VII.
As a caregiver in a long-term survival scenario, you cannot expect that everyone under your care will start off in perfect health. It is likely that one or more members of your family or group will have a long-standing medical issue that cannot be ignored. Thyroid malfunction, diabetes, and heart disease are just some of these issues. They require medications that will not be manufactured in times of trouble. You must, therefore, think “outside the box” to formulate a medical strategy for these patients that does not include modern technology.
It goes without saying that medical conditions that are poorly controlled now could be completely out of control in a survival setting. The most important way to preserve your family’s health will be to have any chronic conditions appropriately treated and monitored before a catastrophe.
In this section we discuss some chronic problems with which the medic may have to deal. If you ever find yourself on your own, having a plan in place will increase your effectiveness as caregiver and improve the health of the community.
THYROID DISEASE
The thyroid gland is positioned just in front of and below the Adam’s apple (laryngeal prominence) and produces hormones that help regulate your metabolism. The organ produces substances that regulate growth, energy, and the body’s use of other hormones and vitamins. Thyroid conditions usually involve the production of either too little or too much of these hormones. These malfunctions are more commonly seen in women.
A thyroid problem that might be common in an austere setting is the development of a goiter, a lump on the thyroid. This is the result of a deficiency of iodine in the body and is one of the reasons why iodine is added to common table salt, making it “iodized.” Potassium iodide tablets may be a treatment option if no other source of iodine is available. It should be noted that iodine-containing drugs should not be administered to those with allergies to seafood.
Hyperthyroidism
Hyperthyroidism is the excessive production of thyroid hormone. Determination of thyroid malfunction depends on certain blood tests and sometimes a scan of the gland. These modalities will be gone in a collapse, so it’s important to learn what a person with elevated thyroid levels looks like. The following are some common signs and symptoms of this condition in adults:
Insomnia
Hand tremors
Nervousness
Feeling excessively hot in normal or cold temperatures
Eyes appearing to be bulging out or “staring”
Frequent bowel movements
Losing weight despite normal or increased appetite
Excessive sweating
Weight loss
Menstrual irregularities
Growth and puberty issues (children)
Muscle weakness, chest pain, and shortness of breath (elderly)
Poorly controlled hyperthyroidism can lead to a condition known as “thyroid storm,” in which large levels of hormone have major effects on the heart and brain. All the above symptoms may combine with elevated heart rate and blood pressure to endanger the patient’s life.
Treatment of hyperthyroidism involves medications such as propylthiouracil and methimazole, which block thyroid function. These medications should be stockpiled if you’re aware of a member of your group with hyperthyroidism, as the drugs will be hard to find if modern medical care is no longer available. Iodide is also useful in blocking the excessive production of thyroid hormone, and can be found in kelp in good quantity. Unfortunately, the use of iodides, while a known treatment, may actually worsen the condition in some cases.
Dietary restriction of nicotine, caffeine, alcohol and other substances that alter metabolism will be useful as well. Vitamins C and B12 are thought to have a beneficial effect on those with this condition. L-carnitine is also beneficial in that it may lower thyroid hormone levels without damaging the gland.
Foods that are thought to depress production of thyroid hormone include cabbage, cauliflower, broccoli, Brussels sprout, and spinach. In addition, foods high in antioxidants are thought to reduce free radicals that might be involved in hyperthyroidism. These include blueberries, cherries, tomatoes, squash, and bell peppers, among many others.
Hypothyroidism
More commonly seen than hyperthyroidism, hypothyroidism is the failure to produce enough thyroid hormone. Various causes of low thyroid levels exist, such as certain drugs or exposure to radiation. Also, the immune system sometimes misfires and targets the thyroid. The following are the most commonly seen signs and symptoms of hypothyroidism in adults:
Fatigue
Intolerance to cold
Constipation
Poor appetite
Weight gain
Dry skin
Hair loss
Hoarseness
Depression
Menstrual irregularity
Poor growth (in children)
Long-standing untreated hypothyroidism may result in thickened skin, hair loss (alopecia), vocal changes, and swelling. Hypothyroidism in a pregnant woman may cause birth defects in the baby.
