Appendicitis and TEOTWAWKI, by Cynthia J. Koelker, MD

When considering the question of appendicitis at TEOTWAWKI the most important questions are these:
1.     What is the cause?
2.     How can it be recognized?
3.     Who is most at risk?
4.     Is it always fatal?
5.     Can it be treated non-surgically?
6.     Should it be removed before TEOTWAWKI?
Appendicitis is caused by a blockage of the appendix, which varies according to age.  In children and young adults this is usually due to infection.  In the elderly it is usually due to hardened feces.  In developing countries appendicitis may be caused by parasites.  In people with an inflamed bowel it can be due to swollen lymphoid tissue, which can also occur with stomach flu, viral respiratory infections, measles, or mononucleosis.
Once the blockage has occurred, the appendix swells due to continued production and trapping of secretions, causing the appendix to enlarge like a water balloon until it bursts, spewing the contents into the abdomen (peritoneal cavity), leading to sepsis (overwhelming infection), and death.  The inflammation also draws white blood cells to the area, which produces pus and additional pressure.
Also, once the pressure within the appendix rises too high, this acts like a tourniquet, cutting off the circulation to the appendix.  This injures the lining of the appendix, which allows infection to invade the wall of the appendix, and may lead to gangrene of the appendix and/or perforation (a hole in, or bursting of, the appendix). 

What symptoms does this lead to?  As S.M.G. describes, the classic history is one of loss of appetite associated with pain around the navel, followed by nausea and right lower abdominal pain.  Unfortunately, no single symptom or test is completely accurate in diagnosing appendicitis.  Only 50% of patients have vomiting.  Because the location of the appendix varies, the location of the pain may vary.  Even with modern medicine, 20% of cases of appendicitis are misdiagnosed as something else.  Though surgeons hope to be 100% accurate, even now up to 40% of patients who undergo emergency appendectomy are found to have a normal appendix.  When someone claims that they have cured appendicitis at the painful and nauseous state by administering a purgative, I question the accuracy of the diagnosis.

The classic signs described above occur only half the time in true appendicitis (diagnosed with surgery and pathological examination of the appendix).  Nausea and loss of appetite occur most but not all the time, and at the same rate that occur with other causes of abdominal pain. Vomiting that follows onset of pain is more typical of appendicitis than vomiting that precedes abdominal pain.  Diarrhea or constipation may occur with appendicitis, and the diagnosis of either as a cause for abdominal pain does not rule out appendicitis.

Abdominal pain is the most consistent symptom of appendicitis.  The migration of the pain from one location to another increases the likelihood of a correct diagnosis of appendicitis.  Fever is not usually present early on.  Appendicitis can be confused with bladder infection, kidney stones, endometriosis, ovarian cysts, diverticulitis, gallbladder disease, intestinal virus or other infection, or duodenal ulcers.   
If this is the case now, what will it be at TEOTWAWKI?  Will diagnostic accuracy improve in a scenario without blood testing or internal imaging (CAT scans, MRI, ultrasounds).  Not likely.   No doubt cases of appendicitis will not be diagnosed as such, possibly leading to fatality.  Other causes of abdominal pain will be mistaken as appendicitis, sometimes leading to treatments being mistaken as cures.

Since a person can live a completely normal life without an appendix, should it then be removed to prevent a life-threatening emergency at TEOTWAWKI?  The current incidence of appendicitis in the U.S. is about 1 per 1,000 people per year, with a 7% lifetime risk.  (This is less than the incidence of breast cancer.  Should women have prophylactic mastectomies before TEOTWAWKI as well?  Just a thought.)  No doctor is likely to perform such a surgery unless you have a documented genetic predisposition to appendicitis (and insurance is not likely to pay either). 
The incidence of appendicitis is less in undeveloped countries where the intake of dietary fiber is much higher, and is actually decreasing in developed countries where dietary intake of fiber has increased.  Dietary fiber draws water into the stool, making feces softer and less likely to form fecaliths (stone-like feces) which may obstruct the bowel or appendix.

The best answer for prevention of appendicitis is a high fiber diet, high enough to keep the stools on the softer side.  A bowel movement that has the consistency of a soft banana is about right.      

Without treatment is appendicitis always fatal?  The standard answer is “yes,” though the truth is “not always.”  If an obstruction is relieved, the inflammation may resolve without treatment.  I have seen a few cases of recurrent appendicitis which were not recognized as such until the appendix was eventually removed.  At times the body will wall off the infection resulting in a local abscess which prevents bacteria from entering the blood stream.    
Can antibiotics help?  An interesting study by Eriksson (BR J Surg. 1995; 82(2):166-9) compared antibiotic therapy alone to surgery.  Their conclusion was that IV antibiotic treatment (followed by oral antibiotics) was as effective for acute appendicitis as was surgery, though 7 of 20 patients who took antibiotic therapy alone had recurrent symptoms within a year (and underwent subsequent appendectomy).

Can appendicitis be treated with oral antibiotics alone?  While I have never tried this, if surgery were not an option, I would treat acute appendicitis much as I have treated acute diverticulitis, a fairly common illness in the middle-aged and elderly.  For diverticulitis I commonly prescribe either ciprofloxacin plus metronidazole, or Levaquin plus metronidazole.  Other possibilities might be amoxicillin-clavulanate plus metronidazole or trimethoprim-sulfamethoxazole plus metronidazole.  It generally takes two antibiotics used in combination to kill intestinal bacteria (aerobic and anaerobic bacteria).   
If you believe you or your loved one is suffering from appendicitis, go to the nearest emergency room.  However, at TEOTWAWKI, if no surgeon is available, administering the above antibiotics may be life-saving.  It will not cure everyone, and the likelihood of recurrence is high.  Still, it is a much better answer than doing nothing at all, and gives the patient at least a fighting chance of survival. 

