Economic Collapse Blog: Serious Shortages Of Amoxicillin, Augmentin, Tamiflu, Albuterol And Tylenol Have Erupted in US

In the article Very Serious Shortages Of Amoxicillin, Augmentin, Tamiflu, Albuterol And Tylenol Have Erupted All Over The United States Michael Snyder of The Economic Collapse blog brings together articles from several sources reporting on drug shortages in the US.

Hospitals are filling up all across America, and there are extremely alarming shortages of some of our most important medications.  Health authorities are warning that RSV, the flu and COVID are combining to create a “tripledemic”, and there are simply not enough medications to go around.  Personally, I am most concerned about RSV.  It is spreading like wildfire from coast to coast, and we are being told that very young children and the elderly are particularly vulnerable.  I wrote an entire article about the RSV outbreak earlier this month, and since that time things have gotten even worse.  Our medical system is being absolutely flooded with sick kids, and this has caused very serious shortages of amoxicillin, augmentin, tamiflu and albuterol…

America is facing a shortage of four key medications used for common illnesses in children as virus season comes back in full force.

Officials have declared a shortage of first-line antibiotics amoxicillin and Augmentin, which are used to treat bacterial infections. Tamiflu, the most common flu medication in the US, and albuterol, an inhaler for asthma and to open airways in the lungs, are also in short supply, according to the American Society of Health-System Pharmacists.

But we haven’t even gotten to the heart of flu season yet.

In fact, the beginning of winter is still about a month away.

So what will things look like by the time we get to the middle of January?

At this point, things are already so bad that we are also starting to see a very serious shortage of tylenol

A children’s Tylenol shortage currently affecting Canada has carried over into the United States, pharmacists in multiple American cities have warned.

The drug’s short supply, experts say, stems from a recent spike in pediatric sickness as seasonal bugs come back with a bang after being suppressed during COVID-related lockdowns.

This is nuts.

In all my years, I have never heard of a shortage of tylenol in the United States.

Unfortunately, we now have millions of people with compromised immune systems all over the country, and so RSV and the flu are hitting us extremely hard.

One doctor told CNN that “I’ve never seen anything like this”…

“In my 25 years of being a pediatrician, I’ve never seen anything like this,” pediatric infectious disease specialist Dr. Stacene Maroushek of Hennepin Healthcare in Minnesota told CNN. “I have seen families who just aren’t getting a break. They have one viral illness after another. And now there’s the secondary effect of ear infections and pneumonia that are prompting amoxicillin shortages.”

The reason for shortages is due to increased demand, especially with a surge in respiratory syncytial virus (RSV) and flu cases. The combination of RSV, flu and COVID circulating has been called a “tripledemic.”

This is going to be one long winter for our medical system.

As I mentioned earlier, hospital beds are rapidly filling up all over the nation

These surges have filled children’s hospitals across these states. The Children’s Hospital of Alabama, the state’s largest pediatric hospital located in Birmingham – 91 per cent of beds are filled, according to official figures.

Vanderbilt University Medical Center, which includes the largest children’s hospital in Tennessee, is at 98 per cent capacity as of Tuesday.

And as I discussed in my article about RSV earlier this month, there are some hospitals that have already filled up all of their beds.

Of course most children that get sick don’t end up in the hospital.

Most of them just stay home and are cared for by their parents until they recover.

In October, more Americans missed work to take care of sick children than ever before

More than 100,000 Americans missed work last month – an all time high – because of child-care problems, many of which come down to sick children and sick daytime caregivers.

Sadly, we will almost certainly set another new all-time record this month.

It sure would be nice if the federal government would step in and help to ensure that everyone has enough medications to give to their children during this medical emergency.

But instead of doing that, the Biden administration has decided to give another 4.5 billion dollars to Ukraine…

The United States, through the U.S. Agency for International Development (USAID) and in coordination with the U.S. Department of the Treasury and the Department of State, is providing an additional $4.5 billion in direct budgetary support to the Government of Ukraine. The funding, which will help alleviate the acute budget deficit caused by Putin’s brutal war of aggression, was made possible with generous bipartisan support from Congress. The Government of Ukraine will receive the funding in two tranches before the end of 2022.

In addition, U.S. Secretary of State Antony Blinken has just announced that the Ukrainians will be receiving another 400 million dollars in military aid…

Secretary of State Antony Blinken announced a new $400 million military aid package to Ukraine on Wednesday.

The package will include “additional arms, munitions, and air defense equipment from U.S. Department of Defense inventories,” Blinken said in a statement, which didn’t provide many specifics on the weapons heading to Ukraine. It is the 26th time the administration is using the presidential drawdown authority, which allows the United States to take from its stockpiles and provide those weapons to Ukraine.

Rather than giving so much money to the Ukrainians, why can’t we spend it on some antibiotics for our children?

It seems to me that our priorities are really messed up.

The RSV outbreak that we are witnessing right now is really serious.  If you have young children, you will want to closely monitor developments in your local area.

After a couple of really tough years, a lot of people had been hoping that we would experience a “return to normal” in 2022.

But as I keep warning my readers, we have now entered an era of great pestilences.

This year we have seen the bird flu kill tens of millions of our chickens and turkeys, a global monkeypox epidemic has spread all over the globe, and now RSV and the flu are ripping across the nation.

We really are living in unprecedented times, and the challenges that we are facing are only going to get even greater as the months roll along.

Doom and Bloom: Tetanus

The Altons at Doom and Bloom Medical have an article up about tetanus and its causes and treatment. More photos in their original article. Go there and read more about emergency and off-grid medical care.

The destruction caused by hurricane Ian in Florida recently was widespread and devastating. Flood waters teeming with contaminants and debris posed a hazard to all who ventured out after the storm. You can bet that there was a run on tetanus shots after citizens had a painful encounter with the proverbial “rusty nail” and other objects. In off-grid settings, tetanus is an ever-present risk. The family medic should have knowledge of risks, symptoms, treatment, and prevention.

What is Tetanus?

Tetanus (from the Greek word tetanos, meaning tight)  is an infection caused by the bacteria Clostridium tetani.  The bacteria produces spores (inactive bacteria-to-be) that primarily live in soil or the feces of animals. These spores are capable of laying dormant for years and are resistant to extremes in temperature.

Tetanus is relatively rare in the United States, with about 50 reported cases a year.  Worldwide, however, there are more than 500,000 cases a year. Most are seen in developing countries in Africa and Asia.  Still, we should realize that developed countries may be thrown into third world status in the aftermath of a mega-catastrophe.  There’ll be many more cases that could be your responsibility as medic to identify and treat.

Causes of Tetanus

Most tetanus infections occur when a person has experienced a break in the skin.  The skin is the most important barrier to infection, and any breach in the armor leaves a person open to infection. The most common cause is some type of puncture wound, such as an insect or animal bite, a splinter, or even that rusty nail.  This is because the bacteria is anaerobic (doesn’t like oxygen); deep, narrow wounds are exposed to less O2, providing a favorable environment for C. tetani. Any injury that compromises the skin, however, is eligible: Burns, crush injuries, and lacerations can also be entryways for tetanus bacteria.

Tetanus spores

When a wound becomes contaminated with Tetanus spores, the spores become full-fledged bacterium and reproduce rapidly.  Damage to the victim comes as a result of a strong toxin excreted by the organism known as tetanospasmin.  This toxin specifically targets nerves that serve muscle tissue.

Tetanospasmin binds to motor nerves, causing “misfires” that lead to involuntary contraction of the affected areas.  This neural damage could be localized or can affect the entire body. You would possibly see the classical symptom of “lockjaw”, where the jaw muscle is taut; any muscle group, however, is susceptible to the contractions if affected by the toxin.  This includes the respiratory musculature, which can inhibit normal breathing and become life-threatening.

The most severe cases seem to occur at extremes of age, with newborns and those over 65 most likely to succumb to the disease. Death rates from generalized Tetanus hover around 25-50%, higher in newborns.

You will be on the lookout for the following early symptoms:

  • Sore muscles (especially near the site of injury)
  • Weakness
  • Irritability
  • Difficulty swallowing
  • Lockjaw (also called “trismus”; facial muscles are often the first affected)

Initial symptoms may not present themselves for one to two weeks. As the disease progresses, you may see:

  • Progressively worsening muscle spasms (may start locally and become generalized over time)
  • Involuntary arching of the back (sometimes so strong that bones may break or dislocations may occur!)
  • Fever
  • Respiratory distress
  • High blood pressure
  • Irregular heartbeats

Complications of untreated tetanus can lead to a fatal outcome in one out of four people. The death rate for newborns is even higher. 

Treating Tetanus

The first thing that the survival medic should understand is that, although an infectious disease, tetanus is not contagious. You can feel confident treating a tetanus victim safely, as long as you wear gloves and observe standard clean technique.  Begin by washing your hands and putting on your gloves.  Then, wash the wound thoroughly with soap and water, using an irrigation syringe with 3% hydrogen peroxide to repeatedly flush out any debris.  This will, hopefully, limit growth of the bacteria and, as a result, decrease toxin production.

You will want to administer antibiotics to kill off the rest of the tetanus bacteria in the system.  Although not used as prevention, antibiotics will decrease the toxin load and speed recovery. Metronidazole (Aqua-zole, Flagyl) 500mg 4 times a day or Penicillin 500 mg 4 times a day are among some of the drugs known to be effective.  Muscle relaxants like tizanidine and cyclobenzaprine are used to treat spasms, but are unlikely to be available to the off-grid caregiver.

Additional strategies include IV hydration, if available, and keeping the patient as comfortable as possible in a quiet and dimly-lit environment.

Late stage Tetanus is difficult to treat without modern technology. For this reason, it’s important for the survival medic to monitor anyone who has sustained a wound for the early symptoms mentioned earlier.

As medic, you must obtain a detailed medical history from anyone that you might be responsible for in times of trouble.  This includes immunization histories where possible.  Has the injured individual been immunized against tetanus? Most people born in the U.S. will have gone through a series of immunizations against diptheria, tetanus, and whooping cough early in their childhood. Booster injections for tetanus are usually given every 10 years (or if 5 years have passed in a person with a fresh wound, sometimes along with tetanus Immunoglobulin antitoxin).

Tetanus vaccine is not without its risks; severe complications such as seizures or brain damage occur in rare cases (less than one in a million).  Milder side effects such as fatigue, fever, nausea and vomiting, headache, and inflammation in the injection site are more common.

Given the life-threatening nature of the disease, though, this is one vaccine that you should encourage your people to receive, regardless of your feelings about vaccines in general. If not caught early, there may be little you, the off-grid medic, can do to treat your patient without all the bells and whistles of modern medicine.

Joe Alton MD

Doom and Bloom: Noroviruses

In this article, Dr. Alton at Doom and Bloom Medical talks about Norovirus symptoms, treatment, and prevention.

Many of us have heard of the “stomach flu” but not the actual virus that causes it: Norovirus. Norovirus has been in the news lately when a long-term outbreak occurred among more than 220 rafters and hikers in the Grand Canyon National Park from April to mid-June of this year. Less well known is 448 norovirus cases reported in the U.S. from Aug 2021 to March of this year. That was six times the number of cases reported during the same time the year before.

We personally an experience with the virus a few years ago when my wife sampled “The World’s Best Hot Dog” at a street stand in New York City while visiting our daughter. Believe me, it’s no fun, and considering that norovirus can be found everywhere from the Big Apple to the Grand Canyon, the family medic should know about it.

ABOUT NOROVIRUSES

The National Foundation for infectious diseases reports that noroviruses are the most common cause of acute stomach and intestinal infections in the United States, The U.S. reports 19 million to 21 million cases a year. Humans are, apparently,  the only hosts of the virus. It affects people of all ages, but it’s particularly dangerous in the elderly, the very young, and those with weakened immune systems. Except for this year, winter is the most common time for outbreaks.