The treatment of this condition is based on the oral replacement of the missing hormone, thyroxine. Such replacements come in a variety of dosages, and it is important to determine the appropriate one for your patient while modern medical care is still available. The lowest dose that will maintain normal thyroid levels is indicated to avoid hyperthyroidism.
Besides standard thyroid medications, such as SynthroidTM and LevothroidTM, there are a number of other remedies that may improve hypothyroidism. A number of thyroid extracts are available that consist of desiccated and powdered pig or cow thyroid gland. The effects of these extracts may be variable. Having said this, in the absence of modern medications, it is better than nothing.
From a dietary standpoint, you should avoid foods that depress thyroid functions, including the following:
• Cauliflower
• Broccoli
• Brussels sprout
• Spinach
• Cabbage
A number of natural supplements, such as Thyromine, are commercially available. They are combinations of various herbs that are touted as beneficial for both low and high thyroid conditions. Your experience may vary.
DIABETES
Diabetes is a common, yet devastating, disease characterized by high sugar (glucose) levels in the blood. Uncontrolled diabetes is known to cause damage to various organs, such as the kidneys, eyes, and heart. The incidence of the disease has been increasing over time in developed countries, perhaps because of issues relating to obesity.
Diabetes is especially problematic for the survival medic in that the medications used to treat the worst cases are unlikely to be produced in a grid-down scenario. Diabetic medications, such as insulin, lose potency over time. Therefore, an alternative strategy to keep diabetics from losing complete control of their blood sugar will have to be formulated.
There are two types of diabetes. Type 1 results from the failure of the pancreas to produce insulin. Insulin is a hormone that controls the level of sugar in your system. The destruction of the cells in the pancreas that produce insulin is thought to be caused by an autoimmune response. This means that the body’s own immune system attacks parts of itself. Type 1 diabetes is often first diagnosed in childhood.
Type 2 diabetes is more commonly the result of the resistance of the cells in your body to the insulin produced by the pancreas. Obesity is thought to be a major factor. In type 2 diabetes, certain cells do not respond appropriately to insulin. Glucose fails to enter these cells and, therefore, it accumulates in the blood. High blood sugar is known as “hyperglycemia.”
Diabetes (mild or severe) may also develop in some pregnancies, even in nondiabetic women. Some believe that those who get diabetes during their pregnancies may be prone to diabetic issues later in life.
There are three classic symptoms of diabetes:
Extreme thirst
Excessive hunger
Frequent urination
Uncontrolled diabetes causes eye and kidney problems, leading to blindness and renal failure. It worsens coronary artery disease, increasing the chances for heart attacks and other cardiac issues. Weight loss may occur despite the consumption of more food; the cells cannot access the glucose in the blood for energy to produce mass.
In a person with diabetes, cuts and scrapes, especially in the extremities, are slow to heal. Over time, nerve damage occurs, which causes numbness, pins-and-needles sensations, and much worse. Many severely uncontrolled diabetics may require amputation.
Type 2 diabetes is most often seen in older, heavier, and less active individuals. Weight control and close attention to controlling the amounts of carbohydrates (which the body turns into sugars) in the diet is important. In some cases, decreasing excess weight and eating frequent small meals may reverse type 2 diabetes in its entirety. Regular exercise will also decrease blood sugar levels and improve glucose control. The most popular medication used for treatment is metformin, which works in various ways, including increasing the cells’ sensitivity to insulin. In tablet form, it is a good candidate for medical storage.
Type 1 diabetes is more problematic, as many with this medical problem have large swings in their blood glucose levels. Regular monitoring of these levels and appropriate treatment with the right amount of insulin is necessary to remain healthy.
There are two common diabetic emergencies. These are related either to very low or very high glucose levels. If a diabetic, especially type 1, fails to eat regularly or takes too much insulin, they may develop hypoglycemia (low blood sugar). Hypoglycemia can occur very rapidly. Common symptoms are sweating, loss of coordination, confusion, and loss of consciousness.