About the Author: Dr. Cynthia J. Koelker is SurvivalBlog’s Medical Editor. Her web site is: www.ArmageddonMedicine.net 

Three Letters Re: Insulin Dependent Diabetics When TSHTF

1

Sir:
I am an Emergency Room physician in Arizona and a preparist.  When I treat people with Type 1 diabetes I routinely mention the need to stockpile and safeguard insulin and diabetes supplies.  When the patient is agreeable I write prescriptions for extra supplies on the spot.  One of my patients told me about Wal-Mart’s ReliOn brand of regular insulin, which is about half the price of other U-100s.  Those SB readers who are physicians and other healthcare providers have an obligation to their patients to inform them and help them obtain the medication and supplies they will need when TSHTF. – Dr. John in in Arizona

JWR:
First, many thanks to AERC for a very well-written article on Type 1 diabetics in SHTF situations. It was greatly appreciated and well written.

My youngest son (now 7) was diagnosed as a Type 1 diabetic about 2 months after I read [the novel] One Second After by William R. Forstchen (the daughter of the main character is a Type 1 diabetic), and along with getting used to our “new normal” lifestyle, I have also been trying to get prepped over the past 18 months in case SHTF. We are stocking up on insulin, test strips and other supplies, but I felt more was needed. My biggest concerns are 1) refrigeration for medications, and 2) protecting vital equipment from EMP/solar flare bursts.

My solution to refrigeration has been to begin testing a small “six-pack” refrigerator with a battery connection, which my father-in-law found at a swap meet. (I’ve also seen “battery powered coolers” for sale elsewhere.) This refrigerator is big enough to hold a few dozen vials of insulin and requires much less power than any other refrigerator. To keep it going long-term, I plan to rotate several car/deep cell batteries with a solar trickle charger for the duration of the emergency. Based on AERC’s article, I’ll also be looking at other alternatives as well. [JWR Adds: With a couple of 40 watt photovoltaic panels and a charge controller, you should be able to keep a refrigerator running for up to eight years. (The limiting factor is the sulfation of lead-acid batteries.]

For protection against EMP and solar flares, I intend to build a Faraday cage for extra diabetes electronic equipment such as an extra blood glucose test kit (along with radios, laptop, etc.). One possibility I will be trying is a 2-drawer filing cabinet conversion; the instructions are at Instructables. There are other possibilities I’m researching now for small, easy-to-build Faraday cages.

Even with a prepper mentality, along with a parent’s acquired nerves of steel….I still haven’t been able to pick up and read One Second After again since my son’s diagnosis. Just can’t do it. But articles like this one give me hope that, with proper planning, we can weather almost anything as a family. Thanks again. – Z. from Arizona

Dear JWR:
Another option not mentioned in the article is a DC refrigerator, batteries, charge controller, and a few solar panels.  There are other uses for this setup as well. One brand of compact refrigerators to consider is Sundanzer. – S.B., MD

Economics and Investing:

Dr. Gary North: A Civil War Inside Austrian Economics

G.H. flagged this over at Time: If There’s No Inflation, Why Are Prices Up So Much?

Kyle Bass Warns “The ‘AIG’ Of The World Is Back”

Items from The Economatrix:

Mark Levin:  Government Is “Simulating The Collapse Of Our Financial System, The Collapse Of Our Society And The Potential For Widespread Violence

The Economic Un-Recovery: A Novel Perspective

Jobless Claims Drop, Signaling Labor Market Gains

Odds ‘n Sods:

G.G. suggested this at Popular Mechanics: How to Stock Your Disaster Pantry

   o o o

Defense Distributed’s Cody Wilson: Rebel. Cause. Some Assembly Required.

   o o o

Chris Walsh of Revolutionary Realty suggested this video: How To: Break an axle on a Daihatsu Hijet

   o o o

Deeper Schumer: We Have Language for S. 374, the Transfer Ban. (Thanks to Bill N. for the link.)

   o o o

Statist scheming, perfected: After Aurora: How Mayor Bloomberg Planned to Make the Next Massacre Count. (Thanks to Pierre M. for the link.)

Jim’s Quote of the Day:

"I believe the single most significant decision I can make on a day-to-day basis is my choice of attitude. It is more important than my past, my education, my bankroll, my successes or failures, fame or pain, what other people think of me or say about me, my circumstances, or my position. Attitude keeps me going or cripples my progress. It alone fuels my fire or assaults my hope. When my attitudes are right, there is no barrier too high, no valley too deep, no dream too extreme, no challenge too great for me." – Charles R. "Chuck" Swindoll

Notes from JWR:

I recently turned in the manuscript for Expatriates: A Novel of the Coming Global Collapse to my editor at E.P. Dutton. The novel should be released in November, 2013. It is a departure from my previous novels, as the majority of the story takes place overseas, and there are no crossover characters with the previous novels except for ProvGov President Maynard Hutchings. But rest assured that the story is set in the same exciting near-future period, amidst the economic collapse. (But geographically is set primarily in The Philippines, Australia, and central Florida.) The cover artwork has already been completed. This is another great cover by Tony Mauro, Jr., who also created the dramatic covers for “Survivors” and “Founders.“

—

We are now quite busy at the ranch, as this is calving/lambing/kidding season. My wife (“Avalanche Lily”) has been bearing the brunt of it. The many hours required–especially feeding the bummer bottle babies–can be taxing. Lily is an amazing woman and I love her dearly.

—

Today we present another entry for Round 45 of the SurvivalBlog non-fiction writing contest. The prizes for this round include:

First Prize: A.) Gunsite Academy Three Day Course Certificate, good for any one, two, or three course. (A $1,195 value.) B.) A course certificate from onPoint Tactical. This certificate will be for the prize winner’s choice of three-day civilian courses. (Excluding those restricted for military or government teams.) Three day onPoint courses normally cost $795, and C.) Two cases of Mountain House freeze dried assorted entrees in #10 cans, courtesy of Ready Made Resources. (A $350 value.) D.) a $300 gift certificate from CJL Enterprize, for any of their military surplus gear, E.) A 9-Tray Excalibur Food Dehydrator from Safecastle.com (a $300 value), and F.) A $250 gift certificate from Sunflower Ammo. and G.) A $200 gift certificate, donated by Shelf Reliance.

Second Prize: A.) A gift certificate worth $1,000, courtesy of Spec Ops Brand, B.) A Glock form factor SIRT laser training pistol and a SIRT AR-15/M4 Laser Training Bolt, courtesy of Next Level Training. Together, these have a retail value of $589. C.) A FloJak FP-50 stainless steel hand well pump (a $600 value), courtesy of FloJak.com. D.) A “grab bag” of preparedness gear and books from Jim’s Amazing Secret Bunker of Redundant Redundancy (JASBORR) with a retail value of at least $300, E.) A $250 gift card from Emergency Essentials and F.) Two cases of Meals, Ready to Eat (MREs), courtesy of CampingSurvival.com (a $180 value).

