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The Constipated Hordes at TEOTWAWKI: A Pharmacologic Strategy - Jonas - 8 August 2013 Another good find at James Rawles Survival Blog! http://www.survivalblog.com/2013/08/the-constipated-hordes-at-teotwawki-a-pharmacologic-strategy-by-anon-md.html The Constipated Hordes at TEOTWAWKI: A Pharmacologic Strategy by Anon, M.D. In a situation that will be characterized by, among other things, gutted pharmacies and unmanned hospitals, the remaining population at TEOTWAWKI will be required to provide their own medical care and to meet their own pharmacologic needs. While there have been numerous helpful articles outlining the importance of antibiotics in the context of TEOTWAWKI there has been very little addressing the importance of an overall pharmacologic strategy. Some of you—especially those who take daily prescription medication—have likely considered this problem before. But perhaps you are young and healthy, unburdened by any medical diagnosis. There should still be a pharmacologic component to your overall survival strategy. Even the robustly healthy occasionally encounter the minor health annoyance—a stomach bug, say, a case of diarrhea or constipation, or perhaps a urinary tract infection. The problem, of course, is that, in the context of TEOTWAWKI, the minor health annoyance can rapidly spiral into something life-threatening. Consider the title of this article, for example. Constipation is, for most people, an infrequent and easily remedied problem—a couple of Sennekot and a quart of juice cures 95% of cases. If worse comes to worse, there are suppositories—or enemas. But suppose that you have no access to over-the-counter laxatives. Suppose you are plagued by constipation for several days but because it ranks low on your list of immediate problems, it goes untreated. By the time you get around to dealing with it, you’ve got a very large, rock-hard ball of stool in the lower rectum, and it isn’t going anywhere. This what medical folks refer to as a fecal impaction. Impactions are common among already sick, weakened individuals; the treatment is manual removal. Without intervention, an impaction can lead to colon perforation, peritonitis, sepsis, and eventually septic shock and death. Or perhaps, in desperation, you attempt to unimpact yourself, or have a willing family member do it. In the process of this procedure, you inadvertently lacerate one of the delicate rectal vessels--and suffer a large hemorrhage. Incidentally, I have encountered this exact scenario before, working as an EMT in rural Alaska. It sounds ridiculous—that a case of constipation could lead to such dire straits. But make no mistake. Due to decreased fluid intake and no access to fresh fruits and vegetables, there will be hordes of constipated people at TEOTWAWKI. Consider another common health complaint, especially for females: the dreaded urinary tract infection. Normally it is cured with a three-day course of nitrofurantoin, or, if you lack health insurance, a slightly longer course of ciprofloxacin, which costs ten dollars. But suppose you have no access to antibiotics, and again, decreased fluid intake. You have nothing with which to treat the fever that develops. Eventually you start passing bloody urine, then clots. The pain evolves from a mild discomfort during urination to a stabbing sensation in the flanks; by day five or six or seven it feels as though every organ in your abdomen and pelvis is on fire. The infection has migrated from the urethra, to the bladder, up the ureters, and has now settled in the kidneys. You have developed what is referred to by medical folks as pyelonephritis. The fever climbs to 105. Your blood pressure bottoms out as the infection spills over into your bloodstream. Untreated pyelonephritis leads to urosepsis. Outcome same as above—septic shock and death. The point is, if you have a body, eventually something will go wrong. Eventually you will require pharmacologic intervention. THE FOUR CATEGORIES From a pharmacologic perspective, there will be four categories of people at TEOTWAWKI: The first are those who are healthy and dependent on no medication, or very little medication, for day-to-day function. They may have diagnoses ranging from seasonal allergies to mild asthma, psoriasis, and the like—the loss of pharmacologic treatment might be inconvenient but it would not be catastrophic. The second category includes those with diagnoses like hypertension and hyperlipidemia, who currently enjoy relatively good health. The loss of pharmacologic treatment will have no immediate impact on function. But in the grand scheme of things, lack of access to drugs will permit deterioration of organ function; in the case of untreated hypertension, for example, long-term exposure to high arterial pressures will