Medical information
for living and cruising
on a boat.

Please send any
comments to me.

This page updated:
February 2009

General section
Supplies section
Injuries / Conditions section
Illnesses section

Use the following at your own risk; I'm not a doctor; this is not medical advice; no liability accepted.

General

Take Red Cross first-aid classes.
Fairly cheap, invaluable, will change your attitude.

Assemble your own medical kit instead of buying a pre-packaged one.
Maybe buy the contents outside of the USA. Cheaper.
But most important: when you get done, you'll know exactly what is in there and why.
Divers Alert Network (DAN) sells a kit appropriate for divers.

There is no one "ideal" list of items you should have in your medical kit.
Instead, tailor your kit to the type of trip you're about to make.
This includes thinking about:
- What problems might occur (most likely, and worst).
- How many people are involved, their conditions and skill levels.
- How long the trip is, and how far from help you'll be.
- Best and worst that environment might throw at you.
- Other gear that will be present (for improvising).
- Capacity to carry the kit, and how to protect it.
- Division into multiple kits, for side-trips or because of weight.

Possible/likely injuries/problems while cruising on a boat (most likely first):
- Dehydration.
- Sunburn.
- Cuts/scrapes.
- Bruises.
- Seasickness.
- Stings/bites.
- Chapped/dried skin from windburn or salt.
- Swimmer's ear (water in ear canal causes inflammation and infection).
- Sprains/strains.
- Burns.
- Infections.
- Food/water poisoning.
  From a health article: "there may be as many as 81 million illnesses - and more than 9,000 deaths - [in the USA] from food-borne bugs each year" and "the vast majority of 24-hour flu in this country is actually food-borne illness".
- Allergic reactions to insects or food.
- Diarrhea.
- Broken bones.
  (I broke a toe when I got tired and accidentally bashed my bare foot into the companionway.)
- Hypothermia.
- Hyperthermia.
- Dinghy-related accidents; the outboard propeller is a menace.
- Shock.
- Heart attack.
- Drowning.

Bag medications into zip-loc bags by treatment group (cut, burn, sting, etc) and label each bag.

Get examinations for likely conditions before a long cruise.
Heart check, prostate exam, dental checkup, eye exam, etc.

Get appropriate vaccinations.

Get supply of drugs from your doctor before long cruise.
Carry the prescriptions with you; customs officials may require them.
Prescriptions should mention the generic names as well as any brand names.
Carry eyeglass prescription as well.
Getting prescriptions filled when you're away from your home doctor:
- Have new prescription orders mailed/faxed from doctor to you; have them filled locally.
- Get extra, undated prescription orders from doctor before leaving.
- Some/many pharmacies won't fill a prescription more than a year old ?
- Tell insurance company you're going on long trip; they may let you buy more than a 30 or 60-day supply of medication. Don't buy too much; it expires.
- Some medications that are prescription in USA are non-prescription in other countries.
From article by George Sass in May/June 2006 issue of Power Cruising magazine:
You'll find it impossible to get a prescription written in one state filled in another state; each state has it's own laws about prescriptions, and often has different laws for different drugs. (But try a pharmacy used by commercial-fishing boats, in a busy seaport; they may fill a prescription faxed from your doctor.)

Carry medications and supplies even if you're not sure how to use them; you can consult a doctor by radio.

Carry a copy of your latest medical records (blood pressure, blood test results, immunizations, dental x-rays, etc).
If you fall ill, the hospital can compare your new test results to the records you carry.

Keep a medical log of everything that happens (for legal reasons, for tracking changes in condition over time, for recording consumption of controlled drugs).

Keep controlled drugs under lock and key.

Have a skin-cancer examination once per year. Very important.
Three types of skin-cancer:
- Basal cell: usually raised, pearly; clear or flesh-toned; may crust or bleed.
- Squamous cell: usually pink, scaly.
- Melanoma: usually asymmetrical, irregular border, non-uniform color, diameter more than 6 mm (size of pencil eraser), irregular elevations, may feel burning, bleeding or itching.
Melanoma.com's "Skin Self-Examination"
EPA's "The Sun, UV, And You"
SailNet - Joy Smith's "Protecting Ourselves from the Elements"

Avoid blood transfusions outside the USA: blood screening typically less reliable. If having elective surgery, give your own blood ahead of time.

The Caribbean has the second-highest incidence of HIV and AIDS in the world, after Africa.

Dr. Mark Anderson's "Cruising Medical Kit"
SailNet - Randy Harman's "Cruiser's Medical Plan"
Fernanda Morley's "You are your own '911' ... and Clinic!"
SailNet - Liza Copeland's "Medical Issues for Cruisers Part One"
Pilothouse Online's Q&A about Medical First Aid Kits
Survival quiz
Kit list and 3 kits reviewed in 1/15/2002 issue of Practical Sailor.
Ship Captain's Medical Guide
"Tools for Treatment" article by Jeffrey Isaac in Ocean Voyager 2001 from Ocean Navigator magazine
Article by Pnina Greenstein in Oct 2001 issue of Blue Water Sailing magazine
"Making the Most of Telemedicine" article by Michael Jacobs in 5/2002 issue of Cruising World magazine
Good articles on myDr First Aid and Self-care Centre

Good book: "Medicine For The Outdoors" by Paul Auerbach.
Good book: "Medicine For Mountaineering" edited by James Wilkerson.

