Friday Funny 06-03/2022 (Another Stunt)

 

Yes, you guessed it.... I had another trip, (see what I did there), to the doctor. 

See that piece of the support for the dock column, normally they are flush with the deck, but this one isn't. I wasn't paying attention, and tripped right over it, landing on my side hip, elbow, and knee. Ouch. Bill helped me back up, and I took advil for the swelling. The next morning, my wrist was out of shape, so a friend drove me to the ER at the Sitka hospital.

As a friend reminded me, I do my own stunts!

I got x-rays of my wrist, elbow, and knee, nothing broken, just some bone contusions, and a wrist brace. I got off light this time. 

We've been hanging out in bays around Sitka, getting some medical appointments accomplished. I had my 30 day post op on my eyes with a local optometrist, and Bill has a doctor appointment later in the month. All is well with my eyes, he even gave me some samples of a "near" contact lens for my left eye. When I wear it, it eliminates the need for cheater glasses. That works well with me, since I wore contacts like this for many years, one contact in the right eye for far, and one in the left for near. I feel like I have the best of all worlds now, far sight in both eyes, and when I want, I can put in the one near contact for reading, sewing, etc. 

Redoubt Bay has been a great place to hang out. Behind those falls is one of the largest lakes in Alaska, and the falls shrink and expand as the tide comes and goes. 

A mooring buoy is available for smaller boats with a shallow draft.

Steep steps, and no handrail.

There are steps leading up to the trail to the lake, and a couple of rowboats to explore the lake from. We had some kayakers show up in the bay, and they hauled their kayaks up the steps to check out the lake for the day.

The internet is spotty here, so that's all the upload frustration I can handle for today. 

As always, we enjoy hearing from you, either here in comments or on our Facebook Denali Rose Sailboat page.

Friday Funny 02-02/18 (On the Mend?)

Eventually

As The World Turns, or so goes the Days of my Life....

My last doctor visit was Monday, and he basically said, "Go forth and walk." That advice surprised me, because the x-ray they took that day showed the breaks hadn't healed yet. When the technician put the photo up on the screen, my heart sank, I thought he was going to say, " Another month of non-weight bearing." Guess again! I'm not a doctor, and I don't play one on TV, (or in real life).

Bionic leg

I put arrows at the breaks you can see, the fourth one is behind the rod, and pins that now exist inside my leg.

My knee is kind of numb, and stiff, but doesn't hurt, and moves fairly well. My ankle is still swollen, and has an odd shape. It also sends shooting zingers out to my leg quite frequently. They say it's because the nerves, and surrounding muscles are getting used to the foreign hardware, and it will eventually settle down. I know this is correct advice, because I have titanium hardware in my wrist also, it did the same thing, and now it's fine.

Bill always says, "Injuries will be amputated."

I'm scheduled for my first physical therapy appointment, for my ankle on Friday. Yes, they initially said no PT needed, but that has changed.

I'm going to the PT office that my niece used to work at, and others in my family have gone there for therapy as well. The office recognized my name right away, "Oh, another one needs help." They must think we are a bunch of dare-devils or something. I wore my new hoodie to the doctor's office, they thought it was funny. It will be appropriate for the PT office too.

Stunt Family

Getting ready for the doctor appointment, it's kind of hard to balance with crutches, and take a selfie.

I should stop doing stunts.

I'm really not trying to be the Bionic Woman, unless I can get that cool background sound when I jump.

Go, go go

The next part of the story here.

As always, we enjoy hearing from you, either here in comments or on our Facebook Denali Rose Sailboat page.

Friday Funny 12-29 (Follow up, or part tres)

Temporary setback.

I had my first follow-up doctor appointment since the surgery on my leg. Mostly all good news, whew!

My leg splint that I wore for 2 weeks after surgery.

Cutting off the leg splint.

New hardware.

I won't post the repulsive photos of my bare leg. Imagine, (if you want), three incisions, secured with staples, and a purple, green, yellow swollen leg that hasn't been shaved in over two weeks. Okay, I bet you're done with that.

