Dr. Mark Monroe has been appointed the SGYC Fleet Surgeon. In that capacity, he will present medical information germane to yachting and SGYC issues. This information will be presented in brief articles with an index at the top of the page. It would be prudent for all members to review these articles to assure they are aware of medical issues related to all boaters.
Be advised that our new “Magnetic Name Tags” should not be worn by any person with a pacemaker. If you have had a pacemaker inserted and also have a SeaGate Yacht Club name badge with a magnet, please discontinue its use immediately! Please contact our Membership Chair, Sharon Courtway, E-mail: firstname.lastname@example.org or (714) 745-3301 in order to obtain a replacement badge with a pin closure.
Q: I was scuba diving in the Red Sea last week. While watching Colossus Grouper in a cave, the back of my left had brushed up against some coral. Later that same day I got a burning red rash on the back of my left hand. What is it and what do I do about it?
A: Coral is a living entity. To protect itself, it has nematocyst stings that carry a venom that can give an allergic reaction, even life-threatening anaphylaxis. Initially, a 5% solution of acetic acid (white vinegar) needs to be poured on the wounds to help dissolve any calcium spines from the coral. Then clean with alcohol as an antiseptic drying agent. It will also help to dry out the nematocysts which are like tiny bulb syringes filled with venom. Scotch tape applied to the rash will help to pull the stingers out of the skin without popping the nematocysts. Cortisone cream will help with the inflammation and itching. Neosporin antibiotic ointment twice a day will help prevent infection. Avoid scratching the rash as that will infect it and spread the venom more. Antihistamines, such as Benadryl, will help against the allergic reaction, but it can make you sleepy. For severe allergic anaphylactic reaction with trouble breathing, an EpiPen is required. Left untreated, it can form scars on the skin. Wear full body Lycra suit and gloves while scuba diving for best protection. Contact your family doctor as he would be the best one to advise you.
The simple answer is NO. The 2018 flu vaccine is made of dead and attenuated strains. There are no live viruses that can give you the flu. The mechanism of the vaccine is to build up resistance to those viral strains in the vaccine. That’s why your body feels like it has a mild case of flu. The actual flu infection could be much more serious with high fever, sore throat, cough, body and muscle aches, head and chest congestion, crying eyes, general malaise and weakness, and possible super infections with bacterial pneumonia. That’s also why the site of the vaccine injection can make it temporarily sore. It takes two weeks following the injection to build immunity. Therefore, avoid being exposed to sick people with above symptoms. Keep at least 3-foot distance from sick people. If you need to cough or sneeze, do it in your elbow and not your hand as your hands are the prime source of spreading the infection to others. Contrary to popular belief, the hand sanitizers are not 100% effective. If you do use it, then wash your hands with soap and water after 4th time of using the sanitizer.
This year there are 3 strengths of flu vaccine. One is regular strength for up to the age of 50. The Flublock is for ages 50 and up to the age of 65. High-dose vaccine is for those 65 and older. All vaccines are quadrivalent (four strains) which are based on the strains of flu in the winter of Australia. Do not get vaccinated if you are already sick. Wait until you are all better.
If you do get the flu, start the treatment as soon as possible. Tamiflu should be started within 48 hours of the onset of symptoms. It does not cure the flu, but just shortens the duration of the flu (from 10 down to 6 days or less). FDA just approved a new medication Xofluza that can be started even after the first 48 hours for ages 12 and up. The mechanism of action is similar to Tamiflu.
FDA just announced that during the 2017-2018 flu season there were 900,000 flu associated hospitalizations and 80,000 deaths. Don’t be a victim of the flu and protect yourself. Talk to your family doctor about flu vaccines appropriate for your age and GET VACCINATED! The best time to vaccinate is NOW!
Q: I was lifting some weights and have noticed painful bruising and lump in my arm. The swelling makes me look like Popeye the Sailor arms. What is it?
A: The biceps muscle extends from the shoulder to the elbow. It helps flex the forearm and supinate it from palm down to palm up (like holding up a cup of soup). It has 2 heads that attach at the shoulder: the long head and the short head. When one of these tendons tears, there is still most functionality and strength preserved without surgery. However, when the common distal end of the muscle of the elbow is torn, surgery is required or it can lead to 30% loss of flexion strength and 35-50% loss of forearm supination strength. The cause of the injury is always overuse of the muscle by lifting too much weight. It is more common in males than females 2:1 and more common in the 65 to 72-year age group, although it can occur at any age especially with athletes. Surgery involves suturing muscle/tendon together and re-attaching them to the bone using suture anchors or buttons. Ice and anti-inflammatory medications will help ease the pain and reduce swelling. Post-op physical will be required to regain muscle strength and functionality. R.I.C.E. (Rest, Ice, Compression with 4” Ace bandage, and Elevation) helps with pain and swelling. Your family doctor would be the best person to advise you on this.
Art asks: Smoke makes me nauseous and short of breath, especially if I am down wind of it or smell on people’s clothing. What is a safe level of tobacco exposure?
There is no safe level of tobacco use or exposure. Hundreds of thousands of people die every year from tobacco exposure. 750,000 hospital bed days are used up for tobacco related illnesses every year. Per 2010 census, the average male lives to 78 years of age and average female lives to 82 years of age. For tobacco users, pack years are deducted. A pack year equals to number of packs per day times years used. For example, a male who smokes 1 pack per day for 10 years will reduce his average life expectancy by 10 years down to 68. One average cigar equals 10 cigarettes or ½ pack of cigarettes. Vaping and chewing tobacco is just another way for the tobacco companies to sell their products. The effects of tobacco include:
Low to moderate dosages
• Initial stimulation with increased alertness and concentration then reduction of activities of brain and nervous system
• Feelings of mild euphoria and relaxation
• Increased blood pressure and heart rate
• Decreased blood flow to fingers and toes with decreased skin temperature
• Bad breath, stained teeth, and tooth decay
• Decreased appetite
• Headache, dizziness, nausea, abdominal cramps, vomiting, and seasickness
• Coughing due to smoke irritation, especially with history of asthma
High dosages can produce symptoms of feeling faint, confusion, seizures, rapid decrease of blood pressure and breathing rate, respiratory arrest, and even death if more than 60mg of nicotine is consumed in any form.
Long-term effects of tobacco abuse include stroke, hardening of the arteries, heart attacks, cancer of the nose, lip, tongue, mouth, larynx, lungs, stomach, bladder, impotency, infertility, reversible asthmatic bronchitis, irreversible emphysema (damage to lungs), stomach ulcers, early wrinkles, poor circulation, and osteoporosis.
First hand tobacco exposure is when you are using it. Second hand is when you are exposed to it. Third hand is when you smell it on other people’s clothes. Some drugs, such as tranquilizers and birth control pills, interact with nicotine increasing the risk of blood clots and decreased breathing. Nicotine affects pregnancy and breastfeeding. Low birth weight and miscarriages are associated with tobacco abuse. Tobacco dependency can be chemical and psychological. We know that nicotine is very addictive because the tobacco industry was researching how to make it more so. Psychologically, addicts craved their next nicotine fix and including oral and tactile gratification while smoking. After time, tobacco abusers developed tolerance requiring greater quantity and frequency of use. That is why the United States Surgeon General required all tobacco manufacturers to print a warning label on their packaging. Contact your family physician if you would like to quit.
After a few hours of boating or fishing I have noticed that my low back starts to hurt. I don’t think that it is a pinched nerve because it does not go down my legs. What’s causing it? What can I do to prevent it? How do I treat it when it starts?
Low back pain is a very common symptom. The muscles of your back are constantly flexing trying to keep the balance against the rocking of the boat. Sometimes you have to bend at the waist in awkward positions causing overstretching of the muscles called muscle strain and overstretching of the ligaments called ligamentous sprain. If you have any preexisting arthritis in your spine, it can be aggravated by the constant motion of the ocean.
A lot of people wear flip flops or go barefooted on the boat, which is a mistake. You should wear deck shoes with good arch supports to prevent the overuse of your muscles and ligaments in both your legs and back. X-rays, MRIs, or CT Scans are not warranted unless there is a red flag such as pain radiating down your legs (i.e. pinched nerves). June 27, 2017 Consumer Reports publication did a study of 3542 low back pain sufferers on what treatments helped, and this is what they reported:
1. Yoga therapist helped 89% of subjects
2. Massage therapist - 84%
3. Chiropractor - 83%
4. Physical Therapist - 75%
5. Neurosurgeons - 67%
6. Acupuncturist - 66%
7. Orthopedist - 65%
8. Primary Care Doctor - 64%
9. Rheumatologist - 61%
Treatment modalities that I have found effective included:
1. Self-massage using 2 tennis balls inside of the white cotton tube sock placed between your back and the back of the seat you are sitting in
2. Ice packs in a terry cloth towel within the first 24-48 hours from the time of acute injury. After 48 hours, heat pad on low setting would be more beneficial
3. Lumbar supports can help prevent the injury as well as provide temporary comfort to the injured back
4. Acetaminophen, NSAIDS (i.e., Ibuprofen and Naprosyn), and muscle relaxants are somewhat effective, but can cause stomach problems and/or drowsiness
5. Yoga back exercises every morning before getting out of bed
Your family doctor would be the best person to advise you of all available treatment options.