Medical advisory services:

From John Harper at Medical Advisory Systems 1/2001:

1. Medical Advisory Systems, Inc. (MAS, for short) does have a medical advice hotline, available to our subscribers on a 24/7 basis.

2. The annual subscription is $400 per year. This entitles you to contact with our duty physician within a minute of the time you call, again, on a 24/7 basis. Also included for the $400 fee are: medical record storage for two persons; a quick communications guide; a radio drill manual; and advice about stocking your vessel's medical locker.

3. Yes, the hotline can be contacted by radio. Many of our clients use single sideband radio or a relay through a shore/marine radio station.

World Clinic
George Washington University
MedAire / MedLink
HealthForce Partners

From Jeanne Pockel's "Cruising Dictionary":

If you need medical care outside of Western Europe, USA, Australia, NZ, we strongly urge that you do not go to the local hospital. In major towns and cities find the private clinic that treats the well-to-do (applies to every South American country, every Caribbean island, and most Pacific islands). If you can find it, read a book called "Sitting Ducks".

American Citizens Abroad

Supplies

Adhesive tape
From Bev Clary on Cruising World message board:

[Carry] plenty of 'real' adhesive tape, sometimes known as trainers tape or athletic tape. Unlike the stuff found in first aid kits, will stick to wet sweaty people."

Anaesthetics
Topical anaesthetic: Opthane.
Simple anaesthetic for splinters and such: chill skin with wrapped ice cube.

Anaphylaxis kit ?
(Same as antihistamines ?)
For treating anaphylactic shock in someone allergic to insect bites.
Benadryl (diphenhydramine).
Asthma inhaler (bronchodilator).
Epinephrine (EpiPen or Ana-Kit auto-injector).
From Jeanne Pockel on Cruising World message board:

I just heard that a cruising friend just died of anaphylactic shock in a hospital in Thailand (in less than three hours from first signs of the allergic reaction). Scary. My point is that a doctor friend, years ago, insisted that we carry Children's Benadryl at all times for just those times when we have an allergic reaction to something new. Children's Benadryl because it's a liquid and can be swallowed when pills might not be, and acts faster than a pill. I am so grateful that I took this person's advice - I've had two severe allergic reactions to things that I encountered on the boat, and the three hours or so that it would have taken us to get to medical help would have been too long.

Antibiotics and Antiseptics
Very important in Tropics; very easy to get infected, and infections spread quickly.
You may have to use 2x of the normal antibiotic dose (or more).

Broad-spectrum oral antibiotics: Cipro, Erythromycin, Keflex, Dicloxacillin, Septra DS, Bactrim DS, Bactrim Fort, Ampicillin, Amoxacillin, Augmentin, Penicillin V, doxycycline, Trimethoprim/Sulfa double strength (e.g. TMP/SMX DS, Bactrim DS, Septra DS), Zithromax.
Injectable antibiotic: cephtriaxone.
Antibiotic ointment: Betadine, Bacitracin (check expiration date).
Antibiotic ear-drops: Cortisporin, Amoxacillin.
Antibiotic eye-drops: sulfacetamide.

There are quite a few kinds of antibiotics, organized by either chemical class, mechanism of action, or type of bacteria. ...

Bacteria are often classified as gram positive (mostly skin organisms like staph and strep) or gram negative (mostly intestinal bacteria like E. coli). They are often also classified as aerobic (requiring oxygen) or anaerobic (nasty bugs like that causing gangrene).

Some useful antibiotics to have on board would include:

Ampicillin/amoxicillin - general antibiotic, could be useful for sinusitis, strep throat.
Augmentin - good for infections involving gram positives and negatives, aerobic and anaerobic.
Keflex - good for skin infections.
Metronidazole - good for anaerobic bacteria.

That's just a suggested few off the top of my head. You have to keep in mind that oral antibiotics have limited usefulness in anything other than superficial infections. If whatever you're treating looks like an infection and does not improve reasonably quickly, you would need to go somewhere to have it looked at and consider the need for intravenous antibiotics.

