# Medical Crisis at Sea



## midwesterner (Dec 14, 2015)

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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## colemj (Jul 10, 2003)

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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## Arcb (Aug 13, 2016)

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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## midwesterner (Dec 14, 2015)

Arcb said:


> 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.
> 
> ...


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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## outbound (Dec 3, 2012)

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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## midwesterner (Dec 14, 2015)

outbound said:


> 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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## capta (Jun 27, 2011)

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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## midwesterner (Dec 14, 2015)

capta said:


> 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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## capta (Jun 27, 2011)

midwesterner said:


> 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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## Capt Len (Oct 9, 2011)

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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## midwesterner (Dec 14, 2015)

Capt Len said:


> ... IN my case a nasty bout of attrial fibrillation causing death caught me by surprise......


Huh? So you died? How are you writing this post?


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## PhilCarlson (Dec 14, 2013)

midwesterner said:


> Huh? So you died? How are you writing this post?


He got better...


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## Slayer (Jul 28, 2006)

colemj said:


> Since starting cruising, both of us have experience a decrease in blood pressure, a lower resting heart rate
> Mark


Until you have to dock :wink


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## outbound (Dec 3, 2012)

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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## videoguy (Feb 27, 2020)

midwesterner said:


> 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.
> 
> ...


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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## outbound (Dec 3, 2012)

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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## videoguy (Feb 27, 2020)

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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## outbound (Dec 3, 2012)

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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## videoguy (Feb 27, 2020)

outbound said:


> 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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## capta (Jun 27, 2011)

videoguy said:


> 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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## outbound (Dec 3, 2012)

Perhaps you might want to read post #17. I offered a commensurate response to your hostile diatribe.

Let’s move on. There’s science to suggest limiting red meat as your major protein source makes sense. Our antecedents were omnivores. Your dentition, G.I. tract and known evolutionary biology supports the same conclusion. Until the western expansion Americans like the rest of the world couldn’t afford daily beef unless wealthy. Historically meat of all sorts was used mainly as a favoring with a major meat dish served rarely. 
The institution of industrial farming allowed sufficient food stocks to allow the “growing” of beef at reasonable cost. Prior the opening of the huge grasslands supported the growing of beef and with railroads having been built transport to eastern markets. Given your biology there’s a drive for meat protein. However, in the past it was rarely satisfied. Profit at a corporate level has been a impetus in the general current high fat, high sugar, high red meat diet of Americans. 
Rarely than in the past when obesity was a sign of wealth now to some degree the reverse is true. It’s expected one of three Americans will be obese. Statistics demonstrate being over weight does not negatively impact life expectancy but obesity does. Climate science demonstrates growing beef has a negative impact beyond the cow farts producing heat absorbing gas. Having less cattle would mean less global warming, and a more productive use of resources. 
Still, see this as a distortion of our biology. We are omnivores. We ate animal protein rarely and red meat even more rarely. We can get by without undue consequences with moderate animal protein, or even little animal protein. Similarly we can get by with no animal protein and no adverse effects. The only thing I wished to point out by my post#16 was to do so requires a small bit of study. I’m glad you have realized that is my position. Perhaps the tenor of your future posts will be less hostile.
For your information I eat red meat once a week or less. Beef in the Caribbean is of poor quality and expensive. I restrict dairy. I eat goat, fish but mostly chicken which is commonly available and cheap. When in the French islands eat occasional pig in various forms. Usually only one meal a day contains animal protein. Often that protein is used as a favoring. Such as a salad with turkey pastrami strips or a stir fry with chicken. I have two kids. Both are omnivores as well and even more than me severely limit animal intake. My grandkids are in single digits. They eat an omnivore diet but rare red meat. Many of my friends are strict vegans. We commonly eat together. See choice of diet as a personal decision. Do wish less animal protein was eaten particularly beef.


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## SloopJonB (Jun 6, 2011)

Capt Len said:


> IN my case a nasty bout of attrial fibrillation causing death caught me by surprise.


You look surprisingly good, all things considered.