According to the American College of Emergency Physicians, these are the signs of medical emergencies:
1. Bleeding that won’t stop.
2. Difficulty breathing.
3. Altered mental status such as confusion, difficulty arousing, or loss of consciousness.
4. Chest pain especially if with shortness of breath.
5. Choking or near-drowning.
6. Coughing up or vomiting blood which may resemble coffee grounds.
7. Head or spine trauma.
8. Feeling of committing suicide or murder.
9. Severe or persistent vomiting which may lead to severe dehydration.
10. Sudden injury such as car accident, falls, burns, smoke inhalation.
11. Sudden severe pain anywhere in the body.
12. Impending stroke, such F.A.S.T. (facial droop, arm/leg weakness, slurred speech, and time last time normal).
13. Exposure to poison.
14. Severe abdominal pain or pressure (acute abdomen).
15. Severe allergic reactions, such as asthma or anaphylaxis with difficulty breathing.
1. Have a complete and readily available first aid kit and know how to use it.
2. Stay calm and communicate via 911 on cell phone or Channel 16 on VHF radio stating the nature of the emergency and your current location. It’s better to call for help rather than transporting the patient yourself.
3. Do not move the patient, especially in head or spinal trauma.
4. Treat first life or limb threatening conditions.
5. Grab a clean towel and put compression to stop bleeding.
Emergency medical services will bring right equipment and expertise to you and transport the patient a lot faster to receive emergency care. If ever in doubt, call your family doctor as he/she will be the best person to advise you.
Although the First Aid Kit and an AED may be readily available, time is measured in how many precious live heart and brain cells survive. First call 911 because ambulances get priority treatment and enter the E.R. by the back door without waiting. Heart attacks are the scariest because they are the leading cause of death in the United States. Heart attack, also called a myocardial infarction, is the death of a part of the heart muscle due to a sudden loss of blood supply. Cholesterol can plug up the coronary artery up to 99%, but it is the blood clot that is the final killer when it completely blocks the artery. The blockage deprives the heart muscle from oxygen. It kills the heart muscle. This lack of oxygen produces symptoms such as shortness of breath, mid to left squeezing pressure chest pain, which may radiate up to the neck, jaw, left shoulder, left arm, and/or upper back, heartburn, and sweating. Death of the heart muscle may also cause an electrical arrhythmia, or irregular heart beat. Regular beating of the heart is essential to efficient pumping of the blood. Certain arrhythmias, such as ventricular fibrillation, make the heart only quiver and not pump oxygenated blood to the brain. Permanent brain damage or death can occur, unless oxygen blood flow to the brain is restored within 5 minutes. Early heart attack deaths can be avoided if a bystander starts CPR within 5 minutes of the onset of the heart attack. CPR involves applying continuous external chest compressions to make the heart pump and allows airflow except in drowning or choking victims. When paramedics arrive, medications and/or electrical shock (cardioversion) can be administered to restore normal heart rhythm. An AED (Automated Electrical Defibrillator) automatically analyzes the rhythm and then gives the appropriate electrical shock. Survivability depends on getting the patient to a Chest Pain Center within that first golden hour from the onset of the heart attack symptoms. This allows the physician to possibly save precious heart muscle by either injecting enzymes to eat up the clot or an angiogram to find the obstruction of the coronary artery and open it with angioplasty (dilation by a balloon catheter and/or stent wire mesh tubing placement). Immediate treatment out in the field includes Aspirin as a blood thinner. 150 mg chewable Aspirin can be placed under the tongue or along the gum as soon as the symptoms start (unless the patient is known to be allergic to Aspirin). 81mg of Aspirin should be taken daily as a prevention of the blood clot. If Nitroglycerin, a blood vessel dilator, is available, it should be given sublingually immediately to lessen the chest pain. Getting annual physicals by your family physician is absolutely the best way to catch heart disease early before it gets to the point of being an emergency. Take a CPR class at least every two years with your significant other so that you can save each other’s life.
Q: Lina asks: I have difficulty clearing my ears when I scuba dive or fly. What can I do?
A: To understand what you can do, you have to understand the underlying mechanism and anatomy. The ear has 3 parts: Inner, Middle, and External. The eardrum or tympanic membrane (TM) separates the middle and external parts. The Eustachian tube drains/equalizes the middle part into the back of the nasopharynx where the sinuses drain, too. When your head gets congested, the drains swell and close. This prevents equalization in all air spaces including the sinuses and ears. Without equalizing the pressure, pain and potential damage to the ear and the eardrum can occur. Yawning, chewing gum, swallowing, or drinking water should be tried first. If this does not work, try the Valsalva maneuver by self-pinching the nose and blowing gently to allow higher pressure from the throat to the Eustachian tube. Swallow until you hear a pop before getting on the airplane or scuba diving. Several hours before going scuba diving, begin equalizing your ears every few minutes. Chewing gum seems to help because it makes you swallow often. The greatest difference in pressure is when you put your head below the surface of the water. Pre-pressurizing at the surface helps get past the critical few feet of descent. Descend feet first as the studies have shown that Valsalva maneuver requires 50% more force with the head down. Avoid milk and dairy products as it causes congestion and mucus production. Avoid tobacco and alcohol as it irritates your mucus membranes promoting more mucus production. If Valsalva isn’t sufficient, try Valsalva plus swallowing at the same time. If this still doesn’t work, then try the sound of the letter K along with the Valsalva maneuver. Do not use anti-histamines as this may make you drowsy and increase the risk of nitrogen narcosis. If all this fails, contact your family physician to discuss using decongestants.
United States Coast Guard Auxiliary Commander John Randall IV has given me assignment of duty to prepare an article on situation awareness in light of the four recent US Naval accidents between February 2017 and August 2017. They have been blamed on lack of training and situation awareness. Total of 17 sailors have lost their lives. Twelve sailors have been relieved of duty, including the commanding officer, and the Rear Admiral of the 7th Naval Fleet has taken early retirement because of this. For the US Coast Guard, operational awareness means maritime domain awareness of the environment, weather, and other vessels in the surrounding area. It simply means knowing what’s going on around you. It is the ability to identify, process, and comprehend the critical elements of information about what is happening to you and your vessel. The consequences of losing situational awareness is the potential of human error mishaps. The USCG analysis of navigational mishaps reveal that 40% are due to a loss of situational awareness. The team approach using the shared mental model, i.e. communicating with each other, lessens the potential of mishaps. Clues to loss of situational awareness include confusion, no proper lookouts for hazards or other ships, use of improper procedures, departure from regulations or rules of the road, failure to meet goals, unresolved discrepancies, ambiguity in commands or communications, and fixation or preoccupations with distractions. Effective communication may be the most important factor in achieving and maintaining situation awareness. Don’t wait to be asked. Speak up when the situation arises that may affect the rest of your crew. In the dynamic world of boating, plan on change, continually assess and re-assess the situation to determine if everything is on-track for successful, safe accomplishment of your goals. Remember that safe boating is no accident.
Q: Ann asks, “I get painful severe night leg cramps that wake me up. What causes them and what can I do to prevent and treat them?”
A: Charley Horse muscle cramps are usually sudden painful muscle spasms or tightening especially in the calves, feet, and thighs. It can occur at night more than daytime. It can last from a few seconds to a few minutes but the muscle soreness can last for days. Predisposing conditions that can bring it on include:
1. Exercising, injury, or overstretching of a muscle which is called a muscle strain.
2. Lack of minerals/electrolytes such as calcium, magnesium, potassium, and/or sodium.
3. Cold Exposure (especially cold water).
4. Poor peripheral blood circulation such as Peripheral Arterial Disease, Diabetic Small Vessel Disease, Hypercholesterolemia, Kidney Disease, Thyroid Disease, or even Multiple Sclerosis (a demyelinating disease of nerves).
5. Compromising the circulation in your legs such as long-term sitting/standing/awkward position sleeping.
6. Dehydration which can concentrate and imbalance your blood electrolytes.
7. Adverse Drug Reactions from diuretics, statins, psych meds, steroids, and hormones like birth control pills, estrogen, progesterone, and testosterone.
Treatment can include: immediate/daily stretching and massaging the muscle, low set heating pad with a cloth, a warm bath, drinking sufficient water/ Gatorade, and even the use of medicines such as Multiple Vitamins, Electrolyte Supplements, Tylenol, Advil, Aleve, and or muscle relaxants. Your family physician who can also do tests for all the above causes to find out your particular cause.
Q: Leslie asks, “My family member is getting easily disoriented and wandering. She is also forgetting where she parked her car or put her car keys. Is this Alzheimer’s Dementia starting?”
