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Old 06-14-2007, 02:27 PM   #1
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The warning of the Dengue Fever outbreak in SE Asia that is posted in the MMNETSEA forum board has prompted me to ask the following; What if you leave a Dengue Fever area on an extended passage and are already far from land, and someone on board develops symtoms that you suspect may be Dengue Fever?

Apart from making full speed to the closest landfall for tests and professional medical assistance, how must this "suspected" Dengue Fever case be handled while still on board? Is it a case of do NOTHING until you get to a doctor?
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Old 06-14-2007, 04:10 PM   #2
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I work in health care and looked this up on the CDC site. Two types, Dengue Fever (DF) and Dengue Hemorragic fever (DHF). Clinical pearl, anything with hemorragic attached is not good. The good news with DHF is pretty rare. DHF is noted by bleeding around the gums, nose,etc..... It is usually late in the illness.

Dengue has a mosquito vector, so lather up with DEET.

Viruses are viruses, treat the symptoms and maintain hydration. They advised not to use Aspirin and other NSAIDS except acetaminophen. If you are unlucky enough to get DHF, no sense helping out with a medication that will promote bleeding.

Keep yourself hydrated!!!!!! The young and the old are the highest at risk of any virus. If you are normally healthy you should do fine.

Here in Idaho we are about to start the annual West Nile Virus paranoia. It does kill a few people each year, but not as much as the seasonal influenza each year.

DW
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Old 06-14-2007, 06:26 PM   #3
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I think that the problem with infections that afflict cruisers is the risk that symptoms will surface only after the cruiser has left his last anchorage on a passage. This passage can be as short as only one or two days, but from personal experience, the risk of more serious infection often mandates that some form of treatment be initiated before making landfall again. For that matter, I've been on passages that should have taken only two days until something went wrong and we were unable to make landfall for almost a week more.

Where there is pain, I doubt that many people will forego something to ease the pain regardless of how many warnings are given to do nothing until one sees a doctor.

I carry "Where There is No Doctor" on the boat, published by the Hesperian Society, which is an excellent medical resource. It can often tell someone when they should be extremely concerned and must seek medical attention "immediately." Sometimes it just isn't possible to find a doctor immediately, and then other measures must be taken.

Dengue fever can be quite painful, and is sometimes called "breakbone fever" which gives you some idea of just how painful it can be. The caution is that only acetominophen (also called paracetamol) should be taken for the pain. Non steroidal anti-inflammatory medications, which should not be taken, include: aspirin, ibuprofen, toradol, naproxin.

From the Center for Disease Control web site,

http://www.cdc.gov/ncidod/dvbid/dengue/dengue-hcp.htm

excerpts: "Treatment emphasizes relief of symptoms, avoiding aspirin and other non steroidal anti-inflamatory medications and encouraging oral fluid intake."

"
To manage the pain and fever, patients suspected of having a dengue infection should be given acetaminophen (paracetamol) preparations. Aspirin and non-steroidal anti-inflammatory medications may aggravate the bleeding tendency associated with some dengue infections..."



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Old 07-04-2007, 01:32 AM   #4
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I was "lucky" enough to experience the pleasures of a dose of dengue fever in Honduras, on the Mosquito Coast. Unfortunately, circumstances and finances did not permit a quick flight to somewhere more civilised, and I was pretty much forced to sit tight and hope I got better... which, luckily, I did. My treatment, such as it was, was to lie in my bunk (with rather regular visits to the dunny) but force myself to get up and stagger to the bar to keep fluid intake, alternating water with orange juice and lemonade or coke, to combat the dehydration and keep a bit of "food" in the system. Fun times...
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Old 07-05-2007, 02:51 AM   #5
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Manor,

I had dengue twice and malaria once (both not nice, but malaira worse!) and your post got me thinking.....

From what little I know you can only sleep off and rehydrate as posted above for dengue. Malaria you really want to treat it with the right drug for the area you're in...or start an educated guess on what you think the area calls for and go from there.

...so at first I was going to say just muscle thorugh it and get somewhere to rest the dengue off...but then I started thinking what if one had malaria?! To me, both had similar feelings and the funny thing about pain is it's easy to forget what it's like until it hits again. Then it always seems the most unbearable at that specific time! If coming from an area with both viruses it seems risky then to assume it's dengue. Now I'm wondering if one could just take their onboard malaria drug(s) to be safe and wait it out IF they can't get a quick reliable blood test. Or is that stupid for some reason...anyone know??

