FAQ - Do you worry about ciguatera (fish poisoning)?

 

We've been asked several times about ciguatera poisoning, how to avoid it and what happens if you get it. We've never had ciguatera (cross our fingers) and tend to avoid any fresh fish caught in reef areas. With that in mind though, a cruising friend bought some fresh fish at a market in Vanuatu and was deathly ill with it. Luckily, our good friend and naturopathic physician, Alan Profke, was in the anchorage at the time and was able to treat Isolde and help her recuperate. So, when yet another person asked us about ciguatera, it only seemed logical to ask Alan if he'd help out with a bit more advice and write up something that might benefit all the cruisers out there.

CIGUATERA POISONING. POISON FIS. (POISON FISH IN BISLAMA)

by Dr Alan Profke ND

At the request of the Nine of Cups crew, I was asked to provide some information to assist yachtsmen and women in the treating of ciguatera. I hope this helps.

What is Ciguatera?

The first recorded case of ciguatera fish poisoning was noted in 1774 in the logs of Captain Cooks' ship, the HMS Resolution. Captain James Cook himself suffered with this malady twice whilst in the New Hebrides, or Vanuatu as it is now known. The toxins that produce ciguatera come from a group of organisms called dinoflagellates that proliferate in tropical and subtropical waters. Dinoflagellates adhere to coral, algae, and seaweed where they are eaten by herbivorous fish who are in turn eaten by larger fish and so on. The larger the fish, the more toxin that can accumulate in its flesh. Gamberdiscus toxicus is the primary dinoflagellate responsible for the production of a number of toxins that bring on ciguatera. The toxins are known as ciguatoxin, palytoxin, maitotoxin, and scaritoxin. Ciguatera is odourless, tasteless and heat resistant, so the toxin cannot be eliminated by cooking.

Which fish carry ciguatera?

The fish that affected Captain Cook was thought to be a red bass, however there are many fish that carry the toxins. In fact, up to 400 species of reef fish have been identified so far that are affected by these toxins. The fish that are most likely to be affected are RED BASS, WRASSE, TRIGGER FISH, SNAPPER, SPANISH MACKEREL, QUEEN FISH, MORAY EELS, CORAL TROUT, BARRACUDAS, PARROT FISH,GROUPERS, AND AMBERJACK. Predator species are the worst affected, but other fish can carry the toxins as well.

Symptoms of Poisoning

The symptoms of ciguatera poisoning range from mild to severe and can be evident within one hour or can take up to 24 hours or more to start showing their effects. The symptoms can last for weeks, or in more severe cases, can take months or even years to finally be gone. In some cases, the poisoning has led to long term disability, but this is not generally the norm. Patients can recover and then have relapses. Many patients that have had severe cases of fish poisoning have told me of repeated symptoms months or years later after eating fish, even when the fish has not affected anyone else who has eaten it. There seems to be an association between the consumption of fish and the development of perceived symptoms even when the fish appears to be "toxin free". It has been reported that symptoms can also be triggered by nuts, seeds, alcohol, products containing fish, chicken, eggs and even exposure to bleach and other chemicals. Exercise can also trigger symptoms to surface. This, I have only found in the worst cases.

The major symptoms in humans are gastrointestinal and neurological. Nausea, vomiting, cramping in the abdomen, metallic taste, aching teeth, and diarrhea are often followed by neurological symptoms, such as headaches, myalgia (muscle aches), paraesthesia, numbness, vertigo, hallucinations and ataxia. Excessive sweating may be the first sign, however tingling or altered sensation around the lips, mouth, tongue and throat are the most common first signs. There may be numbness, tingling or extreme sensitivity or even reversed feelings of heat and cold. It has been reported that healthy partners of a ciguatera-affected person can suffer some of the symptoms after sexual intercourse, signifying that the toxin may be transmitted sexually as well. Facial rashes and diarrhea have been reported in infants being breastfed when the mother has been poisoned, so this may be another route for secondary poisoning. In the most severe cases, breathing can be affected, so the person who is affected needs to be monitored closely.

How do I know if a fish is poisoned?

First of all, when you are near an island check with the locals. They will usually know if the fish are safe to eat or not. They may point out certain areas that are affected, so the advice is steer clear of fishing in that area or even close to it.

There have been many suggestions made and theories put forth as to how one can tell if a fish is affected or not. I will list some of these here, but must stress that none of these is scientifically validated.