Third Prize: A.) A Royal Berkey water filter, courtesy of Directive 21. (This filter system is a $275 value.), B.) A large handmade clothes drying rack, a washboard and a Homesteading for Beginners DVD, all courtesy of The Homestead Store, with a combined value of $206, C.) Expanded sets of both washable feminine pads and liners, donated by Naturally Cozy. This is a $185 retail value, D.) A Commence Fire! emergency stove with three tinder refill kits. (A $160 value. E.) A Tactical Trauma Bag #3 from JRH Enterprises (a $200 value), and F.) Two Super Survival Pack seed collections, a $150 value, courtesy of Seed for Security.

Round 45 ends on March 31st, 2013, so get busy writing and e-mail us your entry. Remember that there is a 1,500-word minimum, and that articles on practical “how to” skills for survival have an advantage in the judging.

Insulin Dependent Diabetics When TSHTF, by AERC

About five years ago, my husband started worrying about many things happening to our country and the world in general.  Bird flu, inflation, resource grabbing, bank bail outs, government policies, Peak Oil… and more provided fuel for his concern.  As I listened to him talk about what was happening in the world, I began to think about what to do in a situation that would dramatically alter our “way of life”.  We already had goats, sheep, pigs, rabbits and chickens.  We already had a nice sized garden and I already canned what we didn’t eat fresh, but it wasn’t done with a plan to store anything for more than a few months.    We started working on our food storage and stockpiling animal feed until we hit a huge wall:  How would I deal with having diabetes if I couldn’t get my monthly insulin and blood checking strip refills? 

I have been a diabetic since the age of 6 – so about 40 years.  I became diabetic when all insulin was derived from pork or beef pancreases.  Blood checking machines weren’t even available until I turned 14.  Back then, I had to collect urine and use an eye dropper to put a certain number of drops of urine and add a reagent to see if I was spilling sugar in my urine.  Unfortunately this is one of the least accurate methods of checking how the body is processing food and if the person needs more insulin which is why I would need to go into the hospital for a finger prick and blood test once a week.  As a child, my blood sugars would vary from 200mg/dl to 350mg/dl and higher (normal is around 70).  Control was very difficult to achieve, particularly in a young person who is growing and going through hormone changes. 

Today, we are fortunate in that we can buy blood checking machines in several different brands and blood checking strips to go with them.  These wonderful devices give a result in 5 seconds and tell the person what is going on in their body right now (taking blood from a finger actually shows what happened 10-15 minutes prior, but it is the most accurate result that is available at home).  We also have different kinds of insulin available, from insulin that will react within a couple minutes to insulin that will last 24 hours.  All insulin available in the US right now is human insulin (it is human derived insulin which is grown in the laboratory using e-coli bacteria that is genetically modified to make insulin that is virtually identical to the insulin made by human pancreases) We also have insulin pumps that can include a device to give up to date blood sugar readings.  A diabetic has so many options that they can have extremely tight control and can live very normal lives with few complications. 

Unfortunately, all of the supplies needed to keep a diabetic under control would soon run out if anything interrupts the system needed to run the laboratory that makes this lifesaving hormone and all of the paraphernalia a person with diabetes needs to keep good control.  Sure, pharmacies keep a supply of insulin on hand, but it needs to be refrigerated and even then, has a relatively short shelf life.  So what can a diabetic do if they are confronted with a widespread grid down situation or even a long term break down of “normal” operations? 

The following is not to be used as medical advice.  I am not a doctor and even if I were, what you take from this article is meant to give you some suggestions based on my experiences.  Make sure that you talk to your regular medical professional and take their advice and make informed decisions.

The diabetic confronts some serious issues in a SHTF situation.  They may not be able to obtain insulin.  They may not be able to keep the insulin they have cool.  They may not be able to check their blood sugar.  They may be able to obtain one kind of insulin but not their usual insulin.  They may be on more than one kind of insulin but only be able to obtain one of them.  They may not have enough blood checking strips.  Their blood checking machines may no longer work (in an EMP situation).  They may not have batteries for their machines.  Their pumps may no longer work.  They may not be able to get the pump components.  Diabetics on Ace inhibitors may not be able to get their pills.  Diabetics who are experiencing complications from their disease may not be able to obtain dialysis or other vital treatments.  The problems facing a person with diabetes seem almost endless.

As a diabetic, I had to take a hard look at what I could be facing if I were not able to get my supplies.  I pondered the problem for a long time.  I did lots of research and came up with all kinds of conflicting information on storing diabetic supplies.  All of the official sites talked about how open vials of insulin should be thrown away on day 28 (because it degrades at room temperature). Syringes were to be used once and tossed.   Insulin was no good after the expiration date.  So, I decided to use myself as a guinea pig.  First I began reusing syringes.  I would keep my bottle of insulin on the refrigerator shelf and put the syringe beside it. Amazingly, I did not get any infections.  I also continued using both kinds of insulin after the 28 day mark.  Here again, I didn’t experience any issues with the insulin degrading past the 28 day mark.  I decided to talk to my doctor about what I had found.  My doctor was not the “prepper” type and was a bit dismayed at my using my insulin differently than before, but knew that not only was I stubborn, but I was also extremely well controlled (HA1C of 6.5).  She told me that if she noticed a spike in my HA1C readings she would take issue with my new way of doing things.  Of course, I check my blood sugars a minimum of 10 times a day before meals, after meals, before bed and during the night so if I had a spike or drop in blood sugar I could immediately correct it.  A little background to explain what an HA1C is; Hemoglobin A1C (HA1C) is a component of hemoglobin that glucose binds to.  Doctors use this measurement to give a broader picture of diabetic control.  This means that it is an average of the blood sugars for the previous three or four months.  A “normal” person’s HA1C should be between 4.5 and 6. 

