Emergency drugs?

[chris smead]

Last month I had an infected hangnail, and an infected tooth that needed a root canal.
(Rough month)
Both crept up overnight, and were horribly painful. Ibuprofen only helped a little.

Luckily In both situations I was close to a doctor/dentist. But it got me thinking about the times when I'm in the backcountry, several days away from help.
I would be nice to get some antibiotics, and prescription painkillers like Percocet.

Has anyone asked their doctor for these? How did it go? Did they look at you like a crack addict?

[Bob Gross]

In the past, I have requested prescriptions from my physician when I was going off to some third-world country and I would be a long way away from any first-class medical care or drugs.

I generally request one broad-spectrum antibiotic such as Bactrim/Cipro, one prescription strength painkiller (minimum Tylenol-codeine), and often Diamox for high altitude. I have encountered some resistance from the physician, but not for the reasons you might expect. He was resistant to Diamox because he thought of it only for treatment of some heart disease, and he was not familiar with it for high altitude illnesses. That was way back in 1997, so I will cut him some slack on that one. The other two were no problem, as long as you can explain why you want them and under what circumstances you would take them. Often the physician can suggest a drug somewhat better than what you had in mind. My current physician and I have a good rapport, so I can simply call him and he will send the prescription message to the pharmacy without ever seeing me.

Strangely, I have given away much more Diamox than I have ever consumed, and I gave it away to a mountain guide. Go figure.

Now when I am out solo in the Sierra Nevada, I will carry some old leftovers from these prescriptions, but I would consume them only in a dire emergency. Some of this stuff goes stale quickly.

Flagyl would be another drug to think about.

–B.G.–

[Mike W]

I carry antibiotics and prescription pain killers. I don't have any problem getting the prescriptions but my doctor knows me very well. It would be a different story if I tried to get them at a drop in clinic.

My doctor "gets it" and prescribes an antibiotic and pain killer that is appropriate for a backcountry FAK. He gives me a broad spectrum antibiotic (although primarily for infected blisters) that is inexpensive and has a long shelf life. When you fill your prescrption, ask the pharmacist to put the expiration date on the prescription. When I need a repeat (hopefully when it expires), I bring in the expired prescription so that he can see that I'm not abusing it and that it "is" being used for my FAK.

[Anonymous]

"I would be nice to get some antibiotics, and prescription painkillers like Percocet."

I get them from my docs whenever the last Rx expires. No problem with either antibiotic or hydrocodone(generic Vicodin) so far. I think a lot depends on your rapport with your doc, and how you present your case. Doesn't hurt to ask. One thing to consider: Cipro and other fluoroquinolones make you sensitive to sunlight and also can predispose you to Achilles tendon rupture, a serious risk if you have a long way to hike out over rough terrain. Maybe something like Bactrim or its generic, SMZ/TMP, or whatever your doc suggests.

[Michael Gunderloy]

Four kids, two adults with various issues = we've always got spare Percocets or equivalent around. ERs hand them out like candy, at least around here.

The one thing I've considered asking my doc for is an Epipen. Not for me or mine – but there are too many times I'm out with Boy Scout units, hours from help, with boys who have never been stung and therefore don't know their allergy status.

[Anonymous]

What we need is a miracle drug.

https://www.youtube.com/watch?v=J2S8r2gJ1ZU

[rowan !]

Someone who has never been exposed to a sting won't have an allergic reaction, because it takes at least one exposure to induce an allergic sensitivity. But once an individual has been stung, they can develop allergic reactions on any subsequent exposure. It's even possible to have a sudden onset of allergy after many uneventful exposures.

[Eric Blumensaadt]

… but they are ONLY for me. Oxicodone and wide spectrum antibiotics that I renew every year – and properly dispose of every year – NOT down the toilet.

I also carry throat lozenges with benzocaine for sore throats and toothaches. And of course Ibuprofen and Alleve (that great "IBleeve" combo) for self-medication of pain.

At my advanced age I am all for "short-suffering" if I must suffer. No hair shirts for me.