1. Take a tiny piece of the raw fish flesh and hold it in your mouth, preferably under your tongue. If you perceive any numbness or a tingling sensation, then ditch the fish.
2. If you have any tingling, numbness or a stinging sensation on your hands or skin whilst filleting the fish, ditch it. You obviously need to have the raw flesh of the fish make contact with your skin to have this occur, so if you wear gloves when filleting, remove them.
3. Flies will not touch the fish.
4. Cats will not touch the flesh. This one I know personally is incorrect having lost my dearly loved moggie on a trip to the Great Barrier Reef. The toxin affected him within two hours and despite our most heroic efforts to save him, he died shortly thereafter. He had eaten part of the liver of a mackerel that I had filleted.
5. Try putting a piece of fish on the ground to see if the ants will touch it. If ants continue to walk on the fish and not die, then it is considered safe.

None of these methods has any scientific validity, so I would not place a lot of faith in any of them. I personally use the sub-lingual method and to date have not suffered any effects of ciguatera. Note that I have ditched a few fish along the way that I suspected of being poisoned.

How do I treat ciguatera poisoning?

I list the following points to assist cruisers who may be exposed to ciguatera and those providing care.

First of all, it is important to monitor the patient carefully and to treat the patient both symptomatically, as well as assisting the body to detoxify the ingested toxin. It is vitally important that the affected person be resting and drink absolutely no alcohol. Keep up fluids by drinking filtered water. I also use Vitamin C, preferably in a powdered form with Bioflavenoids. In the first stages of poisoning, take 1/4 teaspoon (500 mg) in water, ingested three times per day. Make sure the patient continues to take Vitamin C, even after improvement is noted. The dosage can slowly be reduced, i.e. take 1/4 teaspoon three times per day for a week and then 1/4 teaspoon twice daily for a week and then 1/4 teaspoon once a day for a month before discontinuing.

It is also vitally important to keep the bowels open, so one should expect to move ones bowels once or twice per day. Stay away from highly salted and sweet foods. I recommend probiotics. These must be a good species. Many probiotics today are just sold for commercial reasons and are not very effective. I personally use a product from the USA called Trenev Trio or Healthy Trinity (Natren is the company in the US). In the first stages, take one capsule before morning and evening meals and, as you improve, reduce to one capsule only before the evening meal.

Liver support is vitally important, so in this regard, I use a homeopathic medication from a company called Heel (Germany). The product is called Hepeel and I recommend one tablet sucked sub-lingually before meals. This is very effective for treating the nausea and assisting both phase 1 and 2 in detoxifying of these toxins.

To treat the diarrhea, I use Saccharomyces Boulardi. This is available in 250 mg capsules and can be used in the acute phase at two capsules, three times per day. Again, as you improve, lessen the dose to one capsule three times per day and then down to one capsule twice per day until totally recovered.

Calcium channel blocker drugs have been used to reduce the severity of the symptoms of ciguatera. Magnesium is a natural calcium channel blocker, so can be added to the Vitamin C. It is imperative that the magnesium is either a citrate or a diglycinate, so as not to exacerbate the diarrhea. In a powdered form, take 1/4 teaspoon along  with the Vitamin C.

All of the above doses are for human beings 12 years of age or older. Children from 5 years of age to 12 years of age should be administered half that dose. In the case of the homeopathic medicines recommended, you can break the tablet into two.

A drug called Questran has also been used to assist in ridding the body of ciguatera toxins. This drug combines with bile acids and prevents them being reabsorbed, thereby excreting the toxin through the bowel movement. A good liver support that assists phase one and two detoxification is vital along with the probiotics that assist bowel detoxification. I personally will not use Paracetamol as this can have a negative effect on liver detoxification, and so, would recommend Ibuprofen for pain relief, if this can be tolerated.

In closing...

In closing, I must say that it is my belief that the more healthy a body is and the better the body is at detoxifying substances which is largely dependent on liver and gut health, the better the body will handle exposure to ciguatera toxin as with any other toxin to which you may be exposed.. To that end, I always suggest a least a good daily multi-vitamin that contains high doses of Vitamin B along with a good probiotic and a healthy diet.

Many cruising yachties do ocean passages and suffer sleep deprivation and, in some cases, dehydration . This can have a devastating effect on the immune system. To assist the body in its recovery and to support good health, the minimum I would suggest would be the good multi-vitamin and a probiotic. In my clinic in Australia, I seldom see ciguatera, but I often see it in Vanuatu where I also have a clinic. I have had very good results using the above to assist the many native patients I see on our island home and some of the cruisers who visit us from time to time. Without a doubt, the best way to handle ciguatera poisoning is to avoid it.