In this case, a drink containing sugar will rapidly resolve the condition. Never give liquids to someone who is unconscious, however; the fluids could go down the respiratory passages, and suffocation could occur. If the patient is not mentally alert, place some sugar granules under his or her tongue. This will absorb rapidly without causing the tendency to choke.
On the other hand, very high glucose levels lead to diabetic ketoacidosis. This occurs as a result of missed insulin doses, chronically underdosed insulin, or both. Patients with this condition have a characteristic “fruity” odor to their breath. In addition to the usual symptoms, patients will experience nausea, vomiting, and abdominal pain. This is a major emergency that could lead to coma and even death. Small amounts of clear liquids are acceptable to give to someone with this condition, but without insulin and IV therapy, the prognosis is grave.
Insulin, like most liquid medications, will lose potency relatively soon after its expiration date. Because of the complexity of the manufacturing process, it is unlikely to be available in a collapse situation. What, then, can be done to maximize glucose control?
The goal should be to prevent complications, such as ketoacidosis. Diabetics will be unlikely to have perfect control off-grid, but it may be possible to keep their sugars below emergency levels. A period of less-than-optimal control may be survivable and might give some time for things to restabilize.
One therapeutic option is to stockpile the highest dose of metformin (oral diabetes medicine) in the hope that it may have some benefit in the insulin-deprived. Unfortunately, it will not make the pancreas produce insulin. A recent study suggests that metformin may be used along with insulin. In some diabetics, the addition of this drug resulted in lower amounts of insulin required for control. More study is warranted.
Another option is to regulate diet severely and subsist on a diet almost entirely comprised of protein and fats. The key is to restrict caloric intake significantly. This will be harmful in the long run, but frequent, small, high-protein meals may give the type 1 patient some time in a survival setting.
Type 2 diabetics (especially obese ones) may actually improve from the increased physical exertion and dietary restrictions that will be part and parcel of a long-term survival situation. An emphasis on limiting food intake to frequent small meals will be helpful here.
HIGH BLOOD PRESSURE
One of the most common chronic medical conditions is high blood pressure (hypertension). “Blood pressure” is the measure of the blood flow pushing against the walls of the arteries in your body. If this pressure is elevated over time, it can cause long-term damage. Many millions of adults in the United States have this condition, which is often asymptomatic (not noticeable). Because of this, it has been referred to as a “silent killer.” Blood pressure tends to rise with increasing age and weight.
The medic should have, as part of his equipment, a stethoscope for listening and a sphygmomanometer (blood pressure cuff) to monitor blood pressure.
Blood pressure tends to vary at different times of the day and under different circumstances. Document at least three elevated pressures in a row before making the diagnosis. Readings above 160/100 are associated with higher frequency of complications. Persistent hypertension can lead to stroke, heart attack, heart failure, and chronic kidney failure. Commonly seen symptoms may include the following:
Headaches
Blurred vision
Nausea and vomiting
Sometimes elevated pressures can damage a blood vessel in the brain. Strokes (cerebrovascular accidents, or CVAs) are bleeding episodes or clots in the brain that can occur as a high-pressure event and cause paralysis. The blood supply is interrupted, causing oxygen deficit in brain tissue.
A stroke is usually heralded by a sudden severe headache. Whatever functions are associated with the part of the brain affected will be lost or impaired. This might include the inability to speak, blindness, or loss of normal comprehension. Symptoms such as paralysis or weakness usually occur on only one side.
Although it may not be difficult to diagnose a major CVA in an austere setting, few options will exist for treating it. Blood thinners might help a stroke caused by a blockage due to a clot but worsen a stroke caused by a bleeding vessel. It could be difficult to tell which is which without advanced testing.
Keep the CVA victims on bed rest; sometimes, they may recover partial function after a period of time. If they do, most improvement will happen in the first few days.