Types of anti-microbials, mostly summarized from "Medicine For Mountaineering" edited by James Wilkerson:

Antiseptics:
- Povidone-iodine (Betadine, Povidine, Pharmadine, etc).
- Benzalkonium Chloride (Zephiran).
  Good for deep wounds; must store in glass bottle.
- Bactine.
- In a pinch, 70% rubbing alcohol.
For treating established infections:
- Penicillins.
  About 10% of patients are allergic.
  Kill cocci (strep throat, cellulitis, boils, abscesses, wound infections, pneumonia).
  Ampicillin is the only penicillin that is effective against gastrointestinal problems (diarrhea, dysentery, typhoid).
  Good oral penicillins: cloxacillin, dicloxacillin.
- Cephalosporins.
  Ceclor, a cephalosporin antibiotic, is used in the treatment of ear, nose, throat, respiratory tract, urinary tract, and skin infections caused by specific bacteria, including staph, strep, and E. coli.
  Some patients allergic to penicillins are also allergic to cephalosporins.
- Erythromycin.
  Substitute for penicillins in allergic patients.
  Not as effective as penicillins.
- Clindamycin.
- Aminoglycosides.
  Toxic.
  Used only for serious infections.
  Can damage kidneys, inner ear.
- Chloramphenicol.
- Tetracyclines.
  Not as effective.
  Useful for diarrhea and cholera.
  Become toxic when outdated.
- Neosporin (a mixture of 3 drugs).
- Bactrim, Septra (a mixture of 2 drugs).

Use antibiotic powders for open oozing wounds, antibiotic ointments for under-skin infections.
Antiseptics: hydrogen peroxide (turns into water after 6 months; you have to replace it), mercurochrome, alcohol.

Antihistamines
(Overlap with Anaphylaxis kit ?)
Used to reduce swelling (including swelling that threatens airway).
Hismanal, Benadryl, adrenaline.

Automated External Defibrillator (AED) ?
$1500 ? Requires prescription ?
These are very easy to use: just put two pads in the right places and push a button. The machine decides if a shock is appropriate, tells you to stand clear, and you push a button to shock.
From someone at Red Cross, in late 1999:

Senate Bill 911 was passed [in 1999] to protect laypersons who use an AED under the 'Good Samaritan Law'. American Red Cross training is named in that Senate Bill. You do need a Doctor's prescription to purchase an AED, and that is usually no problem. You can purchase AEDs directly from [Red Cross].

There are several bad states a heart may be in: tachycardia, fibrillation, arrest. An AED only works against fibrillation, but most heart-attack victims are in fibrillation for a minute or two before progressing to full arrest. So quick use of an AED is critical. Performing CPR extends the fibrillation period a bit.
Pilothouse Online's "A Shocking Possibility: Defibrillators for Cruisers"

Blood pressure measurement:
- E.g. "Tens" from PCP ($100). Take it to a clinic or hospital to "calibrate" it.

Body Substance Isolation (BSI):
- Gloves: get latex gloves at most big drugstores.
- Rescue breathing mask: Laerdal Pocket Mask, at ProLine, CPR Micromask, Ambu Res-Cue Mask, but you can buy Laerdal w/o O2 port at Red Cross for exactly $12 (no tax or shipping if you pick it up yourself).

Calamine lotion or hydrocortisone cream (islands have "poison wood").

Charcoal tablets
From Jeanne Pockel's "Cruising Dictionary":

Available in most health food stores. Good for absorbing ingested toxins such as Salmonella toxin from food poisoning, or for accidental overdoses of medications. It is not a medicine, but the same activated charcoal used to absorb minerals and odors from drinking water. Must be taken when symptoms first appear to have any effect. Can’t hurt, often helps, and with food poisoning, helps dramatically.

Disinfectants:
Tincture of iodine, diluted bleach.

Ear medicine:
Otic Domeboro, Cortisporin Otic solution.

Eyedrops:
Tetrahydrozaline (Visine).

Gauze roll
Use "vet wrap" (from feed or pet store) instead; works better in wet conditions.

Hypodermic needles:
To make sure a doctor doesn't use a re-used needle on you, provide your own needles.

Otoscope: magnifying lense with light.
Good for looking into ears, removing small spines and splinters, etc.

Oxygen.
Maybe through Divers Alert Network ?
Note: medical oxygen is not the same as welding oxygen.
Medical oxygen is moistened so it doesn't dry out the airway.
Note: SCUBA uses compressed air, not compressed oxygen.
Breathing pure oxygen at depth is deadly.

Snakebite kit.

Surgical stapler, and staple remover.

Toothache kit.
From Coastal Cruise - The FAQ:
"Wax for braces - helpful if your tooth pops a filling and you can't get to a dentist."

Water-purifying tablets.
Globaline or Potable Aqua (tetraglycine hydroperiodide).
Ways of purifying water
Water Treatment Methods
From "Medicine For The Outdoors" by Paul Auerbach:
Use boiling or iodine-based methods or intensive filtering to purify water; chlorine-based methods are less effective, have shorter shelf-life, lose potency when exposed to air.

Witch hazel:
Good for sun-glazed eyes, itchy bug bites, sunburn, general soothing/cooling of skin.

Wound plaster ?
From kaj on Cruising World message board:

... Compeed Hydro Cure System plaster. It cures cuts and grazes and prevents the minor infections to develope. Another item first used this summer was cooling foam in a spray bottle to ease the pain of a badly burnt hand. Then on with Compeed plaster. Although the rope burn took off pretty much of skin, there was no pain or aching, plaster on and forget. Then 4-5 days later, when I went to the doctor, everything was healed.