I wish you Fair Winds and Following Seas.

Dr. Alan Profke. ND. Naturopathic Physician

Brisbane, Australia and Aore Island, Vanuatu

FAQ - Lightning Protection

 

We've seen some dandy lightning and thunderstorms. In some places, like the mid-latitudes in the southern hemisphere, they seem to be pretty rare, while in other places, like Florida and Panama, hardly a day in the summer goes by without at least one big thunder-boomer. While we know quite a few boats that have been struck, we've been fortunate so far.

Actually, the odds of any one boat getting hit are low. According to Boat U.S. statistics, only 1.2 boats out of a thousand are hit by lightning in any one year in the U.S. Even in Florida, where the most claims occur, only 4 sailboats in 1000 boats are hit. If my calculations are accurate, that means Nine of Cup would have a 50-50 chance of getting hit if it spent the next 125 years in Florida. That's pretty good odds, but knowing the odds provides very little comfort when you are aboard a boat watching a big lightning storm approach, especially when you're the only lightning conductor for miles at sea.

There are three questions that come to mind about lightning protection.

1. Can a lightning hit be prevented?
2. If you are hit, how safe is the crew, and can you protect the boat from major damage and/or sinking?
3. Can you prevent damage to the electronics?

Unfortunately, there are no tried and true answers, although there's no shortage of experts providing conflicting answers. I am certainly no expert, but I offer my thoughts anyway.

Can a lightning hit be prevented? There are quite a few suggestions on how to do this. My own sure fire method is to stand on one foot, and rub my stomach in a circular motion while patting the top of my head. It works every time – we've never been hit by lightning. My method makes as much sense to me as most of the other methods I've read about. A Boat U.S. paper cites the following example: a boat “fitted with a popular "fuzzy" static dissipater at the top of the mast was struck twice in one year; ironically, the second time the bolt hit the dissipater even though the VHF antenna right next to it was higher (claim #0308082)”. Until there is a statistically valid study done, I will remain skeptical that a lightning strike can be prevented.

So, if the boat is hit by lightning, are the crew safe and can the boat be protected from major damage and/or sinking? Conventional wisdom seems to think it can. Up until a few years ago, most experts agreed that the best way to protect a fiberglass sailboat was to provide a single direct path down the mast and then to an underwater metal surface of at least one square foot. This could be an external metal keel or a grounding plate attached to the outside of the hull below the waterline. Connecting the mast to an encapsulated metal keel is dangerous – at the very least it would result in hundreds of pinholes through the fiberglass encapsulating the keel. All other large metal objects, like the stays and shrouds and metal tanks should be connected to the lightning system.

Let's assume you have a typical sailboat with an aluminum mast. You have installed the recommended lightning protective system and your boat is hit by lightning. The lightning will probably strike the highest point – the VHF antenna at the top of the mast. The voltage potential of the lightning has been estimated to be 100 million volts. A hundred million volts packs quite a wallop. The enormous current generated will find its way to the water through any path it can. Even if the bulk of the current travels down the mast and into the water via the grounding plate, huge voltage potentials still exist in the other metal objects in the boat like the stays and shrouds. Despite the fact that these are connected to the grounding plate, because of these tremendous voltages present, arcing may occur across materials that are usually thought of as insulators like air and fiberglass, resulting in “side-flashes” as the lightning finds alternate, shorter paths to the water. These side-flashes can create an electrocution hazard to the crew and/or damage the hull. So the answer to the second question is a definite maybe.

The third question is whether the on-board electronics can be protected. Most sailboats that are hit by lightning lose most, if not all, of their on-board electronics due to electromagnetic induction. When a bolt of lightning hits your sailboat, a sudden and immense current flows down through the mast and other conductors, inducing currents in any nearby conductors like antennas, electrical wiring and even the conductors on circuit boards. These induced current surges create voltage surges. Unfortunately, most of our modern electronics, like laptops, chart plotters, GPS's, and autopilots are quite intolerant of voltage surges. Some protection for the electronics can be provided by adding transient voltage surge suppressors (TVSS) to antenna and data cables, and a metal oxide varistor (MOV) to the power cables, but these are not always effective.

Back in 1831, Michael Faraday discovered that if you construct a conductive enclosure, the electromagnetic fields will only produce currents on the surface of the enclosure itself, isolating any conductors inside the enclosure. Such an enclosure is now called a Faraday cage. If you have a microwave oven on-board, this might work as a Faraday cage for your electronics. While it isn't practical to move all our electronics to the microwave whenever a thunderstorm approaches, we do store a backup GPS and VHF there.