Pregnancy-induced hypertension (re-eclampsia) is a serious condition that occurs late in a pregnancy. It may lead to seizures (“eclampsia”) and blood clotting abnormalities. The first step to controlling elevated blood pressures is to return to a normal weight for your height and age. Most people who are overweight find that their blood pressure decreases (often back to normal) when they lose weight through dietary changes and exercise.
Dietary restriction of sodium is paramount in importance when it comes to decreasing pressures. Sodium is in just about everything you eat, so stop adding salt to food. Alcohol, nicotine, and perhaps, caffeine are also known to raise blood pressures, so avoiding these substances is an additional strategy. In a long-term survival situation, forced abstention may actually have a beneficial effect on overweight patients with hypertension.
The US National Institutes of Health (NIH) recommends the DASH (Dietary Approaches to Stop Hypertension) diet. A major feature of the plan is limiting intake of sodium and encouraging the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while decreasing red meats, sweets, and sugar.
A number of medications with impressive names are available for the control of high blood pressure. Those with hypertension should be placed on one or more of these medications until their readings are back to normal. All of these commercially prepared products will be scarce in times of trouble.
Natural supplements have been used to help lower blood pressure, too. Any herb that has a sedative effect may also lower pressures. Valerian, passionflower, and lemon balm are some examples. Coenzyme Q10 has shown some promise in this field. Antioxidants, such as vitamin C and fish oil, may prevent free radicals from damaging artery walls.
Don’t forget natural relaxation techniques. Meditation, yoga, and mild massage therapy should relax your patient and have a beneficial effect on their blood pressure.
Taking Blood Pressure
To use a sphygmomanometer, place the cuff around the upper arm and fill it up with air, using the attached bulb. Place your stethoscope over an area with a pulse (usually the crook of the arm) and listen while looking at the gauge on the cuff. Some new compact blood pressure units are meant to use on the wrist. With these, it is important to keep your wrist at the level of your heart when taking a reading.
When you take blood pressure, you are listening for the pulse to register on your stethoscope. Blood pressure is measured as systolic (blood pressure when the heart beats) and diastolic (blood pressure when the heart is at rest). Therefore, blood pressure is written down as systolic over diastolic; for example: (systolic pressure) 120 over 80 (diastolic pressure), written as 120/80.
Wherever the gauge is when you first hear the pulse is the systolic pressure. As the air deflates from the sphygmomanometer, the pulse will fade away. The point at which it first appears to fade is the diastolic pressure. You should be concerned with numbers that are above 140/90 in the supine or sitting position.
HEART DISEASE AND CHEST PAIN
Unlike in most medical books, we will not be spending a great deal of time discussing coronary artery disease, even though it is one of the leading causes of death in today’s society. Why? Because of the loss of all the advances that have been made to deal with coronary disease, it would be difficult in a survival setting to do very much about heart attacks. We will have to accept that some folks with heart problems will do better than others.
Heart attacks (myocardial infarctions) involve the blockage of an artery that gives oxygen to a part of the heart muscle. That portion of the heart subsequently dies, either killing the patient or leaving them so incapacitated as to be unable to function. This decrease in function is most likely permanent. Men are most likely to have coronary artery disease, as female hormones seem to protect women, at least before menopause.
CPR may have limited value off-grid because of the lack of necessary advanced follow-up care that would be available. Despite this hard reality, it is still compulsory for any effective medic and how to perform it as described later in this book. Suspect a heart event if your patient experiences the following:
A “crushing” sensation in the chest area
Pain down the left arm
Pain in the jaw area
Weakness
Fatigue
Sweating
Pale coloring
The main approach is to immediately give your patient a chewable adult aspirin (325 mg). This will act as a blood thinner, aiding in preventing further damage to the coronary artery and preserving oxygen flow. Aspirin can work within 15 minutes to prevent the formation of blood clots in people with known coronary artery disease or angina (cardiac-related chest pain).