The virus was formerly known as the Norwalk virus because the first known outbreak took place at an elementary school in Norwalk, Ohio. Scientists identified the virus in 1972 from stool samples and renamed it “norovirus.” Since then, it’s been identified everywhere from cruise ships to nursing homes.

Norovirus is very contagious (just 5-20 viral particles can cause illness) and is easily transmitted through contaminated food or water, close personal contact, and even by air droplets from vomit, contaminated kitchen counters, and even toilet flushes. Infection can be passed from person to person for a time even after apparent recovery.

Here’s how contagious the norovirus is: In one outbreak reported in 1998, 126 people were dining at a restaurant when one person vomited onto the floor. Despite a rapid cleanup, 52 customers fell ill within three days. More than 90% of the people who later dined at the same table reported symptoms. More than 70% of the diners at a nearby table got sick; at a table on the other side of the restaurant, the rate was still 25%.

Norovirus is a hardy microbe, and is known to survive for long periods outside a human host. It can live for weeks on countertops and up to twelve days on clothes. It can survive for months in still water. Disinfectants containing chlorine, however, like bleach will quickly eliminate it, as will sufficient heat.

SYMPTOMS OF “STOMACH FLU”

The symptoms of the stomach flu include nausea and vomiting, watery diarrhea, and (sometimes severe) abdominal pain, usually within 12 to 48 hours of exposure. Along with this, muscle aches, headache, and fever may be seen. Luckily, life-threatening illness is rare, with dehydration being the main danger in those infected with the virus. Symptoms may last several days before eventually subsiding.

Unlike some viruses, immunity to norovirus is only temporary. Antibodies against the virus at thought to last up to six months after recovery. Also, there are various types of noroviruses, getting one doesn’t protect you against others.

Outbreaks of norovirus infection often occur in closed spaces such as cruise ships, nursing homes, schools, camps, and prisons. Shellfish, such as oysters, and salad ingredients are the foods most often implicated in norovirus outbreaks (except, of course, “the World’s Best Hot Dog”).

TREATING NOROVIRUS

As is the case with most viruses, there is no known cure for norovirus infection. Antibiotics will not be effective, as they are meant to kill bacteria, not viruses. Treatment involves staying well-hydrated. Suspect dehydration if you see these signs and symptoms:

·        Dry mouth

·        Decrease in quantity or dark color of urine

·        Dizziness when standing up

·        Decreased elasticity of skin (it “tents” when pulled)

·        No tears when crying or unusual irritability in infants

Using antidiarrheal meds like loperamide (Imodium) and anti-vomiting drugs like Ondansetron (Zofran) may also help.

PREVENTING NOROVIRUS

A cure may not be available but prevention is another issue. To decrease the chance of norovirus infection:

·        Wash your hands frequently with soap and water (norovirus is relatively resistant to alcohol), especially after using the restroom or handling food. Be especially sure to do this for 2 weeks after becoming infected (yes, you can be contagious for that long).

·        Wash food before cooking; cook shellfish thoroughly.

·        Frequently disinfect contaminated surfaces with a bleach solution (the EPA recommends 5-25 drops of bleach per gallon).

·        Keep sick individuals away from food preparation areas.

·        Avoid close contact with others when you are sick, and don’t share utensils or other items.

·        Wear disposable gloves while handling soiled items.

·        Immediately remove and wash clothes that may be contaminated with vomit or feces. Machine dry if possible.

It may be difficult to completely eliminate the risk of norovirus infection, but careful attention to hand and food hygiene will go a long way towards avoiding the stomach flu.

Joe Alton MD

Doom and Bloom: Burns

The Altons at Doom and Bloom Medical have a couple of articles on burns. The first is on First and Second Degree Burns, while the third covers Third Degree Burns. Here’s an excerpt from the first of the articles, as always, more pictures in the original article:

A wide variety of situations, both in normal times and disaster settings, put us in proximity with high levels of heat. If we’re knocked off the grid, it won’t be unusual to cook food over a fire of our own making, something very few do on a regular basis. As such, the survival medic will often be faced with burn injuries. Having the materials and knowledge to treat burns will be absolutely necessary in times of trouble.

Burns can be caused by contact with sources other than flames, including:

•             Scalds due to contact with hot water or steam.

•             Contact with electricity associated with lightning or another source.

•             Friction burns due to contact with hard surfaces such as roads (“road rash”), carpets, or hard flooring.

•             Skin exposure to extreme cold and winds. Yes, extreme cold can cause burns.

•             Chemical spills.

•             Radiation due to contact with energy emitted by x-rays and other medical testing or treatment, “dirty bombs,” or thermonuclear explosions.

In general, the different types of burns are treated similarly, although some burns, like those caused by electricity or radiation, may cause internal damage without destroying the skin. Inhalation of superheated air may cause damage to lung tissue. Off the grid, the lack of advanced care will make these cases a challenge for the medic.

The severity of a burn injury and resulting chance of death or disability depends, in part, on the percentage of the total body surface involved, as measured by the “rule of nines.”

Assessing the percentage of body surface area burned is standard practice and helpful in modern medicine. It may, however, have less practical benefit in austere settings where transport isn’t an option. In any case, knowing the “rule of nines” may give the medic an idea of the chances of recovery for a burn victim.

Burns to the face, feet, hands, genitals, and lungs are considered the most problematic. Burns that go completely around a body part, say, an arm, cause constriction that may affect circulation. Areas with a lot of scar tissue may have limited mobility.

BURN DEGREES

Besides total surface area involved, an important factor is the amount of penetration of the burn. This is usually measured in degrees.

First-Degree Burns

Most burns you’ll see will be due to excessive exposure to the sun. A majority of cases will be “first-degree burns.” In first-degree burns, the patient may be red as a lobster, but only the superficial layer of the skin (the “epidermis”) is injured.

A first-degree burn will appear red, warm, and dry. It will be painful to the touch, especially when large areas of skin are involved. Fortunately, major complications are rare unless other symptoms such as nausea and vomiting appear. Treatment is simply focused on relieving discomfort.

Immersion in a cool bath will be helpful; at the very least, run cool water over the injury. A cool moist cloth on the burn for 20 minutes will give some relief. So will anti-inflammatory medicines such as Ibuprofen. Aloe vera, zinc oxide, and benzocaine sprays are effective alternatives. Expect the discomfort to improve after 24 hours. Until then, avoid constrictive, tight clothing and wear light fabrics, such as cotton.

Prevention, of course, is worth a pound of cure. To avoid this type of sunburn:

•             Don’t “sunbathe” (a tan is not healthy).

•             Avoid the peak sun hours for the time of year and latitude.

•             Wear long pants and sleeves, hats, and sunglasses.

•             Spend time in the shade whenever possible.

If extended exposure to sunlight is unavoidable, be certain to use a sunblock. Apply 15 minutes prior to going outside and re-apply frequently throughout the day. Even water-resistant sunscreens should be reapplied every one to two hours. Most people fail to put enough on, so be sure to use plenty.

As an aside, sunblock and sunscreen are not the same thing. Sunblocks contain tiny particles that “block” and reflect UV light. A sunscreen contains substances that absorb UV light, thus preventing it from penetrating the skin below. Many commercial products contain both. Sunblocks and sunscreens should be an integral part of your medical storage.

The SPF (Sun Protection Factor) rating system was developed in 1962 to measure the capacity of a product to protect against UV radiation. It measures the length of exposure to the sun before you burn. A SPF (sun protection factor) of at least 15 is recommended. It takes about 20 minutes without sunscreen for your skin to start turning red. SPF 15 blocks 94 percent of the sun’s rays, SPF 30 blocks 97 percent, and SPF 45 98 percent. The higher the number, the longer it takes for the skin to burn.

Although the increase in protection may seem small, higher SPF numbers are especially beneficial to those with fair skin. They offer better protection against long-term skin damage leading to cancer.

Besides the sun, first-degree injuries will most likely be related to cooking or campfires. Using hand protection will prevent many of these burns, as will careful supervision of children near campfires and food preparation areas.

Second-Degree Burns

Second-degree burns are deeper injuries that penetrate through the superficial epidermis and partially through the deeper layer of the skin (the “dermis”). Thus, they’re often called “partial thickness burns.” While first-degree burns may cover a large percentage of surface area without becoming life-threatening (but are painful), a relatively small percentage of the body covered with significant second-degree burns may require serious medical intervention.

Unlike first-degree burns, which appear dry, second-degree burns will be moist and often have blisters with reddened bases. The area will have a tendency to weep clear or whitish fluid. Second degree burns will cause swelling as well, so it’s important to remove rings and bracelets.

To treat second degrees burns:

Remove the victim from the heat source immediately. Run cool water over the injury for 10-15 minutes (avoid ice, which will traumatize already-damaged skin). After washing and running water over the wound, pat the area dry. The next step is to apply moist skin dressings such as Xeroform, Spenco Second Skin or non-stick dressings (Telfa pads) with thin layers of products like aloe vera or Aquaphor. Be sure to replace regularly and review the progress of healing. Other actions should include:

•             Removing jewelry like rings and bracelets (swelling may cause painful constriction).

•             Elevating burned extremities.

•             Applying cool compresses.

•             Giving oral pain relief such as Ibuprofen (Advil).

•             Applying anesthetic creams such as benzocaine or lidocaine.

•             Avoidance of “peeling” burned skin, which sometimes comes off in sheets.

•             Protecting adjacent burned fingers and toes with a dry barrier in-between.

•             Encouraging hydration.

•             Using a “tenting” method to keep sheets above extensive burns.

We’re often asked whether to pop blisters associated with second-degree burns. It’s wisest to avoid the lancing of blisters, if possible, unless they’re infected and filled with pus. Some very large blisters will, however, break with the slightest pressure and may benefit from controlled drainage. If this is the case, use a sterilized needle or scalpel blade to pierce the side of the blister near the base. The roof of the blister is often retained to provide additional protection to the healing base.

It’s important to avoid the use of lard or butter on burns: They tend to keep in heat and may worsen the injury. Egg whites and toothpaste, long considered to be home remedies, may increase the risk of infection. It’s better to use sterile saline solutions to keep the burn area and (non-stick) dressing moist, especially in severe burns.

In part 2 of this series, we’ll discuss third-degree burns. Is there anything the survival medic can do if confronted with this life-threatening issue?

Doom and Bloom Medical: Bleeding Wound Management, Part. I

The Altons at Doom and Bloom Medical have part one of an article on bleeding wound management.

In a destabilized society, traumatic wounds may be commonplace is scenarios where there is a desperate population and no rule of law. Even routine activities of daily survival may cause injuries that could become life-threatening. Therefore, the family or group medic must always be prepared to deal with bleeding wounds. Some of these, especially those in the abdomen and chest, are likely to be fatal without advanced medical care. In this article, let’s commemorate National Stop The Bleed Month (I’m a certified instructor through the American College of Surgeons) by concentrating on those hemorrhages that are survivable.

Cuts in the skin can be minor or catastrophic, superficial or deep, clean or infected. Significant cuts (also called “lacerations”) penetrate both layers of the skin (dermis and epidermis) and are associated with bleeding, the amount of which depends on the blood vessels disrupted. Knowing how to manage hemorrhagic wounds quickly and effectively will be of paramount importance for the survival medic.

In studies of casualties in recent wars, 50 percent of those killed in action died of blood loss. 25 percent died within the first “golden hour” after being wounded. The golden hour is the time after which a victim’s chance of survival diminishes significantly if untreated, with a threefold increase in death rate for every 30 minutes without care thereafter.

