Walk A Mile In Your Shoes, Part 2*

Boot Selection and Common Hiking Injuries

Boot Selection

Before you walk too far–either by choice or circumstance–I’d strongly encourage you to get a good pair of hiking boots. What I believe you need (as an individual striving to be prepared) is a heavy boot made of leather, at least six inches tall, with a quality sole, and preferably with a water-proof lining. These boots will be a relatively expensive initial investment, ranging from $200 – $300. But, if well cared for, they will last for years and you (and your feet) will never regret that purchase.

A trail shoe, or light weight boot may feel very comfortable, but it won’t hold up to serious walking; especially off-trail and/or for multiple days. A heavy boot will be rigid enough to support your feet (arch and toes), will provide shock absorption for your joints (all the way up to your lower back), will provide good ankle support, and it will last.

If your feet get wet and/or cold you will be miserable. To keep your feet dry, I recommend you buy a boot with a waterproof (such as Gore-Tex) lining. To keep your feet warm, insulated boots are available. Boots insulated with 200 grams of Thinsulate will keep them warm in temperate climates, 400 – 600 grams will work well in cold climates, 1000 grams will ensure warm feet in extreme conditions.

The biggest disadvantage of a heavy boot, other than the initial cost (and the weight), is that they are stiff and require a break-in period. We’ve discussed before that you can’t  buy stuff to have ‘just in case’; this is especially true with a heavy hiking boot. You need to walk in them, start with shorter walks and build up. Figure out how to adjust and lace them up comfortably, and what kind of sock(s) to wear. As endurance improves, start going on longer walks, on dirt trails, carrying a pack.

Common Hiking Injuries

Blisters are formed when skin is damaged by friction (this is accelerated by wetness). Fluid collects between the upper layers of skin, attempting to cushion the tissue underneath and protecting it from further damage. Wet feet, poorly fitted boots, boots not properly broken in, and unconditioned feet all can result in blisters.

Shin splints–pain when you lift your toes to take a step–are frequently caused by a muscle imbalance, specifically tightness of the calf muscles and weak shin (tibialis anterior) muscles. Too quickly increasing intensity and duration of walking causes these lower leg muscles to become fatigued and makes it difficult for them to absorb the shock of the impact from each step. This impact is worse when walking uphill, downhill or on hard surfaces; wearing poor or worn-our shoes also contributes.

In addition to muscle soreness in your feet and legs, your lower back muscles can become fatigued and sore as they are forced to stabilize, along with the abdominal muscles, the upper body each step you take.

Once you throw on a pack your shoulders and neck may become sore from the additional weight. Loading a pack efficiently, with proper weight distribution, takes practice and experience. Remember to use the waist strap, and consider using the chest strap, to redistribute the weight.

We take our ability to walk for granted. We assume that if we need to we can walk as far as is required. But–in the modern, inactive, motorized world we live in–distance walking is becoming a lost skill. But it’s an easy one to regain: invest in a good pair of boots, break them in properly, and start walking.

(Friday: What I Did This Week To Prep)

*review Walk A Mile In Your Shoes, Part 1

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What I Did This Week To Prep

We planted our winter compost crop seed mix this week. The seeds arrived last week (from Bountiful Gardens), but because the ground was frozen we had to wait for warmer weather. There is a mixture of vetch, wheat, and rye, and then the fava beans are planted separately. We’ve never done this before and are not exactly sure what to expect. Will it look like just a bunch of weeds growing? And it seems strange to plan to grow stuff, just to cut it down and leave it in the dirt. I understand the concept and the experts say it’s a good idea, so the only way to fully understand it is to do it. We also sprinkled Dutch White Clover seeds on the backyard areas with less grass which, hopefully, will expand throughout the yard.

