Medicine List

[phorvati]

I am gonna do my final family doctor checkup while my work insurance is still valid. After that we are gonna go onto some of the cruising isurance plans. Meanwhile does anyone know of a list of good medical items, perscription and off-the-shelf, to have on the high seas. Is there a published reccomended list of items I can print out and hand to my doctor to perscribe. Both my wife and I are in our 20's and 30's so we don't pay much attention to health. We've been mostly healthy. But I still want some essential items perscribed by my family doctor before we leave. The doctor doesn't know much about the cruising life so I feel better if I do some research before the visit and hand him the list.
Thanks
Petar

[Gallivanters]

For coastal cruising - we stock our medicine chest with sun block & sunburn cream along the usual assortment of gauze pads, sponges, tape, ointments & band-aids.

For offshore passages - we add a bottle of Betadine, Alcohol & Hydrogen Peroxide and a few packets of suture kits and Steri Strips skin closures for general wound care - plus a large ammount of broad spectrum antibiotics and pain killers. In addition, we have a prescription for morphine and an I.V. drip.

As a boat captain, you have a legitimate reason and are entitled to set up your medicine chest any way you see fit.

I believe it is prudent to be prepared and able to handle medical emergencies at sea (as well as in port) and I get a warm & fuzzy feeling from being able to provide care to someone who is injured.

It all paid off three years ago when I noticed several people standing over the lifeless body of a guy they'd just fished out from under the dinghy dock (pondering their own mortality, I suppose). I ran over, fell to my knees and performed CPR on him... and brought him back from the dead.

Have fun,

Kirk

[Michaele]

There is a UK publication that is carried world wide by many merchant ships - The Ships Captains Medical Guide. Have a look under sailing then medicine on my web site - there is a link to the book plus lists of offshore medical equipment as used by many blue water yachts... A lot of the items can be purchased without prescription from medical shops as opposed to pharmacy.. Your doctor will give you a script for antibiotics etc and it is worth carrying an emergency dental kit - lots more on my page written by doctors and dentists.. Michael

[Talbot]

You can download a copy of the Ship's Captain's Medical Guide from :

http://www.mcga.gov.uk/c4mca/mcga-se...ical_guide.htm

There is quite a good list of what merchant shipping should carry for different types of journey available

http://www.mcga.gov.uk/c4mca/ds-shs-1768cor.pdf

[GordMay]

From the “Travel Medicine “ site at: http://www.travmed.com/

Before departure, your doctor should do the following, where appropriate:

- Review your medical history and current medications, and alter current therapy for travel when necessary.
- Review your travel itinerary in order to advise you regarding the prevention of medical problems. See “The World Medical Guide” below.
- Administer immunizations, as indicated, and complete the International Certificate of Vaccination for yellow fever (if administered) and for cholera (if necessary) to avoid possible border crossing problems.
- Review measures to prevent travelers’ diarrhea, hepatitis, motion sickness, and acute mountain sickness.
- Review methods to prevent insect bites, emphasizing the use of DEET repellents, permethrin, bednets, and insecticide room sprays.
- Prescribe medication to treat travelers’ diarrhea, motion sickness, and other possible problems.
- Perform a physical examination, if there are underlying health concerns for which an examination would be appropriate. Perform appropriate testing.
- Screen for exposure to tuberculosis by administering a PPD skin test if you are traveling for a prolonged period to a risk area. Repeat PPD on return.
- Prescribe drugs for malaria prophylaxis, review the symptoms of malaria, and prescribe, if appropriate, drugs for the emergency self-treatment of malaria.

The World Medical Guide lists disease risk advisories for more than 200 regions and countries as well as entry requirements and embassy information.
http://www.travmed.com/maps/map.epl

Preparation Checklist for Medical and Personal Care Items

Use the following checklist as a general guideline and modify it according to your itinerary and specific travel and health needs. A nylon or canvas pack or a first aid kit are useful for carrying medications and other health care items. Any medical kit containing medications should be in your "carry-on" baggage so access during travel is not a problem.