If there is active bleeding and the wrong artery is severed, however, it could take just a few minutes for a person to “bleed out” and be beyond medical help. A severed femoral artery can lose more than a pint of blood a minute. With hemorrhage, the reality should, perhaps, be called the “platinum five minutes” instead.

Venous bleeding manifests as dark red blood that drains steadily from the wound, while arterial bleeding is bright red (due to higher oxygen content) and comes out in spurts that correspond to the pulse of the patient. As the vein and artery usually run together, a serious laceration can have both.

Once below the level of the skin, large blood vessels, muscles, and nerves may be involved. You’ll identify more problems with vessel and nerve damage in deep lacerations and crush injuries. In any case, bleeding control must be achieved.

In response to fatalities due to bleeding in recent military conflicts, the U.S. instituted Tactical Combat Casualty Care (TCCC) guidelines. It is thought that up to one in five deaths from hemorrhage in the field may be prevented with quick action by those at the scene. Civilian and law enforcement authorities have established similar strategies in response to the hard lessons learned by our soldiers; so should the family medic.

BLOOD BASICS

It’s worthwhile for the medic who may be dealing with bleeding wounds to know some basics about blood. Blood is a specialized fluid that comprises about 7-8 percent of a person’s total weight. It’s involved in:

•             Delivering oxygen to the body from the lungs and eliminating carbon dioxide (a process called “gas exchange”).

•             Forming clots that stop hemorrhages.

•             Transporting substances that fight infections and disease.

•             Delivering waste products to the kidneys and liver.

•             Helping to regulate body temperature.

There are four main components to blood:

Red blood cells (RBCs): RBCs are the cells that carry oxygen to body tissues, thanks to a special iron-containing protein called “hemoglobin.” Red cells account for 40-45 percent of total blood volume. They start as immature cells in the bone marrow that mature and are released into the bloodstream. The average lifespan of a red blood cell is about 120 days.

White blood cells (WBCs): These cells account for only about one percent of total blood volume, but are extremely important for fighting infection and disease.  There are several types, including short-lived cells deployed for immediate response and longer-lived ones that regulate the function of immune cells, make antibodies, and directly attack infected cells and tumors.

Platelets and other clotting factors: These are small cell fragments that allow bleeding to stop by gathering at the wound site and helping to form a clot. Like RBCs and WBCs, they originate in the bone marrow.

Plasma: A yellow liquid that transports all of the above throughout the body.

Together, these components are referred to as “whole blood.”

PHYSICAL EFFECTS OF BLOOD LOSS

Evaluating blood loss is an important aspect of dealing with wounds. An average size human adult has about 10 pints (4.73 liters or 4730 ml) of blood. The effect on the body caused by blood loss varies with the amount incurred. The American College of Surgeons recognizes four classes of acute hemorrhage, along with expected signs and symptoms:

Class I:  Hemorrhage is less or equal to 15 percent of blood volume (1.5 pints/750 ml) in an average adult male. 750 ml is the amount in a bottle of wine. A person donating 1 pint of blood is giving slightly less than 500 ml. At this level there are almost no signs or symptoms, although some may have a slightly rapid pulse and feel vaguely faint or anxious.

Class II:  Hemorrhage is 15 to 30% loss of total blood volume (1.5-3 pints/750-1500 ml).  The body’s efforts to compensate for less red blood cells at this point results in a faster heartbeat and breathing rate to speed oxygen to tissues.  This patient will appear pale and skin will be cool.  They’ll feel shaky, weak, and anxious. Blood pressure remains, for now, within normal range. Urine production begins to slow down in order to retain fluid volume.

Class III: Hemorrhage is 30 to 40% loss of blood (3-4 pints/1500-2000 ml).  At this point, the heart will be beating very quickly and breathing very fast as the body encounters difficulty getting enough oxygen to tissues.  Blood pressure drops. Smaller blood vessels in extremities constrict to keep the body core circulation going. This patient will be confused, pale, and in hypovolemic (low blood volume) shock. Urine decreases significantly. In normal times, blood transfusion is usually necessary. 

Class IV:  Hemorrhage is more than 40% of total blood volume (greater than 4 pints/2000 ml). The heart can no longer maintain blood pressure and circulation.  All parameters are well outside normal range and the patient becomes lethargic due to lack of oxygen and circulation to the brain. Without major resuscitative help at this point, organs like the kidneys fail. The patient loses consciousness. Heart rate and respiration slows and eventually ceases as the patient dies.

ABCDE VS. CABDE

The traditional initial field assessment of a victim usually involves the acronym ABCDE. Although ABCDE may mean different things to different people, one interpretation goes as follows…(continues)

Doom and Bloom: Active Shooters In The New Norm

The Altons at Doom and Bloom Medical write about Active Shooters in the New Norm and training and first aid for the same.

On March 23rd, 2021, a man thought to be mentally disturbed entered a Boulder, Colorado grocery store and began a shooting rampage. 21-year-old Al Aliwi Alissa, born in Syria but living in the United States since the age of three, managed to kill 10 people, including a police officer, before disrobing and surrendering to authorities. It’s thought that the gunman has a long history of anger issues and may have paranoid tendencies.

The shooting follows an incident where another 21-year-old killed 8 people in Georgia at local massage parlors, which he saw as a form of temptation for what is described as a “sex addiction.” The recent shootings in diverse settings follow a lull during the 2020 COVID-19 pandemic.

In the last few years, shooting events by the disaffected, disturbed, and disgruntled have occurred on a regular basis.  Schools, churches, places of business, and other public venues are now fair game for those with bad intentions. Armed not only with weapons but with a blueprint from previous incidents, gunmen can identify soft targets easily and are more “successful” in achieving their goal of creating mass casualties.

Like COVID-19, have these events become part of the “New Normal”? Should we just get used to them?

You might think that the “successes” achieved by active shooters occur at random. The increase in the sheer number of casualties, however, reveal a strategy that is being refined to deadly effect.

The selection of soft targets is becoming a science and is leading to higher numbers of deaths and injuries. In the 2018 South Florida high school shooting, for example, the gunman activated the fire alarm to make sure there would be lots of targets in the hall. To create confusion, he tossed smoke bombs (but prudently wore a gas mask).

If the ill-intentioned are now that much better at creating mayhem, it stands to reason that our society must become better at thwarting those intentions. Here are ways that would, in my opinion, decrease the number of shooter incidents and the deaths caused by them:

Improve security in areas at risk. I would define an “area at risk” as just about anywhere where a crowd of people would gather. Better protection at malls or grocery stores may just be a matter of hiring more security personnel. Given the loss of so many jobs during the pandemic, it’s not a bad idea to train and hire workers specifically to keep an eye out for those with bad intentions. If the money isn’t there, establishing and training a volunteer safety team in places like churches, schools, or workplaces can increase the level of vigilance and identify threats early.

Although the recent attacks occurred in cities, rural areas aren’t immune. Establish volunteer safety officers in small towns where there may not be law enforcement and emergency medical personnel just around the corner. These persons should have training in security, firearms, and first aid for bleeding wounds. If there are volunteer fire departments, while not trained volunteer safety departments?

Instill a culture of situational awareness in our society. Situational awareness is a state of calm, relaxed observation of factors that might indicate a threat. These are called “anomalies”; learning to recognize them can identify suspicious individuals and save lives.

Situational awareness involves always having a plan of action when a threat occurs, even if it’s as simple as making a note of the nearest exit in whatever building you’re in. Seems like common sense, but in these days of smartphone distractions, many are oblivious of their surroundings.

Identify persons of interest through their social media posts. Some active shooter candidates are vocal about their intentions. You might be concerned about “big brother” monitoring our public conversations on social media. It concerns me also, but you must answer this question:  How many deaths are you willing to accept in your community due to a lack of vigilance?

We must always be on the lookout for signs of trouble. Even if this drives some potential gunmen underground, it might identify others in time to abort their mission.

In the case of Alissa, his sister-in-law felt compelled to take a gun away from him when he was acting erratically. In some states, it is possible for family members or police to ask the court to order the temporary removal of firearms from someone who may present a danger to others or themselves. A judge makes the determination to issue the order based on statements made and actions of the person in question. Controversial? Yes, but it could save lives.

Each municipality must set a mechanism (and an earlier trigger) for the authorities to apprehend and interrogate suspicious characters. Indeed, Ali Aliwi Alissa was a known person of interest to authorities before the attack.

Learn how to stop bleeding in wounds
Learn how to stop bleeding in emergencies

Learn how to stop bleeding in emergencies: Teach our citizens to avoid the natural paralysis that occurs in an unexpected event. This paralysis occurs as a result of “normalcy bias”, the tendency to discount risks because most days proceed in a certain standard manner; we usually assume that today will be the same.

By teaching simple courses of action such as the Department of Homeland Security’s “Run, Hide, Fight” triad, the decision-making process may be more intuitive and more rapidly implemented. This is more effectively taught and ingrained at a young age. Make sure it’s a part of every child’s education.

We should also teach our students simple first aid strategies to stop bleeding, the most likely cause of death in these scenarios. Rapid action by bystanders is thought to decrease the number of deaths from hemorrhage. Add “Reduce” hemorrhage to “Reading, ‘Riting, and ‘Rithmetic” as part of school curriculum, and lives might be saved.

Provide first aid kits for bleeding in public venues. In the last few years, bleeding kits have been packed into fire extinguisher wall cabinets in many public venues and can be accessed by those at the scene. Unfortunately, in most places, there isn’t a sign that indicates their presence. With supplies, the Good Samaritan will be more likely to save a life. I predicted, years ago, that these kits will be fixtures everywhere one day. It’s good that they’re there, but let the public know they are.

Our response as a nation has been to do little to correct the problem. I say that era must end. Let’s stop being “soft” targets. We must forsake the notion that shootings are just part and parcel of the New Normal and begin the process by which we change our attitude and level of vigilance, not in isolated cases, but as a society.

The above recommendations wouldn’t affect the average (sane) citizen’s right to bear arms. It would mean more situational awareness so that people can be more ready to “Run, Hide, Fight”.  

If it means more surveillance, we should realize how much there is already. Watching people who publicly threaten violence more closely makes sense; so does increasing access to mental health resources to, perhaps, prevent someone from going off the rails.

The New Normal is an angry, dangerous place. The American identity has been replaced by many tribal ones; Most seem to hate each other. It’s a recipe for disaster that’s likely to get worse if we don’t reverse course, but that takes fortitude and determination on the part of all parties.

You don’t have to be a Department of Homeland Security official to know that there are more active shooter events on the horizon.  Watch for anomalies in behavior and always have a plan of action. A prepared nation wouldn’t be invulnerable to attacks, but its citizens would have a better chance to survive them.

Joe Alton MD

Prolonged Field Care: Medical Support to Resistance

Prolonged Field Care published an article originally from the 2019 Special Warfare magazine on Survivability: Medical Support to Resistance  which discusses “a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency… improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight.”

