[khammett]

Lets say you're sailing. Alone. An hour out, a few miles from shore. Suddenly you get an ocular migraine. Your vision goes into bits and pieces. It's like a LSD trip. And it lasts that way for like an hour.

Ever had a medical emergency like that happen while under way at sea?

 

[svzephyr44]

Actually, historically, the most dangerous single handing accident is falling down the companionway and breaking your legs so you can't move. Heart attacks and strokes are pretty bad too. And try 1500 miles offshore. At "a few miles" miles you are still within VHF radio, rescue boat, and helicopter range.

Whats the point of this thread anyway?

 

[Irunbird]

I've had a couple of those, and happened to be working in a hospital the first time (ICU pharmacist) and it kind of freaked me out a bit... I'm young (or I was at the time) and just shuffled on down to our ophthalmology clinic to ask one of the docs about this. My first thought was "great, I'm sprouting a brain tumor", but she put me at ease and told me it was most likely an ocular migraine and will be gone shortly, and it did. I've only had two in my life, and I associated them with job stress. No big deal, and no REAL headache, thankfully!

 

[miatapaul]

Well a few miles off shore is hardly "at sea." Certainly more dangerous when coastal than if you were really off shore, where you would just lay down for an hour or so. I had migraines including ocular, but only when I was young and working 2 jobs and college full time and not eating right, or sleeping much. First time I had an ocular migraine I though it was a flash back from some chemicals that may or may not have been ingested at a grateful dead concert! Since I slowed down a bit I have not been bothered unless under undue stress. Mostly when dealing with X-wife, wonder if there is a connection there?!?!?!

I agree that ocular migraines would be very low on the list of things to prepare for unless you know you suffer from them. And if that is the case you know what to do. Broken bones, and stroke and heart attack are far more troublesome. If you plan on being far offshore it is normal to have a full medical kit with various prescription drugs, antibiotics, splints and even possibly surgical instruments. You can get books that will aid in taking the correct drugs in the correct doses for emergencies. Not that I would be doing open heart surgery on myself, but perhaps some procedures with help from doctor via Shortwave/Satellite phone.

If you plan on only being a days sail away from help then just a good solid first aid kit is all that is needed as you can reach help via VHF.

 

[travlin-easy]

To be perfectly honest, if you are single handed, and 1,500 miles offshore, it doesn't make a damned bit of difference - THERE'S NOTHING YOU CAN DO OTHER THAN HOPE FOR THE BEST!

Now, if you have a medical background, which I do, there are steps you can take to possibly make it to the nearest port and possibly obtain emergency medical help. Without that background, at best, it's a WAG (Wild Assed Guess) when it comes to the diagnosis. Sure, there are a few books for sailors to make an educated guess at what may or may not be going on, but by and large, it's a crap shoot and the odds are stacked against you making a proper diagnosis without having the tools onboard to do so. I carry a number of medications with me, including anticoagulants, beta blockers, alpha blockers, and good old Bayer Aspirin, which has saved more lives than anyone can imagine. I also carry a blood pressure cuff and a pulse oximeter. I also have a complete first aid kit, old military style, with needles and sutures, a wide variety of bandages, compression bandages, chemical cold packs, antibiotics, pain killers, etc... All that stuff should be on any boat traveling offshore.

Now, I can stitch up most wounds, even bad ones and get good results. I have the background and knowledge to diagnose most medical problems, but definitely, not all - including some of my own. For example, a week ago, while sleeping, I awoke at 3 a.m. with an excruciating pain in the bottom of my foot. I felt the spot that hurt and there was a huge lump. I figured I had ruptured a blood vessel in my foot, therefore, I immediately put an ice pack on my foot and wrapped it with an Ace bandage. The problem persisted and got worse and the following day I was unable to walk without the aid of a cane. I want to a local Doc In A Box, and the young man who examined me ordered some X-rays to be safe. After the X-rays, he did a preliminary exam of the foot, and said "My friend, you have the gout!" Now, I don't eat rich foods, etc..., the things associated with Gout. However, I discovered that sometimes it just happens. He gave me prescription for some tiny pills, said the problem will be gone in three days, and damned if he wasn't right.

