Cruiser's Medical Plan
<HTML><TABLE cellSpacing=0 cellPadding=0 align=right border=0><TBODY><TR><TD width=8></TD><TD vAlign=top align=left width=281><IMG height=228 src="http://www.sailnet.com/images/content/authors/harman/051301_rh_sunet.jpg" width=281><BR><DIV class=captionheader align=left><FONT color=#000000><B>Preparation and planning can solve most cruiser's medical problems before they even occur. </B></FONT></DIV></TD></TR><TR><TD colSpan=2 height=8></TD></TR></TBODY></TABLE><P>When landlubbers hear that you have decided to go cruising when you retire they frequently ask, "What will you do when you get sick?" There is no easy answer to that question. A great deal can be done, however, to avoid most potential health problems and thorough preparation will allow you to deal effectively with those that do occur after you sail off into the sunset. </P><P>A large number of sailors report that their health generally improves after they begin cruising. This really shouldn't come as any revelation, since leaving a sedentary job often translates into reduced stress, more consistent exercise, and an improved diet. And if the newly retired cruiser is coming from a large city, he or she may also benefit from clean, fresh air, unpolluted by excessive noise, light, and chemicals. </P><P><B>Prevention First</B> Keep in mind the old cliché that an ounce of prevention is worth a pound of cure. Take advantage of your health insurance while you are still employed to get a complete checkup for both you and your loved one. This will provide assurance that your new lifestyle will be successful and enjoyable. Even more important is that the medical data accumulated now serve as a baseline in case problems do develop in the future, and an exhaustive physical examination establishes this good foundation. Baseline data should include a complete blood analysis. Explaining your reason for these tests will aid your physician in selecting the correct battery of tests. Although these medical data will be retained in his files, a copy should be carried aboard with all your other important ship's documentation. </P><P>This meeting with your doctor is a good time to enlist his help in procuring items for the ship's medicine chest. It is also the time to obtain copies of all your present prescriptions and discuss adding medications to your inventory of medical stores. </P><P><TABLE cellSpacing=0 cellPadding=10 width=160 align=right border=0><TBODY><TR><TD><IMG height=2 src="http://www.sailnet.com/images/content/authors/Bullets/cruising_1pix.gif" width=160></TD></TR><TR><TD vAlign=top align=middle width=160><FONT face="Arial, Helvetica, sans serif" color=#669966 size=+1><B><I><FONT color=#000000>"Misinterpretations</FONT><FONT color=#000000> by government officials over carrying controlled substances can be less than pleasant."</FONT></I></B></FONT></TD></TR><TR><TD><FONT color=#000000><IMG height=2 src="http://www.sailnet.com/images/content/authors/Bullets/cruising_1pix.gif" width=160></FONT></TD></TR> </TBODY></TABLE><DIV style="FONT-FAMILY: 'Arial', 'Sans-Serif'">The list of scripts will be important later, especially if you sail to foreign countries, since misinterpretations by government officials over carrying controlled substances can be less than pleasant. The prescription roster should include both the manufacturer's brand name and the generic name, given that once out of the US you are more likely to find a medication by using its common chemical name. Medications requiring a prescription in the US can often be obtained over the counter in other nations. Take note of the shelf lives listed with the medications: some just lose their effectiveness while others—like the antibiotic, tetracycline—can become highly toxic when outdated. </DIV><P></P><P>Examine your need for a round of vaccinations or boosters. For those whose retirement cruising plans include coastal cruising, vaccination for polio, tetanus, diphtheria, influenza, hepatitis B, and pneumonia should be seriously considered. If you plan offshore travel abroad, yellow fever, typhoid, and hepatitis A vaccines should be added to the list. </P><P>If you expect to visit areas where malaria is endemic, a regimen of preventative drugs should be considered. The protocol for these is usually started well before you arrive at such a destination. Also quite helpful are the more common measures of using mosquito screens, netting, and insect repellents that contain at least 30 percent N,N-diethyl-m-toluamide, also known as DEET. </P><P>Cholera, which is a severe gastrointenstinal infection, has recently been reported at epidemic proportions in 62 countries—particularly in Africa, Asia, Central and South America, and the Middle East. Although the World Health Organization is not yet recommending that travelers be vaccinated for cholera, officials in many countries may require it. At present, the two oral cholera vaccines that provide a high level of protection for several months are not widely available in the United States.</P><TABLE cellSpacing=0 cellPadding=0 align=right border=0><TBODY><TR><TD width=8></TD><TD vAlign=top align=left width=281><IMG height=214 src="http://www.sailnet.com/images/content/authors/harman/051301_rh_firstaid.jpg" width=281><BR><DIV class=captionheader align=left><FONT color=#000000><B>Along with an on board medical library, you'll of course need a good medical kit with more than just the basics like the one shown here. </B></FONT></DIV></TD></TR><TR><TD colSpan=2 height=8></TD></TR></TBODY></TABLE><P></P><DIV style="FONT-FAMILY: 'Arial', 'Sans-Serif'">Your physical tests won't be complete until you've have had a thorough eye exam which should include testing for glaucoma and macular degeneration. If you presently wear corrective lenses, obtain a copy of your current prescription in case the pair gets lost overboard. Eyeglass straps help reduce the chance of that happening although both Louise and I have presented King Neptune with more than one pair. We found replacements in Mexico and Trinidad far less costly than in the