They pulled the staples out, one by one, (about 30 of them), ... ouch, ouch, ouch. My brother held my hand, because I warned him that I might be light headed over such things. I didn't look, but he assured me that they used a very cool tool, and the staples came out easily.

The doctor's instructions were: 

No air travel for 1 month

NO weight-bearing on the leg for 1 month

No physical therapy needed. I can move my knee, and hip easily now, and when the swelling goes down in my ankle, I can start to move that as well. 

I received a removable boot, so I can shower easier, and wear a sock, and regular pants. Yippee! No more ugly sweatpants with one leg cut off. I pretty much live in yoga pants regularly anyway.

While I was web-surfing, I saw this: 

Bedazzled!

Since I didn't get a cast to decorate, this may be just the thing. My brain is whirling with, "What can I do to make this plain black boot more attractive and fun?"

Perhaps this posted on it:

Maybe I should quit...

I'll stay with my family in Anchorage for another month, and hopefully over time, I will be able to do more things for myself. My boating friends who keep their yacht in Wrangell, and live in Anchorage, are helping me out with all the "broken leg" equipment I could ever ask for. They have loaned me, a shower chair, and have offered a deluxe version of my walker, wheelchair, or crutches. I'm going to try them out this weekend, and see if they help with my mobility.

Just me, and the stairs......

When the month is over, I will go back to Orthopedic Physicians, for an x-ray. After looking at it, Dr. Powell will decide what will be next in the process, and tell me how and when to start putting weight back on the leg.  I'm kind of curious to see the x-rays, and the new hardware, as well as the bones knitting together. I have my original x-rays, and can compare the old to the new.

I'm hoping by then, that we will have a land place to live for a few months, and the doctor will release me to fly home to Wrangell. I'm kind of missing Bill, my kitties, and all the wonderful Wrangellites, and Petersburgers. (I'm not sure either one is a word. 😀) I miss Denali Rose also, but that's off limits for now.

Do you have any suggestions to dress up my plain black boot? Do you like sequins? Do you get squeamish at seeing injuries, especially your own? 

Have a HAPPY NEW YEAR everyone!  🎉🎉🎉

As always, we enjoy hearing from you, either here in comments or on our Facebook Denali Rose Sailboat page.

[Here is the next post about this incident...]

Friday Funny 12-15 (Friday wasn't Funny)

Sounds good to me.

If you've been following along, you know that we decided to spent the holidays on the boat in Petersburg, Alaska, while  enjoying new friends, and the Norwegian festivities. Previously I had shipped all of my Christmas presents to our Wrangell address, so we decided I should fly to Wrangell, pick up mail, packages, bring back a few boat parts, and fly back to Petersburg with the loot. The trip would only be a couple of days.  Best laid plans......

In Wrangell, where I was staying, I had gone through several months of mail, loaded it into a rubbermaid tub, and was going down a flight of stairs to carry it out to my car. I misjudged the number of stairs, and took a tumble. I won't make you recoil from the gory details, but it was a bad fall. I called 911, had an ambulance ride to the hospital, where it was determined that their limited staff couldn't handle the multiple bone breaks, and a Medivac flight on a Lear Jet was arranged to take me to Anchorage. If you're a boater, cruiser, or world traveler, DAN Boater (Divers Alert Network, Travel and Emergency Medical Services) is worth it! They will get you to medical care world-wide.

Medivac Lear Jet, as they were wheeling me on the stretcher through the hanger.

Inside the jet, the view from the stretcher.

The view out the window, very pretty. I wasn't in pain, good drugs.

The short ending is: I had surgery to repair the 4 breaks in my tibia, and fibula. They inserted a rod, and pins, and I am not allowed to put my weight on it for at least 6-8 weeks, or more. (TBD) I'm using a walker, and a wheelchair to get around. I also can't get on and off of Denali Rose. I've been released from the hospital, and I'm staying at my brother and family's home in Anchorage while Bill is still in Petersburg with the boat, and the cats. We're missing each other, but it's the circumstances we have.

We're researching our options for renting ground floor housing in a place that also has Physical Therapy for the next 2-4 months. Who knows where... stay tuned.