Does anyone know too if there are several 'levels' to dengue in a given area? In the caribbean local ex-pats that lived in a certain area swore that they were getting dengue up to four times...each one worse then the last...or was it the other way around, can't recall? Anybody heard of this? Wives tale?...the virus maybe easing up and coming back?? I've been wondering about this for years.

Regardless, both suck plain and simple and you don't...can't...push yourself if ya got it good. Depending on the circumstances you culd be getting set-up for some serious safety and seamanship issues when you finally do make it somewhere.

No longer do I ignore the DEET...before I did and got what I had coming!

- J
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Old 07-05-2007, 04:27 AM   #6
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I did have malaria once, and was carrying Lariam as a recommended treatment should one come down with it. I wasn't sure that I had malaria, but within an hour of taking Lariam the symptoms eased dramatically. The next day I was able to be tested and the doctor put me on an additional treatment regime to be sure the parasite was purged from my system. A comment here - a single-hander anchored in another island, too far from medical treatment, was found dead of cerebral malaria.

Although I never had dengue, at least insofar as knowing I had dengue fever, once I had terrible aches and pain when we arrived in American Samoa. Looking back, the pain was so unusual for me that perhaps I had been suffering from dengue. I still wouldn't want to say that was what it was. If so, however, there was a significant difference (for me) between the symptoms of malaria and dengue. The problem, of course, is that if you have never had either before, how could you know? It is for that reason that a doctor is important. Yet if you're several days from land and you have malaria, particularly where cerebral malaria is common, you might be dead before you can reach land.

Maybe self-medicating could be risky, but so can not self-medicating. I believe that the better your knowledge of your own physical and medical situation, the better able you will be to make these decisions for yourself. Cruising is still one of the few pursuits where self-reliance is most important.

A brief search on the internet suggests that dengue is also a disease that does not confer immunity for the next exposure, though apparently because of the many variations and mutations. Malaria has multiple faces, also, and some malaria, particularly strains common in Latin America, recurs forever in sufferers. So. What to do? Only the individual can know what is most appropriate for him(her)self.

Just another viewpoint to throw into the pot.
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Old 07-06-2007, 01:06 AM   #7
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Quote:
Originally Posted by Manor View Post
... Apart from making full speed to the closest landfall for tests and professional medical assistance, how must this "suspected" Dengue Fever case be handled while still on board? Is it a case of do NOTHING until you get to a doctor?
A few thoughts to share: Regarding medical advice, the cruising net(s) that I am personally familiar with are accessible to any boat with SSB or HAM capability from virtually anywhere in the Pacific, and both I and other physicians volunteer, often on a 24/7 emergency basis to provide medical help to fellow cruisers. How it works in the rest of the world I can't say for sure, but I would suspect that a similar situation exists. Having said that however, I have to say that I am more often than not, absolutely astounded at the incredible lack of preparedness with which many people go to sea. More $$$ are often spent on fishing equipment than a suitable medical kit, not to mention an almost complete lack of even basic first aid knowledge.

A lot of people take classes and attend seminars on various advanced boating topics, yet I remain curious why relatively few seriously acquire an adequate knowledge base on very common things that can and do happen offshore, (e.g., broken bones from falling down the ladder, serious infections from a fish hook that was stepped on, not to mention malaria, dengue, etc. - - all potentially life threatening). I mention this, not to be critical, but hopefully to encourage everyone who enjoys cruising out of the way places, to learn basic medicine-at-sea and equip their boat with the things that just like a life raft or the abandon ship bag, you hope you'll never need.

You probably won't be able to rely solely on your family doctor as it's quite likely that he or she will not be up to the task of recommending suitable medications or a list of items required in an 'off-shore medical kit', but in my exerience they will in general be willing to write prescriptions for medications if they see that you've done your homework. It's critical not only to have a good selection of basic Rx, but other items as well such as materials for splints, bandaging wounds, etc. , and especially important, easy to understand reference books. There are even DVDs available to help evaluate, diagnose and treat illness and injury at sea. Just like practicing an MOB drill or learning how to handle any emergency 'repair' at sea, being prepared requires study and practice. You wouldn't wait until a hurricane is bearing down close on you to see if the ship has storm sails or drogue and then hurredly read up on how to heave-to, and you don't want to wait until someone is seriously sick or injured to see what's in the medical kit.

My encouragement is to read and investigate just like you would any other important aspect of sailing. And then spend the money necessary to have a well found medical kit on board. (Yes, another way to spend money, but your life is probably more important to you than that new ______ ). Just MHO.

The very best to all... fair winds, a following sea, and a green flash in your sunset.

John Kuapa'a, M.D.
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