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Old 11-24-1998
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William Mahaffy is on a distinguished road
Medical Lessons from a Brush with Death

It goes without saying: Sailors in the Around Alone race are tough. Just how tough was recently revealed by one sailor racing a fast 40-footer. Viktor Yazykov, the 40-year old Russian sailor who was forced to perform self surgery on his elbow and then staunch a deadly flow of blood, marks the mettle of the solo world racer.

But all toughness aside, had Yazykov not had the life-death e-mail connection to Dr. Dan Carlin, the Boston physician at New England Medical Center who talked him through the surgery and control of bleeding, the outcome could have been a tragic opening chapter of the 27,000-mile race.

 Yazykovstarted the race with a problem. Arriving six days late for the start at Charleston, South Carolina, he had injured his elbow getting there while on this qualifying passage. Though examined by a doctor before he took off on the Around Alone, the wound flared up again. A month later, it was a festering abscess.

After a harrowing day of replacing a snapped shroud that required seven trips up the mast, Yazykov’s wound became grave, "That’s when the real trouble [with the elbow] began." To lessen the pain, Yazykov took a lot of aspirin, a pain reliever that he had on board. When Dr. Carlin read that the infection was "glossy and shiny white" as e-mailed from Yazykov, surgery was proscribed. An ex-paratrooper, the steely Yazykov cut an inch-long-incision. Though the infection was drained, the bleeding wouldn’t stop. His blood had become thinned by the aspirin in his system. "I have been sitting on the bloody cabin floor ... watching my life drop by drop leave me," Yazykov scribed. After Dr. Carlin directed him to apply direct pressure to the wound, the bleeding finally stopped. Yazykov went on to finish the race and set a new race reord for a 40-footer.

As the Around Alone racers prepared to head out into the Southern Ocean for leg 2 of the Around Alone on December 5, a still-tough but wiser Yazykov will join the fleet, having learned vital basics on the common abscess and bleeding. SailNet’s FIRST AID columnist Bill Mahaffy, PA-C, provided this explanation of these conditions.

"An abscess is a localized bacterial infection that contains pus and can occur anywhere in the body. The location of the abscess and the type of organism determines the required treatment and prognosis. A soft tissue abscess will frequently start with a trauma. The classic signs are redness, heat, tenderness and swelling. In soft-tissue abscess, the infection can rapidly spread to other parts of the body via tissue planes, blood or lymph.

"It has long been known that the treatment for an abscess is surgical incision. The exact reasons for the often remarkable improvement in symptoms after surgical drainage are unknown, but the results are consistently impressive. The timing of surgical drainage is important. Incision prior to the accumulation of pus is often harmful and may actually help spread the infection. Applying heat to the affected area will help relieve pain and encourage the abscess to ripen prior to surgical drainage. Antibiotics have had a major influence on all kinds of bacterial infections; however, in the case of abscesses, antibiotic therapy may help prevent the spread of infection but cannot take the place of surgical incision.

"For the recreational sailor who may do a 24- to 48-hour offshore passage, an evolving abscess can usually be managed with application of heat, elevation of the extremity and a non-aspirin pain reliever. Medical treatment should be sought immediately upon arrival in port.

"Aspirin affects the ability of blood platelets to bind together and begin clot formation. This thinning of the blood persists until the body produces more functional platelets. Aspirin is an effective pain reliever; however, when heading offshore, a better analgesic choice might be Tylenol (Acetaminophen) or Motrin/Advil (ibuprofen, a non-steroidal anti-inflammatory). In the case of a serious injury offshore, aspirin could complicate the recovery through its blood thinning properties.

"Control of bleeding is accomplished by direct pressure on the wound, the use of pressure points and finally a tourniquet. Direct pressure is usually all that is needed to stem the flow of blood without damage to the surrounding tissue. The use of a tourniquet is essentially considered a last resort. Once applied to stop life-threatening hemorrhage (such as a partial limb amputation or laceration of a major artery) the tourniquet should not be removed. The application essentially sacrifices the extremity beyond the tourniquet to save the patient’s life."

- - Micca Hutchins with assistance from Bill Mahaffy, PA-C

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