See:

What Is What Is A1C And What Does It Measure?

and,

The Hemoglobin A1c (HbA1c) Test for Diabetes (at WebMD)

Prior to my experimenting, I had been using the insulin pump but had stopped for a period of time.  I didn’t like the pump because I was prone to getting infections at the injection site.  I talked to my doctor and came up with a Lantus/Humalog combination that worked for me and kept my blood sugars under control.  I then decided I would start stockpiling insulin, but how was I going to overcome the expiration date issue?  I talked to my doctor and mentioned that I was concerned about issues that would cause problems with being able to get diabetes supplies and she gave me a prescription for double my monthly prescriptions. So every month, I used a bottle and saved a bottle.  Of course I rotated my stock but occasionally, a bottle would get overlooked and near its expiration date.  I decided to perform an experiment and leave a couple bottles and use them past the expiration date.  The first bottle I used was 6 months past the expiration date and it worked like one that was brand new so I let another bottle go a year past the expiration date and again, no problems.  Right now, I am using insulin a couple years past its expiration date and it still works.  Of course, my bottles of insulin are kept very cold in a very good refrigerator which might be a reason they haven’t degraded, but they still work as normal.  I think we can conclude that if insulin is kept at optimal temperature, which is around 40 degrees Fahrenheit it doesn’t degrade like insulin kept at improper temperatures which might shorten its storage ability.  As an aside, pork and beef derived insulin is available internationally and might be able to be stored longer due to it being pure insulin and not chemically manufactured.  Keep in mind that using any other kind of insulin other than what your doctor prescribes carries with it a risk.  You need to make sure you are discussing this with your doctor and getting his or her suggestions as far as boluses and times.   If you do decide to go back to using animal derived insulin you are in good company.  I know many diabetics who feel that the genetically modified insulin has made them feel “unhealthy”.  Do your research and decide for yourself with the help of your doctor.

The first concern a person with diabetes should have is how to ensure their insulin is kept cold in a grid down situation.  There are several ways to keep things cool.  The first is a root cellar.  Root cellars which are dug deeply enough and insulated well can maintain a year round temperature of about 40F.  The most important thing to remember is that a thermometer needs to be kept inside the cellar to keep track of the temperature.  If the goal is to create an environment to keep insulin at a constant temperature this needs to be a priority.  A second method of refrigeration could be a “Servel” LP Gas refrigerator.  Unfortunately, long term LP might be a bit iffy, but it is definitely an option which should be considered.  [JWR Adds: There are still a number of brands of LP refrigerators being made. Most of these are made for the RV market and hence are fairly small and thrifty to use. A couple of SurvivalBlog advertisers sell them. Also keep in mind that almost any LP freezer can be run at its lowest flame setting to have it work as a refrigerator, with an interior temperature in the low 40s.] I have heard that this refrigerator is no longer being manufactured in the US due to issues with leakage, but I have used them and as long as they are kept in an outbuilding, and they are monitored for malfunction, they should work just fine.  I have seen them on CraigsList as well.  

Another method that can keep insulin cold is a “pot-in-pot” which uses a large earthenware pot with a smaller pot set inside of it.  Wet sand is put in between the two pots.  The moisture in the sand evaporates and cools the contents of the smaller pot.  The sand needs to be kept wet, but this could be an emergency way of keeping insulin cold. The fourth is to put the insulin in a waterproof container and an insulated cooler (the cooler is to add an extra layer of protection against fluctuating temperatures) and immerse the entire contraption into cold water such as a lake or a stream.  Before doing so however, the temperature of the water must be measured over a period of time to determine if it is an appropriate temperature for the insulin.  However, even if it isn’t, as long as the temperature is not at or below freezing, and it is cooler than ambient temperature, it can help to prolong the life of insulin.  I have heard some medical professionals mention that an additive has been put in human insulin to make it “shelf stable”.  Regardless of this, I still keep my insulin refrigerated.  If only to ensure that I can store it for the longest period of time possible.

The second concern for the diabetic is to find ways to check blood sugars and ketones.   A dangerous problem that diabetics who have prolonged high blood sugar can experience is ketoacidosis.  This is when the body doesn’t have enough insulin to digest food that is ingested and instead starts to break down fat and muscle for fuel.  The waste product created is called ketones.   Now everybody has heard of protein diets and how they cause ketones which in turn cause weight loss.  In a diabetic who is experiencing ketoacidosis, they not only have ketones but they also have high blood sugar.  The biggest problem is that the body has no way to deal with high blood sugar other than insulin and if a person is diabetic, their pancreas does not make any, so a vicious cycle is entered into.   Both ketones and sugar are excreted by the kidneys and can cause kidney damage as well as further complications due to dehydration.  If a person has high blood sugar and ketones for more than 24 hours and this situation is not corrected with insulin, the diabetic will enter into diabetic coma and ultimately die.   

Because of this, diabetics should stockpile Ketostix which is a urine test that can show if the diabetic is spilling ketones.  If they are, checking blood sugars would be the first thing to do.  The easiest way to check blood sugars is to use a blood checking machine.  There are many excellent brands on the market.  I have purchased several of the same brand and keep many months of blood checking strips and batteries.  Blood checking strips can be purchased over the counter but many insurance companies will cover them.  I have a very good relationship with my doctor and routinely ask for about 100 strips more than I use a month.  Of course strips also have an expiration date but I vac pac them to keep moisture out which is the biggest no-no for the reagent strip.  But, what if there is something that causes a problem for the machine?  The best thing to do is to have back up strips that can give a visual reading.  Unfortunately these are not available in the US but BetaChek.com will ship them worldwide.   The key to avoiding ketoacidosis is to make sure to check blood sugars regularly and correct high blood sugar.  This issue needs to be discussed thoroughly with your doctor and a sliding scale of bolus insulin should be charted.  This is vital. 

Many diabetics today use one of the insulin pump models available on the market today.  These devices have helped many people with diabetes achieve very tight control.  Unfortunately the pump components may not be available if we experience an interruption in modern services.  Make sure to store extra batteries for the pump, extra pump sets and reservoirs, extra sterile pads, extra glucose monitoring supplies if you use “continuous glucose monitoring” and/or any other things needed to keep the pump operational.  Additionally, make sure to store plenty of extra insulin.  Not only the fast acting insulin used in the pump, but also long acting insulin for a pump failure.  Prepare for a SHTF situation by having a discussion about what injectable insulin to use with your doctor. 