Adequate supply of your prescription medications. Carry copies of your prescriptions by generic names. How much of each medication will you need for the duration of your trip? If you will be living abroad, or traveling extensively, will you need to refill prescriptions? Check local availability of medications, but also remember this: in some developing countries, regionally manufactured drugs may be substandard. Therefore, it may be necessary to carry a full supply of crucial medications, such as heart drugs, for the entire trip-or make arrangements for additional drugs to be shipped to you.

Antibiotics for treating travelers' diarrhea-Quinolone antibiotics are the most effective and include ofloxacin (Floxin), levofloxacin (Levaquin), ciprofloxacin (Cipro) and nalidixic acid (Negram). Azithromycin (Zithromax), furazolidone (Furoxone), and cefixime (Suprax) are the best alternatives; the last four are available in liquid form and thus more easily taken by children.

Antibiotics for emergency self-treatment of other infections—Levofloxacin is effective against sinusitis, some pneumonias, acute bacterial exacerbations of chronic bronchitis, urinary tract infections, typhoid fever, uncomplicated skin infections, and uncomplicated pelvic inflammatory disease due to gonorrhea and chlamydia. If you have to carry only one antibiotic, levofloxacin is the best choice because of its broader spectrum of activity. Azithromycin is a good alternative multi-purpose antibiotic for travel.

Loperamide (Imodium-AD)—Use to treat mild travelers' diarrhea, or use in combination with an antibiotic to treat more severe diarrhea.

Antimalarial drugs (depending on itinerary, length of stay, etc.)—chloroquine (Aralen), mefloquine (Lariam), atovaquone/proguanil (Malarone), primaquine, or doxycycline.

Medical kit—Carry at least a basic kit that contains a thermometer, Band-Aids and wound dressings, an antibiotic ointment, scissors, tape, and other supplies to treat an abrasion, minor laceration, minor burn, etc.

Water filtration/purification supplies.

Oral rehydration salts (e.g., CeraLyte) to prevent or treat dehydration caused by diarrhea.

1-liter plastic water bottle-for storing water or oral rehydration solution.

Epinephrine kit—If you have a history of severe bee sting reactions or severe food or drug allergies, have your doctor prescribe an emergency epinephrine self-injection kit (Ana-Kit® or Epi-Pen®). Be sure you learn how to use it before you travel.

Sterile needle/syringe kit—recommended for travel to countries where hepatitis B and C and HIV transmission are potential threats and where local medical care is substandard and the sterility and safety of medical supplies are questionable.

Analgesics—such as ibuprofen or acetaminophen, or the newer antiinflammatory drugs, rofecoxid (Vioxx) and celecoxib (Celebrex). Tylenol with codeine is an effective pain medication and also has anti-diarrheal properties. Aspirin can lose potency when exposed to humidity and heat. Acetaminophen (Tylenol) is not affected by these conditions.

Antacids—such as Maalox or Mylanta.

Cathartics and/or stool softeners since constipation is not uncommon, especially in the elderly.

Pepto-Bismol—can be used to prevent or treat diarrhea.

Motion/sea sickness drugs—TransDerm Scop patch (for sea sickness), SCOPACE (scopolamine tablets), Dramamine, Phenergan.

Drugs for acute mountain sickness (acetazolamide, dexamethasone) should be considered for all trekkers to Nepal and other high-altitude destinations.

Jet lag—Melatonin and sleeping pills (e.g., triazolam) are helpful for some people. Temazepan (Restoril), zolpidem (Ambien), and zaleplon (Sonata) may have fewer side effects than Halcion (triazolam).

Antibiotic eye drops (e.g., Ciloxan) should be carried by contact-lens wearers. An untreated infected corneal ulcer can cause serious eye damage.

