Medical Q&A: A year adrift on the Pacific?

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Medical Q&A: A year adrift on the Pacific?
Sea survivor Jose Salvador Alvarenga looks at his mother Maria Julia, as she cups his chin in her hand, during an interview, after arriving at the airport in Mexico City, Friday, March 14, 2014. The Salvadoran fisherman, who was lost at sea for 13 months, traveled from El Salvador to Mexico to fulfill a promise he made to his dead sea mate, Mexican Ezequiel Cordoba. Alvarenga said Cordoba died a month into their ordeal because he couldn't stomach the diet of raw fish, turtles and birds. (AP Photo/Marco Ugarte)
Pacific castaway Jose Salvador Alvarenga (C) accompanied by his parents, Jose Ricardo Orellana (L) and Maria Julia Alvarenga (R) waves upon his arrival at Tapachula airport in Chiapas state, Mexico, on March 14, 2014. Alvarenga, the Salvadoran castaway who says he survived more than a year at sea, flew to Mexico Friday to visit the family of a man who died during the odyssey across the Pacific. Alvarenga washed ashore in the Marshall Islands on January 30, telling reporters he survived the 12,500-kilometer voyage in a seven-meter fiberglass boat after leaving Mexico's Pacific coast 13 months earlier. AFP PHOTO/ Elizabeth RUIZ (Photo credit should read ELIZABETH RUIZ/AFP/Getty Images)
Sea survivor Jose Salvador Alvarenga pauses during an interview, after arriving at the airport in Mexico City, Friday, March 14, 2014. The Salvadoran fisherman, who was lost at sea for 13 months, traveled from El Salvador to Mexico to fulfill a promise he made to his dead sea mate, Mexican Ezequiel Cordoba. Alvarenga said Cordoba died a month into their ordeal because he couldn't stomach the diet of raw fish, turtles and birds. (AP Photo/Marco Ugarte)
Sea survivor Jose Salvador Alvarenga, center, embraces his mother Maria Julia, after they arrived at the airport in Mexico City, Friday, March 14, 2014. The Salvadoran fisherman, who was lost at sea for 13 months, traveled from El Salvador with his parents to Mexico to fulfill a promise he made to his dead sea mate, Mexican Ezequiel Cordoba. Alvarenga said Cordoba died a month into their ordeal because he couldn't stomach the diet of raw fish, turtles and birds. (AP Photo/Marco Ugarte)
Sea survivor Jose Salvador Alvarenga, center, embraces his mother Maria Julia, after they arrive at the airport in Mexico City, Friday, March 14, 2014. The Salvadoran fisherman, who was lost at sea for 13 months, traveled from El Salvador with his parents to Mexico to fulfill a promise he made to his dead sea mate, Mexican Ezequiel Cordoba. Alvarenga said Cordoba died a month into their ordeal because he couldn't stomach the diet of raw fish, turtles and birds. (AP Photo/Marco Ugarte)
Pacific castaway Jose Salvador Alvarenga gestures upon arriving at Tapachula airport in Chiapas state, Mexico, on March 14, 2014. Alvarenga, the Salvadoran castaway who says he survived more than a year at sea, flew to Mexico Friday to visit the family of a man who died during the odyssey across the Pacific. Alvarenga washed ashore in the Marshall Islands on January 30, telling reporters he survived the 12,500-kilometer voyage in a seven-meter fiberglass boat after leaving Mexico's Pacific coast 13 months earlier. AFP PHOTO/ Elizabeth RUIZ (Photo credit should read ELIZABETH RUIZ/AFP/Getty Images)
Pacific castaway Jose Salvador Alvarenga speaks to the press upon arriving at Tapachula airport in Chiapas state, Mexico, on March 14, 2014 as his father, Jose Ricardo Orellana, looks on. Alvarenga, the Salvadoran castaway who says he survived more than a year at sea, flew to Mexico Friday to visit the family of a man who died during the odyssey across the Pacific. Alvarenga washed ashore in the Marshall Islands on January 30, telling reporters he survived the 12,500-kilometer voyage in a seven-meter fiberglass boat after leaving Mexico's Pacific coast 13 months earlier. AFP PHOTO/ Elizabeth RUIZ (Photo credit should read ELIZABETH RUIZ/AFP/Getty Images)
Fatima Alvarenga, embraces her father, Jose Salvador Alvarenga, 37, the fisherman who says he drifted at sea for more than a year surviving on raw fish, turtles and bird blood, after arriving at his hometown in Garita Palmera, El Salvador, Wednesday, Feb. 19, 2014. Alvarenga, 37, underwent a battery of tests after returning home from the Marshall Islands, where he washed up after what he has described as 6,500-mile (10,500-kilometer) journey from Mexico that began when his small fishing boat was thrown off course by bad weather. (AP Photo/Salvador Melendez)
Salvadorean castaway Jose Salvador Alvarenga holds a microphone upon his arrival to El Salvador international airport in San Luis Talpa, 50 km south of San Salvador on February 11, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Johan Ordonez (Photo credit should read JOHAN ORDONEZ/AFP/Getty Images)
