Isn't this kind of the same thing as the alcohol prohibition? That it's simpler messaging and therefore a net health gain to just say one thing to everyone?

"You're only too drunk to drive if your pee is clear" isn't really that great of a message.

Anyway, I haven't seen any research on this, but I've always assumed that at some point in the next century a double-digit percentage of the human race was going to die in global pandemic of some kind. I'm hope for something pulmonary and not an Ebola-like bleeding out of every where thing.

Minimum order 500 kilograms of colistin.

That and MRSA outbreaks in hospitals are I believe the most common causes of resistant strains appearing in people. Not to say that the phenomenon your dad notes doesn't happen, but IMO it's not near the top of the list of causes.

Parenthetically, there's a reservoir of new resistant strains that exists independently of human activity. Soil often offers a pretty hostile environment to particular bacteria, they evolve elaborate defenses there and some of those then migrate elsewhere. No idea a bout seawater-- I have read hints of huge variety of ocean dwelling viruses, but do not know much.

Yeah, if the link in (4) swamps the effects of the full-course PSA business, that would not necessarily be on my dad's mind professionally. I'm sure he knows about it as a citizen, but might not really use it to change his landscape about how he thinks medically about the problem.

4 gets it right. I have rarely seen people as upset as doctors finding out that colistin, one of our "last line of defense" antibiotics, very rarely prescribed, is also given in vast quantities to farm animals just because it happens to be cheap (off patent) and it makes them grow faster somehow. This only applies to colistin, but it's still important.

Is heebiedad an MD?

Let's hope he's not a D.O. after all the shit we talked about them last week.

Not taking the scrip thru til the end leaves the problem of what to do with the medications. Eventually they expire and people throw them away, where they tend sooner or later to wind up in the water supply. My wife serves on a state environmental quality council and various medicinal compounds now show up regularly in water tests of rivers, streams, ponds, lakes.

Does taking the medications fix that problem? I thought that substantial portions of most medicines get pissed out after you take them. And that's why now all fish are basically taking birth control pills.

As someone who is in medical education, your dad is correct for most-not all-bacterial infections. The idea that most antibiotic courses needed to be completed was based on the assumption that not doing it would lead to antibiotic resistance, but there was never any evidence of that. Current research shows that you feel better when the infection clears, in most cases. There are exceptions, TB, etc. The next generation of doctors should be more receptive to this than the current batch, who probably are keeping up with these studies.

That sounds reasonable, but keep in mind that, technically, I'm in medical education and I put all kinds of bullshit on the internet.

As long as you don't put any medicine in the bulls.

7: yeah, and this is his area.

As announced today, the FDA is going to crack down on Imodium AD. Either Charmin has a powerful lobbying arm or some people really desperate for a high.

9 is so depressing. Can I just put them in a baggie with all the batteries that I don't know what to do with?

When we had a whole bunch of morphine around the house, my sister made us dump it in used coffee grounds and put it in a plastic bag in the trash.

Possibly because I asked if I should try some.

Incineration would probably work for drugs, don't you think? Not that there's any practical way set up to do this, but I would guess most drugs don't have anything in them that wouldn't burn to a fairly harmless ash, if you burned them hot enough.

9 is so depressing. Can I just put them in a baggie with all the batteries that I don't know what to do with?

Over here, if a store sells (above a relatively low threshold of) batteries, they have to accept them back for safe disposal. I assume Texas does not have such a law.

19: I would think so, yes. But the FDA reckons flushing them away is no problem; most drugs that end up in the waterways have passed through a person first.
https://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm

I guess I'm an environmentalist now.

16 My town now says we can just throw batteries away, no longer need to recycle. Which is good since I used to throw them in the same garbage bag where I threw the twisty flourescents and you can guess what happened.

As for meds, the local police department will take the pseudoephed decongestant pills but not the rest of the stuff. Societies eventually figured out that throwing human waste into waterways in the middle of the street wasn't good, likewise ordinary garbage, and I'd say that concerned government officials will eventually figure out what to do with expired meds, but our leader is now suggesting that we destroy the civil service so perhaps we should give the pseudoepheds to cookers on condition that they figure out how to turn the other meds into illegal drugs as well.