A: Cognition is defined as the act or process of knowing or perceiving. Memory is the mental capacity of retaining and reviving facts, events, impressions, or previous experiences. These can be short term or long term. Dementia is a psychiatric term defined as loss of intellectual capacity and personality integration due to damage or loss of brain neurons. This may be due to Traumatic Brain Injury (TBI) such as blunt force trauma, fall, Transient Ischemic Attack (TIA) also nick named mini-strokes, stroke (i.e., hemorrhagic (bleeding) or thrombotic (clots) strokes), small vessel ischemia (i.e., Diabetes Mellitus or Hyperlipidemia (cholesterol)), Parkinson’s Disease (i.e., dopamine deficiency), or Alzheimer’s ((plaques and tangles) protein deposits covering neurons and not letting glucose into the brain cells causing cerebral atrophy). Alzheimer’s Dementia is a common form, approximately 60% of dementia, usually beginning in late middle age, and equally in both genders. It is characterized by progressive loss of mental abilities, lapses of short term recent memory, confusion, and emotional instability. Dr. Alois Alzheimer, a German neurologist first described it in 1907. The genetic familial form is rare. It is associated with genetic mutations on chromosomes 1, 14, and 21. Huntington’s Chorea Disease is another form of genetic disease that can present with dementia. According to a July 17, 2017 medical article from Cardiff Medical School in UK, 2 more genes have been implicated in Alzheimer’s Disease. Ongoing gene manipulation and repair research using CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) CAS-9 (Crispr Associated Sequence) enzymes shows great promise. Also anticholinergic medications such as Aricept (donepezil) and Exelon (rivastigmine) and NMDA antagonist Namenda (memantine) help to stabilize the symptoms for about 2 years before the progression restarts. Gradually, bodily functions are lost, they forget to eat, drink, or swallow: losing their gag reflex, leading to death from 3-9 years after diagnosis. Your family doctor would be best to advise and test for this using tools like Mini Mental State Exam (MMSE), Clock Drawing (Visual Spatial Orientation), PET Scan, etc.. He can refer you to a Neurology Specialist as well. You can also get more information from the Alzheimer’s Association USA @ alz.org. In all the lectures I have gone to on this subject, one common denominator is prevention. Think of the brain as you would a muscle: the more actively one uses it, the less likely it is to atrophy. Puzzles or learning a new language is the best way to exercise the brain.
Q: David asks: In Boston, the meteorologist posts the temperature forecast with the weather forecast then he throws in a wind chill factor. What is that and why is it important?
A: The definition of A Windchill Factor is the quantity of effective lowering of the temperature of the air, object, or human body caused by the wind affecting the rate of heat loss. For example, as the human body makes heat to maintain an average body temperature of 98.6 degrees Fahrenheit, the blood transports this heat to the blood vessels in the skin to radiate heat out to cool it. A layer of surface air close to the skin receives this heat. If the skin is exposed to the wind, the wind disrupts and disperses this layer which further cools the skin and by conduction, the human body. The faster the wind, the more the surface cools. This makes the air feel colder than it is because of the chilling effect on the skin. In extreme cases, this can lead to frostbite with discoloration, painful blisters, numbness, necrosis, and even loss of tissues. Fingers, toes, noses, ears, and lips are most prone to frostbite due to limited blood circulation. Water and ice is a great conductor of heat. Layers of protection such as clothing, gloves, wetsuits, dry suits, etc. protect against this loss of heat. The Layer Effect is using multiple layers of clothing for protection. As it gets colder, you put more layers on. As it gets warmer, you take layers off. The affected skin must be slowly warmed up with luke warm water to prevent burns. Frostbite can act and be treated like a burn but it is due to cold instead of heat. Burn creams and non-adherent sterile dressings, pain medicines such as Aspirin, Ibuprofen, Naprosyn, and even narcotics are sometimes necessary as well as transport to the emergency room. Your family physician would be the best one to advise you so give him a call.
Q: On a long voyage, sailors used to get scurvy. What is it and what can I do to avoid it? I am planning to sail to Hawaii and if all goes well, then cruise westward around the world.
A: Scurvy is the lack of Vitamin C (Ascorbic Acid) which is found in fresh fruits especially citrus (i.e., oranges, lemons, grapefruits, kiwis, and apples) and vegetables such as tomatoes and potatoes. It is heat sensitive which means cooking it decreases it in foods. Scurvy occurs more often in malnutrition, elderly living alone, mental illness, fad diets (i.e., Atkins diet, canned foods only, etc.), alcoholism, mal-absorption, and kidney dialysis. Although the Egyptians recorded the symptoms as early as 1550 BCE, the British Royal Navy Surgeon, Dr. James Lind in 1753 was the first to recognize that a month of no fresh fruit was associated with the onset of symptoms. He advised issuing lemon juice to the ship crews. Within three weeks of this treatment, the symptoms resolved. The symptoms include: weakness, fatigue, curly hair, sore arms and legs, bleeding inflamed scorbutic gums, tongue, and skin. If untreated, seizures and death can occur thereafter especially in children and the elderly. Vitamin C 500mg tablets may be purchased cheaply over the counter without a prescription. Maximum daily recommended dosage is 2,000mg due to increased stomach acidity. Your family physician would be best to advise you about all your cruising needs prior to your embarkation.
Q: If on a long cruise with our sailboat we were to get caught by a lightning storm, what should we do?
A: First off, you are much more likely to get hit by lightning on land than at sea. Please be assured that it is very rare to get struck by lightning at all. But it’s good to be prepared. Lightning is a million volts of electricity with high amperage which can burn, stop a heart, or produce life-threatening arrhythmia which will required CPR and the use an Automatic External Defibrillator (AED). Immediate evacuation to a nearest Emergency Room and possible hospitalization will be required. Prevention is the key to avoiding lightning strikes. First, let’s see how lightning works: you take a puffy white cottony cumulous cloud, add heat from the sun causing upward circulation of warm moist air in the center while condensing water droplets fall around the periphery. Now we have a vertical uplift of warm air creating a cumulo-nimbus cloud which may develop a classic flat “anvil top”. The cloud base may turn gray as the rain starts. This is when your radar can pick it up. The cloud’s internal water circulation creates an electric dynamo with positive charge on the top and negative charge on the bottom. One cloud may arc to another. An AM radio receiver may pick this up as crackling noise. As the water molecules get heated by the lightening, thunder can be heard. The approximate distance can be estimated in miles by counting the seconds from the flash to the thunder, and then dividing by five. This thunder cloud can induce a positive charge to the sea below it. This is called “St. Elmo’s Fire” and can be seen as blue sparks dancing around the hull and rigging. Once the critical voltage is reached, lightning arcs downward at the same time as an upward “return” strike from the sea to the cloud base like an electric capacitor. The distinctive metallic smell is the ozone produced as the air is ionized along the lightening path.
The boat’s submersed metal like your propeller shaft, makes good electrical contact from the positively charged water around the hull enabling this “return” path from the sea to the cloud. If you don’t disconnect electronic equipment, such as VHF or radar, your VHF antennae is the first to go. Bond the metal parts of your boat, such as mast and rigging, by using a 2 inch wide copper strap to connect all metal parts to the grounding plate underneath the boat. Any gaps in this bonding can cause an electric arch that can cause blistering or burn down of the fiberglass boat. Crew should wear their rubberized heavy weather gear including rubber gloves and boots. Everyone should put on their life jackets. Do not touch metal and stay as low in the boat as possible.
Shannon asked me if there is anything new, improved, and preventative for motion sickness that is non-drowsy. This is an update of my 2004 article.
As Ian Cameron Smith stated in his book MOONRISE: “There are two types of people in this world: those who are terrified of going out in the ocean in case they spend the entire time barfing, and those who think they have guts of steel until they get out in the ocean and spend the entire time barfing.”
Many people believe that there is the third type of people who seem to be able to cruise around the world in small boats without ever feeling seasick. Sensible sailors know that seasickness is just part of the game and needs to be handled properly. To properly handle it, one should understand the anatomy and psychology of seasickness and the steps to prevent and treat it once one gets it.
Many people think that seasickness occurs in the stomach, but actually, it is due to over stimulation of the sensory hair cells in the semi-circulatory canals in the inner ear by excessive motion of the endolymph fluid. This is where the person’s balance mechanism is. You can get dizzy (vertigo), nauseous, and loss of equilibrium. It takes on the average about 3 days to get your “sea legs” once you get on the boat and about the same time to get your “land legs” once back on land. Roll in rhythm with the boat’s motion as fighting it can cause fatigue and seasickness.
The psychology of seasickness can be the power of suggestion, i.e. certain smells, someone talking about it/getting seasick, or going down below inside the cabin thus losing sight of the horizon. Stay facing forward in a well ventilate place outside near the center of the boat or front seat of a car. Keep your eyes on the horizon, stay on deck steering the boat or on the look out, and keep yourself well hydrated with non-alcoholic and decaffeinated beverages. Avoid bad smells or even strong perfumes can bring on nausea.
Nutrition is extremely important in prevention of seasickness and should be started the day before sailing. Avoid alcohol, rich, spicy foods, i.e. pizza, as they will stimulate more acid production in your stomach. The day of the sailing try to eat oatmeal, bread products, crackers, and foods that will help absorb the acids. If you start feeling queasy, take 2 TUMS right away and more, as needed. Ginger, either in ginger ale, candy, gum, or powder form (it can be found in a Japanese market), can be very effective once the seasickness starts or as a preventive measure. Take 1 gram per teaspoon of ginger powder with 8oz of water. Ginger candies or gums are quite effective also, although some swear that the taste of the candy is worse than the sickness. Non-pharmaceutical remedies such as manual or electronic wrist bracelets stimulate wrist pressure points to prevent motion sickness as long as you keep moving your wrists or until the batteries run down.