Salvadorean doctor Manuel Bello speaks during a press conference about the health condition of his patient, castaway Jose Salvador Alvarenga, at the San Rafael hospital in Santa Tecla, El Salvador on February 12, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Johan ORDONEZ (Photo credit should read JOHAN ORDONEZ/AFP/Getty Images)
A woman buys a newspaper with the a picture of castaway Jose Salvador Alvarenga in the front page, in Santa Tecla, El Salvador on February 12, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Johan ORDONEZ (Photo credit should read JOHAN ORDONEZ/AFP/Getty Images)
Salvadorean Health Minister Maria Isabel Rodriguez speaks during a press conference about the health condition of castaway Jose Salvador Alvarenga, at the San Rafael hospital in Santa Tecla, El Salvador on February 12, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Johan ORDONEZ (Photo credit should read JOHAN ORDONEZ/AFP/Getty Images)
Salvadorean castaway Jose Salvador Alvarenga speaks to journalists in an ambulance on his way to San Rafael hospital in Santa Tecla, El Salvador on February 11, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Marvin Recinos (Photo credit should read Marvin RECINOS/AFP/Getty Images)
People wait outside the family house of pacific castaway Jose Salvador Alvarenga at their house in Garita Palmera 118 km. west from San Salvador, El Salvador, on February 11, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived in San Salvador to the warm embrace of a family that thought him dead. AFP PHOTO/ Jose CABEZAS (Photo credit should read JOSE CABEZAS/AFP/Getty Images)
Salvadorean castaway Jose Salvador Alvarenga arrives in a wheelchair to El Salvador international airport in San Luis Talpa, 50 km south of San Salvador on February 11, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived home Tuesday to the warm embrace of a family that thought him dead. Alvarenga traveled across the ocean by plane this time, two weeks after the fisherman washed ashore in the Marshall Islands, telling the world he had floated for 12,500 kilometers (8,000 miles) in a small boat. AFP PHOTO / Johan Ordonez (Photo credit should read JOHAN ORDONEZ/AFP/Getty Images)
In this photo released by El Salvador's Foreign Ministry, Foreign Minister Jaime Miranda, second left, Vice Foreign Minister Juan Jose Garcia, third left, and Vice Minister of Health Violeta Menjivar, right, greet Jose Salvador Alvarenga, who lies on a stretcher after arriving at the airport in San Salvador, El Salvador, Tuesday, Feb. 11, 2014. Alvarenga was wheeled in a wheelchair before a crush of more than 100 mostly foreign journalists. But when handed the microphone, he held it in silence. The 37-year-old, who says he survived more than a year on a small boat drifting from Mexico across the Pacific Ocean to the Marshall Islands, arrived in his native El Salvador late Tuesday. (AP Photo/El Salvador's Foreign Ministry)
In this photo released by El Salvador's Foreign Ministry, Jose Salvador Alvarenga holds a microphone intending to speak, after arriving at the airport in San Salvador, El Salvador, Tuesday, Feb. 11, 2014. Alvarenga was wheeled in a wheelchair before a crush of more than 100 mostly foreign journalists. But when handed the microphone, he held it in silence. The 37-year-old, who says he survived more than a year on a small boat drifting from Mexico across the Pacific Ocean to the Marshall Islands, arrived in his native El Salvador late Tuesday. Pictured from left to right are El Salvador's Vice Minister of Foreign Affairs Juan Jose Garcia, Foreign Affairs Minister Jaime Miranda, an unidentified official, Alvarenga and Vice Minister of Health Violeta Menjivar. (AP Photo/El Salvador's Foreign Ministry)
Family watch the broadcast of the arrival of pacific castaway Jose Salvador Alvarenga at their house in Garita Palmera 118 km. west from San Salvador, El Salvador, on February 11, 2014. The Salvadoran castaway who says he spent 13 months adrift in the Pacific arrived in San Salvador to the warm embrace of a family that thought him dead. AFP PHOTO/ Jose CABEZAS (Photo credit should read JOSE CABEZAS/AFP/Getty Images)
In this video image taken from AP video, Jose Salvador Alvarenga, wearing a hat second from bottom, a Salvadoran man who says he drifted in an open boat across the Pacific for more than a year, gets on the plane at an airport in Majuro, Marshall Islands Monday, Feb. 10, 2014. Alvarenga thanked people for taking care of him after he washed ashore in the island nation late last month and said he was "doing very well" before starting his journey home. (AP Photo/AP Video)