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## MarkofSeaLife (Nov 7, 2010)

midwesterner said:


> 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.


If you have a "clear" CAC Agatston score that would suggest your score is Zero? Even under 10 or 20, then you cannot physically have a blockage of your arteries from arterial disease (no matter what anyone says). Neither is it likely to have a stroke.
So you don't need any anti clotting drugs at sea unless you expect a gun shot would to give you a clot.

The CAC score is the holy grail... and a zero score of the CAC score is the holy grail of the holy grail.

Everyone over 50 should have a CAC score done!! :grin


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## videoguy (Feb 27, 2020)

capta said:


> 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.


""As for the second part, since the vast majority of cardiac events in modern society are caused by stress"" - 
This is absolutely not true. Please give me a source for this. Leading cardiac surgeons would not agree to this one bit. It is laughable!


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## capta (Jun 27, 2011)

videoguy said:


> ""As for the second part, since the vast majority of cardiac events in modern society are caused by stress"" -
> This is absolutely not true. Please give me a source for this. Leading cardiac surgeons would not agree to this one bit. It is laughable!


Laughable? Wow that's really refuting my statement with facts. Instead of deflecting, perhaps it would have gone a bit better with alternative facts?


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## midwesterner (Dec 14, 2015)

capta said:


> videoguy said:
> 
> 
> > ""As for the second part, since the vast majority of cardiac events in modern society are caused by stress"" -
> ...


Well this discussion has gotten a little heated. I had no idea that this subject had the potential for that. Maybe I should have posted a question about gun control, abortion, or man made climate change.


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## videoguy (Feb 27, 2020)

capta said:


> Laughable? Wow that's really refuting my statement with facts. Instead of deflecting, perhaps it would have gone a bit better with alternative facts?


Well... I had already posted the facts, but I guess you did not see it, so I will post it again. I can't post a URL, so you will have to copy and paste this in to youtube. It is by a retired cardiac surgeon from the Cleveland Clinic, and he was the head surgeon. I think he knows what he is talking about.

"The Nutritional Reversal of Cardiovascular Disease: Fact or Fiction"


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## MastUndSchotbruch (Nov 26, 2010)

outbound said:


> It's expected one of three Americans will be obese. .


You are not up to date, Doc. "By 2019, figures from the CDC found that more than one-third (36.5%) of U.S. adults age 20 and older[2] and 17% of children and adolescents aged 2-19 years were obese" https://en.wikipedia.org/wiki/Obesity_in_the_United_States


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## capta (Jun 27, 2011)

videoguy said:


> Well... I had already posted the facts, but I guess you did not see it, so I will post it again. I can't post a URL, so you will have to copy and paste this in to youtube. It is by a retired cardiac surgeon from the Cleveland Clinic, and he was the head surgeon. I think he knows what he is talking about.
> 
> "The Nutritional Reversal of Cardiovascular Disease: Fact or Fiction"


 You know, I really couldn't give two sheets what that *(your) *cardiologist has to say, because the twenty or so I've seen since I had *my* cardiac even in my early 40s, have kept me alive and healthy on almost the opposite recommendations you are putting forth.
You can find any side of any idea or suggestion put forth, on the web to justify the craziest theories, but to me it makes a lot more sense to listen to those who are caring for me. The medical professionals I've dealt with (not all American trained medical professionals) have suggested a sensible diet of veges *and* meat, some homeopathic meds, some not so much, 81mg aspirin, and pay a lot of attention to their patients' mental state. Any medical professional that professes that any one thing is the solution to something like cardiovascular health, is nothing more than a charlatan IMO.