Pharmaceutical alternatives include: TRANSDERMSCOP 1.5gm patch, SCOPOLOMINE tablets, antihistamines, such as dimenhydrinate (Dramamine), diphenhydramine (Benadryl), cinnarizine (Stugeron), meclizine (Bonine), promethazine (Phenergan), anti-seizure (phenytoin) medication, and combination of antihistamines with stimulants. The cruise ships use meclizine (Bonine) a lot. The antihistamines can produce drowsiness; therefore they were combined with stimulants, such as dextroamphetamine, ephedrine, and pseudoephedrine (Sudafed). Only Sudafed is available over the counter since stimulants can lead to drug abuse. It is contraindicated for people with hypertension or arrhythmia. Phenergan is the only one available in oral or rectal suppository form (if you are already vomiting). Stronger Zofran (ondansetron) which is prescribed for nausea/vomiting prevention or treatment for chemotherapy or post-op is the latest but contraindicated in liver disease. It comes in 4 & 8 mg swallow tablets, Oral Disintegrating Tablets on the tongue, and injectable forms. Some medications require prescriptions (Rx), and some are over the counter (OTC). Prevention by starting the medications the night before travel is the most successful. Your doctor would be the best one to advise you and should explain to you all possible side effects and drug-drug interactions of prescribed medications.
Lloyd asks: My wife wore new shoes on our vacation and got painful blisters on her feet. What could we do to prevent ruining our vacation?
Blisters are very common ailment especially with new shoes and/or a wet environment. They are caused by chafe which causes friction and heat build-up. Moisture softens the skin thus making it more likely to develop the blisters. Wearing thick socks will help prevent the chafing. Nylon stockings do not protect your feet from chafe. As soon as the red tender hot spot is detected, try to cool your feet in cold water and then dry them very well. Stop the friction by using moleskin tape which is available in large drug stores, or using duct tape which is available pretty much everywhere. Tincture of Benzoin topical solution can be applied to skin to prevent adhesive tape irritation. It is available in most drug stores and should be in your first aid kit anyway. Never use Gorilla tape as that will pull your skin off when it’s time to remove it.
Once the blister has formed, do not try to pop it on your own as your intact skin is the best barrier against infection. Use silver sulfadiazine 1% cream (if not allergic to sulfur) on a Band-Aid to cover the blister. Then use a large piece of duct tape (twice as big) on top of the Band-Aid to further protect the injured skin. You should do it twice a day until the wound has healed. The duct tape has no elasticity and should not stretch out of shape. Do not wrap the duct tape all the way around your foot as it may act as a tourniquet and cause a painful and dangerous compartment syndrome.
Contact your family doctor as he/she will be the best person to advise you.
Lloyd asks: On a past cruise to Mexico, we were trolling for fish behind the boat and accidentally got a large fish hook caught in one of the crewman’s leg. We did not know how to remove it and had to send him by air ambulance to San Diego to have it removed. Is there an easy painless way to remove a fish hook without causing complications?
First one needs to know the anatomy of the hook. There is the eye for tying the fishing line, the shaft which may have barbs on it, the bend, and the final barb or harpoon end. There are number of methods to remove the fish hook such as Pass Through, Cut Down, and the Snatch methods. The best method is the Snatch method. First, detach the fishing line from the fishing pole. Take a 6 inch loop of 10lb test monofilament fishing line and loop it around the bend of the hook. While gently pressing on the eye of the hook to dislodge the barb, pull on the 6 inch loop to pull the barb out of the skin. It is quick, simple, and relatively less painful as long as you get it right and quickly on the first try. Patients usually won’t let you try again without local anesthetic. If possible, try to clean the area with Betadine solution or soap and water if the patient is allergic to iodine. This technique changes the angle of the attachment of the harpoon end of the hook away from the underside of the skin. I use 10lb test because it is more likely to break before tearing any nerves or blood vessels on the way out. If there is bleeding, put compression on it for 10-20 minutes with a sterile gauze or clean towel.
After cleaning the wound with Betadine and hydrogen peroxide, apply antibiotic ointment that the victim is not allergic to and bandage the wound. Tetanus (i.e. lockjaw) vaccinations should be routinely done every 10 years. They should be given every 5 years if you get cut. Always contact your family physician for further evaluation and treatment. So be careful out there and catch lots of fish, not humans.
I have been recently asked again: "What should be in a good first aid kit for the weekend trip to Catalina?".
Here it is!
First aid kits should be classified four ways:
I. A readily available first aid kit for handling minor
cuts, scrapes, sunburns and seasickness.
II. A bigger first aid kit that can help with second degree burns, fractures, sprains, etc. until outside medical assistance is available.
III. First aid kit with medications.
IV. Customized first aid kit.
All First Aid kits should be stored in the waterproof plastic container to keep the moisture out. The alternative is a canvas bag with contents in ziplock bags deflated of air.
I. A readily available kit should contain Betadine (Hibiclens
if allergic to iodine) antiseptic solution and soap with
a scrub brush. Individual packets are preferable and available
from pharmacies and medical supply companies. Sterile
gauze dressing pads, Kling roll bandages, Telfa ouchless
bandages and waterproof adhesive tape as well as band-aids,
steristrips, Tegaderm waterproof plastic dressings, Dermabond
(super glue) and Spenco second skin glues are all good
first aid kit stuffers. You should also include Bacitracin
antibiotic ointment, Silvadine burn cream, Caladryl rash
lotion, Lotrimin anti-fungal cream, Hydrocortisone 0.5%
itch cream, Solarcaine (pain relief) analgesic spray, tweezers,
scissors, small flash light, q-tips, sterile gloves, eye
patches with a bottle of buffered eye irrigation solution,
an extra pair of sunglasses and #18 SPF sunscreen.
II. This first aid kit is much more extensive in its contents. It should include: instant cold packs, dental glue for emergency broken tooth repair, splints, sling, safety pins and elastic 2/4/6" ace bandages. Digital blood pressure/pulse meter and stethoscope are good to include also.
III. The medications that are included in this first aid kit should be updated every six months. It's best to store them in the waterproof ziploc bags. The following medications included but not limited to:
a) Dramamine, Bonine, Phenergan(liquid, tablets and suppositories), Transderm-scop patches, accupressure wrist straps and Japanese ginger candy (in a very minute quantities as they are very strong);
b) Benadryl (for allergies or seasickness or insomnia);
c) Analgesics such as Tylenol, Motrin, Aspirin;
d) Immodium or Pepto Bismol for diarrhea;
e) Zantac or antacids for indigestion;
f) Ana-Kit for severe allergic reactions such as bee stings;
g) Ipecac for inducing vomiting in case of accidental poisoning;
h) Floxin antibiotic eye and ear drops.
IV. Customized kit should include an extra set of the medications that you regularly use and you might forget at home such as an inhaler for your asthma, heart and blood pressure medicines, etc.
REMEMBER TO KEEP ALL MEDICATIONS AWAY FROM CHILDREN! Make sure all your guests bring their own medications.
Henry asks, “What should be in an updated offshore cruisers medical kit for a 2-3 week trip to Hawaii”? Here it is!
The first thing that I would recommend is to bring along with you a trained medical professional like myself who loves to go sailing and fishing. Since this is not always possible, bring a textbook such as Advanced First Aid Afloat by Peter Eastman, M.D., Yachtsman’s Emergency Handbook by Hollander and Mertes, or The Boater’s Medical Companion by Robert Gould, M.D. It’s important to read these books before you go so that you will know exactly where to research when you will need it. Make sure that the crew onboard has updated their CPR certificates. If you have a single-side band radio onboard, the Safety and Survival at Sea by E.C.B. and Kenneth Lee list the following frequencies for the International Radio Medical Center: 4342 kHz, 6365 kHz, 8685 kHz, 12760 kHz, 12748 kHz, 17105 kHz and 22525 kHz or call the US Coast Guard who will forward it to the nearest medical center. Also remember that 90% of the time the patient will get better on their own, even if you do nothing. The first rule is “Do No Harm”. Remember the liability you take on anytime you do to or give anything to another individual beyond first aid can be considered as practicing medicine without a license. Use the information here at your own risk. The best source for your particular requirements is your family physician. Your doctor can order necessary items from his local supplier or give you a prescription to your favorite pharmacy.
In addition to what was covered in a previous Weekend First Aid Kit article, the following items should also be included:
Instruments: preferably surgical stainless steel, which can be sterilized with boiling water for 20 minutes including straight suture and curved iris scissors; scalpels with #10, 11 and 15 size blades; clamps such as curved 6” Kelly’s or 5” mosquito hemostats; tweezers, preferably small Adson’s without teeth or splinter forceps; syringes in 1, 5, 10ml sizes; needles 1.5” #21 and #25 gauge, ½” #27 and #30 gauge; sutures, such as 4-0 nylon with a PS-2 curved needle and 5-0 nylon with a PS-3 cutting needle; thermometer, blood pressure cuff, stethoscope, D5NS 500ml X2 with IV tubing and intracath needles #21 gauge (intraosseous needle if for a child), oral rehydration fluid such as Gatorade or Pedialyte.
