162

For the features we are presenting in this first issue,  you can either scroll down the page or go directly to a feature by clicking on one of these links:

Ciguatera Poisoning
Alternative Remedies
Removal Of An Embedded Fish Hook

Do you know of a good doctor, dentist or other health practice which can be reached by cruisers visiting places you have been to?
Have you found a good medical insurance policy for cruisers?
Tell us about it! We'll put any information we get on the Are You Covered page in the Money Talks section. Anything else to do with health and medicine belongs here.

Tell us about it! How to find the practice, what impressed you about the services you received and anything else which may be helpful.
What is in your First Aid Kit aboard? What should we carry in our First Aid Kits?  Are you versed in the correct techniques for dealing with emergencies on board? How do you cope with sea-sickness? What have you tried that works? What have you tried that doesn't work?

What inoculations are needed where? Where can you get them if you are already away from home when you find out? Can you give us any hints and tips, tell us where to find out more?
Are you a medical practitioner living aboard a yacht? Can you give any advice to fellow cruisers? 

We quite understand any reluctance to put ones name to any kind of advice in these days of ludicrous lawsuits but we will be glad to publish anonymous help, provided that it seems sensible advice to us and, as always, individuals must use their own judgment as to the usefulness of the information we receive and put on offer. We like to think that our readers are people of character and maturity enough to know that the responsibility for one's own actions is always one's own, regardless of laws passed by governments who see themselves in the role of public nannies.

One must always review advice, even from so-called experts, let alone those of us who are happy to admit that we are no more knowledgeable than the next man, in the light of what one knows, apply common sense to it and then act on the outcome of the analysis one has made. 
If you do not feel able to do that, we hope that you are not about to embark on a voyage as captain, or indeed crew, of any sort of vessel!
We invite you to tell us your stories of accidents and illness aboard and their outcomes.
Don't fret about your writing skills, we can edit your letter if needs be.
You are also invited to open any topic of discussion which is relevant to this page, by telling us or asking anything you wish.
We have a few interesting bits and pieces here for you, to start the ball rolling...

We open with an interesting article from  Edward MacIntyre aboard the S/Y 'Just Reward'

CIGUATERA POISONING

This form of poisoning is called 'Ciguatera' because of it's symptoms are so similar to those produced, in a much milder form, by the Cigua conch, commonly consumed in the Caribbean, in a small proportion of people who eat it.  The toxin has been identified in over 300 different species of reef fish, particularly in the Bahamas, Puerto Rico, the Virgin Islands, South Florida, Hawaii, the Marshall Islands, American Samoa, French Polynesia, New Guinea and parts of Australia. It also occurs in certain species of crab in Asia.

Affected species include Mackerel, Barracuda, Grouper, Red Snapper, Queen fish, Surgeon fish, Coral Trout, Red Emperor and 'Sweet Lip'.
Since turbulence in the water churns up the algae, and brings a greater quantity within the reach of the fish which feed on them, the incidences of poisoning tend to rise sharply after hurricanes and other rough weather.
The toxin is produced in a chain of events which begins with certain species of fish, notably Scarus microrhinus, the Parrot fish, feeding on a particular type of algae, upon which grow organisms, which go by the painful-sounding name of dino-flagellates.

Those fish are, in turn, consumed by other fish and the toxins become concentrated in their flesh because, being insoluble in water, the toxins does not dissipate, and get excreted, but build up in the tissues of the fish. 

As the fish grows, so the toxicity increases, so that between five and ten pounds (two and a quarter to four kilos) in weight, there is already a danger and above ten pounds (four kilos) any potentially suspect fish must be regarded with extreme caution.

Although there are occasional exceptions, it is usual for the first symptoms to appear approximately 4 hours after the contaminated fish has been ingested, a typical exception being when a person has been regularly eating quantities of fish with a lower individual level of toxins but a cumulative total which tips the balance.

At the onset, there are usually symptoms of exhaustion and the victim may sweat profusely.  Nausea is common, accompanied by a tingling sensation around the mouth, tongue and throat, which may extend to the face and even to the extremities (fingers and toes). The afflicted person usually becomes extremely weak and unable to co-ordinate simple actions like walking properly or picking up and holding an object.

In the second stage there is usually vomiting and diarrhea, accompanied by severe abdominal pain. The symptoms are not unlike those of a bad case of influenza combined with gastro-enteritis. There may be reversal in the detection of heat and cold, so that ice feels hot and boiling liquids cold.

In slightly less than 3% of cases, Ciguatera poisoning proves fatal.
In a fatally afflicted patient, the weakness and lack of co-ordination become total and the victim collapses.
The toxin acts directly on the cardio-vascular system, reducing blood pressure drastically, causing collapse, perispheric dysfunction and, ultimately, death.

Traditionally, suspect fish was 'tested' by extracting the liver, being the organ in which any toxins will be at their most concentrated, and rubbing the raw liver across the lips, to check for tingling or numbness. 
Unfortunately, whilst this method might stop one from eating a fish with a massive concentration of the toxin, which is, incidentally, a thousand times more poisonous than the equivalent quantity of arsenic, it would not, necessarily, protect one from eating fish with lower levels of Ciguatera. 

Just as the toxins accumulates in the tissues of the fish, so they do in those of the human being. Regular consumption of fish with a low enough toxin level to evade detection by the 'lip' test, could bring about poisoning, since any toxins ingested will take several days to clear from the body. Thus, a person eating fish daily, or on alternate days, with a low level of toxicity, may become poisoned.