Hope is a primary driver of resistance movements, and the best way to keep hope alive in a resistance movement is to keep people alive. There are many aspects to enhancing survivability of a resistance movement, and medical support is one critical part. Doctrinal military health service support constructs, such as combat support hospitals or forward surgical teams, will be wholly inadequate to support resistance movements in a peer conflict in Europe for the primary reasons that they are overmanned and under trained. This article will discuss a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency of our allies or partners, improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight to regain territorial sovereignty against an illegal occupation. Medical infrastructure is vastly different in peacetime Europe than in more austere areas frequented by U.S. Special Operations Forces. Medical evacuations begin with calling 112, the European 911 equivalent, ambulances arrive to provide pre-hospital care, sometimes with physicians onboard, the patient is transported to a trauma center, and medical care is generally comparable to U.S. standards. If peer conflict occurs again in Europe, medical infrastructure will be severely degraded and significant obstacles to medical support will immediately arise, especially regarding extremely prolonged evacuation times and scarce resource availability. The U.S. military has not faced as severe a challenge to provide medical support since World War II. The SOF medical community has been bracing for the regression of medical support in emerging conflicts since at least November 2017 when U.S Army COL (Ret.) Dr. Warner “Rocky” Farr published The Death of the Golden Hour and the Return of the Future Guerrilla Hospital; yet the existential threat facing Eastern Europe poses the worst case scenario for medical support to resistance. The restricted mobility for friendly forces in territory occupied by a peer adversary will severely limit external medical support to U.S. SOF and our allied partners, including the resistance. The isolation of U.S. and allied forces in a denied environment will by necessity convert the delivery of medical care from a linear progression of medical evacuations from point of injury to higher echelons of care outside the combat zone, to a cyclical progression of evacuation, treatment, convalescence and return to duty, all completely within occupied territory.

A resistance scenario in Europe presents a unique risk to U.S. SOF supporting resistance movements, as organic capabilities will not be able to provide required medical support in this tactical environment. Recent exercises have demonstrated that U.S. SOF surgical teams will be severely restrained and may not be survivable in a denied environment, and conventional medical forces will likewise be absent. U.S. SOF medics are highly capable within their scope of practice, but over-inflation of their ability results in commanders miscalculating risk; a medic’s ability to reduce serious risk is often predicated on access to definitive care. The Maquis in occupied France and Partisans of Yugoslavia faced similar challenges in World War II but were still able to provide medical support despite great odds. The relevance of these historical precedents might be limited, however, by exponential advances in technology over the last 75 years. Providing medical support to U.S. SOF and resistance forces will be immensely challenging, but there is one great advantage over historical precedence: there is time and space now to enable ourselves and our allies and partners to be prepared to provide medical support to resistance prior to conflict, instead of reacting after a violation of a country’s national sovereignty.

BACKGROUND

In early 2018, SOCEUR conducted a multinational SOF exercise focused on irregular warfare and resistance in the Baltic region of Eastern Europe. Key medical lessons learned from the exercise were that medical evacuation in restricted areas during peer conflict is incredibly challenging, and U.S. SOF surgical teams as currently configured and trained will have low, if any, chance of survival in occupied territory. It was evident that planning medical support solely using only a U.S. military doctrinal construct was impractical and ineffective; civilian medical resources were identified as, and will necessarily be, the center of gravity for medical support to resistance. Resistance doctrine was turned to as a possible solution to the way ahead, but existing doctrine was found to be largely inadequate for the range of potential operational environments in future conflicts against a peer adversary in Eastern Europe. The focus of U.S. resistance doctrine on unconventional warfare and resistance movements assumes that conflicts have already begun or are ongoing. Furthermore, reverse engineering resistance constructs prior to conflict is difficult because it is impossible to forecast who and what will survive the initial invasion. The whole-of-society approach advocated by the Resistance Operating Concept was embraced as a potential solution for addressing critical gaps in providing medical support to resistance.

WHOLE-OF-SOCIETY APPROACH TO MEDICAL SUPPORT FOR RESISTANCE

The SOCEUR Surgeon’s Office has developed a whole-of-society approach to enable medical support to resistance (Figure 01) as a tiered approach to improve trauma care from point of injury through surgical intervention, convalescence and return to duty. Additionally, it aims to increase medical interoperability with Allies and partners in preparation for a resistance scenario in Eastern Europe.

U.S. SOF MEDICINE

The core of this approach begins with increased readiness for U.S. SOF. If peer conflict in Eastern Europe occurs, U.S. SOF medics will be required to treat casualties on extended timelines with limited supplies. Proficiency in Prolonged Field Care improves the SOF medic’s ability to do this, but is dependent on the medic’s ability to transfer casualties to higher echelons of care for definitive treatment or required convalescence. SOF surgical teams may be part of the solution, but will require manning changes and additional training in order to improve survivability in peer-adversary occupied territory.

Previously, the SOCEUR Surgeon’s office developed and conducted a course in UW medicine for surgical teams. This training was conducted as a proof of concept in Fall 2017, and was subsequently turned over to U.S. Army Special Operations Command with a request to further develop UW training for SOF surgical teams. Currently, the SOCEUR Surgeon’s office is continuing to develop Trojan Footprint as an opportunity for U.S. SOF medical units to practice UW medical tactics and techniques in a major exercise. The command is developing training opportunities for U.S. SOF medics and surgical teams to work in partner-nation trauma centers in Eastern Europe. This aims to achieve multiple objectives including enhanced interoperability of U.S. medical personnel and potential partners, information sharing regarding medical materiel and techniques and potentially to raise standards of trauma care as best practices are shared between allies and partners. The strong relationships that would be created by this course of action would be mutually beneficial. These types of training opportunities may be expanded beyond U.S. SOF to other U.S. military medical personnel, further increasing interoperability and alliance building. SOCEUR is also assisting USSOCOM to define the Special Operations Forces Baseline Interoperability Standards for medics and surgical teams. These efforts attempt to link SOF medical requirements to National Defense Strategy priorities in order to develop the force for the future, and not simply to fight the last battle. Finally, current U.S. SOF doctrine on medical support to resistance appears to have gaps in Eastern Europe’s potential operational environment, especially with regard to preparing Allies and partners to conduct resistance prior to conflict. Working with USASOC’s medical teams will help develop future iterations of doctrine in order to prepare U.S. SOF for best success in an extremely challenging environment… (continues)

Click here to download a PDF version of the article.

Urban Survival Network: Nine Important Survival Antibiotics Every Prepper Should Know

Urban Survival Network has an piece on Nine Important Survival Antibiotics Every Prepper Should Know. Someone recently quipped that there are two stages to serious gut infections: Stage One you wonder is you’re going to die, and Stage Two you wish you would die. My wife, who spent some days hospitalized because of such while in the Peace Corps, confirmed the truth of this witticism. Questionable meat/food and bad water, staples of a disaster situation as well as remote third world villages, can lead to just such circumstances. In good times, the doctor and antibiotics may only be a miserable, embarrassing few hours drive away, but in a disaster…

It often happens that preppers overlook antibiotics as a part of their preps, but these wonder meds can actually turn out to be life savers. Effective and easy to use, survival antibiotics will certainly come in handy post collapse and when you’re having to deal with an infection. To be completely honest with you, I had been blissfully unaware of the many types of antibiotics that existed until not too long ago when I developed an infectious colitis in my colon. I didn’t know about the condition until I was in excruciating pain and I went to see my doctor. This infection was triggered by a bacterial infection, and one of the causes may have been through the consumption of uncooked meat.

The situation was life-threatening and it was something I could no longer ignore – this is where antibiotics stepped in and literally saved my life. For no less than 10 days I took a cocktail of two different antibiotics (Metronidazole and Ciprofloxacin) and in less than two weeks I was back on track. I do not even want to think about what could have happened to me if I didn’t take the antibiotics. Now just put yourself in my shoes – what if you were confronted with a similar situation and were in urgent need of medication? This is why stocking up on survival antibiotics could be a serious matter.

In this article you will find the top 9 most efficient and most widely used survival antibiotics, but before we move on to describing each type it is important to understand that I am not a doctor and I am not entitled to give any medical advice. If you want professional and competent advice, I strongly recommend you to consult your doctor as he/she is the only one who can give you the details you need.

Also, it is important to understand that one should never take antibiotics for a simple cold, a small fever or a slight pain – these medications are aimed exclusively at bacterial infections and they should be taken only in case of emergency, and only when your doctor tells you to. If you take antibiotics on a constant basis, you will become immune to them and their efficiency will be decreased in the long term, which means that you will have a hard time trying to treat bacterial infections in the future.

Like any other type of medication, antibiotics may trigger some side effects – if you notice a rash, then you might be allergic to a compound in the antibiotic, and you must stop taking the medication and consult your doctor immediately. Also, the meds must be taken for as long as recommended by your doctor, even though you may feel better after only a couple of days – this does not necessarily mean you have overcome the infection completely!

In a nutshell, there is a wide range of antibiotics available on the market and they come in many different sizes, shapes and strengths. The following antibiotics can treat most bacterial infections, and for further information on antibiotics, their uses and their mechanism of action I strongly recommend you to read some medical books (many of them are available in PDF format as well). Having said that, here are (in my opinion) the top 9 most efficient survival antibiotics:

1. Cephalexyn
Cephalexyn is currently one of the most commonly used antibiotics for respiratory infections of all kind, mainly pneumonia and severe bronchitis. At the same time, doctors prescribe Cephalexyn to treat middle ear infections as well. This survival antibiotic comes with few adverse reactions and what’s most important is that it can be safely used by children as well as by pregnant women.

2. Amoxicilin
Amoxicilin has almost the same mechanism of action as Cephalexyn, keeping in mind that it is aimed at respiratory infections and it deals with the same types of bacteria. Children and pregnant women can safely take Amoxicilin to treat bacterial infections, although this survival antibiotic can trigger serious allergic reactions. If you notice any of the signs that indicate an allergic reaction, stop taking Amoxicilin and get in touch with your doctor immediately.

3. Ciprofloxacin
Ciprofloxacin can be considered an all-purpose survival antibiotic, given the fact that it can treat a wealth of infections, from infections of the prostate and the urinary tract to bronchitis, pneumonia, bacterial diarrhea and even the infectious colitis I was talking about at the beginning of the article. However, it must be mentioned that Ciprofloxacin must never be used by pregnant women and children at all costs!

4. Metronidazole
Metronidazole is widely used for the treatment of anaerobic bacteria and it is commonly used in conjunction with other survival antibiotics to treat colitis, diverticulitis and other infections of the intestines. Moreover, it is also very good for the treatment of meningitis, lung and bone infections as well as for the treatment of bacterial vaginosis. Nursing or pregnant women and children should avoid taking Metronidazole.

5. Sulfamethoxazole And Trimethoprim
This is a combination of powerful antibiotics that are especially created for urinary tract infections and respiratory infections. At the same time, this antibiotic cocktail is highly efficient against staphylococcus aureus that is resistant to Methicillin – a very strong strain of staph .

6. Ampicilin
Ampicilin is certainly one of the most popular survival drugs at the moment, because it carries a very low allergy risk and it is aimed at treating different infections like gastrointestinal infections, bacterial meningitis, infections of the respiratory tract and even the feared Anthrax.

7. Azithromycin
Azythromycin is not exactly the cheapest survival antibiotic on the market, but it is a very versatile and effective medication as it treats Syphilis, Typhoid, Chlamydia, Lyme disease and a wealth of respiratory tract infections. It has some side effects like nausea and diarrhea but they are rare, therefore it is generally safe to use.

8. Erythromycin
Erythromycin treats the well-known Lyme disease, Chlamydia, Syphilis and various infections of the respiratory system and middle ear. Nonetheless, it must be mentioned that Erythromycin can trigger several unpleasant side effects, from diarrhea and vomiting to nausea and severe abdominal pain. Even so, it is still great to have this survival antibiotic around, just in case!

9. Doxycycline
Doxycycline has the same effects as Erythromycin. Doxycycline can treat some dangerous illnesses such as Malaria or Typhus. This antibiotic must never be used by pregnant/nursing women or children. You’ll also need to drink a lot of water while on Doxycycline. This Antibiotic can be found as “Fish Cycline”, and although not intended for humans, it can still be used with little issue (unless of course expired).