cause the heart muscle to become thickened and stiff. A stiff, noncompliant heart does not pump efficiently: the inevitable result is heart failure and all its symptoms. This group also includes those with type II diabetes, as long-term exposure to elevated blood glucose spares no organ system in the body. The third category of people encompasses those who are able to maintain a normal lifestyle in the sense that may still be capable of work, of managing activities of self care—indeed they may even be fit and athletic depending on the nature of the diagnosis--but they suffer from a condition requiring daily intake of prescription medication, the loss of which would be serious or even fatal. This category includes individuals with diagnoses like type I diabetes, some types of heart disease, and severe hypothyroidism. It also includes patients who received a donor organ for transplant and rely on immunosuppressive drugs to prevent organ rejection. The last category of people are those who would be considered unhealthy, either because of a systemic disease that limits function, function that cannot be fully restored even with daily medication, or because, even though they may still have moderately good day-to-day function, they are dependent on a constant supply of medication and/or medical technology for survival. The former suffer from severe heart disease, cancer, congenital heart disease, and degenerative neurological conditions such as Huntington’s or Parkinson’s. The latter group includes dialysis patients, COPD patients who require constant supplemental oxygen, tracheostomy-dependent patients, or those who can only take nutrition via tube feeds. This article is aimed at all but the last group. Not that members of the last group have no chance of survival at TEOTWAWKI, but the preparations that would be required are outside the scope of this article. Pharmacologic preparation of the first three groups, if undertaken with a specific strategy and numeric goals in mind, is quite feasible. THE STRATEGY Determine your daily prescription medication needs. If you and your family are perfectly healthy then the task is simple. See Appendix A for my recommendations of prescription drugs. If not, the task is still relatively simple: a one year’s extra supply of necessary prescription medications, in addition to those listed in Appendix A. You may need to estimate—in the case of an asthmatic that uses inhaled steroids, for example, or for the migraine medication that is taken on an as-needed basis. Determine what constitutes a one-year supply of the drug. Record the data, with the names, dosages, and schedule, in a spreadsheet. Determine your over the counter (OTC) medication needs. See Appendix B for my recommendations for the average individual. Gauge your needs by looking in your medicine cabinet—perhaps you use a lot of liquid acetaminophen because you have small children in the home. Perhaps your family goes through more Inventory what you already have. Develop a plan for obtaining the rest. Plan to obtain the drugs listed in Appendices A and B within one year. This will require extra visits to doctors, calling in refills on schedule, being willing to fib about international travel perhaps, or being willing to change physicians. More on this below. Store the drug stockpile in an organized and responsible way (indoors, labeled, airtight containers, with 02 absorbers, under lock and key if any controlled substances are included). After OTC and prescription needs are met, work on a stockpile for bartering purposes. See Appendix C for ideas. Buy pharmacology reference books. See Appendix D for recommended titles. A WORD ABOUT OTC MEDICATION Don’t discount the potency or usefulness of a drug just because you can buy it at the local drugstore. Many drugs that used to be prescription-only are now sold OTC. One example of that is the proton-pump inhibitor omeprazole, used to treat acid reflux disease. To expand on this example, imagine a situation in which a person who suffers from acid reflux disease exists solely on a diet of canned chili for an extended period of time, without access to his usual proton-pump inhibiting medication. One day he begins vomiting blood, having developed a gastric ulcer as a result of his untreated condition. If one of his companions has a supply of omeprazole on hand, currently available at any Walgreens or CVS without a prescription, his condition could be treated in the same manner in which it would be treated at the ER—with a large dose of a proton-pump inhibiting medication. Another example is aspirin. Aspirin has a multitude of uses beyond pain relief. It is a blood thinner. For this reason it is often the first medication someone receives when they show up at the ER exhibiting signs and symptoms of stroke. Aspirin is a central component