A natural substance (capsaicin) found in cayenne pepper (at least 90,000 Scoville heat units, a measurement of perceived heat from spices) may also be helpful during a myocardial infarction. Give the conscious patient a glass of warm water mixed with 1 teaspoon of cayenne pepper. An alternative is to give two full droppers of cayenne pepper tincture or extract underneath the patient’s tongue. Studies at the University of Cincinnati show an 85 percent decrease in cardiac cell death when cayenne pepper is given.
A person suffering a heart attack will feel most comfortable at a 45-degree angle, rather than lying flat. Complete rest will cause the least oxygen demand on the damaged heart. Loosen constrictive clothing, as tight clothes make a cardiac patient feel anxious and causes their damaged heart to beat faster, leading to more strain.
Aspirin, in small doses, is also reasonable as a preventative strategy. One baby aspirin (81 mg) daily is thought to help prevent the deposition of plaque inside the blood vessels. You might consider having all of your adults forty and over on this treatment.
Those in your group with coronary artery issues should stockpile whatever medications they take to deal with their symptoms. Angina can be treated with nitroglycerine tablets. Placed under the tongue, they will give rapid relief in most cases.
There are various other causes of chest pain. Injury to muscles and joints in the torso may mimic cardiac pain. This type of pain gets worse with movement of the affected area, and can be elicited by pressing on that area. Rest patients with angina and give them ibuprofen or acetaminophen for pain.
Chest pain is also seen in some patients with anxiety issues. This is usually accompanied by tremors, a rapid heart rate, and hyperventilation. Sedative herbs, such as valerian root, passion flower, and chamomile, may be helpful in this situation, as are some prescription medications, such as diazepam (Valium).
Acid reflux may also cause pain (usually burning in nature) in the chest area. This type of pain is usually improved with antacids in tablet form, such as calcium carbonate (Tums, RolaidsTM, etc.) or liquid versions with magnesium hydroxide or aluminum hydroxide (Maalox, MylantaTM). Relaxation techniques, such as massage in a sitting position, may also help.
Ulcer and Acid Reflux Disease
Chronic stress, as will be seen in a survival setting, can manifest itself in both emotional and physical ways. One of the physical effects is increased stomach acid levels.
Excessive acid can cause an inflammation of the esophagus (the tube that goes from the throat to the stomach), the stomach itself, and the next part of the bowel (duodenum). The irritated lining weakens and forms an erosion (ulcer) and can cause bleeding or even perforate the entire thickness of the lining.
The major symptom of an ulcer is a burning or gnawing discomfort in the stomach area. This pain is often described as “heartburn.” It usually occurs in the left or mid-upper abdomen or may travel up to the breastbone. Sometimes it is described as hunger pangs or indigestion.
To make the diagnosis of ulcer or acid reflux disease, the timing of the discomfort is important. Ulcer and acid reflux discomfort occurs soon after eating but is sometimes seen several hours after a meal. It can be differentiated from other causes of chest pain in another way: it gets better by drinking milk or taking antacids. As you can imagine, this wouldn’t do much for angina.
Many ulcers and inflammation are caused by a bacterium, Helicobacter pylori. Antibiotics, such as amoxicillin and metronidazole, in combination are the most effective treatment for these ulcers.
Other causes include the overuse of ibuprofen or aspirin, which can be an irritant to the stomach in some people. Avoidance of these drugs can prevent these ulcers and inflammatory pain.
Acid reflux disease is caused by acid traveling up the esophagus. This is sometimes caused by an out-pouching at its base (hiatal hernia). The primary symptom is heartburn. It is usually relieved by antacids or by sleeping with the upper body raised.
Your patient may benefit from avoiding certain foods, including the following:
• Acidic fruit (for example, oranges)
• Fatty foods
• Coffee
• Certain teas
• Onions
• Peppermint
• Chocolate
Eating smaller meals and avoiding acidic foods before bedtime is a good strategy to prevent reflux. Chewing sugarless gum may also work. Obese individuals seem to suffer more from this problem, so weight loss might be helpful.
