An 8-Week Telehealth Remote Management of a Lower Limb Vascular Condition with Evolving Diagnosis at Sea

Patient: 58-year-old male
Rank: Senior Officer
Vessel: Cargo

Initial Consultation Date: May 1, 2025
Final Case Closure: June 26, 2025
Total Duration of Monitoring: 8 weeks

Case Overview
While at sea, senior officer onboard a cargo vessel presented with acute onset of pain, swelling, and redness extending from below the left knee up to the mid-thigh. The patient reported a pain scale of 8/10 with no history of trauma. Onboard medical assessment raised concern for cellulitis or superficial phlebitis, and empirical therapy was initiated including anti-inflammatory and corticosteroid medications. Vital signs were stable; however, close monitoring was deemed essential due to the possibility of progression.

Given the remote location and lack of immediate shoreside access, the patient was managed under close telehealth supervision, with daily check-ins and response to evolving symptoms. A shoreside referral was arranged at the next available port in Tokyo on May 2, where the initial diagnosis of phlebitis was made. Oral antibiotics were prescribed, and the patient was deemed fit to continue working with advisories for escalation if symptoms worsened.

Telehealth Monitoring & Case Escalation
Over the following weeks, the case remained under tight telemedical observation. Despite initial clinical improvement, a relapse of symptoms prompted re-evaluation. The case was re-opened on May 24 and the patient was referred again. A definitive diagnosis of Deep Vein Thrombosis (DVT) of the left leg was confirmed via Doppler ultrasound during a subsequent shoreside consult.

The patient was prescribed an anticoagulant along with associated gastroprotective medications. Given the seriousness of the diagnosis, telehealth protocols allowed for frequent medication reconciliation, monitoring of side effects (e.g., gastrointestinal bleeding), and decisions on dose adjustments while the vessel continued its voyage between ports in Asia.

Outcome
The condition improved steadily, with leg pain resolving and inflammatory signs subsiding. The patient remained hemodynamically stable throughout and completed the full course of anticoagulation therapy under remote guidance. The case was officially closed on June 26, with the patient advised to continue taking the anticoagulant until he could be seen by his primary care physician upon his scheduled sign-off on July 29.

Demonstrating the Value of Telehealth in Maritime Operations

This case underscores the critical role of telehealth in ensuring timely, continuous medical care onboard commercial vessels. The patient, a senior officer with critical operational responsibilities, was successfully managed at sea for a potentially serious vascular condition without unnecessary delays or medical repatriation.

The multi-week, structured telemedical follow-up allowed for:

• Ongoing clinical reassessment
• Triage for appropriate timing of shoreside referrals
• Monitoring of treatment response and side effects
• Prevention of complications such as embolism or systemic infection

In situations where shore access is delayed or unavailable, telehealth provides a vital bridge, ensuring seafarer health and operational continuity. The effective resolution of this case highlights the indispensable role of digital health solutions in modern maritime medicine.