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Old 12-06-2014, 15:43   #16
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Re: Epipen Offshore?

Unfortunately it is unrealistic to keep one's food AND medicine chest refrigerated in tropical climes. Antibiotics and EpiPens have relatively short lifespans, although expiry dates on medicines are somewhat different than those found on foods.
When Offshore the odds of having an anaphylactic event are quite low; it is when swimming close to shore, or walking ashore, when stings or contact can occur. If the offshore kit includes being ashore in places with no primary medical care, then by all means add some sort of epiphedrine.
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Old 12-06-2014, 16:04   #17
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Originally Posted by Delancey View Post
Could be a real lifesaver and I have seen it included in a few medication lists, but my cost is like $400 and I have been spending a lot of money lately which makes me think twice.

Nobody onboard has any allergies and I don't think their are many poisonous snakes where we are going. Yeah or nay?
Don't forget jellyfish and the like. A bad man-of-war sting can make you wish you had died...
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Old 12-06-2014, 16:18   #18
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Epinephrine plus a syringe is not expensive. Far far cheaper than the $400 pen.
+1. I am just an engineer so I repeat like a parrot what the MDs in the family said when I was preparing for a Pacific crossing

Take the opportunity to add some IM dexamethasone aka Decadron, which after all is what they would give in a hospital after you used the Epipen. As it happens, in the 3rd world where people cannot pay for Epipens they use IM Decadron instead..

You will need to learn how to apply IM injections, but it is a good thing to know when far away from civilization. While you are at that, take the opportunity to learn IV injections/hydration and how to stitch people up, buy the relevant toolkit and you will be an asset to your fellow crewmembers...What is the point of having three grand of first aid kit if no one on board can give IV or IM injections that beat oral medication in many situations....

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Old 12-06-2014, 17:15   #19
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Re: Epipen Offshore?

My wife carries one for bees. I plan to restock her prescription for the boat's kit before we head south.
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Old 20-06-2014, 19:18   #20
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Re: Epipen Offshore?

Just a little follow-up for what it's worth. I emailed my doctor two questions.

First, after indicating that no one had onboard had any known allergies and there were not likely many bumble bees offshore, I asked her if were we at risk of reaction to any of the antibiotics she had prescribed? and if we chose to forego the Epipen, was Primatene and acceptable alternative?

Secondly, I made the observation that she had only prescribed sufficient quantity of analgesics for about two days (qty 30 x dosage rate) and that we were potentially two weeks from outside assistance.

I expressed that I was concerned about injuries that are more painful when the victim is moved and I explained that when you are on a boat, the boat is always moving, and you're body is constantly working against that movement, and that as a result many people loose weight when passagemaking.

Her brief response amounted to "you're not at specific risk from the anitbiotics, get an Epipen. I will give you more pain meds."

I love my doctor, she is superawesome. I more or less trust her with my life, but my point to this little story is that in spite of how great she is, she's not a sailor, and you can't hold someone accountable for something they don't know about.

Her position on the Epipen had changed from "well you're asking and I don't see any harm" to "well you're telling me you're going to be two weeks from outside assistance and you are worried about being in pain, I advise you to get an Epipen and I will give you more pain meds if you want them"

It's like, when I went for my visit and outlined the scope of our trip, discussed the first responder training of the crew, and went over an extensive drug list, she seemed to get it.

However, when I told her after the visit that we were gonna loose weight, her outlook on the matter seemed to change.

As a result of this I think I would encourage people consider allowing their doctors an opportunity for consideration. People often change their opinions on things when they have a chance to think things through, and your doctors are people too.

It was funny going down the drug list with her. She kept saying "oh, that's a good one, oh that's great..."

At one point I was asking about how much this stuff was gonna cost me and she said she didn't think it would be too bad.

I responded by asking about the ciprofloxacin, wasn't that expensive? She said no and then I reminded her of the time when someone was spreading anthrax around the city.

"Oh, there was a supply problem back then, plenty of the stuff now"

In fact my cost for qty (60) 500mg was $2.26. Thank god for modern medicine!
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Old 20-06-2014, 20:13   #21
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Re: Epipen Offshore?

Great post, Delancey!

Yes, it does take doctors who are not circumnavigators a long time to figure out how to really help us. And each new one has to be broken in. Some "get it" better than others.
Glad you were able to get what you need.

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Old 20-06-2014, 20:36   #22
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Re: Epipen Offshore?

Like I said, she is a great doctor. She always takes whatever time with me is necessary. She's smart and attentive and has great resources available to her. She's the best!

But going offshore is a big topic to cover in fifteen or twenty minutes.

I'll have to ask her when I see her next but I think the losing weight detail, which hadn't been covered in out brief visit, was something that gave her pause to reconsider. Maybe not.

Regardless, I would encourage people to allow their doctors an opportunity for consideration. That is to say when going offshore make a visit well in advance, get your **** squared-away, and then follow-up after the fact.

It's all about the details. Don't create situations where people don't have the opportunity to process those details.
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Old 19-07-2014, 01:49   #23
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Re: Epipen Offshore?

WRT general long distance meds: UK MCA Category A med kit list is an excellent place to start.

With regard to Epipens: they can be lifesavers in case of anaphylaxis. I have seen a few cases over the years. However, as has been pointed out above, they are very expensive, and have a poor shelf life. IMHO the ONLY reason to have them is for ease of delivery. A good and far cheaper alternative, as has also been suggested above, is to simply get ampoules of Epinephrine, and syringe/needle conventional injection kit. Exactly the same drug. Only the delivery method is different and slower/more complicated, and more care and expertise must be taken for dosage etc. IF THAT ROUTE IS TAKEN GREAT CARE MUST BE TAKEN AS TO DOSE, HOWEVER, AND EXPERT HELP SOUGHT IF NOT ABSOLUTELY SURE/QUALIFIED/ OR TRAINED.

IMPORTANT TO NOTE: for strong allergic reactions, including anaphylaxis, an alternate line of defence which is an over the counter available everyone has it type is antihistamine. I have effectively used antihistamine to stabilise a person with moderate to severe food allergy based anaphylaxis. IT IS NOT A SUBSTITUTE FOR EPINEPHRINE, but may be used to help when the latter is not available easily or at all.
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Old 19-07-2014, 01:59   #24
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Re: Epipen Offshore?

FURTHER GENERAL NOTE ON MEDS FOR US SAILORS:

Many drugs which are proprietary in the US are generic in other countries. Also, the costs of insurance based medicine cause many meds to be DRAMATICALLY more expensive in the US than in other countries. If you are considering sailing long distance abroad, you will find in places such as French Polynesia, and especially in NZ and many other countries, that local doctors can, for a very small fee, be relied upon to prescribe an astonishing range of excellent meds for VERY little money indeed. You may actually be shocked at just how little. For US sailors, they may well find that common useful meds are cheaper by a factor of scores or more of their cost in the us, such that buying 100 tablets in the likes of NZ may very well cost the same as 2 in the US.

I do not recommend the street available generics in places such as Mexico and other non-regulated jurisdictions. However, in French territories, NZ, and others with strong medical and regulatory services and a positive attitude towards socialised medicine, you will be very pleasantly surprised.

Sadly, as Epipens are proprietary the world over (as simply the delivery system, not the drug which is entirely generic), they are also expensive in the abovementioned jurisdictions.

Of course... there's the getting there first.
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