Long-term health effects of being lost at sea?

How much drinking water they have had? Surviving more than 7 days at sea without drinking water (or desalination device) is a rarity.

30 days without any food (strict fasting) but with water available is probably not a big issue for any otherwise healthy grown up person. "Official" (medically supervised) 30 or even 40 days fasting programs were performed so far; I've personally seen people participating in one of them (40 days) during their regular daily work - and doing well. 30 days without food is not necessary a big malnutrition issue (of course some potassium and vitamin B1 and C deficiencies can occur in this time, but not likely with long-term and untreatable consequences).

As far as I know (medical faculty) you don't get "painful joints" or anything long-term what would be specifically related to 30-day fasting or severe dehydration.

Now, you can wait for a pediatrist to come here and give his expert opinion about the 6-years old.

Hmmm. What about gout? There's a dietary component (perhaps the stranded folks had enough to eat, but only of certain foods) and it also runs in families, so you could believably have him be the only one to suffer from it out of the group. It's very painful (some female sufferers say worse than childbirth!) and typically affects the joints, as this is where the crystals tend to build up.

Perhaps something related to the exposure rather than the scarcity of food or water on board? Or to a lack of medical care? As a kid I had this ridiculously high fever and I haven't been able to regulate temperature well since then. The doctor tells me I have to have another responsible adult around any time I'm feverish, and there are things it's alright for most folks to do to deal with symptoms of a cold that I shouldn't ever do.

Or, maybe your character did something physically taxing on his joints for a long periods of time to keep the thing afloat, and it's only starting to affect him now. Battered-but-not-torn cartilege can sometimes not bother a person after the initial inflamation goes away, until the natural wear that comes with age starts to add up.

Dehydration can trigger pain in the existing or silent gout; the pain lasts until dehydration lasts, I'd say. I don't think one month of dehydration would turn an asymptomatic gout into a chronically painful gout.

Kidney damage if they were on reduced water rations?

So, I'm not a doctor. But, on hearing this, my first thought was that maybe he picked up some kind of parasite from eating raw seafood. I did a bit of snooping and found some interesting wikipedia articles, but my PCs crashed so I lost it all . Although eating Freshwater fish raw is considered more dangerous than Saltwater, there are still risks attached. If you haven't considered if you may try some googling and get something useful

N.B. Apparently not even the Japanese eat Sushi truly raw. It's freezed at very low temperatures for some time first to kill off any bugs. Makes you think..

In what era does your story take place?
Have you considered the psychological effect of being adrift for 30 days? It could be dealt with , if the story is set in a time and place where he would get some help with dealing with his experience. Mental problems could be triggered by a memory that he had suppressed.
Some of the information here:
http://www.survivaltopics.com/survival/how-long-can-you-survive-without-water
might be of use to you.

Long-term aftereffects from sun exposure?

Were they lost at sea in a warm climate or a cool one? Consider possibilities such as malaria (which can recur near indefinitely- ouch!) and the Epstein-Barr virus.

Hell, psychological impact can show up years later with painful physical symptoms! How'd I miss that? Myalgic encephalomyelitis ("chronic fatigue syndrome") for example. Literally crippling joint pain being the most prominent symptom. Not always the result of trauma, but if it doesn't hit in the early 20s, the chance of that being the cause is higher. Strikes more women than men, but in men it seems to preferentially strike soldiers, emergency workers, and general heroic types.

How did the group end up lost at sea in a dinghy? What happened while they were on board? I'm specifically wondering if the guy could have sustained some sort of impact force.

My dad was in a pretty serious car accident at 33. Along with the things they treated him for (ruptured spleen, partially collapsed left lung from his stomach going through his diaphragm, and shattered left pelvis), he also had undiagnosed/untreated damage to the vertebrae in his spine. Ten years later, he was diagnosed with severe osteoarthritis in his spine (along with chronic Hep C from the blood transfusions ).

If your guy was banged around hard enough, it's possible that he sustained similar injuries that weren't bad enough to warrant diagnosis/treatment in the immediate aftermath. But as age catches up to him, it could easily turn into arthritis. Just a thought.

I'll split my post into two sections, one on the beating/joint abuse route and one on CFS/ME. I can also ask a doctor buddy of mine on another message board, if you want.

BEATEN/ROWING:

I completely forgot to mention that this would have a disastrous effect on the ability to survive starvation. See, an otherwise healthy person can go several weeks without food specifically because the body cannibalizes tissues like fat and muscle. What most people without a lot of medical knowledge aren't told is that if there is a lot of inflammation in the body- regardless of cause- then the chemical signals the brain secretes to start up that process get ignored. The same person who can go weeks without food normally will be in big trouble (very weak, and possibly near death) if they've recently been beaten, have a cold, have been extremely hard on their joints, or anything like that. Because their body is neither being fed nor eating itself like it usually would if not fed.

Now, if there was anybody on board who'd know this, and nobody else on board was beaten (Mr. Leader Type took the brunt of it for standing up for 'em?) then maybe he was administered something to keep inflammation at bay for a few days, meaning his normal response to starvation would commence unhindered. I'm not sure but I could easily find out if regular ol' aspirin or ibuprofen would do the trick. There's usually some in emergency first aid/survival kits anyway.

That said, if the fishing is real good, blackrose602's idea works great with this. If he's already swollen from being banged around by the baddies, and THEN ignores the inflammation (which is partly the body's way of saying "Hey! Don't move me!") to do something strenuous on the joints, you've got a lovely recipe for athritis! This is even more plausible than if he just did something strenuous.

If this is the route you choose to go, you might also need to consider the potential of unseen scarring.

