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Old 29-09-2018, 11:24   #31
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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Best advice I can give is, don't make holes if you don't have to. Have a backstop you can talk to who can track the progress of the complaint, and give the best treatment advice possible in the circumstances. It may mean, directing commercial traffic your way to help you.
Been there, done that.

In 2012, a thousand miles north of Hawaii, a crew member had prostate issues and was unable to catheterize himself. We contacted the RCC in Honolulu via sat phone; they had him talk to the Flight Surgeon who arranged a medevac through AMVER. We rendezvoused with a container ship. I now always have the phone numbers of the appropriate RCCs when making a passage.

BTW - The captain of the container ship was named the Greek seafarer of the year by Lloyd's for his role in the evacuation.
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Old 29-09-2018, 11:46   #32
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Re: Appendicitis while offshore? New study shows that you might not need surgery

"Anyone going to stay/work/study in Antarctica must have their appendix removed. "
No. There are many nations with permanent stations in Antarctica and AFAIK there is only *one* country that makes that requirement. They were written up on the BBC about a month ago, because they have a village on an island with no transport or surgical aid possible. I think it was Chile.
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Old 29-09-2018, 12:49   #33
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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...There are a multitude of wretched things that can come on quickly creating a medical emergency, best to leave long distance sailing to the young who think they are immortal.
I would count the risk of dying in a car crash ashore as maybe 100 times more likely than the sum total of all that can possibly go wrong at sea. My figures may be way, way out but let's try keep things in proportion. Sh** happens, shouldn't stop us living life to the utmost.

[BTW, there are other ways to treat gallstones (ask how I know) and non-medical ways to prevent recurrence (at least for those prepared to devote much time and effort and study).] Edit: may have been kidney stones - can't recall now as it was so long ago.
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Old 29-09-2018, 13:16   #34
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Re: Appendicitis while offshore? New study shows that you might not need surgery

“This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis,” the authors conclude.
The finding suggests that many appendicitis patients could be spared the risks of surgical procedures, such as infections.
.....
That said, the authors note that the antibiotic treatment was also heavy-handed in the study. The researchers went with a "conservative" three-day IV treatment followed by more oral antibiotics, which may have been overkill.


So it's possible the IV is unnecessary too...

In my younger days, having adenoids and tonsils removed was a commonplace thing to inflict on poor innocent kids; hardly ever nowadays I believe. I wonder how many other medical interventions will prove to be unnecessary as we learn more about alternatives to currently accepted doctrines.
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Old 29-09-2018, 14:03   #35
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Re: Appendicitis while offshore? New study shows that you might not need surgery

I'm surprised no one has mentioned the incident, from the 1970's IIRC, that was widely written about at the time. Three young men, from South America, were going off to see the world and decided that they should all get appendectomies first. One of them died as a result. The remaining two did continue, naming the boat after their friend.

People die from surgeries as well as appendicitis, although with today's endoscopic techniques the surgical risk may be quite low.

A lot of cruising is about managing, not eliminating, risk. There will always be risk. The likelihood of appendicitis at sea for a typical cruiser is very small, and can be further managed by carrying appropriate drugs. Spending the time and money, and taking on the surgical risk, to have a prophylactic appendectomy is too high a cost for the tiny risk reduction. There are lots of other, more likely possibilities, that can be prepared for instead.

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Old 29-09-2018, 14:59   #36
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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If it were me, I would suggest the combination of Cipro and flagyl might keep things at bay until medical attention was reached. Cipro is as effective by mouth as IV as long as you can keep it down. Flagyl is effective for anaerobes and will get good serum levels BUT
this regimen will not eradicate the infection, only tamp it down to allow medevac.
I am NOT recommending this, just sayin'. This is not to misconstrued as medical advice
and I take no responsibility for anyone who does this.

This is the kind of advice you get from a clinic on a random street in the developing world, or at a bar, or on cruisersforum.
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Old 29-09-2018, 16:02   #37
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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If it were me, I would suggest the combination of Cipro and flagyl might keep things at bay until medical attention was reached. Cipro is as effective by mouth as IV as long as you can keep it down. Flagyl is effective for anaerobes and will get good serum levels BUT
this regimen will not eradicate the infection, only tamp it down to allow medevac.
I am NOT recommending this, just sayin'. This is not to misconstrued as medical advice
and I take no responsibility for anyone who does this.