of the standard protocol in treating patients who are suspected of having a heart attack—the blood thinning properties of aspirin are useful when a clot has occluded a coronary artery. Aspirin also has unique anti-inflammatory properties—its use is normally avoided in children, but in the context of certain pediatric diseases, high-dose aspirin is a critical component of treatment. Every time I shop at Sam’s club for groceries, I purchase aspirin in bulk. Aspirin is inexpensive and potentially useful in so many ways. A WORD ABOUT PSYCHIATRIC MEDS Not long ago a friend mentioned to me that he had thrown away some expired anti-depressant medication. I suggested that he might instead sock away such medication for the possibility of a survival situation. His position was simple: in a true survival situation, he would have no tolerance for psychiatric illness. People suffering from depression and other psychiatric maladies would be a drain on resources and a liability for everyone around them. I considered my friend’s position on this matter for a time and concluded that he was mistaken, for several reasons. Number one, in extreme situations like TEOTWAWKI, people will inevitably experience depression, psychosis, PTSD, and so on. Many scientists consider the aforementioned to be adaptive evolutionary responses to trauma, disappointment, and loss (research “Behavioral Shutdown Hypothesis” and “Analytical Rumination Hypothesis” if interested in further information). These conditions affect the toughest, most seasoned soldiers in the US military, so it is folly to assume that a meticulously chosen survival companion will be immune to them. Depending on the nature of the psychiatric illness, at the very least it will affect the morale of the group; in the worst-case scenario it may indeed adversely affect the group’s chances of survival. Having the means to treat such a condition may ultimately determine the fate of an entire group—consider a well-prepared, well-stocked family, the head of which is then struck down by a paralyzing depression—imagine that this happens at the worst possible time, at the very height of danger. Second, a survival companion may (whether they have chosen to share this information or not) already be taking a medication for depression or other psychiatric illness. As aptly noted by author West Texas Prepper in the article Letter Re: When the Anti-Depressants Run Out, ceasing certain medications cold turkey leads to a crippling withdrawal syndrome. Having a small supply of the same medicine on hand would allow a dose taper, thereby sparing the individual of any withdrawal symptoms. I have witnessed patients, normally fully-functioning, contributing members of society, completely bedbound with nausea, vertigo, and paresthesias after running out of their daily anti-depressant medication. In an already tenuous survival scenario, it would be imperative to avoid such a situation. Third, many psychiatric medications have multiple indications. Some were developed and manufactured for the treatment of other diseases years before their usefulness in treating psychiatric illness was discovered. Case in point, my friend had thrown away four sample packages of the drug Depakote, known generically as valproate sodium, or valproic acid. It had been prescribed for a patient diagnosed with bipolar disorder who was experiencing a depressive phase of the illness. But, unbeknownst to my friend, valproic acid is used to treat a multitude of other conditions, most notably seizure disorders, but also migraine headaches, and chronic pain characterized by neuropathic symptoms. A WORD ABOUT EXPIRATION DATES The expiration dates assigned to drugs is arbitrary and very few drugs are actually toxic past the expiration date (tetracycline and doxycycline being the exception). Testing has demonstrated that drugs maintain their potency decades after their expiration dates. Save drugs you are certain you will never use, or never need again, save the ones you think were prescribed in error. It is impossible to predict what might be useful. Save them regardless of the expiration date, regardless of how few tablets might be left in the package or how little ointment left inside the tube. My grandmother suffered an extended illness, the cause of which was unknown for a time. Her physicians, not knowing what they were treating, hoping to eventually hit on the right drug, prescribed countless medicines, medicines from different classes and of varying strengths. When I helped my grandfather clean out his medicine cabinet last summer, I found a cardboard box filled with bottles of unused diuretics and anti-inflammatory meds used to treat autoimmune diseases (and also useful in treating malaria). With my grandfather’s permission I took the unused medication, removed the pharmacy stickers