Many doctors will put their patients on several different medications that will lower blood pressure, protect kidneys or lower cholesterol.  It goes without saying that the most important thing a prepper can do is to make lifestyle changes that will protect the circulatory system, but it is vital that a diabetic who is on these medications stockpile them as well.  It is crucial that the diabetic speak with his or her doctor and ask for double prescriptions.  This is easier to do than most people think.  If the diabetic is on a 50mg pill once a day, ask for a prescription that is 50mg twice a day or 100mg once a day and split the pills.  This way the person can put the extra away every month.  It might be a good idea to look outside of the US to purchase additional stock of these medications.  These meds can often prolong a person’s health and are an important addition to a diabetic’s medical stockpile.    Again, discuss this with your doctor.  Some pills can’t be split without it affecting the medication delivery.  These choices should not be attempted without thorough research and medical advice.

Unfortunately there are diabetics that have had additional complications that have compromised their eyesight or kidneys (or other organs).  It can’t be stressed enough that the person with these complications be completely forthright with their doctor with concerns about the future.  Discuss options that can be done at home.  A good way to get your medical professional on your side is to talk to them about the aftermath of Katrina, Sandy and the weather issues that have caused blackouts and power failures.  Talk to them about how you can deal with this.  This is particularly important if you are on dialysis or suffer from infections that aren’t healing.  Talk to them about how to manage these problems if you can’t go into the clinic.  Ask them what medications to use and ask them for additional supplies “just in case”.  Talk to your medical professional about alternative dialysis procedures, and if you are a candidate for these.  If you have already had transplant surgery, make sure you discuss what you should be doing for your immune system and how you can get additional anti-rejection medication as well as the shelf life of these necessary drugs. 

Something that needs to be discussed is pregnancy in diabetics.  In a long term SHTF situation, pregnancy must be avoided.  A diabetic pregnancy is very high risk now when we have modern conveniences available.  If they are interrupted long term, the repercussions could be terrible for a diabetic.  I have had three children and my last was the most difficult.  My blood sugars were perfect throughout my pregnancy but diabetes affects the entire system.  My daughter was born 6 weeks early because of placental insufficiency.  In a SHTF situation both she and I would have died.  Make sure to store condoms, birth control pills, and/or anything else to prevent pregnancy. 

The last part of this is dealing with reality.  I know that if systems are interrupted long term that I most likely won’t survive.  Yes, I feel as if I can stockpile my medications for years, but ultimately they will lose their effectiveness over time.  If I am unable to get more, I need to prepare for the inevitable.  I don’t want to think that way, but just because I don’t like it doesn’t mean I shouldn’t prepare for it.  We do the best we can for as long we can but a diabetic has an organ that no longer works.  If insulin is no longer available it won’t take long before the diabetic goes into ketoacidosis, coma and death.  This conversation should be had with all family members so all can prepare for this eventuality.  I hope and pray that if we do experience a SHTF scenario that we can rebuild before my stockpiles run out, but if not, I want my heart, soul and family to be ready for the end.

There are 25.8 million diabetics in the US and about 371 million worldwide. Most of these are Type II diabetes but for those of us who are Type I, we need to think ahead.  Most Type II diabetics can control their disease with diet and exercise, but not all.  For those of us who need insulin and other medication, we need to plan.  I hope that this will help a person who has diabetes as well as their family prepare for a SHTF situation.  Do your research.  Decide what the best approach is for you and talk to your medical professional.  Find a doctor that is willing to work with you and help you prepare.  I have included some links at the bottom of this article that can help give some suggestions about the different types of insulin available.  Look at the links that are included in the article as well as those at the bottom.  Learn as much as you can about your condition and prepare, prepare, prepare. 

Further Reading:

http://care.diabetesjournals.org/content/25/suppl_1/s112.full
http://www.iddt.org/wp-content/uploads/2011/05/JDN15-1pg32-6.pdf
http://www.iddtindia.org/whichinsulin.asp
https://secure.pharmacytimes.com/lessons/200510-03.asp
http://www.diabeticconnect.com/discussions/5892-pork-insulin-what-i-have-learned
http://www.idf.org/about-insulin-0
http://care.diabetesjournals.org/content/4/2/180

Two Letters Re: Storing Coconut Oil

JWR,
I work in the oleochemcals industry, just a little info on oil storage.
Oxygen is by far your worst enemy when it comes to long term storage for any fat based materials. The oxygen will primarily interact with any of the double bonds located on a fatty acid chain, breaking down the fatty acid and creating the compounds that cause the oil to become rancid. The more unsaturated the oil is the more double bonds that will be available for the oxygen to interact with. Coconut oil is naturally highly saturated (typically ~94%), therefore fewer double bond sites on the fatty acid chain for oxygen to attack and degrade the product. That said, it is still best to store any of these oils in an environment where there is little to no exposure to oxygen.
• Purchase only high quality oils, if it is a major brand – it is high quality. These will already have been processed to eliminate the vast majority of the compounds that occur naturally in the oils that help to speed up the degradation of the oils.     
• At our facility, we nitrogen blanket our tanks for product protection. Use of dry ice, similar to long term storage of grains, will provide the same effect. 
• Plastic is NOT impermeable. While convenient and unbreakable, I have had Olive oil (poly unsaturated) go rancid while still in its original unopened plastic bottle. Metal and glass are better choices. 
• Storage as a solid (frozen) will ensure that only the material on the top can have any exposure. We actually do this also at work for some of our high $ materials that don’t get processed as often. Melting point of coconut is ~75 Degrees F, just keep in a cool place.
Use of these methods can stretch oils storage times greatly – far past the 2 years on the label. – P.M.R.

Jim,
I’m writing about the recent letter on coconut oil. It takes away odors as well. It is antiviral, antibacterial and antifungal. I use the natural tasting extra virgin coconut oil when using for everything except cooking items where I really don’t care for the coconut taste in a particular food. Since coconut oil melts at 76 degrees it can be easily melted and used in place of unhealthy corn oils. My local Costco started selling this only about 6 or 7 months ago. I have found unflavored Extra Virgin coconut oil at Swanson Vitamins (an Internet/mailorder company that I have used for years that has very good prices in North Dakota). We only use coconut oil for my daughter’s babies and not only is it healthy, no stinging or horrible taste if it gets into their mouth. Hope this helps. God Bless, – Diana

Odds ‘n Sods:

David S. was the first of several readers to send this: It’s Official – L.A. Officials Say : Prep For Two Weeks On Your Own

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H.L. sent: Has Gun Ownership in American Homes Really Decreased This Dramatically? H.L. opines, perhaps correctly: “No, gun ownership has probably increased, but the willingness to mention them to government officials and pollsters has decreased.”