CHRONIC FATIGUE SYNDROME:
This one has a lot of flexibility in symptoms and degree of severity, some folks can go through a few months of treatment and be alright, others end up bedridden for life. Most are in between, and will improve with treatment but still be adversely affected the rest of their lives.

Onset of myalgic encephalomyelitis frequently follows an injury or long illness (which could include long-term partial starvation/dehydration/etc). This is especially true of patients who were never emotionally or sexually abused. Besides the joint pain, he would experience persistent tiredness, typically more of the achiness/feeling crappy variety than the drowsiness/dozing variety. Rest wouldn't help. After exercise of any kind he'd experience malaise, meaning a general, seriously icky feeling and sense that something is wrong with your body.

If he's suffering from M.E. you could add on any or all of the following depending on how bad you want it to get: othrostatic intolerance (difficulty standing for too long), constant or recurring sore throat, frequent headaches, constant or recurring cough, tender lymph nodes, night sweats.

Occasionally M.E. can also bring on a disruption in heart rhythm, a disruption in bowel habits, or the onset of a new allergy.

JoNightshade said:

With your dad, was an actual fracture or what? Did they not see it, or he didn't feel it until later? Just wondering how it went undiagnosed.

The character is the type of guy to be like "no no I'm fine," and just continue powering on through his life until he crashes. At the point when my story starts, he's hit that wall and is still in total denial.

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I'm not totally clear on how it all went down with my dad, because I was only 8 when it happened, and he's pretty fuzzy on the details (was on very heavy painkillers in the hospital). But from what I understand, they did X-rays of his back and didn't see anything, and he didn't have paralysis or any obvious symptoms.

He was so badly injured otherwise, though, that they only gave him a 10 percent chance of making it off the operating table...and there were other obvious things, like his left ear being partially detached. So it's possible that they missed something. When he developed the arthritis ten years later and had MRIs done, the doctor told him he had the spine of a 90 year old, many of the discs were almost touching!

My dad's exactly the same as your character--my cousin went for a hot air balloon ride about a week after Dad got out of the hospital, and we were on the chase crew. The company also offers skydiving. Dad hobbled up to the guy in charge, still on crutches, unable to put weight on his left leg at all--and completely seriously, not being facetious, asked if he could go skydiving the next day! Years later, he sprained his ankle a few hours before we left for a vacation in Atlanta. He climbed Stone Mountain two days later, wearing a walking cast.

Just keep in mind that if your guy's stubborn like that, he'll still be the same way even after the health conditions kick in. Two years ago, now 100 percent disabled from osteoarthritis, Hep C and COPD, and bearing two shiny new stents in his heart, Dad had the opportunity to touch a glacier when we were in Alaska. So off he went across three glacier streams, using his cane to measure the depth. He once had a psychologist tell him, "You know, sometimes you're going to do something and it's going to hurt like hell. But it'll be so worth it." Dad was in pretty severe pain while crossing those streams. But he kept yelling out, "It's so worth it! It's so worth it!" Your guy will likely feel the same.

I love Raventongue's ideas as well. My mom had chronic fatigue syndrome for several years before she passed of sleep apnea. She had pretty much every symptom on the list, as well as narcolepsy. It's a pretty nasty condition, and frustrating as hell for someone who's used to being alert and active all the time.

ETA: Dad used a travel scooter for a long time after he was diagnosed. But a little over a year ago, he saw the head neurosurgeon at Shand's in Gainesville, FL. He said that there's no real cure except major back surgery, which might or might not work, but Dad's spine is stable and he's not going to break or damage anything. Between that and having his new primary care doctor prescribe Arthrotec (a miracle drug that's not narcotic), Dad has pretty much abandoned his scooter and is getting more exercise than ever. So your guy's likely to "give in" at first, fearing massive damage, but if a doctor gives him an all-clear, then even if he hurts, he'll do stuff anyway.

Also, when Dad first got his stents, the doctor told him to take it easy for the first few weeks until his body adapted. Knowing his love of theme parks, the cardiac nurses gave Dad specific instructions to stay off of roller coasters until his next appointment. Dad spent the night at the hospital, got out and went straight to Disney (the hospital was 20 minutes away). He called the cardiac nurse's station to check in, and got the "stay off the roller coasters" lecture again. So he tried to convince them to let him ride Tower of Terror. "But it's not *technically* a roller coaster." This was his second cardiologist, by the way. The first one told Dad he's "not normal" when he asked about roller coaster BEFORE the stents were put in, when he had a 99 percent blockage in the widowmaker artery.

Raventongue said:

Were they lost at sea in a warm climate or a cool one? Consider possibilities such as malaria (which can recur near indefinitely- ouch!) and the Epstein-Barr virus.

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Mosquitoes aren't found in the middle of the ocean, so that's out. If it weren't, I'd suggest chikungunya, which can leave its effects behind for years.

Current day. Well, ten years prior to present day. The lost-at-sea thing is back story to the current day tale.

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Ah, thanks. That rules out my other thoughts which were based on Custom of the Sea - see http://en.wikipedia.org/wiki/R_v_Dudley_and_Stephens

Skin cancer from being sunburned?

It would be a lot worse than plain sunburn- human skin doesn't like being wet for extended periods of time, and even less so if the water is salt. Add sunburn in and you've got sores that you may never fully heal from.

Severe sunburn on the part of the skin that is usually not exposed to the sun (back, upper thighs, feet...) may cause skin cancer (melanoma) years later. Now, melanoma is not exactly "chronic." Basically, either it can be treated completely or you die from it.

Acute renal failure from a prolonged episode of dehydration could cause some sort of permanent kidney damage that could slowly develop at some later time, but this would need some research...