GL: Fwd: Michigan Woman Boater Dies from Head Trauma (Sting Ray)

[Thomas L Rogers]

---------- Forwarded message ----------
From: Thomas L Rogers <tomlrogers at gmail.com>
Date: Tue, Mar 25, 2008 at 4:33 PM
Subject: Michigan Woman Boater Dies from Head Trauma (Sting Ray)
To: great-loop at lists.samurai.com


Fellow Cruisers,

Unfortunately for this woman she was in the wrong place at the wrong time
when the sting ray took flight.  Head trauma of the nature she suffered was
likely unavoidable even with protective equipment.  A video last year posted
on the list showed speed boat occupants being struck by Asian carp and some
wearing hockey helmets!  Last week I had the opportunity to care for a
patient (boater) that fell a short distance from a ladder  while adjusting
the winter cover on his boat and sustained a subdural hemorrhage (SDH). The
fellow was on blood thinners and his symptoms came on gradually and were
attributed to fatigue initially. Fortunately we intervened with transfusions
of plasma and he was discharged without the need for surgery.

As boaters we are constantly exposed to the inherent risks leading to  falls
from uneven moving and slippery surfaces, fatigue, poor lighting, a sun
downer or two, etc.  I would like to create an appreciation for boaters that
even seemingly minor head trauma if using blood thinning medications can
have serious complications or even lethal consequences if unrecognized and
untreated.  I offer some information based on my experience as a Trauma PA
at Level I and II centers for 25 years having seen many forms or major
trauma... it is the minor fall  that seems innocent that I bring to your
attention... not to be an alarmist so take it for what it is worth and of
course as they say "consult your physician".

Three medications that are commonly used as blood thinners are Aspirin,
Plavix (clopidrigeol) and Coumadin (warfarin). Hopefully you are familiar
with the use and side effects if you or your cruising partner are required
to be on them for different indications however I am often surprised that
patients are not well informed.  Quite likely you are in reasonable health
and may have had a heart valve replaced, bare metal coronary stents or
atrial fibrillation that allow you to enjoy a cruising lifestyle but are
safer on medication to prevent blood clot from forming (risk management).  I
will confine my comments basically to Coumadin as it is widely used
for patients with a history of leg blood clots that could migrate to the
lung, atrial fibrillation or heart valve replacement and needs to be in a
therapeutic range (INR 2-3).  Plavix or combinations of medications are
frequently used for coronary stents, although there is a test to measure the
platelet inhibition they are not routinely done.

So what is the message...

When starting coumadin the level, INR, needs to be checked two or three
times per week for the first week to monitor the response.  If you are just
starting this medication a week without monitoring may be to long however it
is possible to have out patient labs drawn and the results sent to your
doctor although it may not be convenient or timely. As you and your doctor
learn the necessary dose over several months it is possible to do spot
checks 1 or two times per month however...

Dietary changes can drastically change the response... Vitamin K present in
leafy veggies, legumes, peanuts, cooking oils are the biggies... they
decrease the INR and increase the risk of blood clots. The usual response
from the physician or PA or NP is to increase your coumadin dose and monitor
the response,  then you take a nice trip for a few weeks and change your
diet,  alter your schedule or maybe miss or take an extra  dose, have a few
extra sun downers and there you have the the dilemma, is it to high or to
low?  Herbs and new medications can change things either way and you should
not take aspirin containing medications when on coumadin unless recommended
by your doctor.

*Soft signs* to be aware of vary but usually you will notice bleeding easily
from your gums while brushing, more than the usual bruising on the thighs as
they strike the gunnel on lumpy passages perhaps a nose bleed that lasts
longer.  You may notice darker urine although it is not always blood and
even dark stools or frank blood in the head (potty).  If still menstruating
the bleeding is usually more and longer.

*Hard signs* that would instigate immediate treatment to include a cat scan
to evaluate for possible subdural, epidural or intracranial hemorrhages and
a blood draw to evaluate the INR. Symptoms include a known blow to the head
of someone on blood thinners with or without a loss of consciousness,
unequal pupils, head aches, nausea or vomiting lethargy or mental status
changes.  You should go to the nearest Trauma Center immediately NOT an out
patient clinic or minor emergency center . Please call for emergency
evacuation and ambulance transport as the person may deteriorate rapidly.

 I could go on but feel this forum may not be the place to continue.  I will
reply to any further interest off-list however it may be a day or two before
I can post a reply.

Bottom Line...  Hopefully you and your cruising partner are healthy and do
not require any blood thinners now or ever... BUT what about that guest you
brought aboard that did not understand the marine environment (risk
management)?  You may encounter an unexpected emergency in that  remote
location on our travels.  At least find a polite way to ask if someone
aboard has health issues or takes blood thinners before you plan an extended
time with them aboard your vessel.  You may be able to accommodate their
established diet and have a plan if problems develop.  No special diet is
necessary,  just staying consistent with what you eat and keeping to the
dose and schedule is the best you can do between monitored blood draws.

At last, our Michigan hard water is becoming softer this month... hurrah!


To your good health,

Tom R
Cat's Away
MotorCat30
Oscoda, MI

tomlrogers at gmail.com
HP 810 635-4628
CP 810 287-8397