As always, we enjoy hearing from you, either here in comments or on our Facebook Denali Rose Sailboat page.

[Here is the next post about this incident...]

First Aid Training, Knowledge, & Supplies

This post has now been added to our list of Stuff we have and use [and do...] sidebar where we will keep it up-to-date in the future.

Please read that updated version.

________________________________

Original Version:

We prefer exploring remote areas- both on land and sea. [Or is it we prefer to stay away from crowds...?] Consequently, we lean toward self-sufficiency and focus on prevention as well as preparedness. 

This philosophy is also our approach for rescuing a person overboard; we focus most of our efforts on preventing it from happening– leaving rescue procedures for last.

As part of our safety briefing with guests we discuss accident prevention. To emphasize how important injury avoidance is to us, we warn everyone that injuries— no matter how minor— will be amputated. No exceptions...

Invariably this prompts questions about First Aid kits, preparation [training] and most importantly, prevention.

From my experience, the answers to questions regarding how much training [and kit content] depend upon where and how we will be traveling [e.g., sailboat cruising, kayaking, and hiking in this context] and how isolated the areas will be. [i.e., How self-sufficient do you need/desire to be in an emergency?] 

I personally believe proactive prevention, followed by reactive training is even more important than the first aid supplies onboard for ocean crossing and remote area coastal cruising. Proper training will help you deal well with emergencies and give you the knowledge to formulate [and evaluate...] your own concepts for what to carry in your kit(s). 

Training will also help you find your balance for risk tolerance vs. those associated with your planned adventure(s).

I believe proper training also facilitates efficient communication with remote medical support services in an emergency. [e.g., Working with medical specialists over a radio or phone. (i.e., Telemedicine) It also makes it easier to obtain prescription meds for your kit(s)...]

There are, however, those who feel specialized First Aid training is not useful because they believe those lacking a medical background will not benefit from nor retain unpracticed training. [e.g., Dr. Welch]  

Do you agree?


How our strategy evolved:

We are prone to traveling in fairly remote areas where it is often unusual to see another vessel [or person] for days, or sometimes weeks at a time.

Therefore, when pondering prevention, First Aid kits [and training...] the first question we ask ourselves is how long might we have to cope with an emergency situation before we could anticipate the arrival of qualified assistance? [Whether that be someone arriving on scene- e.g., an ambulance; or us transiting the patient(s) to medical facilities.]

In a big city, it might be 10-20 minutes or so before an ambulance arrives on scene. Much First Aid training is based upon this scenario. But what if it took 2 hours; or 10; or a day; or two days before you could reasonably expect qualified assistance? [Whether they are coming to you, or you to them...] 

Ask yourself if you are you prepared for that...

Delayed [or remote via voice call; e.g., Telemedicine] assistance is the more likely scenario for a cruising boat. [See the Yachting World article in Additional Reading section, below...]

Can't we just read a good First Aid kit and book and be prepared for most contingencies?  

Possibly... And you could possibly read a book about sailing or driving a car, and then just go do it... 

More questions to ask yourself: [or; what did we ask ourselves...?]

Could you stand to listen to someone you care about [or a stranger for that matter] moan and scream in pain while you to read [and interpret] a book, or use an app on your phone? [Will your hands be clean and dry enough to use either?] Can you keep pressure on that bleeding wound, and/or keep their spine immobilized while you search your reference materials for what to do next? 

If there is more than one injury and/or patient, are you comfortable deciding who to assist first and the priorities of treatment?

In a remote location scenario, are you prepared to converse effectively with medical professionals on a phone or radio, provide the feedback they request, and understand their advice and guidance? 

If you answered yes to all of the preceding questions, then there is no need to waste more of your time here...

So, what is our current strategy? 

We plan around hands-on medical assistance [on-scene or self-transport to assistance] always being a minimum of 1-4 days out. Even if we activate an emergency beacon [e.g., EPIRB, PLB] or make a sat phone or radio call. Therefore we try to be prepared to cope and manage for 4 days as our designated worse case scenario. 