Conclusion
To sum it up, you don’t need to have all 9 survival antibiotics when you travel – you only need two or three types that cover the widest variety of infections, just to stay on the safe side. They should be kept in the refrigerator to expand their lifespan (without freezing them, as this affects their efficacy). These antibiotics are cost-effective and they can save your life or the life of somebody dear to your heart, so make sure you do not neglect them! It is better to have them and not need them, than to need them and not to find them at a looted/plundered drug store.

Raconteur Report Reminds “Tourniquets Work”

From Aesop at Raconteur Report, Medical Tip: Tourniquets Work reminds you to get tourniquet training if you don’t have it already.

One of the local constabularies recently encountered Nameless Crazy Person with butcher knife in hand, agitated and in a stabby mood. Despite repeated commands, NCP refused to drop knife, and/or broke the containment bubble, whereupon officer plugged NCP. Unknown number of rounds fired, but two connected.
One to each arm. (-25 points for lousy marksmanship at knifefighting – which is knifefight dying – distance. Bonus points for unintended humanitarian efforts.)
One nicked the right outer bicep. Literally, a flesh wound. Rub some dirt on it (or, in this case, a wad of 4x4s) and walk it off. No harm, no foul.
Other round: in the stabby knife-wielding arm, 9mm or 40SW pellet entered the upraised left arm proximal to the inner elbow, and travelled along the near-horizontal upper arm, and exited just below the left armpit (axilla for medical types).
Neither round close to anything obviously vital, except…
 
Round #2, during its journey through the meaty bicep area, must obviously have punctured/torn/lacerated the L brachial artery, i.e. the one what all the blood from Mr. Heart travels in to arrive in the rest of Mr. Arm.
Result: a steady blurp-blurp-blurp of bright red blood, all over the ground.
To his everlasting credit, Constable quickly applied first an Israeli Battle Dressing to the arm of the now knifeless suspect, to whom the application of lead had reduced his crazy efforts noticeably. Which IBD application slowed the blurp-blurp nary a whit.
So, reverting to academy-standard (nowadays) training, he whipped out his CAT Tourniquet, and lashed that sucker down just like in training videos, and turned off the blurp-blurp in about 6 twists of the windlass, despite the pained response from NCP.
Medics brought NCP to our world, where our trauma nurse and trauma doc were certain that applying a TQ was waaaaaay overkill, but “Bless their hearts for doing too much instead of too little”. So, they untwisted that TQ, and were immediately rewarded with blurp-blurp-blurp of bright red arterial blood, again.
I twisted the TQ back on and tightened it, and we sent NCP directly to trauma surgery for vascular repair, so that he could continue to be crazy with two functioning arms.
And I told the paramedics and the PD officer responsible for the TQ that they’d saved an actual life with that thing, because NCP would have died at the scene in about two minutes if they hadn’t tourniquetted off the flow of arterial blood from a “mere” arm wound. Which not only saved his life, it prevented about two trees-worth of resultant officer-involved homicide paperwork.
TL;DR:
Put the effing TQ on if the bleeding doesn’t stop with pressure, and make it holy by cranking the hell out of it.
 
You needn’t carry four TQs on your body, but you have four limbs, so if you like them, and you enjoy living, you’d be well-advised to have four TQs somewhere close by, like kit/pack/bag, etc.
Not at home in your medicine cabinet 20 miles away.
When you need one (or, God forbid, more than one) it will be Right Effing NOW, and not “in twenty minutes or so”.
If you’d rather ignore that advice: Suture self.
FTR, trauma literature based on medical trauma data from Sandbox I and Sandbox II have documented applications of as long as 4 hours before removal in surgery with no residual harm of any kind to extremities as a result of the TQ application, in young, otherwise-healthy, military-aged troops. YMMV, but they are not in any way “sacrificing a limb to save a life”, anytime in the last 20 years. If you’re within that time span for arrival at definitive medical care, and it’s medically justified, it’s better to slap one on than watch your patient exsanguinate and die.
And now, refresher training for those who wish it:

“This sh*t works!” – everyone who’s ever needed one.

Thus endeth the lesson.

 

Practical Self Reliance: How to Make an Herbal Tincture

Ashley Adamant at Practical Self Reliance has another well written and highly useful article with How to Make an Herbal Tincture. As usual, more pictures and instruction through link.

Herbal tinctures are extracts made from medicinal plants, mushrooms, or lichen.  Whether made with alcohol or glycerite, homemade tinctures are a shelf-stable way to preserve the medicinal benefits of herbs for year-round use.  They’re an easy way to always have natural medicine on hand at a moment’s notice.

Homemade Yarrow Tincture (Alcohol extract of yarrow)

Homemade Yarrow Tincture (Alcohol extract of yarrow)

Making your own herbal tinctures is a deeply satisfying feeling, and once made, it’s incredibly comforting to know that you have shelf-stable herbal medicine ready whenever it’s needed.

Essentially, you’re distilling all of the therapeutic properties of any given plant material into a super-concentrated, super-powerful elixir that can be taken for any number of health concerns. Depending on the tincture in question, the benefits range from preventative to immune-boosting to sleep-inducing — all in a dropperful of herbal extract!

What you might not realize about tinctures is how easy they are to make. All you need to get started is your desired plant material, a solvent, and a solid 6 to 8 weeks for the extraction process to complete itself.

What is a Tincture?

A tincture is a concentrated herbal extract prepared with alcohol, a solvent that extracts the active medicinal compounds from alcohol-soluble plant matter. Tinctures are a means to ingest super-condensed herbal extracts for their medicinal properties.

The use of tinctures isn’t a new activity, people from all over the world have been making tinctures for thousands of years.

Today, the tincture market is rich with options. You could purchase a tincture for every ailment you can think of, but the prices are often high — especially when you’re buying multiple tinctures at once.  Usually, tinctures are around $12 to 15 an ounce, but the same medicine can be made for pennies on the dollar.

When you make your own tinctures at home you can choose the best quality ingredients to make a potent tincture, all at a fraction of the price of a store-bought version.

Homemade tinctures are made with minimal equipment, using the leaves, flowers, roots, bark, and flowers of fresh or dried herbs and mushrooms as plant material.

Tincture vs. Herbal Extract

You might notice the term “herbal extract” is sometimes used interchangeably with the word “tincture” when you’re reading up on the topic, but there is a difference between the two classifications.

A tincture is prepared using alcohol as a solvent to extract the desired compounds from plant material. Glycerite tinctures use vegetable glycerin as a solvent, and are generally considered part of the tincture family.

An herbal extract is an umbrella term that refers to plant material extracts made with various types of solvents including, but not limited to, alcohol, oil, honey, and vinegar.

How are Tinctures Used?

Depending on the particular extract you’re using, tinctures are taken orally or applied externally. Tinctures are dosed by the dropperful, and are often dropped directly under the tongue, where they’re absorbed into the bloodstream more quickly.

Different types of tinctures have different recommended dosages and means of ingestion. Bitter tinctures, which are taken to stimulate the appetite and relieve signs of digestive distress, are typically ingested 15 minutes before eating.

Some tinctures, like those made from lemon balm and motherwort, tend to be fast-acting, and are of the soothing variety.

Tinctures mades from adaptogenic and immune-boosting herbs and mushrooms, such as ginseng root or reishi mushrooms, must be taken continuously over a period of several weeks before their therapeutic benefits are apparent.

Not all tinctures are meant to be taken orally. Tinctures prepared with black walnut and yarrow are, among others, applied directly to the skin or mixed in with a carrier oil or basic lotion.

Topically-applied tinctures are used to treat everything from parasitic infection to eczema, and certain types can even be mixed in with misting sprays or face cream to add powerful herbal benefits (and at a fraction of the cost of commercially-made, herb extract-enriched beauty products).

Types of Tinctures

By definition, alcohol-based tinctures are the only “true” tincture, although some resources are laxer about this than others.  Glycerine based or Alcohol-free “tinctures” aren’t technically tinctures, but they’re often referred to by this name since they’re pretty much equivalent in terms of how they’re used.  (Technically, they’re glycerites.)

Some plant materials, such as dried mushrooms, contain high amounts of both alcohol-soluble and water-soluble compounds. When this is the case, the double extraction method is the way to go. It’s an additional step, but an easy one, and you’ll find that the result is definitely worth the (very minimal) extra time it takes.

If you prefer an alcohol-free extract, you can also make a potent glycerite tincture using vegetable glycerin — the method is almost exactly the same as a tincture with alcohol, which I’ll walk you through below.

Are Tinctures Shelf Stable?

Because tinctures are prepared with ethyl alcohol they have a naturally long shelf life. Alcohol drastically slows down natural decomposition and the growth of bacteria, so if properly stored a tincture can last for a couple of years (even longer if the alcohol is 100-proof or higher).

Never use isopropyl alcohol (rubbing alcohol), it’s toxic to ingest and therefore not suitable for making tinctures — although it can be used to make herbal liniments for external use.

All of my tinctures are made using vodka. I like to use Smirnoff because it’s relatively inexpensive, but not so cheap that it’s completely unpalatable.

Some people prefer to make their tinctures with brandy or rum — pretty much any high-test alcohol can be used. Make sure you choose alcohol that’s at least 80-proof (40 percent) for making tinctures or, if you can find it, 100-proof (50 percent) or higher to ensure safe preservation.

Once the tincture is ready to be decanted, I carefully transfer the extract to a dark amber glass bottle with a dropper and store it in a darkened location away from any light or heat sources — no need for refrigeration.

If stored with care, tinctures will maintain their potency for 2 to 3 years (with some higher alcohol preparations lasting up to 5 years).  The Herbal Academy has an excellent guide to the shelf life of herbal preparations, which has much more specific and detailed estimates, depending on how the tincture is prepared.

How to Make a Tincture

The first step when preparing a homemade tincture is to select your plant material.

One question I see regularly is in regards to using fresh or dried herbs, and if one is better than the other. The answer I would give is: there are advantages to choosing either medium!

Depending on where you live, fresh herbs can be found growing wild or in your garden, which makes them readily available. Fresh herbs have a high water content, which means they’re susceptible to spoilage if they aren’t used immediately after being picked. If you’re fortunate enough to have a surplus of fresh herbs, I would recommend drying them for later projects using this guide to preserving herbs.

If you’re making a tincture from dried herbs, you can use herbs you’ve dried yourself or you can buy the best-quality dried herbs. Dried herbs have a maximum shelf life of 2 years, if you aren’t drying the herbs yourself it’s important to find a source with rapid product turnover.

The main mechanism behind tincture-making is the same: put plant material in a jar, cover with alcohol, and let steep for several weeks. However, a little bit of finesse with herb to alcohol ratios will result in the most potent of tinctures.

For a tincture made with fresh leaves and flowers, finely chop or grind clean plant material (the goal is to expose as much surface area as possible). Fill a jar about 3/4 of the way with chopped leaves and flowers — don’t pack the jar too tightly.

Cover the contents of the jar completely with alcohol and seal with a lid.

How to Make Chickweed Tincture

Making chickweed tincture with fresh chickweed

If you’re preparing a tincture using dried leaves and flowers, you’ll want to fill a jar about 1/2 of the way full with dried plant material.  Dried herbs are more concentrated, and they absorb liquid and expand during the extraction process.  If you fill the jar completely full, your yield will be pitifully small (but intensely concentrated).

Cover the contents of the jar completely with alcohol and seal with a lid.

To make a tincture with either fresh or dried bark, berries, and/or roots, finely chop or grind the plant material to expose optimal surface area or to release the juice of berries.  Roots and bark are especially hard to extract, so increasing surface area is important.

Fill the jar 1/3 to 1/2 full with chopped bark, berries, and roots.  These materials tend to be even more concentrated and expand further than dried flowers or leaves.