A few years ago, the National Fire Protection Association (NFPA) suggested another approach for lightning protection. While there isn't all that much empirical data on lightning strikes to boats, there are several centuries of information on how to protect buildings on land. Buildings are protected by putting a number of heavy conductors at intervals around the outside of the building. These conductors are connected to one or possibly several terminals on the roof, and to grounding stakes buried in the earth at the bottom. In addition, all other metal conductors that a person might come in contact with, like gutters, downspouts, exterior railings, pipes, etc., are connected to the lightning protection system.

Applying this approach to boats, the NFPA published an updated standard (NFPA 780) in 2011 that recommends using the stays and shrouds as well as the mast as conductors to the water. All these conductors would be connected together at deck level, and several paths to the water would be implemented. This, in theory, would greatly reduce the likelihood of side-flashes. Since all these conductors would form a rudimentary Faraday cage, it might help protect on-board electronics as well, especially if TVSS and MOV devices were also incorporated in the lightning protection system.

In theory, the new standard seems to make sense, but there are several issues to think about before taking the plunge and incorporating a new lightning protection system. First, there is no one formula for every boat. Each boat design has to be carefully evaluated with respect to stays, shrouds, chain plates, internal metal tanks, thru-hulls, metal lifelines and other metal conductors when designing the lightning protection. Once designed, it will be difficult and expensive to retrofit an existing vessel.

In addition, since the standard is relatively new, there aren't that many boats that have incorporated the new system, and therefore there is not much data showing whether the system really works and/or whether the standard needs to be tweaked a bit in the next revision. I know, that's sort of a “Catch-22” - no one wants to incorporate the new system until there is more data, and there won't be any more data until more boats incorporate the system.

So what have we done on Nine of Cups? To date, we have virtually no lightning protection system. We will take a “wait and see” position on the new standard. And of course we will continue with the lightning prevention technique that has worked so well for us in the past - standing on one foot while rubbing our stomachs and patting our heads and hope the odds stay in our favor. So far...so good.

FAQ: Do you work along the way to add to the cruising kitty?

 

“Feeding the kitty” is a common point of discussion among full-time and part-time cruising folk. Maintaining the boat, adding or replacing equipment, living expenses, fuel, travel expenses … everything adds up and without a solid plan and/or regular income source, cruising can quickly become a memory instead of a way of life.

If you plan to remain in your home country, working is easy. Some folks we know maintain regular jobs, live aboard in a marina and sail away on weekends, holidays and vacations This is very restrictive, but they're still living on a boat. Others pick up casual work in the different ports they visit. If they have a specific skill, canvas work or rigging, for instance, they can usually pick up some work easily. Otherwise, a local chandlery or West Marine is usually hiring.

Sailing out of your home country, however, poses a whole other set of issues if you plan to work. First of all, unless you have a work visa, it's usually against the law to work in other countries. Again, if you have a specific trade you can sometimes offer it to other yachties. We've met dentists, barbers, vets, and riggers who sell their services to other cruisers. Some artists create jewelry and artwork to sell along the way. We've met some consultants and full-time writers who work from their boats. Communication is sometimes an issue, but with a little foresight, they manage. Some cruisers have found casual work in foreign ports and get paid “under the table”, but it's not something you can rely on.

That said, seasonal work, like fruit picking for instance, can provide a short-term, legal influx of cash if you're physically willing and able. Teaching English might also be a valid alternative, although when I taught English in Ecuador, it was gratis.

A growing number of folks we've met, cruise for half a year, leave their boats in a local marina and go home to work. After all, there's usually a good season for sailing and a bad season, no matter where we go. Go home for hurricane/cyclone/rainy season and work. Come back when the weather is fair, the sailing is good and the kitty has been replenished.

As an electrical engineer, David has helped innumerable other boats with electrical problems, but he's never felt comfortable charging people for his services. Cruisers help other cruisers. There's not usually any financial remuneration involved. Any work he's done ashore fixing generators and solar panels is all gratis to the local community. We get paid in friendship, fresh fruits and veggies and sometimes lobsters. These feed us, but not the kitty. Don't count on other cruisers as a good income source. We're a rather parsimonious lot by nature.

We do write articles for several sailing magazines and get paid for them. Marcie sells photographs once in awhile. Neither of these provide enough to live on. So... do we work along the way. No. We bought our boat outright, paid off all debt before leaving to cruise, had adequate savings and stick to a reasonable budget. Recently, we've started collecting Social Security. It's not much, but the kitty loves it.