Figure this out for yourself and it will help you decide how comfortable you are with your level of knowledge and preparedness... Because we figure we may have to be self-sufficient for up to 4 days in a medical emergency, we both obtained Emergency Medical Technician [EMT] and other training. 

A reasonable alternative for those who cannot commit one or two college semesters to EMT training [EMT levels 1 and 2 are all we felt we needed] is the NOLS Wilderness First Responder [WFR] course [80 hours in 9 full days in a row- mostly outdoors...] 

Whether you have EMT, Paramedic, or NOLS WFR training, the NOLS Advanced Wilderness First Aid course [WAFA] is icing on the cake. [40 hours over 5 full days- time divided between classroom and outdoors...]

We really got a lot out of the NOLS WAFA course, and highly recommend it. But either of these courses will boost your knowledge and confidence immensely.

We have also heard very good things about the Offshore Emergency Medicine course by Wilderness Medical Associates International, but have not had an opportunity to attend one... yet... [Textbook included in book references, below.]

Do we really need all of this training?
   Hopefully not.

Have we had occasion to put it to use?  
   Unfortunately, yes. [More below...]

Do we need such diverse First Aid 'kits'? 
   Again, hopefully not. [But we don't normally need fire extinguishers either...]

Would lack of training or First Aid supplies prevent us from pursuing our adventures? 
   Not a chance. 

But if I have learned one thing about myself [with many requisite lessons in humility...] it is the more I delve into a subject, the more I discover I don't know... 

So, I have proved to myself more than once that ignorance truly is blissful– but not very useful in a pinch...

If you plan to always be close to first world societies and reliable means of emergency communication and transport, then you may be able to justify [rationalize?] less knowledge and training. 

It all depends on your personal risk tolerance, desired level of self-sufficiency, and the situations you may encounter on your chosen adventures. 

To help mitigate the risk of delayed response times in remote areas, we joined DAN Boater. 

This service [note: this is NOT insurance...] includes a 24/7 emergency medical hotline and worldwide emergency evacuation– among other related services– for US$100/year for a [US or Canadian] family [up to 5 individuals.]

This is a no brainer for us...

First Aid Kits

What supplies do we include in our First Aid kit(s)? [We found we were better able to formulate our own lists after some advanced training...]

A good initial reference [for boaters] is Practical Sailor's series of articles on this topic which includes evaluations of commercial First Aid kit offerings for various levels of need.

Independently, we decided upon the Adventure Medical [Marine] Kits line of offerings for our major kit. 

We have 4 levels of kits ranging from the usual stuff we need for minor, day-to-day issues, up to major trauma kits with neck braces, various splints, IV solutions, an AED in the near future, etc.

Adventure Medical Kits also happen to be what NOLS and many other organizations rebrand and sell.

We have amassed various levels of First Aid Kits, and carry what is appropriate for the adventure at hand. For instance, we have about everything you could need on the boat; carry a smaller subset of that in our kayaks, and an even less when exploring on land... [And no, we are not 'gram weenies'... Our kits are somewhat larger than many...]

For our boat ditch bag kit [and for grab-and-go and more extreme emergencies onboard] we chose the Adventure Medical Marine 3000 kit, and supplemented it with additional items we felt were worthwhile for our current risk factors. 

List of supplies included with basic kit

We added items like a traction splint, 4 neck braces in 3 different sizes, inflatable arm and leg splints, additional IV solutions, tooth/cap repair kits, Epi-pens [and spare ampules of Epinephrine and syringes...] fast dissolving [sublingual] antihistamines, prescription antibiotics and painkillers, high energy goo packs, and other specialty items. 

If you are wondering why we added some of these items [or what they are...] then you may be ready to augment your first aid knowledge...

We stow our kits in [truly waterproof] ditch bags made by Watershed. [They also make military bags and rifle cases Navy SEALs swim with... These are not your typical roll-top 'dry' bags– which in our experience leak if left floating on water for a while; and definitely leak if submerged...] 

Here are a couple of our ditch bags: the yellow one is the typical non-waterproof floating bag packed mainly with waterproof signaling and communication devices, and a few survival goodies. 