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## chef2sail (Nov 27, 2007)

So how did a nice thread about medical crisis events at sea get hijacked into a Political discussion of vegan diets.
This still is a sailing forum. Aren’t there better places to argue about what you eat😄😄😄


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## outbound (Dec 3, 2012)

When cruising I think there’s several important things to know.
First is what’s trivial and can be deferred until you get to your battery of providers that you know (or believe) are good.
Second how to handle trauma and other common serious ills you may actually encounter - fish or jellyfish toxins, severe motion sickness., rashes, shock etc. Here a medical background +/or wilderness medicine courses are most helpful.
Third - the ability to judge the quality of care in novel, foreign places. This is perhaps the most important as you spend a minute amount of time on passage and most cruising. Unfortunately it’s extremely difficult for people to judge even at home. There’s a massive divergence between bedside manner and skill set/knowledge. All too frequently as a specialist I saw highly regarded providers who were sub par providers-poor diagnosticians, or very late to refer do to ego or financial incentives. One needs to ignore the setting. We’ve gotten excellent care in places where the bedsheets are patched (but spotlessly laundered), the surrounding primitive but the practitioners well trained, intelligent and skilled. On other occasions have been forced to stabilize, arrange how to leave the boat and flown out in order to get decent care. We continue to carry medvac insurance.
This fear of dying due to a salvageable situation is one of the strongest incentives to not cruise alone. I did it for a year because wife was still working. The sailing part wasn’t hard. The logistics of life was much more difficult. If you choose to do this it’s important to try to network with other cruisers in your cruising grounds.
What to put in your medkit is totally determined by your skill set. Professionally have seen more avoidable damage done by misdirected non professional care than the absence of care. Being dependent on the Internet for advice is ludicrous. When you need it it’s likely unavailable or given the multiplicity of opinions offered as fact can be misleading. Sure there are subscription services such as UpToDate or Sciencific American Medicine which are accurate and peer reviewed but cumbersome for lay people to use. 
Think a medvac service is reasonable. Many use PADI or Medijet. Worth shopping it. Think educating yourself is very worthwhile. Beyond that like life it’s a crapshoot.


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## Minnewaska (Feb 21, 2010)

One of the greatest life skills I achieved was taking an EMT course, when I was in my 20s. It was pretty inexpensive and sponsored by our local community college and hospital. A buddy and I were gaining the certification, for dive rescue purposes at the time, even though the standard was far below this level. 

Most in the course were intending to volunteer at their local firehouses or work for an ambulance company or go on to paramedic. 

It was not your weekend first aid course. There was testing in anatomy and bio-science, as much as training basic diagnosis and stabilization. You learned wound management at a professional level. You learned how to stabilize a patient long enough to get higher level care. We were not certified to administer drugs, other than Oxygen, which btw, was virtually the first thing administered to any breathing patient. Proper use of a defibrilator too. 

I've used the wound management skills countless times. I also was first on the scene of a random car accident (hit a deer), as I was traveling down a country highway and was able to stabilize the driver long enough for an ambulance to arrive. That was a first. Heart was pounding out of my chest.

If you can spare the time and make the commitment, I'd highly recommend it to anyone that would cruise offshore. You're not going to do much about a stroke for very long, but the odds of seeing one are far below a severe cut or break. For severe maladies, just extending life long enough for a commercial ship with higher level resources to get to you, could be the difference. 

Getting into another lane, we are at the infancy of tele-medicine, let alone artificial intelligence providing primary care. Even today, there are subscription services one can access by sat phone, from anywhere in the world. My primary physician has said he'd take my call, for anyone aboard.


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## outbound (Dec 3, 2012)

