c.) If you desire a more permanent “fix” for your BPH, you may want to discuss the option of a TURP (transurethral resection of prostate) surgery with a Urologist. It is essentially a roto-rooter of the enlarged prostate, and may be an option to prevent this issue from occurring during a tenuous time.
d.) Please remember that all of these treatments (both medical and surgical for prostate cancer or BPH) are available now while modern technology and medicine exists. These options will probably go away if a WTSHTF event occurs. I would encourage you to not delay in addressing them while we are able to take advantage of modern medicine.
** Please keep in mind I am an anesthesiologist, not a urologist, so I would encourage you to seek professional help from a specialist most knowledgeable on your particular condition. **
Insurers are unlikely to pay for “extra” prescriptions, so people must be prepared to pay cash. Most pharmacies are willing to work with customers to find ways to lower the cost of prescriptions (manufacturer coupons, rebates, generics, etc). You may also search online pharmacies.
I recommend purchasing what you can from some retailers who have significant discounts on common prescriptions. For instance, Walmart has a $4/$10 Rx plan on a host of medications…price depends on the drug and the quantity (and 30 vs 90 day supply). Target, Meijer, and other retailers offer this as well in some form or another, mostly on generic/common Rx’s. It’s worth investigating.
My wife practices emergency medicine, and they commonly refer patients to this, and will attempt to prescribe medications that fall on the discount lists. Many practitioners may be receptive to this request when they are Rx your BP, cholesterol, diabetes Rx if you take them a list from the retailers, so they can customize the Rx to this criteria.
what shtf vaccinations should we consider now. for example if i google vaccines travel india or afrika the list may vary.
Tetanus vaccinations should be kept current for sure. The risk vs. reward ratio indicates this would be a sensible action to take. Ordinarily I don’t like the idea of big pharm vaccinations but in a SHTF situation there is likely to be much more contact with the outdoors, with dirt and rusty metal. We won’t always have the luxury of taking the time to be extra careful and injuries are sure to increase.
If we were going anywhere unusual, the Navy used to vaccinate us for Typhoid and Yellow Fever. I have heard that Typhoid is making a comeback in some US cities so maybe it would be a good one. Have not heard much about yellow fever.
Here is some information on the Typhoid vaccine. https://www.passporthealthusa.com/vaccinations/typhoid/
Here is some information on the Yellow Fever vaccine.https://www.passporthealthusa.com/vaccinations/yellow-fever/
I don’t remember which one of these it was, but one of them was not pleasant. Lots of us were moderately miserable after getting it.
I am not in the pocket of Big Pharma, but I do think prevention is a lot better than trying to cure a potentially fatal disease, especially after a WTSHTF event occurs. The treatments for these diseases (if a cure even exists) is often much more toxic than any vaccine.
I would look over this list to see if you’d wish any of these diseases on your child…which is much more likely to happen if they aren’t vaccinated:
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
And I don’t know about you, but I would prefer to avoid these conditions as well:
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
I’m unsure why vaccines are so controversial. Statistically they overwhelmingly save far more lives than they potentially adversely impact. In terms of a prepping plan, protection from transmissible communicable diseases is paramount to survival. Disease will be rampant without modern sanitation and medical treatments, regardless if the initial cause is pandemic or economic collapse.
I am not in the pocket of Big Pharma, but I do think prevention is a lot better than trying to cure a potentially fatal disease, especially after a WTSHTF event occurs. The treatments for these diseases (if a cure even exists) is often much more toxic than any vaccine.
I would look over this list to see if you’d wish any of these diseases on your child…which is much more likely to happen if they aren’t vaccinated:
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
And I don’t know about you, but I would prefer to avoid these conditions as well:
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
I’m unsure why vaccines are so controversial. Statistically they overwhelmingly save far more lives than they potentially adversely impact. In terms of a prepping plan, protection from transmissible communicable diseases is paramount to survival. Disease will be rampant without modern sanitation and medical treatments, regardless if the initial cause is pandemic or economic collapse.
As a fellow physician, I think this is a nice article. Really good work.