The red bag is one of our Watershed ditch bags currently containing our near-shore survival gear. [e.g., tent, sleeping bags and pads, food, cooking supplies, etc.– all packed in waterproof bags within the ditch bag... Remember we are playing on the Inside Passage at present and ditching the boat would typically lead us to shore quickly...]

The black snake on top of the bag is a paddle board leash. We install bungee style leashes on all of our ditch bags to safely and easily tether them to us, the raft, dinghy, etc. in a hectic emergency situation...

And speaking of ditch bags— we have 3; not including the First Aid Kits— stand-by for a separate post on that topic...

Many cruisers choose to make up their own First Aid Kits. Using the list from the Practical Sailor reference, above, and/or one of these commercial offerings is a good starting point if you decide to do that. 

However, we have discovered there really isn't much savings building our own comprehensive First Aid Kit(s) [especially if you include your time...] We also feel that the organization and ease of refilling/reordering contents included with the commercial kits is a worthwhile added value for us.

What is in our medical library? 
[We are not including EMT and other specialty titles here...]

Emergency and general First Aid: [In alphabetical order- by publisher where applicable]

• Hesperian Health Guides:
• Where there is no Doctor
• Where there is no Dentist
• Marine Medicine: A comprehensive guide 
• Included with Adventure [Marine] Medical Kits
• NOLS: [Not a DIY resource; requires the training...]
• Wilderness Medicine
• Wilderness Medicine Field Guide
• Wilderness Medicine Pocket Guide 
• Helps get you past 'brain freeze' in an emergency...
• Where there is no Pet Doctor  [If you have pets onboard as we do...]

Other books worth considering include:

• Merck Manual(s)
• Various titles of interest; great for diagnosing and treatment
• Don't forget the Veterinary version if you have pets...
• Physician's Desktop Reference [PDR]
• Various titles; useful if you need to understand medications in remote situations
• Wilderness and Rescue Medicine 
• Offshore Emergency Medicine course textbook referenced above

Have we ever been put to the test as a couple?

Yes, but luckily our personal worse injury to date [and here's hoping this record holds...] has been a fractured wrist; in inclement conditions at night in a remote setting on shore during a kayak trip. [Colles' fracture; very painful, but more inconvenient than life threatening...] Third-party water evacuation back to our vehicle– 20 kayak paddling miles away– was not possible until the next day [~16 hours- and one overnight- later] due to timing and inclement conditions. Subsequent ground transport and arrival at a medical facility occurred late on day 2. [~21 hours after the incident...] All-in-all not bad— unless you were the patient...

Lessons learned from that incident:

• More powerful pain relief meds were needed. [Now in inventory. Otherwise the kit was more than adequate.]
• Voice communication with rescue and transport resources [via sat phone in this case] is invaluable in an emergency requiring assistance. [Without that, it would have been 4 days before conditions abated enough where I could tow the patient- in their sea kayak- roughly 20 miles back to our vehicle, and then drive another 2 hours to medical facilities...

Is that the worst incident I have ever been involved with? Unfortunately, no...

I hope this explanation of how our strategies developed will help you continue your own discussions, and that you never have the occasion to test your First Aid skills or use your kit(s)!


Additional Reading of Note:

• Attainable Adventure Cruising: Medical Emergencies eBook
• Modest membership fee required, and so worth it to us...
• DAN Boater: member stories 
• Yachting World: Telemedicine at Sea

Please leave a comment sharing your First Aid strategy [and philosophy if you like]; favorite preventative measures; books on this topic; and any unique inclusions in your kit(s), if any. 
[e.g., We don't need snake antivenom in our current latitudes...]

Friday Funny 02/24 (First Aid Knowledge)

Gus loves cat puns, he thinks they are funny!

So we, (mainly me), survived the NOLS Wilderness Advanced First Aid Course, and even though we've both had EMT training, we learned quite a bit.  There's a difference between patient care in urban settings, and wilderness settings. Mainly you're on your own, no 911, no screeching ambulance, no well-trained paramedic.

In attendance, we had two great instructors from out of town, and 26 students from Sitka, Juneau, Petersburg, Ketchikan, Wrangell, and Olympia WA.