Dressings: Steristrips and Coverlet cloth Band-Aids of various sizes, gauze 3” rolls and 3x3” pads, Ace 2, 4 and 6” wraps, ½ and 1” cloth tape, 1” paper tape, Benzoin tincture, alcohol wipes, Betadine antiseptic solution, aluminum and fiberglass splints and casting materials, arm slings and inflatable arm and leg splints.
Tests: urinalysis, dipsticks, blood sugar chemstrip, pregnancy tests (if women are onboard).
Over the Counter medicines: Tylenol, Advil, and Aspirin in various strengths, Zantac 75, Benadryl, Dramamine, Sudafed, Bonine, Immodium AD, Dulcolax, Gyne-Lotrimin, Monistat or Lotrimin AF anti-fungal creams, Dental First Aid kit, sunscreen, hydrocortisone cream, insect repellent with DEET, Neosporin or Bacitracin antibiotic ointment.
Prescriptions: Epinephrine (1:1000) such as EpiPen, Xylocaine local anesthetic, Vicodin 5mg pain pills, Prednisone 10mg, Phenergan 25mg oral tablets or liquid or rectal suppository or intramuscular injections, Ammoxicillin, Keflex, Flagyl and/or Levaquin 500-750mg antibiotics, Albuterol inhalers, Nitroglycerin tablets, Digoxin 0.125 tablets, Lasix, Altace 5mg, injectable pain medicines such as Demorol or Toradol, Rocephin 1g injectable antibiotic.
I. A readily available waterproof first aid kit for handling minor cuts scrapes sunburns and seasickness such as the one at Sams Club for $25.
II. A bigger kit that can help with second degree burns, fractures, sprains, etc. until outside medical assistance is available.
III. A kit with medications.
IV. Customized first aid kit.
I. A readily available kit should contain
• Betadine (Hibiclens if allergic to iodine) antiseptic solution and soap with a scrub brush. Individual packets are preferable and available from pharmacies and medical supply companies.
• Sterile gauze dressing pads
• Kling roll bandages,
• Telfa ouchless bandages
• Waterproof adhesive tape as well as band-aids,
• Steristrips, Tegaderm waterproof plastic dressings
• Dermabond (super glue) and Spenco second skin glues
• Bacitracin antibiotic ointment,
• Silvadine burn cream,
• Caladryl rash lotion, Lotrimin anti-fungal cream, Hydrocortisone 0.5% itch cream, Solarcaine (pain relief) analgesic spray,
• tweezers, scissors, small flash light, q-tips, sterile gloves,
• eye patches with a bottle of buffered eye irrigation solution
• extra pair of sunglasses and reading eyeglasses
• #50 SPF sunscreen chap stick and lotion
II. Bigger first aid kit
• Instant cold packs
• Dental glue for emergency
broken tooth repair • Splints, sling, safety pins and elastic 2/4/6” ace bandages.
• Digital blood pressure/pulse meter and stethoscope
• Should be updated every six months. It’s best to store them in the waterproof ziploc bags
• Dramamine, Bonine, Phenergan(liquid, tablets and suppositories), Transderm-scop patches, accupressure wrist straps and Japanese ginger candy (in a very minute quantities as they are very strong), and Sudafed PE Decongestant
• Benadryl (for allergies or seasickness or insomnia);
• Analgesics such as Tylenol, Motrin, Aspirin;
• Immodium and Pepto Bismol for diarrhea
• Zantac and antacids for indigestion;
• Ana-Kit for severe allergic reactions such as bee stings;
• Ipecac for inducing vomiting in case of accidental poisoning;
• Floxin antibiotic eye and ear drops.
• Levaquin/Keflex/Zpack oral antibiotics
IV Customized kit
• Should include an extra set of the medications that you regularly use and you might forget at home such as an inhaler for your asthma, heart and blood pressure medicines, etc.
REMEMBER TO KEEP ALL MEDICATIONS AWAY FROM CHILDREN! Make sure all your guests bring their own medications that they regularly use.
Q: My niece, her husband, and a 2-year-old son went to Rio de Janeiro for Carnival. The World Health Organization has come out with the travel warning for travel to Brazil. Should I be worried?
A: The short answer is NO. The long answer is that Zika virus can give flu-like symptoms for about 2 weeks including muscle aches, body aches, fever… However, if your niece gets pregnant and gets infected with Zika virus, the virus can produce microencephaly in the baby which can cause learning deficits. The virus can be spread by the transmission of body fluids (such as sex) or through a vector (such as Aedes aegypti or Aedes albopictus mosquitos). These mosquitos can also carry Dengue Fever or Chikungunyan Fever. The Anophales mosquito can carry malaria. The Culex mosquito can carry the West Nile virus which causes deadly encephalitis. Zika virus originally started in Western Africa and has spread to Southeast Asia, South America, and North America. 12 out of 58 California counties have Aedes mosquitos. Nationwide, Aedes mosquitos are found in Eastern and Southern states, including California. Interesting facto to know is that Aedes mosquitos are not born with the virus. They bite someone already infected with it and then spread it to someone else. Mosquito larvae eggs need standing water to hatch. Inspect your home to make sure that there is no standing water.
The best way to prevent these mosquito bites is to use 2 FDA approved mosquito repellents: either 30% DEET such as in Johnson Off or Lemon Eucalyptus Tree Bark Oil such as in Repel. Read the fine print on the label to make sure it contains one of these two ingredients or contact your family doctor for advice.
Q: Roy asks, I just back from one week in Paris, France. I still sleep on their time and can’t sleep on our time here. I tried over the counter sleep remedies without help. What can I do?
A: Jet Lag is the desynchronization of an individual’s internal clock called Circadian Rhythm. This clock determines when adrenaline shuts down in order to sleep and starts up when it is time to wake up. Without sleep medications to induce and maintain sleep, the guideline was one day recovery per time zone crossed. Jet lag is more so in professions such as pilots, crew, and frequent travelers that do not have the luxury of a prolonged recovery. The FAA has strict regulations at combating pilot and crew fatigue caused by jet lag and what medications can and can not be used. Second shift workers also suffer from it when they work nights weekdays but want to be with their families during the daytime weekends.
Symptoms can include difficulty in falling asleep and staying asleep, daytime fatigue, poor memory and concentration, headaches and irritability, and constipation.
Light is the strongest stimulus for maintaining a person’s sleep-wake schedule as discovered by the US Navy’s Submarine Service. The best way to avoid jet lag is to keep the same schedule all the time every day without any changes. However, if this is not possible, then a four hour sleep inducer like Diphenhydramine (i.e.., Tylenol PM,Benadryl) 50mg or triazolam (i.e..,Halcion) 0.5 mg nightly for 3 nights in a row at the new schedule should do the trick. Avoiding any caffeine products during this 3 day period is required as the caffeine counteracts the sleep inducer.
Your family physician would be the best person to advise you on this issue.
Q. My wedding ring is stuck as my finger got swollen and I don’t want to cut it. I already tried elevating my hand, lotions and soap, and even putting it in ice water without help.
A. We use a ring cutter in the emergency room. The removed ring will then have to be taken to the jeweler for repairs which could get pretty expensive. I have found a better way to remove the ring. I use a cotton or silk ribbon (like for gift wrapping) that is ¼” wide and 24” long. I pass about 6” of the ribbon underneath the ring by lifting the ring gently on the palm side towards the palm. I wrap tightly the long end of the ribbon from the ring to the tip of the finger thus reducing the swelling of the finger. Tie or tape the end of the ribbon to the tip of the finger so that it doesn’t unravel. Then I rub a little bit of dishwater soap underneath the ring while rotating the ring. Next, I pull the short end of the ribbon that is underneath the ring allowing the ring to progress down the wrapped finger. Remove the ribbon once the ring is off and take the ring to the jeweler to have it re-sized. Do not use very thin ribbon (such as dental floss) as it may cut your finger and cause infection.
Please contact your family doctor if you have any problems.
Q: I have fever, chills, stomach cramps, diarrhea, cough with yellow phlegm, burning mid chest pain, head and chest congestion, wheezing, muscle aches and weakness. What should I do?
A: The flu season is upon us. Every year the Federal Center for Disease Control in Atlanta, Georgia tries to predict the flu strains for the up-coming flu season. The 2015-2016 flu vaccine contains 3 strains: type A (H1N1 and H3N2) and type B. If you already have the flu symptoms, then you should get treated first before getting vaccinated. EVERYONE should have gotten vaccinated by now! Please remember that if you are allergic to eggs or any ingredients in the vaccine or if you have a history of Guillian Barre syndrome, you should not get vaccinated. There are some simple steps to lessen the chance of contracting the flu. Wash your hands frequently. Use the hand sanitizers as often as you can. Get plenty of rest and follow health diet for strong immune system. If all fails and you do get the flu symptoms, go see your family doctor right away. Starting the treatment within 24-48 hours from onset of the symptoms will make the recovery so much easier and faster. Stay well!