Hopkins Medical Products, 800-835-1995

Overseas prescription drug suppliers:
Imported Drugs.Com (generic drugs; high shipping cost)
Planetdrugsdirect.com (no generic drugs; no shipping cost)
Pharmacy International Inc (moderate shipping cost)

From John / truelove on World-Cruising mailing list:

My doctors say that most prescription drugs are good for 2 years, despite expiration dates. Do *not* photocopy your prescriptions - it's illegal to do so. Ask your doctor to give you 2 originals - get one filled and take the other with you. Prescriptions should be understood by pharmacists worldwide.

From John Titterton on World-Cruising mailing list:

Some prescription drugs are like colour (color in the US) photographic film - it loses sensitivity and stability before the expiration date when in humid and/or hot conditions. I keep film and prescription drugs that are not stable or deteriorate quickly in the refrigerator. They do not take up much space, and it will normally extend their useful life well beyond the expiration date. There are exceptions to this, such as compounds or medications made from animal extract or ones with a high natural content in cream form. My wife also uses some special drops for her eyes to treat enzyme infections once in a blue moon - she wears contact lenses. This small bottle has a very short shelf life (6 months from manufacture) and once opened should be thrown away after two days, before the infection has cleared up. We experimented keeping the unopened bottle (you can fit two into a matchbox) in the refrigerator and found that it was still 100% effective after a year. Also, once opened and kept in the refrigerator, it lasted approximately a week instead of the two days.

A pharmacist once told me to not only keep the cream he had made up for me in the refrigerator, but to keep a small plastic film on the surface of the cream to prevent air reaching it. He informed me the cream would deteriorate quickly if exposed to the air and become ineffective. It cured my ailment quickly and thus I was never able to see how long it would actually last.

From John / truelove on World-Cruising mailing list:

You make some good points. I had not thought of compounds -- of course you are right. I recall when the Trans-Derm Scop patch was temporarily banned and I was able to get topical syringes filled with Scop gel -- it had to be constantly refrigerated. When I quoted my doctors, I was referring to caps like Vioxx and Cephalexin and also BP meds, which I should have clarified. It's true that cooler and less humidity is better.

Eyeglasses:

You can buy frames and lenses very cheaply through the internet (although customer service can be bad if anything goes wrong). The process is explained at Glassy Eyes' "Online Eyeglasses: How it works". Use store links on Glassy Eyes to get extra discounts.

But you still need to visit an optometrist to get an eye examination and prescription (make sure it includes your Pupillary Distance and Near Pupillary Distance). This costs $50-$100 (try Walmart or CostCo for cheapest ?), and really should be done every year or two.

And you need the frame measurements, best taken from an existing set of your frames. The measurements will be in the form "Lens Width - Bridge Width - Temple Width (earpiece length) - Lens Height", in MM. Often the first three numbers are stamped on the earpiece.

Injuries / Conditions

Anxiety attacks; it is not uncommon for someone to panic when far offshore.
Xanac/Valium.

Burns:
- Silvadene ointment (silver-sulfadiazine).
- Foille burn ointment (topical antibacterial containing neomycin, polymyxin B, and bacitracin).
- Vitamin A and D ointment.
- Fresh aloe-vera gel from fresh leaves.
- Water-Jel and Burn-Jel
Minor burns:
- Immediately soak in cold or iced water for 15 minutes.
- Leave wound open, or coat with plastic skin or very soapy water or paste of baking soda and water.
- Don't break blisters.
- Toothpaste is good on minor burns, especially steam burns.
- Apply soy sauce, or miso paste.
Major burns:
- Clean with soap and water.
- No oils or ointments.
- Leave wound open.
- Keep victim warm.
- Give plenty of fluids, with salts.
To avoid scarring while a serious burn heals, keep it very moist; don't let the skin dry out and a scab form.

Cuts / sores / scrapes:
- Clean with warm soapy water, or antiseptic solution, or hydrogen peroxide.
- Antibiotic cream or powder.
- Bactericidal soap: Hibiclens.
- Bactine.
- Keep salt water out.
- On clean, recent cuts, use spray-on bandage (Mistdress).
- If deep and not bleeding, or animal bite, or dirt in it, start antibiotics.

Dehydration:
- Symptom may be a headache.

Dental:
- To reseat a crown temporarily, use Vaseline instead of cement, to avoid sealing in decay.
- To reseat a crown, use temporary denture glue (available over-the-counter).
- For a broken tooth or loose filling, use two-part zinc oxide dental cement (available over-the-counter).
- For an infected or abscessed tooth, use antibiotics.

Digestive / Diarrhea:
- Pepto-Bismol.
- Antacid (Tums).
- Imodium.
- Milk of Magnesia.
From Judy Lamar's "Illnesses Related To Water":
"Prevent or control dehydration. ... For most causes of diarrhea, no medicines are needed, and can cause harm because they work like a plug keeping in what should be coming out."

Drowning victim:
BoatSafe's "Help Prevent Drowning with These Tips"
If in cold water (especially if a child), they may be alive.
Perform CPR. They are not dead until they are warm and dead.

