Sea sickness pills cause a medical emergency! :huh:

An OCC boat left Denmark this summer bound for Inverness and the Caledonian Canal. Strong westerlies had stirred the North Sea making for a lumpy passage so out came the sea sickness pills. One of the crew, a man in his early 60 's succumbed quite quickly and retreated to his berth. Only later did it emerge that this guest crew was taking a drug called alfuzosin to control his prostate symptoms. Within 24 hours he found that he could no longer pass urine and was becoming increasingly uncomfortable.

As his distress increased the skipper tried to contact any Coastguard for advice on the ship 's VHF but was unable to raise anyone. Eventually a passing helicopter picked up their call and relayed it to Aberdeen who recommended the yacht divert to there where they would be met by an ambulance. By now the crewman was in acute urinary retention and extreme discomfort. As this had been a relatively short passage the yacht was not equipped with urinary catheters and strong painkillers so there was no option but to forge ahead as fast as possible.

The story ended happily. The poor guy was transferred to hospital where the insertion of a catheter gave instant relief. He was treated for urine infection but has not been back on a boat since!

So a few questions for discussion.
Is everyone aware that most sea sickness remedies (including patches) have, what are called, parasympathetic side effects? This means they can cause a worsening of certain conditions such as urinary retention and glaucoma. Men with pre-existing prostate problems should be wary as they may tip the balance and result in acute urinary retention.
My guess is that most boats on passages of less than 500 miles would not routinely carry the equipment and skills required to catheterise a man. Should they do so if they have male crew on board above the age of 55?
My guess is this man got into trouble because he had a mixture of infection and parasympathetic drug side effects conspiring together to exacerbate his already precarious prostate. Do we all carry antibiotics and if so which ones?
If you are someone susceptible to urinary retention which sea sickness remedies should you use and which should you avoid?

Many, if not all - motion sickness medication have antimuscurinic (anticholinergic) side effects, which could include effects such as blurred vision, difficulty in micturition, dysuria, dryness of mouth, constipation etc. These effects occur because of a relaxing effect of the active drug on the bladder muscle (Similar drugs are used in case of 'overactive ' bladder - having to go frequently and not making it in time - for exactly that effect). Some drugs are more prone to causing these effects and some people are more prone to develop side effects.

People with uncorrected narrow angle glaucoma should be extremely careful since anticholinergic effects could potentially cause a spike in eyeball pressure.

Suddenly taking larger doses, such as when weather deteriorates quickly, might also increase the likelihood of problems, in contrast to when the medication is gradually started. Transdermal anti-seasickness patches have the same side effect profile. Many other drugs also have similar side effects.

In contrast, Alfuzosin is supposed to do the opposite - namely relax the bladder opening (in contrast to the bladder muscle) to make urination easier. It is used for prostate hypertrophy (increased prostate size) and is unlikely to be the cause here. More likely this gentleman was balanced on the edge, with the Alfuzosin allowing him to continue voiding, and then the antimuscurinic effects of his motion sickness medication pushed him over the edge.

In the 2010 Vic-Maui yacht race return trip (Maui to Victoria, BC ), the same thing happened and the victim - also a gentleman of the same general age - had to be taken off the yacht by a cargo ship, for the exact same reason.

Urinary catheters are very easy to insert and minimal training is required. It is definitely worth having on board. It could change a very painful and potentially serious (bladder rupture) ordeal into a five minute procedure with very little risk.

Magnus Murphy
Assistant Professor
University of Calgary
Division of Urogynecology

Magnus,
Many thanks for your excellent contribution and welcome to the OCC Forum
Simon

Sea Sickness has always been a major problem for me, on a trip across the Irish Sea I was so bad that the skipper actually thought he was going to have to call the Coastguard to get me airlifted off the boat because hypothermia was setting in. In the end we did manage to reach a marina.

On my next trip from Scotland to Isle of Man, I took Stugeron and although they did help a little with the sea sickness it made me very drowsy which could have been very dangerous for the rest of the crew as I fell asleep while on watch and steering the boat, luckily someone else was able to take over. Again it meant that I was unable to help and became a passenger on the yacht.