I am actually at this very moment frantically writing a brief partially about the effects of pharmaceuticals and personal care products (PPCPs to those of us in the business) in sanitary waste. But that doesn't mean I know much of anything about it.

You haven't discovered anything?

"Vested in the authority granted to me by the state of New York, I hereby do proclaim and require that all residents and visitors to the state save all of their urine in jars until such a date as an effective safe method of disposal has been developed. Violators will be subject to a $10 fine on the first offense and death for second and subsequent offenses."

It's a privilege to pee.

the effects of pharmaceuticals and personal care products (PPCPs to those of us in the business) in sanitary waste.

A more junior lawyer has been given the much more unpleasant task of writing a brief about their effects in unsanitary waste.

The brief after the briefs, as it were.

We've been trying to get his office moved out of the unsanitary waste, but working for the state, we're short on room.

Leaving aside the very real problems of antibiotic resistance and improper urine storage, what I worry about is that we are creating bits of the United States that have most disadvantages of the Third World. Sometimes it seems like we should just get it over with and have the "Make America Great (at incubating TB) Again" Act.

19: Yes. That's the technique used when you see a big coke / heroin / marijuana bust on the TV, and with good reason (most illicit substances, like most licit drugs, are small molecules in the pharmaceutical sense and are susceptible to being violently oxidised. Plus petrol and matches are cheap.)

Here's my story in TFA about incinerating cocaine.

I suppose with some anticancer drugs you might have ash contaminated with heavy metals. And if we're being pedantic (why not) you'll also be producing CO2 and other oxides, which contribute to climate change; coincidentally, one of my big two "awake at midnight in a cold sweat" issues, along with the subject of this very thread.

My police department has a locked box for drugs. You can drop off any you want to get rid of - antibiotics and OCPs would be fine.

15 Given the part of the world I live in can I just say fuck. I usually buy a lot when I go back to the states just in case because you can't get it here.

On the plus side, now you know that you can get high from it.

Not that it's that frequent a problem but it's not unusual here. Maybe it's my favorite felafel place.

Don't eat the rare chickpeas.

I think alkaline batteries are ok to throw in the trash, but if you have 9v batteries put electrical tape over the contacts first. Cylinder batteries can't randomly form a circuit, but if you have two 9V together they can contact and start a fire.

Or one 9V battery and a chewing gum wrapper, if we aren't forgetting our MacGuyver.

Steel wool and a 9V battery works much better.

I honestly didn't know it was considered important to complete an antibiotic course until I mentioned something here about some antibiotic I'd stopped taking and people yelled at me. Like I don't think any doctor ever mentioned it (maybe because it's considered common knowledge for non-morons?) so I would routinely stop taking antibiotics when I felt better, again until mentioning it here. And now you're telling me the opposite.

In short, literally all of my knowledge about when to stop taking antibiotics or not comes from Unfogged.

And that's why the burning sensation persists.

42: For best results, start and stop at random intervals.

Another piece of received wisdom about antibiotics is that you can't drink while taking them, but I'm pretty sure that only applies to the beta-lactam ones (or at least, it doesn't apply to all classes). Anyway, I always check when they're prescribed, but it doesn't stop people being horrified if they find out that I'm drinking while on antibiotics.

45 - I always just ignore that part. I figure if mild drinking is actually bad for some kind of medical thing the doctors will say something like TAKING A SINGLE DRINK WHILE ON THIS MEDICATION WILL LITERALLY KILL YOU, if they don't do that (given the inflation of claims about alcohol) you're probably OK.

Doctors often fail to say important things, see antibiotics and birth control.

I'm not really defending this position but it's helpful if you want to continue mild drinking.

Don't drink while pregnant, don't drink on antibiotics, but the negatives cancel each other if you're pregnant and on antibiotics.

The birth control thing is a myth too, or at least it only applies to one specific antibiotic: https://www.plannedparenthood.org/learn/teens/ask-experts/i-was-watching-tv-and-they-said-that-if-your-on-birth-control-and-taking-antibiotics-the-birth-control-will-stop-working-im-on-the-pill-right-now-and-ive-had-to-start-taking-antibiotics-because-o

If people didn't even own an television, they wouldn't have that problem.

I once took an antibiotic and the doctor said I had to stay out of the sun or I would get a horrible burn. At the time I thought it was something to do with the antibiotic, but on reflection he may have just been looking at me and stating the obvious.

