2. Along with fatigue, eating the right food is also important in maintaining body and soul. What did you eat for those days at sea?
Even though we didn't have any eggs or fresh meats or vegetables (except for onions, potatoes, and tomatoes) I really did enjoy and appreciate the food that Eric Forsyth cooked aboard his Westsail 42 'Fiona' when we sailed from Ireland to Portugal...
Some new videos from Drake on his Vagabond 42 adventure. Lots of crazy stuff going on with the boat - and the rtrip. But a few shots of Kraken can kill the pains of ownership:
Some new videos from Drake on his Vagabond 42 adventure. Lots of crazy stuff going on with the boat - and the rtrip. But a few shots of Kraken can kill the pains of ownership:
Looks like he'll be on a Swan 42 in the next series.
Go the Drake!
I've watched a few episodes. That is one cluttered boat. I couldn't stand being aboard. I know that some were shot from the dock, but even those underway look pretty messy. And all the broken stuff. Yikes.
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Jeanneau 54DS
In the harsh marine environment, something is always in need of repair. Margaritas fix everything.
Re: Reality at Sea - For Cruisers, Singlehanders, and Normal People.
I found another good one. 4 videos of 3 regular guys on a 37ft Ketch on a 44day passage from Neah Bay Washington to the Marquesas. The boat isn't fancy and the guys seem like normal folks. I like that the video covers the true day to day life at sea. They document everything form the disposal of trash and doing laundry, to doing minor surgery aboard. They also document the highs and lows of their moods.
"I was prepared for everything. Heavy gear, storm sails. What I wasn't prepared for was crawling along with the sails slamming all the time."
MedSailor
PS One small piece of medical advice. DON'T get excited to stitch up every little cut on a boat. It drives me crazy that the first thing everybody wants to put in a remote medicine kit is suturing supplies. Stitching up a wound greatly increases risk of infection and it's often better to leave it open (even in a hospital setting it is often left open if dirty).
Watching stuff fall onto their "sterile field" in the cockpit was giving me hives. If you have a wound clean it COPIOUSLY with pressurized water using a syringe. 1-2 liters of water at a minimum. Don't apply any idodine, neosporin, hiblclens etc, use clean water only.Then close loosely with steri-strips (if you can apply tape with the skill of a kindergarderner you can use these). Finally, give oral antibiotics that have a high bioavailability in the skin and target staph and mycobacterium marinum. Docycycline is one good choice.
This for cleaning with water (might want eye protection for splatter)
Followed by this if the wound is really open wide (they usually stay on for a week or two):
Followed by this:
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"True, your boat will outperform mine to windward, but my boat will always outperform yours at anchor." --MedSailor
Re: Reality at Sea - For Cruisers, Singlehanders, and Normal People.
Good video and good medical advice, thanks Med. I don't want to highjack this thread, but I had a question about this:
Quote:
Originally Posted by MedSailor
Finally, give oral antibiotics that have a high bioavailability in the skin and target staph and mycobacterium marinum. Docycycline is one good choice.
This is just for discussion and my own edification, not to question your advice. The tetracyclines do have good bioavailability in skin, but for that reason and the cyclic rings they often have the adverse effect of sunlight sensitivity. For land-based patients you can tell them to stay indoors, but this is harder to do for sailors. I'm not an MD, but I teach antimicrobial pharmacology to med students so I am more familiar with that aspect as opposed to practice. Are there other antibiotics that you would suggest throwing in the kit for skin wounds?
Re: Reality at Sea - For Cruisers, Singlehanders, and Normal People.
Off topic:
Yes you are absolutely right that Doxy will cause sun sensitivity in some, but not all patients. The quinolones (Cipro, levofloxacin) can do that too.
Unfortunately the question of which antibiotic to administer following a wound that has been contaminated by salt-water is NOT an easy one to answer. Ideally your ABX should cover Staph Aureus and Beta hemolytic Strep (not water based pathogens, but still the most common soft tissue pathogens) and the 5 most common water bugs:
From UpToDate Online: "...five bacteria that most commonly produce soft tissue infections in association with exposure to water or water-related animals. These include Aeromonas species, Edwardsiella tarda, Erysipelothrix rhusiopathiae, Vibrio vulnificus, and Mycobacterium marinum."
In order to cover the 2 common bugs and the 5 water bugs UpToDate recommends the following (hold on to your hat):
"Empiric antibiotic treatment — No randomized controlled studies have evaluated empiric antibiotic regimens for treatment of soft tissue infections following water exposure. Treatment regimens are based on the most likely organisms to cause infection in this setting, in vitro susceptibility studies, and treatment case series with some organisms. We recommend the following antibiotics for initial empiric therapy whether treatment is ambulatory (oral) or inpatient (parenteral):
Either a first generation cephalosporin (cephalexin 500 mg orally four times daily or cefazolin 1 g IV every eight hours) OR clindamycin (300 mg orally four times daily or 600 mg IV every eight hours, in those patients with immediate hypersensitivity reactions to penicillin)
PLUS Levofloxacin (750 mg once daily)
PLUS either of the following if the epidemiologic risk is present:
Metronidazole (500 mg four times daily) if exposure to sewage-contaminated water or if soil-contaminated wound; (not necessary to include if the regimen includes clindamycin) OR Doxycycline (100 mg twice daily) for coverage of Vibrio species if seawater exposure"
That's a lot of antibiotics for a cut finger. Enough to probably kill the bacteria in the person sitting next to you too.
They don't actually recommend coverage of M. Marinum from the outset, though I think it might be prudent because we won't be doing invitro culturing on the boat. Doxy isn't the best for M. Marinum (clarithromycin and Rifampin are) but it's got decent activity against it and seems like a good compromise choice to me considering it has good activity against our other actors.:
"Empiric antibiotic coverage should not include coverage for M. marinum infection in most cases, since the presentation is subacute and without associated systemic toxicity. Instead, a specimen (eg, lesion aspirate, biopsy) should be obtained and the microbiology laboratory notified that M. marinum is suspected so that appropriate culture conditions will be included. If acid fast staining is positive, or if the exposure history and physical examination findings suggest M. marinum infection (eg, laceration from an aquarium), then we suggest that specific treatment for M. marinum infection should be initiated."
To directly answer your question with a bit of a "seat of the pants answer" I would say that acceptable choices for monotherapy other than Docycycline (100mg twice daily) would be Bactrim DS twice daily, or Keflex 500mg 4 times daily all for 7-14days depending on wound healing time, immune status, and contamination of wound.
With any monotherapy on a salt water wound you'd be rolling the dice. That said, it should be noted by way of observation, that many many thousands of salt-water wounds heal just fine with no antibiotic therapy at all. I think you have to judge the aggressiveness of your therapy based on the severity of the wound and the immunocompetence of your patient. Certainly if fascia is involved, or if the patient was a diabetic or alcoholic, I would go all out with multi-drug therapy, with a superficial wound in an immunocompetent patient I might only clean and observe. For most common (but non-trivial) wounds I would clean, initiate monotherapy with Doxy, Bactrim or Keflex, monitor and NOT suture.
Thanks for the segue. Infectious Disease and antibiotic therapy are a hobby of mine (probably because it's so complex and it blends art/clinical judgement with science). We should probably get back on topic though.
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