Sunday, March 29, 2020

Plan and Be Cautious






      In September, 2003 a hurricane named Isabel came, and the resultant bad weather hit our Mid-Atlantic farm and much of our state.  Multiple large oaks blew over the gravel entrance road to our farm, and our two chain saws were insufficient to cut them up remove them.  Power poles became piles of matchsticks in the area. Power might not be restored for months, we were told. Warm winds and heavy rains continued.  On that particular farm we depended upon electricity to pump water both for animal use and for our own. We couldn't even get out to get additional bottled water.  We did well because we'd had almost two weeks notice in order to line new plastic trash cans with plastic liners from Sam's Club and to store twenty-five large new trash cans with water for the animals. We filled every water container we had for us, and we also filled three bathtubs.

              Although there was a long waiting list for tree experts who would cut and remove large trees, our neighbor found one, and asked if he could cut one large tree for us while the professionals were there. It was a good thing he did because when the tree was partially still held in the deep soil and when it was cut it snapped back, nearly killing the man doing the cutting. Afterward, with the toughest tree work done, we were able to use our chainsaws to clear and path from the farm to get out.

             At that time we owned only a small generator, and we were able to charge some things so that our kids were able to watch television. As a result, we learned that our power company was giving away a package of dry ice to each family, and a couple of large packages of water in small bottles, but that they were doing so many miles from our home.  Still, we could pick up the freebies and buy some food and extra supplies, so we happily loaded the most rugged vehicle we had and made the trip.

             We were early to the hand out, and so was everyone else.  The power company had far fewer of the items than the demand seemed to be.  The packages of water and dry ice for refrigerators went quickly.  Most of the people who showed up for the distribution were women with kids from the fairly wealthy suburb of Glen Allen.  As the supplies dwindled only to three units, women who'd arrived in Land Rovers and Mercedes Benz SUVs began to fight over bottled water and the remaining few ice packs.

             We had remained because we thought that when the initial offerings were gone, the power company might have another pallet of them, but they did not. We left immediately not wanting to get into a brawl or to have our children who'd come, witness women injuring or perhaps killing each other.

             It took only a couple of weeks without power to turn wealthy soccer moms into women who would fight over and take bottled water from another family, just like their own, while her own children actually watched. The facade of politeness or decency was completely gone.

          At the time, I wondered what they would have done is faced with a protracted emergency.  In some ways, we have a protracted emergency now.  If supplies became truly hard to find, what would soccer moms, and everyone else choose to do ?


               When you do choose to go out into the world during COVID-19, take reasonable precautions in self protection.  The mask and the gloves are a good idea. Change your clothes and take a shower, washing your hair also, on your return home.

                 Most of all understand that in difficult times, many people jump to thinking their survival is at stake, often when it isn't, and they will quickly move on to feeling justified in either out and out theft or even in looting.   Don't be paranoid, but be cautious during this time, and for many areas, the COVID-19 emergency has just begun.




 

Wednesday, February 26, 2020

As COVID-19 Spreads


COVID-19
 

           Most of my own flock knows that I have advocated preparing for two basic disaster scenarios, one is for emergencies which require family (and pet) evacuation from home, and the other is the sheltering-in-place type of emergency. No matter what the emergency, they likely fit in one of these two categories. The potential pandemic emergency fits squarely within the sheltering-in-place scenario.  Those who have followed my book, Rational Preparedness:A Primer to Preparedness, should already be prepared for such emergencies, and should perhaps only need to invest in some additional masks, and some vinyl or nitrile gloves, and perhaps some extra food for both family and for pets.


            As most of you know, COVID-19 is spreading faster than most viral respiratory infections and has triggered lockdowns and quarantines in China, Italy and other locations in the Far East and in Europe.  Sooner or later, it will spread in lesser or in greater numbers, all over the Earth.   Most of all, this pandemic will cause economic hardships and supply line difficulties from everything from medical supplies to car parts. Experts have indicated that they expect the average case to be tougher going than the flu, and that 20% of the people who develop the illness, will require hospitalization.  However, most of us will be able to manage this illness, should someone in our family contract it, by remaining at home and rendering what is normal supportive care.





What is supportive care ?