Professionally have been involved with telemedicine services in the past. They represent a major breakthrough in health care delivery. It allowed one to review imaging, and one can supervise the clinical exam and any intervention in real time. However, the practitioner providing advice is sitting in front of a video feed as well as a computer feed from the remote site. The provider on site has medical sophistication.. Bandwidth to support this service is large and transmission speed fast. I have a fleet one satphone. Although it is a step up from my prior globalstar it would be incapable of supporting such a service. It could support dialogue and perhaps some limited video or stills but likely not much more. Imaging, of course, is unavailable on a cruising boat. 
You need to know the questions to ask. You need to know what observations are important. You need the skill set and supplies to intervene. Hence, strongly support the expansion of telemedicine services but for the cruising sailor, hiker, climber, hunter or fisherman in remote areas nothing supersedes the need for education and training before leaving.
We do not subscribe to a telemedicine service. Our medivac does include advice. Can’t reasonably justify the expense of full blown telemedicine. However, I’m a doc and wife’s a nurse so our decision is predicated on value added. We have used the satphone, local phone to speak to colleagues for advice concerning ourselves, visitors and crew. Is important to know what you don’t know. 
Trauma is more likely to occur when it’s snotty. The Immarsat device seems to better than the globalstar. But still would not wish to be dependent upon any device for likely emergent care. What Minnie did is brilliant on multiple levels. A blessing to himself and those around him. 
Would encourage posters here to get some form of training. Daysailors, coastal cruisers and racers are also subject to injury, burns, sudden acute illness. The golden hour is generic so see no downside for all sailors having training. Totally support Minnies decision.


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## mbianka (Sep 19, 2014)

Just got off a cruise ship that sailed out of New York to the Bahamas and back. First night out I just gone to bed when an announcement came over the PA for any passengers using Neosporian or Tacrolimus to come to the Medical Office on board. I had no idea why as that was all they mentioned. My mind was thinking a major recall of these medications or some onboard restrictions. Since I had been using Tacrolimus ointment to treat a skin condition I got dressed and went to the Med Office on board. I showed them the tube I had. The doctor said thanks but, they were looking for the medication in pill form. I don't know why but, someone may have had some type of allergic reaction that required the medication internally.

The next day I heard a plane come by and buzz the ship. I did not see it but, I wondered if it had flown by and dropped some of the medication on the deck. Nice to have these facilities on board and maybe in a pinch be able to have access to them. But, I wonder if you will get a $$$ bill from the cruise line eventually.


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## Minnewaska (Feb 21, 2010)

The thought of getting sick, or anyone else getting sick, on a cruise "petri dish" ship, is enough to have kept me off them so far. I'm sure I'd love the ocean part, perhaps the chow, but being crammed in with thousands of germ factories, recirculating their sputum, no so much. 

Okay, that's a little overboard. Still. I'm out.


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## mbianka (Sep 19, 2014)

Minnewaska said:


> The thought of getting sick, or anyone else getting sick, on a cruise "petri dish" ship, is enough to have kept me off them so far. I'm sure I'd love the ocean part, perhaps the chow, but being crammed in with thousands of germ factories, recirculating their sputum, no so much.
> 
> Okay, that's a little overboard. Still. I'm out.


Certainly a risk but, not as risky as flying in a metal tube with recirculating air IMO. Noticed there was not as many Asians or Indians on board as on the same cruise I did in December. I tried some of the specialty restaurants and never had to make a reservation as they were never full. I dined alone and did not really chat with anyone. I observed everyone was either using the sinks or the hand cleaner the staff was spraying into your hand as you entered the restaurants saying "Washy washy. Good for you good for me."

Even when disembarking back in New York while taking the escalator down to pickup my luggage at the Pier things were sanitized. There was a staff member spraying and wiping the escalator handrails as it moved by. I do feel sorry for those who need to take the Subway in New York on a daily basis these days. I'd rather take my chances on a ocean going vessel any day.


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## Minnewaska (Feb 21, 2010)

I don't know. I'm not aware of any disease actually named after an outbreak on an airplane, ie legionnaires. Then again, no one sick is allowed aboard private aircraft. 

A confined space with a couple of hundred people, such as subways and aircraft, are certainly potential hot spots. However, cruise ships confine you with thousands, which changes the odds substantially. No doubt, they'd be taking good sanitizing precautions. I like it... good for you good for me. 

That's really the point. It's not a terribly deadly disease. It's just very contagious and we have to stop giving it to each other to kill it out.


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## MastUndSchotbruch (Nov 26, 2010)

Minnewaska said:


> I don't know. I'm not aware of any disease actually named after an outbreak on an airplane, ie legionnaires. Then again, no one sick is allowed aboard private aircraft.