Shooting real firearms in suburbia isn’t very convenient, plus winter is frequently cold and wet when you go to the range, and ammunition quickly gets expensive. So I’m going to try using airsoft guns as an alternative way to practice and teach shooting skills. I got the idea from listening to Jack Spirko’s TSP, Becoming a Better Shooter and Trainer with Airsoft Guns (Episode 671). Last week Ryan and I went and bought a Crossman Air Mag C11 CO2 pistol, a box of CO2 cartridges, and a 2000 pellets (total cost less than $100). We came home and built a frame (8 1/2 by 11 inches), with a plywood back, lined the inside with a towel (to absorb the impact and prevent ricochet), and tacked up a normal piece of paper with a target drawn on it. We hung it on the wall and paced off ten feet. Sarah, Ryan, Alison, Emily and I took turns shooting in our custom indoor-range. I think it will be a good cost and time-saving, teaching and practice tool. Of course it’s not the real thing, but it’s the right weight and size and it allows you to practice: stance, grip/hand placement, sight alignment and sight picture, and trigger control. About the only thing missing is the loud “bang” and recoil. I’m excited about this new training venue. Once we get our skills up to a good level, we can–since it’s not a real gun and can be shot in the house–practice some “what if a stranger breaks into the house” scenarios. I think this will be a good winter activity that will allow any and all of us, who want to shoot, to have almost unlimited practice.

December 1st was yesterday. 2011 is almost over. Now is the time to reflect on our 2011 goals and either hurry up and finish, or revise as necessary. My post the last Friday of this month/year will be: What I Did This Year To Prep. Then, in early January, I’ll write: Goals For 2012. I’d encourage you to reflect back on this year and start thinking about your goals for next year.

Lastly, I wanted to link to some follow-up information regarding antibiotics in our long-term preps. From The Doom and Bloom Hour blog with Dr. Bones, a medical doctor, and his wife Nurse Amy, a Nurse Practitioner: Antibiotics And Their Use In Collapse Medicine, Part 1 and Antibiotics And Their Use In Collapse Medicine, Part 2. I applaud this couple for their diligence and determination to share life-saving material about collapse medicine. It is difficult to get good information on this topic and they are my top resource.

What did you do?

Something To Lean On

No one plans to trip and fall–especially not to fall and get hurt–but we do. It happens faster than we can say “oops”. Most of the time we quickly (or slowly) get back up, check to ensure all our parts still work, and somewhat sheepishly go on. But sometimes you either can’t get up, or it really hurts when you do.

A little while back I was thinking how difficult it would be to get around in a collapse situation with a leg injury. Trying to improvise crutches or a cane, though doable, wouldn’t be ideal. So we decided to purchase (from a thrift store) a set of crutches, a cane, and a wheelchair. So far we’ve got the crutches and a cane, hanging neatly in a corner of the garage. We haven’t found a decent wheelchair for good price yet, but when we do it’ll be folded down and hung with the others.

When an injury first happens, especially if it looks serious, everyone available helps and cares for the injured. But in the days afterward, the injury is mostly forgotten by everyone except the injured. He (or she) now has to get around and function as best they can. Injuries such as sprains and strains* are rarely crippling, but they make even minimal walking painful and difficult. Having that set of crutches or a cane (though a cane is easier to improvise, storing one takes almost no space) allows a patient to be ambulatory and more independent. In addition a wheelchair, for someone who can’t even get around on crutches, would be invaluable. Remember we’re discussing a situation where there is no other medical assistance available; a situation where you only have what you have.

This doesn’t have to be just a collapse situation. What about an injury during an ice or snow storm where it’s difficult to get out, or to have an ambulance respond? How much easier would it be if you had what was needed to allow your patient to be ambulatory? Then, when care is available, hang it back up until it’s needed again – they’re reusable.

Ryan is currently healing from an injury of his own. His involves the collar-bone and shoulder region (bike crash), so it doesn’t limit him walking around. But I was reminded how long those type of injuries take to heal, the pain associated with them, and the inconveniences they cause doing simple day-to-day activities.