1. Control of fevers, in adults greater than 103 degrees F     (39.4 C)
                                 in children, greater than 101 degrees F  (38.3 C)

Have adequate supplies of liquid acetaminophen, and liquid ibuprofen which is especially useful for those with high fevers at night.   Aspirin may be given to adults who have no medical contraindication.

UPDATE:  Some physicians have expressed concern that anti-pyretics should not be given regularly, (around the clock) for COVID-19 infections.  This remains a complex question, and you should ask your own physician who knows your history, your other diagnoses, and allow him/her to order any anti-pyretics and to provide guidelines on frequency.  Not everyone can manage a sustained high fever either.

 This is a British authoritative paper on this matter.

  https://www.cebm.net/covid-19/managing-fever-in-adults-with-possible-or-confirmed-covid-19-in-primary-care/

 (Paracetamol is called acetaminophen in the US and in Canada)



Family members who have additional diagnoses beyond COVID-19 should speak with their physician and get guidance, and perhaps some amendments to the supportive care I have outlined here.  Those with heart failure syndromes, gastrointestinal bleeding history, Crohn's Disease, etc. should ideally not take ibuprofen without a physician's direction.

Make sure that patients are hydrated before continuing to administer OTC drugs to reduce fevers. (Such drugs are known as anti-pyretics)


2.   Maintaining hydration.

Anyone who is ill, especially babies, children and the elderly must stay hydrated.  We are seeking a state of hydration in which the patient urinates about once every two to four hours and we are looking for a yellow urine rather than a dark yellow or yellowish tea colored one.  Hydrate in order to attain this goal.

Offer, water, gatorade, varied cool drinks, ribena, glucozade (in other parts of the world) etc. Sodas are acceptable, but should be varied with plain water, and other drinks.   Coffee and tea require water for the body to process, and may not be excellent choices.

This is additional information I have created:

Dehydration and Rehydration



3.  Bedrest

Keep ill patients in their bedroom with a radio or television. Encourage them to vary their position throughout the day. They need to be sitting up at the bedside at intervals, lying down with their heads elevated, and lying down to sleep. Varying position every 1-2 hours while awake will help to avoid pneumonias, and to a lesser degree, in order to avoid blood clots in legs from immobility.  Most can walk to the bathroom.  Encourage a brief daily shower.


4.   Soft diet

Patients can eat what they may comfortably chew and swallow. Choking hazards are enhanced for those with a respiratory infection and coughing.  It is especially important that children eat something during this illness. Febrile seizures are caused by hypoglycemia, a lack of glucose for the brain in adequate amounts, and fever burns glucose.  This is the time that it's perfectly alright to feed the child a toasted frozen waffle with ice cream on it, if they will eat it.



5. Manage issues of cross contamination


Run your dishes through the dishwasher using a standard bleach based dishwashing detergent.  If you have no dishwasher, you may wash dishes in the sink using a full sink of hot soapy water with 4 capfuls of bleach added to the soapy water. Please rinse the dishes well also.


Those patients with a history of asthma or other respiratory difficulties should have their nebulizers cleaned and ready for use.  Each patient in your house who uses a nebulizer needs to have a separate nebulizer set for each family member who uses it.  Clean these sets as directed after each use in a home setting as directed.

Clean your bathrooms, wearing gloves,  each day with cleaners with bleach.  If you have more than one bathroom, you could have sick family members use one bathroom and reserve the other bathroom for family members who are well.

Glove when handling refuse or contaminated dishes. Wash your hands after removing gloves, on arriving at home from being out, or after attending to a sick person.

Double trash bag body fluids from sick family members (like used facial tissues) if they cannot be flushed down a toilet. Find an enclosed and safe place, away from people and pets for your double bagged trash. There may be value in considering separating food trash from contaminated facial tissue type trash during this emergency.


6. Continue to follow treatment guidelines for other medical problems your family members may have. 


Diabetics will still require treatment. Diabetes and many other chronic illnesses become more challenging to treat during infections. Those with other issues may see their medical problems worsen a bit during any respiratory illness or a viremia which travels through the entire body. Make sure you have contact information for any specialists your family member sees, handy.

