Tuesday, August 13, 2019

Appendicitis--Prepping for the Possibility in a Post-Apocalyptic World

Disclaimer.  I am not a licensed health practitioner.  This is just another post on an item you might wish to have available if needed so that a physician can treat you and your family as best as possible.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment.

I have thoroughly enjoyed all the off-grid medicine classes I've attended.  The doctors teaching these courses have been professional and at the same time practical, down-to-earth people who have a pretty good idea that at some point our medical system and our society are totally going to collapse.  Of course, most of the students in these classes hold the same view, but a great number of them seem to be fixated on the less likely problems.  They want to know how to deal with gunshot wounds, when and how to amputate, how to treat a pneumothorax, how to perform an appendectomy, and how to do it all while under gunfire.  Of course, it is good to know all these things, but most of them aren't really likely to be needed.  How many people do you know that have had any of the above?

Yeah, with the exception of the appendectomy, you may not know anyone.  However, there is that matter of appendicitis.  And you're pretty sure it can be fatal.  How common is it, actually?

Just over 1% of all hospitalizations in the US are for appendicitis.  Nearly 12% of all hospitalizations for gastrointestinal problems are related to appendicitis.  So maybe those numbers aren't so concerning.  But let's look at some other numbers.

Keep in mind that appendicitis can happen to anybody, but is most common in those under the age of 40.  About seven percent of the US population has or will have appendicitis and the resulting appendectomy.  That number is a little more disconcerting, especially when science has yet to determine if there are any behaviors or foods that are risk factors for developing appendicitis.  You can't do anything to prevent it if you don't know what to do.

Appendicitis is more common in males than females, by about 40%.  Appendicitis rates are 50% higher for whites than for non-whites.  The majority of cases, 74%, occur in people between the ages of 5 and 34 years, with most cases occurring in 10-19 year olds.  Oh, and to make the numbers even more interesting, the rates of appendicitis are 11% higher in summer than in winter, and there is a higher incidence of appendicitis cases in the west north central region of the US.  ("[W]est north central" is exactly how the article worded it--sounds like Eastern Washington and Eastern Oregon, Idaho, and Northern Nevada and Northern Utah to me.)

Doctors have been performing appendectomies for over 100 years.  It's one of the first surgeries budding surgeons ever do, and supposedly pretty simple and easy to learn.  For most of the last 100 years, doctors have routinely advised appendectomies for their patients with appendicitis, but recently this habit has come under scrutiny.  More and more, especially in Europe, doctors are using antibiotics in an effort to resolve uncomplicated appendicitis and prevent the need for surgery.

Unfortunately, without lab equipment, it's going to be difficult to determine whether appendicitis is complicated and likely to lead to a rupture of the appendix, or whether antibiotics alone should do the job.  One study showed that in cases of mild to moderate appendicitis, antibiotics were effective about 88% of the time.  However, in about 24% of these patients there was a recurrence of appendicitis, with most of these recurrences occurring within one year, and surgery was undertaken.

So while antibiotics may not be a perfect solution for appendicitis, they may buy you some time in being able to procure supplies, or hopefully until you can get to a functioning hospital, or until some normalcy of life returns.

Without a functioning medical system, and without a medical degree, how are you going to determine whether a family member has appendicitis?

Usually appendicitis begins with a vague discomfort in the area of the belly button.  It then moves to the lower right section of the abdomen, about two-thirds of the way from the navel to the top of the right pelvic bone, within 12-24 hours. 

Other common symptoms include:
  • nausea and vomiting
  • loss of appetite
  • fever and chills
  • abdominal swelling
  • pain that worsens when walking
A patient with appendicitis will move as if he is walking on eggshells, as any movement of the legs causes movement of the abdominal muscles.  If you are suspecting appendicitis at this point, continue with this test to get a better idea of what is going on:
  • Press down on the lower right section of the abdomen.  Someone with appendicitis should find this painful.  
  • Now press on the same spot but on the left side of the abdomen.  Does this also cause pain on the right side?  
  • And finally, for an idea of whether the appendix has ruptured, press down again on the right side.  Does it hurt even more when you release the pressure?  If so, there's a greater likelihood that the appendix has ruptured.

Two other diagnostic tests to conduct:
  • Ask the patient to hop on his right leg.  If there is a significant increase in pain, appendicitis is likely.
  • Have the patient lie flat on a bed or table.  Ask the patient to raise the right leg.  If this causes pain in the right lower quadrant, appendicitis is likely.  