Before crossing the Atlantic I went to the doctor to see about transdermal patches but he said I was an unsuitable candidate for them and he prescribed tablets for me (no idea what they were called). After leaving Gran Canaria I started taking the tablets and while on watch during the night I started with hallucinations, was positive I was seeing animals leaping out the water and people jumping off the yacht so the tablets went overboard. Luckily enough I had brought a backup solution with me. Sea Bands which uses acupressure on a point on your wrist.

As someone who suffers from urinary retention I would highly recommend the Sea Bands over any form of medication.

As for carrying a catheter to use on someone with this problem, you should be properly trained on how to use one because if it is not done right the first time it can cause a lot of stress to the patient and the person who is trying to insert it, especially if it is your partner or someone you know. Totally different for a medically trained professional who can remain detached.

Frances,
As ever a lovely thoughtful contribution from yourself which touches on two major problems that afflict mariners. Sea sickness and mental health problems. As you rightly describe some sickness treatments can bring on hallucinations etc. Both of these afflictions are worthy of threads in their own right so i will be starting these shortly.
Simon

Its 's great that Seabands or accupressure bands work for some.. But garlic works to prevent flu for some too - until it doesn 't.
Placebo effects are real, but I would not have that as my only plan when offshore.

As for the difficulty of catheterization- I maintain that it is easy to learn. My position is that the stress potential is much less if one knows how to do this - or even struggle a bit, but manages it - compared with having an acute medical emergency onboard.

Remember that acute urinary obstruction can happen without taking any medication - something the other contributor acknowledged, but then ignored.

MMurphy

Magnus,
No I don 't ignore the fact that acute retention can happen regardless of exposure to sea sickness remedies. I just wanted to make folk aware that these drugs can exacerbate a pre-existing problem. I agree though catheterisation is easy and could (should) be attempted by most folk and will be immediately effective in relieving distress.
Simon

Going back to the first post I assume nobody read the small print regarding seasickness tablets in which case the poor gentleman’s problem may not have happened. People often give medicine believing they are doing the right thing and this can include paracetamol for pain relief unaware that the other person may have an allergy to it, or it could react with medication the person is already taking. A good idea may be for all members aboard a yacht to complete a medical questionnaire so that if something does happen then you may have a better idea on how to cope with a medical emergency and how to treat it.

Airlines carry a fully equipped medical bag but cabin crew are only allowed to administer CPR that is why the call usually goes out “Are there any qualified medical persons on board” as they need a Doctor to give injections etc. The airlines do not want to get sued if an unqualified person did it, same scenario could happen aboard a yacht. Being told by a Doctor over the radio would absolve the skipper if anything went wrong.

As for carrying antibiotics, we had aboard a broad spectrum antibiotic but there again 1 in 15 people can have an allergic reaction to certain antibiotics which brings me back to the need to complete a medical questionnaire when you have someone else on board other than family.

Good Points. I agree. Even for a physician getting into an unknown medical emergency situation is no fun at all. I 've been the one on the plane forced to respond - even once when the casualty was the main pilot - believe me we 'd rather not.

But back to the suggestion of the skipper being abreast the crew 's medical history; I think that is crucial. When I skippered my own boat in the Vic-Maui race recently (Victoria BC, to Maui - about 2500 nm), each crew member had to give me a detailed account of any medical issues. It was easier for them knowing that I am a physician, but even if not, at least one person on the boat and in the abscence of a physician crew member I would suggest the skipper - or maybe someone with the most first aid training, should know each crew member 's history, medication list and allergies, sensitivities, etc. Preferably in writing so that nothing can be forgotten in a pinch. This way the medical bag can be stocked in specific preparation for any likely scenario. For instance, if someone is very allergic to a specific antibiotic, either make a LARGE note of that in the med bag, or better yet, don 't even have that particular type of antibiotic on board if there are good alternatives.
Oh and just one comment - the airlines ' medial bag is pretty pathetic, sorry to disillusion you...

Magnus

Following on from obtaining medical information there are two apps for mobile phones where you can put all your relevant medical information and can be accessed in an emergency even although your phone may be locked.

https://play.google.com/store/apps/details?id=com.clusor.ice&hl=en which is suitable for Android phones

http://support.apple.com/en-gb/HT203037 for an iPhone