[Stephen M]

I asked my Doctor for Diamox and she didn't have a clue what I was asking for.

Next visit I am going to ask for a strong pain killer.

[Alexander S]

Taking an antibiotic for an unknown infection is not the best plan if you don't know whether or not the pathogen is even susceptible. You may end up just as infected and without your normal flora of intestinal bacteria (you don't want that). "Broad Spectrum" does not necessarily mean what it sounds like.

As far as pain management is concerened, your physician may agree to a limited prescription, enough to take along on travels. Keep in mind that Ultram is easier to get and works great for emergency pain management.

Remember that if you are crossing into Mexico or Canada and have narcotics on you without a prescription, you are smuggling drugs.

All prescriptions should be filled and picked up just prior to the trip because drugs and especially antibiotics degrade quickly.

If your physician knows and trusts you, you'll prolly get what you need.

[Anonymous]

"
At my advanced age I am all for "short-suffering" if I must suffer. No hair shirts for me."

+1 A basic insight gained thru the experience that comes with age is that there is no glory in pain.

[Ross Bale]

Going to have a lot more luck getting the latter unless you have a bad MD or good rapport with a good one. Vicodin seems like a more appropriate Rx for most of us narcotic naive types.

[cody yochum]

I am surprised at those carrying antiobiotics? Kind of seems like a pack your fears type of deal. Are you that far from a physician that will require carrying such a drug? I seriously hope those who are carrying antiobiotics are not using them without medical advice. And I am shocked MD's hand them out. That is how we create antiobiotic resistance.

[chris smead]

Not to derail my own thread…but that Epipen comment got me thinking.
Turns out I just hung out with an EMT/fire captain this weekend, and he said Epipens save lives…however are are short lived. He's seen them wear off in as little as 20 minutes….but it depends on the person and the reaction.
When factoring that into the backcountry equation he suggested lots of Benadryl on top of the Epipen for major reactions, and just get help asap. So maybe worth carrying.

Also, not to rehash an old topic, but I asked him about snake bites. He said in the city…don't cut and suck…that will make it worse. You should get to an ER within a few hours or you could lose a limb. We've all heard that.
But if you're days away from help…that's a tough one…but he would probably cut/suck…but don't use your mouth…as you can poison yourself via your mouth, and introduce bacteria into your wound. He said not to use a tourniquet. It will just cause more tissue damage.

I'm thinking I'd take my sawyer squeeze backflush syringe, cut off the tip, and use it to suck out poison.
Then drench it all in iodine and stay put until help arrives.

While most are dry bites…he said don't risk it and get help asap. Spot beacon is ok….satellite phone is preferred.
Don't try to walk out unless you are very close to the TH.

[Bob Gross]

"I am surprised at those carrying antiobiotics?"

Cody, if you read the entire thread, we were not advocating carrying antibiotics on every backpacking trip. As I mentioned, sometimes we are going to third-world countries to places where we will be completely off the grid for weeks, and we really can't expect any form of professional medical advice or treatment.

My physician is savvy enough to discern between an ordinary patient and somebody with some mountain medicine training.

One particular river in Nepal I remember well. We were told by the Sherpa guides that it was a sacred river. If we even touched the water, it would make the river gods mad and we would get very bad luck. Well, actually, the river was fairly well contaminated by upstream villages, so the bad luck was probably in the form of illness. GI distress would follow. Immodium was the first course of treatment, and the broad spectrum antibiotic was the second course if Immodium didn't fix it in a couple of days.

–B.G.–

[chris smead]

I'm certainly no doctor or drug expert…and yeah I've heard antibiotics being overprescribed is bad…so you probably have a good point.
All I know is that when I had an infected hangnail…it swelled up twice it's normal size and felt like someone was squishing it with pliers. 24 hours after starting an antibiotic it was better. So if I could add some pills to my FAK for extended trips…heck yeah I'd do it.
And yes…I admit I'm a pansy for whining about a hangnail. ;)

[Ian]

I go to my travel clinic and receive antibiotics to fight off stomach bugs. Normally its Cipro but they gave me something else for India; forgot which one though.

