Monday, September 10, 2012

Guest Post: Post Peak Medicine PART 1

Here's a treat for you. Too long to be a single blog post, this essay by a family physician addresses prescription medications after societal collapse. He is working on a website (which needs work but promises to be a fabulous resource) at Post Peak Medicine.

POST PEAK MEDICINE
- Peter Gray

A subject which comes up fairly regularly in collapse-oriented discussions is “after a societal collapse or TEOTWAWKI, what will happen to people who take prescription medications?” As a family physician, this is something which I’ve been thinking about for some time, not because I think a sudden and dramatic societal collapse is particularly likely, but because it’s within the range of things which might occur in the wake of peak oil and other looming disasters of the 21st century. I feel I have an obligation to consider what it might look like from a medical perspective, and what the options might be for dealing with it, because if it happens, I’m likely to be one of the front line responders. It’s rather like, you don’t expect the guy at the next table in the restaurant to have a heart attack, but if he does, it’s good idea to know how to use the defibrillator.

There are some medications which are so critical that if patients don’t get them they are going to die within days or weeks: insulin, for example. If you are an insulin dependent diabetic and you are worried about a societal collapse, the best advice I can give you is to go and live within walking distance of an insulin-producing facility and hope for the best.

However, only a very small percentage of the population are critically dependent on life-saving medications, so I’m not going to say much more about them. What is of more interest to me, and will have a much larger impact on society generally, is how the average person on common medications is going to manage. With that in mind, I would like to introduce you to one of my patients, Average Joe. Or let’s just call him Joe for short. Joe is a fictitious patient, but I have hundreds of patients on my roster just like him, and I see several of them every day in my office.

Joe is in his late fifties and works a sedentary job at a call centre. His height is 5 feet 9 inches, he weighs 237 pounds and he has a Body Mass Index (BMI) of 35, putting him in the middle of the “obese” range. He doesn’t have any rare or immediately life-threatening diseases, but he does take the following regular medications:

Vitamin B12 injection once monthly
Zantac ( for acid reflux / indigestion)
Coversyl (a blood pressure lowering medication)
Metformin and Glyburide (pills to lower blood sugar in diabetics)
Lipitor (to lower cholesterol)
Low dose asprin (to protect against heart attacks and strokes)
Celexa (an antidepressant)
Ativan (a tranquilliser)
Temazepam (a sleeping pill)
Arthrotec (a painkiller, for arthritis)

He also has sleep apnea and uses a Continuous Positive Airways Pressure (CPAP) machine to help him breathe at night, which is electrically operated.

Because of his multiple medical conditions and medications, Joe comes to see me about once a month. Regardless of what he is coming to see me about, the fact that he seeks medical attention so often makes me concerned about his lack of resiliency in the event of a sudden collapse. If I were Joe, I wouldn’t want to come and see me every month. I’ve got better things to do with my time, and I would make every effort to cut down the frequency of my visits to the absolute minimum. But Joe seems to quite enjoy his visits here, even if I keep him waiting. It makes him feel cared for, and it’s part of the routine of his life. If his medications go away, or the Government is no longer able to pay for his visits, Joe is likely to feel disorientated, upset and angry.

So now let’s look at each of Joe’s medications and try to imagine what will happen if they suddenly become unavailable. We’ll start with the least important first.

Joe gets an injection of Vitamin B12 every month, but he really doesn’t need it and he is unlikely to suffer any ill effects if it goes away. Before starting the injections he had a borderline low B12 level, but that was probably partly due to his diet which consisted mainly of pizza, chicken wings and pop and was deficient in fresh vegetables and dairy produce, and partly due to an unrealistically high laboratory reference range for what constitutes a “normal” Vitamin B12 level. Correcting his diet will correct the deficiency (if any). The injections were started by a predecessor of mine, who decided that as he got paid $6.75 for each injection, but nothing for giving dietary advice, he would give the injections instead of the dietary advice. I suppose I could stop them, but I know Joe would be very disappointed, so I continue giving them and claiming the monthly $6.75 just like my predecessor.

Joe has acid reflux mainly because of his obesity. Slim down, and the unpleasant burning sensations will go away and he won’t need the Zantac. Joe finds it difficult to lose weight on a diet of pizza and chicken wings, but he will find it much easier once he starts growing his own food or walking to the farm gate

The same can be said of his sleep apnea machine. Sleep apnea is mainly a disease of obese people, where the fatty tissue at the back of the throat obstructs breathing during the night. Slim down, and he won’t need the machine.

Losing weight and reducing the amount of fat and salt in his diet will also help his blood pressure and cholesterol levels. Slim down, and he won’t need his Coversyl or his Lipitor.

Joe has difficulty getting to sleep at night, and a few years ago his physician put him on Temazepam sleeping pills which he has taken ever since. However, insomnia isn’t a medical illness but a lifestyle problem, caused by a combination of stress, poor sleep hygiene, lack of exercise and possibly a secondary effect of other medical conditions such as sleep apnea (see above). If his sleeping pills go away, Joe will suffer a few weeks of withdrawal symptoms which may be unpleasant but not fatal, and eventually he will settle back into a natural sleep rhythm and feel better for it.

Tomorrow: Part 2
Thanks for reading! Please leave a comment - positive or negative - and let me know your thoughts. Don't forget to subscribe to Canadian Doomer in a Reader or by email.

7 comments:

  1. What an interesting topic. I have said before that catastrophic collapse is not what I am preparing for, as my husband is type 1 diabetic and I am realistic about his fate in such a scenario.

    I have also said before that midwifery skills may become a real premium skill in certain types of future. The ability to assist in safe childbirth with women who have no possibility of reaching a hospital could really be worth its weight in gold. ( I am not advocating for hospital birth, just pointing out it might not be available in certain scenarios)

    I have a had a quick look at the fledgling website.  It occurs to me that some of the opinions and information you seek could be elicited through a poll of website visitors or a questionnaire.  As an ex nurse, I know I had some thoughts on a few of the topic areas mentioned :-).

    Looking forward to tomorrow's post.

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  2. High cholesterol is something that my husband is being treated for - and at roughly $2.35 a pill, his Crestor is a bit of a concern if we lose our coverage or otherwise need to do without. Problem is, his high cholesterol is genetic, not caused by his diet. Are there any other options for diy treatment if the worst happens?

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  3. Very interesting, I look forward to part 2

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  4. For some reason, I can't log into Blogger properly, so I can't put up a new post. I'm trying to figure out what's going on. :(

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  5. If you go to PubMed Central (the index to worldwide medical research) and type something like "herbal cholesterol" in the search box, you can find research papers about all sorts of herbs which are claimed to lower cholesterol, and what the results were.  Try this:
    http://www.ncbi.nlm.nih.gov/pubmed?term=herbal%20cholesterol

    However, it is important not to accidentally start barking up the wrong tree.  What you really want is not necessarily to lower cholesterol but to increase life expectancy, and there is some controversy about whether these things are the same, or not.

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  6. I commented on this on the day it was posted but it's not here :-(

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  7.  It didn't show up on Disqus, in Blogger, or in my email. :( Seems to have been one of those "lost in cyberspace" things. I *think* that Blogger has been doing some maintenance, which I really hope is over.

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