Jose Salvador Alvarenga (R) of El Salvador talks with Marshall Islands President Christopher Loeak prior to his departure at the airport in Majuro on February 10, 2014. Pacific castaway Jose Salvador Alvarenga departed the Marshall Islands on a Honolulu-bound flight today to begin his journey home to El Salvador. AFP PHOTO / HILARY HOSIA (Photo credit should read HILARY HOSIA/AFP/Getty Images)
Jose Salvador Alvarenga (R) of El Salvador shakes hands with Marshall Islands President Christopher Loeak prior to his departure at the airport in Majuro on February 10, 2014. Pacific castaway Jose Salvador Alvarenga departed the Marshall Islands on a Honolulu-bound flight to begin his journey home to El Salvador. AFP PHOTO / HILARY HOSIA (Photo credit should read HILARY HOSIA/AFP/Getty Images)
In this video image taken from AP video, Jose Salvador Alvarenga, a Salvadoran man who says he drifted in an open boat across the Pacific for more than a year, bids farewell to Marshall Islands President Christopher Loeak and people of the islands before flying home at an airport in Majuro, Marshall Islands Monday, Feb. 10, 2014. Alvarenga thanked people for taking care of him after he washed ashore in the island nation late last month and said he was "doing very well" before his departure. (AP Photo/AP Video)
Jose Salvador Alvarenga of El Salvadore attends a press conference in Majuro on February 6, 2014. Alvarenga was born in El Salvador but had lived for years in Mexico, where he says he set off on a fishing trip in late 2012 before becoming lost and drifting some 12,500-kilometres (8,000-miles) to the Marshalls in a small boat. The 37-year-old said he survived by eating raw fish and birds as well as drinking turtle blood, urine and rainwater for 13 months, but a teenage companion named Ezequiel starved to death during the ordeal. AFP PHOTO (Photo credit should read STR/AFP/Getty Images)
Pacific castaway Jose Salvador Alvarenga (L) is helped into a press conference in the Marshall Islands capital of Majuro on February 6, 2014. Pacific castaway Jose Salvador Alvarenga's departure from the Marshall Islands was delayed on February 6 for health reasons as the family of the now-dead companion with whom he set sail sought answers. AFP PHOTO (Photo credit should read STR/AFP/Getty Images)
A Mexican castaway who identified himself as Jose Ivan and later told that his full name is Jose Salvador Alvarenga walks with the help of a Majuro Hospital nurse in Majuro after a 22-hour boat ride from isolated Ebon Atoll on February 3, 2014. Jose was washed up on Ebon Atoll on January 30, 2014, and told his rescuers he set sail from Mexico for El Salvador in September 2012 and has been floating on the ocean ever since. AFP PHOTO / Hilary Hosia (Photo credit should read HILARY HOSIA/AFP/Getty Images)
Mexican castaway who identified himself as Jose Ivan and later told that his full name is Jose Salvador Alvarenga steps off the 'Lomor' Sea Patrol vessel in Majuro with the help of a Majuro Hospital nurse after a 22-hour boat ride from isolated Ebon Atoll on February 3, 2014. Jose Ivan was washed up on Ebon Atoll on January 30, 2014, and told his rescuers he set sail from Mexico for El Salvador in September 2012 and has been floating on the ocean ever since. AFP PHOTO / Giff Johnson (Photo credit should read GIFF JOHNSON/AFP/Getty Images)
Mexican castaway who identified himself as Jose Ivan and later told that his full name is Jose Salvador Alvarenga steps off the 'Lomor' Sea Patrol vessel in Majuro with the help of a Majuro Hospital nurse after a 22-hour boat ride from isolated Ebon Atoll on February 3, 2014. Jose Ivan was washed up on Ebon Atoll on January 30, 2014, and told his rescuers he set sail from Mexico for El Salvador in September 2012 and has been floating on the ocean ever since. AFP PHOTO / Giff Johnson (Photo credit should read GIFF JOHNSON/AFP/Getty Images)
In this Feb. 3, 2014 photo, a man who identifies himself as Jose Salvador Alvarenga, center, gets off a ship in Majuro, the Marshall Islands, after he was rescued from being washed ashore on the tiny atoll of Ebon in the Pacific Ocean. Alvarenga told the U.S. Ambassador in the Marshall Islands Tom Armbruster and the nation's officials that he left Mexico in December 2012 for a day of shark fishing and ended up surviving 13 months on fish, birds and turtles before washing ashore on the remote Marshall Islands thousands of miles (kilometers) away. (AP Photo/Marshall Island Journal) MARSHALL ISLANDS OUT
