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

[MondayNever]

I came across this article today and it has direct relevance to the sailing community. Appendicitis is a real risk for offshore sailors, as it is a relatively common issue and requires rapid response to avoid potentially deadly consequences. Traditionally, this has meant an appendectomy (surgery to remove the appendix). If you're somewhere in the middle of the Atlantic and you start displaying the symptoms of appendicitis, you're going to have make some quick decisions. What happens if you leave this for another 10 days until you make landfall in St. Lucia? Are you going to have push the button and get rescued? Even if you're transferred to a faster vessel, will you reach airlift range in time?


This dilemma has caused some sailors (and other adventurers) to have an appendectomy prior to ever having appendicitis, so as to prevent the issue from ever coming up at all. Voluntary surgery is a little extreme for most of us, so thankfully it looks like there is another option if we're faced with appendicitis at sea.


https://arstechnica.com/science/2018...can-be-enough/


This article summarizes the results of a 5 year study that examined the outcomes of 272 appendicitis patients who underwent antibiotic treatment instead of surgery. They received a 3 day IV antibiotic regimen followed by 7 days of oral antibiotics. The majority (61 percent) made full recoveries and did not require surgery in the following 5 year period. The remainder of patients required surgical intervention at some later point.



From my perspective as a sailor, the latter result is not a problem. The goal is to get to medical care without having to abandon my boat or rupture my appendix in the process. Even if I need surgery later, no big deal.



The take away - offshore sailors should explore the option of carrying the necessary drugs and gaining basic medical training to treat acute appendicitis using antibiotics.

[Thalas]

I've only chartered boats a week at a time so there are "full-time" sailing things I don't know. One of them is this...

How do full time sailors source a medical professional in their area who understands and will prescribe necessary medicine for boats that will be at sea for extended periods of time?

[danielamartindm]

Just my take. Appendicitis is a capricious risk for anyone with an appendix. Abdominal pain, especially pain that migrates from center to right, vomiting, fever, and chills mean

1. Immediately beginning an oral regimen of antibiotics prescribed by your physician for this eventuality before you headed offshore, AND

2. A mayday call for medical evacuation if possible or, failing that, an immediate course change for the closest medical care. A ruptured appendix and resulting peritonitis can kill you right quick, and surgical remedies are beyond the capabilities of laymen. I would not advise just taking an oral antibiotic and watchful waiting at sea.

[MondayNever]

Originally Posted by danielamartindm

Just my take. Appendicitis is a capricious risk for anyone with an appendix. Abdominal pain, especially pain that migrates from center to right, vomiting, fever, and chills mean

1. Immediately beginning an oral regimen of antibiotics prescribed by your physician for this eventuality before you headed offshore, AND

2. A mayday call for medical evacuation if possible or, failing that, an immediate course change for the closest medical care. A ruptured appendix and resulting peritonitis can kill you right quick, and surgical remedies are beyond the capabilities of laymen. I would not advise just taking an oral antibiotic and watchful waiting at sea.

Regarding point 2 - the study cited uses intravenous antibiotics for the initial 3 days. While I agree that if there's anything that can be done to expedite professional medical intervention, that is not an option if you're 1000+ miles offshore. Even if you punch the epirb, there could be a long wait before you're in a hospital. Given that, the course of treatment described in the study may serve as the best possible action that one can take in that scenario.

[danielamartindm]

Originally Posted by MondayNever

Regarding point 2 - the study cited uses intravenous antibiotics for the initial 3 days. While I agree that if there's anything that can be done to expedite professional medical intervention, that is not an option if you're 1000+ miles offshore. Even if you punch the epirb, there could be a long wait before you're in a hospital. Given that, the course of treatment described in the study may serve as the best possible action that one can take in that scenario.

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.

[MondayNever]

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.

I imagine that IV administration is covered in some wilderness medicine courses, which is well within the realm of **** 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.



While you may be right about the chances of IV use going bad, considering that we're talking about a situation in which one's appendix will rupture imminently, isn't the IV risk kind of a moot point?

[flyingfin]

Anyone going to stay/work/study in Antarctica must have their appendix removed. If you are in a remote location or third world country without decent medical facilties, the air medivac costs can be pricey if you do not have medical evacuation insurance. If you are off shore and get helo evac, your boat is abandoned (unless you have several crew left aboard to get her home). Maybe pre-emptive surgery is the right move.

[Paul L]

Originally Posted by flyingfin

Anyone going to stay/work/study in Antarctica must have their appendix removed. If you are in a remote location or third world country without decent medical facilties, the air medivac costs can be pricey if you do not have medical evacuation insurance. If you are off shore and get helo evac, your boat is abandoned (unless you have several crew left aboard to get her home). Maybe pre-emptive surgery is the right move.

