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Friday, March 4, 2016

Health Care Planning for Cruising

Our goal:  To remain as healthy as possible for as long as possible while cruising.   To that end, we have made a number of health care related decisions in advance of leaving the dock.

Photo taken in Titusville, FL, a few weeks before crossing to the Bahamas

First off, I am not a doctor or a nurse.  I am a retired medical social worker and perhaps know a few things about arranging for health care services, however, for the purpose of this post, I would prefer the reader to see this information as reflecting what is important for us and what we have learned in our preparation to go cruising.  Perhaps it will be helpful for others.
Take care of elective surgeries in advance


Our first decision was to maintain our regular care providers.  My husband has been followed for diabetes Type II for many years by the same clinic.  All of his records are there, and he is very well managed.  I have narcolepsy and that diagnosis requires a controlled substance to ensure wakefulness during crucial times—while driving a car for example, and driving the boat. It would be foolish for me to expect a physician meeting me for the first time to write me a prescription for a controlled substance.  If you are someone with any pre-existing conditions, I urge you to think carefully before jumping around for your health care management. 
Favorite narcolepsy quote: "When I die, I want to go quietly in my sleep, not screaming like the passengers in his car."


We began conversing with our primary care physician, dentist and ophthalmologist more than a year in advance of our intended departure date.  Because my husband and I share the same doctor and dentist, I think that some of our planning may have been a bit easier for us. There are a number of reasons why having these discussions well in advance is helpful.  


EXCEPT when the M.D. is right.  
Give your physician ample time to consider any possible concerns he or she may have about your health care at sea. If you want your physician to continue as your primary care doc, then present yourself as someone who will be a reasonable patient.  Physicians are not obligated to keep you on as a patient, just because you’ve had the same one for a long time.  If the doctor doesn’t believe that he/she can provide adequate care within whatever parameters are in your mind, you will want to know that well in advance.   Our doctor proposed annual visits, (the minimum allowed for her to write our scripts) with some labs to be done in remote locations with the results forwarded to her.


Our doctor had time to work with our insurance company to get prior approval for 90 day prescriptions as opposed to the usual 30 days scripts.  For some medications that might be difficult to acquire outside the U.S., allow time to problem solve with the doctor.
Waiting while someone has a colonoscopy.  Duluth Clinic, overlooking Lake Superior


There are routine annual specialty visits that go along with certain diagnoses. An annual eye exam, for example, is in order for someone who has diabetes.  Is it feasible for the required primary care and specialty care appointments to be grouped together for efficient future follow-up visits?  Since your primary doctor has oversight for all your health care, have that discussion with him/her as well as your specialists.  Can your preventative care procedures (ie colonoscopy, mammogram) be performed at the same time of the year as your primary care visits?


These are all meds we hope we never need.  Our EMERGENCY meds for illness.
Our primary care doctor referred us to the Travel Center, which is part of the Infectious Disease Clinic at Essentia Health in Duluth, MN.  We went together for this appointment.  With thoughtful discussion, we were given prescriptions for medications to treat things such as anaphylactic shock, dehydration, infection, poisonous critter stings, etc.  The Travel Center folks understood that we could be in situations where the nearest doctor may be one to several days’ sail away.   The Travel Center clinicians also determined which immunizations we should have for diseases that could be encountered in the Caribbean and Central America.  Typhoid was one of them.


We keep a file onboard with our most recent medical information which we carry with us when we do need to go to another clinic somewhere.  We also keep a little stack of Releases of Information from our primary care clinic in case we would need to request records be sent to or from our regular care providers.  It is wise to have that same information laminated and stored in your ditch bag*, just in case.  If you have seizures or take insulin or have any other disorder that could require immediate attention, a medical alert bracelet may be invaluable.
Sometimes we smile showing our teeth.  Thank you dental care team.


We requested our dentist at Gregorich Family Dental to look at our teeth from the perspective of what could become problematic over the next few years.  Were there some procedures that could be performed in advance of tooth pain? In my case, there were.  I had two crowns placed one year and two more crowns the following year, just before moving onto the boat. When we returned to town after a year for our medical visits, our dental hygienist kindly offered to see us for dental cleaning over his lunch hour.  He understood that we would have multiple appointments to accomplish within a short time period, and he wanted to help us. Nice guy!  Our dentist also squeezed us in with little advance notice.  Love those guys!
Duluth specific eye chart.  Note aerial lift bridge.