The other thing I plan to add to our medical preps is a folding military-style stretcher. I thought about this again when I read Dr. Bones’ post, Thoughts on Patient Transport. A stretcher is in a somewhat different category since it’s used to carry an injured person, and may not be as necessary because it can be improvised. But we know that people are going to get hurt and that they are going to need to be moved; so we may as well prepare for it.

I know this isn’t brain surgery, but frequently we don’t think about preparing for medical injuries beyond having a first aid kit. As I’ve stressed before, in a collapse situation people who aren’t used to physical exertion will be forced to be much more active and injuries will happen – and they will happen more frequently.

(Friday: What I Did This Week To Prep)

*A sprain is an injury to a ligament (in a joint), i.e. sprained ankle; a strain (aka as ‘pulled’) is an injury to a tendon or muscle, i.e. strained, or pulled, hamstring). For first aid treatment, remember the mnemonic: P.R.I.C.E. – protect, rest, ice, compress, elevate. Crutches, a cane, or a wheelchair will help protect the injured extremity by not putting weight on it, and allow it to rest by using it as little as possible.

Expired, or Not Expired… That is the Question

What medications* do we keep in our preps? We store: 1) over-the-counter (OTC) drugs: ibuprofen (Motrin), acetaminophen (Tylenol), aspirin, diphenhydramine (Benadryl), pseudoephedrine (Sudafed), loratadine (Claritin), guaifenesin (Mucinex), and 2) antibiotics (that I recently posted about): amoxicillin, cephalexin, ciprofloxacin, doxycycline, metronidazole.

How long can they be stored? They have expiration dates, does that mean they go bad?

Let’s start with what do drug expiration dates mean? Required since 1979, the expiration date is the last date that the pharmaceutical company will guarantee 100% potency (some sources state at least 90% potency). So then we ask, how long does it take a drug to lose it’s beneficial effects?

That is the question that the Department of Defense (DOD) asked the Food and Drug Administration (FDA) in 1985 (the military had over a billion dollars worth of medication stored). So in response, in 1986, the DOD and the FDA began the Shelf Life Extension Program (SLEP).

The SLEP program is documented in the Wall Street Journal article, Many Medicines Are Potent Years Past Expiration Dates, by Laurie P. Cohen, March 28, 2000. The military submitted, and the FDA has evaluated, over 100 drugs – prescription and OTC. The results showed that about 90% of them were safe and effective well past their expiration dates, some for 10 years or longer. Joel Davis, a former FDA expiration-date compliance chief, said that with a handful of exceptions – notably nitroglycerin, insulin and some liquid antibiotics – most expired drugs are probably effective.

In light of these results, a former [FDA] director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer.

Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn’t mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

“Manufacturers put expiration dates on for marketing, rather than scientific, reasons,” said Mr. Flaherty, a pharmacist at the FDA until his retirement in 1999. “It’s not profitable for them to have products on a shelf for 10 years. They want turnover.”

The Harvard Medical School Family Health Guide, in Drug Expiration Dates – Do They Mean Anything?, notes that, with rare exceptions, “it’s true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date”.

Where and how medications are stored is an important factor in minimizing their degradation. Storing in a cool, dry, dark place will maximize their lifespan; when possible keep sealed in their original container until ready to use. Medications stored in bathroom cabinets or shelves could have effectiveness significantly reduced. Be sure to discard any pills that become discolored, turn powdery, or smell overly strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked.

Dr. Bones, from The Doom and Bloom Show, states in his blog post, The Truth About Expiration Dates, “I put forth to you this recommendation: Do not throw away medications that are in pill or capsule form after their expiration dates if you are stockpiling for a collapse. Even if a small amount of potency is lost after time, they will be of use when we no longer have the ability to mass-produce these medicines. I’m aware that this is against the conventional medical wisdom, but we may find ourselves in a situation one day where something is better than nothing.”