Was this linked at the time? Bitcoin carnivores.

In an epic plot twist, climate change will save us. (And then destroy us later by other means.) The 25,000-year-old bacteria won't be resistant to any antibiotics.

53: They Live is apparently way harder to interpret that I figured.

52 is correct medical advice. My mom used to see people who had to get antibiotic prescriptions and they would hand out a bottle of high SPF sunscreen with it.

The google ad in my email was encouraging me to roll over my 401k into a Bitcoin IRA.

One commonly prescribed antimalarial* is also a mild antibiotic and is famous for making you super sensitive to the sun (which is unfortunate, because lots of sunny places also have malaria).

When I lived in somewhere very malarial, the choice was between a really expensive antimalarial, one that made you very sensitive to the sun, or one that made you psychotic. Or malaria.

*Having looked it up, it's doxycycline.

57: Assuming you were planning to spend your pension on buying drugs from the darkweb, that's a pretty decent idea. Or, if you're really prone to ransomware.

58: I took the one that gives terrifying nightmares.

That was a big part of what made Samoa an easy Peace Corps placement -- no malaria, so no terrible anti-malarial drugs.

So far, in the malarial places I've been, "hoping I don't get malaria" seems to have worked pretty well.

I don't go outside the city in case there is malaria in the suburbs.

I'm kind of terrified of getting malaria since I've seen what it can do to one's health*. I'm glad I live in a country where it is non-existent.

*A close friend of mine contracted both malaria and Lyme. They interacted in a very strange way and she was a puzzle to all the specialists for a few years. A walking House episode, when she was able to walk.

62: There's plenty that you can do to avoid being bitten, and when I lived in Libertatia* I was privileged enough to know about malaria and mosquitos and nets and repellent and so on, and to have ready access to reasonable medical care (and insurance to pay for it). So I took some fairly unpleasant antimalarials at first, and after a while I just took care. But I knew several people who contracted cerebral malaria, and it's really no joke - even if you're healthy and wealthy, it often can be touch-and-go. In the course of a year I saw more than enough people who didn't have the same resources and who didn't make it, several of them kids.

Sorry, that was kind of a downer. But it's really not something to fuck around with if you're somewhere for a few months or less and have the option of prophylaxis.

*I've decided to anonymise it from now on, because - it's a small world.

||
I'm at the airport in Buenos Aires on my way down to Ushuaia in Tierra del Fuego -- the furthest fucking place on the planet -- where my father is critically ill. He and his wife were on a 2-month cruise around South America when he got severe stomach pain which turned out to be a bowel obstruction and diverticulitis. He had surgery and is now in renal failure. My brother and I are getting there as fast as we can, which turns out to be more than 24 hours. We're still 9 hours away.

The doctor's reports suck but he had a tiny improvement today. Still in critical condition.
|>

I'm so sorry to hear that. All the best to you, your father and your family. What an awful and terrifying situation.

Oh Jesus Sir Kraab I'm so sorry to hear that. Sending good thoughts your way.

That is unbelievably terrible and the trip to the end of the earth aspect makes it horrifically surreal. Best hopes for you and your family. My own Dad got pretty sick in Ushuaia as a college student in the 1960s and for some reason it was easier to get care if you had a family member there so some Tierra del Fuegan formally "adopted" him. He kept the adoption certificate but didn't keep in touch with the guy. That has nothing to do with your situation except
to comment on the awfulness and absurdity of the place. Stay well and thoughts your way.

Best wishes Sir Kraab.

Take care of you and your family Kraabs.

Oh, that's awful. Serious illness and at the end of the earth! That is scary. My BIL had diverticulitis that went bad. It resulted in peritonitis (and major emergency surgery) and it has been a long haul back for him. Truly wishing that it all turns out okay for Kraab père.

Oh man, Sir K, I am so very, very sorry to hear it. Thinking all my good thoughts for you, your dad, your brother, and your whole family.

All good thoughts, Sir K

Ditto to what everyone else said, Sir Kraab. So sorry.

Yikes! Hoping for continued improvement of the kidneys and everything else too. Hope your travels are smooth and not delayed.

53 Still waiting for the inevitable Bitcoin cannibals.

Thinking of you and your family, Sir K.

Oh gosh. Best of luck.