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Some food for thought: Christians, The Second Amendment And The Duty Of Self Defense

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Freeze Dry Guy has announced that they are giving back 20%-30% back in Survival Bucks  on all “Necessities” unit orders placed by March 31, 2013. As usual, they offer free shipping in CONUS.  

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Schakowsky: Assault Weapons Ban is Just the Beginning. (Thanks to J. McC. for the link.)

Jim’s Quote of the Day:

“And many a man with life out of tune
All battered with bourbon and gin
Is auctioned cheap to a thoughtless crowd
Much like that old violin

A mess of pottage, a glass of wine,
A game and he travels on.
He is going once, he is going twice,
He is going and almost gone.

But the Master comes,
And the foolish crowd never can quite understand,
The worth of a soul and the change that is wrought
By the Touch of the Masters’ Hand.”

Excerpt from The Master’s Hand, by Myra Brooks Welch

Notes from JWR:

The C.R.O.S.S. benefit auction for a PVS-14 night vision monocular has ended. See details in the Auction Recap, below.

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Today we present another entry for Round 45 of the SurvivalBlog non-fiction writing contest. The prizes for this round include:

First Prize: A.) Gunsite Academy Three Day Course Certificate, good for any one, two, or three course. (A $1,195 value.) B.) A course certificate from onPoint Tactical. This certificate will be for the prize winner’s choice of three-day civilian courses. (Excluding those restricted for military or government teams.) Three day onPoint courses normally cost $795, and C.) Two cases of Mountain House freeze dried assorted entrees in #10 cans, courtesy of Ready Made Resources. (A $350 value.) D.) a $300 gift certificate from CJL Enterprize, for any of their military surplus gear, E.) A 9-Tray Excalibur Food Dehydrator from Safecastle.com (a $300 value), and F.) A $250 gift certificate from Sunflower Ammo. and G.) A $200 gift certificate, donated by Shelf Reliance.

Second Prize: A.) A gift certificate worth $1,000, courtesy of Spec Ops Brand, B.) A Glock form factor SIRT laser training pistol and a SIRT AR-15/M4 Laser Training Bolt, courtesy of Next Level Training. Together, these have a retail value of $589. C.) A FloJak FP-50 stainless steel hand well pump (a $600 value), courtesy of FloJak.com. D.) A “grab bag” of preparedness gear and books from Jim’s Amazing Secret Bunker of Redundant Redundancy (JASBORR) with a retail value of at least $300, E.) A $250 gift card from Emergency Essentials and F.) Two cases of Meals, Ready to Eat (MREs), courtesy of CampingSurvival.com (a $180 value).

Third Prize: A.) A Royal Berkey water filter, courtesy of Directive 21. (This filter system is a $275 value.), B.) A large handmade clothes drying rack, a washboard and a Homesteading for Beginners DVD, all courtesy of The Homestead Store, with a combined value of $206, C.) Expanded sets of both washable feminine pads and liners, donated by Naturally Cozy. This is a $185 retail value, D.) A Commence Fire! emergency stove with three tinder refill kits. (A $160 value. E.) A Tactical Trauma Bag #3 from JRH Enterprises (a $200 value), and F.) Two Super Survival Pack seed collections, a $150 value, courtesy of Seed for Security.

Round 45 ends on March 31st, 2013, so get busy writing and e-mail us your entry. Remember that there is a 1,500-word minimum, and that articles on practical “how to” skills for survival have an advantage in the judging.

Getting Prescription Drugs for TEOTWAWKI, by Sara Sue

It was quite a shocker when I couldn’t get my husband’s heart medication prescriptions filled in January.  After numerous phone calls to our pharmaceutical insurer, I finally found someone who assessed and fixed the problem, but it took over 6 weeks to get his prescriptions filled.  (Fortunately, I had stocked up last year, so he wasn’t completely out of his medications.  Stocking up was not intentional.  The insurer accidentally sent twice the amount requested and when I called to let them know, they said not to worry about it and they would stop the auto-refill feature).  As to why my husband’s prescriptions could not be filled, the customer care representative said something about a “glitch” in the system.  At least, that is how it was explained to me.  How one customer care representative described it – “…all Medicare eligible persons are being switched over to a Medicare type plan and your husband’s record did not make it into the new database”.  The net effect was that it appeared he didn’t have any drug insurance coverage.  The problem was “fixed”, but the costs skyrocketed.  

Hey, wait a minute, we have private drug insurance through my husband’s previous employer – he is now retired.  We didn’t sign up for Medicare Part D because we didn’t need it.  We already had good insurance.  How can they switch you over like that without your knowledge or permission?  ObamaCare, that’s how.  The out of pocket costs for his prescriptions is now more than 10 times what they were the last year (i.e., $10 co-pay versus a $100 co-pay per prescription + a deductible that quadrupled and an out of pocket cap that doubled).  And this happened with no warning.  Our budget is fairly tight each month, so it was a budget shocker too.  I scrambled to rob Peter to pay Paul to get the medications he needed, but I was angry.  I thought of all the seniors who are less fortunate than ourselves.  How would they pay for their medications?  And how in the world can anyone stock up on medications for TEOTWAWKI?

This article provided some information about skyrocketing drug costs and the changes being made in Medicare right now under ObamaCare.  (Listen up people, the sequester and the Republicans have nothing to do with this, as Mr. O declares.  These changes are a direct result of ObamaCare.)  The title, Medicare drug costs to fall in 2014, but donut hole widens, is a bit misleading.  Costs are up for 2013, so don’t believe they are going down in 2014.  Here’s a quote from the article:

“Seniors fall into the “donut hole” when spending on drugs (the combination of what the individual and the insurance company spend) reaches a predetermined threshold.  This year, the number is $2,970; after that point, the senior pays 50 percent (a new change this year from the Affordable Care Act) of brand-name drug costs, until individual spending exceeds $4,750…

But for 2014, the CMS has proposed that beneficiaries enter the hole when combined spending reaches $2,850 – $120 less than in 2013.  That means seniors would start paying more out-of-pocket at a lower level of spending.  That will surprise seniors, since one of the key touted benefits of President Barack Obama’s healthcare reform law is the gradual closing of the donut hole entirely between now and 2020.”

