Surviving the Medical Meltdown (24 page)

There is nothing good to say about the potential threats facing us medically in an increasingly unstable modern world. Ironically, the government is regulating us to the point that we are losing our scientific and medical edge. But the Obama administration is failing in its one constitutionally mandated function of protecting the American people against invasion. And the medical result of that failure is yet to be fully manifest.

EBOLA

Ebola (named after the Ebola River in Zaire) is a very fatal disease of African origin. It is a long fibrous-appearing virus that is spread only by direct contact. Known as “hemorrhagic fever” because those affected bleed from every orifice, the disease is manifest within ten days of exposure, often much earlier. Depending on population and access to care, disease fatality ranges from 20 to 90 percent, and there is no treatment except supportive care. However, this disease is easily controllable by quarantine since it is not airborne. Before the paving of the Kinshasa highway, which increased access to remote villages, people from endemic areas of deepest sub-Saharan Africa
might have been wiped out, but it would not have spread. Now an infected person can drive or be driven to unaffected areas more easily and spread the disease. The disease manifests generally within 72 hours from exposure. If a small outbreak in America does occur, simply stay away from people outside your immediate family until the outbreak is controlled. The degree of isolation and/or need for isolation is related to the degree of outbreak. Duct taping windows, Hazmat suits, gas masks, and the like are unnecessary because this virus is not airborne.

ROTATION OF SUPPLIES

Stockpiling supplies means keeping things fresh and rotating items. The only things you really need to worry about in this regard are the medications. Elastic bandages and sticky bandages, such as Band-Aids, will degrade over the years, but if kept at room temperature in a closet or basement, these items will last decades. As noted previously, shelf life of most medications is also over five years.

As you add medications to your stockpile, put a label on the outside of your stored medicine bin that lists the contents by name and the date of expiration. Use small return address labels, one per medicine; and as you replace drugs, simply make a new sticker and put it over the old. Don’t be tempted to write with magic marker directly on the bin. I did that, and as things changed, the bin got too scratched out and written over. (In fact, in my experience, writing directly on storage bins doesn’t even work with simple things like Christmas decorations.)

Some of the medications you store you hope you never use. But then there are also stores of medications you do use. As noted earlier, due to the uncertainty of the supply in the future, it is prudent to keep on hand three to six months’ worth of the meds you use regularly. Store these medications where they are easily accessible – either in a separate bin or on top of all the ones you don’t plan on using often. Every time you refill your prescription, add the new meds
to the box, and use the oldest in the box for that month. And of course, medications that need to stay cool should be stored in the refrigerator. If in doubt, ask your pharmacist.

EpiPens, because they may be lifesaving, need to be scattered around your life – purse, desk drawer at work, kitchen cabinet, and so on. If you are at high risk of anaphylactic airway constriction, it doesn’t help to have your EpiPen buried deep in a storage box. Because they really do expire shortly after the given expiration date, make sure to use them or replace them by the date indicated. Any in a storage box must be kept handy and rotated on time!

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REAL EMERGENCIES THAT CAN’T WAIT

I
t is critical to determine when you can temporize a medical problem with a “wait and see” attitude, possibly avoiding an unnecessary trip to the doctor, or when you have to go
now
. In the following chapters we will explore home care for a variety of things in depth. But some things just have to receive some level of professional help. These are some of the things you cannot afford to self-treat beyond initial emergency care:

• Airway obstruction (significant difficulty breathing)

• Compromised circulation

• Progressive numbness or weakness (possible stroke)

• Open fractures (bone through skin)

• Dislocation (that can’t be reduced)

• Penetrating wound to a joint

• Chest pain (possible heart attack)

• Loss of consciousness or changed mental status

• Poisoning

• Venomous human and animal bites

• Fever with other symptoms

• Spontaneous bleeding

• Inability to urinate or defecate (have bowel movement)

• Abdominal pain

AIRWAY OBSTRUCTION

An airway obstruction should always be taken seriously. There are two types of “obstruction”: (1) inhalation of an object and (2) intrinsic airway collapse or constriction. Sometimes the source is obvious: your kid swallows a quarter and it lodges in the trachea, and he can barely breathe. Sometimes it is not: your kid complains of shortness of breath but seems to be moving his chest and moving air. An airway problem is so critical that you should err on the side of caution.

When we say “airway obstruction,” we include in our thinking asthma and other forms of constriction that are not caused by a foreign body such as a quarter. Asthma “obstructs” the airway by squeezing closed the tubes in the lungs that allow air to pass. If asthma runs in the family and your child complains she can’t breathe and her airways are clear, an asthma inhaler may provide temporary relief. If you don’t have an inhaler, you can try taking a hot shower. The steam relaxes the airways. Fast-acting allergy medicine like Benadryl or Claritin might help, as many asthma attacks are triggered by allergies. Caffeine is another trick to opening constricted airways. A couple of cups of coffee or cans of soda might be enough to find relief. But if symptoms persist or continue to worsen, you need to seek medical attention immediately.

If asthma is not the culprit and you are not sure what is happening, look around the collarbone near the neck. Any skin sinking in toward the lung with attempts at breathing is called “retraction” and is a sign of respiratory distress. Put your ear to the chest. Do
you hear air moving? Are there wheezes? Is there a hornlike sound as air squeaks around the quarter or Lego or other inhaled object?