Best wishes to your dad, SK.

Safe travels to you and best wishes to your dad, Sir Kraab.

Thinking of you and your dad, Sir K.

Good luck with everything -- I'm so sorry you have to deal with this.

Just caught this. So sorry, best wishes to you and all concerned.

Good luck with journey, hope your dad starts to stabilize. How terrifying.

That is a frightening story S.K.. I hope your dad recovers and that the emergency travel goes as smoothly as possible given the trying circumstances.

Oh god, SK, how awful. I'm so sorry, and best wishes.

Thanks, everyone. Finally made it here around 10 yesterday morning and his kidneys are working well enough that they haven't had to give him dialysis again.

I'll admit that I thought I was basically coming here to say goodbye, but it appears that there's a non-zero chance he'll get better. He's still critical and still sedated and on a ventilator and plugged into a couple of dozen tubes and wires, though they're saying they may be able to lower the sedation enough that they could take him off the ventilator in the next couple of days.

He's actually really lucky that it happened when it did because they were headed for Antarctica next for 4 or 5 days.

Excellent news. Kidneys, sir, are like women: ideally a man should have two of them, and they should both be kept working constantly. Here's hoping for a full recovery (and actually making it to Antarctica next time).

That's reall good news Sir K. Here's hoping for more to come.

More hopeful best wishes SK!

Yay! Pulling for you all!

We were able to have a conversation with my dad for the first time today. He's tired and groggy as hell and it's hard for him to talk because his throat is irritated from the breathing tube, but he's back in the waking world. We're trying to keep something of a lid on our optimism (and pretty much failing) because he's 82 and various complications could still arise, but the doctors are really pleased.

It looks like in about 3 days they'll be able to start the air ambulance trip back to the States. There will be multiple stops because it's such a long way and they may have to stay a day or two in some places depending on how he's doing.

I can't tell you how incredible it has been to feel sure that he was going to die suddenly 5,000 miles from home to deciding that I should find him a nice beer glass as a memento.

Thanks for all the thoughts and encouragements, my imaginary friends.

I'm so glad to hear that and hope the return goes well.

What a horrifying experience. I'm glad the news has gotten gradually better.

Very glad to hear that.

Yikes. Hope he continues to improve and that the two of you can turn the experience into anecdotes together.
Take care of yourself, putting on your own mask first.

Just like bank robbery.

Wow Sir Kraab, what a horrendous experience! So glad your dad is getting better, he must be a gloriously tough old dude! Warmest wishes to you from SF!

93 warms my heart to read. Continued best wishes your way.

I'm so glad there's so much improvement! Please keep us updated, Sir K.

Glad to hear he's doing better, and I hope he recovers fully!

So happy to read this good news!

Thinking of you, Sir K.

He feels like total shit and talks slowly and in a whisper but, true to form, is grilling us about arrangements with the travel insurance company and whether we remembered to cancel a private tour of the Falklands they were scheduled for. He's a detail-oriented guy.

I told him ajay's kidney joke in 89 tonight and he loved it.

Holy moly, I'm so glad he's making such good progress.

Your dad sounds like a real force of nature, SK.

Safe home to him, and here's to a seamless and uncomplicated journey back to the States.

Out of the ICU! They moved my dad to a regular room yesterday. He's still in considerable pain and has very little strength or stamina but they're letting him have jello (why is it always orange jello?)

Now there's all sorts of haggling with the travel insurance company about when he leaves, whether he should go to a larger hospital in Buenos Aires before going to the States, and by what conveyance. I assumed that an air ambulance would be the best thing and the only reason the company might want us to use commercial is to protect their profits. Though cynicism is the correct default position, it turns out that there are advantages to flying commercial vs. air ambulance (commercial is faster and more pleasant; the air ambulance is small so has many more takeoffs and landings and it's louder and potentially bumpier). If we did fly commercial, there would be a nurse with him and IVs and oxygen if needed. The plane would have to seats that can go totally flat. But he would have to be able to sit upright for 20 or so minutes for takeoffs and landings.

Hooray!

Good to hear - and that's interesting about the air ambulance; makes sense.
105.2 is very flattering.

If we did fly commercial, there would be a nurse with him and IVs and oxygen if needed.

Just like the little girl in Airplane! Safe travels.