Medications that temporarily relieve acid reflux include calcium, magnesium, aluminum, and bismuth antacids, such as Tums, Maalox, Mylanta or Pepto-Bismol, as well as other medications, including ranitidine (ZantacTM), cimetidine (TagametTM), and omeprazole (PrilosecTM). These medications are available in nonprescription strength and are easy to accumulate in quantity.
Home remedies abound for acid reflux, including the following:
Organic apple cider vinegar
Mix 1 tablespoon in 4 ounces of water and drink before each meal.
Aloe vera juice
Mix 1 ounce in 2 ounces of water and drink before a meal.
Baking soda
Mix 1 tablespoon in a glass of water and drink right away when you begin to feel heartburn.
Glutamine
An amino acid that has an anti-inflammatory effect and reduces acid reflux. It can be found in milk and eggs.
SEIZURE DISORDERS
Seizures occur when the brain’s electrical system misfires. Instead of sending out signals in a controlled manner, a surge of haphazard energy goes through the brain. These abnormal signals can cause involuntary muscle contractions, poor control of certain organs, and loss of consciousness. A person with chronic convulsions is sometimes said to have “epilepsy.”
Seizures may involve the entire brain or just one area. There are several types that have been identified, but we will concentrate on the most severe, a “grand mal” seizure. In grand mal seizures, you’ll see violent shaking and jerking with loss of consciousness and bladder control. Strange sensations, known as “auras” (smells, colors, etc.), may herald an imminent convulsion.
There are various causes of convulsive disorders, such as the following:
High fever (in children, mostly)
Head injury
Meningitis (infection of the central nervous system)
Stroke
Brain tumors
Genetic predisposition
Idiopathic (unknown—about 50 percent of cases)
Without modern medicine, we will have to watch for physical signs and symptoms to identify the problem. It is important to know that one seizure does not make someone an epileptic. In some cases (especially childhood seizures associated with fevers), a person might even outgrow the condition.
In addition to auras, there are triggers that sometimes cause a convulsion. A good example is a bright flashing light. Avoidance of these triggers will decrease the number of episodes.
The most important aspect of treatment when intravenous medication is no longer available will be to prevent the patient from injuring themselves during an attack. A tongue depressor with gauze taped around it and placed in the mouth was once a standard recommendation, but it was found to cause injuries to both the patient and the rescuer. Keep everything away from the patient’s mouth, especially your fingers.
You shouldn’t restrain the person physically, but remove nearby objects that could cause injury. An exception is if the patient is standing when the seizure starts. In this case, grab the patient and gently lower them to the floor. Placing them in the CPR “recovery” position (discussed in the CPR section of this book) will help keep their airway open.
Do not give oral fluids or medications to an epileptic after a seizure until they are fully awake and alert. A person who has had a seizure will tend to be difficult to rouse for a period of time. This “post-ictal” state will resolve on its own over time.
If the convulsion is caused by a fever, as in children, cool the patient down with wet compresses. Anyone in your survival group with a convulsive disorder should work towards stockpiling their medicine. Popular drugs are Dilantin, TegretolTM, valproic acid, and diazepam (Valium). Emphasize the importance of extra medications in cases of natural disaster or other emergencies.
Natural alternatives have long been espoused to decrease the frequency and severity of convulsions. Many vitamins and herbal supplements have a sedative effect, which calms the brain’s electrical energy. They may be taken as a tea (1 teaspoon of the herb in 1 cup of water) or as a tincture (an extract with grain alcohol). The following are among those that have been reported as beneficial for prevention:
• Bacopa (Bacopa monnieri)
• Chamomile (Matricaria recutita)
• Kava (Piper methysticum—too much may damage the liver)
• Valerian (Valeriana officinalis)
• Lemon balm (Melissa officinalis)
• Passionflower (Passiflora incarnata)
• Vitamin B12 supplements
• Vitamin E supplements
When a Person Collapses
Sometimes, a patient may collapse, not from a convulsion but from simple fainting or head trauma. This person
• Will not have jerky spasms.
