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

[CHM]

I was in the Navy for 28 yrs and and have never seen or heard of pre-emptive appendectomies. I would likely lose my medical license for such a practice also.

[Nicholson58]

Originally Posted by danielamartindm

How many cruisers have the ability to safely administer an IV push of antibiotics? Oral antibiotics and IV antibiotics are two entirely different animals in terms of efficacy and possible complications.When things go bad from an IV dose of a drug, they go bad fast; and oral dosages are capricious in that they cannot be titrated or readily reversed.

Perhaps this would help.

[Franziska]

Btw. have a cup of vodka and have a go at it yourself [emoji6]
That is, if you are Russian and a trained medical doctor:

https://en.wikipedia.org/wiki/Leonid...ov?wprov=sfla1

At least he had stable ground.
..

[44'cruisingcat]

Originally Posted by Paul L

A little vodka and you can remove your own appendix

All we need is a you-tube video to show us how it's done.

[Kenomac]

This entire concept of having a pre-emptive appendectomy is medically ridiculous. If you sit around worrying about issues like getting an appendicitis, maybe cruising isn’t a good life choice for you.

[Lepke]

In WWII 2 seamen in US subs on war patrols had to have an emergency appendectomy by the corpsman on board. Naval warships have on board medical do-it-yourself books for such emergencies. In both cases the corpsmen went "by the book". The Pacific submarine command considered requiring pre-emptive appendectomies, but never did.

[Nicholson58]

Originally Posted by 44'cruisingcat

All we need is a you-tube video to show us how it's done.

Here Are a couple. YouTube is a wealth of self help.

https://m.youtube.com/watch?v=aEi_4Cyx4Uw

https://m.youtube.com/watch?v=QAgYMSUUYAM

[jackdale]

Originally Posted by Kenomac

This entire concept of having a pre-emptive appendectomy is medically ridiculous. If you sit around worrying about issues like getting an appendicitis, maybe cruising isn’t a good life choice for you.

Kay Cottee had her appendix removed before her non-stop, unassisted, solo round the world.

As an aside, I had a hernia operation a couple years ago. My doctor told me that it was only necessary because I did ocean passages. If the hernia strangulated I would be in big do-do. For "ordinary folks" they would have left alone.

[fatherchronica]

I have read a lot of books by or about folks who had their appendixes removed to either sail far away from civilization or trek to remote locales. Always seemed extreme to me. I used to tell people I met on construction sites that I was getting a colostomy bag so I wouldn't need breaks, then adult diapers appeared and me and some of my crew would tell members of other crews that we all wore Depends, that I made them do it. Later, as I got old, and knew people with colostomy bags I sort of worried about my karma.

[Kenomac]

Originally Posted by jackdale

Kay Cottee had her appendix removed before her non-stop, unassisted, solo round the world.

As an aside, I had a hernia operation a couple years ago. My doctor told me that it was only necessary because I did ocean passages. If the hernia strangulated I would be in big do-do. For "ordinary folks" they would have left alone.

Ridiculous nutty stuff regarding the appendix, yes your hernia needed repair. Two entirely different issues.

[Steve Bean]

I can personally attest that appendicitis is not just for the young. A year or so ago, at age 73, my lower right abdomen became painful. The more I pressed on it, the more it hurt, so I stopped pressing. At the hospital, a scan showed it was enlarged, so I had endoscopic appendectomy the next day. At least that's what I was told. I woke up with 3 tiny scars and no more pain. It took a week or so to rehabilitate my intestinal flora after the IV antibiotics.

[Sailor647]

Originally Posted by MondayNever

I imagine that IV administration is covered in some wilderness medicine courses, which is well within the realm of Stuff Worth Doing while preparing for voyaging. Even if not for this use case, being able to administer a saline drip would be highly useful in the event of severe sea sickness.

We both took Wildmed's Offshore Emergency Medicine course before we left to go cruising. Instructor Jeff Issac PA agreed that dehydration is a real possibility with sea sickness. However, he said it would be practically impossible to administer an IV to a severely dehydrated person while on a rocking boat. In other words, getting a needle into the tiny space between the walls of a collapsed vein ON A MOVING BOAT would be very, very difficult - even for a person who has done the procedure every day for 30 years.

So, our medical kit contains four Aqua-C hydration systems from Norfolk Medical. It allows for the administration of sterile fluids sub-q (through the skin) and not through a vein. The recommended attachment site is the abdominal belly fat below the bellybutton line.

"With the Aqua-C Hydration System, hypodermoclysis is now simple, easy to administer, and relatively painless for the patient. The Aqua-C is easier and less distressing to administer than IV hydration, more suitable for home use, and often eliminates the need for hospitalization to find a vein."

Offshore Emergency Medicine Training- WMA

Norfolk Medical Products | Products

As far as appendicitis goes, we met a man last year whose wife refused medical treatment for her "abdominal pain" choosing instead to treat it herself on the boat with herbal remedies. She died from appendicitis within days, even though she was within a mile of several hospitals capable of saving her life. She was only 52.

Severe abdominal pain requires medical attention just as fast as you can get to it. I might start by taking the high-powered antibiotics we have on the boat, but you can bet your a** I'd be calling DAN for an emergency evacuation to the closest medical facility.

I'll never understand why people think they can outsmart sophisticated medical science in this day and age.

[Biomed]

Hi all, I am aware of the study referred to. There is, however, another boy on the block worth watching. I see a good few patients a day, who were prescribed antibiotics. These antibiotics were not tested on samples taken from patients, such as skin scrapes, sputum, stools and more. This means, that the bug's sensitivity to the antibiotic was not established. Not only that aspect, but the identity of the pathogen (s), was a ? as well. A viral infection will not respond to antibiotics, neither will a good many parasites. And that is not a good place to be. Many patients have been through one course after another and present with the consequences. Bugs (pathogens) mutate, that is to say, they change and adapt. If one does not get the diagnosis and prescription right, the result can be a resistant, multiple resistant or ultimately, extreme resistant bug. That means that pretty much nothing, including very toxic latest generation antibiotics, work anymore.
The consequences are very serious, and wide ranging. For this reason, I have issues with people taking any odd antibiotic to sort out an unidentified problem. Carrying them on board can be a good and life saving option. But I strongly recommend, that long distance sailors get some serious training and learn how to identify and rank signs and symptoms. Then, learn to relay those by radio or sat phone to a competent practitioner, in a way that makes sense to us. I have had questions relayed via freighters, and assisted injured and sick seafarers. There are organisations, you can sign up with, who provide this service as a subscription service.
IV routing of any medication, is not always an option, shock and a resulting blood pressure crash will make things difficult, when trying to get the set in and running. Seen it, been there.
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. Diagnosis is not easy: the National Health Service in the UK published not long ago, that 50.000 patients died as a result of sepsis, that was missed by their doctors, over a period of I think 5-10 years. No one is 100% failsafe.
And for Pete's sake, treat medications with the respect they deserve. Get it right, first time, or as close as dammit.
Fair winds!

[bjymd]

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.

[rsn48]

I have had three bouts of kidney stones and the idea of long trips out on the big pond has zero appeal to me. I can't imagine getting kidney stones in the middle of the Pacific or Atlantic oceans.

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.