TPA Treatment on Cruise Ships

[dkjretired]

My daughter asked me today if we knew whether any cruise lines have TPA treatment on board. This treatment can be live saving and help tremendously towards rehab after a stroke. Not all hospitals have this treatment, usually special facilities. The ability to give this IV within a few hours is absolutely necessary. I am interested about Celebrity, my daughter was quite concerned since I have A fib.

[Denny01]

I’d strongly recommend you check with Celebrity itself, which I assume knowing your extensive knowledge of cruising, you know to do.

 

You have a very caring daughter!

 

Den

[jkgourmet]

I'm not a nurse or doctor, but I can't imagine that they carry TPA on cruise ships, and there's a good reason why. One HAS to have a CT scan prior to getting a dose of TPA. That isn't gonna happen on ANY cruise ship.

 

Travel insurance that includes at least $250K of medical coverage is the best prevention of a catastrophe, I'm afraid.. Maybe more, depending on where you're going.

Edited August 11, 2018 by jkgourmet

[cb at sea]

Cruise ships don't generally have maintenance therapies. I wouldn't count on that being available. You should talk to your doctor about anything you MIGHT need, in the event that A-fib happens while at sea.

[Denny01]

You betcha! You need tPA within 3hrs or so for it be be very effective. If the ship Medical can handle it, it’d be a good idea to check with your Dr to make sure you have no issues that preclude using it since ther are restrictions.

 

Love this instead of some of the things we end up posting about.......and of course I end up posting about!!

 

Den

[broberts]

I believe TPA is absolutely contraindicated in the case of hemorrhagic strokes. Hence the need for a CT scan before deciding on treatment. I don't think CT scanners are standard equipment on cruise ships.

[phoenix_dream]

I believe TPA is absolutely contraindicated in the case of hemorrhagic strokes. Hence the need for a CT scan before deciding on treatment. I don't think CT scanners are standard equipment on cruise ships.

Exactly. There is no way other than a scan for them to know what type of stroke it is. If it is hemorrhagic then TPA would kill the patient (actually in all likelihood the patient would die anyway if that type of stroke hit at sea).

 

 

I understand the concern. I do not have Afib (to my knowledge) but do have two younger siblings who had strokes in the past year. Makes me think twice about alot of things.

[Silkroad]

Previous posters are correct. I’ve recently had this very discussion with a neurologist friend, due to my concerns about a dear aunt. A neurological examination and CT scan are the minimum requirements before prescribing tPA. Other diagnostic scans can rule out more disorders that may mimic strokes than CT scans do, but they’re less widely available. I very much doubt Celebrity has CT scanners aboard their ships. I’m not even certain they’d be allowed to have them, but cost/benefit analysis alone would preclude them doing so.

 

In your position, I would discuss my travel plans with my physician, and purchase excellent travel insurance with a robust medical evacuation rider. I would also consider avoiding repositioning cruises because of the long periods spent far from shore (and hospitals).

 

I worry about my dad too, so I understand your daughter’s concerns, but in the end, it’s your life, and you’re the the one best equipped to decide which risks you’re willing to take. I hope you’ll find the right cruise, and have a great time:-)

Edited August 12, 2018 by Silkroad
Addition

[dkjretired]

Sorry I didn't explain a little better, I do have Afib and am being treated with meds. My wife and son are both EMTS and both of them live with me. They have certain knowledge as part of their training and they made me aware of the necessity of having a Cat Scan. Quite frankly I don't know how extensive the medical equipment is on the cruise ships thus the question I guess from the answers they don't have the necessary equipment to make the decision. Thanks for all the help to everyone.

[jkgourmet]

During our lifetimes, IMO, TPC will never be offered in cruise lines because there will not be CT scanners on the ship. Reasons:

 

1. Used CT scanners cost $250k to $1 million. New CT scanners cost 1.5 million to $3 million. The cost variances are because of the number of 'slices' the scanner makes. The more slices, the higher the cost - AND the better to the scan. Each ship is gonna have to do a lot of CT scans to break even, let alone make a profit (which is the goal of the business.)

 

2. CT scans require specialized training to read them properly. Would you need a second doctor on board for that, a radiologist? Probably.

 

3. Liability.

 

Twenty years ago, I had a stroke at forty years old. The CT scan showed that I should NOT get TPA. I've gone to the hospital three times since with issues that MIGHT indicate a stroke. CT scan each time - no stroke.

 

Sadly, sometimes health issues make it unsafe to cruise. An acquaintance has very unstable, fragile diabetes. No cruises for him. Another gets dialysis 3x per week, but does very poorly on it. Yes, they offer dialysis on SOME sailings on SOME ships now (and isn't that wonderful!!! :) ) but his doctor said no.

 

OP, maybe ask your cardiologist - if only to ease your families concerns.

[TrustMeI'mANurse]

Absolutely not. 100% no.

 

Unless you find a ship that has a CT on board, and an neurologist to read the scan (that part can be done online) you will not be seeing TPA given in a ship infirmary.

 

It gives me a little tic in my eye to even contemplate it.

[Globehoppers]

I've been in Afib for about 9 years. Cruise frequently. Fly 14 hour routes across the oceans. Do take the medications prescribed by my cardiologist. No restrictions on travel. Several cardioversions. Once restarted Afib in the middle of the Atlantic following 30 minutes on a exercise bike (the bike's monitor gave me the indication). Went to the infirmary/sick bay for an EKG to confirm Afib. First EKG unit, a very old one, failed to work. They found a second, which confirmed Afib. Celebrity ship. Since I was already taking blood thinner medication there was nothing else to do except be aware and be careful until returning home. Debarked Civitavecchia and spent three days touring/walking Rome prior to flying back to CONUS. Back on Amiodarone once home to control heart rate (since informed that I have acquired peripheral neuropathy from the Amiodarone).

 

So, no, cruise ships do not have CT scanners on board and some of the medical equipment can be "shaky." Remember, cruise lines contract out for their medical facilities/personnel just as they do for the spas. Best is self-understanding of your condition and to follow the guidance of your cardiologist. Eighteen months ago did an excursion cruise (Hurtigruten) with landings on Antarctica - no way to medically evacuate. No problem, except for having a TKR 3-months prior (walking on rocks was a challenge). Just be aware and follow your cardiologist's orders.

 

Off to Australia/NZ in October. Long flights. Touring the Outback. You can either enjoy life or park yourself next to a medical center and wait. Nothing is a given. I suggest enjoy cruising, seeing new ports and countries, experiencing new cultures and enjoying yourself.

[Miaminice]

I'm not a nurse or doctor, but I can't imagine that they carry TPA on cruise ships, and there's a good reason why. One HAS to have a CT scan prior to getting a dose of TPA. That isn't gonna happen on ANY cruise ship.

 

You are very correct! You can not administer TPA without determining the kind of stroke - hemorrhagic or ischemic stroke.

In simple terms that means a stroke caused by a bleeding or the opposite: due to lack of blood flow. While it would help in the latter case, it will most certainly kill the patient in the other.

 

In order to determine the difference a CT is necessary - and that will probably not be available on cruise ships for quite a while to come.