• Will usually regain alertness quickly.
• Will not lose control of their bladder.
Dehydration, overheating, low blood sugar and various other medical conditions can cause fainting. If someone feels as if they are about to collapse, they should sit down and put their head down between their knees to increase blood flow to the brain. If you see someone who is fainting from a standing position, grab them and gently lower them to the ground (in this case, on their back).
Evaluate the victim quickly. If someone has only fainted, they will be breathing and have a pulse. If this is the case, raise their legs about 12 inches off the ground and above the level of their heart and head. This will increase blood flow to the brain. Assess the patient for evidence of trauma, bleeding, or seizures. If so, treat as previously discussed in this book. If no pulse or breathing, begin CPR as discussed later.
Once a person who has fainted has been determined to be breathing, have a pulse, and have no bleeding injuries, tap on their shoulder and ask in a clear voice “Can you hear me?” or “Are you OK?” Loosen any obviously constricting clothing and make sure that they are getting lots of fresh air by keeping the area around them clear of crowds. If you are in an area that is hot, fan the patient or carefully carry them to a cooler area.
If you are successful in arousing the patient, ask them if they have any preexisting medical conditions, such as diabetes, heart disease, or epilepsy. Stay calm and speak in a reassuring manner. Don’t let them get up for a period of time, even if they say that they are fine. People oftentimes are embarrassed and want to brush off the incident, but they are still at risk for another fall.
Once the victim is awake and alert (Do they know their name? Do they know where they are? What year it is?), you may slowly have the patient sit up if they are not otherwise injured. In normal times, call emergency medical personnel and wait until they arrive before having the patient stand up. If these aren’t available, observe closely the rest of the day.
Common causes of fainting include dehydration and low blood sugar, so some oral intake may be helpful. Do this only if it is clear that they are completely conscious, alert, and able to function. Test their strength by having them raise their knees against the pressure of your hands. If they are weak, they should continue to rest. Close monitoring of the patient will be very important, as some internal injuries may not manifest for hours.
KIDNEY STONES AND GALL BLADDER DISEASE
The kidney and gall bladder are two organs that have the propensity in some people to develop an accumulation of crystals. These crystals form masses known as “stones.” Some are large and some are as small as grains of sand, but any size can cause pain (sometimes excruciating). These issues can put group members out of commission at a time when they are most needed.
Kidney Stones
Kidney stones are most commonly seen in people who fail to keep themselves well hydrated. Even small stones can lead to significant pain (renal colic), and the larger ones can cause blockages that can disrupt the function of the organ. Once you have had a kidney stone, it is likely you will get them again at one point or another. Kidney stones are usually not associated with infections.
Once formed in the kidney, stones usually do not cause symptoms until they begin to move down the tubes that connect the kidneys to the bladder (the ureters). When this happens, the stones can block the flow of urine. This causes swelling of the kidney affected as well as significant pain. Kidney stones as small as grains of sand may reach the bladder without incident and then cause pain as they attempt to pass through the tube that goes from the bladder to the outside (the urethra).
There are several different types of kidney stones:
• Calcium stones. The most common, they occur more often in men than in women, usually in those 20–40 years old. Calcium can combine with other substances, such as oxalate, phosphate, or carbonate, to form a stone.
• Cysteine stones. These form in people who have cysteinuria, a condition that tends to run in families.
• Struvite stones. This variety is mostly found in women and can grow quite large. They can cause blockages at any point in the urinary tract. Frequent and chronic infections are a risk factor.
• Uric acid stones. More common in men than in women, these stones are associated with conditions such as gout.
To diagnose a kidney stone, look for pain that starts suddenly and comes and goes. Pain is commonly felt on the side of the back (the flank). Lightly pounding on the right and left flank at the level of the lowest rib will cause significant pain in patients with kidney stones or kidney infections. As the stone moves, so will the pain; it will travel down the abdomen and could settle in the groin or even the urethral area.