Nasal decongestant spray—Afrin or Neo-Synephrine (short-term use only).

EarPlanes—Pressure-regulating ear plugs will reduce pain associated with air travel. Especially recommended if you have trouble clearing your nasal passages.

Antihistamine tablets—for allergic reactions and rhinitis (hay fever). Consider Zyrtec or Claritin-D—they are long-acting and nonsedating.

Vosol solution—to prevent or treat swimmer's ear.

Corticosteroid cream—such as Cortaid, or Topicort by prescription.

Antifungal skin and foot cream—Lotrisone and Nizoral are good choices.

Antifungal tablets—A single, oral 150-mg tablet of fluconazole (Diflucan) will eradicate a vaginal yeast infection.

Extra pair of prescription glasses or contact lenses. Copy of lens prescription.



The drugs listed in this section are among the most important for preventing or treating many travel-related illnesses (e.g., malaria, travelers' diarrhea, and acute mountain sickness).
ACETAZOLAMIDE
ATOVAQUONE/PROGUANIL
AZITHROMYCIN
CHLOROQUINE
CIPROFLOXACIN
DOXYCYCLINE
LEVOFLOXACIN
LOPERAMIDE
MEFLOQUINE

[GordMay]

Ask your Doctor for copies of the “Physicians' Desk Reference” (“Merck Manual”, or whatever he uses) entry for any drugs you will be acquiring. These will provide valuable usage information and warnings, such as: drug interactions, contraindications; clinical pharmacology; adverse reactions, and dosages, etc.

[kimberlite]

Contact seaseide marine pharmacy.
they sell complete offshore medical kits including about 40 prescription drugs included in the kit.
the best i have ever seen.
fair winds,
eric

[hellosailor]

Gord, in the US any doctor who is accepting insurance plans is usually so hard pressed for time that asking them for copies from a reference book is, well, like asking them to pay you for the visit. I'd just make copies at the local library, the MM is readily available at library reference desks here.
The complete manual is available on CD for about $50US which could be a good thing to keep aboard, so you can check on foreign meds. But for a short list of drugs, most of the info is available on the internet (bless its pointy little aethereal head<G>).

Some of the immunizations that are often recommended (like an adult tetanus booster every <10 years) or hepatitis A/B, can involve a series of shots that need to be spaced out, so anyone thinking about immunizations needs to plan months ahead. It is better to have only one shot on any one day(s) so that if there is an adverse reaction, you know exactly what it is from.

And with any strong medicines, it is best to actually TAKE THE MEDS and try them before you set out, so you will find out if there are any complications or adverse reactions while you are still in the comfort of home and your home medical care. This applies to antibiotics and seasickness meds especially, take a daily dose and see how your day goes.

Case in point, scopalamine. Great seasickness med for some people, but very bad side affects for a small portion. If the phrase "I may become a raving ax murderer with bugged out eyes and a coronary, but at least I won't be seasick" sounds scary to you...obviously you've never really been seasick.<G> Or had to worry about a crew who was.<G>

And with antibiotics, there's no way to predict which ones can cause a deadly reaction, especially if they are anywhere in the pencillin family. So, ask for the rx to cover a couple of days extra pills, and try them out (only one test per day!<G>) while you still have the best support system around you.

Good stuff at http://equipped.org/medical.htm that web site started out with aviation/marine emergency information, like life raft tests.

[lexxyahoy]

One more thing that I have never seen suggested and we have found helpful
A drug called Provigil...this is a safe stimulant...look it up. Will keep you alert for 8 hours, even if you are tired...nonaddictive or schedule 11. My doctor suggested it and we have been glad to use it when we have had a cold and had to take a voyage. The Capt calls it "Mr Feelgood". I think more folks could use it. We keep it for sailing thru storms...not needed yet for that...we just in the Caribbean now.