Josef asked if there was any update on sunblock as their doctors keep on finding sun-caused pre-malignant skin grows even though they are using over-the-counter sunblock.
There is recent research at the University of California, Riverside, that was published in 2013 that updated original FDA’s recommendations of 2009. SPF, or Skin Protection Factor, is a measurement of how effective the sunscreen is in preventing sunburn. For example, if you normally burn in 10 minutes, SPF of 15 will multiply this time by 15 i.e. 150 minutes before burning. It is best to re-apply the sunscreen after 2 hours. No sunscreen is waterproof and can be diminished with swimming, rubbing, or wiping off. The ultraviolet rays can be in either UVA or UVB frequency range. Many former over-the-counter sunscreens did not block UVA radiation which does not primarily cause sunburn, but can increase the rate of aging, photo dermatitis (brown sun spots), pre-malignant and malignant skin lesions, such us basal cell cancer, squamous cell cancer, or malignant melanoma. Broad spectrum sunscreen covers both UVA and UVB frequencies. The FDA set out the comprehensive set of rules in 2011 to take effect in 2013 designed consumers identify and select suitable sunscreen protection products.
The two ingredients that have been approved by the FDA are Zinc Oxide and Titanium Dioxide. In the past, it was 3-4% of active ingredient but now it is recommended 9-10%. The best sunscreen is still broad brimmed hat, polarized UVA/UVB wrap-around sunglasses, and long sleeve shirts and pants. Light colored cotton fabrics are the best alternative to sunscreens. When selecting the sunscreen, pay close attention to active ingredients on the label. If you cannot find the right sunscreen locally, check the internet for alternatives.
By 2/1/2015, there have been close to 100 cases of Measles reported since 12/15-20/2014 initial exposure at Disneyland. The majority of these cases have been unvaccinated children as the MMR vaccine (Measles (Rubeola), Mumps, and Rubella(German Measles)) has a 93 percent protection rate after the first dose and 97 percent protection rate after the second dose. The first dose should be administered between 12 – 18 months of age and the second one at the age of 4 – 6 years old. There had not been a previous case of measles in the United States since 2000. The myth that MMR vaccine causes autism was the result of the erroneous report in British magazine Lancet by Dr. Andrew Wakefield in 1998. The Lancet retracted the report in 2010 and British officials revoked his license to practice medicine. In the report, Dr. Wakefield had manipulated the data in order to show that the vaccine was associated with autism. This has since been proven a deliberate fraud. Similar myth occurred in 1982 documentary on the NBC affiliate titled DPT: Vaccine Roulette which claimed there were serious questions of DPT vaccine safety. Dr. James Cherry, UCLA research professor, and primary editor of the Textbook of Pediatric Infectious Diseases, showed there was no relationship to any “severe neurological illness”. The mercury preservative used in routine childhood vaccines – ethyl mercury- is nontoxic. It is eliminated from the body quickly and doesn’t accumulate unlike methyl mercury, such as in tuna fish. It’s like comparing ethanol in wine versus methanol in moon shine that can cause blindness. All 50 states require vaccinations for students. Huntington Beach High School required the vaccinations and banned non-vaccinated students from classes for a month hopefully until this epidemic resolves. The initial symptoms are coughing, runny nose, red watery eyes, and high fever are common to many illnesses. The red rash begins 3-5 days after initial symptoms and quickly spreads all over the body. The initials symptoms appear 10-14 days after exposure. The rash is made up of flat red patches that often flow one into another starting at the face and spreading outwards. The communicable period starts 4 days before the rash for 8 days total. The telltale is the appearance of Koplik’s spots, tiny white spots with bluish white centers on the red background. They are found inside the mouth. Complications can include ear infections, encephalitis, pneumonia, dehydration, shock, and even death. If you are pregnant, you can even miscarry. Treatment includes hydration, orally or IV, fever control, and isolation as this is an air born virus. It’s much better to have the vaccine than to have the disease. Please call your doctor and don’t go to his/her office if you think you have been exposed. If you must know more about the measles, you can have a PCR swab test to detect it, IgM test to know if you were exposed in the last 30 days, and IgG test to find out about your lifelong immunity to measles.
Q: I twisted my right ankle going down the ladder on my boat. Despite elevation and ice, it swelled and turned black and blue. It was very painful and worse with walking or trying to put weight on it. What should I do?
A: A sprain is an overstretching or tearing of a ligament. A strain is an overstretching or partial tearing of a muscle. A fracture is a broken bone. A rolled or twisted ankle can cause any of these. Symptoms include inflammation, swelling, bruising, and pain worse with weight bearing or movement. Predisposing risk factors include weak muscles, tendons, or ligaments due to previous injuries, hereditary, inadequate running shoes, high heels, or elevated shoes. There are 3 grades of ankle sprains. Grade 1 is mild ligament damage without joint instability. Grade 2 is partial ligament tear resulting in a loose ligament. Grade 3 is complete ligament tear. In 1992, the E.R. physicians at Ottawa, Canada Civic Hospital published the "Ottawa Ankle Rules" with a 100% sensitivity for adults and 98.5% for children greater than 6 years old, specificity, and very low rate of false negatives for excluding fractures and the necessity of Xrays. Xrays are required if there is ankle/foot pain and tenderness within 3 inches of the edges of the ankle/foot bones and inability to bear weight for 4 steps. Exclusions include pregnancy, head/spine injury, intoxication, or children less than 6 years old. Treatment includes nonsteroidal anti-inflammatories (ie., ibuprofen, naprosyn), R.I.C.E. (Rest, Ice, Compression, Elevation), Crutches, and even immobilization in a compression Walker Boot for 2 weeks. Isometric and range of motion exercises help quicken recuperation. Isometric exercises include using opposing flexor and extensor muscles at the same time to prevent muscle atrophy. Range of Motion exercises include clockwise and counter clockwise rotation of the ankle as well as rolled up towel stretching of the foot. Your family physician would be the best one to advise you.
On June 26th, 2015, The Tonight Show’s host Jimmy Fallon nearly amputated his left 4th ring finger when his wedding ring got caught on a table as he tripped and fell at home. He was able to save the finger and have it re-attached at the hospital. We had a similar episode at the Huntington Harbour Yacht Club when a member tripped and fell on his boat catching his wedding ring on the head of a screw amputating his finger. What should be done to prevent and treat this kind of injury? Don’t wear rings when boating. Even watches can get caught and can cause amputations of the hand and/or wrist. If an amputation does occur, put hard compression on the stump to stop the bleeding. Wrap the severed part in a paper towel and place it in a Ziploc bag. Place that bag inside another Ziploc bag with ice in it. The patient needs immediate evacuation to the nearest emergency room where the severed part can be re-attached surgically. Time is of the essence. The best outcome occurs if the re-attachment is performed within the first 2 hours of injury. Functionality can be restored with rehabilitation, but sensation may not fully return. Your family doctor can call in an orthopedic hand specialist to help you.
Q: On Saturday I went to a sushi restaurant and had a seared ahi salad. Within two hours I was nausea and vomiting with diarrhea, sweating, abdominal cramps, chills, and low fever 99°F. What was wrong?
A: Scombroid food poisoning is a food borne illness from eating spoiled fish such as tuna, mackerel, bluefish, bonito, mahi-mahi, sardines, and anchovies that were not stored properly. Tuna and bonito are especially prone to it since they have a long dark maroon stripe along the sides that are used by the fish for temperature regulation. However, it can carry bacteria that can produce toxic histidine which is a histamine. Therefore, patients with asthma are more prone to respiratory problems such as wheezing and bronchospasms. Symptoms can occur anywhere from 10 minutes to 2 hours after consumption of undercooked fish. These symptoms include nausea, vomiting and diarrhea to evacuate the poison from the body, rapid heartbeat, dizziness, chills, sweating, abdominal cramps, and flulike symptoms. Severe symptoms can include rash, blurred vision, respiratory distress, and swelling of the tongue. Death is rare, but has been reported. There is no laboratory test for it so it is based on clinical diagnosis. Treatment includes rehydration with at least 64 ounces of Gatorade daily, antihistamines such as Benadryl plus Zantac together, and antibiotics such as Levaquin, if not allergic. If problems breathing or anaphylaxis (swollen tongue or lips), use the Epipen (adrenalin), go to the nearest emergency room or contact your family doctor immediately.
Since I am one of several members of SGYC to receive a total knee replacement, I thought it would be appropriate to discuss indications, benefits, alternatives and possible risks and benefits of this procedure. When the knee is so severely damaged by injury or arthritis to the point that the pain can no longer be managed by medications, exercises, braces, or physical therapy, then it is time to evaluate for more invasive procedures such as arthroscopy or total knee replacement.
The evaluation starts with a thorough history and physical examination. Symptoms may include pain on simple activities such as walking or climbing stairs and in severe cases even at rest. Examination can include range of motion test, loose ligaments, tears such as Lachman sign, Drawer sign, McMurray sign, or crepitations underneath the knee cap. Upright weight-bearing x-rays are a good way to see how much cartilage is left. In the case of joint space narrowing to the point that it is bone on bone that is considered severe osteoarthritis and is an indication for Total Knee Replacement (TKR). If there is torn meniscus, arthroscopic surgery may be all that is required. An MRI of the knee will confirm the diagnosis.