Good to know, but I am allergic to cipro. I also had my appendix removed when I was in college. One of my friends was in pre-vet at the time, and he insisted I go to the hospital. Being the dog I was, I agreed to go, and they removed it that evening. Good thing, too, it was ready to burst. Since that was in the early 60s, I have the long scar to prove it. Good news for the world: kept me from wearing speedos.


Not something to mess around with, like the post about the 52 year old woman. Man, I can't figure that kinda logic at all.


But one should also know about allergies and write them down, keep it in your wallet, just in case.
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Old 29-09-2018, 16:29   #38
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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Make the effort to receive certification in venipuncture, advanced CPR and emergency medicine, and then talk to me. Until then, you're just a cowboy aiming at a vein and advocating dangerous measures for those who lack such training.
As a Paramedic who's been in the field in various roles for close to 20 years, and who's had the opportunity in recent years to practice IV starts during relatively CALM days on the boat, I can attest that this is likely to be a complete non-starter.

I'm good with IV's, and on a calm day getting a good line started on a small sailboat in settled conditions is as challenging as any lines I typically did on the street. Trying to do so in the circumstances you would actually need to start one -- with a dehydrated crew member (poor veins), in unsettled seas, with random motion, will make most experts quake with fear. Not to mention, just having that line in for any length of time in wet, dirty conditions is increasingly likely to lead to an infection.

At first glance, this may sound like a great idea, and I do keep IVs in my personal kit aboard -- but I recognize the odds of being in a position to use them are low. As for IV antibiotics, they'd be a waste. They often don't last that long and require careful climate control, both problems aboard small boats. You also really wouldn't want to start an IV antibiotic in the middle of the Atlantic for the first time and discover you're allergic to it. That would be a very bad day.

All that said -- I'm not all that worried about my appendix. If I set out to do a round-the-world nonstop, I'd likely have a chat with my PCP and whatever Doc (ideally with long distance sailing experience) I'll be relying on for shoreside support about it, and then weigh the risks of keeping it vs an entirely elective procedure to remove a healthy appendix "just in case". For me? I'm probably avoiding that elective procedure -- but that's a decision each person has to make for themselves.
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Old 29-09-2018, 16:34   #39
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Re: Appendicitis while offshore? New study shows that you might not need surgery

Hello,

I am rebuilding a 1972 Pearson 33 and 2 weeks I had an ER Appendectomy. The pain really seriously pushed the threshold. I am 68 and frankly glad I was not cruising. They fully expected it was ruptured.

Not sure that I added to the thread except it was freakin' painful....

It could be serious.....even fatal.
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Old 29-09-2018, 17:43   #40
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Re: Appendicitis while offshore? New study shows that you might not need surgery

A few things to consider:
1)Rocephin (a cephalosporin antibiotic) is a good choice and the shelf life is good due to it being a powder that needs to be reconstituted with normal saline (don't try to substitute sea water, hee, hee) in the same sterile vial it comes in, and then piggy backed or injected directly into a little port on a bag of saline IV fluid. You can use the same port to draw out the fluid to mix it with. It can be followed up with a similar cephalosporin in the oral form on day 4.

But, how is the person going to know if it's appendicitis? Most likely the antibiotic will be used for at least 3 out of 4 sailors w/belly pain other than appendicitis.

Also, if you are keen on diagnosing yourself:
1) appendicitis does not always cause pain in the right lower side of the abdomen;
2) plump bellied people may have very little or even no pain at all until the appendix ruptures and then within a few hours peritonitis and septicemia begins.
3) Of nearly half of all those people who do have appendicitis and then wind up needing surgery, it's because the surgeon is faced with lab test results, signs & symptoms that indicate the need for the appendectomy at "any point in time" during the course of the antibiotic treatment regimen.

For the above reasons, as an M.D. I would be very hesitant to prescribe an antibiotic kit to anyone regardless of their experience in sterile technique, treating a 1st time allergic reaction, etc.

So, it's probably best not to rely too heavily on the antibiotic approach which after all should ideally be under the relatively close eye of a doctor who knows when to get a general surgeon involved.
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Old 29-09-2018, 18:55   #41
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Re: Appendicitis while offshore? New study shows that you might not need surgery

I am a general surgeon.

With 3 crew (40-57) for a 7-9 day passage, I did take along Cipro & Flagyl as it would be appropriate for Appendicitis or diverticulitis and hopefully would be sufficient for 3-4 days. Fortunately did not need. Other uses as well, but these were my top 2 on this trip.