Ehm, can't confirm that:

"Legionnaires' disease acquired its name in 1976 after an outbreak of pneumonia occurred among people attending the American Legion convention at the Bellevue-Stratford Hotel in Philadelphia. Later, the bacterium causing the illness was named Legionella pneumophila."

https://www.medicinenet.com/legionnaire_disease_and_pontiac_fever/article.htm


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## chef2sail (Nov 27, 2007)

MastUndSchotbruch said:


> Ehm, can't confirm that:
> 
> "Legionnaires' disease acquired its name in 1976 after an outbreak of pneumonia occurred among people attending the American Legion convention at the Bellevue-Stratford Hotel in Philadelphia. Later, the bacterium causing the illness was named Legionella pneumophila."
> 
> https://www.medicinenet.com/legionnaire_disease_and_pontiac_fever/article.htm


Is correct.

I lived in Philly at the time. The bacteria lived/ grew in the air conditioning generation system which to this day has created many more inspections of them. Almost all future outbreaks are attributed to stagnant water in air con systems.


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## Minnewaska (Feb 21, 2010)

MastUndSchotbruch said:


> Ehm, can't confirm that:....


Yup, my mistake. I was just poking a little fun anyway. Cruise ships are just huge floating hotels anyway. 

I googled Cruise Ship Disease Outbreak. It seems Norovirus is a fav on cruiseships.


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## eherlihy (Jan 2, 2007)

I just returned from a week aboard a "Flo-tel" on Sunday. It was a great way to get out of the house, and to see some more islands to which I have yet to sail. Don't knock it untill you've tried it. Air-travel, however... I PREFER the three day DRIVE (1500 miles) from MA to FL rather than to participate in the TSA theatre, followed by spending 2.5 hours stuck in a tube with 125 people and several of their pets. I did that for 30 years, and have grown to hate it.

Regarding the medical crisis while at sea; I had to take an "approved" First-Aid & CPR course in order to qualify for my OUPV. I took the class through the Red Cross. I also took a refresher that was mandated by the person that ran the sailing school I used to work for. I found both courses to be essentially worthless. I believe that I had better first aid training through the cub scouts as a kid. I'm not knocking getting trained. But I am discouraging anyone that has only attended the two-weekend "training" that many organizations offer from believing that they are prepared.

On my boat I carry two first aid kits, and a first aid handbook, and a simple pamphlet that I developed to instruct the crew on what to do in an emergency. Because I am the only one that has had ANY training, and because I view part of my responsibility as protecting my crew; more than likely I am the one that is going to get hurt. I show the book and the pamhlet to everyone that comes aboard, and show them where they are kept.

Because I am sure that I pirated this information from somewhere else on the internet and then edited it to suit my purposes, I will post it here and enable you to do the same. I hope that someone else finds it useful. Also, because there are several physicians here that might comment on it (looking at you Lee), I hope to hear from them. (You can tell me it would be most useful as toilet paper - I'm OK with that)

I have cut & pasted the pamphlet contents below (realize that the formatting will be lost). Here it is;


> There have been many articles written on First Aid, of course. However, there are some basics
> on three basic problems one could encounter while aboard: Heat related injuries, bleeding and broken
> bones.
> 
> ...


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## capttb (Dec 13, 2003)

I was some variety of EMT or paramedic from 1971 to 2003 and it was sort of a running joke that the final step of treatment for anything was "administer O2 and RAPID transport". I can stop your bleeding, splint your arm, keep your airway open etc. but can't really "fix" very much. Last time I was asked to aid someone I wasn't much help. A dockmate slipped on her companionway steps lacerating her shin, they asked me to "throw a couple butterflies or something" on it I said "Yeah, no, she needs to go to a doc and get that closed, above my paygrade". They took her to a "doc in a box" (urgent care) where they said "Yeah, no, she needs to go to the REAL hospital to get that closed, above our paygrade".


