Category Archives: Health

Prescription Meds and Personal Care Needs

11/21/2020 – Initial post

ON THE WATER, FOR ANYONE HAVING CHEST PAIN OR DIFFICULTY BREATHING, A “M’AIDEZ” CALL SHOULD BE MADE IMMEDIATELY.  LIKEWISE, MENTAL CONFUSION, SLURRING OF WORDS OR DROOPING OF FACIAL EXPRESSION, HEAD INJURIES WITH OR WITHOUT CONFUSION AND SERIOUS FALLS REQUIRE IMMEDIATE, URGENT EVALUATION AND CARE.  Plan and drill ahead of time for the possibility of a “m’aidez” call.  Know what you will need to be able to tell the USCG and rescue personnel about your location and the nature of your emergency.  Emergencies don’t care about the weather or seastate, so consider how you would handle the boat while caring for your spouse’s chest pain BEFORE an emergency happens.  Plan and drill for the sudden and unexpected possibility of being “Suddenly Alone.”  Plan for sudden disability of the Captain; plan for sudden disability of the First Mate or visiting crew member.

Prescription Medications and Medical Devices:  Always do  your own due diligence!  My Admiral and I take over-the-counter vitamins and aspirin, and prescription statin anti-lipid drugs.  I take prescription eye drops, and she takes several cardiac medications.  Well in advance of cruise departure, order a 3-month supply of all prescription medications and personal care needs.  With the proper documentation, customs and immigration officers (Bahamas, Canada) will clear them.  Without documentation, check-in delays are possible, if not likely.  It can be a problem to ship some medications across international borders, so medications that you absolutely cannot be without must be transported with you.

In the past several years, we have dealt with several different mail-order pharmacies.  They are not very good at supporting travelers.  (No, it’s worse than that; they are a superb pain in the posterior.)  We know that they can accommodate travelers, so stay calm, but be persistent.  Order early, and order only when you’re going to be in one place for long enough to wait them out.  Different medications will come from different warehouses in different parts of the country.  Be sure to update your delivery address a couple of days before you actually place the medication order.

Expect surprises.  We have gotten to the point that we call the pharmacy company a day or two ahead of placing the order just to update our shipping address.  That allows time for the updated delivery address to propagate across the pharmacy company’s computer server farm. We have had parts of our medication orders go to several different, random delivery addresses.  The pharmacy companies will always blame that on you.  They will want to use up one of your refills and will threaten to charge you full price for a re-do of the order.  We can scramble through all that, but it’s time-consuming and annoying.  If you change your permanent address before you place the order, there is a better chance they’ll get fulfillment and delivery right.  But, it’s on you to manage the process and your pharmacy company.

When cruising, be sure to have documentation aboard for any injectable medications and injection supplies that you transport.  What particularly comes to mind is diabetes medications and needles, and epinephrine injectors for anaphylactic allergic reactions.  Sanctuary’s Admiral uses a medical device called a “TENS unit.”  It’s electrical; it runs on batteries and needs electrode wires.  Carry spare batteries, and if you need/use rechargeable batteries, carry a spare charger.  Carry spare electrodes.  Get a copy of the prescription from the doctor to keep in your onboard file.  Consumable supplies for CPAP, BPAP, infusion pumps, catheters and ostomy supplies, glucose test strips and INR measurement test strips should be secured in advance of cruise departure.

Talk with your doctor before departure about having a 10-day supply of antibiotics and pain killers aboard for use in emergent situations.  If you’re cruising in some remote place, it may be a day or two or three before you can get to see a nurse, let alone a doctor.  Assuming no allergies to the antibiotic, starting an antibiotic right away may be/can be the right thing to do.  Your doctor can advise products suitable to your personal needs.  We were traveling in the salt marshes of the US southeast when the Admiral came down with an abscessed tooth.  Having a pain killer at hand definitely made us both more comfortable until we could locate a dentist.  I nicked a finger with a screwdriver, and within 18 hours, the finger was three times normal size and very painful.  I caught the wheel of a shopping cart at Walmart with my ankle.  By the next morning, my ankle was several times normal size.  Things happen.  Having a supply of Cephalexin/Ciprofloxacin was a really wise exercise in planning ahead, but it does not replace seeing a doctor as soon as you can.

Emergency Care: many pharmacies offer emergent care services intended to manage relatively minor health incidents.  They also administer flu, pneumonia, tetanus and shingles shots (shingles with a prescription, of course).  Walgreens and CVS are two national pharmacy chains we have used successfully.  These facilities are typically  staffed by a Nurse Practitioner.  The ARNP will be able to prescribe antibiotics, and handle simple conditions like skin rashes, bruises, splinters, cuts with simple stitches, burns, sprains, and similar types of injuries.  Depending on state law, an ARNP may not be able to prescribe opiate pain medications.  For initial assessment of an emerging situation, these facilities are very helpful, if available.