Can you make it until 2020 for things to improve?  There’s a lot of double talk put out by the federal government on how costs are going to be lowered for seniors.  I’m not seeing it.  Neither are my friends and family.  Our cost spike was a result of being forced from a private plan into a Medicare plan.  However, my parents have both Medicare and a private plan and experienced huge increases when they went to refill their prescriptions in January this year.  Something’s fishy, right?
I shared my story with a few friends, and they had also experienced the “sticker shock” and this includes people who are not Medicare eligible.  I don’t know what’s going on, but I’m not going to put up with it.  I have choice (ah, so American of me, right?).  I started my quest to find an alternative source for medications.  Something I had never thought of before.  I recall my sister mentioning to me that her doctor at a major medical university had prescribed her a drug that was not FDA approved and gave her the link to a Canadian pharmacy.  I researched Canadian pharmacies and there appears to be a lot of confusion about them.  Is it legal for a US citizen to purchase medications from a Canadian pharmacy?  Some say yes, some say no.  I went to the source, the FDA, and read their policies.  It appears that for personal use and in small quantities (30-90 days), the FDA may “look the other way” when US citizens “import” Canadian pharmaceuticals.  The trick is finding a legitimate online pharmacy and protecting yourself against identity theft by purchasing from an legitimate source.  There exists policy only and I have not found a federal law on the books that prohibits US citizens from purchasing pharmaceuticals for personal use from Canada.  (Maybe that will be made a law as the vast ObamaCare bill is slowly morphing into legislation.)

Just a quick note:  If you travel overseas and are able to purchase your drugs there, make sure you dump the pills into existing pill containers (that you have taken with you) that are labeled by a US pharmacy; trash your receipts and new pill bottles prior to traveling home, just in case a customs agent decides to hassle you upon re-entry.  You never know how far the federal government will go in forcing people into paying into the ObamaCare system.  Without your dollars, the system will fail and they know that.

There is an organization, RxRights.org, which is fighting to retain the right to purchase prescription drugs from overseas.  God bless them.  They wrote an article that described the FDA’s new campaign to warn citizens away from purchasing drugs from outside the United States.  The FDA’s web site for the campaign (BeSafeRx: Know Your Online Pharmacy) can be found here. Key points from the FDA: Know the Risks, Know the Signs, and Know your Online Pharmacy.  (The very fact that the FDA is counseling citizens about safely buying outside the US, is permission enough for me.)  However, RxRights.org depicts the FDA’s campaign as being misleading by scaring people away from online pharmacies. RxRights.org stated that “…a recent Consumer Reports survey indicated that nearly half of those under age 65 without prescription drug coverage neglected to fill a prescription due to cost in 2012.  As Americans struggling to survive in this economy seek ways to save money, scare tactics are not what they need”.  And yes, there are many rogue Internet pharmacies out there, so BE CAREFUL, but don’t be deterred.  I am going to use the pharmacy that my sister’s doctor recommended.  

We have a close relationship with our family doctor.  Something I didn’t really care about a few years ago, but major health changes in our family forced us into regular doctor visits.  Now, I see this relationship as critical as we all work our way through what ObamaCare has done to destroy healthcare in America.  Our family doctor also practices what I call “Chinese medicine” in addition to traditional medicine, which is an indication to me that she is open minded.  She also listens and she cares.  When my husband’s insurance changed to Medicare primary, she continued to see him.  Many doctors are stating that they are “not taking new patients”, but that’s a response you will most likely get after you answer the question, “What is your insurance?”  It’s the first question asked, when you call to make an appointment now.  My next step is to call her for a new prescription and I will ask her for a couple of copies and explain that I am going to “shop pharmacies” due to the increase in drug costs.  I don’t think she will complain, but we’ll see.  This where your relationship with your doctor counts.  

I called my sister and she explained that getting her drugs from the Canadian pharmacy was fairly straightforward.  First, she had to call them.  Secondly, she had to fax her prescriptions to them.  Once she paid (they take Visa and Mastercard), her medications were shipped to her with no problems.  I have high confidence that her recent positive experience will be the same for us.  We are forced in this direction because the Affordable HealthCare Act is not affordable and the government takeover of private insurance plans is an outrage.  Once accomplished, I am hoping to be able use several online reputable pharmacies for stocking up purposes.  Expensive as it may be, I can still refill his prescriptions through our insurer, (and oh by the way – your insurer has become Big Brother too.  If you don’t refill your prescriptions in a timely manner, they not only will send you a letter or call you on the phone, they will alert your doctor as well.  Maybe they instituted that practice under the guise of “we care”, but I think more likely it’s about “we want your money”.)  My plan is to use the insurer despite the cost, and also use the online pharmacies for stocking up.  I can do this because I can.  If you can’t, get what you need any way you can.

2013 started out with increased taxes, higher healthcare premiums, higher food prices, higher gas prices, higher utility bills, and a huge increase in drug costs.  Inflation is here as forecasted.  Family budgets were slaughtered.  Not a good start.  I hope this helps others in finding a reputable online pharmacy, understanding the process, and understanding the risks in preparing for TEOTWAWKI.  

Living in The Age of Sequestration

I’ve observed that we are now living in The Age of Sequestration, in many senses of the word.

First, and most noticeably, is all mass media talk about the Federal Budget Sequestration. Despite all of the hoopla and handwringing, it is actually just a token decrease to an already enormously bloated budget.

Second, is the forced sequestration of some Bad People. You’ve probably heard the latest news: following a lengthy jury sequestration former Detroit Mayor Kwame Kilppatrick was found guilty. But his upcoming sequestration is hardly a news flash. Everyone knew he was a crook and this is of course his second conviction.