Create a listing on one sheet of all the physicians who see your family and their phone and internet contact addresses. Call them if you need advice or strategies on either COVID-19 care or care of other issues during your COVID-19 family lockdown.


7. Develop strategies in order to obtain supplies you may not have in sufficient amount. 

This may not be as difficult as it sounds.  In towns and cities, pharmacies will deliver, and may place in a mailbox.  In rural areas, they may deliver to your porch.  Plan how you would do this, before you need to.

PRINT THESE STRATEGIES OUT, before you need them, or before the person who is normally the caregiver in your family is sick themselves.  Understand that one family member may be getting well by the time that another is becoming ill.

These directions will also work well for family influenzas.


When to contact a PHYSICIAN:

1. At the moment, you should contact your physician as soon as you suspect a viral illness, as he/she may be able to provide an antiviral medication, or depending upon your health history, an antibiotic in order to prevent a secondary infection, especially for those who are immunocompromised for some reason. Give your physician a chance to provide guidelines if possible.

2. Once you shelter at home, most people will be able to render supportive care and recover gradually from this infection.

The following complications should cause you to contact or see a physician for additional aid or advice:

1. A failure to urinate within 8 hours for a child, and 12 for an adult.
2. Weakness or coughing that prevents drinking fluids about every couple of hours while awake.
3. Very rapid respirations or blue tint to fingers, lips, toes etc.
4. Weakness that prevents the patient from being able to get up to go to the bathroom.
5. A complete inability to eat, even apple sauce, for 24 hours.
6. More than three episodes of diarrhea within 24 hours.
7. The onset of severe wheezing, or signs that patient is worsening from a respiratory standpoint. This includes the sound of "water" in lungs as the patient breaths, rapid respirations, or an inability of the patient to manage their secretions sufficiently to breath. An increase in anxiety may also be a sign and symptom of a respiratory deterioration. Smokers may be at higher risk than non-smokers here.
8. A persistent fever in a child or an adult, that exceeds 101F  (38.6 C) in a child, or 103F (39.4) in an adult and that does not respond well when treated with acetaminophen, or ibuprofen.  NEVER GIVE ASPIRIN TO A CHILD OR ANYONE UNDER 18 YEARS WITHOUT A SPECIFIC PHYSICIAN'S ORDER TO DO SO.

If you have questions, call your physician.



The prior page is a guide in order to aid planning for the potential need to shelter in place due to a local COVID-19 infection. It is not designed to provide medical advice or to substitute for telephone or actual examination by a physician.


Supplemental information:

Rehydration and different animal species       (Animals do occasionally become ill when their human families do also.)



IMPORTANT:   Do not relinquish or abandon any of your animals. They cannot communicate COVID-19 to you, and if you abandon them, they will be euthanized as no one is adopting animals at this time. In fact, many animal shelters are closed to the public for adoptions in order to prevent person to person communication of the virus.



 UPDATE:  The purpose of this post is to define what constitutes supportive care for patients with uncomplicated viral illnesses. The moment your infection deviates from the expected course from a standpoint of fever, pain, etc., a licensed physician who knows all of your prior history and your meds, should be the one making modifications to your practices.  Please phone your physician first and let him/her make modifications in what you are doing, or make arrangements to see you.


Tuesday, January 28, 2020

Concerning Home Rapid Blood Typing Tests

          




         Recently, some of you have been asking me about the accuracy of the home blood typing kits, available on Amazon, etc.  According to physicians with whom I have spoken, the tests are highly accurate with common blood types, possibly as high as 99%.   However, there have been problems and inaccuracies when rare blood types have been tested in this manner. These tests can determine the A,B,AB, or O status, and also the Rh factor presence or absence.

              It used to be that when a child was born, the pediatrician would write the child's blood type on the paperwork that went home with the parents.  This is apparently no longer being done, and parents, are therefore curious.   Please know that normally when someone needs blood, they are immediately typed and cross matched and their blood is tested for compatibility with the units that the hospital expects to give them.   A plasma expander may be given while waiting for this process to be completed, and sometimes a unit of O negative, the universal donor is given while the patient is waiting.  Even if you know your blood type, that process does not change. No one is going to take your word for your blood type.