Won't go too far into the weeds with stomach maladies but I take a pepto pill every night prophylacticly. At the first sign of trouble, I start taking the cipro and immodium.

I've never been further away than a day or two from help here in the US so I don't self medicate antibiotics.

I also don't understand the need for narcotics when you can mix and match OTC painkillers, safely, to achieve the same effect. We would take 800mg Motrin, aka Ranger or Grunt candy, combined with "drink water" and "change your socks" there was very little it would not fix. As previously mentioned, make sure you have the script when carrying narcotics or you may find yourself charged with a felony. My guess is doing time in Pakistan isn't all that fun.

[Bob Bankhead]

The best way to carry a prescription drug is in the original pharmacy bottle with the label on it. If you re-package the drug for whatever reason, carry a copy of the prescription with you.

Perhaps more important, IT IS ILLEGAL TO GIVE YOUR PRESCRIPTION DRUG TO ANYONE ELSE, unless you are normally licensed to do so (i.e. a doctor, dentist, or nurse practitioner). Without knowledge of the recipient's possible allergies, other meds being taken, and medical conditions, you could be risking their life and your freedom in a well-intended effort to help. Just hope you never have to face that possibility.

Be sure you know when and when NOT to take a given drug, as well as the maximum safe daily dosage.

For example, ibuprofin has a maximum daily dosage of 2400 mg; that's 12 200 mg OTC tablets (6 doses of 2 tablets each). There are also 800 mg tablets available only by prescription.

[Ian]

Good point Bob. Don't take more than the daily dosage on the bottle without talking to a Dr. first.

[Mike W]

To clear up a few concerns people have about carrying antibiotics in your FAK, I'd like to point out that the OP specifically mentioned his hangnail becoming infected very quickly. He is not recommending that you treat cold, flu or other maladies with antibiotics while on the trail. If you've ever had an infected blister, cut or bite (or hangnail), you will know it. It's not a tough diagnosis.

Antibiotic resistance is caused by overuse or misuse. If you carry antibiotics in your FAK for emergencies only, it's unlikely that they will ever get used. If you do need to take them then finish the entire prescription. Taking them for a few days until you think you are better and then stopping is one of the scenarios that creates resistant bacteria. Chances are they will just sit in your kit and never be needed, but if you do ever need them, you will be thankful that you have them.

Not all antibiotics have a short shelf life. I saw my doctor before the summer and got my prescription renewed and it's expiration date is July 2017. Once again, talk to your doctor and explain why you want the antibiotics. This will allow him to prescribe something that is suitable for a FAK.

[Sarah Kirkconnell]

I carry a double set of Epi-Pen Jr's for my youngest son. No matter where I am at. I also carry a full bottle of Benadryl as well. I have used an Epi-Pen before, and yes, it does amazing work. The method that is recommended by my son's allergist dr and regular doctor is Benadryl in mild issues (flushed face, itching). Give it and watch carefully. Epi-Pens are for when the &^%$ goes down. Having seen my son go into anaphylaxis twice, once you see it, you know what to watch for. Anytime there are hives, puffing up, where the person cannot breathe right, they must be injected – and then given a dose of Benadryl immediately after. Two Epi-Pens can be given, if the first wears off – but directions MUST be followed. With Epi-Pens, the patient MUST be taken to emergency care immediately. This affected me a lot last year with taking him hiking – because I didn't feel safe enough to take him with me. I have overcome much of that fear, with him now being over 2 years old.

There are 2 versions of Epi-Pens: adult and jr, which have different doses. They should not be stored in cars. They must be kept at a normal temperature, not refrigerated nor hot. They are not cheap I can tell you. I get 2 sets of 2 each year (one for a home e-med kit and one for on the go). While my insurance covers all of it for one kit, the second kit I have to sign that "we need it" and pay a co-pay. Cash price is….. $453 PER KIT.

Having said that, an Epi-Pen saved his life after finding out he was allergic to cashews. I'd pay cash if I had to. They are a miracle with a needle if you need one.

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