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Dr. K.
Dr. K., Board Certified MD
Category: Medical
Satisfied Customers: 4823
Experience:  Board certified with experience in primary care.
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During a recent Baltic Cruise I had a medical problem. Ship's

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During a recent Baltic Cruise I had a medical problem.
Ship's Doctor diagnosed oedema (swelling).prescribing diuretic tablets for 4 days advising return in 4 days.This I did and he evacuated me off ship to a Hospital in Denmark with query heart as cause of swelling.
Ambulance Paramedics transferred me to ambulance on dockside and therein performed EKG. Paramedic concluded heart fine but followed ship's orders to take me to Denmark hospital.
At hospital I had blood test and Cardiologist performed diagnostic ultrasound,He concluded that heart fine for man of 65 years. He spoke to ships doctor over the phone and questioned his credentials and quizzed him as to what advice he gave with diuretics. When the response was made by ships doctor the consultant Cardiologist at the hospital Lectured him on the proper advice that must be given to patients. This was in short :-restrict fluid intake to 1.5 to 2 litres per day.Elevate legs where possible and measure every item of fluid intake. This should continue for four days after which problem subsides.
The rationale was that diuretics whilst shedding body fluid naturally make the patient very thirsty and naturally you drink to quench the excess thirst.
I had not been given that advice by ships doctors. Had I have done I would not have continued with the initial swelling but reduced it and evacuation would not then have been required.
I was left in Denmark and celebrated my 65th birthday/retirement on my own and had to get a taxi to airport hotel in Allborg Denmark. Two flights and two taxis home.
It also meant leaving my sick wife alone onboard to complete the cruise without me being there. I am her 24/7 carer as she suffers from Dementia. She becomes stressed and panics when I am not around to help her through complex travel boarding disembarkation.
The 'Missing Advice' with the medication on reflection seems fundamental. The tablets were dispensed in a plain envelope without the usual data sheet one gets when a pharmacy supplied medicine is prescribed.
I would appreciate advice regarding medical negligence and a suggested way forward.
The above evacuation caused a ruined holiday with around 800 euro extra expenditure that was not planned and still await payment by holiday insurance. This was the subject of my 1st question to your service which you have kindly advised on.
This is not negligence. Its common practice to give a person your age a diuretic when there is swelling. It is an emergency stop gap measure if heart failure could be the cause. Fluid restriction is not a treatment. The Dr did the right thing. Its never possible to know for sure if heart failure is present. Any time you are on a cruise, you run the risk of becoming ill and needing to leave the cruise. Its not the fault of the ships Dr that this happened. Sorry.
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Customer: replied 2 years ago.

Thank you for the advice. I believe you may have misunderstood my point.

I was content with prescribing water tablets for oedema - I would have expected that.I was happy to take the tablets and boy! they did what one expected and I wore the carpet out back and forth to the toilet.

My point of contention was the swelling continued due to the fact that I maintained for the key four days my fluid intake at usual levels.

Had I been appropriately advised to limit intake to 1.5 litres/day on first taking them the benefit would have been received.

I was not aware how crucial the fluid embargo was till properly advised by the Denmark cardiologist. He made it seem so obvious to me when he explained the vicious cycle that needed breaking.

Does this alter your view now and subsequent advise?

Thank you for your kind attention

No it doesnt. Fluid restriction is not helpful and can sometimes be harmful. It really would not have helped at all. In addition it appears that your hear was fine. So the edema was due to vascular insufficiency. A pair of support stockings may have helped. Thats why the diuretic pill did not help at all, it is primarily for heart failure. You cant say that restricting fluid would have helped at all. Its not an appropriated treatment.
Customer: replied 2 years ago.

Thanks for your view

As a layman, I. Have now to decide between your synopsis and the Danish Hospital Consultant Cardiologist.

It seems you both would professionaly disagree.

Should I get one of your colleagues to arbitrate? What is polite and the correct protocol in these cases.?

You can do whatever you please. I doubt youre going to get anyone else to respond. Its an 8$ question. :)
Customer: replied 2 years ago.

At the risk of appearing dumb what's an 8 dollar question?

It is just what we get paid to answer your question. Generally for the lower amounts, its not going to attract multiple experts. Sorry :)