Cover the contents of the jar completely with alcohol and seal with a lid.

I always use a standard canning jar, but I use a plastic mason jar lid when making tinctures. There are certain tinctures that will, over time, eat through plastic.

Most tinctures need to sit for a period of 6 to 8 weeks before they can be used, during this time the alcohol extracts beneficial alcohol-soluble compounds found in the plant material.

Store developing tinctures in a cool, dry place away from light. Give them a good shake every couple of days, keeping an eye on alcohol levels. If at any point it appears the alcohol level is getting lower, add more to the jar to completely cover the plant material to prevent unwanted mold growth.

When you’re ready to bottle your tincture, it will need to be strained first. The easiest way to do this is to line a funnel with a cheesecloth, placing the tip of the funnel directly into a dark amber glass bottle.

I often skip the cheesecloth and just use a fine mesh strainer, which is usually fine enough for most tinctures.  If you’re making a tincture with particularly fine material, like pine pollen tincture, definitely go with cheesecloth.

How to Make A Tincture without Alcohol

If you’re abstaining from alcohol for any reason you can still make a tincture using a different menstruum. A menstruum is a term that refers to the solvent chosen for making extracts.

Food Grade Vegetable Glycerine has been used as a solvent to make tinctures called glycerites for close to 200 years. It has a syrupy texture and sweet flavor, making it an excellent choice for tinctures that will be ingested by children.

Most recipes for glycerite tinctures are made with 75 percent vegetable glycerin and 25 percent water, resulting in an herbal extract with a shelf life of 14 to 24 months.

You can also use vinegar as a menstruum when preparing an herbal extract — I like to use apple cider vinegar as a solvent because it has the best taste, but almost any kind of vinegar will work. As long as the tincture is made with no less than 5 percent vinegar, it’s generally shelf-stable for a minimum of 6 months (usually longer).

Like alcohol-based solutions, tinctures made with glycerine or vinegar are made by soaking herbs or mushrooms in the menstruum for several weeks to extract therapeutic and medicinal properties.

Common Herbal Tinctures

Tinctures can be made from most types of medicinal plants or mushrooms, but the specific benefits of each herbal extract will depend on the specific herbs used.  Here are a few of the most common types of homemade herbal tinctures, along with their benefits:

Black Walnut Tincture

If you have black walnuts to harvest, a homemade black walnut tincture is a great way to use those otherwise inedible walnut husks that would normally be discarded. Black walnut tinctures are applied topically and are prized for their anti-fungal and anti-parasitic properties thanks to a natural abundance of tannins.

Tinctures made from black walnut husks are a rare source of land-based iodine, making them a good tincture to have on hand for disinfecting wounds and irritated skin.

My post about the benefits of black walnut tincture provides all the instructions you need to make your own potent tincture…

This article continues with additional specific herbal tinctures.

Doom and Bloom: Double Masking

The Altons at Doom and Bloom Medical have a post talking about the most recent recommendation for Double Masking. The mask mandate has been one of the worst handled public health campaigns that I have ever witnessed. The messaging from government health agencies at all levels has ranged from incorrect lies at worst and incompetent at best. Putting aside the deliberate prevarications at the beginning the ongoing failures are manifold:

(1) I have yet to see a campaign at any level on the proper procedure for donning and removing a mask. I should be seeing PSAs as YouTube ads, on TV, and maybe even in regular mail. Medical journal articles on the inefficacies of mask mandates often cite the lay person’s inability to wear a mask correctly, but no one has tried to remedy this.

(2) All masks are not equal. No effort has been made to educate people on this front either. Presumably government health agencies at the beginning of the crisis though something like, “There aren’t enough N95 masks to go around. How do we protect people? We can’t. Let’s just tell them to slap anything over their face.” Like unarmed national guard soldiers at airports are for security theater, we can think of this failure as health theater. Different masks and different materials offer differing levels of protection to different parties. An N95 mask is far superior than a homemade cloth mask. If any air can be sucked in around the edges of your mask, then your mask only serves to protect other people from your breath, and it is not protecting you very much if at all.

(3) Related to taking off and putting on your mask, but different, people need to be taught what to do and not do with their masks while they are on. Sucking on your mask is bad. Wearing your mask below your nose is bad. Touching the front of your mask with your hands is bad. All of those either reduce or negate the effectiveness of your mask or contaminate other body parts.

Luckily private parties before and after the pandemic started have produced videos on proper mask wearing.

Both the CDC and the Mandalorian say “This is the Way

After a year of wearing masks, the Centers for Disease Control and Prevention has decided that wearing two masks on your face is really what you should do if you want to avoid COVID-19.

Recent studies using mechanical devices that simulate breathing and generate “cough droplets” gave the alarming result that you receive only 42% protection wearing a standard surgical mask and 44% wearing a cloth mask. The researchers used 3-ply masks for the experiment. Therefore, they recommend double masking: a disposable medical mask under a cloth mask.

I have been saying all along that I felt cloth masks were not enough to provide the protection needed to avoid getting the virus. I have also said that standard surgical masks are not enough either, at least compared to the well-known N95. Still, I was surprised to see a protection rate in the low forties for both cloth and surgical masks, since the Wake Forest Institute of Regenerative Medicine published data in April 2020 suggesting that these masks gave protection rates in the 62-79 percent range.

N95 masks are supposed to give at least 95% protection against particles 3 microns in size or more. The SARS-CoV2 virus is actually smaller than that, though, so how can I say that wearing an N95 is the way to go? Is it better than the other options? Wouldn’t those tiny particles just go right through even N95s?

Studies were performed using medical workers dealing with the related (and similarly-sized) MERS virus in 2012. Results showed that those who used the N95 had less incidence of infection than those wearing lesser protection. The researchers stated that “policymakers might prefer to err on the side of caution and support recommendations for full protective equipment, including the use of N95 masks for MERS-CoV, an emerging novel respiratory virus.”

Well, in the 2020s, there’s a new novel respiratory virus (not so novel now), but the CDC has given mixed and confusing signals about mask wear since the pandemic began. They said not to buy N95 masks so that medical workers could have them.  This was in the face of a scarce supply of these masks in the Strategic National Stockpile.

Mask production has ramped up since then, but the FDA.gov website still publishes this statement: “The Centers for Disease Control and Prevention (CDC) does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19).”

They cite the importance of availability to health workers (certainly true), but then, the CDC endorsed home care for mild-moderate cases of COVID-19, cases that won’t kill you but certainly make you contagious. That made the average family caregiver a “health care worker” at risk too. The unavailability of quality masks, however, led to most people using cloth coverings or standard surgical masks.

The problem with these masks is that it’s hard to get a tight fit. The grand majority of procedure masks are fluid-resistant “melt blown” fabric secured with ear loops. They’re produced according to American Society of Testing and Materials (ASTM International) standards and designed to protect from splashes and prevent aerosol particles from getting into the air. They don’t offer a perfect seal and tend to have openings where microbes can go in or out. Not a good thing, if you’re dealing with a virus that’s airborne.

N95 masks, however, are manufactured according to standards set by another body, NIOSH (The National Institute for Occupational Safety and Health). NIOSH testing considers a “worst-case” scenario as the testing conditions are the most severe likely to be experienced by the wearer.

On top of discouraging N95 usage, the FDA issued an Emergency Use Authorization on April 18th, 2020, allowing for the production of medical face masks without fluid resistance. These may be manufactured from materials other than melt blown fabric, such as cloth. This began the cottage industry in cloth coverings encouraged by the government.

N95 mask with elastic straps

The problem with these masks is that it’s hard to get a tight fit with ear loops.  All N95 “respirator” masks are equipped with elastic straps which hold the mask tightly to the users face. The recently-reported low percentage of protection from cloth coverings and standard procedure masks could possibly be improved with training in proper mask fitting.

standard surgical mask with ear loops tied together and tucked for better fit

A good mask fit forms a seal between the mask and the person’s face, decreasing the chance of infection. One recent recommendation is to tie a knot in each ear loop as close to their attachment to the mask itself as possible, in the hopes of getting a better seal. This involves modifying each mask, and making sure to tie it properly. It’s very important to tuck in material that may represent a hole in your defenses. This method, the government says, is almost as good as wearing two masks.

Poorly tucked, a surgical mask gives poor protection even if ear loops are tied together

Also important is training on how to properly remove masks so as not to contaminate one’s hands. The front of the mask should be considered at risk for contamination and shouldn’t be touched if possible. To learn how to get a proper fit and seal for different masks, and how to properly remove them to avoid contamination, see my video from January of 2020, at the very beginning of the pandemic, where I originally discussed the importance of correct mask techniques. Click below:

Truth is, there is nothing like having the right medical equipment in normal times as well as pandemic times. If you can find N95 masks, you should invest in a supply. If you don’t have the best mask, you end up wearing two or modifying a less protective one. Next month’s CDC recommendations? Use the contact form to let me know what you think.

Chestnut School of Herbal Medicine: Growing Healing Herbs for the Home Garden – Elderberry, Lemon Balm & Rose

Written by Meghan Gemma with Juliet Blankespoor, this article from the Chestnut School of Herbal Medicine discusses Medicinal Plants:
Growing Healing Herbs for the Home Garden- Elderberry, Lemon Balm & Rose. While you are thinking of ideas for your spring garden, don’t forget the medicinal plants.

Ready to start or expand your herb garden?

Here we’re introducing medicinal, edible, and cultivation profiles for three cherished healing plants: elderberry, lemon balm, and rose. You can also find a wheelbarrow-full of articles on designing, growing, and tending a home herb garden via our Medicinal Herb Gardening Hub (and you’ll find cultivation featurettes for dozens more herbs!).

Elderberry (Sambucus nigra var. canadensis)

Elderberry (Sambucus nigra var. canadensis)

Elderberry
(Sambucus nigra, S. nigra var. canadensis, Adoxaceae)

Elderberry is an herb gardener’s reverie. Blessed with lush foliage, creamy clusters of frothy blossoms, and heavy bunches of dark fruit that beckon birds to flit and flutter between its branches, elder captures the eye and the heart. Humans are drawn to its canopy just as readily as the birds. This herbal shrub is a rich source of immune-boosting medicine, and is deeply steeped in lore; around the world, stories abound about a healing spirit said to live within the tree. She is often called the Elder Mother, Elder Lady, or Elda Mor—and she can be appealed to on behalf of the ill.1

Elder’s Medicinal Uses

Parts used: Flowers and berries
Preparations: Syrup, tincture, infusion, decoction, mead, wine, honey, shrub, and vinegar
Herbal Actions:

  • Berries:
    • Antiviral
    • Immune tonic
    • Antibacterial
    • Antioxidant
    • Antirheumatic
    • Anticatarrhal
    • Anti-inflammatory
    • Diaphoretic
    • Cardiovascular tonic
    • Diuretic
  • Flowers:
    • Antiviral
    • Anticatarrhal
    • Diaphoretic
    • Antispasmodic
    • Astringent
    • Alterative
    • Anti-inflammatory
    • Diuretic
    • Nervine

Elder is a traditional immune system tonic with significant antiviral properties. The berries are more potent than the flowers in this light, and work by strengthening cell membranes against viral penetration. Elderberry also increases the production of cytokines—chemical messengers that enhance communication between white blood cells and the body during an infection.2 You may have read concerns regarding elderberry as a possible cause of cytokine storms. My opinion is that elder is likely safe for most people, but if you’d like to read more on the topic, I recommend this article by herbalist Paul Bergner.

Elderberry is effective against many viruses, including the common cold and a broad spectrum of influenza strains (especially when taken at the first signs of illness).

