Seasickness, sometimes referred to as "mal de mer," is the mariner's most common ailment, and among the most dreaded. Susceptibility is virtually universal. Untreated, seasickness leads to rapid physical and mental deterioration, posing a major hazard to crew health, safety and morale. As anyone who has been seasick knows, it is an illness to be reckoned with.
Seasickness results from a mismatch of sensory inputs processed by the brain's balance center to help orient the body's position. Place someone in the cabin of a heeling and rolling boat, and you immediately invite mal de mer. Below decks, the eyes are oriented to the floor and ceiling and detect no tilt. But fluid in the inner ear shifts with the boat's motion, sending a different position signal to the brain. Sensors in the neck, muscles and joints relay additional information, depending on how the person moves.
The conflict of sensory data from all these sources ultimately activates a series of responses we recognize as seasickness, especially the intense nausea and vomiting. The trick to preventing seasickness is to avoid sensory conflict by coordinating the sensory input, especially between your eyes and ears. Simply put: If your eyes are seeing what your ears are feeling, you are going to have a great day at sea. If not, you may want to find the nearest railing.
PREVENTION
You want to minimize the time you're going to spend below decks while underway. That requires some pre-trip preparation. Try to bring the things you will need, such as chart books or binoculars, to the cockpit or flying bridge before you leave.
It's always best to stay in the fresh air, away from engine fumes, and near the center of the boat, where motion is less pronounced. Try to keep your eyes on the horizon to provide a stable reference point. Sit or stand upright with your head and upper body balanced over your hips, and anticipate the boat's motion as though "riding" the waves.
Standing and taking the helm will help you accomplish this by reducing sensory conflict. Steer the boat by reference to the horizon, clouds, oncoming waves and distant marks. When possible, avoid close-focused visual tasks such as reading charts, working on computers and studying the screens of navigation instruments.
The same advice given to pregnant women trying to stave-off nausea also holds true here: Nibble on saltines and sip water or juice.
Sadly, medication and other remedies are generally more effective in preventing seasickness than reversing it. It may take as long as three days to adapt to the boat's motion and get your "sea legs."
MEDICATION
To fight seasickness, start your trip well hydrated, avoid alcohol and eat a light meal that's low in fat and high in starch. Keep in mind that the protection conferred by a drug is a matter of degree. At present, no drug reliably prevents seasickness for everyone.
A variety of medications, devices and herbal remedies, alone or in combination, work for some people and not others. It is not uncommon for one drug, such as an antihistamine, to be effective for one person and a related drug provide no benefit. The same is true with side effects. The result is that you may have to try different remedies–responsibly and in consultation with your doctor–to find what works for you.
If one drug fails, try another. Do not be afraid to try different medications or modalities on land to see if there are any unacceptable side effects. Timing too can play a role. If you anticipate becoming seasick early in the trip, begin medication the night before departure. Time-release forms and longer-acting drugs may be preferable when storms are expected to last a few days.
If you have discovered a system that works for you, stick with it and believe in what you use. If you are looking for remedies, there are many currently available, ranging from over-the-counter pills to prescription narcotics.
THE PATCH
Transdermal scopolamine hydrobromide, otherwise known as Transderm-Scop or "the patch," is the most popular drug used for prevention and treatment of motion sickness. Scopolamine prevents motion-induced nausea by inhibiting inner ear (called vestibular) input to the brain, thereby blocking the vomiting reflex. It may also act directly to suppress the vomiting center.
The drug enters the bloodstream from a dime size adhesive patch–actually a disc–placed on the skin behind the ear. A therapeutic blood concentration of the drug is maintained for up to three days. The most common adverse effects are dry mouth (66 percent) and drowsiness (17 percent). Additional undesirable side effects include blurred vision (which may persist for weeks), short term memory loss, confusion, behavioral changes and other problems denoted by the well-known mnemonic: "Hot as hell, dry as a bone, blind as a bat, mad as a hatter."
