Seasickness

Or, I Didn't Know it Could Happen to Me!

Somewhere in this blog I said once that seasickness can turn into a true medical emergency. I wish I could figure out where I said that so I could quote it now.

Last week my sailing club, BCYC, went on a three day sailing trip, Saturday through Monday. We planned to sail to Moore's Crab House on Longboat Key on Saturday, and then on Sunday go on to either Sarasota or Twin Dolphin Marina.

Meanwhile, age had started to catch up with me. I had an extremely sore knee, which my doctor's office determined to be caused by arthritis. Because I don't tolerate NSAIDS (as in, they could kill me), they put me on Prednisone. I was prescribed the standard blister pack, with a big dose the first day and then tapering off over the next five days. The Nurse Practitioner was sure my knee would be better in a few days with this.

That was Wednesday. Wednesday night and Thursday I took the big dose, and by Friday I had started tapering off. Unfortunately the blister pack fell out of my purse Friday night at the grocery store, so I missed a dose, but the pamphlet explained how to handle that, and the grocery store returned my pills to me Saturday morning, so I left on the weekend trip as a guest on someone else's boat. I was looking forward to it. She has a Catalina 27' and they can be a lot of fun to sail.

Unfortunately, the boat didn't have a chart plotter, and as three boats including my boat and her Catalina were planning on a 10-day trip in a few weeks, I convinced my friend to try my chart plotter. Another friend put in the cable at the last moment, but unfortunately soldered it to dead wires. He didn't have time to re-wire it before we left. So we had no chart plotter.

Samantha Ring, the skipper, is a good navigator, but we had gotten a late start and we wanted to get in before dark. "No worries," I said. "I have Navionics on my cell phone. I'll use that, and it will take us right to the entrance of Longboat Key Channel." It's a tricky entrance, and Samantha was glad to be able to be very precise about where it was.

So as we went out the Pass-A-Grille Channel, I huddled in the cockpit, with head down and hat shielding the sun so I could see the screen. This version of Navionics has few menus, probably to save on space, so it was a job to figure out how to do it, but after about 20 minutes I finally got a route in and it started tracking our boat.

Unfortunately, the channel had been quite rough, and I started to feel pretty sick. Next thing I knew, I was hanging my head over the leeward side calling -- several times -- for Ralph. It was fortunate, I thought, that I had eaten breakfast so early. My stomach was empty. I figured that was the end of that.

Well, it wasn't. Turns out that Prednisone has a tendency to trigger nausea. I got sicker, and sicker, and sicker. It didn't go away. Eventually I had dry heaves. I couldn't say two words without calling for Ralph in between them. Samantha was beginning to worry. We had had some mechanical problems with the boat that had delayed us. While the boat was now sailing very well, we didn't really know why the mechanical problem had happened, and we were afraid it might happen again. The fuel gauge said she was low on fuel.

I wasn't in a state of medical emergency yet, but it was close to 5PM, I was still retching, and it would be several hours before we got to shore. We both thought I might be in pretty rough shape by then.

Samantha triangulated a precise location for us and called the Coast Guard.  The Coasties initially weren't certain they needed to come, but after some debate (their flight surgeon finally said "Go get her!"), they came out and got me.

While I am extremely grateful to them, it was a terrifying ride. Their boat was moving at at least 50 mph forward (and about 80 mph up and down!) I had declined riding in the cabin because I saw nowhere I could call for Ralph without making a mess in there. I said I would ride in the back, and one of the Coasties rode with me, holding on to my life jacket. I was glad -- we were bouncing all over the place. I nearly landed on the floor a couple of times, and there was an open space in the gunnels I would have fit through! I looked inside the cabin. Those chairs had huge shock absorbers, and the three crew in the cockpit gently bobbed up and down. Meanwhile I was in the back, bouncing hard -- BANG! BANG! BANG!  I clung to what I think was a gun turret, very glad the gun wasn't there as it would have gotten in my way. I was soaked from ocean spray.

Somehow I made it in to the Cortez Bridge Coast Guard Station without soiling their boat. An ambulance was waiting to take me to a nearby hospital. I was glad to be on land!

We did not call for help too soon. While I seemed to finally be done bellowing for Ralph, I hadn't had any food since 6:30 AM, and had only had about 6 oz. of diet soda to drink since the boat had left the dook about noon. My blood chemistry was a little off, and the ER doctor invited me for an overnight stay. I really had no choice. I was in south Bradenton; I had no wearable clothes (never mind why); my car was up in Gulfport; and all my friends were 15 miles south of me. They had no cars either, but it didn't matter, because the battery on my phone was dead (Navionics uses up a lot of battery power) and I couldn't call anyone to bring me clothes and give me a ride home.

It was a good thing I stayed in the hospital. In the middle of the night they drew blood again, and I got the news Saturday morning: my blood chemistry had continued to go sour overnight, and I was now very sick. They were very glad I had opted for admission.

It was 3PM on Monday afternoon before I was released.

It turns out that Prednisone's tendency to trigger nausea is multiplied if you don't finish the blister pack. Oops.

Here's my point: even if your doctor tells you lots of information about what you're taking, even if the pharmacist buries you with details, you still don't know everything about that medication under all possible conditions. Or you might not be on any medications at all, but also not realize that you are about to come down with strep throat or a bladder infection, both of which can make you nauseous. At any time, there could be events sneaking up on you that could turn a minor bout of seasickness into a serious medical problem.

My seasickness did not become life threatening only because I got to the hospital when I did, but ... even though I was very sick on the sailboat, I did not have the classic symptoms of someone about to crash from dehydration. Only a blood chemistry analysis let the doctor know that I was actually headed for a medical cliff, and because I was already in the hospital, that was prevented. If we had waited for the classic symptoms of serious dehydration, I would have been in a whole lot of trouble by the time I got to the hospital. The flight surgeon knew something we did not: moving from "Oh spit I really don't feel good" to "How do you call 911 from a sailboat?" can happen very, very rapidly.

Talk to your doctor about how to manage seasickness. Experiment and find out how you react to Bonine, to Dramamine, to the little wrist bands (they don't work for me but some people swear by them), etc. Know yourself. If you're going on any kind of extended trip, have your crew try these things ahead of time as well.

Then talk to your doctor about the realities of sailing (in particular, being some hours from medical help) and ask what you can stock on your boat. I know they make rectal suppositories that can turn off nausea when someone can't keep anything in their stomach long enough to help. If we had had those suppositories on the boat, it might have saved me 2 days in the hospital, with, I think, a $125 deductible for each day for me to pay, plus $250 for my share of the ambulance. If I could have gotten the nausea under control, I could have drunk Gator-Ade, which includes the potassium I needed so desperately. It all might have been a non-event.

This, by the way, answers, forever for me, the question of whether I should *ever* use Navionics on my phone. Never. Again. Ever. Never. Using the chart plotter, you can still see the horizon. If you can see the horizon, you're less likely to get seasick.

I might have gotten sick anyway. I am now on a new blister pack of Prednisone ("You are NOT going sailing while you're on this, right?" the NP asked.) No ma'am. I've learned my lesson! Maybe because I have just been through so much, this round of Prednisone has made me a little nauseous. I've taken Prednisone before without any nausea, but not this time.

Seasickness really can turn into a medical emergency. I never thought it would happen to me, but it did. It is something to be prepared for.

...

Oh yeah -- one more piece of advice, probably something everyone on the planet with a cell phone except me knew: keep a list of emergency numbers with you. If I had done that, I still could have called a friend from the hospital phone. It wouldn't have changed my medical condition, but would have relieved me of the vision of me walking out of the hospital bare-assed!