Appendicitis while offshore? New study shows that you might not need surgery

[fatherchronica]

I would want my body to be strapped under the bowsprit until we got to shore.

[dwinsemius]

I was surprised that so few of the persons rightly criticizing the idea of IV administration while at sea didn't suggest an IM (intra-muscular) route. The treatment in cited article was intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin (closely related to "Cipro") and metronidazole ("Flagyl").

Ertapenem can be administered IM and would probably have comparable blood levels. It is stored as a powder that is reconstituted with 1 g vial of INVANZ (tradename for ertapenem) with 3.2 mL of 1.0% or 2.0% lidocaine HCI injection***(without epinephrine). The subcutaneous route for fluid administration did sound reasonable to my ears; the sternal interosseous route much less so.

[hellosailor]

Not so new really. There has been public discussion (not just among the doctors) for over a decade as to how the "useless" appendix may actually serve a critical purpose of allowing the gut microbiome to keep a reserve of "critters" so it can restore balance after any kind of gastrointestinal disruption.

The importance of the gut microbiome has been fairly well established only in the last decade, and the agreement now is that it may regulate far more of our bodily functions than anyone has suspected. Including depression, several types of mental illness, and autoimmune diseases.

So, the importance of the appendix? Yeah, any doctor who tries to just cut it out without that being absolutely necessary, is someone who's at least a decade behind the times.

Same way that they finally figured out tonsils DO something, they no longer are so fast to lop those out either.

[Biomed]

Originally Posted by hellosailor

Not so new really. There has been public discussion (not just among the doctors) for over a decade as to how the "useless" appendix may actually serve a critical purpose of allowing the gut microbiome to keep a reserve of "critters" so it can restore balance after any kind of gastrointestinal disruption.

The importance of the gut microbiome has been fairly well established only in the last decade, and the agreement now is that it may regulate far more of our bodily functions than anyone has suspected. Including depression, several types of mental illness, and autoimmune diseases.

So, the importance of the appendix? Yeah, any doctor who tries to just cut it out without that being absolutely necessary, is someone who's at least a decade behind the times.

Same way that they finally figured out tonsils DO something, they no longer are so fast to lop those out either.

Plus one!!
Antibiotics can and do save lives. They can and do mask symptoms. Pathogens, as I said before, are sensitive or resistant to the antibiotic. What antibiotics do to friendly gut flora, is not pretty. Tend to wipe out a lot of it, and that has consequences.
When weak, vomiting does not assist regaining the strength required to operate the boat. The "Italian Job" referred to earlier, illustrates the need for a culture and sensitivity testing. At sea: not possible, and getting the diagnosis right is paramount. Taking antiemetics, is a problem, when food poisening is the issue, or one of them. Hence, getting advice and a professional opinion by radio, or sat phone is useful in developing a treatment plan. Referred pain, can easily cause confusion regarding the complaint to a lay person, and not only them! Get professional help on the horn, and keep talking to them, until help arrives, if that is the solution decided on. When the pro has a run down on the medical inventory you carry on board, he will help pick the best option as things develop.
Not all LRQ pain is appendicitis, and coming from ports you may have picked up a bacterial, viral or parasitic infection which may be quick, or take time to incubate, and present as appendicitis, in reality, one is dealing with an infestation of unknown etiology.
Please don't be too quick to grab antibiotics! Acute pain, particularly exquisite pain, is frightening. All the more reason, to have a trained, objective professional on your side, to avoid damaging kneejerk treatments. Talk to your family physician about an exhaustive kit, good courses to teach you how to use it, and if you don't wish to put in the effort, stay within reach of hospitals and Coast Guard assistance.
Invest in a defibrillator, these things come in handy way more often than an appendectomy kit! They are not expensive, and actually tell you or your crew step by step, what to do. Prophylactic transplant as a preferred option, anyone??? Fair winds!!

[dwinsemius]

Re: buying a defibrillator versus carrying injectable antibiotics: The numbers I could find regarding the incidence of ventricular fibrillation and appendicitis suggested that appendicitis was probably 4 times as common at least in young persons. 23/10,000/yr versus 60/100,000,yr. If one of your crew has a history of cardiac disease that calculation would obviously need to be modified in light of the specifics.