Ear infection:
- Prevent with 50/50 isopropyl alcohol / vinegar drops after swimming.
- Treat with drops containing cortisones and antibiotics.
- Treat external infection with merthiolate solution.

Fever blisters (especially on lips, from sun):
- Acyclovire pills.

Itchy Fiberglass fibers on skin:
- Vacuum off fibers, then apply and remove adhesive tape.
- Don't take a hot shower; it opens the pores and lets fibers in.
  Wash with very cold water and soap/detergent.
- Benadryl or Calamine lotion for itching ?

Fiberglass splinters in skin:
- Apply and remove adhesive tape, again and again.

Fatigue / Exhaustion / Sleepiness when on passage:
- Do any extra sleeping (with lack of a proper watch) when well at sea, not near land or shipping lanes or fishing areas.
- If not on watch, you should be sleeping.

Fungus:
- Fungus infection of skin (jungle rot, tinea versicolor, sun-spots): selsun lotion, Selsun-Blue shampoo, tinver lotion.
  If using Selsun-Blue shampoo: wet the skin, apply shampoo to spots, let dry for 5-10 minutes, wash off. Do every day for at least 3 weeks.
- Athlete's foot: Tinactin, Lotrimin, sunshine.
- Nystatin.

Hyperthermia (too hot):

Hypothermia (too cold):
If serious hypothermia, warm trunk of body before warming extremities.

Infections:
Very easy to get infected in Tropics, and infections spread quickly.
Signs of infection: swelling, redness, heat, discoloration, pus ?
Basic prevention/care for infections:

Clean the wound.
Protect with clean dressing.
Change dressings frequently.
Let the wound drain naturally.
Soak crusted wound in warm disinfected water with antiseptic.
Take antibiotics.

Types of infections, mostly summarized from "Medicine For Mountaineering" edited by James Wilkerson:

Bacterial:
- Abscess / Boil:
  Usually staphylococci.
  If larger than 1 inch, or fever or chills, use cloxacillin.
- Cellulitis (skin red, swollen, hot, tender, not sharply demarcated, usually fever):
  Use cloxacillin, and hot wet compresses to increase circulation.
- Bacteremia / Septicimia (chills, high fever, sweating, prostration):
  Use nafcillin and gentamicin, and rest, warmth, soft diet, fluids, mild pain medication, acetaminophen for fever.
- Typhoid / Dysentery:
  Use sulfa or chloramphenicol (Bactrim, Septra).
Viral:
- Influenza (chills, fever, muscle aches, coughing, weakness, headache):
  No antibiotics. Rest, warmth, light diet, mild pain medication.
Parasitic:
- Malaria (muscle soreness, low fever. Later, chills and fever. Then repeated febrile episodes: feeling of intense heat, headache, delirium, high temperature.)
- Cryptosporidiosis (severe diarrhea):
  There is no adequate treatment.
- Cyclospora.
- Giardiasis.

Summarized from "Yachtsman's Emergency Handbook" by Neil Hollander and Harald Mertes:

Chest, throat, ear infections, boils, infected cuts: use tetracycline.
If no improvement after 3-4 days, switch to ampicillin or erythromycin.
Urinary tract infection: use Bactrim or Septrim.
Dysentery: use tetracycline.
If no improvement after 3-4 days, switch to Flagyl.
Skin infection, minor infected wounds: use Bacitracin (check expiration date) or Neosporin ointments.
Eye infection: use chloramphenicol drops.

Women's vaginal yeast infection: use Monistat.
Fungal infection: use Clotrimazole.
Skin infections: use antibiotic powders instead of ointments.

Insect bites:
Apply baking soda or witch hazel or soap to reduce itching.

Lice:

Lightning strike victim:
Heart/electrical system may be severely disrupted but recoverable.
Perform CPR, for hours if possible; victim may revive long after the event.

Poisoning (lots of nasty chemicals are on board):
Good practice to have the MSDS (Manufacturer's Safety Data Sheet) for every product that you use on board.
Fume poisoning: common symptoms are drowsiness and headache.
Carbon monoxide poisoning is very insidious: victim may appear to recover within hours, then crash and die a day or two later. Supply oxygen and get them to a hospital even if they appear to have recovered.
See fume alarms in Safety Equipment section of my Boat Equipment page.

Seasickness:

Seasickness article in 7/2000 issue of Cruising World magazine.
Prudence Meads' "Fish Food"
SailNet - Liza Copeland's "The Delicate Art of Preventing Seasickness"
SailNet - William Mahaffy's "Dealing with Seasickness"

From Roger and Misty Jones on the WorldCruising mailing list:

... sea sickness comes with the territory. Some will succumb, some will not. However, don't read that the same will succumb each time. It doesn't work that way. One time it will be their turn, the next time yours...

