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In preparation for retirement with some plans for making passages, I asked my doctor about my potential risk for stroke and heart attack. He gave me a referral to a local surgical group that offers a series of free screening tests. They performed an Aortic Aneurysm Ultrasound, a Carotid Artery Ultrasound, and an Ankle Brachial Index test. All was clear.

My doctor also referred me for a CAT scan of my cardiac coronary artery for Cardiac Calcium Scoring. That one only cost me $105 out of pocket and also showed me to have clear arteries.

Questions:
1) I'm curious to hear from folks (this may be a question for the medical professionals in the group) about whether or not anybody carries blood clot busting drug Alteplase to sea, in the event of a stroke or heart attack, due to a blood clot. Is it something that a non-medical person could administer to themselves? And would it be feasible to administer it outside of a hospital or clinic? Would a doctor even prescribe it to have on hand?

2) What is the current recommendation regarding a daily small dose of aspirin? I'm reading lots of conflicting recommendations on the benefit of that.

What are old sailors doing about this?
 

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I can't answer any of your questions, but I can provide a perspective specific to us, but seen in other cruisers also. Since starting cruising, both of us have experience a decrease in blood pressure, a lower resting heart rate, and less body fat.

Everyone is different, of course, and there are cruisers out there that look like they will keel over clutching their chests at any moment.

If you have a pre-existing condition, or are genetically prone to a disease, then certainly involve a physician in your plans. If you are in good health, and checkout just fine, then just go cruising and get yearly checkups. Your concerns might melt away.

Mark
 

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Have you considered some kind of marine advanced first aid type course? They don't go much into precription drugs but certainly cover things like aspirin.

I have taken different ones. One was 40 hours and they taught you a bunch of stuff.

Another one was 80 hours. Same course material as the first one, but the second 40 hours was all scenarios. The scenarios, which you were tested and debreifed on, covered most common medical emegencies; stroke, heart attack, diabetes, hypothermia, anaphylaxis etc.

I think the 80 hour one was more than twice as good as the 40 hour one. At the end of both courses you went home with reference books. Think recomended refresher is every 3-5 years. Refresher courses are shorter and cheaper.
 

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Discussion Starter #4
Have you considered some kind of marine advanced first aid type course? They don't go much into precription drugs but certainly cover things like aspirin.

I have taken different ones. One was 40 hours and they taught you a bunch of stuff.

Another one was 80 hours. Same course material as the first one, but the second 40 hours was all scenarios. The scenarios, which you were tested and debreifed on, covered most common medical emegencies; stroke, heart attack, diabetes, hypothermia, anaphylaxis etc.

I think the 80 hour one was more than twice as good as the 40 hour one. At the end of both courses you went home with reference books. Think recomended refresher is every 3-5 years. Refresher courses are shorter and cheaper.
I have not. I will check into this before I go offshore. I have lots of first aid and CPR training. This other sounds good.
Thanks
 

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Have degree in stroke medicine. No I won’t administer any thrombolytic during a passage. Risk of post use bleeding and absence of a way to control and support a stroke victim afterwards precludes use. More importantly guidelines require preadministration imaging. Of course one doesn’t want to administer this class of drugs in the presence intracerebral hemorrhage, subarachnoid hemorrhage or existing hemorrhagic conversion. So imaging is key prior to use.
With ischemic stroke administration within 90 minutes of the event is fruitful and should be done in accordance with the American Stroke Association protocol whenever feasible. However once segments of brain have died risk of hemorrhagic conversion increases and benefit decreases as any dead brain tissue is already lost for ever. If dead brain tissue is reperfused it may just leak blood and isn’t restored anyway.
So at least for stroke use of this class of agents on a cruising boat isn’t practical. I defer to the cardiologists here to speak to M.I.
 

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Discussion Starter #6
Have degree in stroke medicine. No I won’t administer any thrombolytic during a passage.
So at least for stroke use of this class of agents on a cruising boat isn’t practical.
Thanks. That is very helpful information. You described it very well, for a non-medical person like me to understand.
 

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Part of the problem with this discussion is that most "life saving" medical help and equipment we can administer at sea is a stop gap measure to give the patient time to get to professional medical care, usually considered to be a few hours. Defibrillation, Adrenaline or CPR for instance, are not intended for patients a number of days away from professional medical care.