from the pill bottles, and replaced them with medical tape on which I wrote the names of the drugs and the milligrams per tablet. For those without medical training, I suggest also recording the indication and recommended dose. Although there are laws prohibiting the stockpiling of prescription medications, there are no reports of arrests for stockpiling medication in the manner described above. Those who fall under legal scrutiny do so because they stockpile controlled substances, with intent to supply their own habit or to profit financially from supplying the habits of others. That being said it is best to not discuss this type of preparation with others. Nor would I advertise on craigslist requesting unwanted prescription antibiotics. Limit those you involve to immediate family and trusted friends. A WORD ABOUT YOUR PRIMARY CARE DOCTOR Your primary care physician (PCP) may or may not be a good resource. On the one hand, he or she may be in total agreement with you, and willing to write scrips for an extra supply of your regular medications, and perhaps even some antibiotics. On the other hand, he or she may interpret your desire to prepare for a worst-case scenario as a manifestation of mental illness, one that is potentially dangerous and requires further investigation. If the physician knows you have weapons at home, the situation becomes further complicated. Therefore I do not recommend that people approach their PCP and ask for prescriptions for stockpiling purposes. If you decide to do so and are honest about the reason why, and your physician responds by asking searching questions about your psychiatric history, or says, “Now tell me, how long you have had this obsession with the apocalypse?” then abort the mission immediately and refocus all efforts on damage control. However, there are ‘legitimate’ reasons that physicians sometimes write prescriptions for large amounts of antibiotics, and there are numerous taken as needed (PRN) drugs that physicians write prescriptions for on a daily basis. Odansetron, the anti-nausea medication, is one that comes to mind. Benzonatate, the cough medication known as “tesselon pearls” is another. If you are willing to ask for such medications, citing the presence of nausea or a cough that keeps you awake at night, you can easily obtain such prescriptions. If you ask that refills be available if needed, your doctor is likely to oblige. Refill the drug on schedule as refills are sometimes limited to a twelve-month period. Be a hypochondriac for a year. Get more than one PCP. Pay out of pocket for duplicate prescriptions. Ask for samples. Have a lot of colds. Another strategy is to go to the physician with a request for prescription meds for international travel. Present a list of recommended drugs to have on hand when traveling in that area, perhaps one printed from a reputable web site (CDC). I don’t know of any physicians that require the patient to present their boarding pass before writing such prescriptions. APPENDIX A: RECOMMENDED PRESCRIPTIONS Antibiotics Augmentin-600mg-60 tablets per person (three 10-day courses) Ampicillin-500mg-63 tablets per person (three 7-day courses) Amoxicillin-500mg-100 tabs per person (50 days’ worth per person; ten 5-day courses, five 10-day courses, seven 7-day courses—it can be tailored to what is being treated) TMP-SMX (Bactrim DS)-84 tablets per person (three 14-day courses) Azithromycin-500mg-15 tabs per person (three 5-day courses) Cephalexin-500mg-120 tablets per person (three 10-day courses) Clindamycin-900mg-90 tablets per person (three 10-day courses) Metronidazole-500mg-90 tablets per person (three 10-day courses) Cefdinir-300mg-60 per person (three 10-day courses) Nitrofurantoin-200mg-42 tablets per person (three 7-day courses) Gentamicin ophthalmic solution-two bottles per person Erythromycin 0.5% opthalmic ointment-three tubes per person Ciprodex Otic-ciprofloxacin 0.3%, dexamethasone 0.1% solution-two bottles per person Aurodex Otic-antipyrine/benzocaine solution-one bottle per person (this is not an anti-microbial but it is useful for attenuating symptoms of ear infection) Mupirocin 2% antibiotic ointment-two tubes per person Anti-virals Acyclovir-400mg-63 tablets per person (three 7-day courses) Oseltamivir-75mg-30 tablets per person (three 5-day courses) Anti-fungals Fluconazole-100mg or 200mg tablets-60 per person Clotrimazole topical-several per person Nystatin suspension-100mL per person Nystatin cream-two tubes per person Ketoconazole-200mg-28 per person (one four week course) Anti-parasitic (for treating intestinal worms) Mebendazole 100mg-20 tablets per person Pyrantel pamoate (Pin X)-720.5mg-10 tablets per person Thiabendazole (Mintezol) 500mg tablets-10 per person Cardiovascular Health Anti-hypertensives HCTZ-25mg-365 per person Metoprolol-100mg-200 per