Per Dr. Joe Alton of The Survival Medicine Handbook, the patient should be restricted to small amounts of clear liquids as soon as appendicitis is diagnosed.  Surgery in a medical facility is the best option for most people.  But if it really is not an option:
  • IV antibiotics, like cefoxitin, for at least three days, followed by oral antibiotics for 8-10 days, have the best outcome.
  • A combination of ciprofloxacin and metronidazole may work, and would be especially indicated for those allergic to penicillins.  Dr. Cynthia Koelker, author of Armageddon Medicine, recommends:
    • Augmentin, 500 mg, 3x per day, OR
    • SMZ-TMP DS or ciprofloxacin, 500 mg, 2x per day PLUS 
    • Metronidazole, 500 mg, 3-4x per day.
    • Both options should be continued until 3-4 days after symptoms have resolved.
  • Surgeons in third world countries commonly perform appendectomies under local anesthesia.
Before going the surgery route, make sure you are dealing with appendicitis.  Other conditions that mimic appendicitis include the following.  All of them will be discussed in future posts, but the quick test for differentiating between appendicitis and these other conditions is provided here:
  • ectopic pregnancy (a woman with a missed period, positive pregnancy test, and severe pain on one side of the lower abdomen is more likely to be an ectopic pregnancy)
  • diverticulitis (symptoms are very similar, but most patients have pain in the lower left side, rather than the lower right)
  • pelvic inflammatory disease (only in women, pain is on both sides of lower abdomen, there is a fever, and sometimes, foul vaginal discharge)
  • ovarian cysts (differentiation from appendicitis is difficult without diagnostic equipment)
If you are going to have to go the surgery route, the procedure is described in detail in Survival and Austere Medicine, 3rd Edition.   Of course, you will want to have a clean operating field, with sterile gown, gloves, and drapes, at least a local anesthetic, and scalpels, clamps, and sutures. 

Links to related posts:
Survival and Austere Medicine, 3rd Edition review
Survival and Austere Medicine, 3rd Edition  download
The Survival Medicine Handbook  review
Acquiring Antibiotics 

For further reading:
(All articles accessed 21 June 2019)
https://www.ncbi.nlm.nih.gov/pubmed/2239906
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2417863/
https://www.everydayhealth.com/appendicitis/guide/antibiotics/
https://www.webmd.com/drug-medication/news/20120405/antibiotics-appendicitis-option-some#1
https://www.medicinenet.com/appendicitis_treatment_with_antibiotics/views.htm
https://www.drweil.com/health-wellness/body-mind-spirit/gastrointestinal/antibiotics-for-appendicitis/
https://www.ncbi.nlm.nih.gov/pubmed/25121154
https://www.uspharmacist.com/article/antibiotic-therapy-for-appendicitis-in-children
Dr Joseph Alton, The Survival Medicine Handbook, pp 173-178.
Survival and Austere Medicine, pp 165-166.

© 2019, PrepSchoolDaily.blogspot.com  

3 comments:

  1. I'm a retired Physician Assistant/Family Nurse Practitioner, with over 40 years experience in medicine. This is a great article, with only one exception, your comment on pressing on the right lower quadrant, then releasing, causing pain, being diagnostic of a rupture. This is called rebound tenderness, and is "pathonomic," (disease naming) of appendicitis. Once an appendix ruptures, the pain stops, for a time, until generalized, whole abdomen pain starts.

    Also, there may, or may not be fever, may or may not be nausea, vomiting, may or may not be elevated white count. Based on my personal experience (I finally had mine out at 45) pain is elusive until well involved, rebound tenderness was absent until after the diagnosis was confirmed by ultrasound. I just felt really sick, with a burning sensation around the belly button. What I'm trying to say is, your index of suspicion has to be high in belly pain.

    SteveF PA-C/FNP

    ReplyDelete
    Replies
    1. Thank you so much for your comments. If all of us were built the same and our bodies all acted the same, it would make life a whole lot easier (if less interesting). When the time comes that we have no hospitals, no advanced diagnostic equipment, and perhaps no trained medical personnel, either, it's gonna be rough.

      Delete
  2. Curiously, I grew up in Eastern Washington, and looking back on it, had my first, undiagnosed bout of appendicitis at the age of 7. There followed two more undiagnosed attacks that resolved without treatment in my early 20s. I finally had it out at 45 in San Diego. Only by the grace of God was i not at sea.

    SteveF. PA-C/FNP

    ReplyDelete