When I was preparing for my circumnavigation in 1970, I asked my father, a surgeon, to put together a medical kit. What I basically got was a fancy first aid kit. No syringes, sutures or ultra-modern medications.. When I questioned him about this he laid it out very simply. No one aboard was a medical professional, so he gave us nothing requiring medical expertise. No sutures (butterfly bandages instead), as we'd most likely not be able to disinfect the wound sufficiently to close it. No injectables as they could be a problem moving internationally, and again we had no medical professionals aboard to assess the situation.
And by far the most intelligent thing he added was a twenty year old Merck Manual. This book had the kind of medications we were likely to find easily in the third world, not the newest ones unavailable outside the fanciest first world hospitals. With that book and the key to the aid station meds locker (kept by the chef du village or mayor) on some tiny islands we were able to save a few lives on our trip.
As with falling overboard, injuries aboard at sea are not something that will happen if all aboard are careful and have good situational awareness. SH*T does not just happen. People allow it to happen.
 

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Discussion Starter #8 (Edited)
Part of the problem with this discussion is that most "life saving" medical help and equipment we can administer at sea is a stop gap measure to give the patient time to get to professional medical care, usually considered to be a few hours. Defibrillation, Adrenaline or CPR for instance, are not intended for patients a number of days away from professional medical care.

As with falling overboard, injuries aboard at sea are not something that will happen if all aboard are careful and have good situational awareness. SH*T does not just happen. People allow it to happen.
That makes sense. I have been forbidden to die at sea, by my daughter.
One day I was reading an account of an 86 year old sailor who fell off his boat, and was lost at sea, presumed dead. I muttered to myself, "Lucky guy. That's how I hope to go".
My grown daughter heard me and forbade me to do anything like that. I pointed out that he was twenty years older than me, but she said it doesn't matter.

And I asked about different scenarios like, what if I start to show the signs of my mother's Alzheimer's coming on, and she said, "No!". She wants me to die at home, on land.
I asked about what if I am diagnosed at 96 with incurable pancreatic cancer, and I'm facing a long, painful excruciating death, and she still said that she wants me to die on land, so she knows what happened to me, and she can say goodbye. And she's a medical professional.

I maintain that, when the time comes, I should have the right to wheel myself down the docks to my boat, crawl aboard, sail far out to sea, drink a half pint or two, then slip into the water, to become shark food. But my daughter says "No".
So, dying at sea is something I'm not allowed to do. :crying
 

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I maintain that, when the time comes, I should have the right to wheel myself down the docks to my boat, crawl aboard, sail far out to sea, drink a half pint or two, then slip into the water, to become shark food. But my daughter says "No".
So, dying at sea is something I'm not allowed to do. :crying
Fortunately, I don't have that problem. No cold hard ground or embalming for me! I intend to give back to the oceans which have sustained me so well for the last nearly 6 decades. My kids have nothing to say about it and my wife will insure I'm not hooked up to a plethora of tubes in a sterile environment when the end comes.
Of course, my end could have come on any voyage over the last 50 odd years, so all my living relatives have pretty well settled on the fact that there may not be any 'closure' for them.
 

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It's that partial closure that can be so damm annoying. IN my case a nasty bout of attrial fibrillation causing death caught me by surprise.This apparently brought on by a severe case of central sleep apnea caused by an interesting fall from considerable hight .I'd never heard of any of this before so a great learning experience. Not that I'm a fan of a rat poison anti blood clotting program. there are medicines that may be considered preventive over the long term as is the application of a breathing assist device (BiPAP) .At the least the assisting air pump will make sure my blood is oxygenated as I'm overtaken by some less preventable medical problem. Losing control of the situation can be discombobulating to any plans you think are in your future
 

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Continue to be amazed by people’s judgment.
Do to change in insurance requirements current insurance requires me and at least two others for passage. Prior to last year only requirement was me and there was no vetting of crew. Never had a claim and now have done this passage biannually for 6 years (eastern Caribbean to/from Newport R.I.).
Have had people on Coumadin, defibrillators, serious episodic autoimmune disease, recurrent uncontrolled syncope and other illnesses I couldn’t treat while on passage or that would place the boat and souls aboard at risk.
Have a simple rule. If there’s any medical condition that could possibly prevent you from standing watch alone I don’t want you on my boat. If it’s a condition easily remedied such as mild motion sickness I’ll ask my other crew if they are okay with it. I feel as captain/owner I have a clear cut responsibility to my other crew. Feel I would be irresponsible to place their life at risk without their consent.
I’ve had people get quite snotty when they’re not selected. Usually try to be gentle telling them my decision is to their benefit and was made with their safety in mind. Once had a individual with such high myopia he was functionally blind without lens. He also seemed to have mild CP with resultant clumsiness and poor balance. He was deceitful on his resume, phone calls as where his references when called. He was furious when in the BVIs I left him behind.
Think age is no restriction. As long as everything works adequately and the odds of death on passage are low. Hypertension, mild arthritis, and other ills of aging aren’t a disqualification as long as you’re fully functional. Idea is to live until you die. But there’s no justification for you to place others at significant risk doing so.
 