IV would likely be difficult for lay person. Ans Cipro orally has same effect as IV. I do agree need to be aware of allergies.

If having another procedure on abdomen (ie Gallbladder removal), I would discuss concurrent removal of appendix with my surgeon... As a surgeon, I would feel appropriate for one planning long passages.
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Old 29-09-2018, 21:00   #42
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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I am a general surgeon.

With 3 crew (40-57) for a 7-9 day passage, I did take along Cipro & Flagyl as it would be appropriate for Appendicitis or diverticulitis and hopefully would be sufficient for 3-4 days. Fortunately did not need. Other uses as well, but these were my top 2 on this trip.

IV would likely be difficult for lay person. Ans Cipro orally has same effect as IV. I do agree need to be aware of allergies.

If having another procedure on abdomen (ie Gallbladder removal), I would discuss concurrent removal of appendix with my surgeon... As a surgeon, I would feel appropriate for one planning long passages.
Just put up a YouTube instructional video, we'll be OK from there.
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Old 29-09-2018, 21:19   #43
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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Interesting, I didn’t know that.
I looked at this as a possibility years ago, and considered having the thing out proactively, then bumped into the fact that NASA and the Russians didn’t and don’t for long duration space flights.
I’m thinking the risk must be pretty low for whatever reason, cause I would have thought that the Apollo Astronauts would have had theirs removed for instance.
Space Station I assume can handle such contingencies.
IV’s are easy, Wife was an RN, I was taught how it in the Army, if I can, anyone can.
However where are you getting the drugs, and what is their shelf life?
I carry a few antibiotics, but wonder about shelf life, and what happens when they reach shelf life?
Many things the answer is nothing, just the manufacturer picks a date that they are comfortable guaranteeing purity and potency etc., there was no testing to determine max shelf life, cause why would you?
I must respectfully disagree with the thought that IV's are easy. Depends on the patient, of course, but for my last 'surgical procedure' 3 different nurses, including the nurse anesthetist, botched the effort and left me with ten (10) punctures scattered across my 2 hands. 10 attempts; before they got it - and that was on a steady, stable hospital floor. I can just imagine being inexperienced, stressed, and trying to start an IV on a moving boat.
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Old 30-09-2018, 02:39   #44
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Re: Appendicitis while offshore? New study shows that you might not need surgery

Hello everyone,

With regards to what jackdale posted, I had one emergency medical evacuation, due to a femoral hernia. Following consultation, I found out that the repair had failed. At that time, I determined to have repairs done both sides. The surgeon happened to be a yachtie, and so, he put in kevlar patches, over the holes, secured with titanium screws, and told Jim and me that he would fix it for free if it failed. So far, it's really good!

So, while I wouldn't and didn't have my [perfectly good appendix, imo] removed, I have had that preventive surgery. The reason is that it could have killed me to have another event, and fairly quickly: the intestine would have strangulated in the hole, and blown up, and leaked, with peritonitis and septicemia to follow, a bad thing, to happen when one is far out of contact with civilization.

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Old 30-09-2018, 03:37   #45
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Re: Appendicitis while offshore? New study shows that you might not need surgery

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Hello everyone,

With regards to what jackdale posted, I had one emergency medical evacuation, due to a femoral hernia. Following consultation, I found out that the repair had failed. At that time, I determined to have repairs done both sides. The surgeon happened to be a yachtie, and so, he put in kevlar patches, over the holes, secured with titanium screws, and told Jim and me that he would fix it for free if it failed. So far, it's really good!

So, while I wouldn't and didn't have my [perfectly good appendix, imo] removed, I have had that preventive surgery. The reason is that it could have killed me to have another event, and fairly quickly: the intestine would have strangulated in the hole, and blown up, and leaked, with peritonitis and septicemia to follow, a bad thing, to happen when one is far out of contact with civilization.

Ann
A hernia repair and preventative hernia repair to a known weak spot is much different than pre-treating an appendix, which in all probability will never give the vast majority of people any problem during their lifetime.

Many people get cancer at some point, so does it make sense that everyone who ventures offshore should receive preventative chemo therapy? This entire topic makes about as much sense as preventative chemo on a perfectly healthy person. Or why stop there, why not preventative heart bypass surgery?
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