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## ps23435 (Jul 13, 2011)

I know this has been said in different ways throughout this thread, but the level of medical/first aid training and content (and quantity) of medical kits obviously varies depending on size and type of vessel, duration of voyages and where you go! I've been an Advanced EMT for years and while that training and experience has undoubtedly made me more confident in dealing with problems encountered underway, the most valuable training has been the wilderness first aid programs. Having gone through several and been an instructor for one, I think the wilderness programs give you the right mindset and approach for dealing with medical and trauma emergencies when 911 is not an option! A 16 hour wilderness course is (in my humble opinion) a great investment of time and $$ for any cruiser. Of course, if you have more time and money (and if you are going on an extended voyage there are more specialized offshore medical courses (for example "Offshore Emergency Medicine" - https://www.wildmed.com/offshore-emergency-medicine/).

There are other short (and oftentimes free) training that can't hurt, the new "Stop the Bleed" courses provide the latest info on dealing with severe bleeding (updates the old direct pressure/pressure point approaches to current standards). - https://www.stopthebleed.org

Finally, yes, there are differences in quality among first aid programs, but in the end some training is better then none. Get what you can afford in time, money and effort, but get something!!


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## Zanshin (Aug 27, 2006)

I do a 2-day offshore or wilderness medical course every 2-3 years and consider it some of the best invested time and $$ that I can do with regards to sailing. It also gives you an appreciation of what kind of training medical professionals go through as you cannot compare 2 days of training with several years of training plus practical experience!

Those wilderness or offshore classes differ markedly from standard first-aid courses that most of us have taken. The latter trains you to keep someone alive or stabilized for 10-20 minutes until professional help arrives while the former shows you aspects of keeping someone stabilized for two weeks or until you can get to professional care. Luckily, we humans are pretty hardy!


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## Minnewaska (Feb 21, 2010)

capttb said:


> I was some variety of EMT or paramedic from 1971 to 2003......


What was some variety? No way one would confuse EMT from Paramedic. EMT is 100-200 hours of training, Paramedic was 1000-2000 hours, hospital rounds and often accompanied by an associates degree.

Were you a volunteer with a local Fire Department?


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## capttb (Dec 13, 2003)

Nope, professional firefighter, first EMT1S when a lifeguard, 2 week course at USC, then EMT1, then LA county medic at LA Harbor/USC in '78 which was EMT 4 I think, then EMT1 or 2 (I forget) again when captain supervising paramedics, then there was an additional EMT1A or something required for a while for automatic defibrillators. And probably others I've forgotten. Oh, I almost forgot, I was in a volunteer department in '74 but I was already a state certified Firefighter 1 and EMT1 by then and working professionally in a larger city department.


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## outbound (Dec 3, 2012)

Alluded to but not stated explicitly is the level of isolation you may find yourself in.
Depending upon nature of your passages help may not be on its way or delayed to a varying degree. This issue should inform both what is stocked in your med kit and ditchbag. It should also inform the degree of training you should seek.
Some hold the generally false belief that if in extremis of any sort a friendly ship will be nearby and divert in short order to lead a hand. It’s true commercial craft do go out of their way to an extraordinary degree to help us hapless sailors. However, given nature of propulsion even our courses from the same harbor to the same destination are usually different. The density of vessels in commonly use shipping lanes maybe but on the open ocean significantly less. Its even less on the common routes for sailboats such as transatlantic or New England eastern Caribbean. Even in my limited experience I’ve done multiple passages never seeing another vessel within sight, VHF, or AIS range once 50m from landfall. Now add in weather and the difficulties of victim transfer between a ship and small vessel. So the old saw”if you didn’t bring it with you-you ain’t got it” holds true. Bringing it with you includes knowledge, practice, skills, communication and supplies. I consider my immersat and SSB as part of the medical support system. I think given it’s important for small vessels to not be dependent upon just one individual and all crew should have basic skills. I think it’s the responsibility of the captain to walk through the what ifs with crew before leaving. I think this is just like safety at sea training. 
Best crew I ever had was
A NYC firefighter
Trekker with wilderness training 
Ex special forces 
Knew if I went down I’d be in good hands. Knew I’d be spelled to run the boat if someone else when down.
Even if never used most people who go through training acquire the skills to judge if other providers are skilled. When in foreign countries this is of huge benefit.


