From the Survival Blog
With 2014 and the enactment of
Obamacare only days away, we’re all wondering what this so-called Affordable
Care Act will really cost us. Will your premiums be higher? Or your
deductible? Will you lose employer-based coverage? Will your doctor
simply give up and retire?
But Obamacare is not all bad. I view it as a wake-up call. In fact, I wouldn’t be writing this article nor teaching people survival medicine skills if not for our current president.
People tend to blame Obamacare for all the upcoming health care woes, but many of the looming hassles (from a doctor’s point of view) were in the pipeline long before his tenure, including penalties for not using an electronic health record, the costly conversion to a new coding system, and never-ending threats of Medicare payment cuts to levels far below the cost of care.
This article is not about finding the cheapest insurance; rather, it’s about decreasing your reliance on the system and learning how to care for yourself as far as possible. What follows are seven practical ways you can save a trip to the doctor now and how you can help yourself if and when you’re on your own.
But Obamacare is not all bad. I view it as a wake-up call. In fact, I wouldn’t be writing this article nor teaching people survival medicine skills if not for our current president.
People tend to blame Obamacare for all the upcoming health care woes, but many of the looming hassles (from a doctor’s point of view) were in the pipeline long before his tenure, including penalties for not using an electronic health record, the costly conversion to a new coding system, and never-ending threats of Medicare payment cuts to levels far below the cost of care.
This article is not about finding the cheapest insurance; rather, it’s about decreasing your reliance on the system and learning how to care for yourself as far as possible. What follows are seven practical ways you can save a trip to the doctor now and how you can help yourself if and when you’re on your own.
·
Sore throats. Most sore
throats are caused by viruses, particularly when associated with hoarseness or
a cough, and thus require no antibiotics. But what if it’s strep?
Wouldn’t you love to be able to test yourself at home? It turns out you
can. The same Rapid Strep Kits used by doctors are available to you
over-the-counter at a very reasonable price. For as little as $35 you can
purchase a box of 25 test kits online, with a listed shelf life of at least 1–2
years (and likely much longer). The tests are really no more difficult
than checking your own blood sugar. Performed correctly, accuracy
(specificity and sensitivity) is on the order of 95%.
Another way to determine the
likelihood of strep throat is by the Centor Criteria. Each of four
symptoms receives a point: fever, pus on tonsils, tender glands in the
neck, and absence of cough. Then add a point for age
<15 a="" age="" for="" or="" point="" subtract="">44.
The risk of strep is determined based on total points:
0–1 <10 antibiotics="" br="" indicated="" nbsp="" no="" risk=""> 2–3 15–32% risk (consider testing, and treat if positive)
4–5 56% risk (treat with antibiotics)
Currently recommended antibiotics include penicillin and amoxicillin (250 –500 mg 3x daily for 10 days). Other possible choices are erythromycin, azithromycin, cephalexin, other cephalosporins, or Augmentin. 10>15>
The risk of strep is determined based on total points:
0–1 <10 antibiotics="" br="" indicated="" nbsp="" no="" risk=""> 2–3 15–32% risk (consider testing, and treat if positive)
4–5 56% risk (treat with antibiotics)
Currently recommended antibiotics include penicillin and amoxicillin (250 –500 mg 3x daily for 10 days). Other possible choices are erythromycin, azithromycin, cephalexin, other cephalosporins, or Augmentin.
·
Bladder infections. If you’re
getting up three times a night to urinate, are you just drinking too much water
or is it perhaps a bladder infection? Again, wouldn’t it be nice to test
yourself at home? Yet again, it turns out you can. The same test
strips doctors use are also available online (Multistix 10 SG or generic
equivalent) for $15 to $50 for a box of 100. If leukocytes (white blood
cells) and/or nitrites or blood are present in the urine, an infection is quite
likely. Treatment is directed at drinking plenty of water (aim for 8 glasses
a day) and short-term treatment (usually 3 days is sufficient) with an
antibiotic such as trimethoprim-sulfamethoxazole, ciprofloxacin, amoxicillin,
or amoxicillin-clavulanate. (This information applies to women only; men
with urinary symptoms may have an STD, prostate infection, or a kidney stone.)