Although Total Knee Replacements have been performed in the United States since 1968, the technology for these procedures has improved exponentially with the use of fibro optics, titanium, and matrix polyethylene plastic joint bearings instead of Teflon thus extending the life of the joint from 10 to up to 20 years. The new surgical techniques are much improved also. Cutting from the side and underneath vastus medialis muscle vs cutting in the front, reduces the recovery time from 8-12 weeks to just 3-4 weeks. The usage of new intra-operative and post-operative pain management techniques such as epidural anesthesia, general and long-acting local anesthesia, and IV patient controlled analgesia (PCA), help the patient recover faster by controlling the pain level. Icing the new knee, pain meds and anti-inflammatories are crucial in controlling pain and swelling. CPM (Continuous Passive Motion) machine is extremely important in recovery process as it promotes faster healing and prevents the scarring of the knee.
Your family doctor would be the person to advise you in your particular situation.
In the event that you or a crew member must be evacuated by helicopter, the U.S. Coast Guard will provide a specific list of instructions by radio. But if you know the procedure beforehand, you will be able to evacuate the injured person more quickly and efficiently.
Minutes can mean the difference between life and death, injury and health. A detailed log or record with an exact time must be kept and given to the authorities (i.e., sheriff, physician, paramedics) when requested. If you are not directly involved in the rescue, keep clear and don't get in the way.
Next, lower all antennae, bimini covers, outriggers, masts, booms, etc. Clear the deck of all loose gear and unnecessary personnel. If you have to move the victim, minimize jostling by log-rolling him/her. PUT A LIFE JACKET ON THE VICTIM with a note attached stating his condition and life signs (i.e., blood pressure, pulse, respirations, temperature (if available as in cases of hypothermia), and mental alertness (i.e., who he is, where he is, what happened, date and time) along with the recorded log as above in case the victim becomes unconscious or brain damaged from trauma or hypoxia (lack of oxygen) or air embolism (i.e., the bends from scuba diving).
When the helicopter arrives, the boat has to change course to put the wind 30 degrees off the port (left) bow as most helicopter hoists are located on their starboard (right) sides. Make contact with helicopter by VHF radiotelephone for further instructions. The rotors’ downdraft may make it difficult to control your vessel unless you maintain enough speed and steerage. The rotors are also loud, so have a designated person standing by in the cabin with a hand held VHF to relay messages or use an earphone jack.
A tether line will be lowered first into the water to dissipate any static electricity from the rotors which might shock the rescuer. Then a rescue device (i.e., a sling, litter, or basket) will be lowered on a steel cable. Have a crew member guide the rescue device into contact with your vessel. DISCONNECT THE CABLE AND LET THE HOOK END OF THE LINE GO FREE in order to put the victim in the rescue device.
DO NOT ATTACHE THE CABLE TO THE BOAT as each helicopter comes equipped with only one cable and has an automatic guillotine type cable cutter built into the winch in case of excessive load (i.e., your boat). That helicopter would have to fly back empty and a new helicopter would have to be sent out delaying the rescue.
Once the victim is in the rescue device, connect the cable only after the static electricity has been dissipated a second time. Then, signal the helicopter to hoist away with a "THUMBS UP" sign.
Hypothermia, as defined by decreased body temperature, develops faster in water than air. Water conducts heat better than air. Any movement in the water accelerates heat loss reducing survival time to minutes depending on the temperature of the water.
Cold shock is defined as the sudden exposure to cold. The cold constricts blood vessels in the arms and legs causing low perfusion of muscles and tissues. Hands, arms and legs become numb and useless. Without thermal protection, swimming is difficult if not impossible.
The victim, though conscious, is soon helpless. Without a life jacket, drowning is unavoidable. As soon as the victim falls in the cold water, he experiences an involuntary gasp reflex. Just as his head goes under water, he inhales. Once the victim is in the water, he should try to get back in or on the boat immediately if it is still floating. If you cannot get out of the water, or do not have thermal protection, such as a wet suit or survival suit, stay as still as possible in the H.E.L.P. (Heat Escape Lessening Posture) position with folded arms and crossed legs, floating with your back to the waves.
If two or more people are in the water put your arms around one another in the huddle position until help arrives.
Treatment depends on the severity of hypothermia.
In mild hypothermia the victim is shivering, but coherent. Move victim to sheltered place of warmth. Remove wet clothes. Give warm (not hot) sweet drinks, but no alcohol or caffeine. Keep victim warm for several hours. Use your own body heat, if necessary.
In moderate hypothermia, the shivering may decrease or stop, but the victim is no longer coherent and may seem irrational with deteriorating coordination. Treat same as mild, but no drinks to prevent aspiration. Keep the victim lying down with his torso, thighs, head and neck covered with dry clothes or blankets to stop further heat loss. Seek medical attention immediately.
In severe hypothermia, the shivering has stopped, the victim may be semi-conscious or unconscious. Do not assume he is dead just because he is cold. The saying in the emergency room is: "Nobody suffering from hypothermia is dead until they are warm and dead". Victims have survived 45 minutes or longer under water due to a cold reflex that shunts the oxygenated blood to the vital organs while slowing their rate of metabolism prolonging their survivability. If pulse and breathing are totally absent, start CPR and call for immediate medical evacuation.
Plan ahead! Wear clothing by the "layer" effect. As the weather gets colder, put more layers on. As the weather gets warmer, take layers off. Personal flotation devices, such as life jackets especially for children, are the only ways to survive cold water emersion. Wool, nylon, polypropylene fabrics do not effectively prevent heat loss in cold water. Fleece-lined polartec clothing (Patagonia) is rated equal to 2.5mm neoprene and is comfortable under outer clothing. These can be found in catalogs and marine stores. Carry dry clothing in waterproof bags.
A short rope sling tied to the transom with a foot rest in the loop may assist boat re-entry. A lifesling or harness can help you stay with the boat. Attach a whistle and light to your life jacket to signal for help. Tell someone where you are going and when will you return. More men have fallen overboard with their zippers open. Have a safe boating experience!
Q: So, what is the best way to survive a heart attack?
A: Call 911 because ambulances get priority treatment and enter the E.R. by the back door without waiting.
Heart attacks are the scariest because they are the leading cause of death in the United States. Heart attack, also called a myocardial infarction, is the death of a part of the heart muscle due to a sudden loss of blood supply.
Cholesterol can plug up the coronary artery up to 99%, but it is the blood clot that is the final killer when it completely blocks the artery. The blockage deprives the heart muscle from oxygen. It kills the heart muscle. This lack of oxygen produces symptoms such as shortness of breath, mid to left squeezing pressure chest pain, which may radiate up to the neck, jaw, left shoulder, left arm, and/or upper back, heartburn, and sweating. Death of the heart muscle may also cause an electrical arrhythmia, or irregular heart beat.
Regular beating of the heart is essential to efficient pumping of the blood. Certain arrhythmias, such as ventricular fibrillation, make the heart only quiver and not pump oxygenated blood to the brain. Permanent brain damage or death can occur, unless oxygen blood flow to the brain is restored within 5 minutes. Early heart attack deaths can be avoided if a bystander starts CPR within 5 minutes of the onset of the heart attack. CPR involves applying continuous external chest compressions to make the heart pump and allows airflow except in drowning or choking victims. When paramedics arrive, medications and/or electrical shock (cardioversion) can be administered to restore normal heart rhythm.
An AED (Automated Electrical Defibrillator) automatically analyzes the rhythm and then gives the appropriate electrical shock. Survivability depends on getting the patient to a Chest Pain Center within that first golden hour from the onset of the heart attack symptoms. This allows the physician to possibly save precious heart muscle by either injecting enzymes to eat up the clot or an angiogram to find the obstruction of the coronary artery and open it with angioplasty (dilation by a balloon catheter and/or stent wire mesh tubing placement).
Immediate treatment out in the field includes Aspirin as a blood thinner. 150 mg chewable Aspirin can be placed under the tongue or along the gum as soon as the symptoms start (unless the patient is known to be allergic to Aspirin). Eighty-one mg of Aspirin should be taken daily as a prevention of the blood clot. If Nitroglycerin, a blood vessel dilator, is available, it should be given sublingually immediately to lessen the chest pain. Getting annual physicals by your family physician is absolutely the best way to catch heart disease early before it gets to the point of being an emergency.
On April 28, 2012 at 1:30 A.M. on a moonless night with 8 foot seas and mild winds, four sailors were lost at sea during the Newport to Ensenada Race. None of the three bodies recovered were wearing a life jacket or safety harness. It is the first time in the 65 years of this race that there has been any fatalities. Although the USCG investigation is still ongoing, the search of the debris area (10 miles south of San Diego near Los Coronados Islands and 10 miles off the Pacific Coast of Baja Mexico) has been called off. The San Diego Coroner has declared the cause of death of two of the victims as Blunt Force Trauma. The scrapes and contusions on the victims as well as the total destruction of the 37.5 foot Hunter sloop “Aegean” raises the suspicion of a collision at sea by a large commercial vessel such as the ones that transit that area at approximately 20 knots or 1 mile every 3 minutes. The question arises: Could crew fatigue on either or both vessels have played a role in this tragedy? If so, how could it be avoided and/ or treated?
