So there’s tons of advice online about how to prepare ahead of time for medical emergencies on a boat. There are lots of med kits out there that you can buy that range from glorified multi-packs of generic Band-Aids to mongo-expensive full-on EMT med kits, complete with AED’s (defibrillators). You play the same game when buying med kits as you do when buying insurance: balancing cost against likelihood and danger of the worried-about event. As a doctor, Mel had probably a better glimpse into the “likelihood” and “danger” part of that equation than most, but as you will see, even she had trouble predicting what was going to happen out on the Big Blue.
Here is a list of the most useful medical professions offshore:
- A nurse of any kind
- Dermatologist (for all those skin diseases—you will see)
- ENT (Ear, Nose, Throat doctor) (for divers and our GD ears)
- General practitioner: Internist/Family Medicine/Pediatrics (for the big picture, and all those icky kid problems)
- Physical Medicine/Physiatrist (back pain from spinnaker hoisting and George Town Toe)
- Infectious Disease specialist (Hey, doc, what caused my pus? I’m in the tropics, I walk around in my bare feet, I swim in the ocean, and I’ve been bitten by EVERYTHING!)
- Orthopedic surgeon (see physiatrist, but less useful without fancy tools)
- Emergency Medicine (good at triage and calming panicked people)
And here is a list of one of the least helpful medical professions offshore:
And that’s what Mel is.
Anyhoo, so that’s how much this advice is worth. Here is a quick list of the medical events that actually befell this healthy family that suffers from seasonal allergies as they cruised the peri-Atlantic world.
- Communicable staph skin infection in the kids, AKA “impetigo.” This is weird because it normally happens to younger kids, but that’s what Mel determined it was, especially when it persisted for three weeks but then resolved with antibiotics in 48 hours.
Treatment: Bactrim DS (a broad-spectrum antibiotic that requires careful dosing in kids)
- Tinea corporis (a fungal infection of the groin and armpits)
Treatment: Topical Lotrimin and Lamisil and then prevention by drying the skin completely with a fan before dressing. A doctor in Curacao told us it was also preventable by washing the groin with diluted vinegar several times a day, but that sounded like too much work.
- Sea lice (an encounter with jellyfish larvae that manifests as what looks like tens of itchy mosquito bites in areas compressed by a swimsuit)
Treatment: Scratching, hydrocortisone cream on occasion, time, and the sheer joy of grossing out your family by squirming in your chair in a nice restaurant and announcing loudly, “Ugh! My sea lice itches!”
- Pityriasis Rosea: A weird, idiopathic skin condition that starts with a rough red “herald” patch and turns into slightly itchy spots over the body that takes 6-8 weeks to clear up. This is tricky, as it starts out looking fungal.
Treatment: Satisfaction in a self-diagnosis and the fact that this condition normally affects much younger people who are in their 20’s.
- External otitis: (Ear infections of the canal, presenting as pain in the ear in the parts you can touch with your finger)
Treatment: Ciprofloxacin eye drops. Yes, eye drops work in the ear! (We bought some CiproDex, which has an anti-inflammatory, once we were out of the states and we could get it for $18 a bottle instead of $300 a bottle – OH DO NOT GET ME STARTED!) Note: Oral antibiotics for this is usually overkill.
- Traveler’s diarrhea: In Colombia, we were fine drinking the marina water for three whole weeks, but then we ate some candy from the Candy Arcade in Cartagena. It wasn’t even any good!
Treatment: Since it was not bloody, as instructed per Mayo Travel Medicine, we did not treat it for two weeks. After that, Mel lost patience and it cleared up with azithromycin.
- Jellyfish stings: all mild
Treatment: You do not have to pee on these unless you want to look all outdoorsy and dramatic. You can rub sand on it to pull out the nematocysts, and then you rub vinegar on it. It will hurt worse initially, but in about 5 minutes you will never know you have been stung. I repeat: INITIALLY IT WILL HURT WORSE, AND YOUR FAMILY WILL HATE YOU AND TELL YOU THAT YOU WENT TO A CRAP MEDICAL SCHOOL.
- Conjunctivitis (Mild eye irritation): Mel suffered allergic conjunctivitis as part of her seasonal allergies, and for some reason while crossing the Atlantic she developed a full-blown viral conjunctivitis with a mild fever that spread to the cat. No, seriously.
Treatment: Antihistamine eyedrops purchased in Europe, cheap, over the counter. Bacterial conjunctivitis is rare and much pussier than what Mel had, so the Cipro eyedrops stayed in the med bag and it cleared up in a couple of days on its own.
- “Diver’s Ear” Here’s the scenario: someone, usually a kid, jumps off of the topsides into the water 10 feet down and then surfaces, screaming that an ear hurts. Alternatively, a diver says that they always have ear pain and a pressure sensation after a dive. Diagnosis: impacted wax. THIS HAPPENED ALL THE TIME.
Treatment: Debrox ear wax remover (or liquid colase, a stool softener) followed by lavage, which involves squirting water into the ear canal with a bulb syringe and watching the wax pop out. Yes, you are right, it is gross, but effective!
- Thumb laceration: This whole stupid story is here.
Treatment: Whiskey (which was remarkably effective), squirting benzocaine into the wound because we couldn’t find our syringes, vigorous flushing with just plain water for 5-10 minutes, Steri-Strips, SuperGlue, a protective thumb splint, and a single dose of cephalexin that day. Mel is left with some numbness and a scar, but it never got infected. Altering her thumbprint is all part of her evil plan…Mwahahaha!
- Benign skin lesion
Treatment: Mel noticed a growing bump on her nose, thought it was a basal cell skin cancer, had it removed and biopsied in Gran Canaria, and it turned out benign. So much for Mel’s clinical acumen.
- Back pain (presumed lateral recess syndrome): You get this from hyperextending your back. Like when you hoist and douse a spinnaker on a 48-ft catamaran.
Treatment: Yoga, massage, and avoidance of triggers, like sitting on a hard surface. We saw a physiatrist in Gran Canaria who prescribed some physical therapy that basically involved TENS and massage but no stretching or exercise, so Mel concluded it wasn’t very good.
- Plantar wart resolution: a medical mystery!
Multiple family members had pre-existing plantar warts (warts on the bottom of your feet) that cleared up after we had been walking barefoot around the boat and the beach for 10 weeks. One of these warts had been present for 30 years! It’s probably lying on a beach somewhere in Colombia. I hear…Treasure Hunt!
- A single chronic, non-life-threatening medical diagnosis: Mel won’t get into it, but she will share an interesting story about securing medication for this condition in Spain in a future post.
Note that seven out of the thirteen conditions were skin conditions! Also, while we continued to battle allergies, we suffered much fewer upper respiratory infections and sinus infections than typical for us. We took vitamin C as a preventative every day. Who knows if it helped! It was yummy.
Here’s a list of things Mel worried about that didn’t happen:
Pirate-induced gunshot or knife wound
Mercury poisoning from all of the fish
Rabid animal attack
Worms coming out of our butts
You see, sometimes, it’s not an advantage to be a doctor.
Stay tuned for more unsolicited medical advice!