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In preparation for retirement with some plans for making passages, I asked my doctor about my potential risk for stroke and heart attack. He gave me a referral to a local surgical group that offers a series of free screening tests. They performed an Aortic Aneurysm Ultrasound, a Carotid Artery Ultrasound, and an Ankle Brachial Index test. All was clear.

My doctor also referred me for a CAT scan of my cardiac coronary artery for Cardiac Calcium Scoring. That one only cost me $105 out of pocket and also showed me to have clear arteries.

Questions:
1) I'm curious to hear from folks (this may be a question for the medical professionals in the group) about whether or not anybody carries blood clot busting drug Alteplase to sea, in the event of a stroke or heart attack, due to a blood clot. Is it something that a non-medical person could administer to themselves? And would it be feasible to administer it outside of a hospital or clinic? Would a doctor even prescribe it to have on hand?

2) What is the current recommendation regarding a daily small dose of aspirin? I'm reading lots of conflicting recommendations on the benefit of that.

What are old sailors doing about this?
About 8 years ago, the American College of Cardiology came out and announced that taking aspirin increases your risk of bleeding events mainly - stroke and brain bleeds. If you have not had a previous heart event, DON'T TAKE ASPIRIN. For some reason... doctors have not adopted the latest information. My elderly mother had a brain bleed event because of the aspirin - just as the warning said. She is aspirin free for a coupld years now. If you want to stop a heart attack dead in its tracks, carry some good cayenne pepper. It dilates the blood vessels and stops the heart attack fast. No side effects either.

Dr. Esselstyn is now a retired cardiac surgeon from the Cleveland Clinic. He has shown since 1985, that you can heart attack proof yourself by adopting a plant based diet. This conversation becomes a mute point when you take away the daily injury that is the major cause of heart disease and related chronic issues. This does not make $$$ for the medical industry so is not taught to doctors and the general public, but is true! Here ya go - straight from the horses mouth. Well, they would not let me post the youtube link so search this and you will find it. He was the head cardiac surgeon. It does not get much authoritative than that. "The Nutritional Reversal of Cardiovascular Disease: Fact or Fiction". There ya go. If you have the correct video, it is 1:43:21 in length.
 

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Health care professionals accept nothing except double blinded, randomized controlled clinical trials with no type one or type two errors and an adequate N to achieve 0.5 Pierson as proof of the null.

There are multiple vasodilators. Some maybe of mild benefit in very specific circumstances. None will dilate a calcified atherosclerotic vessel nor clear an organized clot. Systemic vasodilation if overdone can produce hypotensive shock and death or injury to key organs such as brain or kidney.

The above link does not meet the criteria of a valid clinical trial. Therefore it’s efficacy is unknown. If the poster can present a favorable trial meeting that criteria I would be more favorably inclined to accept his premise.

Due to a multiplicity of favors most clinical societies and payers will not approve a intervention as standard of care without several clinical trials showing a favorable result.

Many people don’t appreciate you can never absolutely prove anything in science. Be it medicine, physics or even civil engineering. Best you can do is demonstrate your statement is true or false at a particular level of probability. The civil engineer maybe able to say in this wind with this load this bridge is this likely (X%) to remain safe and intact for future use. In medicine we strive to prove in trials that our statement (this drug lowers death rate by this much for this disease) to the criteria it’s equal to or more than 95% likely to be true and 5% or less likely to be untrue.
Trials are very expensive. The phase 3 trial for the “clot buster” used now routinely for stroke was funded by the NIH not any drug company. The prior large scale trials were done in Europe and several smaller phase 2 trials were done in the US.

It’s very unfortunate that many lay people accept statements that may or may not be true as definitive guidance. In my professional life saw injury and illness on a near daily basis in well meaning educated individuals due to their following such information. Beyond direct injury the occurrence of unintended consequences is quite common.
Example. Saw a 14 year old girl. Parents placed her on a strict vegan diet with virtually no fat intake and inadequate protein. They also never used tap water so she had virtually no iodine intake.Although they knew enough to supplement B12 she presented as being nearly non ambulatory, doing extremely poorly in school. Although left with mild cognitive impairment and resolving neuropathy she flourished with proper diet. Please don’t misunderstand. There’s nothing wrong with a vegan diet. There’s something wrong with taking it to an extreme in the absence of a complete understanding of human dietary needs. In this case other than initial supplements she remained on a vegan diet. However parents were referred to a clinical dietitian to be further educated.
Surprisingly kids need some cholesterol. You make your own cholesterol. Eating cholesterol or its precursors makes it easy to make cholesterol. Eating too much chronically isn’t a great idea. But for a growing brain and nervous system being unable to make adequate amounts of specific fats (myelin) isn’t too wonderful either.
 

