Health Onboard

Oct 13th 2017

I have been meaning to blog about health items aboard sv Honey Ryder for quite some time.  Interesting that I picked today since I'm feeling a tad under the weather.  Nothing serious, just a sore throat indicating that a cold is in my future.  No doubt some airplane bug I picked up with all the cruisers flying back in here.  So many cruisers with grandkids slobbering all over them right before they board the airplane to come back here.  Ugh – kid kooties!  I am trying to rest and stave off the coming cold - yeah right!  But "resting" does give me the chance to blog a bit.  Some of this might be a bit too much info (TMI) but maybe it will help others in some way. 

Anyway, health items – I am going to discuss in categories.  We actually stay pretty healthy on sv Honey Ryder.  An occasional rash, cold, sore or pulled muscle.

 

Skin Rashes -.  Our most frequent challenge onboard is skin rashes.  In this hot, humid, sweaty environment, we end up with our fair share of skin rashes.  Some simply come from the environment – (wet, sticky), while others are contact rashes (contact dermatitis) from various plants and fruits (let's not forget the Mango Rash).  Still other rashes come from the sea - our being wet with seawater on a daily basis as well as stings and scrapes from microscopic sea creatures.  A recent inventory of our med kits proved that rashes are our biggest challenge.  We have a VAST assortment of meds to treat all kinds of skin rashes, from simply over the counter to strong creams, and pills - Prednisone to Cipro.  On the serious side, Tom did end up with a case of Cellulitis.  His was relatively minor.  We only knew what it was because a fellow cruiser got a bad case in Guyana / Tobago five months earlier. His took three rounds of different antibiotics to kill it.  Scary!  Because we caught Tom’s early and it was not as serious, I started him on a basic, old school antibiotic, thinking that if that one didn’t work, we have two stronger, different antibiotics we could work our way through if needed.   As for me, I have a recurring neck rash at the base of my neck.  It has been diagnosed and I have prescription body wash to keep it at bay and cream (which works only so so) if I do get it.  This season I decided to try something new, Anti-itch Monkey Butt Powder.  I know, crazy name.  Tom used this for the first time this summer while doing a crazy 340 mile endurance canoe race.  They used it on their hands to keep from blistering.  It was amazing and worked really well as he only got 1 little blister after 58 hrs of constant paddling.  So, I decided to bring some back to try on my neck.  I have never been a powder person at all so this was a first.  I powder my neck each night before bed.  It has worked wonders in keeping sweating down and thus I have yet to get my neck rash.

Muscle Relaxer -  We have a supply or two of generic Flexrall for pulled muscles and strains. 

Pain Killers – We have an assortment of pain killers.  Over the counter equivalents of ibuprofen and Tylenol – Panadol  * Panacetamol (brand you find this in Caribbean, UK and Europe and probably the rest of the world).   Nubtone is generic Relafen.  I have 500mg and 750mg.  Finally, strong pain killers like Vicodine, Oxycontone and such. 

Filling Prescriptions  – Many prescriptions can be filled in the Caribbean without a new script.  In fact, most of the time, that is the case unless it is a really serious “controlled substance” type med.  If you have a bottle of blood pressure med or cholesterol med or such, you simply take the bottle into a pharmacy and they fill it.  And this is at all pharmacies big and small in all Caribbean countries.  So lest you think it is just some shady, local pharmacy.  No.  Sometimes they don’t have the exact USA brand.  We often end up with South American or European or India brands.  And I know many USA persons worry about counterfeit drugs.  However, again, these are legitimate pharmacies just like CVS or a smaller regional like Bruce Smith in KC.  The label often says “Bayer South American” or some other big pharma company found in the UK or India.  If you think all your prescriptions you get in the US are “Made in the USA” think again!  They may be US based but those pills are coming from someplace offshore in most cases.  Sometimes getting the other brand will mean two pills to make up for the one pill dose you might get in the US.  Additionally, many, many items that are prescription only in the USA are available from the pharmacy without a script or bottle at all.  For example, birth control pills are available without a script.  When we're stateside each year, we try to do our routine, annual doctor appointments and tests but only if they are covered 100% by insurance.  Otherwise we go here in Trinidad.  We work with the US doctor/nurse/PA to be sure that they are prescribing generic drugs off the discount pricing list at Wal-Mart Pharmacy as much as possible.  I am talking about the $4 and $9 drug lists.  We actually take that list to our appointment.  This takes some work.  Healthcare providers are not yet used to patients managing the scripts and costs to this level.  We have had to be firm at times.  Of course, not everything is available on the discount list.  For those items not available, I hit the internet for discount coupons.  This takes some work at well.  I find GoodRX the best – no sign up or login.  It is amazing how much the coupons help – big discounts.  Wal-Mart seems to have the lowest discount list costs and regular costs.  I also find they are the best at applying the coupons and working with me to suggest additional cost savings.  I try to go early in the morning before it gets busy.   When we get our scripts filled at Wal-mart I do not use insurance.  Our insurance does not cover prescriptions.  I have no idea of there is a discounted rate.  I don’t think there is or if there is, it is not much.  By using drugs from the $4 and $9 list and no insurance, we can purchase a year supply,  Using insurance, you are only allowed 30 -60-90 day supply depending on the med.  Not good for daily med as a cruisers out of the country.  Frankly I have never understood this.  If I am on daily med, prescribed by my doctor, why the hell can’t I go ahead and get a year supply?  Anyway, back to our annual supply – any specific drugs that are not daily like antibiotics or pain meds, we try to get as many refills as the healthcare provider will allow.  Wal-Mart is great because they don’t even make me come back for the refills.  They will let me get all the refills.  I just tell them I am going to be traveling outside the USA extensively and I want to have meds with me in case.  I let my primary know in advance of moving aboard that we were going cruising and what all that entails –well in advance.  Right before moving aboard, I had a full range of tests and he prescribed a wide variety of drugs for us to use just in case. Tom’s doctor did the same.  It has been a little more of a challenge since.  For example, last year I wanted a new prescription for Prednisone.  I called the doctor’s office.  They wanted an appointment.  When I called back, I explained “I don't have a rash now.  I will be traveling internationally in the Caribbean over the next several months and I want have this with me.”  They still wanted me to come in.  “WHY?  I don’t have the rash now?”  Didn’t matter, I had to come in which mean an office visit fee.  No thank you.