person Lisinopril-20mg or 40mg-365 per person An alternative is one of the –sartans (i.e. Valsartan, 320mg) but they are more expensive Clonidine-0.2mg-100 tablets per person Spironolactone-50mg-100 tablets per person Furosemide-40mg-100 tablets per person Phenoxybenzamine-10mg-25 per person Lipid Reduction Agents Simvastatin-10mg-365 per person Fenofibrate-35mg-100 per person Gastrointestinal Health Omeprazole-20mg-365 per person Ranitidine-150mg-365 per person Misoprostol-200mcg-80 per person Odansetron-4mg-100 per person Promethazine suppositories-25mg-25 per person Metaclopramide-10mg-25 per person Diphenoxylate-atropine-300mL per person Anusol HC suppositories (2.5% hydrocortisone)-10 per person Lactulose-100mL per person Urinary Tract Health Allopurinol-100mg-100 per male Finasteride-5mg-365 tablets per male Bethanechol-25mg-20 per person Oxybutynin-5mg-20 per peron Colchicine-0.5mg-100 per person Gynecological Health Ethinyl estradiol/norethindrone combination-28 day packets-12 per female (useful for a multitude of menstrual problems) Contraceptive method of choice-one year’s worth per sexually active female Estradiol gel 0.06%-several tubes per older female Estratab-0.3mg-365 tablets per post-menopausal female Pain Medications Carbamazepine-200mg-50 tablets per person Gabapentin-400mg-100 tablets per person Diclofenac-50mg-200 tablets per person Cyclobenzaprine-5mg-50 tablets per person Keterolac-30mg-50 per person Tramadol-25mg-50 per person Immediate Release Morphine tabs-5mg-25 per person Extended Release Morphine tabs-15mg-50 per person Sumatatriptan-100mg-25 per person Allergies/Asthma/Respiratory Hydroxyzine-25mg-50 per person Prednisone-10mg-200 per person Loratidine-10mg-100 tablets per person Albuterol metered dose inhaler-3 per person Steroid metered dose inhaler (Advair, etc)-3 per person Benzonatate-100mg-100 per person Hycodan syrup (each 5mL contains hydrocodone 5mg-homatotrropine 1.5mg)-150ml per person Epinephrine injection (EpiPen, EpiPenJr)-two injection pack-three per person Guafenisin-phenylephrine (Entex)-100mL per person Montelukast-10mg-100 per person Metaproterenol-20mg-30 per person Skin Conditions Mometasone furoate 0.1%-15g or 45g tube-two per person Silver sulfdiazene-45g tube-five per person Cleocin 1%-two tubes per person Permethrin (Lindane)-five bottles per person Psychiatric/CNS Medications Lorazepam-1mg-50 per person Lorazepam suppositories-0.5mg-10 per person Alprazolam-0.5mg-30 per person Fluoxetine-20mg-60 per person Wellbutrin-150mg-30 per person Haldol-5mg-10 per person Amitryptiline-50mg-30 per person Bromocriptine-1.25mg-10 tabs per person Meclizine-25mg-50 per person Scopolamine patch-ten per person Endocrine Health Metformin-500mg-500 per person For those with a strong family history of diabetes, Hispanic background, or prediabetes, I recommend stockpiling a one year’s supply of 1000mg strength metformin. Levothyroxine-150mcg-100 per person Insulin-300units-10 bottles per family (must be kept refrigerated) APPENDIX B: Recommended OTC Drugs Acetaminophen-500mg-1000 tablets per person Acetaminophen liquid-five bottles per person Ibuprofen-500mg-1000 tablets per person Ibuprofen liquid-five bottles per person Naproxen Sodium-500mg-1000 tablets per person Aspirin-325mg-1000 tablets per person 325mg tablets can be cut into quarters, the quarters then approximate the normal 81mg dose recommended for most people with mild coronary artery disease or hypertension Alternative you can purchase the ‘baby aspirin’ version, often in chewable form, which is 81mg per tablet, though it is not common to find this in bulk and it is more expensive. Water-based lubricant jelly (KY)-5 tubes per person Petroleum jelly 100%, 13oz containers (i.e. Vaseline)-5 per person Immodium (loperamide)-100 caplets per person Docusate sodium-100mg-500 caplets per person Simply Right Stool Softener with 400 gel caps per bottle is an inexpensive example of this. Glycerin suppositories 2gm glycerin per suppository-100 per person Consider purchasing the pediatric version, containing 1gm glycerin per suppository Diphendydramine HCl-25mg-1000 tabs per person Fleet enemas (containing monobasic and dibasic sodium phosphate)-eight per person Alternatively you can purchase empty enema bottles and make your own saline solution, 1.5 teaspoons table salt to 1000mL of water; this can be preferable to the phosphate solution in store-bought enemas as phosphate can cause cramping. You may also want to research how to make a soap suds enema, the type often used in hospitals, and store the ingredients—liquid castile soap is the standard. Hemorrhoidal cream (Preparation H or Equate Brand Hemorrhoidal cream-contains 0.25% phenylephrine to constrict vessels, glycerin 14% as a protectant, pramoxine 1% as a local anesthetic)-2oz tube-5 per person Phenylephrine is the active