OBTW, does Mayors Against Illegal Guns have a special Life Sentence Membership option? And coincidentally it looks like former New Orleans Mayor Ray Nagin (another one in Mikey Bloomberg’s Elite “Crime-Fighting” anti-gun club) may also be sequestered. If convicted, Nagin would join a long list of very ex-Mayors. One thing more gratifying than seing a bit of the Federal budget sequestered is seeing more of Bloomberg’s Band of Fools sequestered for long stretches in Club Fed, where they can’t do the public any more harm.

Third, Germany is sequestering its gold reserves. Once thought safe under the streets of New York City, the German government has announced that it is repatriating its gold. Since there are probably more banker IOUs than there is physical gold in the depository, this will surely be seen as a wise move, in retrospect. (Nobody wants to be the proverbial Third Guy In Line.)

Fourth, in reaction to economic turmoil and Quantitative easing (monetization) the citizens of many countries are wisely sequestering part of their life savings by buying more silver and gold.

Fifth, a bunch of collectivists are trying to sequester your gun collection. They tell us that melting our guns down to make manhole covers is for our protection. Yeah, right.

Sixth, American gun owners, in reaction to the gun grabbers, are sequestering part of their life savings by buying more guns, more ammunition and more full capacity magazines. That is a wise move.

Seventh, and most important to SurvivalBlog readers is the quiet exodus of American gun owners and other freedom lovers. They are moving from Blue States to Red States. Many people are fed up and have wisely chosen to vote with their feet. They are moving to places like The American Redoubt. May God bless them, provide for them, and protect them. We have our own ideas about where we want to sequester our gun collections, and sequester our kids, too. – J.W.R.

Four Letters Re: The Human Appendix

Mr. Rawles:
I am writing to address some of the questions in the letter on The Human Appendix. I am a physician who works at a large academic center.

Regarding The letter writer’s questions, an inflamed appendix is not uncommon (This is know as appendicitis), and removal of the appendix is one of the simplest surgery’s we perform in modern medicine. It is unclear why the inflammation occurs, but if untreated it can be fatal. The appendix was historically thought to be a vestigial organ (useless), or an immune presenting organ ( i.e.: helps the immune system fight off infections). It is thought to have no role in the digestions of foods, and people can live a normal life span without it. The symptoms that go with appendicitis are mid belly pain (pain around the belly button) which moves to the lower right corner of our abdomen over time, and the inability/lack of desire to eat. Recent evidence in the scientific literature points to the fact that the appendix may actually be more important then once thought (see the recent Wired Science article which points to the original science) though this is still under debate . There is nothing you can independently do to keep the appendix healthy (other then try to eat a healthy diet and not take unneeded antibiotics), and we no longer remove appendixes prophetically, that is we do not take them out unless they are infected. There is nothing you can do to keep your babies appendix healthy beyond possibly breastfeeding to make sure he/she develops a healthy immune system.

The Gallbladder is a different story. Most gallbladder problems are caused by gallstones, which are stones made of bile and cholesterol (two substances which the gallbladder stores in order to aid with digestion). When we think about people who get gallstones, the classic med school mnemonic is “fat, female, fertile and forty”. Woman, of reproductive/middle age who are fat get gallstones. So the only preventative measure is to stay fit and skinny, as you can’t really control your age or gender.

I hope this helps, – S.M.G. MD
 

Jim,
 Regarding Letter Re: The Human Appendix, I am not a medical professional but I’ve had reason to learn about some of what was asked regarding the appendix and gall bladder as I had both of mine removed when I had a gastric bypass.  First, there is evidence the appendix actually has a purpose by storing good bacteria.  It’s not critical, but it is helpful.  Without an appendix, the some antibiotics can cause you GI distress.
 
Next, the gall bladder helps you digest, among other things, fatty food.  Without a gall bladder, you will likely regret eating too much fat for dinner as you will tend to need the bathroom more urgently the next day.  Without the gall bladder, tracking what you eat is important to maintain good GI comfort.
 
As a GB patient, fat rushes through me and I don’t have a very big stomach which can not easily process certain foods (especially proteins) thus causing discomfort.  Further, as a person over 50, my body naturally does not grow the helpful bacteria or enzymes as well.
 
I’ve read various medical sites talking about probiotics and there are certain probiotics that create a very good mix of the suggested helpful bacteria.  However, they need to be encapsulated properly to bypass your stomach and get into the intestines lest they be destroyed by the stomach acids.  Probiotics can help you maintain a comfortable life and help you draw in the nutrition from the foods you eat.
 
I use a product that I found on the internet and researched their claims.  After some consideration I decided to try them and have been happily using their products for over a year.  I found that after a few weeks, I can back off of the probiotic pill to every other day or so.  Can I live without them?  You bet!  But my overall GI comfort level is harder to maintain without them.  
 
I have not had much luck finding medical information regarding enzymes beyond the fact that as you get older, your body does not produce as many.  What I have learned is that certain freshly picked greens make my digestive system very happy and, for everything else, the enzyme pills help me digest protein and other foods with greater comfort.
 
I have no ties with this company and am simply an avid user of their products. I personally use them and swear by their effectiveness.
 
IMHO, their web site leaves much to be desired, but their products perform quite well. – J.W. from Virginia

 

James,
I’ve benefited from so many tips from survivalblog that I’d be gratified if you could pass this preventive measure on to your readers.  I have on several occasions cured a case of appendicitis at the painful and nauseous stage by administering a purgative.  Appendicitis is caused by a blockage in the bowel, a hard piece of stool that is blocking the secretions of the appendix.  A purge that leads to full elimination can remove the blockage and give immediate relief.  Aloe vera or gum of aloes is excellent for this purpose.  (Do not use senna or epsom salts if ulcers or hemorrhoids are present.  Purgatives should be used with caution during the first trimester of pregnancy.)
 
In an environment where people have no choice but to eat high fiber foods, appendicitis would be a rare problem.  There are many other “modern” diseases that would disappear if our diet were not so “modern”.  For example, diabetes is only a problem because of the high percentage of refined starches and sugars in most people’s diet.  The natural human diet is one of the many things that God set and humans tampered with, to their own detriment. – Suzan G.

 

JWR:
There was an article from the Institute for Creation Research just yesterday on this topic, highlighting recent research showing that the appendix harbors a “cache” of bacteria that are used to re-colonize the gut following a major illness or condition that disrupts the digestive system. Evidently there are no vestigial organs. – Tip H. in Washington