In this Monday, Feb. 3, 2014 photo provided by the Marshall Islands Foreign Affairs Department, a man identifying himself as 37-year-old Jose Salvador Alvarenga sits on a couch in Majuro in the Marshall Islands, after he was rescued from being washed ashore on the tiny atoll of Ebon in the Pacific Ocean. Alvarenga told the U.S. ambassador in the Marshall Islands Tom Armbruster and the nation's officials that he left Mexico in December 2012 for a day of shark fishing and ended up surviving 13 months on fish, birds and turtles before washing ashore on the remote Marshall Islands thousands of miles (kilometers) away. (AP Photo/Foreign Affairs Department The Marshall Islands, Gee Bing)
In this Monday, Feb. 3, 2014 photo provided by the Marshall Islands Foreign Affairs Department, a man identifying himself as 37-year-old Jose Salvador Alvarenga sits on a couch in Majuro in the Marshall Islands, after he was rescued from being washed ashore on the tiny atoll of Ebon in the Pacific Ocean. Alvarenga told the U.S. ambassador in the Marshall Islands Tom Armbruster and the nation's officials that he left Mexico in December 2012 for a day of shark fishing and ended up surviving 13 months on fish, birds and turtles before washing ashore on the remote Marshall Islands thousands of miles (kilometers) away. (AP Photo/Foreign Affairs Department The Marshall Islands, Gee Bing)
In this Monday, Feb. 3, 2014 photo shown on a tablet device and released by Willing Kajidrik of the Marshall Islands Sea Patrol on Sunday, Feb. 9, 2014, police check a 7-meter fishing boat of Jose Salvador Alvarenga after it was pulled onto the shore following his rescue, on Marshall Islands. Salvadoran man Alvarenga, 37, washed ashore late last month. Alvarenga who says he spent more than a year drifting across the Pacific Ocean before making landfall in the Marshall Islands is too weak to travel and will remain in the island nation for a while, an official said Saturday, Feb. 9. He was taken last week to the Marshall Islands' capital, Majuro, where he has been resting at a hotel. (AP Photo/Willing Kajidrik)
Jose Ricardo Orellana shows a photo of his son Jose Salvador Alvarenga when he was in his late twenties during an interview at his home in the village of Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of Alvarenga's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Alvarenga says he left Mexico in December 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
Fatima Alvarenga, the daughter of Jose Salvador Alvarenga, poses for a portrait holding a photograph of herself held by her father when she was a baby, at her family's home in the village of Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of her father's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Jose Salvador Alvarenga said he left Mexico in December 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
Maria Alvarenga, mother of the Jose Salvador Alvarenga talks by cell phone, at of her house in the village Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of her son's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Alvarenga says he left Mexico early 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
Fatima Alvarenga, left, Jose Ricardo Orellana, center, and Maria Alvarenga, the daughter and parents of Jose Salvador Alvarenga, walk on the beach after an interview near their home in the village of Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of Alvarenga's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Alvarenga says he left Mexico in December 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
Fatima Alvarenga, left, Jose Ricardo Orellana, center, and Maria Alvarenga, the daughter and parents of Jose Salvador Alvarenga, walk on the beach after an interview near their home in the village of Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of Alvarenga's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Alvarenga says he left Mexico in December 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
Maria Alvarenga, the mother of Jose Salvador Alvarenga, is comforted by relatives during an interview inside her home in the village of Garita Palmera, El Salvador, Tuesday, Feb. 4, 2014. The account of her son's survival after more than 13 months in an open boat has proven a double miracle for his family, who lost touch with him years ago and thought he was dead. Jose Salvador Alvarenga said he left Mexico in December 2012 for a day of shark fishing and ended up on the remote Marshall Islands. (AP Photo/Esteban Felix)
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WELLINGTON, New Zealand (AP) -- The story of a Salvadoran fisherman who says he survived more than a year adrift on the Pacific Ocean raises many medical questions. The Associated Press spoke with Claude Piantadosi, a professor of medicine at Duke University and author of the book "The Biology of Human Survival," to find out what is physically possible and for his view on the tale of Jose Salvador Alvarenga. This is an edited version of the interview:

Q: How long can a human survive without any water, or without any food?

A: The average is about 100 hours (approximately four days) without water and about five or six weeks without food. You can survive much longer with just a little food, although you'll lose weight and run into vitamin deficiency problems. So it would have been vital for Alvarenga to have collected both food and water during his journey. The Pacific's regular squalls would have provided some rainwater that he could have scooped from the bottom of his boat.

Q: How important is shade?

A: Absolutely critical. You get significantly warmer in direct sunlight and sweat more. The pictures of the boat show a fiberglass box in the middle which he could have sheltered in, and any type of canvas would have helped keep him out of the sun.

Q: Alvarenga described catching turtles, fish and birds with his hands and eating them. Is that plausible?

A: Over time, the underside of the boat would have become its own ecosystem as barnacles, seaweed and jellyfish collected there, which in turn attracts other creatures. How often can you grab a turtle or catch a fish with your bare hands? I don't know. Bird blood is no more salty than human blood, so would have provided some hydration.

Q: Without fruit and vegetables, wouldn't he have developed scurvy?

A: Actually, unlike humans, birds and turtles make their own vitamin C, so fresh meat from those creatures, especially the livers, would provide sufficient vitamin C to prevent scurvy. British sailors used to get scurvy because they ate preserved meat which had oxidized and lost its vitamin C.

Q: Wouldn't he get skin sores from all that water?

A: He'd need to keep mopping himself off and stay dry to avoid that. People on life rafts, or say a piece of floating wood, can develop real problems with macerated skin. Staying out of the water is a huge advantage.

Q: There's some suggestion that Alvarenga was a large man before he left. Would being overweight provide an advantage?

A: It would be a significant advantage. He could live off his own body fat and muscle for a long time, so long as he was able to get some water, vitamins, micronutrients and a little protein.

Q: Didn't he look too healthy, even a little bloated, when he arrived?

A: The appearances of malnutrition can manifest differently depending on how short you are on calories or protein. Some underfed children in Africa look like stick figures, others get swollen. It's only in end stage starvation that people get that really emaciated appearance.

Q: Alvarenga seemed to give confused and contradictory answers to authorities. What kind of psychological effects would such a journey have?

A: I'm not an expert in psychiatry, but we all have the feature of resilience. It can be trained or even learned on the fly. For instance, soldiers learn to deal with combat horrors. Presumably he was out on the ocean every day as a fisherman before he went missing, so he would have been familiar with the environment and with adapting his behavior to the elements.

If he had nutritional deficiencies, he may have developed some dementia or other syndromes which compromised his mental state. I'm not surprised that some of the answers he gave were a bit off and he wasn't able to remember things.

Q: How long would it take to recover from a voyage like this?

A: Hydration can be restored in just a day or two. Re-feeding can be tricky after a long period of starvation, as the body can lose the ability to absorb nutrients. Muscle rehabilitation and physical therapy can take several weeks.

Q: Bottom line - is Alvarenga's story plausible?

A: Yes. It's unusual to say the least. But reports out of Mexico indicate he did go missing in late 2012. As we have gotten more information, it's probably likely that he did survive at sea for 13 months.

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