Avoidance/prevention:

Acclimate people to the boat slowly; don't go from land to close-hauled ocean sailing in one jump. Spend some time just sitting on the boat, then some gentle sailing. Sleep overnight on boat before starting trip ?
Eat something light.
Drink adequate amounts of water.
Start taking medicine a day ahead of time, to get it in your system and to find out any side-effects.
Minimize time belowdecks, especially in enclosed spaces.
Avoid diesel and exhaust fumes.
Volunteer for helm duty.
Ask helmsman to sail boat on gentler point of sail.

From Dave Richardson on the WorldCruising mailing list:

... My experience would indicate that most people "overindulge" the night before leaving port. Myself included. Then add foods which don't do much for our stability and we have created a monster waiting to explode over the side. Lee I hope. Start by trying to treat this cause but good luck. ...

From Roger and Misty Jones on the WorldCruising mailing list:

... Most sea sickness medicine is useless if taken after the problem; you need to take it before you set out. ...

From Matt Pedersen on the Morgan mailing list:

My Scottish grandfather always told me the best way for a Scotsman not to get seasick was to put a penny in his mouth. It takes a lot for a Scotsman to part with his money.

From Matt Pedersen on the Morgan mailing list:

From our last Safety at Sea seminar, here's a list of medications and their trade names:

Trade Name	Generic
Dramamine	Dimenhydrinate
Gravol	Dimenhydrinate
Calm-X	Dimenhydrinate
Marmine	Dimenhydrinate
Bonine	Meclizine
Antivert	Meclizine
Dramamine II	Meclizine
Benedryl	Diphenhydrinate
Nordryl	Diphenhydrinate
Marezine	Cyclizine
Phenergan	Promethazine
TransdermSCoP Xtr	Scopolamine
Scopace Xtr	Scopolamine
Scopolamine Gel Xtr	Scopolamine
Stugeron	Cinnarizine
Antimet	Cinnarizine

The Cinnarizine is not available in the USA, but it is in some other countries.

Dimenhydrinate and Meclizine are usually effective for most people (I do pretty well with Meclizine).

Promethazine and Scopolamine are available by prescription only. The Promethazine also comes in a suppository form for really drastic cases. BTW, Scopolamine was off the market for a couple years not because it was ineffective but because in its original form there was no control over the dosage - an 80 pound person got the same amount of medication as a 240 pounder. The latest generation of Scop medications takes care of that.

The doctor who gave our SAS talk said it may be necessary to take some sort of stimulant (e.g. NoDoze) to avoid drowsiness. He also recommended that you take these medications while you're going about your daily business sometime to see if there are any side effects. It's not a good idea to learn about those things while you're at sea. ...

Early signs of seasickness: sleepiness and lethargy.

Treatment:

From Roger and Misty Jones on the WorldCruising mailing list:

... Get the sick person on deck. Seeing the horizon and getting fresh air tend to help. If they can doze off on deck so much the better. But remember, they are sick. Make sure they are harnessed and latched to the boat so they don't go overboard when doing the old heave ho!!!! Part of sea sickness is loss of balance. Remember that and don't let them near the storm rail without a safety harness. ...

From SailNet - Sue and Larry's "How to passage safely and comfortably":

We have found that the active ingredient in Bonine and Dramamine II, meclizine hydrochloride 25 mg, works great without causing drowsiness. If you want to fall asleep fast, take the regular Dramamine. They should market this product as a sleep pill.

[Meclazine is cheaper than Dramamine II / Dramamine Plus.]

Seasickness remedy: Compazine suppository (prochlorperazine). Includes a little anti-anxiety medicine too.

"Navy Cocktail": 50 mg ephedrine and 25 mg Phenergan (promethazine).

Scopolamine patch can cause blurred vision. And don't touch the patch and then rub your eyes.

Electronic wrist-band: ReliefBand ($100).

Other remedies recommended by various people:
ginger (dried candied, or ginger snaps),
wrist-pressure-strap (can be used after symptoms appear; velcro better than elastic, must be tight),
eye-patch over one eye (maybe that's why pirates are always pictured with an eye-patch !),
Flonase (prescription),
Marezine (spelling ?).

Vomit into a bucket, not directly over the side (unsafe).

A severely seasick person needs to be supervised closely: watch for dehydration, overexposure to heat/cold, make them wear a harness abovedecks (balance is affected, and survival instinct is suppressed).

Sail boat more gently (less close to wind) to reduce motion.

Stroke: From John Smith in 5/2006 issue of Caribbean Compass magazine:

Recognize a stroke by asking the victim to:

Smile.
Talk coherently.
Raise both arms.

If they can't do any one of these, get help immediately.

Also, if when they stick out their tongue, it is crooked (goes to one side or the other), that is an indication of a stroke.

Sunburn:
- Moderate:
  Cool wet compresses.
  Solarcaine.
  Hydrocortisone cream.
  Vitamin E oil.
  Pure aloe vera gel.
  Sunscreen that has been refrigerated.
  Witch hazel.
  Baking soda paste to relieve pain.
  Talcum powder on the bedsheets.
  Dab wet teabags on and let liquid evaporate.
- Extreme:
  Prednisone.
  Watch out for dehydration.
  Maintain proper body temperature.
- Preventative:
  PABA pills ?
  Penaten cream.
  Zinc oxide cream.
  Sun-protecting clothing.
  Limiting exposure.
  Facial cream/moisturizer with sun protection (less oily than suntan lotion), such as Oil of Olay.
  Note: sunscreen's potency declines over time; years-old sunscreen may not work. And SPF applies to UVB rays only; there is no standard for UVA protection. And most people don't apply it anywhere near thickly enough.