Other symptoms of renal stones can include the following:
Bloody urine
Fever and chills
Nausea and vomiting
Some dietary changes may prevent the formation of kidney stones, especially if they are made of calcium. Avoid foods such as the following:
• Spinach
• Rhubarb
• Beets
• Parsley
• Sorrel
• Chocolate
Decreasing dairy intake is another step to take, as this will restrict the amount of calcium available for stone formation, keeping them as small as possible and, therefore, easier to pass.
Your treatment goal as medical provider is to assist the stone to pass through the system quickly. Have your patient drink at least 8 glasses of water per day to produce a large amount of urine. The flow will help move the stone along. Cranberry juice is very helpful, as well; one advantage is that it does not deplete the body of potassium, while diuretics such as furosemide (LasixTM) and hydrochlorothiazide (HCTZ) often do.
Pain relievers can help control the pain of passing the stones (renal colic). For most pain, ibuprofen will be the available treatment of choice. Stronger pain medications, if you can get them, may be necessary for severe cases.
Some of the larger stones will be chronic issues, as the technology and surgical options used to remove these will not be available in a collapse scenario. Medications specific to the type of stone may be helpful. The following decrease the likelihood of formation of uric acid stones:
• Allopurinol (prescription medicine for uric acid stones and gout)
• Antibiotics (for struvite stones)
• Sodium bicarbonate or sodium citrate (which increases the alkalinity of the urine)
A good home remedy to relieve discomfort and aid passage of the stone is lemon juice, olive oil, and apple cider vinegar. With the first twinge of pain, drink a mixture of 2 ounces of lemon juice and 2 ounces of olive oil. Then, drink a large glass of water. After 1 hour, drink a mixture of 1 tablespoon of raw apple cider vinegar with 2 ounces of lemon juice in a large glass of water. Repeat this process every 1–2 hours until improved.
Other natural substances that may help:
• Horsetail tea (a natural diuretic)
• Pomegranate juice
• Dandelion root tea
• Celery tea
• Basil tea
Gall Bladder Stones
The gall bladder is a sac-like organ that is attached to the liver; it stores the bile that the liver secretes. Gallstones are firm deposits that form inside the gallbladder and could block the passage of bile. This blockage can cause a great deal of pain and inflammation (cholecystitis).
There are two main types of gallstones:
Cholesterol stones—The grand majority, these are not related to the actual cholesterol levels in the bloodstream.
Bilirubin stones—These occur in those people who have illnesses that destroy their red blood cells. The byproducts of this destruction releases a substance (bilirubin) into the bile and forms a stone.
Risk factors for gallstones include obesity, female gender (especially if they have had children), and age over forty. Additional risk factors include diabetes, chronic liver disease, and low blood counts (anemia).
Luckily, most people with gallstones don’t have any symptoms. If a large stone causes a blockage, however, they may experience biliary colic. Symptoms of biliary colic include the following:
Cramping right upper abdomen pain (spreading to the back)
Fever
Jaundice (yellowing of the skin and whites of the eyes)
Discolored bowel movements (gray or grayish-white)
Nausea and vomiting
The classical finding on physical examination is “Murphy’s sign.” Press with one hand just below the midline of the lowest rib on the front right. Then, ask your patient to breathe deeply. If the gallbladder is tender, the patient should complain of significant pain at the site.
Unfortunately, the main treatment for gallstones is to surgically remove the gallbladder (which you can live without and stay healthy). As surgical suites are unlikely to be available in a collapse situation, you might consider some alternative remedies. The following are mostly preventative measures:
• Apple cider vinegar (mixed with apple juice)
• Chanca piedra, a plant that is native to the Amazon; translated, the name means “break stones.”
• Peppermint
• Turmeric
• Alfalfa
• Ginger root
• Dandelion root
• Artichoke leaves
• Beet, carrot, grape, lemon juices
Sadly, it is very difficult to eliminate most of the risk factors for gallbladder disease. If you’re forty, female, and have children, there is not much you can do about it. Dietary changes to decrease intake of high-cholesterol foods may be helpful.