Just a few comments with regard to fish antibiotics, and this reflects my understanding to date. This does NOT constitute medical advice, and I am not suggesting anyone take veterinary medications. Now that we have that covered:
It’s my understanding that fish antibiotics are in fact produced off the same manufacturing line as human antibiotics.
It is my understanding that any medication that is intended to be distributed for the consumption of animals must by law be labeled “not for human consumption“, even if the medication is identical to that used on humans, and comes off the same line at the same time.
It is my understanding that every prescription medication distributed in this country must have by law a UNIQUE number and letter designator on the pill. In this way, we can ensure no confusion when a patient drops their medications on the floor and mixes them up. The pharmacist can easily separate the various medications by the designator code.
The website drugs.com has an application where you can put in the pill identifier and it will tell you exactly who made it, what it is, and what the dose is.
I have yet to review any fish antibiotic (and I have reviewed many) that did not have the same designation as the human counterpart.
I am not offering any conclusions, simply providing the known facts that I understand at this time. Hopefully this is helpful.
Thanks
FYI pill identifier
https://www.drugs.com/pill_identification.html
Fish antibiotics and animal antibiotics cannot be lumped together. Fish antibiotics are made to human pharmaceutical standards. Animal antibiotics are NOT made to human standards, and should be used only if desperate.
FishMox is a decent brand.
To dose, I grind the contents of the capsules in a mortar and pestle (the are pretty hard and lumpy in the capsule) to a very fine, silky powder. It does not take long. I then add the appropriate amount of purified water to the contents of the mortar, and pour them into a bottle. I put a label giving the contents of the bottle, and the appropriate dosage.
(For cats/kittens, the formula is 500 mg. Amoxycillin/Fishmox, plus 10 ml. purified water, and the dosage is .1ml per pound of body weight twice a day for ten days.)
For human dosage, consult your doctor.
Thanks Dr. Marc!
I have found this guide to be extremely helpful for dosing many different antibiotics:
https://bookstore.acep.org/emra-antibiotic-guide-900152
** Hypothetically (with the proviso this doesn’t constitute specific medical advice): one could use this book to dose fish antibiotics based on the various conditions found in the book. Some basic medical knowledge would be helpful in forming a differential diagnosis, so that appropriate therapy can be instituted. **
Thanks Dr. Marc!
I have found this guide to be extremely helpful for dosing many different antibiotics:
https://bookstore.acep.org/emra-antibiotic-guide-900152
** Hypothetically (with the proviso this doesn’t constitute specific medical advice): one could use this book to dose fish antibiotics based on the various conditions found in the book. Some basic medical knowledge would be helpful in forming a differential diagnosis, so that appropriate therapy can be instituted. **
Good article. Would like to see more of this. That is; good advice from medical professionals about health and injury care. Thank you.
Very good advice.
As a fellow physician in family medicine I share your opinions regarding especially the preventive side of preps.
Appreciated your article very much.
Thank you!
Look forward to the rest of the article.
For OTC meds we keep a good supply of Benadryl, Meclizine, Orajel, and, epinephrine.
our ability to survive and thrive are heavily influenced by our prepredness actions. Good teeth, good blood pressure, and overall good health is a much better place to start Post-TEOTWAWKI than 100 pounds over weight, unable to walk to get the mail without resting, and your first meal of the day is a handful of pills. I think part of our medical preparedness NEEDS to include training beyond that of “Boy Scout” first aid. Knowing how to take a pulse, a BP, and a capillary refill test and be able to make some assumptions based on those signs.
Do not overlook the prevention tools,safety glasses,sun glasses,mouth guards,gloves,face guards,helmets,chain saw chaps. An ounce of prevention is worth tons of cures(rehab sucks even if scars are cool)
Prevention tools are a great point.
For shooting, I recommend eyewear, ear protection, and a tourniquet (in case of an accidental GSW).
For cutting firewood, I wear eyewear, ear protection, a helmet with face shield, leather gloves, kevlar chaps, leather boots, and carry a tourniquet in my chaps pocket “just in case” the saw bites me while I’m out in the woods.
Regarding getting and staying fit. The book “The Barbell Prescription, strength training after 40” if awesome. It totally changed how I work out.
We are all competing in the extreme sport of aging. We must have a strength training (not exercise) regime.