·
Ankle injuries. Say your son
twists his ankle, and you wonder if it’s broken. Do you really need an
X-ray? Not as often as you might think. The Ottawa Ankle Rules give
an excellent estimate of whether or not a bone is likely broken. An ankle
X-ray is only needed if there is any pain in the malleolar zone (ankle
bones on either side) PLUS any of the following:
·
Bone tenderness along either ankle bone (right over the
bone, or up the leg 2–3 inches)
·
Inability to bear weight for 4 steps BOTH immediately after
injury AND in the ER.
If you can walk on a sprained ankle,
odds are quite slim that it is broken.
Another test is the tuning fork
test. Placing a vibrating tuning fork over a broken bone causes pain, but
not so if the ankle is simply sprained.
A presumed fractured ankle should be
splinted a few days with no weight-bearing permitted, then casted after danger
of additional swelling is past (total of 6 to 8 weeks). A sprained ankle
should be splinted as well, but with walking permitted as tolerated.
·
Poison ivy. Most people
still think poison ivy is contagious, but it’s not. And it will resolve
on its own by two weeks. Treatment is only aimed at making the patient
more comfortable (unless you’ve inhaled poison ivy smoke or rubbed it in your
eyes). So you don’t have to see a doctor for simple poison ivy, poison
oak, or poison sumac. Over-the-counter hydrocortisone cream can help (and
many people swear by jewelweed). Some doctors will call in a stronger
steroid without an appointment. OTC antihistamines help the itch
(Benadryl, Zyrtec, Claritin, Allegra), and are as strong as prescription
drugs. Of all the patients I’ve seen with poison ivy over the years, at
most 5% actually needed to see a physician.
·
Ear ache. Most ear
aches don’t require antibiotics or a trip to the doctor. A few days of
pain medication is all that is required in adults and older children with
otitis media. Physicians still prescribe antibiotics at times, but often
only to please the patient. With every rule there are exceptions:
the very ill-looking child, babies, and some children with recurrent ear
infections do benefit from antibiotics. Top antibiotic choices
include amoxicillin, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole,
cefdinir, and azithromycin.
·
GERD. Would you
rather pay $150 for the “purple pill” or $5 for its first cousin? It’s
not really amazing that a brand-name medication for acid reflux would be so
expensive, but rather that a similar generic has dropped in price so
quickly. The “purple pill” is esomeprazole, which decreases the amount of
stomach acid produced. A very similar medication, pantoprazole, does the
same job, but the generic is now dirt cheap. If you are taking
prescription Nexium, Aciphex, Prilosec, Prevacid, or Dexilant for heartburn or
acid reflux, you may want to switch to this money-saving generic.
Unfortunately, pantoprazole remains by prescription only. Second-best
inexpensive choices would be OTC generic Prevacid or Prilosec. Checking
these online today, I find prices as low as $10 for 60 count 20-mg omeprazole
(generic Prilosec) – also a great deal.
And don’t forget that heartburn can
be greatly reduced by avoiding aspirin, other anti-inflammatory drugs
(ibuprofen, naproxen), tobacco, alcohol, caffeine, spicy foods, fatty, foods,
acid foods, and too much food. (If it tastes good, don’t eat it.)
·
Diabetes. You can
learn to treat diabetes (Type 2) on your own with very little danger of
complications [if you closely monitor your blood sugar levels.] Of course, you
should begin with a reasonable diet and exercise, but beyond that certain herbs
will help a mild case (e.g. cinnamon 1 to 6 grams a day), and OTC insulin may
be required for more severe disease. Anyone can get a blood sugar monitor
without a prescription, though the test strips can be costly. You can
also obtain a test kit for hemoglobin A1C for under $10/test on Amazon and
elsewhere. Simple urine strips (see above) aid in testing your urine for
protein, ketones, and sugar. There is more information available free
online to anyone than I had access to as a medical student. Check out
aafp.org for dozens of free articles. Ideally you should work with your
own doctor now (while you can) to establish a treatment regimen you can
follow and monitor on your own when no doctor’s help is available.
When I teach my Survival Medicine classes, I tell my
students that we’re aiming at the 90%, i.e. those with typical problems – not
the 10% with severe or unusual conditions. The foregoing information does
not cover every situation, but it does apply to most, and I think 90% is a good
place to start.
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