The Cigua-Check detection test kit was developed by Dr. Yoshitsugi Hokami of the University of Hawaii School of Medicine.
There have been over ten thousand tests in the field and a verified sensitivity for cigua toxin of over 92%.  This is the only kit known to verify the presence of this toxin in fish flesh. 
It is available worldwide in tackle shops, marine shops etc. Price is typically around $30.00 and the test time is around 45 minutes.
For more information on Cigua-Check, and Ciguatera poisoning, you can log on to: http://www.cigua.com
 
Ed says: Thanks to Edward MacIntyre of 'Just Reward' for this fascinating treatise. No doubt many of our previously unaware readers will certainly be looking into the local availability of a test kit before venturing to eat fish in even vaguely suspect areas from now on. Have you ever suffered from Ciguatera poisoning? It certainly sounds very unpleasant, to say the least. We've heard of it before, of course, but had no idea it was so common a danger. Has anyone more to add on this subject?

ALTERNATIVE REMEDIES

We always carry a small bottle of 'Arnica' on board. It's a plant extract of some kind and you rub it gently over knocks and bruises to ease pain and aid healing. It really works. We bought it in a health food/ homeopathic remedy kind of store. It shouldn't be hard to obtain.
A friend told us about it. She has been using it for years. We've had several occasions to need it and it was a real help.
Mo and Jim on S/Y 'Seabird'.

Ed says: We can endorse that recommendation from our own experiences with Arnica, it really does help. Anyone else with a favourite natural remedy?

HOOKED!

We were on the last leg of an Atlantic crossing, Cape Verde Islands to Trinidad and Tobago,  in the early spring of '98, with a motley assortment of people on board, all of whom had begged us not to leave them in the Cape Verde Islands, whence transport across the Atlantic is unobtainable, save aboard yachts, the only commercial traffic being with Africa and Europe. We had a youngish Austrian couple, on a backpacking (and, as it turned out, freeloading) tour of the world, a young Croatian poet who had worked as a waiter on a cruise ship, a single Austrian lad, Peter, 21, and a Californian surfer in his late thirties, with us.

The Californian, Randy Dale, was an absolute star! We would sail with him again in the blink of an eyelid. Apart from all his other qualities, he was an absolute ace at fishing off the back of the boat, catching at least one large fish, usually Dorado (dolphin-fish), every day. He introduced us to a lure, with three triple hooks hung beneath a lifelike plastic fish, with which he enjoyed a great deal of success.

Because the others had no experience with fishing, he made them promise that they would call him if a fish was hooked whilst he was off watch. Unfortunately, the promise was broken, early one morning. A good-sized Dorado had been caught, the older Austrian had taken charge of the rod and  Peter, forgetting that one must never take hold of the fishing line until the fish is safely aboard, (using the gaff hook instead, to bring it in) hauled the fish up by the line, landing it on the deck, where the lure flew out of its mouth.

In the pandemonium that ensued, the lure with the three triple hooks managed to tear gashes in the shoulder and thigh of the Croatian and then catch young Peter in the middle of the outside portion of the heel of his right foot, embedding one barb of one of the triple hooks deep inside his foot.

The two First Aid manuals for yachts, which we carry on board, refer to the removal of fish hooks quite briefly and both suggest that one should push the hook the rest of the way through the flesh, snip off the barb and then send the remaining part of the hook back the way it came. 
Since we had never encountered any incident involving an embedded fish hook before, we had imagined that this advice would be sufficient, should the occasion ever arise.

This technique is, doubtless, all very well in a finger or other place where the hook can be sent out of the other side of the affected part. In Peter's case, the barb was buried in such a way that this would be impossible. It seemed obvious that we were going to have to make a small incision to get the hook out. Apart from any pain considerations, during or after the operation, there is always a risk of infection, no matter how careful you are, even in the clean and healthy environment of the open ocean and we were not looking forwards to having to do it.

Randy Dale, on the other hand, having been awoken by the commotion, had arrived on the aft deck and, having taken a look at the hook buried in the ashen-faced youth, announced that removing it would be no problem at all.

Leaving the embedded hook attached to the lure, with a cloth wrapped around the lure and the remaining hooks to prevent further mishap, Randy attached one piece of thin cord to the ring at the end of the triple hook and, taking another piece of thin cord, he passed one end under the central part of the curve in the hook.

Grasping the piece of cord attached to the ring in one hand and both ends of the piece which was placed under the curve of the hook in the other, he warned the unfortunate Peter that there would be a moment of severe discomfort. Someone handed Peter a novel to bite down on (upon which he left a permanent reminder of the event) and Randy, pulling downwards on the ring and upwards on the curve, simultaneously, removed the offending object in a single swift gesture without increasing the size of the existing wound one iota! The barb had been returned down exactly the same route it had taken to enter the foot. 

Randy suggested that we practise doing this, in case we ever need to be able to do it again, using an orange as the 'victim'. He told us to embed the fish-hook (whether a single or multiple model, as only one barb is likely to have entered the flesh in an accident) in the orange, with one sharp movement and then attach the pieces of cord to it and practise removing the hook as described above. It has to be done in a single gesture, confidently and swiftly, to work, hence the need for practise. We found that about six tries each was sufficient to 'get the knack' of removing the hook smoothly. Let's hope we never have to put our proficiency to the test!

Linnet Woods for MarineZine