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## midwesterner (Dec 14, 2015)

ps23435 said:


> ..... Having gone through several and been an instructor for one, I think the wilderness programs give you the right mindset and approach for dealing with medical and trauma emergencies when 911 is not an option! A 16 hour wilderness course is (in my humble opinion) a great investment of time and $$ for any cruiser. Of course, if you have more time and money (and if you are going on an extended voyage there are more specialized offshore medical courses (for example "Offshore Emergency Medicine" - https://www.wildmed.com/offshore-emergency-medicine/).
> 
> There are other short (and oftentimes free) training that can't hurt, the new "Stop the Bleed" courses provide the latest info on dealing with severe bleeding (updates the old direct pressure/pressure point approaches to current standards). - https://www.stopthebleed.org
> 
> Finally, yes, there are differences in quality among first aid programs, but in the end some training is better then none. Get what you can afford in time, money and effort, but get something!!


Thanks so much to everyone. This has been very informative and I intend to take some form of the training before I take any off shore trips.

I have *ANOTHER QUESTION*:

I've read about the coagulant that military medics carry to reduce bleeding in combat situations. I have read that this coagulant has saved many lives, since it has come into use, slowing bleeding, to allow more time to get injured people evacuated to Med-Surgical unit without bleeding out.

Is that something that a non-medically trained sailor could, or should, carry on board?


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## outbound (Dec 3, 2012)

Quick clot dressing are commercially available to the public to my knowledge. Given ~40% of fatalities from trauma are due to blood loss not unreasonable to put in your medkit.


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## Zanshin (Aug 27, 2006)

While I've got the coagulant packs, one should remember that sugar will work in a pinch - it will work as a coagulant and is antiseptic when dry. And "crazy glue" works wonders, the medical variant substitutes the minuscule amounts of cyaninde with another compound, but is vastly more expensive and much more difficult to come by. In an emergency situation crazy-glue can save lives!


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## colemj (Jul 10, 2003)

Zanshin said:


> And "crazy glue" works wonders, the medical variant substitutes the minuscule amounts of cyaninde with another compound, but is vastly more expensive and much more difficult to come by. In an emergency situation crazy-glue can save lives!


Or non-emergency. A large box of tiny crazy glue tubes is a part of my (note I'm avoiding the pronoun "our") medical kit. I keep it with the rest of the the glues because I do use it for boat-related stuff, but it seems to get more use on me than on boat things.

Me: _"I'll just hold this 1" piece of material while I hit it with an angle grinder. The last time that failed was a fluke..."_
Me: _"I'll just block this round piece of material with my thigh while I hammer a chisel through it. This time I'll stop before I drive the chisel into my leg..."_
Me: _"I'll just use my thumb to push against the box cutter to shave this piece a bit. This time I'll be careful..."_
Me: - _a hundred other similar situations that I seem to be in almost daily._

Tool winning vs. Me winning: 10000000000000 to zero.

Superglue to the rescue.

Mark


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## Capt Len (Oct 9, 2011)

Long ago, before crazy glue. the go to stuff was 'friction tape' ,,tar impregated cotton tape used to cover electrical wiring joints. .Had excellent anti bacterial features too ,which was good because it held together some pretty major wounds. I know this how?


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## colemj (Jul 10, 2003)

Capt Len said:


> Long ago, before crazy glue. the go to stuff was 'friction tape' ,,tar impregated cotton tape used to cover electrical wiring joints. .Had excellent anti bacterial features too ,which was good because it held together some pretty major wounds. I know this how?


HA! I've got a big roll of this too. I call it "hockey tape" because I used to use it on my hockey sticks. We may be the only boat in the tropics where "_Michele, where did you put my hockey tape?_" has ever been heard.

At any given time, I'm covered in hockey tape and crazy glue.

And 5200, but not for medical reasons - if a drop of that stuff is within 50' of me, I get immediately covered in it.

Mark


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