              This said, I do understand and sympathize with families who would like to know their family members blood types.  In a family I know, the father has the same blood type as the daughters, and the mother has the same blood type as the sons.  In an emergency, this might be important information to have, although only very rarely now, does someone donate blood that winds up being administered to a family member.

               Please know that if you are seeking to confirm a child's parentage that this is not the way to go.  A child doesn't always have the blood type of either of his parents, as he may have a type for which both of his parents have a recessive gene. If DNA testing is what you need, then ask your physician. I don't know how accurate the home tests for that really are.





Saturday, November 16, 2019

Considering Buying a Property With a Conservation Easement ?

              






         On the surface, buying a large property, a farm, or other large acreage for a potentially reduced price sounds like a great idea. After all, it's more acreage than you have now, or you wouldn't be considering it. But what does it mean, now and in the future, for you, the property and for your own inheritees ?  Should you BUY a property than is already in a permanent conservation easement ?

                   A conservation easement is something you can decide to legally draft paperwork at an attorneys, in order to implement.  The benefit is that you are legally agreeing not to develop the land, now or in the future, and to preserve the land as it is. The benefit is that your land afterward, will be worth much less. Your taxes may be worth much less. You may also obliterate the possibility of your children or other inheritees from paying inheritance tax, by lowering the value of your large acreage. This choice may make it much more possible for your family to keep the farm or acreage intact and within the family. Sometimes, there are other significant tax advantages in addition.

                 If you are considering buying a property that is already within a conservation easement, then make sure that you have the Contract that specifically runs with the piece of land in question, and that you, and your attorney understand it.  Such Contracts are not identical and could prevent you from doing something you wish to do with the land in the future.  For example, some Contracts might allow you to construct barns in places where they already exist, but may not allow you to build additional barns. The Contract might restrict the types of farming you could do, even though you might be allowed to continue to timber when selected stands are mature and ready for it. Do not buy a conservation easement property without understanding the specific contract as it applies to the land you intend to purchase.

               If you are considering placing land you already own within a conservation easement, make sure you use an attorney who is well versed in this type of law. Secondly, think of your access and rights to the land as parcels of sticks. There are some parcels of sticks you wish to keep, and then others you might wish to agree to forego in order to reduce your property value and your taxes.  For example, I might not have any trouble agreeing never to mine uranium on my farm, since I would never do it anyway. I might not feel that way about other mineral rights that could be safer to extract though.

               Some of the negatives might be that a conservation easement is perpetual. It may be able to be amended, but it cannot be terminated.  Future owners or even your inheritees may curse your choice to place the property in a conservation easement because a property that could have been worth millions developed, might simply exist to preserve a habitat for animals, and to preserve wetlands.

            Not all properties qualify for such a thing. A sharp tax accountant and an attorney skilled in drafting conservation easements is a MUST when considering placing your own property in one.

           If you are considering purchasing a property that is already within a conservation easement, then don't let anyone rush you. Have your realtor obtain the recorded copy of the easement for THAT property. If you wish to hunt on your own large acreage, make sure the easement permits that.  Make sure you understand ALL of the restrictions on the property you are buying, because they will not be changing.  Even when the original owner has died, the restrictions will remain in full force.  Don't buy such a property unless you truly agree with the restrictions and the reasons for such.

           Remember also that if you buy a large acreage property or farm with a conservation easement,that even if you bought it reasonably, that your children will never be able to sell it for its true value when you leave it to them. In a sense, it's Deed will always be restricted in terms of its possible uses, by the fact that it is held under a conservation easement.  These are the reasons that I recently declined to purchase a particular large acreage parcel myself.



More information:

https://murraywiseassociates.com/conservation-easements-some-things-to-think-about/

https://www.taxnotes.com/tax-notes-federal/appraisals-and-valuations/conservation-easements-21st-century-abusive-tax-shelter/2018/06/04/282g5?utm_term=&utm_source=adwords&utm_campaign=Dynamic+Search&utm_medium=ppc&hsa_src=g&hsa_acc=3287128132&hsa_ver=3&hsa_mt=b&hsa_tgt=dsa-761510096127&hsa_grp=71740048255&hsa_kw=&hsa_cam=2022302601&hsa_net=adwords&hsa_ad=354560513493&gclid=EAIaIQobChMIoL7HwM3v5QIVibWzCh3dRQc6EAMYASAAEgIFX_D_BwE

 https://www.landtrustalliance.org/news/adverse-possession-land-whose-land


"The Granite Rock" Has Been Released




              I am really pleased to announce the release of my sixth book, and third novel, "The Granite Rock".   This book traces the story of a psychiatrist and his wife, a psychologist, who discover a natural phenomenon which facilitates short term time travel.