(Friday: What I Did This Week To Prep)

* The terms medications and drugs (referring to legal drugs) are used interchangeably.

Post Script: Dealing With The ‘Tetracycline Becomes Toxic’ Myth

There has long been a belief that the antibiotic tetracycline becomes toxic once it has past it’s expiration date.

In Medscape Today’s article, Do Medications Really Expire?, they discusses the original case, “A contested example of a rare exception [of expired drugs possibly becoming toxic] is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient.”

The case was thoroughly evaluated in the 1978 article, Tetracycline in a Renal Insufficiency: Resolution of a Therapeutic Dilemma, it states, “”Old” and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem.” It also states, “It has often been stated that the tetracyclines should be avoided in patients with severe renal disease, but, as we shall see, doxycycline represents an important exception to the rule”.

In Cohen’s article on the Shelf Life Extension Program, Many Medicines Are Potent Years Past Expiration Dates, it goes on to state, “Only one report known to the medical community linked an old drug to human toxicity. A 1963 Journal of the American Medical Association article said degraded tetracycline caused kidney damage. Even this study, though, has been challenged by other scientists. Mr. Flaherty says the Shelf Life program encountered no toxicity with tetracycline”.

Dr. Bones and Nurse Amy, from The Doom and Bloom Show, when interviewed on TSP, clearly state that tetracycline past it’s expiration date is safe (episode 736, beginning at 43:45). Nurse Amy concludes the topic with “. . . if they can just get that in their heads that tetracycline isn’t going to kill you when it’s past expiration”.

Medical evidence supports that tetracycline, past it’s expiration date–especially in the form of doxycycline–is as safe as any other expired antibiotic.

Antibiotics In Your Preps?

“The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them.” – Paul Marino The ICU Book 2007

Cellulitis

Last week in Soap and Water I posted about the risk, in a collapse situation, of an infection–from minor cuts and scrapes–known as cellulitis. I linked to Dr. Bones Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. Here’s another good article by Dr. Bones, A Doctor’s Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI. For additional perspective about antibiotics before and during a collapse I recommend comments by Dr. ‘Walker’ on TSP forum. Additional, non-prepper/collapse, antibiotic information can be found at eMedicineHealth.com.

I need to state, though I was previously certified and worked as a paramedic for almost ten years, I am currently not a medical professional of any type; thus I am not giving any professional medical advice. All the information in this post is from open internet sources. As Dr. Bones states “. . . [these] are hypothetical strategies for a post-apocalyptic setting. They are not meant to replace standard care and advice when modern medical technology and resources are available.” And always remember, the practice of medicine or dentistry without a license is illegal and punishable by law.

So with all the caveats stated:

Antibiotics refer to a substance that kills, slows or disrupts the growth of:

  • bacterial infections: caused by a pathogenic (a ‘germ’/microorganism that causes disease) bacteria
  • protozoan infections: caused by a parasitic disease, i.e. giardia which occurs through ingestion of infected fecal contaminated water or food

Antibiotics do not fight infections caused by viruses, such as: colds, flu, most coughs, and most sore throats (unless caused by strep).

Much of my information comes from Dr. Bones. I trust his advice. I applaud him; he is a medical doctor who is willing to say what he believes will save lives in a collapse situation. But as he clearly states, “[This] advice is contrary to standard medical practice, and is a strategy that is appropriate only in the event of societal collapse. If there are modern medical resources available to you, seek them out.”

As discussed in Soap and Water, describing a collapse situation, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, 2) We will be doing a lot more manual labor and other activities that can easily lead to cuts and scrapes, and 3) Clean water and basic hygiene will not be as accessible or convenient. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

Dr. Bones states in Fish Antibiotics in a Collapse, “These injuries can begin to show infection, in the form of redness, heat and swelling, within a relatively short time. Treatment of such infections, called “cellulitis”, at an early stage improves the chance that they will heal quickly and completely.  However, many rugged individualists are most likely to “tough it out” until their condition worsens and spreads to their blood.  This causes a condition known as sepsis; fever ensues as well as other problems that could eventually be life-threatening. The availability of antibiotics would allow the possibility of dealing with the issue safely and effectively.”