ingredient in some decongestant nasal sprays like Neo-Synephrine Extra Strength Nasal Spray or WalGreens Ephrine Nose Drops; moreover these sprays contain a more concentrated dose of phenylephrine (usually 1%)—I have found that a cotton ball soaked with aforementioned spray works far better than Preparation H (or its equivalent) cream for getting the patient quick, effective relief—as an alternative to stocking up on Preparation H, I recommend stocking up on extra nasal spray for the purpose of treating hemorrhoids If you want a local anesthetic component for treating hemorrhoids, any local anesthetic ointment can be used to supplant a vasoconstrictor—I recommend using lidocaine, 2% or 5%, which requires a prescription. Medicated hemorrhoidal pads, active ingredient witch’s hazel 50% (i.e. Tucks)-several boxes per person An alternative to purchasing $6 boxes of Tucks pads containing 20 pads each, is to purchase a $3 16-oz bottle of 100% witch hazel (at Wal-Mart or most drug stores) and make your own pads using cotton balls or the like; witch hazel has many other uses too. Zinc oxide ointment 40% (i.e. Desitin)-five large containers per person Medicinal foot powder-1% menthol-(Gold Bond, Walgreen’s brand)-10oz bottle-three per person Anti-fungal foot powder 2% miconazole nitrate (Tinactin, Lotrimin AF, Walgreen brand ‘Athlete’s Foot Powder)-3-4 oz containers-five per person Pepto Bismol (bismuth subsalicylate)-16oz-5 per person Triple antibiotic ointment(should contain bacitracin, neomycin, and polymixin b)-ten tubes per person Tea tree oil-2 fluid ounces-ten bottles per person. This is an expensive oil; however it has many uses—a recent study indicated that tea tree oil is more effective than prescription medication for the treatment of lice, which is the main reason I have it listed here, as the rate of parasitic infections will be increased at TEOTWAWKI Pseudoephedrine-25mg-100 caplets per person Dextromethorphan syrup, 30mg dextromethorphan per dose (Robitussin, Delsym))-5 bottles per person Isopropyl (rubbing) alcohol 16oz-ten or more bottles per person Warning-in a TEOTWAWKI situation, there will be desperate alcoholics in withdrawal, willing to drink anything with a label that indicates any percentage of alcohol within, no matter how small—isopropyl alcohol is usually not fatal if ingested and its effects resemble those of ethanol (the form of alcohol for drinking); the treatment is supportive care and to not do anything or give anything that interrupts metabolism, as the metabolite (acetone) is less poisonous than isopropyl. Drinking of isopropyl alcohol will not have the same effects as the ingestion of methanol (found in windshield wiper fluid-causes blindness, confusion, respiratory failure and death), or ethylene glycol (found in antifreeze-causes muscle spasms, heart dysrhythmias, congestive heart failure, kidney failure, death); nevertheless, for any product containing any percentage of alcohol on the label, I recommend adding a bright red sticker with the words “NOT FOR DRINKING-POISONOUS!” with skull and crossbones drawn—and if the TEOTWAWKI happens, keep these items stored in a place that is not well-frequented. Hydrogen peroxide-10-20 gallons per person There are many uses of hydrogen peroxide. See this site as an example of where inexpensive hydrogen peroxide can be purchased (Less than 10 dollars per gallon) Ben Gay Muscle Pain/Ultra Strength (30% methyl salicylate, 10% menthol, 4% camphor)-three tubes per person For those with allergy to aspirin an alternative is Tiger Balm Ultra, which contains 11% camphor and 11% menthol Mentholated topical cream, active ingredients camphor, eucalyptol, menthol (i.e. Vick’s VapoRub)-three jars per person Electrolyte replacement packets (Pedialyte makes these; a 4-pack costs about $5, Walgreens carries the equivalent; an 8-pack costs $4)-20 per adult, 40 per child Multivitamins-1000 per person (make sure and include some chewable forms for children or those who cannot swallow pills) Vitamin D-(1000-5000IU)-500 per person (also comes in liquid form) Folic Acid (400mcg-1mg)-500 per ovulating female Vitamin B12-(comes is dosages as low as 100mcg, as high as 5000mcg-recommend a variety)-500 per person Hydrocortisone cream 1% hydrocortisone, comes in 2oz tubes-10 per person Alternatively you can ask your doctor to prescribe a stronger version of the same medication, 2.5% strength hydrocortisone cream; this may be preferable if you or your loved ones suffer often from dermatitis, eczema, or other skin inflammation. Calamine lotion, contains calamine and zinc oxide, can be purchased in 6 oz bottles for about $1.50 at Wal-Mart. - Three bottles per person Sterile saline solution 0.9% concentration-1L bottles-10 per person You can make your own 0.9% saline solution but it will not be sterile; this becomes important