              The book has just be released and is available both electronically and in softcover form at:

https://booklocker.com/books/10664.html


            In the weeks which follow, the book will be available on Amazon and at other fine booksellers worldwide, and in a variety of electronic versions.

          You can learn more about "The Granite Rock" at its blog at:

https://graniterocknovel.blogspot.com





Monday, October 28, 2019

An Alternative Treatment for Aneurysms

                

Many aneurysms are very small, but you get the idea here.





           Some years ago, during about a break of about a week in college, one of my friends, developed a severe headache, and before the day was over, had surgery for a bleeding aneurysm, in a community hospital.  As a nursing major, I was flabbergasted that he'd left for the holiday, and almost immediately developed an almost blinding headache while driving, and chosen to go to the ER. From there, a neurosurgeon saw him and off he went for an aneurysm clipping, which is certainly brain surgery. A couple of weeks later, once back in school, he seemed fine, if perhaps a little more outgoing following his near brush with death. He continued to do well afterward.

                      The clipping of an aneurysm, using a metallic clip of some design, is the surgery with which most of us are familiar. An aneurysm is a bubble in the arterial system of the brain, that can either remain small and often undetected for many years. Most aneurysms are in fact detected when a CT or an MRI is done for some other reason entirely.  A bleeding aneurysm can be very dangerous. A bleeding aneurysm carries with it a 40% chance of death and an 80% chance of disability.  In addition to releasing blood in a closed space, a ruptured aneurysm can cause a vasospasm or narrowing of an artery of the brain, and this complication can also be devastating, and this alone may cause death.

                     At one time, the permanent clipping of an aneurysm was the only treatment for it. However, in about 1991, neurosurgeons found that they could treat some aneurysms using a "minimally invasive technique".  In a hospital suite, they found they could insert a lengthy and fairly large catheter into the arteries of the groin and thread them up toward the patient's brain.  Since many aneurysms patient to patient, occur in similar locations, techniques to access them from the inside were mastered.  Neurosurgeons who specialized in this technique found that using fluoroscopy allowed them to track the progress of floating the catheter, and that by depositing very thin platinum wires, either interrupted or continuously, inside the aneurysm itself, they could cause it to clot off, seal and become very unlikely to leak in future.  At first, this allowed a different technique to be used for patients who simply weren't well enough for brain surgery.  The technique was also only used for specially selected or aneurysms, at that time.

                   In the present day, the medical literature still considers the interior embolization of aneurysms to be a slightly less effective modality than clipping the aneurysm from the outside.  However, this may not be true for much longer.  Enough of these types of embolization, coiling or stenting of aneurysms has been done so that data can be studied.  It seems that some neurosurgeons who perform this technique have never had an aneurysm leak or rupture following their platinum wire coiling of it.  In fact, almost all aneurysms may be potentially treated using the minimally invasive method as described under present US medical standards.

                   What can you do to avoid aneurysms ?  The ones that are simply a genetic weakness and error don't give us much of a chance to avoid them. However, the aneurysms that we acquired as adults from untreated or poorly treated hypertension or high blood pressure, could potentially be avoided.

                 A patient who has an embolization may be given general anesthesia. Often though, they are medicated, but are awake and cooperative through the procedure. Please know that even if a patient has an aneurysm embolization that they will still remain in ICU for about a day after the procedure. They will still need follow up.  They should still have a follow up examination every year or more with their neurosurgeon on the timetable he/she recommends.  However, the less invasive procedure should take less time, be safer, cheaper, and should get you or your loved one back to work and functioning again more quickly that brain surgery would.

                  Yes, this is the kind of procedure most survivalists would choose !


 http://brainavm.oci.utoronto.ca/malformations/embo_treat_aneurysm_index.htm