Having antibiotics available in a collapse situation will be very important, even lifesaving. The question is how can we as preppers obtain a stockpile to be used if other ‘medical resources’ are no longer available?

Dr. Bones continues, “After years of using [antibiotics] on fish, I decided to evaluate these drugs for their potential use in collapse situations. A close inspection of the bottles revealed that the only ingredient was the drug itself, identical to those obtained by prescription at the local pharmacy. If the bottle says FISH-MOX, for example, the sole ingredient is Amoxicillin, which is an antibiotic commonly used in humans.  There are no additional chemicals . . .”

So it seems that fish antibiotics are the same drugs as used in human antibiotics. I believe that adding fish antibiotics to my preps is a sound strategy. They are available, without a prescription, through many fish supply websites. I have purchased, or plan to purchase, the following:

  • Fish-Mox Forte (amoxicillin 500mg): used to treat infections of the ears, nose, throat, urinary tract, skin, pneumonia, and gonorrhea
  • Fish-Flex Forte (cephalexin 500mg): used to treat infections of the bone, ear, skin, urinary tract, and pneumonia; it has very low side effects, (it is typically safe for those with penicillin allergies)
  • Fish-Flox Forte (ciprofloxacin 500mg): used to treat infections of bones and joints, sinuses, skin, urinary tract, gastroenteritis (stomach ‘flu’), typhoid, plague, and anthrax
  • Aqua-Doxy (doxycycline 100mg): used to treat infections of the sinus and respiratory tract, skin (staph), urinary tract, intestines, chlamydia, anthrax, Rickettsia, Lyme disease, plague, and cholera
  • *Fish-Zole (metronidazole (Flagyl) 250mg): as an antiprotozoal, used to treat giardia and dysentery

For any medication you choose to stock (antibiotics or otherwise) print out the entire drug card and keep that information stored with the drug; a good online source of drug information is the U.S. National Library of Medicine. Also it’s always best to store them in the original package and, like food storage, keep in a dry, dark, cool place.

If you choose to add antibiotics to your preps it is your responsibility to be thoroughly educated about their usages, contradictions, doses, and side effects. This is something you can’t just buy and figure you have it if you need it. Obtain additional medical publications such as the Physicians Desk Reference (PDR) or Delmar Nurse’s Drug Handbook*. Antibiotics are drugs, taking an antibiotic is a medical treatment, do not take this lightly. When I was going through my Army medic training one of my instructors said, “Every medicine you put into the body is a toxin, be sure the benefits outweigh the risks.”

(Wednesday: Expired, or Not Expired; That Is The Question)

* There are many other good references available, these are just two examples. There is no reason to buy a current edition; older editions are much cheaper and have essentially all the information a layperson would ever need. 

Soap and Water

Minor cuts and scrapes happen from time to time. Though any open wound is a potential site for infection, we really don’t think much about the small ones other than their initial pain and the inconveniences they cause us as they heal. Most of us live in a world that is relatively safe and even minor wounds don’t happen very often. When they do, the simple steps we take to care for them plus our daily hygiene practices prevent most infections. In rare situations, when the injury becomes infected often the biggest hassle is finding the time to get to the doctor’s office for prescribed antibiotics.

But in a long-term disaster/collapse situation, a minor wound–if neglected–could become deadly. In that scenario, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, i.e. working outside, building fires, handling animals; 2) We will be doing a lot more manual labor, i.e. cutting wood, cooking over a fire, building and repairing, and other activities that can easily lead to cuts and scrapes; and 3) Clean water and basic hygiene will not be as accessible or convenient, i.e. no running water in the house. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

What is the best way to clean and care for a minor wound? Common answers frequently include hydrogen peroxide or alcohol, but not only do both of these harm the healthy tissue they can also delay wound healing. I’ve even heard someone say that ‘alcohol must be the best because it burns the most when you apply it’ – it burns because you are killing the exposed healthy tissue.