First is to avoid fatigue of the crew just like avoiding chafe and metal fatigue of the parts of the boat. When off watch, sleep and do not succumb to the adrenalin of racing by small talking with your fellow crew members or drinking alcohol. When on watch especially at night, two pairs of eyes are better than one. Stay warm, eat high protein snacks, avoid seasickness, unnecessary exertion, and night blindness by keeping lights down or use red lights or night vision binoculars scanning the horizon. The COLREGS Rules of the Road state that every vessel is required to maintain a watch by sight and sound at all times in order to avoid a collision at sea. If your boat has radar, turn it on, tune the gain to get the best picture, maintain a watch on it both manually and electronically with at least an 8 mile radius alarm guard zone which gives both vessels about 20 minutes to change course drastically by at least 60 degrees. If the relative bearing of two vessels is constant then they are on a converging course. International Rules also require all commercial vessels greater than 290 tons to have an Automatic Identification System which identifies the vessel, shows its photo if available, as well as its ports of origin and destination, and its current location, speed, and course. The Aegean’s AIS stopped working at 1:30 A.M. I wish to convey my condolences to their families. My next article will be an update on seasickness including which medications and methods do not cause drowsiness.
Q. I was accidentally shocked in my right hand while fixing 110v system on my boat. Now my right arm is numb and tingling at the same time. Should I be concerned?
It is common to become accidentally shocked or electrocuted. About 400 die each year from accidental electrocution. Electricity needs two things to function: a power source and conductor. The conductor could be an insulated piece of wire, metal or you. Wearing latex rubber gloves could have protected you from the shock. You should always turn off the source of electricity before working on the electric system. Test the wire with volt ohm meter to make sure that electricity is turned off. The electricity can enter your body through a small spot like on your hand and expand up your arm causing muscle and/or nerve damage. The damage could be anything from mild tingling or 2nd or 3rd degree burns. It could be temporary or permanent and if the electricity crosses your heart, it can even result in a cardiac arrest. The lower the voltage, the more current will be needed to do the damage and vice versa.
If you get numbness and tingling, sometimes desensitizing the nerve by rubbing it on your clothes will cause nerve pathways to generate returning sensation. If there are blisters, then you need to be treated for burns or referred to emergency room if you don’t know how to treat burns. If the heart is affected, such as chest pain or arrhythmia, then call 911 immediately and start CPR right away. If there is nerve pain involved and the symptoms don’t go away quickly, a neurologist could prescribe a nerve pain medication. Your family doctor is the best source of information, treatment and referral, if appropriate.
Q: I fell down the steps on my boat and broke my hand and wrist requiring surgery to fix it. Now I have severe pain, swelling, and mottled skin there. My doctor diagnosed me with CRPS and referred me to a pain specialist who wants to give me nerve block shots, but I don’t want anything so invasive. Can you tell me what is CRPS and what else I can do?
A: Complex Regional Pain Syndrome (CRPS) can become a chronic progressive disease with severe pain, swelling, and local skin color changes. The key is early diagnosis and treatment. The cause is trauma or surgery to an arm or leg. There are two kinds of CRPS. Type I is called Reflex Sympathetic Dystrophy (RSD) which does not have demonstrable nerve damage. Type II is Causalgia which has obvious nerve damage.
Early multimodal treatment is the key to successful management and even possible resolution of the disease. Start with topical treatments such as Flector patch or Lidoderm patch or DMSO 50% cream. Physical therapy by a physical therapist who specializes in hands can help greatly. He can set you up with a TENS (Transcutaneous Nerve Simulation) unit which blocks the transmission of the pain up to your brain. Elevation of the injured part will help with swelling.
Some patients get very depressed from pain which could lead to insomnia. Anti-depressants are very helpful for these patients. Anti-inflammatory medications such as ibuprofen or naprosyn will help to reduce inflammation, pain and swelling. Non-narcotic analgesic such as tramadol as needed can help relieve the pain.
If non-invasive pain management is not successful, then the next step would be the Nerve Block injections given by a board certified anesthesiologist who specializes in pain management.
As always, your family doctor is the best source for pain management and referral.
Q: On 1/24/13, Janet Kwak on the NBC 11pm evening news talked about The Norovirus Outbreak in Southern California. Would you please tell me what it is, its symptoms, and treatment/prevention?
A: In a previous article, I wrote about the Norwalk Virus whose name has now been shortened to Norovirus. Although it first started in Sydney, Australia, it spread quickly through cruise ships and vacation resort hotels. Now, those vacationers are bringing it back home to Southern California as well as the infected crews passing it on to other cruise ships around the world. The virus is highly contagious with as little as 20 viral particles sufficient to spread it. Each episode of diarrhea or vomiting can put out millions of these viral particles. Prevention is best by the crew washing hands frequenting especially after going to the restroom or before preparing/eating food, disinfecting bathrooms with bleach using latex gloves, masks, and goggles and letting it thoroughly dry for 24 hours before usage by uninfected people.
Most symptoms are mild and self limiting such as vomiting and diarrhea so Norovirus is underreported. However, the immunocompromised patients such as the very young or old, smokers, insomniacs, malnourished (i.e., dieting, not taking vitamins), fighting other infections such as the common cold, or on prednisone or other immunocompromising treatments (i.e., Rheumatoid Arthritis, Lupus, COPD, etc.) are more prone to getting dehydration requiring inpatient intravenous fluids and supportive care. Outpatient care includes:
Q: I burned my hands from towing the dinghy while holding the dinghy’s painter line in my hands. Now I have painful blisters on both hands. What did I do wrong? What should I do now to treat the burns?
A: Next time, tie the line to a cleat and never hold it in your hands. Recently at an elementary school, two teams of girls were having a tug of war with a rope. Not only did one girl lose 2 fingers from coiling the rope around her hand, but several participants suffered friction rope burns as well. It does not take a lot of force to produce traumatic injuries to fingers and hands.
I personally have suffered similar friction burns on my hands once. This taught me an important lesson to always use sailing gloves to protect my hands against chafe (friction) such as when anchoring, raising/lowering/adjusting sails or dinghy or docking lines. The friction produces heat which can burn the skin. The burn can be a minimal first degree burn like a sun burn or a moderate second degree burn producing blisters. Third degree burns where it is deep past the skin is rare. Your intact skin is also your best protection against infection as burnt skin is more susceptible to infection.
Initial treatment is putting your hands under running cold water and washing them. The cold water will also help relieve some of the pain as well as taking an ibuprofen can help if you are not allergic to it. Pat dry the burns gently with a clean paper towel or sterile gauze.
Do not rub! Applying aseptically, with gloves and a sterile tongue depressor, topical burn creams such as silver sulfadiazine 1% cream will not only help relieve the pain but also the sulfur antibiotic component will help prevent/treat an infection as long as you are not allergic to it.
Do not put butter or grease on a burn as it will not relieve the pain or infection. Next, apply a Telfa Ouchless Nonadherent Dressing from your first aid kit.
Do not use any adhesive tape as this will produce pain when it is time to remove it. The cream and dressings have to be changed twice daily for a week for nondiabetics. Diabetics are poor healers and take twice as long to heal. Elevate the injured hand(s) above your heart level so as to reduce the swelling. Less swelling means less pain.
Contact your family physician as your best source of addition advice including but not limited to debridement of necrotic tissue/blisters but do not debride it yourself so as to prevent infection. Please keep your tetanus shots up to date every 10 years as well.
Q: On the recent cruise to Avalon I was jumping off my boat’s swimstep while holding on to it. I felt excruciating pain in m shoulder and thought I have dislocated it. When I went to Avalon clinic, the doctor told me I have a Rotator Cuff tear after he x-rayed it. What is the Rotator Cuff Tear?
A: The shoulder is a ball and socket joint that is held together by the capsular ligament and four muscles and tendons: the supraspinatus on top, the subscapularis in front, infraspinatus and teres minor in the back and bottom. This provides stability to the shoulder. The muscles provide the ability to rotate and form a cuff around the head of the upper arm humerus bone. Trauma, whether acute or chronic, causes the injury to shoulder:
Rotator Cuff tear is an inury that tears a rotator cuff tendon that has been weakened by age or by wear and tear. Rotator Cuff Tendonitis is inflammation of the tendon due to repetitive overhead use of the arm such as throwing. Rotator Cuff Impingement Syndrome is a pinching of the supraspinatus endon between two bones. Adhesive Capsulitis (Frozen Shoulder) is not using the shoulder due to pain and causing loss of range of motion thus letting scar tissue settle in. Bursitis is inflammation of the lubricating sacs that lubricate the tendons.
The most important thing is to see a medical professional for a thorough examination. By performing some in-the-office tests, such as range of motion, painful arch test, tender trigger point, your doctor will determine if further tests such as x-rays, MRI (if no pacemaker), and ultrasound, need to be ordered.
Your family doctor is the best one to advise you on all the above.