Venom / stings:

Jellyfish stings:
- Seawater (not fresh water) to wash off tentacles without activating them.
- Use gloves or rags to pull off tentacles.
- Wash with vinegar.
- Wash with fresh water and dilute ammonia.
- Coat area with baking soda paste.
- Take antihistamine (Benadryl) ?

Stingray stings:
Summarized from letter from Jan Loomis in 6/2001 issue of Seven Seas Cruising Association bulletin:

Avoid stings by shuffling your feet (not lifting up and down) as you walk on the bottom.
Wash wound with fresh water.
Remove foreign material from wound.
Immerse area in hot water for 30-90 minutes; continue to remove foreign material.
Take pain medication.
Apply sterile dressing, elevate the wound, stay out of seawater, let wound drain.
Infection is very likely; start antibiotics.

Sea-urchin spines: don't try to remove them; treat with hot lime juice to help dissolve them, or use urine to neutralize the toxin.
In general, treat sea-life stings/venom with wet compresses as hot as you can stand them; it breaks down the venom.
Benadryl to reduce swelling.

Windburn protection:
Thin coat of petroleum jelly (on top of sunscreen).

From Beth Leonard's "An Apple a Day When the Doctor's Away":

Allergy and infection can give same symptoms: heat and swelling.
Rub area with cortisone cream.
If it works, you have an allergy: take an antihistamine.
If it doesn't work, you have an infection: take an antibiotic.

Illnesses

CDC travel info
Judy Lamar's "Illnesses Related To Water"
International Association for Medical Assistance to Travellers (IAMAT)

Some of this from CDC and Travel Health Online:

Amoebic Dysentery:
Parasitic; don't treat with antibiotics. See doctor; treat with oral medications.

Bilharzia:
Parasitic: don't swim in fresh water in South America, Caribbean, Africa, Asia.

Cholera:
In most of Central and South America, including Mexico and Venezuela.
A single vaccination is effective for 2 to 6 months.
The vaccination is only about 50%-80% effective.
Treat with fluids and antibiotics. See doctor; some complications can be fatal.

Dengue fever:
Rare, but present on all Caribbean islands (mosquito-borne).
There is no vaccine.
There is no specific treatment; replenish fluids and take non-aspirin pain reliever; taking aspirin while infected can lead to internal bleeding. Viral; don't treat with antibiotics. See doctor; there are two types and four viral varieties of the fever, and some complications can be fatal.

Diptheria:

Giardiasis:
Treat with Fasigyn (tinidazole) or Flagyl (Metronidazole).

Hepatitis A:
"Vaccination should be considered if travel to areas of questionable sanitation is anticipated." (Central and South America, Mexico, Caribbean. Especially Mexico, Jamaica, Haiti.)
"Immune Globulin" is one vaccine; it provides temporary immunity; clinic recommends better 2-shot vaccine.
Vaccination is 2 shots about 6 months apart; first shot gives good protection; second probably gives lifetime protection. Get first shot at least one month before travel.
The vaccine is 94-100% effective.
Symptoms: long-term fatigue, nausea, stomachache, jaundice.

Hepatitis B:
Viral.
"Vaccination is advised for ... persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population)".
Don't need it unless you're in risk of contact with blood or other body fluids of infected person.
Vaccination is 3 shots over 6-8 months.

Influenza:
Common in the Caribbean and USA.

Malaria: Present in the tropics and subtropics. In the Caribbean, mainly in Haiti and the Dominican Republic.

You don't get a vaccination for malaria; you take prescription medicine before/during/after trip (usually start one week before and end several weeks after).

Not all anti-malarials work in all areas; you have to get the right one for your area. But strains change and migrate, so the appropriate medicine may vary from year to year.

Anti-malarials often are ineffective.

Summarized from a Chicago Tribune article by Alfred Borcover:

In USA, there are 3 drugs commonly used:

Chloroquine (Aralen): taken orally once a week. Ineffective in severe malaria areas, but often used for Central America, Haiti, parts of Mediterranean.

Doxycycline: taken orally every day. Effective in severe malaria areas.

Mefloquine (Lariam): taken orally once a week. Effective in severe malaria areas. Can have fairly severe side-effects (hallucinations, nightmares).

The disease is much worse than most of the possible side-effects.

Malarone pills: one per day, $8 per pill. Start 2 days before trip, continue 7 days after trip.

Symptoms (can appear months after exposure): fever, then chills and aches, then organ failure.

Use physical prevention (screens, nets, DEET, long-sleeved clothing).

Some cruisers, and reportedly some doctors in Guatemala, disagree with the "disease worse than side-effects of the medicine" statement. They say the strain in the NW Caribbean is easily cured, and the possible side-effects of the preventive pills include death.