Re: the pain of appendicitis being "exquisite": Not the word I would have chosen. Generally, acute appendicitis is a dull, steady pain. It may become severe over time. It often starts with upper abdominal pain

[Biomed]

Originally Posted by dwinsemius

Re: buying a defibrillator versus carrying injectable antibiotics: The numbers I could find regarding the incidence of ventricular fibrillation and appendicitis suggested that appendicitis was probably 4 times as common at least in young persons. 23/10,000/yr versus 60/100,000,yr. If one of your crew has a history of cardiac disease that calculation would obviously need to be modified in light of the specifics.

Re: the pain of appendicitis being "exquisite": Not the word I would have chosen. Generally, acute appendicitis is a dull, steady pain. It may become severe over time. It often starts with upper abdominal pain

I did not postulate anywhere that antibiotics should not be carried, in fact I suggested an exhaustive kit.
I did not, as per the text, refer to exquisite pain, other than being a frightening experience, in general.
We see cardiac patients of all ages. We have cruising patients of all ages, including those statistically most at risk. Few boats carry a defibrillator.
I have time nor inclination to enter into a pedantic statistics argument, I merely tried to share what I hoped was useful information.
Bye, bye!

[jackdale]

Originally Posted by BillCH

On the other hand, before a long crossing be sure to think about what you - or your crew - want done with your body if you die. Are your loved ones on shore OK with a burial at sea? Towing your carcass back in the liferaft, or stowing it in the chain locker in a big bag is not an appealing prospect. Just be sure to document the whole thing for explaining the crew manifest changes to Immigration on the other side!

More importantly, you had better contact a Rescue Coordination Center and inform them of the death. They might be to arrange an AMVER rendezvous to transfer the body.

[sgunes]

I don't know if it was already mentioned but all patients underwent a CT scan to diagnose the "uncomplicated appendicitis".
How many here have a CT scanner on their ship and the personnel to run it and interpret the study?
I can imagine that some of the fancy cruise ships may have a CT scanner but that's about it.

[tbodine88]

Originally Posted by Suijin

Seems like it is considered “rare” after you pass 40.

I'm good. Had appendicitis at 44. Just after I'd had the boat hauled for a trip across the country.

This means of course, that I am rare 😊

[Hoosierdoc]

Honestly I find this thread hilarious. So many egos.

As an ER doc I do however love that clinical diagnosis of appendicitis without a CT scan does still exist, even if only on a sailing forum

[Hoosierdoc]

Originally Posted by dwinsemius

I was surprised that so few of the persons rightly criticizing the idea of IV administration while at sea didn't suggest an IM (intra-muscular) route. The treatment in cited article was intravenous ertapenem for 3 days followed by 7 days of oral levofloxacin (closely related to "Cipro") and metronidazole ("Flagyl").

Ertapenem can be administered IM and would probably have comparable blood levels. It is stored as a powder that is reconstituted with 1 g vial of INVANZ (tradename for ertapenem) with 3.2 mL of 1.0% or 2.0% lidocaine HCI injection***(without epinephrine). The subcutaneous route for fluid administration did sound reasonable to my ears; the sternal interosseous route much less so.

“Hey guys, can you all chip in? I’m buying $1000 worth of antibiotics in case we get appendicitis”

Rofl

[Bulawayo]

Im also a doctor ...... and you wrote exactly what I was thinking. One massive ego in particular!

Originally Posted by Hoosierdoc

Honestly I find this thread hilarious. So many egos.

As an ER doc I do however love that clinical diagnosis of appendicitis without a CT scan does still exist, even if only on a sailing forum

[sgunes]

Mod should just close the thread, too many MD's here.

[Pete7]

Originally Posted by sgunes

Mod should just close the thread, too many MD's here.

That's a good thing isn't it? After all we could have a thread asking how to do it mid ocean next month. Perhaps live on YT with a linked Patreon account to make donations for the after care.

Pete

[dwinsemius]

Originally Posted by Hoosierdoc

“Hey guys, can you all chip in? I’m buying $1000 worth of antibiotics in case we get appendicitis”

Rofl

Does this mean you have useful information regarding the cost of antibiotics and the likelihood of appendicitis versus the cost of an AED and the likelihood of needing one of those?