So, if you have no practical medical experience whatsoever, my best advice is to carry a big first aid kit, get one of those first aid for sailors books and read it a couple times cover to cover, and stay close to shore.

Most medical problems at sea can usually be prevented by using nothing more than a bit of common sense. Hey, sailing is supposed to be fun. When it's no longer fun, find another hobby.

Gary

 

[capta]

When I began my circumnavigation, my father, a surgeon, put together a med kit for me. One of the big surprises was no suture equipment. When queried he stated emphatically that even if it was calm enough to do that kind of sewing aboard a small craft at sea, by a professional or not, it was unlikely that the wound could be cleaned well enough to be sutured. His answer was a very large quantity of butterfly bandages in various sizes and a bunch of broad spectrum antibiotics. Allowing he wound to weep, he said was infinitely preferable to closing an infection inside.
A bit off topic, perhaps, but I thought it might be a good place to mention it.

 

[MarkofSeaLife]

It doesnt matter what the syndrome is, no matter how unusual or fatal, all you can do is look at each one on its merits.

If close to shore take a tack out so you can go below for a day or so to get rid of the headache, fever, heart attack etc.

Like the ice bucket over your head thing there ate many sickneses we have never heard of so instead of being silly on each we should have a plan for many.

Go to sea and go below. If you die the chances are you were going to die before getting to hospital anyway.

As for what Zepher says Hold on in the first place or you are dead.

 

[mad_machine]

I suffer from Ocular Migraines on a not so regular basis. Never had a problem with dealing with them on the water. in a car, yes.. it is hard to keep a vehicle on the road when you cannot see 100%.. but at sea, you can still manage well enough to keep wind in the sails and out of the way of other vessels..

If it gets bad enough, you can always hove to.

I know with mine.. I get about half an hour of warning as my vision slowly gets worse and worse

 

[Multihullgirl]

The Ship's Captain's Medical Guide, download here:
https://www.gov.uk/government/publications/the-ship-captains-medical-guide

If you have an iPhone, then download the app:
https://itunes.apple.com/us/app/ship-captains-medical-guide/id332752870?mt=8

 

[northoceanbeach]

Whoa. Miatapaul is injecting drugs at dead concerts. No smoking pot for him, he's straight to the needle. He's probably killed people too.

I see a point to this thread though, learning what to do if you are incapacitated while singlehanded. Seems important.

I haven't had a medical emergency myself. I think my biggest danger is falling overboard.

 

[khammett]

I've had a couple of those, and happened to be working in a hospital the first time (ICU pharmacist) and it kind of freaked me out a bit... I'm young (or I was at the time) and just shuffled on down to our ophthalmology clinic to ask one of the docs about this. My first thought was "great, I'm sprouting a brain tumor", but she put me at ease and told me it was most likely an ocular migraine and will be gone shortly, and it did. I've only had two in my life, and I associated them with job stress. No big deal, and no REAL headache, thankfully!

I've had ocular migraines happen over 20 times in the past 8 years.

 

[AlaskaMC]

There was a sailor in the Singlehanded TransPac a while back that sufferered from a staff infection as I recall that was quickly about to kill him. He hit the EPIRB, got picked up by a freighter and set his wind vane to sail the boat to Hawaii.

Incredibly wonderful fellow sailors rescued his boat as it sailed 15 miles or so near the islands. Had he just sat and hoped for the best he would have been dead. In fact, being singlehanded really wasn't an issue per se as even had he had crew, it would have required him getting treatment or die.

He was OK and got his boat back. Maybe the message is to carry antibiotics (no matter what the FDA says about it-geesh) and have a wind vane

Not sure what the point of the point of the thread was but I don't think it was migraines, I think that was an example. I think Capta's response was spot on. What do you carry and how to you mitigate the risk somewhat. I also agree with the butterfly bandages. We also carry liquid stitches in the backcountry instead of suture gear and my wife is an RN who would have no problem stitching someone up.

EDIT: "singlehanded sailor in the Singlehanded TransPac" is just a tad redundant

 

[AKscooter]

Shoot, I was a week out and ran out of my "medicinal" rum........but....
more on point....stuff happens be prepared for what is the common stuff........common sense......