Both of us require eyeglasses.  Because of the difficulty in acquiring a new pair of glasses in a remote location, we each have a second pair, a back-up pair of glasses onboard too.  We also have a back-up pair of sunglasses with good protection from UV rays.  Being out in bright sun is very tiring on eyes, especially when the water reflects the glare upward as well.  We use floaty holders on our sunglasses, or the thin wire kind that attaches to the bows.  


There are several books that have been written specifically for cruisers by medical doctors.  One of them that was recommended at the Chicago Sailboat Show was Advanced First Aid Afloat, by Eastman, M.D. and Levinson, M.D..  We have the book aboard and we have read it.... okay, not all of it—we skipped the chapters on child health care and miscarriage.  I happen to know CPR already and I asked a nurse to teach me how to use a blood pressure cuff as well. 
What a mess of supplies


With the information in hand about what makes a good First Aid Kit, I tackled the task of compiling all of the OTC (over-the-counter) meds and supplies that I could.  Although it is possible to buy a ready-made First Aid Kits, it makes a LOT of sense to me to take the time to go through the stores to find specific items needed.  We then had an opportunity together to became familiar with the items and could spend time figuring out how to best organize our supplies so that we can find them when needed.  A pre-loaded First Aid Kit is, to my way of thinking, a mysterious case that you may someday HOPE to find what you need when you need it and that you will also know what to do with it.  
Tah Dah!  Two tackle boxes and two boxes from Michael's.


Our first aid “kit” is actually four boxes because one container would be too large to handle and smaller boxes are able to fit more easily on a boat too. Tackle boxes can make good first aid containers because it’s easy to find your supplies when they’re spread out a little.  Our first aid kits are not pretty, but they are very user friendly.  Ours are divided and labeled as follows:  
Could be considered a "pest"
Ears, Mouth and Pests —  Eyes, Nausea and Gastrointestinal —   Burns and Topical Treatments— and the largest of the four boxes is labeled: Bleeding and Bandages.   This organization works for us—maybe a different system would work best for you.  A few items may be too large to fit into a kit such as the hot water bottle, Pedialyte bottles and a blood pressure cuff.

Drawer is ajar only at night for tubing

Because both my husband and I have sleep apnea, we need supplies for our CPAP (continuous positive airway pressure) machines.  We both use the same DME company (durable medical equipment).  They contact us via email at appropriate intervals to inquire about supply needs.  One of the first things my husband did after moving aboard was to find a clever guy (Pat, that’s you) to install wiring for (2) 12V outlets beneath our bed for our CPAP machines.  Pat installed the outlets and ran the lines to our units so that they are hidden within a drawer and a cupboard.  They are easily and completely tucked away during the day.
Voila!  Disappearing CPAP machine

Why Don’t All Cruisers Use Their CPAP Onboard?   One reason that cruisers give for NOT using their CPAP is that electronic equipment running on 120V eats up a lot of energy.  My husband researched and found the 12V adapters immediately.  The energy draw savings from (2) CPAP machines using 12V vs. 120V is about 10 amps per day instead of 100 amps per day. This is a big difference for those living afloat with limited charging capability.  I strongly encourage folks who have sleep apnea to continue using their CPAP machines while living aboard.  The cost of not using them is increased risk for stroke and heart attack.  These major health accidents do not match our goal of staying healthy as long as possible. 
Quebec City, Quebec, Canada Aye?


Investigate whether your medical insurance will cover you when out of the country.  If you find that your coverage is inadequate, perhaps you may want to look into other avenues, for example Divers’ Alert Network, DAN which offers insurance for its’ members.  Know your own insurance.
Happy, healthy Jax


Health care for our dog is important too.  I attended a Community Education course in dog first aid which was very helpful, and came away with a nice manual by the American Red Cross, too, called Dog First Aid:  Be Red Cross Ready.  We carry Jax' health care records with us too, of course.

Okay, so, admittedly this post is WAY too long.   Sorry about that (but not too sorry because your health is important).  Hope our information is helpful for somebody else. Stay healthy out there on the water.  

**Ditch bag - a large bag specifically prepared in advance with the critical items you would need to bring with you if abandoning ship.  This would of course, include among other things, copies of personal identification, cash, medical history and medication for a few days.  

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