To reduce the dose of scopolamine, allow only half of the intact patch to contact the skin by placing the other half onto a Band-Aid or tape attached to the area. Do not disrupt the integrity of the disc by cutting it. Follow the directions carefully, wash hands thoroughly after application and apply only one disc at a time.
Scopolamine is not recommended for children, people with narrow-angle glaucoma (remove the patch immediately if eye pain should occurs), and men with an enlarged prostate. Long-term use may produce withdrawal symptoms when the patch is removed, such as nausea, dizziness, headache, and equilibrium disturbances. Discuss the potential side effects with your physician before trying scopolamine.
Scopolamine in pill form (Scopace) is an alternative to the patch. The chief advantage is the dosing flexibility; the fixed dose from the patch may be excessive for small individuals while inadequate for larger people. Scopace tablets allow sailors to regulate the amount of scopolamine to minimize the side effects by taking the lowest effective dose. The current recommendation is 1-2 tablets (0.4 mg) one hour prior to departure, and another 1-2 tablets every 8 hours as needed.
ANTIHISTAMINES
The antihistamines Bonine and Dramamine are available over-the-counter without a prescription and they are effective for many sailors. The popular antihistamine Stugeron (Cinnarizine), although not sold in the US, is available in other countries. Many sailors claim it has the fewest side effects.
However, over-the-counter antihistamines do have potential side effects. They include drowsiness, dry mouth, blurred vision, irritability, urinary retention, dizziness, and headache. Sudafed, an over-the-counter decongestant, or Nodoz, a caffeine pill, may counteract the drowsiness caused by antihistamines.
Alternative and natural therapies are beneficial for some boaters, although there are no conclusive studies proving that they work. Vitamin C–one to two grams daily in energy drinks such as Emergen-C or tablets–may reduce nausea, as may ginger capsules (one gram every six hours) supplemented with ginger cookies, candied ginger and ginger ale. Ginger is sold in health food stores and in marine stores as Sailor's Secret. Be warned: Ingesting too much ginger may cause heartburn.
Queasy Drops is an extract of ginger, cola, papaya and other flavoring formulated into a candy or lolly pop. There are no reported side effects. Motion Eaze is an herbal extract applied behind both ears. The Reliefband is a wristwatch-like device that delivers electrical stimulation to nerves in the P6 acupuncture site in the wrist. When positioned properly, the wearer feels a pulsed tingling sensation across the palm and in the middle two fingers. SEA Band is an elastic wristband with a plastic stud that applies pressure to the same acupuncture site without electrical stimulation and tingling.
All of these appear to be effective for some boaters–and they might be for you. If you are healthy and use these remedies as intended, there is generally no harm in trying.
SIGNS, SYMPTOMS AND TREATMENT
The earliest signs and symptoms of seasickness are yawning and drowsiness, progressing to dry mouth, headache, dizziness, and extreme listlessness. Some people initially experience an unsettled stomach, slight sweating, mild blushing, and a feeling of warmth. Untreated, the person becomes pale, cold, and clammy. Nausea comes in waves with belching, salivation, and then uncontrollable vomiting.
Recognize these symptoms and begin treatment with prescription anti-nausea medication such as Phenergan when early signs appear. Phenergan taken as a pill, suppository or injection will prevent vomiting and subsequent dehydration. NASA astronauts use Phenergan for treatment of "space sickness." During treatment, lie down and try to sleep. Take in small amounts of fluid, crackers and hard candy.
Sailors now have many options to manage seasickness. It is no longer necessary to follow Samuel Johnson's eighteenth century advice: "To cure seasickness, find a good big oak tree and wrap your arms around it."
Although, that may work, too.
Dr. Michael Jacobs is a Medical Doctor and co-author of a "Comprehensive Guide to Marine Medicine." He is the author of numerous articles on medicine for mariners and safety at sea, as well as the founder of MedSail and a consultant to Adventure Medical Kits. He teaches marine medicine around the country, practices medicine on Martha's Vineyard and has been a lifelong sailor.