The most delicious and nourishing way to imbibe elderberry’s medicine is to prepare a rich purple syrup that combines elderberry tincture, elderberry tea, and elderberry-infused honey. For children and folks who avoid alcohol, I swap out the alcohol in the tincture for apple cider vinegar. I also add liberal quantities of cinnamon (Cinnamomum verum) and ginger (Zingiber officinale). It is beyond tasty! See our video tutorial on preparing herbal honeys and syrups for more guidance.

Taken tonically, elderberry has a range of other benefits; it is anti-inflammatory for arthritic conditions, iron-rich and building to the blood, a preventative for vascular disease and atherosclerosis, and an antioxidant preventative for cancer.

Elder flowers are gently antiviral and healing for the upper respiratory system. Rich in tannins and volatile oils, they effectively dry up excessive fluids and help mucus flow more freely from the sinuses, alleviating stuffy nose, headache, and earache. In addition, their flavonoid compounds are anti-inflammatory, antioxidant, and immune-stimulating.

When taken hot, a tea or tincture of elder flower can help sweat out a cold or fever, especially when combined with other diaphoretic herbs like peppermint (Mentha x piperita) and yarrow (Achillea millefolium).

Safety and Contraindications: All parts of elder (except the flowers) contain cyanogenic glycosides (CGs) that can cause varying degrees of upset stomach—nausea, vomiting, and diarrhea. The seeds and unripe berries are the most common culprits, but any toxicity is generally neutralized by cooking or tincturing. The leaves, bark, and roots contain progressively higher levels of CGs and are more likely to cause side effects. Once the plant has been purged from the system, there is no lasting illness.

Edibility

Elderberry is an exemplary nutritive tonic food that is rich in vitamin C, minerals, and bioflavonoids. The berries are not naturally very sweet and benefit from a bit of added honey, maple syrup, or other sugar. This makes them classic for pies, cobblers, jams, syrups, homemade sodas, and meads. Try combining them with other wild berries like serviceberries (Amelanchier spp.), black cap raspberries (Rubus occidentalis), and blackberries (Rubus spp.).

Elder blossoms contain fatty acids and have an almost buttery consistency. They can be added to pancakes, banana bread, muffins, and crepes. They’re also traditional in cordials, liquors, sodas, and tea. And if a special occasion is on the horizon, you might consider looking up a recipe for elderflower champagne.

How to Grow + Gather Elderberry

In Old World Europe, elders were traditionally planted near the home or at the edge of the herb garden as a guardian and protector. In North America, Native Americans have gathered medicine from wild elders (including S. canadensis) for millennia. Given their own choice, elders will prefer a moist habitat with rich, loamy soils. To raise a lush tree or hedge, I recommend a little pampering: enrich the soil with organic matter, mulch heavily after planting to retain moisture, and water young plants frequently. Once established, they need little care. Note: elders are generally tolerant and can establish themselves in dry conditions and poor, salty, or clayey soils.

Elderberries are propagated easily from seed, and even more easily from vegetative cuttings. Follow the guidelines for taking cuttings below. (You can also order cuttings and live plants from many edible plant and permaculture nurseries.)

If you have a local stand of elders, or know someone who has planted a shrub or two, you can harvest cuttings. Be sure to gather cuttings from bushes that have tasty berries, healthy growth, and prolific fruit.

  1. Take cuttings in late winter or very early spring, before the branches have begun to leaf out. From a living branch, take several 10- to 12-inch (25 to 30 cm) cuttings with at least two pairs of leaf nodes apiece. Make an angled cut at the “root” end, about ½ inch or so below a leaf node. At the other end, make a flat cut about ½ inch above a pair of leaf nodes. Use sharp pruners that have been sterilized with hydrogen peroxide or rubbing alcohol.
  2. Apply a rooting hormone. Dust the angled ends of your cuttings with a rooting hormone. Alternately, you can try using willow (Salix spp.) tea. This will increase your success in propagating viable plants.
  3. Fill 1-gallon pots with a planting medium. You can use coarse sand or perlite. If you don’t have either of these on hand, regular potting soil (preferably without fertilizer) will be adequate.
  4. Make holes in the soil in the center of each pot using a pencil or twig and settle cuttings into the holes. Plant the cutting, burying the bottom leaf nodes about 2 inches (5 cm) below the surface of the soil. It’s fine to plant many cuttings into one large pot. Make sure to tamp the soil securely around each cutting.
  5. Water, and try to keep the cuttings consistently moist but not soaking wet. Place them in diffused sunlight until they begin to grow both roots and leaves. Harden them off by gradually introducing them to direct sunlight.

When ready, transplant the cuttings that have successfully rooted in fall or early spring. Space transplants about 6 feet (1.8 m) apart. Many transplants flower and fruit in their first year, though it may take several years before you can gather a sizable harvest.

The berries ripen in mid- to late summer and should be a deep dark purple before they are plucked. You’ll likely have competition from the birds, so be sure to check your bushes regularly. The stems of the berry clusters are considered somewhat toxic, so you’ll want to remove all of the larger stems and most of the smaller ones. If a little “stemlette” or two finds its way into your medicine, don’t fret—it won’t do any harm! Berries can be used fresh for medicine making or cooking, frozen for later use, or dried, which sweetens up their flavor.

Lemon balm (Melissa officinalis)

Lemon Balm
(Melissa officinalis, Lamiaceae)

The patron herb of bees, lemon balm encourages a bounty of sweetness in the world—not only does it gladden the heart, but it’s traditionally planted near honeybee hives to dissuade the bees from swarming (they adore lemon balm’s aroma). I know few herbalists who are without this plant in the garden. It is a traditional nervine, digestive, and antiviral ally.

Lemon Balm’s Medicinal Uses

Parts used: Leaves and flowering tops
Preparations: Infusion, tincture, vinegar, essential oil, salve, succus, pesto, and condiment

Herbal Actions:

  • Nervine
  • Carminative
  • Antiviral
  • Antidepressant
  • Diaphoretic

With bright green leaves that waft an uplifting lemony fragrance into the air, lemon balm is known to levitate the spirit. It is a brightening nervine remedy for melancholy, mild anxiety, seasonal affective disorder (SAD), and mild depression.* With relaxing, antispasmodic, and gently sedative qualities, it’s also indicated for tension headaches, stress-related insomnia, panic attacks accompanied by heart palpitations, attention-deficit/hyperactivity disorder (ADHD), and overexcitement or restlessness in children.3

I find a fragrant infusion of lemon balm to be more encouraging for downcast spirits than a tincture, but both are effective. Try blending in other gladdening herbs like rose (Rosa spp.) and tulsi (Ocimum tenuiflorum). For tonic use, you might consider adding replenishing nervines like milky oats (Avena sativa) and skullcap (Scutellaria spp.). Taken regularly, these herbs can strengthen and rehabilitate a stressed, strained, and saddened nervous system.

Like many members of the mint family, lemon balm extends its aid as a carminative herb and digestive remedy. Its high concentration of essential oils has an antispasmodic and calming effect on dyspepsia, gas, nervous indigestion, nausea, heartburn, and the pains and cramping associated with irritable bowel syndrome (IBS).4

Lemon balm is also widely used as a topical and internal antiviral herb, especially for herpes (types 1 and 2), chickenpox, shingles, mononucleosis (mono), and sixth disease (roseola).5 Internally, the tincture or strong tea will be appropriate, taken regularly. Topically, a concentrated store-bought cream is highly effective. A dab of the essential oil diluted in a carrier oil is also wonderfully relieving (note that the essential oil is very expensive).

Safety and Contraindications: Lemon balm may be contraindicated for hypothyroidism (in large or consistent doses) because it inhibits the thyroid-stimulating hormone (TSH).6

*A note here on depression: Therapies to treat mental illness are highly individualized; each person and situation is unique. People typically need therapeutic treatment beyond herbalism: this might include acupuncture, talk therapy, nutrition, supplements, or pharmaceuticals. Please do not judge yourself or anyone else for needing and seeking help, natural or otherwise!

If you’re in a dark place or considering hurting yourself, please reach out right now—there are folks who want to talk to you. And we’re in this together. You are not alone! This helpline is one option: (1-800-273-TALK).

Edibility

Lemon balm is one of my favorite nutritive kitchen herbs; its fresh and tender shoots can be added to salsas, jams, liquors, ice cream, sorbet, smoothies, pestos, finishing salts, and infused vinegars. I often chop up a handful and combine it with mint (Mentha spp.) and flower petals as a topping for tacos. Likewise, the fresh leaves can be minced and tossed into fruit salads, tabouleh, and leafy green salads. Lemon balm leaves stirred into lentils or bean dishes add a nice flavor and improve their digestibility.

The simplest way to prepare lemon balm, however, is as a summertime iced tea. It is delicious on its own or combined with herbs like calendula (Calendula officinalis), hibiscus (Hibiscus sabdariffa), and mint. I also love Dina Falconi’s recipe for Everything Lemony Lime, which blends lemon balm, lemongrass, lemon verbena, lime zest, lime juice, sea salt, and raw honey. I make this at the height of summer when all the herbs can be gathered fresh from the garden. You can find the recipe in Dina’s exquisite book, Foraging & Feasting: A Field Guide and Wild Food Cookbook.

How to Grow + Gather Lemon Balm

Lemon balm has been cultivated in medicinal gardens for over 2,000 years. Native to the Mediterranean regions of south-central Europe and the Middle East, it is a sun-loving botanical that can thrive in USDA zones 3–10.

Among the easiest culinary and medicinal herbs to grow, lemon balm is most easily propagated by root division. If you know someone who already has a patch in their garden, you might promise to bring them a plate of lemon balm shortbread cookies in exchange for a division or two. For best success, see our guide to herbal root division here.

Lemon balm is also easily started from seed. Because this plant is a light-dependent germinator (LDG), the seeds should be planted right on the surface of the soil or just barely covered. Watering will gently press them into full contact with the soil. Expect germination after 7 to 14 days.

Lemon balm prefers rich soil with a bit of moisture but will also do well in dry or sandy soils. It is a bushing herbaceous perennial and can become extravagantly lush as summer unfolds. Space plants 1–2 feet (0.3–0.6 m) apart.

If you’ve heard rumors that lemon balm wantonly sows its seeds, I have to tell you the reputation is well-deserved. Many gardeners complain about its proclivity to produce offspring that will inhabit the near and far corners of your garden (though I don’t mind this myself). If you wish to thwart lemon balm’s advance, be sure to harvest the flowering tops before they set seed (but after the bees have had an opportunity to sip their nectar!).

I like to harvest lemon balm several times throughout the growing season. You can simply cut back all of the aboveground growth when the plant is looking at its verdant peak, usually right before it flowers. The leaves and stems can be dried, but I prefer to use lemon balm fresh as its aromatic oils quickly disperse. For fresh preparation suggestions, see the Edibility section above.

Rose
(Rosa spp., Rosaceae)

As an herbalist, it took me a while to come around to rose. Growing up, my only context for its blooms were the florist-perfect, sanguine-red bouquets that emanated a cloying scent on Valentine’s Day. I had never seen an heirloom rose in the garden or buried my nose in the petals of a wild bramble. So, I held little favor for this luxuriant medicine. Years later, as a budding gardener and herbal student, I discovered—with surprise and wonder—that I love rose with all my heart.