A little vodka and you can remove your own appendix

Do you need your appendix removed before you go?

The health and safety of expeditioners in Antarctica is a top priority, therefore they must undergo various health checks before being selected as fit to work in Antarctica. There is also a doctor at each Australian Antarctic and subantarctic station who is trained in remote medicine, including dentistry.

One of the most common questions people ask is, do expeditioners need to have their appendix removed before going south? The answer is no, however doctors who are wintering at Australian Antarctic stations are required to have their appendix removed. This is because there is usually only one doctor on station during winter, and evacuation back to medical care in Australia is impossible for at least part of the year. The requirement dates from the 1950s, when an Australian Antarctic doctor developed appendicitis on Heard Island and required a very challenging evacuation back to Australia.

In 1961 a Russian doctor successfully removed his own appendix at Novolazarevskaya station in Antarctica. With no outside help possible, he used local anaesthetic and had two expeditioners assist with surgical retractors and a mirror so that he could see what he was doing. The operation was a success and the doctor was back on duty within two weeks. It's not a situation that Australian Antarctic doctors would like to find themselves in!

[Singularity]

Originally Posted by MondayNever

The take away - offshore sailors should explore the option of carrying the necessary drugs and gaining basic medical training to treat acute appendicitis using antibiotics.

You mean uncomplicated acute appendicitis. The study is about uncomplicated acute appendicitis. To reliably understand the difference between complicated and uncomplicated appendicitis takes surgeons forever, and they still get it wrong in a hospital full of equipment and smarter people.



I agree that one should sit down with a medical provider before heading out (or establishing with one while afloat) preparing a med kit and "phoning it in" every time. If anything close to appendicitis was suspected, medical evac would be indicated regardless.


If one is has academic questions about dealing with medical problems at sea on a small boat, consider looking at the research done by various space agencies. Space medical research largely deals the question of "how can we provided advanced medical care for someone who will not be be able to reach hospital until it would usually be too late."

[Suijin]

I spent five days in a French clinic while they tried to decide if I had appendicitis or acute food poisoning. Irony was that I ate great while I was there with wine every meal. Turned out to be food poisoning.

Seems like it is considered “rare” after you pass 40. At 60 I think I’ll just take my chances and consider it one of the risks of being offshore, mitigated as best as possible short of preemptive surgery.

[danielamartindm]

Originally Posted by MondayNever

I imagine that IV administration is covered in some wilderness medicine courses, which is well within the realm of **** 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.



While you may be right about the chances of IV use going bad, considering that we're talking about a situation in which one's appendix will rupture imminently, isn't the IV risk kind of a moot point?

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.

[danielamartindm]

Originally Posted by Paul L

A little vodka and you can remove your own appendix

OK, show of hands: How many cruisers are prepared to get drunk and remove their own appendices?

[danielamartindm]

Originally Posted by Suijin

I spent five days in a French clinic while they tried to decide if I had appendicitis or acute food poisoning. Irony was that I ate great while I was there with wine every meal. Turned out to be food poisoning.

Seems like it is considered “rare” after you pass 40. At 60 I think I’ll just take my chances and consider it one of the risks of being offshore, mitigated as best as possible short of preemptive surgery.

IMHO, having one's appendix prophylactically removed to obviate the risk of appendicitis is akin to having one's brain removed to obviate the risk of meningioma.

[CHM]

Honestly, the chances of getting acute appendicitis aren’t really that high, especially if you are older. There is as much or more of a chance having a heart attack or orthopedic injury while underway. Appendicitis is a disease of the younger crowd. The incidence decreases with age. Back in the day, Navy Corpsman we’re trained to do appendectomies at sea when a medical officer wasn’t available. Most of the sailors were 18-25 yrs old. It almost never happened. Now, sailors are transported to a platform where they can be treated safely. Anyway, medical emergencies can definitely occur offshore and all you can do is make sure you are checked out by your doctor before you go and prepare the best you can for an emergency. First Aid kits can get to be quite extensive and one may consider having an AED on board as aspirin, NSAIDs, bandages, splints, basic GI meds to handle motion sickness, nausea, vomiting and diarrhea. Antibiotics can be useful if you have some training in their use for dysentery. There are always side effects to be aware of as well. I’ll stop here as this can get pretty extensive. Oh, I am a surgeon so have some background knowledge.

[a64pilot]

Originally Posted by flyingfin

Anyone going to stay/work/study in Antarctica must have their appendix removed. If you are in a remote location or third world country without decent medical facilties, the air medivac costs can be pricey if you do not have medical evacuation insurance. If you are off shore and get helo evac, your boat is abandoned (unless you have several crew left aboard to get her home). Maybe pre-emptive surgery is the right move.

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?