US. </DIV><P></P><P><B>Be Your Own Doctor</B> The onboard library that you are accumulating before you retire should include medical guides and handbooks—now is the time to acquire and review one or more books on the subject. <I>Oui si</I>'s library has both <I>The Onboard Medical Guide</I> by Paul G. Gill Jr., MD and <I>Advanced First Aid Afloat</I> by Peter F. Eastman, MD. They both provide lists of medical items for cruisers. Background information is also available on the web at such places as The Center for Disease Control (www.cdc.gov/travel) and The International Society of Travel Medicine (www.istm.org). </P><P>If you have not recently taken courses in CPR (cardiopulmonary resuscitation) and first aid, arrange for both you and your significant other to do so at your earliest convenience. Those who plan offshore passages should consider taking a more extensive course in emergency medical care. </P><P>Of all the medical problems faced by older cruisers, the most common are skin ailments, and of these, the most serious are skin cancers. The major cause of these carcinomas is generally accepted to be overexposure to sunlight. Even without significant sun exposure during years of working indoors, those times you got sunburned as a child may now come back to haunt you. According to the American Academy of Dermatology, 80 percent of skin damage occurs before age 18 and a latent period of decades can occur before skin cancers appear. But now, your new retirement cruising lifestyle will aggravate past indiscretions, and you may find that skin problems become a major concern. </P><P><TABLE cellSpacing=0 cellPadding=0 align=right border=0><TBODY><TR><TD width=8> </TD><TD vAlign=top align=left width=221><IMG height=278 src="http://www.sailnet.com/images/content/authors/harman/072200rh_RH_htsungls.jpg" width=221><BR><DIV class=captionheader align=left><FONT color=#000000><B>Sporting hats, sunglasses, and protective clothing, the author and his wife take their own advice seriously.</B></FONT></DIV></TD></TR><TR><TD colSpan=2 height=8> </TD></TR></TBODY></TABLE><DIV style="FONT-FAMILY: 'Arial', 'Sans-Serif'">A dermatologist can show you techniques of self-examination, provide descriptive data to help identify suspect areas, and alert you to any presence of pre-cancerous lesions called actinic keratosis. The best way to avoid these problems is by using sunscreen lotions and protective clothing to reduce sun damage. The screen's Sun Protection Factor, SPF, should be greater than 15 and have broad-spectrum protection against both UV-A and UV-B rays. <P></P></DIV><P>Numerous eye problems are also caused by or exacerbated by ultraviolet (UV) rays. Just by being on board, you'll get lots of indirect exposure to the solar flux reflected off the water, the deck, and the beach. It is vitally important that your eyes be effectively shielded from the resulting sun damage with sunglasses that block 100 percent of both UV-A and UV-B rays with a wraparound design to limit damage from peripheral rays. A hat with a wide brim can block about 50 percent of the UV entering above or around the glasses. The hat will also help reduce sun damage to skin from the neck up. </P><P>Although cruising can give a strong feeling of well being, it is foolhardy to ignore the possibility of accidents and the need for treatment beyond "first-aid". Through effective preparation, we were able to deal with those situations where medical assistance was not readily available. I had to surgically remove a large fishhook from my finger at a remote island off Venezuela. While underway off the Pacific coast of Mexico, coolant from an over-heated engine gave both Louise and I extensive second-degree burns. We treated them with SILVADENE—a prescription burn ointment—and they healed without scaring. With medical self-reliance, our lives aboard are effectively maintained with a minimum of external support. </P><P><TABLE cellSpacing=0 cellPadding=0 align=right border=0><TBODY><TR><TD width=8></TD><TD vAlign=top align=left width=281><IMG height=214 src="http://www.sailnet.com/images/content/authors/harman/051301_rh_ice.jpg" width=281><BR><DIV class=captionheader align=left><FONT color=#000000><B>Where there are no doctors nor emergency clinics, cruisers are left to their own devices and medical preparation. </B></FONT></DIV></TD></TR><TR><TD colSpan=2 height=8></TD></TR></TBODY></TABLE>Where there are no doctors nor emergency clinics, a cruiser is left to his or her own devices or medical knowledge. <P><B>When All Else Fails<BR></B>Prevention and preparation go a long way toward avoiding medical problems, but eventually a trip to the doctor will be in order. Although routine matters can be handled locally, a trip back to your family doctor is the ideal way to handle any major problem if your cruising budget allows it. An added advantage is that your medical insurance will apply. With very few exceptions, Medicare and Medigap coverage exclude treatment outside the US. Organizations such as Blue Water Insurance Inc.(Jupiter, FL, (561/743-3442) and Cassen (Westfield, MA, (413/568-1243) are among those supplying insurance to those uncomfortable with loss of coverage outside of US borders. The cruiser having offshore medical insurance typically makes all payments for services rendered with later reimbursement by the underwriter.</P><P>Many prospective cruisers—especially those who are nearing senior status—seem unduly concerned about the availability of doctors and dentists when they are traveling away from home. But the reality is that many of the world's practitioners have been trained in first world countries of North America and Europe. We've had dental work done in Mexico, Guatemala, and Trinidad, and I had a cut above one eye sutured in Mexico. All of our medical experiences outside of the US have been positive. A fellow cruiser elected hernia surgery in Puerto La Cruz, Venezuela, and he felt that his treatment was equal to what he would have obtained in the US—and at a reduced cost. </P></HTML>
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