Rose’s Medicinal Uses

Parts used: Flower buds, blossoms, and hips
Preparations: Infusion (buds and flowers), decoction (hips), tincture, oil, salve, honey, syrup, elixir, rose otto essential oil, vinegar, flower essence, hydrosol, compress, poultice, and soak
Herbal Actions:

  • Flowers and Buds:
    • Nervine
    • Astringent
    • Anti-inflammatory
    • Cardiotonic
    • Antimicrobial
    • Diuretic
    • Anticatarrhal
    • Antianxiety
    • Aphrodisiac
  • Rosehips:
    • Blood tonic
    • Nutritive tonic
    • Astringent
    • Antimicrobial

Rose is a deliciously nuanced medicine—it is ancient, paradoxical, and mythic. The Greek poetess Sappho aptly named it “Queen of the Flowers.” After all, wild roses have been rambling on the planet for at least 70 million years (compare that to the first fossil evidence of Homo sapiens appearing around 300,000 years ago).

With velvety, kitten-soft petals, rose bears a doctrine of signatures that suggests succor and soothing. Both the blossoms and unopened buds are a remedy for those who are experiencing grief or loss, or feeling tenderhearted or unloved. The benefits are amplified when combined with hawthorn blossoms (Crataegus spp.), lavender blooms, (Lavandula angustifolia), and/or mimosa flowers (Albizia julibrissin). Rose is also an ally for those in conflict—a tea, elixir, cordial, or essence of the blooms can temper anger and encourage resolution.

In children, rose can impart a sense of comfort and security. It calms irritability, fits of anger, and nightmares. A spritz of rosewater on the pillow right before bedtime is a soothing ritual and helpful measure toward sweet sleep…(continues)

Doom and Bloom: Labor and Delivery in Austere Settings

The Altons at Doom and Bloom Medical have an article on Labor and Deliver in Austere Settings. Given the topic, it is a longer article with more diagrams and visual aids than usual. Below is an abbreviated excerpt, so please click through the link to read the entire article with visual aids.

Pregnancy and childbirth are usually considered a blessing in modern times. Off the grid, however, the family medic/midwife will be thrown back to the 19th century, when childbirth was associated with a much higher rate of complications than now.

Even if the group has no women of childbearing age at present, at one point or another the medic may be called upon to attend a delivery without the benefits of a modern medical system. This article will focus on a pregnancy at term, classically defined as one that has reached 37-42 weeks from the first day of the last menstrual period. More articles on pregnancy diagnosis, care, and complications can be found at doomandbloom.net.

(Note: I am an actively-licensed Life Fellow of the College of Ob/Gyn and my wife is an actively licensed Certified Nurse Midwife.)

As the woman approaches her due date, several things happen. The fetus begins to “drop”, assuming a position deep in the pelvis. The patient’s abdomen may look different, or the “fundus” (the top of the uterus) may appear lower. As the neck of the uterus (the cervix) relaxes, the patient may notice a mucus-like discharge mixed with a little blood. This is referred to as the “bloody show” and is usually a sign that labor will occur soon, anywhere from the next few hours to a week or so.

If you examine your patient vaginally by gently inserting two fingers of a gloved hand, you’ll notice the cervix is firm like your nose when it is not ripe, but becomes soft like your lips when the due date is approaching. This softening and thinning out of the cervix is called “effacement”

Effacement is measured in percentages. When 50% effaced, the cervix is half its normal thickness and length. At 100% effacement (“completely effaced”), the cervix is paper-thin. Effacement usually occurs before any significant opening of the cervix (also called “dilation”).

Contractions will start becoming more frequent. To identify a contraction, feel the skin on the soft area of your cheek, and then touch your forehead. A contraction will feel like your forehead. False labor, Braxton-Hicks contractions, will be irregular and will go away with bed rest (especially on the left side) and hydration. If contractions are coming faster and more furious even with bed rest and hydration, it’s likely the real thing!

A gush of watery fluid from the vagina will often signify “breaking the water”, and is also a sign of impending labor and delivery. The timing will be highly variable, however, and sometimes urine leakage may confuse the situation. A product called “nitrazine paper” will turn a bright blue when it touches amniotic fluid due to its high Ph. A bright blue result (nitrazine positive) usually verifies that the bag of water is broken. If you have a microscope in the hospital tent, a little amniotic fluid on a slide will reveal fern-like crystals. This is called “ferning” and is more solid proof of membrane rupture than nitrazine positive tests.

There are three stages of labor:

FIRST STAGE (LATENT PHASE)

Latent phase

The first stage is the longest part of labor: lasting up to 20 hours or more. It begins when your cervix starts to dilate and efface, and is separated into a latent phase and an active phase. The first stage is considered complete when the cervix reaches 10 centimeters and is so effaced that you can barely identify it.

The latent phase is when labor begins. False labor has been ruled out and contractions are becoming stronger, more regularly, and in greater frequency. They may also last longer (60-90 seconds). The contractions cause your cervix to dilate and efface. In latent phase, dilation to about 4 centimeters or so often progresses slowly.

The mother should be given as much freedom to walk, sit, practice breathing techniques, or do other activities as she can handle. Keeping her occupied and moving is a good way to move the process along. A soak in a warm tub or shower is helpful if the water hasn’t broken. Oral hydration and small meals are also acceptable.

Once the cervix reaches 4 centimeters of dilation, a vaginal exam will allow you to place two (normal-sized) fingertips in the cervix. You’ll feel something firm; this is the baby’s head. In general, however, vaginal exams are invasive and shouldn’t be performed more often than, perhaps, every two hours.

FIRST STAGE (ACTIVE PHASE)

When the cervix reaches 5 centimeters or so of dilation, labor enters the active phase. Contractions get even stronger and spacing becomes closer. As the baby’s head descends, the mother may notice back pressure and bloody vaginal discharge. If the water membrane hasn’t ruptured, it will likely happen during this time.

Cervical dilation in active phase speeds up to about a centimeter an hour, although women who have had children may go much faster. Breathing techniques may be needed to manage discomfort during contractions (you won’t have epidural anesthesia or strong pain meds off the grid). Other strategies include:

-Changing positions. Some women prefer being on hands and knees to improve back pain.

-Walking between contractions with a helper.

-Emptying the bladder often.

-Gently massaging the mother’s back.

It may help to remind the mother that each contraction brings her closer to having a baby in her arms. Despite that, don’t encourage her to push until the cervix is completely dilated and the baby’s head has descended into the pelvis.

SECOND STAGE

Various position to help with contractions

The second stage of labor begins when the cervix is fully dilated and ends when the baby is born. This stage is usually completed within two hours, but is dependent on the strength and frequency of contractions. First-time mothers take longer than those who have had children.  Those who have delivered several children may proceed through this stage very quickly.

At this point, the mother will likely feel a strong urge to push. Encourage rest between contractions. When pushing, different positions may work for different mothers. Try squatting, lying on their side with a leg raised, or even hands and knees. The body should “curl into” the push as much as possible, almost exactly like have a bowel movement.

The delivery of a baby is best accomplished with the help of an experienced midwife or obstetrician, but those professionals will be hard to find in survival settings. If there is no chance of accessing modern medical care, you must prepare to perform the delivery…(continues)

Doom and Bloom: Anemia

The Altons at Doom and Bloom Medical talk about Anemia and how to recognize and deal with it in survival situations.

In survival scenarios, there are plenty of occasions where the medic will encounter a group member suffering from anemia. Anemia is a condition in which you lack enough healthy red blood cells in your circulation. Red blood cells are what make your blood, well, red; their job is to carry oxygen to your body’s tissues and carbon dioxide away. If you don’t have enough of these tiny, disc-shaped cells, it can have major effects on your health.

Red cells primarily consist of a protein made in bone marrow called hemoglobin. In men, anemia is typically defined as a hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.

Anemia happens for different reasons. Survivors in a prolonged disaster setting are unaccustomed to being off the grid, and could easily injure themselves and bleed heavily from a wound. This is the most sudden cause of severe anemia, but it can also occur from lack of production due to malnutrition or medical conditions that destroy red blood cells or shortens their life span (normally, about 115-120 days).

Depending on the cause, signs and symptoms of anemia may vary.  If your patient’s case is mild and they’ve had it for a while, their body may have accommodated to the extent that they might not have symptoms. If they do occur, they might include:

  • Fatigue
  • Weakness
  • Headache
  • Pale or yellowish skin
  • Cold hands and feet
pale inner eyelid seen in anemia

Simple blood tests could identify the problem, but won’t be available off the grid. Just checking under the lower eyelid, however, may reveal a hemoglobin deficiency. Normally, the inside of the eyelid is light red or pink; in anemia, it’s very pale or yellow. Worse cases can cause major symptoms:

  • Irregular or fast heart rates
  • Shortness of breath
  • Dizziness or lightheadedness
  • Chest pain

The worse the anemia, the less productive your group member will be, so it’s important to do everything possible to treat it and increase the hemoglobin level.

Iron deficiency is the most common cause of anemia. It’s often seen in women who are or were recently pregnant.  Heavy periods will also cause iron-deficiency anemia. Treatment usually involves oral supplements like ferrous sulfate or ferrous gluconate. The usual dose is 325 mg (65 mg of elemental iron) three times a day. Some complain of intestinal issues at that dose: dark stools, constipation, nausea, and cramps. This can take a lot out of a person, so consider a lower dose or every other day dosing in those afflicted. Be aware that caffeinated beverages may delay iron absorption, while vitamin C at 500 mg promotes it.

In addition to iron, your body needs folate (vitamin B9) and vitamin B12 to produce enough healthy red blood cells. A diet lacking in these and vitamin C can impair the production of red cells. Some people get enough B12 but can’t absorb it due to an autoimmune reaction, causing a condition called “pernicious anemia”.  Special B12 injections are given for this and other conditions.

Anemia can also be related to inflammation. Certain diseases, such as cancers like leukemia and lymphoma, AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other inflammatory ailments can lower production of red blood cells or destroy them. For these, you have to treat the main problem, a major challenge for the off-grid medic.

Another group of anemias are known as “hemolytic” (blood disintegraters). They develop when red blood cells are destroyed faster than bone marrow can replace them. You can inherit a hemolytic anemia, or you can develop it later in life.

Sickle cell anemia (sometimes called “sick-as-hell” anemia) is a type of hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal (sickle) shape instead of a disc. These irregular blood cells die prematurely, resulting in a chronic shortage. Patients, often African Americans, go into what we call “crises” that can be very painful when these abnormally shaped cells clog small blood vessels.

Hemolytic anemias can also be caused by certain drugs, which can cause the immune system to mistake your own red blood cells for foreign substances. The body responds by making antibodies to attack and destroy its own cells. Make sure your healthcare provider knows if you take any of these medicines:

  • Cephalosporins like Keflex
  • Fluoroquinolones like Levaquin
  • Penicillins
  • Nitrofurantoin (Macrodantin) and phenazopyridine (Pyridium; used for bladder infections)
  • Levodopa for Parkinson’s disease
  • Dapsone for skin disease
  • Quinidine for irregular heartbeats
  • Methyldopa for high blood pressure
  • Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs

Dietary sources of iron may be helpful, so adjust your food storage and survival garden goals accordingly. Eating a diet high in meats, especially red meats, may help. Nonmeat iron sources include:

  • Spinach and other dark green leafy vegetables
  • Peas and certain other legumes like chickpeas
  • Beans
  • Dried fruits, such as prunes, raisins, and apricots

Some foods are Iron-fortified, like certain cereals and breads. Many also have B12 added, as well. Other food sources of B12 are:

  • Meats, such as liver, beef, fish, and poultry
  • Eggs
  • Dairy products

For folic acid:

  • Spinach and other dark green leafy vegetables
  • Black-eyed peas and other dried beans
  • Beef liver
  • Eggs
  • Bananas, oranges, and related fruits and juices

As mentioned earlier, vitamin C is a tool to help absorb iron. Good sources of vitamin C can be found in many fruits as well. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.  Vegetables rich in vitamin C include tomatoes, peppers, broccoli, brussels sprouts, potatoes, and spinach.

Joe Alton MD