The best way to clean a minor wound, and prevent infection, is to remove all debris from the wound with cool, clean running water (this could also be poured or squirted from a container) and a mild soap. Then prior to bandaging it, lightly apply (think chapstick application) petroleum jelly on the wound. This will help the healing process by keeping the wound moist and clean and stop the bandage from sticking. Using antibiotic ointments is unnecessary, they add unneeded cost and may help create more antibiotic resistant bacteria; their main benefit is the same as the petroleum jelly.

Remember there’s a fine line between tough and stupid. The only medical aid available might be from your own group. So plan ahead to minimize injury: wear protective gloves, long pants and long sleeves, and, if appropriate, a helmet and/or goggles. When you do get a minor wound (and you will), make it a priority to clean and dress it as soon as possible. Be sure to know where the nearest first aid kit is kept, have water available for washing, and keep soap in your preps.

Even if you’ve done everything right, there’s a chance infection will occur. The type of infection common in these type wounds is cellulitis. Cellulitis, if not treated by antibiotics, “can cause a life-threatening condition known as sepsis”. This is described by Dr. Bones on his Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. I recommend reading it. Next Monday I’ll explain what I’ve learned, and recently done myself, to acquire a stockpile of ‘collapse medicine’ antibiotics.

(Friday: What I Did This Week To Prep)

One Man’s Tool

…could be another man’s weapon, or different kind of tool.

I was recently reading over a BOB list put together by a co-worker of Sarah’s (it was distributed for September National Preparedness Month). We preppers frequently look at others’ lists and compare them to what we have ourselves. As I read it through, I mentally checked off each item he listed thinking of the equivalent I had in my bag. At the end he mentioned that he keep all his stuff in a pack near his garage door, except his crowbar which he kept under the bed. Crowbar? I don’t have a crowbar. And under the bed? Oh, he’s keeping it there as a weapon…

The crowbar, in it’s current form, has been documented since the 1400s. Also known as a wrecking bar, pry bar, or by the British as a prisebar.

I decided a crowbar would be a good idea. So a trip to the hardware store and $15 later I had a 30 inch iron crowbar for my BOB.

Since we have to be prepared to carry our BOBs, it is helpful if the items we bring along have multiple uses. A crowbar can be used:

  • as a lever to move heavy items
  • to pry things apart
  • to open a damaged car door
  • to open a house door or window
  • to safely break glass
  • as a support anchor
  • as a leg splint
  • as a cane
  • to remove nails
  • as a hammer
  • as a pick axe
  • to break the hasp on a padlock
  • for smashing things

Or as a weapon. I’m not wanting to advocate or predict violence, but desperate times frequently bring out the very best or the very worst in people. I see the crowbar as a defensive weapon, holding it in two hands across your body with the curved portion on top in your dominate hand. It can be used to defend against other blunt weapons, punches, or to create a physical barrier. Offensively, if necessary, holding it the same way and striking with the curved portion using the straight end for a follow-up strike. I would avoid using it like a baseball bat because it’s heavy to swing around, and the momentum could throw you off-balance and out of position. Likely it’s just going to be a psychological weapon. If you’re standing there empty-handed, you look vulnerable; if you’re holding a relatively large crowbar, not so much.

Weight is it’s biggest disadvantage. Five pounds may not seem like much, until you have to carry it in hand for any distance. Strapping it to a pack is an option, but it’s not as accessible. I’d happily deal with the extra weight in an urban setting where I felt defenseless, but in a rural area–especially if I needed to walk for long–I’d likely leave it behind.

The humble crowbar, a tool of many uses – something I hadn’t thought to add to my kit, and now wouldn’t want to do without.

(Wednesday: Soap and Water)