If you know there is a physical obstruction to the airway, then attempt to clear it out. The classic obstruction is food. A person is eating in the restaurant and starts to choke. He cannot talk and makes the sign for choking (at least in theory). In spite of what you may have heard, DO NOT HIT HIM ON THE BACK. Banging on the back only serves to lodge the food or other obstruction even more deeply. There are total obstructions where the patient cannot speak and cannot breathe, and partial obstructions where he cannot talk but can still cough or breathe around the obstruction. If possible, in a partial airway obstruction, invert the person and let this clear the obstruction. When the head is down, there is a natural tendency for the airway to relax and allow the food or toy to work itself out. (This is something a person can try if alone and choking.) This is a great move for a choking child who can be held upside down.

NONEMERGENCIES THAT NEED ATTENTION:

• Sprains

• Migraines

• Stomachaches

• Minor fever

• Earaches

• Minor wounds (not requiring stitches)

• Sore throats

• Tick bites

• Minor eye injury

• Insomnia

• Hypertension

• Diarrhea

The classic maneuver is the abdominal squeeze – two quick thrusts upward at the base of the sternum that forces the air to propel the obstruction out. That can be done with the patient upright or on the floor if unconscious. Taking a first aid/CPR course is a good idea to really learn this technique (and the technique for CPR).

In sum, when in doubt about a person who is having trouble breathing, seek help early. This is not
a problem where you “wait and see.” Better to arrive at an ER and not need to be seen, than to wait too long and turn a small problem into a catastrophe. As a personal example, years ago, I took my two-year-old to the ER in the middle of the night because of an asthmalike attack. He was suddenly audibly wheezing and had retractions of the chest as described earlier. Until this time no one in the family needed any asthma treatment, so I had no medications and could do nothing at home. I put him in the car and raced off to the ER. But after the ten minutes it took to get to the ER, probably thanks to the cool air and a little bit of excitement-induced adrenaline, he was almost normal. We waited and waited to be seen by the ER doctor, and during this time my young son toddled out into the hall and said loudly, “If no one is coming, I’m going home!” As a doctor who is usually on the other end of such complaints, I had to laugh. And now we have experience (and medicine) for just such an emergency.

COMPROMISED CIRCULATION

There are many older people who have a long history of diminished circulation characterized by cool feet, hairless toes, and chronic skin darkening. They may occasionally have a bluish toe, which should be under the care of a vascular surgeon. Usually this situation is already known and is not an emergency. Similarly, one may have a cold, pale, or bluish finger or toe or foot from cold exposure. This can usually be treated by warming the extremity and is usually not a critical emergency.

An emergency is a sudden pale, cold, pulseless extremity without clear cause. This is often due to trauma. Any injury with swelling that seems to be cutting off circulation is critical. It is important in this situation to restore the general alignment of the extremity and splint the limb. Occasionally, a clot will form in an artery and cause a limb to lose circulation. In these settings, while you are getting to definitive medical care, icing the extremity will increase the time the limb can survive without blood circulation. A limb can last one and
a half hours without circulation. After that, ice extends the survival time. If you need several hours to reach higher-level care, icing will improve the chance of limb salvage.

Another true emergency is a suddenly swollen leg – and I mean obviously swollen and usually painful,
without known cause
. A sprained ankle or significant bang to the shin can give you swelling but is not a flat-out emergency. Swelling of a leg without clear cause may be due to DVT – deep venous thrombosis – a blood clot in the deep veins of the legs. This is serious both for the leg and for the fact that the clot may break apart and move into the lung. A clot in the lung can cause severe oxygen deprivation or heart failure and thereby cause death. Leg clots are more apt to happen to people recently immobilized in a cast or other constricting device, or to people who are bedridden, who smoke, or who have a history of blood clots in their legs or lungs. There is no home remedy for this problem, and you need to seek help. Taking a baby aspirin is a good idea while arranging transport. Keep the leg elevated, and don’t walk around.

RISK FACTORS FOR BLOOD CLOTS

• Cancer or other chronic illness

• Cast, brace, or other immobilization

• Long-distance plane travel

• History of clotting problem

• Prolonged bed rest

• Smoking

PROGRESSIVE NUMBNESS OR WEAKNESS (POSSIBLE STROKE)

A stroke or cerebrovascular accident (CVA) is due to altered blood to the brain. This can present with slurred speech, sudden altered mental status, or weakness or numbness of the extremities or face, usually on one side of the body. Use the F.A.S.T. (Face, Arms, Speech, Time)
test to see if someone is having a stroke. Ask her to smile, to raise her hands above her head, to speak, and to stick out her tongue. Look for drooping eye or mouth, inability to raise one hand, inability to speak, or deviation of the tongue to one side. Symptoms of a ministroke include minor motor dysfunction or weakness on one side of the body, diminished vision and/or light sensitivity in one eye, and a severe headache. Sometimes you are having a transient ischemic attack, or TIA, and these resolve over twenty-four hours. But you cannot know this ahead of time. If you are experiencing symptoms of a stroke or someone else notices your slurred speech or lopsided face, there are three things you
must not do
:

1.
Do not delay in getting help at a hospital.

2.
Do not take an aspirin (some strokes may be from bleeding, and this will worsen it).

3.
Do not drive yourself.

Progressive neurologic deficit without evidence of stroke – in other words, loss of nerve function, such as weakness, confusion, or decreased sensation that occurs over hours – is rare, but it can happen in spinal cord disease or herniated disks. You should seek emergent care if the person experiences progressive weakness or numbness over hours or days. For example, if a person has back pain radiating into a leg, then has weakness of the foot, and later that day weakness of the leg, that is “progressive deficit,” and the patient needs transport to a hospital. Any numbness around the rectum or vagina or loss of control of bowel or bladder (meaning leaking stool and urine) that comes on over hours or days also requires emergent evaluation.