Free-standing emergency care facilities are also available in many areas.  These usually have on-site staff physicians.  Obviously, they can handle a wider range of health problems, including x-rays, simple blood and urine labs, and EKGs.

If you are taking responsibility for minor children (grandchildren, for example), make sure you understand any medications they need to take and whatever condition(s) those medications are intended to treat!  For minor children in the absence of their parents/legal guardians, have written and notarized parental permission to seek and request medical treatment if that should become necessary.  As we Boy Scouts are fond of saying: Be Prepared!

Mycobacterium Marinum: an Unpleasant Bacterial Infection

Two friends – both retired and both long-time boaters – have recently encountered a little known and extremely unpleasant bacterial infection called “Mycobacterium Marinum,” or “M. Marinum.”  Following is their “story,” for awareness.

M. Marinum infection has several “street names,” including “fish tank granuloma,” “fish-handlers’ nodules,” “surfers’ nodules” and “waterman’s disease.”  M. Marinum is a rarely-occurring infection in humans, but medical diagnosis can be difficult.  One affected friend spends half of his year in Arizona and half his year cruising the US East Coast.  The other lives in suburban Maryland and enjoys recreational skin diving.  Both victims regularly participate in in-water boat maintenance and recreational activities, and neither is actually sure how or when they were infected.  In both cases, diagnosis of their M. Marinum was long delayed, with several mis-diagnoses by physicians along the way.  In both cases, the delays in diagnosis resulted in well established infection, required extensive surgical remediation, and risked the real possibility of limb amputation, or worse.  In one of these case, delayed correct diagnosis resulted in extensive hospital time, antibiotic-induced kidney failure, and necessitated kidney transplant.  As I said, an extremely unpleasant bacterial infection!

M. Marinum is found in fresh, brackish and salt water in various parts of the world.  It has been found in the Chesapeake Bay and other regional waters.  People who have breaks in the skin, such as cuts and scrapes, may be at risk:

•    when in contact with water from an aquarium or fish tank,
•    when handling, cleaning, or processing fish, or
•    while swimming or working in fresh or salt water.

M. Marinum infection is not spread from person to person. There is no evidence that human infections of M. Marinum occur if fresh or salt water is swallowed.

After exposure to the bacterium, symptoms usually appear within 2 to 4 weeks, however some reported cases have developed symptoms months later.  The most frequent symptom is localized discomfort with a slowly developing lump (nodule) at the site where the bacteria entered the body.  Frequently, the nodule is noticed on the hand or upper arm.  Late, the nodule can become an enlarging, oozing sore.  Swelling of nearby lymph nodes occurs.  This infection can also involve the joints and bones.  Serious complications involving internal organs is possible.  This occurs more commonly in immunocompromised individuals, such as those with AIDS, cancers, or are pregnant, or people taking immunosuppressive drugs such as steroids, chemotherapy, radiation, or immunosuppressive post-transplant medications. Infections with this bacterium can be treated with antibiotics.  Antibiotics may need to be taken for 6 months or more.

The delayed appearance of symptoms can make it hard to associate the onset of symptoms with water-based activity as the source of exposure.  Discomfort and swelling is frequently associated with more recent strenuous physical activity rather than long healed scratches. Therefore, correct diagnosis and effective antibiotic treatment can be seriously delayed. Common mis-diagnoses by physicians include fungal and parasitic infection, cellulitis, skin tuberculosis, rheumatoid arthritis, foreign body reaction, and skin tumor.  Delays in diagnosis can result in severely destructive infection.

M. Marinum is a gram positive rod, very closely related to the tuberculosis bacillus.  The definitive diagnosis for M. Marinum is a laboratory culture and DNA sequencing of the bacterium.  “Standard” lab culturing processes may lead to false negative conclusions.  A laboratory “Culture and Sensitivity” study for M. Marinum may take as long as 3 weeks of incubator time, and that at warmer temperatures, to produce reliable results.

Here’s what one affected victim wants us all to know about Mycobacterium Marinum;

“First, it’s not your ordinary bacteria, not even close.  As the surgeon put it, it’s a different animal altogether, more like TB than anything else.

“Second, it can be contracted through both salt and fresh water—and often through fish tank water!  What we know now is that fishermen and crabbers carry a bottle of bleach.  If they have a cut or scrape, they pour some bleach over it. Who knew?

“Third, this is not a deadly threat hanging over your head every time you take the boat out. Very few people actually get it.  But if something like this should happen to you–and your doctor can’t find a solution—tell him about the MTOA guy you know who contracted Mycobacterium Marinum.  Ask him to Google it. You might want to do that too.  We found a lot of information out there—once we knew what to look for!”

In closing, prevention is far better than correction.  Watermen who regularly handle fish, crabs, oysters, shrimp and other sea creatures routinely rinse their hands in a dilute mixture of household bleach and water.  “Bleach water” will kill the bacteria.  Routine use of antibacterial soap or bleach water is advisable for anyone working in aquatic environments.