No CPR needed!

We did have some odd CPR practice dummys. This is how they were described: Actar has a pale white head, with a blue cyanotic torso, and a cold black heart.

You attach the head to the torso, and put the round heart into the hole in the center. The heart has accordion folds that compress when you use your CPR technique on it. We also had CPR mouth guards to practice keeping body fluids to ones-self.

Getting instructions from Steve.

Steve demonstrating the "breastbone nuggie" on Bob, used to try to wake up an unresponsive patient.

Actar has a question.......  or does Brenda?

As part of the course, we received, the NOLS Wilderness Medicine, (6th ed), folder with NOLS info, course handouts, and the Wilderness First Aid pocket guide. 

All good resources. (We put a Denali Rose logo sticker on ours. 😀 )

Laminated for water-proofness. (Is that a word?)

We were encouraged to bring out own first aid packs, so that we could practice how easy/hard it was to use in an actual scenario. We brought the large one we used on multi-day kayak trips. We also used our packs to hold items that were supplied by NOLS for our outdoor medical scenarios.

Bags lined up, ready for the next outdoor medical emergency.

During the day, we would learn Patient Assessment, and medical practices, and then it would be announced, " get suited up, we're going outside for a scenario". Out would come the rain-pants, coats, boots, (a majority of Xtra-Tuffs, it's an Alaskan thing), hat, gloves, and tarp, or ground pad. If you were designated as a patient, the scene usually had you lying on the ground.

Annie, our other wonderful instructor.

Rapt attention, and note taking.

Steve explains....

Over the course of five days, as the patient, I had broken wrists, (I was an expert actor at this), broken clavicle, bruised rib, broken ankle, and horse-kicked in the kidney. As the medical care provider, I splinted arms, wrapped ribs, taped ankles, was supposed to diagnosis a diabetic in confusion, (didn't get that one, now I know), and a bunch of other ailments.

The first two days of class were rainy, so I didn't get any photos of us lying in the rain, and mud.

We're spread out, awaiting someone to care for us.

Asleep or hurt?

Mike is roll-playing a 13 year old girl who was kicked by a horse in the kidney, but won't admit it...

Then we gather to de-brief, and ask questions.

Added bonus, it's SUNNY outside.

Annie likes to use wound makeup, and she bruised me up. As part of the course, it's important to expose the injury, so it was good to have something that the student could find, and treat.

Clavicle bruise

Broken wrist.

How's that for a realistic horse kick?

One skill that I didn't foresee, or know that we were going to learn, was how to use a syringe.

(EEEEK, a hard one for me!) Steve was demonstrating the syringe, and had the man next to him expose his arm, and Steve plunged it in. OMGOSH, he didn't really do that did he!!!! Not only DID he do it, he expected us to do it too. I would have been better prepared, and not as queasy, if I had eaten breakfast that morning. I ended up using a sleeping mat instead of a real person. (FYI, I wasn't the only one using the mat.)

I did it! 

We ended the week on Friday with what Steve calls, "a celebration of knowledge". Which is instructor speak for we're taking tests. We did a written, and a scenario test. Bill and I did the scenario together, and passed our Patient Assessment with flying colors. (Trivia fact: Flying Colors is a nautical term for raising your flag showing that you have been victorious.)

A few of the students had to catch the afternoon flight home, so some of us, (and a few spouses), met at the Marine Bar and Pizza to decompress, eat pizza, and enjoy adult beverages.

Holly from Alaska Crossings, and Steve.

Holly and the staff at Alaska Crossings was the local organization that coordinated, and hosted the NOLS course. Thank you so much for providing this for us. We learned some valuable skills, enjoyed ourselves, and made some new friends. It's all a win-win.

For those who are Star Trek fans.

That one cracks me up, but this one is really more my style.

Would you like to take a course like this one? NOLS has 2 day, 5 day, and 10 day courses, as well as multi-week expeditions. They take place all over the world, even in Alaska.

Do you know CPR, or advanced First Aid?

Update: 15-Mar-2017 Follow-up post: First Aid Training, Knowledge, and Supplies