 

[Group9]

The one way range for the Coast Guard Seahawks (HH-60) is about 350 miles if I remember correctly. The Air National Guard, Air Force, and Navy have similarly configured HH-60's that also have in-flight refueling capability for a lot more range, but they aren't as available for emergencies as the Coast Guard is.

But, once you are out of range of those, you are own your own for any kind of fast medical help unless you are lucky enough to have a cruise ship nearby with a doctor on board.

 

[smurphny]

I truly sympathize with those who suffer from migraines. I used to get them but seem to have thankfully grown out of them. Also, mine had a definite connection to a food allergy: CORN. It's in everything and I would strongly suggest food allergies may be the trip for migraine headaches.

The International Medical Guide for Shipshttp://www.stkittsnevisregistry.net/Forms/mlc/WHO%20Medical%20Guide%20for%20Ships,%203rd%20Edition.pdf is available for free download and can be kept in a Pdf file on your computer. It is an extensive, 500 page tome and has more information than you need. The best thing that anyone can do, no, SHOULD do is get first aid training before even thinking about venturing very far in a boat. The Red Cross offers training everywhere for basic and advanced F.A.

 

[killarney_sailor]

There was a sailor in the Singlehanded TransPac a while back that sufferered from a staff infection as I recall that was quickly about to kill him. …

He was OK and got his boat back. Maybe the message is to carry antibiotics (no matter what the FDA says about it-geesh) and have a wind vane

Not sure what the point of the point of the thread was but I don't think it was migraines, I think that was an example. I think Capta's response was spot on. What do you carry and how to you mitigate the risk somewhat. I also agree with the butterfly bandages. We also carry liquid stitches in the backcountry instead of suture gear and my wife is an RN who would have no problem stitching someone up.

There is more to it than just carrying antibiotics. I had a staph infection on the back of my leg that started a few days west of Easter Island heading to the Gambier Islands. Picture an infected golf ball imbedded with an area about the size of a silver dollar open and oozing nasty stuff. We were in contact socially with another Canadian boat with a doctor on it that was heading towards southern Chile so we were able to have 'consultations' with him for several days until we lost radio contact. I took Ciproflaxin which was the antibiotic recommended to us but it basically did nothing.

It became the Pacific Ocean infection for me. I was treated at a clinic in Mangareva on an outpatient basis for close to two weeks and then went to the hospital in Papeete to get another infected area cleaned up (had eruptions in several spots on my left leg) along with a different kind of antibiotic and with a couple of kind of surface washes. Finally disappeared after a third type of antibiotic (Keflex as I remember) was prescribed in Suva, Fiji. The doctor there said that I needed an antibiotic that was designed for skin infections. We now have four different antibiotics onboard for various types of infections (gastro, skin, dental, etc). Apparently an infection like this can come after a mosquito bite or even if a hair becomes ingrown.

Was given a skin stapler by a surgeon friend who said it is a great alternative to suturing for an amateur. In a way I've always wanted to use it - then again I didn't want to use it. We have a lot of medical stuff onboard and took a wilderness first aid course before we took off.

My advice, for extended cruising where you may be many days from medical care - get training, have appropriate reference books onboard, have an extensive medical kit (equipment and medications), be sure the boat can be handled by all onboard. My wife sailed the boat and did nurse duties when I was dealing with a high fever and sleeping for 20 hours a day.

 

[knuterikt]

As soon as you sail into waters out of helicopter reach you are alone (with your crew), as most of the professional sailors out there.

Getting some training and having supplies on board is a must.

In the old days where coastal radio stations where operating on most of the coasts of the civilized world there was a service called MEDICO.

In Norway we still have this service in operation, the Norwegian maritime radio service can put us in contact with doctors trained in giving medical help using radio.
Medical Advice.

In today's modern world it's even possible to reach them by sat phone and e-mail.

I would think that US would also operate a similar service?

 

[RichH]

My advice, for extended cruising where you may be many days from medical care - get training, have appropriate reference books onboard, have an extensive medical kit (equipment and medications), be sure the boat can be handled by all onboard.