ParaSight-F dipstick test, ICT Malaria Pf test, both awaiting FDA approval ?

"The most frequently used anti-malarial drug is hydroxychloroquine and the most common trade name for this is 'Plaquenil'."
Hydroxychloroquine Sulfate.
Generic (Hydroxychloroquine Sulfate) at drugstore.com.

Another medicine: Chloroquine (chloroquine phosphate tablets or chloroquine hydrochloride injection).

In Caribbean (in Haiti and Dominican Republic and Central America), take either Proguanil daily or Chloroquine weekly.

"The anti-malarial medication [for Central African Republic] is mefloquine (Lariam)." [Also for Brazil.]
But see Lariam Action USA.
Lariam at drugstore.com.
Mefloquine Hydrochloride.

Poliomyelitis (Polio):
Vaccination good for 5 years.

"Schistosomiasis:
A parasitic infection; found in fresh water in parts of Antigua, the Dominican Republic, Guadeloupe, Martinique, Montserrat, Puerto Rico, and St. Lucia. Do not swim in fresh water (except in well-chlorinated swimming pools) in these countries."

Rabies:

Tetanus:
Vaccination good for 5 to 10 years.

Typhoid:
Present in Latin America. You can get it from swimming in polluted water (most islands don't do sewage treatment ?), or by eating risky foods (contaminated food or water, and raw vegetables or fruits that can't be peeled).
The vaccination is only about 50%-80% effective, but also significantly reduces severity of infections that do occur.
Two forms of vaccination: one shot taken at least 1 week before travel, or four-pill regimen.
Boosters required every 5 years for the oral vaccine and every 2 years for the injectable vaccine. More frequent booster recommended in known risk areas.
Symptoms: sustained high fever, often fatigue, headache, loss of appetite. Must have test to confirm.
Treated with antibiotics.

Yellow fever:
Present in some parts of Brazil, Trinidad and Tobago. Spread by mosquitoes.
Get a "vaccination certificate"; other countries may require it when you enter.
A single vaccination is effective for 10 years. Get it at least 10 days before traveling.
CDC yellow fever info.

Immunizations, summarized from "Medicine For Mountaineering" edited by James Wilkerson:

Viral vaccines (hepatitis A, tetanus, diptheria, and others): can be given 6 months or more before trip; benefits persist for years.
Bacterial immunizations (typhoid, cholera, and others): must be given just before trip; benefits don't persist long.

From Donal Philby on the SailNet liveaboard-list:

I just received $500 worth of vaccinations and other health medications prior to an upcoming trip this month to Thailand, Cambodia and Laos. Holy smokes! And another $300 for hep A and B boosters on return.

Included in this is Malarone, an anti-malarial which you take a couple days before and all during and for a week after returning. At $5.75 a pill/day (some pharmacies sell this for up to $13/pill), this is no small investment. It was $170 for a three-week trip. But after watching my father suffer recurring bouts of malaria contracted during WWII in the Pacific, I'm not interested in sharing that experience.

It made me realize that planning a cruise through malaria-prone areas of the tropics could prove wildly expensive unless one can find a cheaper source of such medications. The source I found seemed less than other places. I'm going to check to see if these could be gotten via VA hospital (I just got my records to apply for services, if needed).

I expect that the health precautions are going to cost more than our on the ground travels, since we are going where things are cheap.

From Franz Karl Byars on the SailNet liveaboard-list:

As one who prescribes Malarone for travelers, I'm pretty sure that you don't take the med on a daily basis but once a week. You should start the med prior to leaving and then continue the med for at least 3 weeks after you leave the infested area. You should double-check on the prescription.

From Rick Kennerly:

Re: Getting vaccinations:

Not a lot of doctors carry these vaccines because they expire before they use them all, so they will order them or send you where you can get them. Most hospitals do have a vaccinations nurse. Some county health departments do some or all vaccinations for free. But any county health department will know where to get the shots in your local area.

Prices of vaccinations (11/2004 at Marathon FL health clinic):

Cholera: 1 shot $36.
Hepatitis A: 2 shots $68 each, at least 6 months apart.
Hepatitis B: 3 shots $60 each, over a 6- to 8-month period.
Typhoid: 1 shot $70, or four-pill regimen ($???).
Tetanus booster: 1 shot about $36.
Yellow Fever: 1 shot $90.

My experience:

I decided to get hepatitis A and typhoid vaccinations before my Caribbean cruise, on the theory that you can get those diseases from contaminated water. I think my tetanus is up-to-date.

[Later, got a Tetanus booster in Salinas PR for $10.]

From article by Bernadette Bernon in 11/2003 issue of Cruising World magazine:

We met one crusty coot who'd had such a wicked toothache on a transocean passage that he finally wrenched it out with vise-grip pliers, "leaving only one damn tooth on top," he crowed, "What the hell good's that ? I pulled it out, too."

"Lucky he didn't have a urinary-tract infection," Douglas whispered to me.

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