Voice of Experience: When Ciguatera Strikes

After over five months of sailing from the Pacific Northwest, down the west coast of North America, through the Panama Canal and on into the Caribbean, we were finally approaching St. Maarten. We were only 100 miles from our final destination, and a giddy feeling of anticipation had begun to set in.
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After over five months of sailing from the Pacific Northwest, down the west coast of North America, through the Panama Canal and on into the Caribbean, we were finally approaching St. Maarten. We were only 100 miles from our final destination, and a giddy feeling of anticipation had begun to set in. Our boat, a 34-foot gaff ketch, was still heavy on her lines from all the stores we carried. Along with ample supplies of water and fuel, we carried hundreds of cans of food that had long since lost their appeal. To avoid opening them, we routinely trailed a line or two, hoping to catch some fresh fish for dinner.

That afternoon, a near perfect day at sea, we cleared the west end of St. Thomas and had just left tiny Buck Island to port when our fishing line went taut. 

 Bruce with a fish he caught that did not make them sick

Bruce with a fish he caught that did not make them sick

“Fish on!” cried my husband, Bruce, from the cockpit. He reeled in all four pounds of his catch, held it up for inspection and announced, “I think it’s a Sierra mackerel.” But to my eye it looked like just another fish. 

As the West Indians say, Bruce “put it to cook” and when it was done loaded two plates with appetizing seafood. The portions were huge, but not wanting to waste it, we shoveled it down.

We beat our way past St. John, Cooper Island and finally Virgin Gorda. With the last of the Virgins astern, we had only one body of water between us and the end of our journey. Anegada Passage, known to all who’ve crossed it as “Oh-My-Godda Passage,” is subject to heavy, often unlit traffic and larger-than-life seas. We had traversed it many times and rarely found it pleasant, but on that evening, with our bellies full of fish, things looked promising. “This might be our best Anegada crossing ever,” Bruce remarked, although I couldn’t help thinking, “It isn’t over yet.”

Later I was in my bunk, ready to bank some sleep, when I felt a roiling pain in my gut. Each time I started to drift off, the discomfort pulled me awake, until I knew I better get on deck. I jumped up and made the first of numerous trips to deal with vomiting and diarrhea. As my body tried to purge itself, my legs started aching. Between forays to the rail, I curled up on the cabin sole. In spite of the tropical climate and the heat from the running engine, I was soon shivering underneath a layer of blankets.

My groggy mind ran through recent events trying to diagnose the cause— who or what I’d been exposed to—and then it occurred to me, that fish! Dinner had tasted so good. It certainly wasn’t rotten, but it might have been ciguatoxic. It might have been one of those mysterious fish we had carefully avoided for years.

Ciguatera poisoning is an illness caused by eating fish that contain toxins produced by a particular sort of marine algae. The gastrointestinal symptoms are usually followed by neurological symptoms that can range from bad to worse. Symptoms can persist for days, weeks, even years, and there is no known cure. 

If it was the fish, I reasoned, then Bruce would be affected, too. I watched him from the cabin sole—he was still energized, driving the boat, checking the engine, plotting our course. The one food we hadn’t shared was a can of oranges, and I found myself hoping I was merely the victim of food contamination.

I rapidly grew weaker, and my chills were punctuated by flashes of fever. When Bruce came below to check on me, I muttered, “I think it’s ciguatera.”

“No, I think it’s that can of oranges,” he countered as he placed a cool cloth on my forehead. “Try to sleep. It’s a nice night out here. I can handle the boat by myself.”

The pain in my legs spread all through my body, and my symptoms got weirder—a feeling of pins and needles, aching teeth and the scary realization that my lungs weren’t working correctly. I wondered what we should do. We were probably within VHF radio range of the U.S. Coast Guard; we also had a satellite phone onboard. The Coast Guard could help. But how sick is sick enough? When should we call? What if Bruce was next?

I focused on breathing, forcing my lungs to pull in and release air, until eventually I fell asleep. Then suddenly an alarm sounded. Bruce was in the galley, pulling apart the engine box, trying to figure out why the engine was stuttering.

“I think it’s the fuel filter. I’m going to change it,” he announced.

“What next?” I wondered and soon had an answer. Once the filter was on, the engine continued to run unevenly, a sign of an empty tank. Bruce’s next circus act involved pulling a 10-gallon fuel jug out of the foc’sle and transferring it to the tank.

I tumbled in and out of sleep until Bruce touched my shoulder and said, “There’s something wrapped around the prop. When it gets light, I need to go in and cut it loose.”

This was a job we would normally do together—he’s the guy in the water; I spot and run for tools. The thought of Bruce diving on the prop alone in a seaway would normally upset me, but I was too sick to worry. I asked him to wake me before he went overboard, but since I could barely move, it was false security for both of us. He woke me at dawn, mask and knife in hand. When he reappeared, having cut a piece of net off the prop, I gratefully fell asleep again.

The next thing I heard was Bruce yelling from the cockpit, “Honey, do you want to see Simpson Bay?”

I crawled out to the cockpit and propped myself up in one corner. We were almost there! I lasted all of three minutes before I retreated again to the cabin sole.

Bruce anchored the boat at Phillipsburg and rowed ashore to find help. His first stop, a Dutch pharmacy, netted results. Ciguatera is common in the Caribbean, and the pharmacist knew what to do. He told Bruce it was important to keep me hydrated and that pain medication would alleviate my aching muscles. Though there is no antidote, several different medications can be used to relieve the symptoms of ciguatera. He also gave Bruce directions to the local hospital, just in case.

Bruce returned to the boat with Pedialight to help rehydrate me and an assortment of food he hoped might appeal to my flagging appetite. He pulled some pain meds from our ditch kit and recounted to me the pharmacist’s advice. We concluded I must have ciguatera. I remembered the charcoal capsules in our med box, useful for absorbing ingested toxins, but we agreed it was now probably too late. There was nothing left in my stomach to absorb.

I was bed-ridden for some time, my sleep interrupted by intense aching pain. When awake, I consumed all the food and liquids I could handle. Eventually the malady hit Bruce, too, mildly at first, but it grew stronger over time. We spent weeks down for the count, thankful to be anchored, before we were able to function again.

Over the next few years we stayed away from all fish. Just one bite, we had learned, might bring the symptoms back with a vengeance. Eventually, we resumed eating cold-water fish, but we’ll never again eat one from the tropics. Our fishing gear is long gone, but we often think of that small, very powerful fish we caught that day off Buck Island.

What We Did Right

We didn’t panic. We assessed the situation and made a deliberate choice to continue sailing. We felt it was safer to stay in open water until daylight.

Bruce was capable of

handling the boat on his own without my assistance.

We did a good job of

educating ourselves about ciguatera and were able to guide ourselves to recovery.

What We Did Wrong

 We weren’t certain about the fish we caught and should have returned it to the sea. If we had consulted books we had onboard, we’d have learned that our fish, a Spanish mackerel, was definitely not safe to eat.

We should have used our radio and/or satellite phone to seek medical advice and to notify the authorities and other vessels in the area of our situation. By making a “pan-pan” call we could have let people know that we had a situation on our hands and might require assistance. If Bruce had also started suffering severe symptoms during the passage, or if he had problems while diving on the prop, we would have been in serious trouble. If others had known what was going on, we’d have been safer and more secure.

We later learned that taking the charcoal capsules even days after ingesting the fish might have helped alleviate my symptoms. If we had sought medical advice during our passage, I might have taken the capsules in a timely manner.

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