Records - Speaking of which, be careful what you tell USA healthcare providers because it goes in your record.  In other words, we now say “We will be traveling extensively out of the country for several months” which is true.  Some insurance limits how long you can be out of the country and still have coverage in the US.  BTW – our ACA (BCBS KC) only covers us in the USA.  We also have DAN (Divers Alert Network) insurance that covers us while cruising but really only for emergencies and such.  Back to the whole be careful what you say, I was shocked at what my medical records said when I gathered them all prior to setting off.  It was the wording.  Example – you go to the doctor and you always have to fill out a basic health form – Do you have this?  This?  This?  When?  Family history of this?  This?  Have you ever smoked?  Drank?  How much?  Ect….right?  What shows up on your record is not yes or no with the details you put but “Patient CLAIMS this.  Patient CLAIMS that.”  OMG!  I know that sounds like a small change but think about how big the ramifications of that small change are.  There are other little things.  So be truthful but be careful, don’t over share unless you are really comfortable with your doctor/provider.  You should get a copy of all medical records.  Start early, this is a process and involves fees to third parties.  Electronic are the best.  Backup on a drive or Dropbox is good too.  I have also made a several quick spreadsheets that I have printed off and keep in a folder.  When we go to a doctor now, we take the spreadsheets.  Tabs are as follows :  Sabrina Drs, Sabrina Med, Procedures – starting with most recent back to when we moved aboard with additional for past surgeries, important procedures and inoculations, Sabrina Drug Allergies, Tom Drs, Tom Meds.  Yes, he is much healthier than me, his lists are shorter.  I update the lists as we travel and print out new spreadsheet each hurricane season.  Having the printed form is just easier for us then having it on a phone, ipad, flashdrive or other.  What if your cell phone/ ipad is loss/damaged/stolen or battery goes dead or not access to the internet and thus Dropbox on the way to the doctor/clinic, hospital? 

Health Insurance –

Affordable Health Care was a huge relief for us when it passed.  We both have preexisting conditions.  Mine was an exception that WAS NOT covered prior to ACA even though I had surgery to correct and am doing fine.  Under ACA, we choose a plan each year that is a basic level with high deductible ($5000) each.  This covers us when we are in USA in case of emergency or serious illness.  DAN (Divers Alert Network) insurance is $155.00 each.  It covers emergency, serious illness and evacuation if needed and approved.  This is not limited to diving but covers us while cruising.  When we need simple treatment in the Caribbean, we pay out of pocket.  Healthcare costs are much, much, much lower here.  In fact they are actually reasonable.  I will be doing another blog specifically on this.  The ACA insurance is based on our income which is substantially lower now that we are not working.  Thus we qualify for subsidies.  Our insurance was approx. $200 a month for both of us last year and $150 a month for both this year.  It went down!  On the same income it went down!  Again, ours is a bare bone basic plan with high deductible.  We also live in a metro area so we had options on plans and found most healthcare providers take it.  However, with the all out war on ACA, who knows what will happen next year. 

Warning Political Rant Ahead  – ACA is not perfect.  No Government plan is!  It needs tweaking and fixing NOT replacing.  It works!  Shame, shame, shame on politicians if they repeal and leave millions of now insured American’s without equal insurance or no insurance.  There will be hell to pay if that happens.  Serious, hell to pay!  DO NOT leave me a comment that health care is not a right.  Are you freaking kidding me?  Healthcare and care of ALL American’s is the morally right thing to do.  In a civil, well functioning, modern society you should not have to mandate healthcare for all but want and demand it for all.  A healthy society is a functioning, good society.  And don’t tell me people should earn it – really?  The majority of all Medicaid (poorest of the poor) are children – CHILDREN.  So implementing a mandatory work requirement is just stupid.  Ohhhh……don’t get me started.  But I know I am probably preaching to the choir here so I will stop.  Rant over, back to health aboard sv Honey Ryder.

Coming up next - healthcare costs