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Duke University Medical Center authorities offer health tips on dealing with a hurricane. Each can be reached for additional comments.

Food for thought

If living well is the best revenge, get your grill ready for an oncoming hurricane. That's the best way to use the food that will likely spoil in your refrigerator - and to heat up water for that necessary cup of java. According to Joyce Price, director of nutrition services at Duke Hospital, the best way to know if your (formerly) refrigerated food is in trouble is to use a thermometer. The rule of thumb is that food should be kept at 40 degrees Fahrenheit or colder and that it should not be eaten if it has spent a total of four hours at a temperature above that benchmark. Eggs, milk and meat so affected should be dumped, along with any prepared foods like mayonnaise made from any of these original ingredients.

She said it makes sense to keep your refrigerator and freezer door closed as much as possible to retain whatever cold air has been trapped.

Price further recommends that if you have time to do some grocery shopping before the storm, foods like peanut butter and bread are safe and easy to handle and that individual sized containers of juice and cans of fruit, apple sauce, tuna, crackers, puddings and dried fruits (good for energy!), are handy to have because there's no worry about keeping extra portions fresh. She also urges parents of babies and toddlers not to use leftover baby food that has warmed up. And don't forget about stocking fresh fruit - it's always good for you.

Price can be reached at (919) 681-6016.

Put medications on your checklist

Batteries, milk, bread. Those are usually the first items people think about when preparing for a hurricane or other severe weather, but Duke pharmacists say medications should also be on the priority list.

There are three key points to consider now, while you still have time before severe weather could hit the area: how to get your medications, how to keep them and how to take them.

First, make a list of the medications you take and check to see that you have an adequate supply to stay healthy if you're stuck at home or the power's out. There's no need to overstock on medications -- a five- to seven-day supply should be sufficient, according to John Kessler, assistant director of Duke Pharmacy.

You'll also want to plan how you'll store your medications. Know which ones need refrigeration and make plans for storing them properly. If you don't have back-up power, perhaps a neighbor who has a generator will agree to store your medications. Your pharmacist should be able to tell you how long your drugs will last without refrigeration and may be able to suggest storage alternatives.

Next, think about how you'll take your medications. People who use mechanical equipment for health care need to make provisions for an alternative method of taking medications if they lose electricity. Someone who usually relies on an inhaler machine, for example, might need a manual drug delivery method like a "puffer."

It also helps to check with your local pharmacy about its plan for emergency coverage and for being open after the severe weather passes.

Kessler can be reached at (919) 681-2414.

Avoiding storm injuries

Most hurricane-related injuries come in the aftermath rather than the fury of the storm, Duke emergency medicine specialists say. That means you've got some control over whether a hurricane will hurt you.

The majority of post-Fran emergency cases came after the hurricane cleared the Triangle, according to Dr. John Dallara of Duke's emergency services. Topping the list of potentially deadly ailments was carbon monoxide exposure, caused by poor placement of generators. Next came motor vehicle accidents, when people ventured out before conditions were clear and the roads safe from storm debris.

Clean-up injuries like chain-saw accidents made up the remaining bulk of post-hurricane patients to Duke's emergency department, Dallara said. Insect bites and stings were more prevalent because bees' and spiders' habitats were destroyed.

"People need to be careful during cleanup. Take the precaution of wearing gloves, goggles and the right clothing," he warned. "If you're using a chain saw, make sure your clothes are protective, not too loose so they could get caught up in machinery or limbs."

Dallara can be reached at (919) 684-5537.

Keep it outside

Before firing up that generator to provide electricity, Duke physicians advise a little common sense to keep from being exposed to carbon monoxide, a potentially harmful byproduct of gasoline combustion.

After Fran, the last major hurricane to hit the Triangle, physicians in the Duke hyperbaric center treated 10 people in two days for carbon monoxide sickness caused by improperly ventilated generators. And in most cases, the generator was located outside, but unfortunately too close to the house.

Physicians recommend that generators be placed at least 25 feet from the house, and not near open windows or air vents. Carbon monoxide detectors in living areas of the house are also a good idea.

Generators, just like kerosene heaters used indoors during the winter, emit carbon monoxide as they burn fuel. However, since they usually burn gasoline, people are not as likely to smell anything.

"Carbon monoxide poisoning is insidious, because the gas itself is odorless, tasteless and invisible," said Dr. Guy Dear, a hyperbaric specialist at Duke. "For this reason, it is often called the silent killer."

Early on, the symptoms may be a headache and nausea, but as the intake increases, symptoms turn to vomiting, chest pain, unconsciousness and even death, Dear said.

"Detecting symptoms can especially be a problem if people go to sleep with improperly ventilated generator running," Dear continued.

Physicians in the hyperbaric center, which is one of the largest such centers in the United States, also have advice for physicians who may treat the victims of such poisoning. Hyperbaric therapy involves the use of pressurized oxygen administered in large chamber that "squeezes" carbon monoxide out of the blood.

"Often, oxygen given through the nose can clear the carbon monoxide out of the blood, but that doesn't prevent the potential long-term neurological problems," said Dr. Brian Stolp, also from the hyperbaric center. "Our research has shown that hyperbaric therapy given early is beneficial for these long-term problems, which may not become obvious until three to six weeks after exposure.

Dear can be reached at (919) 681-3460 and Stolp at (919) 681-6069.

Drinking water prudence

Even in the face of a massive hurricane -- and the cleanup afterward -- there is little likelihood that rampaging infectious diseases will become an issue, says Dr. John Hamilton, director of the infectious disease division at Duke University Medical Center. That's because there would have to be a significant breach of "purifying systems" such as water sanitation plants, and that would most likely occur during a catastrophic earthquake that shakes and tears water pipes apart, says Hamilton.

In a hurricane, a community will most likely lose water service because electrical outages make it impossible to pump water into homes, not because the water supply is becoming contaminated with sewage. Still, listen to radio reports on water conditions, he says.

It's prudent to store extra water in any case, Hamilton suggests. Water used for drinking should be put into containers that have lids to keep it pure. Bathtubs can be filled with water for washing, or to flush the toilet, but any used for cooking or drinking should be boiled first, he says.