when using it for the irrigation of wounds, etc For making your own solution, 9grams of sodium is dissolved in 991 mL of water Research and print the many uses of saline solution. Oral liquid/gel anesthetic (20% benzocaine)-3 per person Coal tar shampoo (T Gel 2%, Denorex 2%, Psoriatrix 5%)-one per person If you or your loved ones suffer from psoriasis you may want to purchase other OTC coal tar products (bar soap, ointment, etc) For those with skin issues, three bottles per person recommended. Selenium sulfide shampoo-three per person Phenazopyridine (Urostat)- Miralax powder-17.9oz-three per person Fiber powder (Metamucil)-16oz-three per person Magnesium hydroxide suspension, 1200-2400mg per 10-30mL (Milk of Magnesia, etc)-16oz-five per person Antacid tablets, calcium carbonate 500mg per dose (Tums)-1000 per person Mineral oil (liquid petroleum)-16oz-three per person Earwax removal solution (carbamide peroxide)-three per person Nasal spray (Oxymetolazone HCl, phenylephrine)-five per person, more if you plan to use these to treat hemorrhoids too Doxylamine succinate 6.25-50mg per dose-50 doses per person This is the sedating component of NyQuil brand drugs It is a potent anticholinergic and can be used to treat a multitude of conditions (morning sickness, allergies, insomnia) Caffeine tablets-50mg-200 per person Trolamine salicylate cream 10% (Aspercreme)-5oz-five per person Tiger Balm Liniment (Menthol 16%, Oil of wintergreen 28%)-0.63oz-three per person Capsaicin products 0.05-0.1% strength-this is the natural ingredient found in hot peppers; it has been found to inhibit the actions of substance P in pain transmission; it can be used to treat the pain associated with diabetic neuropathy, tension and cluster headaches, osteoarthritis, trigeminal neuralgia, shingles, and more) Creams (Capsa Cream 8, Zostrix, Walgreens brand) Nasal sprays (Sinol, Sinus Plumber) Qutenza, a prescription pain patch that contains 8% capsaicin Povidone-iodine topical antiseptic-16oz bottle-five per person Phenol lozenges 14.5mg per lozenge/spray 1.4% in solution (Cepestat, Chloraseptic)-three per person Cinnamon supplement, 500mg-1000 capsules per person See the scientific evidence in support of cinnamon as having multiple healing properties Because I was a gestational diabetic, and because of my Latina heritage (my father emigrated from South America), and because my father, and multiple relatives on my mother’s side suffer from Type II Diabetes, I know that is where I am headed, despite a normal BMI and active life style. Evidence suggests that cinnamon aids in glucose metabolism; studies have shown a decrease in A1C in diabetics who take cinnamon daily over a period of months. I take cinnamon every day, in hopes of preventing or postponing Type II Diabetes. Fish oil (Omega-3)-1000 caps per person A cardiologist I trust recommends daily fish oil even for the young and healthy. Here is an article outlining the evidence. Baking soda-several five pound bags per individual There are many medicinal uses for baking soda, and whole books written on this subject Baking soda is also useful for cooking, cleaning, hygiene, as a fire extinguisher, biopesticide, cattle feed supplement, numerous others. Nutritional supplementation-Boost, Pediasure, etc To be used after electrolyte replacement therapy but before someone is ready to take regular foods again. A nutritional shake can make a huge difference in whether someone gets much-needed calories during a medically vulnerable period. Appendix C: Drugs for Bartering The two categories of medication likely to be most useful for bartering are antibiotics and pain medication. Antibiotics Amoxicillin-500mg-easy to get and inexpensive Bactrim DS-excellent for skin and wound infections Opthalmic antibiotics Pain Medications Aspirin Acetaminophen Ibuprofen Any narcotic/opioid (i.e. Vicodin, Percocet)—would be highly desirable in a situation involving serious injury Vitamins Insulin-will be a commonly needed, highly valued item since there are so many diabetics in our population. Inhalers for those with asthma/COPD Contraceptive devices—condoms, foam, other types of birth control Caffeine pills-ability to stay wired at critical times will be priceless at TEOTWAWKI Anti-diarrheals (loperamide, Pepto Bismol) Appendix D: Pharmacology Bookshelf The Pill Book (Prescription medications) The Pill Book Guide to Over-the-counter Medications Any basic pharmacology textbook Sanford Guide to Antimicrobial Therapy Current Medical Diagnosis and Treatment 2013 (Lange) RE: The Constipated Hordes at TEOTWAWKI: A Pharmacologic Strategy - Grumpy Grandpa - 8 August 2013 Wow! But thanks Jonas. they say that it never rains but it pours and today has been a medical tropical storm! First, such a huge amount of useful goodies from RS now this! Ma poor wee brain canna take it...