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At 64 years old... I have seen enough of standard AMA style medicine and related treatments, and a more natural method. Sure... when I say natural, that can be taken in many directions. I hear what you are saying. I KNOW for instance, that hard core diabetics, can take daily cayenne and never develop neuropathy and the resulting removal of toes (or more) throughout their lifetime. I don't need to see the triple blind study to know it works. If a heart attack happens to someone that never produces nitric oxide with resulting rigid blood vessels... this discussion is kind of ridiculous anyway because out on a sailboat, they are going to die. Cleaning up the diet is the only and best solution, hands down. All your studies have been done to prove this for... how many years????

Oh.. and you said this, "There’s something wrong with taking it to an extreme in the absence of a complete understanding of human dietary needs" hmmm... Yes, this has been said over and over, that going plant based is extreme... but I agree with my hero doctors that having your ribcage cut and spread open while cutting and sewing blood vessels from your legs in to your chest seems to be the extreme thing here! lol..... And who has the absence of human dietary needs? I surely don't. We should compare our bp's some day! How much data do you want to show what the best way to fuel the human body is? Whether it is Dr. McDougall, Dr. Greger, Dr. Esselstyn, Dr. Campbell... Klapper... Fuhrman... Pritican, Kempner, and countless others that have done the studies and don't deny the results... it is all there! Even so called enemies of a plant based diet do come around and admit they are wrong after correctly understanding the data from the China Study. Which way you want to go? I gave the best advice to be given unless the best advice is not to sail too far from the ER.
 

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It’s unfortunate your reading comprehension is so poor. Please note in the above post I wrote there is nothing wrong with a plant based diet. I referred to a case where it was taken to an unfortunate extreme. I didn’t write that a plant based diet was extreme. Your failure to comprehend this distinction is unfortunate. I can only suspect you have another agenda, are cognitively limited or trolling. In fact agree the western consumption of excessive meat products is not good on multiple levels. Health just being one with impact on the environment a second strong reason. From my reading see no medical reason to not follow such a plant based diet with adequate understanding of your nutritional needs.

Given your inability to read and comprehend simple statements it seems fruitless to discuss this further with you.
Have a good time.
 

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It’s unfortunate your reading comprehension is so poor. Please note in the above post I wrote there is nothing wrong with a plant based diet. I referred to a case where it was taken to an unfortunate extreme. I didn’t write that a plant based diet was extreme. Your failure to comprehend this distinction is unfortunate. I can only suspect you have another agenda, are cognitively limited or trolling. In fact agree the western consumption of excessive meat products is not good on multiple levels. Health just being one with impact on the environment a second strong reason. From my reading see no medical reason to not follow such a plant based diet with adequate understanding of your nutritional needs.

Given your inability to read and comprehend simple statements it seems fruitless to discuss this further with you.
Have a good time.
I am glad you are such an astute reader. Yes in your abundance of words, I failed to see what you were saying. Usually, when someone can't agree that the plant based diet is the most effective way of treating heart disease, it is because they don't believe it. But to call someone with cognitive decline a troll with an agenda... ummm... sounds like a character issue. Yes I do have an agenda as the doors open for me to walk through... I try to shed light on a subject that most are clueless.. It could save a life... or 2. I don't think trolls give a hoot about anyone other than them selves. And as I do this where ever the opportunity arises.. I sooner or later run in to a wise a$$.
 

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If you want to stop a heart attack dead in its tracks, carry some good cayenne pepper. It dilates the blood vessels and stops the heart attack fast. No side effects either.

Dr. Esselstyn is now a retired cardiac surgeon from the Cleveland Clinic. He has shown since 1985, that you can heart attack proof yourself by adopting a plant based diet. This conversation becomes a mute point when you take away the daily injury that is the major cause of heart disease and related chronic issues. This does not make $$$ for the medical industry so is not taught to doctors and the general public, but is true! Here ya go - straight from the horses mouth. Well, they would not let me post the youtube link so search this and you will find it. He was the head cardiac surgeon. It does not get much authoritative than that. "The Nutritional Reversal of Cardiovascular Disease: Fact or Fiction". There ya go. If you have the correct video, it is 1:43:21 in length.
Nitro can also "stop a heart attack dead in its tracks," and is a great deal easier to carry in a standardized dose than some vegetable powder. Strike one against homeopathic medicine.
As for the second part, since the vast majority of cardiac events in modern society are caused by stress, perhaps these doctors pushing plant based diets are seeking something other than the best patient care?

I was taught that everything in moderation is the most healthy way to eat, not throw out the baby with the bathwater.
 
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