[hellosailor]

A word on vaccinations: Ask your doctor about them *now* because some are given as a series over 90 days, not just one shot. And, in case you react to one of them, you are best off spacing them out a week or two apart (or more) rather than going in to be a pin-cushion for the day.

HepA, HepB, cholera, tetanus...you may need more visits over more weeks than you'd think.

[alanperry]

Here is something to think about based on my 34 years of travelling the world and having lived and worked in such places as Egypt, China, Switzerland, Britain, and traveling to most of the developing world, including a stint in the Peace Corps in the West African Nations of Sierra Leone and Senegal in the '70's.

The myth that the US govt wants you to believe that all drugs bought outside of this country are unsafe in pure hogwash. Drugs bought in "MOST" countries from reputable pharmacies are made either by the same companies that make the ones we buy here or are made under license and are just as good as ours. Many are made by European drug manufacturers.

So, rather than spending a literal ton of money on buying all those supplies here in the USA, where by the way your insurance company may well balk at paying their share, I would give serious consideration to getting your medical kit in another country. If I knew precicsely where you were going I might be able to offer some first hand experience. This would save you hundreds of dollars and be much easier to do offshore than here where we are so paranoid about these things.

If your first landfall will be Mexico, Venezuela, Costa Rica, or a few select countries in the Carrbbean I would take a good first aid kit with just a few drugs and then get my kit once out of the US. Don't worry about making yourself understood, most doctors and health care folks speak enough english to do this easily. And in most countries there are clinics and hospitals that are designated as "travellers" or "American" or "Canadian" these are great places to go.

In addition many of the drugs that require a prescription in the US can be bought "over-the-counter" in many other countries saving you that much more and making it even easier.

I don't know how much experience you have travelling, and the more you have the easier it is to negotiate this kind of task in other countries.

Also your drugs will go past their "use by" date while you are out cruising and you will be forced to replenish in other countries at some point anyway. Good places in Asia to do this are Thailand, Singapore (also great for getting new contacts/glasses and dental work done) Bombay (Mumbai) India is a place that some of my Swiss-Air friends get medical work done. Almost all of the doctors have been trained in England, speak great english and have spotless high tech facilities. Of course New Zealand would be a good place too but more expensive.

Just a couple of personal notes: I have recieved medical treatment in many countries and always found it to be very good. The last time was in Luang Prabang Laos, with a Doc trained in Eastern Europe. Got good treatment and fine drugs and felt much better the next day. My son had a mortorcycle accident while he and I were riding mortorcycles around northern Thailand a few years ago and he was treated in a wonderful hospital given first class care equal to anything here in the US and 12 days later my bill was $250 US.

This is just in the spirit of hoping to take some of the worry out of considering getting your med kit and drugs out of the USA.

Alan Perry
S/V Oceanus
Seattle WA

[chuckr]

one thing no one mentioned is dental -- i am trying to move aboard as soon as my house sells and just broke and lost a cavity -- got to thinking - what would i do if i was off way off shore and lost a cavity -
as soon as a denist can see me i will ask - anybody any ideas?
by the way i am an exbackcountry emt and if i had to treat this in the backcountry i would expect and evac within hours not days or weeks so the problem is different.
chuck and soulmates

[hellosailor]

"what would i do if i was off way off shore and lost a cavity - "
AFAIK the only thing you CAN do is to clean it well (i.e. h.peroxide rinse) then use a temporary filling compound (which is mainly wax with inert fillers) to pack it and keep it clean. Anything more permanent is likely to just make it that much harder to replace a filling when you do get ashore.
And then of course, make landfall as soon as possible.

Preventive care (regular cleanings and x-rays more often than when land based) also becomes more important.

[GordMay]

Downloadable Online Books:

Where There Is No Dentist ~ by Murray Dickson
http://www.healthwrights.org/books/W...tistonline.htm

Where There Is No Doctor ~ by David Werner
http://www.healthwrights.org/books/WTINDonline.htm
or
http://www.hesperian.org/publications_download.php#wtnd