Here's an example of a training system for laypersons - essentially EMT or First Responder courses for wilderness situations, including 'floating' wilderness courses: SOLO Wilderness Medicine - The leader in wilderness medicine training in the United States
There are other sources and all based on and adapted from the national US EMS-DOT standards. If interested, do your websearch for "Wilderness + EMT" or "Wilderness + EMR".

 

[AlaskaMC]

Wow Killarney! What a scary story and I totally agree that the odds of having the "right" antibiotic on hand would just be plain luck depending on the bug that was trying to kill you. I have had a similar problem to what you describe but it was thankfully on land. Also, turns out I am allergic to some antibiotics and almost lost my achillies tendon to one course. That was scary too, can't imagine having it happen at sea.

On the case of training, get as much as you can. Outdoor wilderness courses are fantastic. Me, I just keep my RN wife nearby

And that is a joke by the way, two people on board? Don't rely on one to have any particular training, you should always both have it when practical. What if your doctor on board is the one unconscious from a boom hit to the head?

 

[MedSailor]

Now, if you have a medical background, which I do, there are steps you can take to possibly make it to the nearest port and possibly obtain emergency medical help. Without that background, at best, it's a WAG (Wild Assed Guess) when it comes to the diagnosis. Sure, there are a few books for sailors to make an educated guess at what may or may not be going on, but by and large, it's a crap shoot and the odds are stacked against you making a proper diagnosis without having the tools onboard to do so.
Gary

THIS, what Gary said, is really important.

Here's the deal with self doctoring, be it at home or a million miles away at sea. CORRECTLY DIAGNOSING THE CONDITION is the difficult part. The rest is easy. The ocular migraine is a great example. 99% of folks who aren't a higher level medical expert would think it is an emergency possibly worthy of pressing the EPIRB button. I had my first ocular migraine when I was an experienced full time critical care EMT and I didn't know what it was and thought I was going to die. What a shame that would be to initiate a rescue and abandon a boat over something that needs no treatment. On the other hand, the ocular migraine has a similar presentation to stroke or a blood clot in the blood supply of the optic nerve, and these conditions need immediate treatment and likely evacuation. Not getting the diagnosis right in either case can result in the loss of a boat (for a false alarm) or death/disability for a missed diagnosis.

A well stocked kit can be helpful, but can be extremely harmful too. Antibiotics, sutures, drugs of all kinds, casting material and many other items can do much more harm than good in the wrong hands. Antibiotics accumulate in certain parts of the body, and kill certain bugs. Some will work for a bladder infection but won't do squat for a skin infection. Some are great for pneumonia but do nothing in the gut. The tetracycline group can become lethal if taken past it's expiration date.

So, what's a cruiser to do? We gain knowledge of diesel, electrics, fiberglass, rigging, and become a jack of all trades. Can't we just take a few books or a course or two to gain "enough" medical knowledge? In my opinion, no, it unfortunately can't be done, not to a relevant level of competence with diagnosis. THAT'S WHY BECOMING A PROVIDER STILL TAKES SO LONG. No quick course will get you up to speed on diagnosis. At my PA school they routinely told us "focus on learning how to diagnose. You can always just look up the treatment." There is wisdom in that. BUT if you don't have several years, and many thousands of dollars for medical school, you're not going to be able to do the diagnosing.

There is hope however. If you can arrange your communications in such a way as to be able to communicate at any time (sat phone comes to mind, or SSB to shore operator) and you spend a little money on an international travel evacuation insurance plan, they will have real doctors and providers available to consult by phone 24/7. DAN (diver's alert network) also has similar services. If you have a professional to help with the diagnosis and a well stocked kit aboard, then you're in good shape.

This, by the way is how the Australians who are living in extremely remote out-stations do it. (I worked with the flying doctors in remote Australia for 2 months) They all have ham radios and they all are issued the exact same medical kit from the government. The kit contains items that are numbered but not labeled. This discourages self treatment, but once they get on the radio with the "flying doctors" the doctor can instruct the patient to "inject item number 27 from your kit." A real consult from a working professional that is invested in your care (not a friendly cruising doctor who may be a psychiatrist for all you know) and a good kit are the best option in my opinion. Lucky for us, with today's communications advances it is getting easier and easier to be able to set up this kind of communication.

MedSailor