Being seasick stinks. Everybody knows this. Seasickness is a top complaint that boaters deliver to doctors, and it's an ailment that will affect almost everyone if enough stimulus is applied. Yes, that means you with the iron stomach. Try holding onto your cookies in a 40-foot open-Atlantic sea, and then you'll know how your illness-prone, green-faced friend feels a half-mile from the dock. Empathize and read on.

What causes seasickness – the pathophysiology of the disease, in medical-speak – is a conflict of sensory input. Your body uses sensory input from your eyes and inner ear to orient the body's position in space every awake minute of every day.

If you're standing in the cabin of a heeling sailboat whose ceiling you can constantly see above your head,, you may see yourself as vertical, but fluid in the inner ear detects a tilt from vertical, and the sensory inputs are in conflict. You become seasick. The result is the same in every case: The brain triggers your impulse to vomit, and you can be kissing the bucket for hours.

It doesn't end there. Doctors describe this next phase as "rapid mental and physical deterioration." You can lose the ability to think clearly, and you may make poor decisions that can put you in danger. Your manual dexterity can also be compromised, so you can no longer perform basic tasks like calling for help over a hand-held VHF. Your short-term memory can also falter – perhaps, some physiologists say, because the human brain can only store short-term data when it knows where the body is located in space.

What causes seasickness is conflict of sensory input.This is debilitating stuff. For some seasick boaters, the will to live can even vanish.

"You hear about these guys out at sea who call for help and want to abandon their boats because they're seasick," said Dr. Michael Jacobs, a specialist in internal medicine, co-author of "A Comprehensive Guide to Marine Medicine" and a lifelong boater. "It's not that they're cowards. There's something else going on."

POINT OF NO RETURN

But back to the part about you kissing the bucket. The miserable reality is that once seasickness gets to this point, you're in trouble. "All the drugs are better at preventing seasickness than treating it," said Jacobs, who spoke at the week-long "Medicine for Mariners and Safety at Sea" conference at The Bitter End Yacht Club on Virgin Gorda in January. "Plus, every drug has side effects. Drowsiness and dry mouth are the two big ones. You'll do a lot better if you can avoid getting sick in the first place."

If only it were so easy. It seems that everybody has a remedy to suggest, but there are no major, controlled studies that prove the efficacy of one preventive measure over another.

In general, Jacobs says, these basics can help:

If you plan to take medication such as Bonine or Dramamine, begin doing so one to 12 hours before getting onboard, and continue with regular doses. Some boaters also try Stugeron. It's not approved by the U.S. Food and Drug Administration, but it's legal in Canada, Mexico, Bermuda and Europe – and it has fewer side effects, including less-sedative properties.

Stay well hydrated. Avoid alcohol.

Eat light carbohydrates an hour or two before leaving the dock. Snack on crackers, popcorn or trail mix throughout the day.

Consider powdered ginger capsules, 1 gram every six hours. A brand such as "Sailor's Secret" is more potent than ginger ale or ginger cookies.

If you wear an anti-seasickness patch such as the Transderm Scop, be sure its entire surface is "activated." Don't cut the patch in half to ease side effects. Instead, put a Band-Aid on and then apply the patch with half touching the Band-Aid and half touching your skin. (Don't use the patch on children or if you have glaucoma, and immediately remove it if you experience eye pain.)

Most medication is better at preventing seasickness than treating it.Frequently drink small amounts of fluid. Consider vitamin-sugar-electrolyte replacement brands such as Emergen-C. Many sailors swear by the Vitamin C in such drinks.

Know the location of your Neiguan P6 acupressure point. It's three finger widths away from the crease in your wrist. This is the spot that ReliefBand, BioBand, and Queaz-Away bracelets target. Many sailors recommend these bands, which don't have the side effects of drugs.

STAY ON DECK

On the boat, stay on deck and amidships. If you can steer, do. Something about the brain figuring out where to put the boat next may help to keep the body oriented. Whether you're steering or not, face forward. "Gimbal yourself" by standing and looking over the bow, as though your body is anticipating a ride on the waves. This tells your brain you are controlling your motion, instead of the motion controlling you. Watch the horizon.

"Being inside and looking at the horizon is different than being outside and looking at the horizon," Jacobs says. "The quickest way to get seasick is by reading a book down below. The eyes need to be oriented toward the space outside. Don't go sit on the aft deck and face backwards. Stand like a helmsman does."

If you do all these things and your belly still decides to host a Monster Truck rally, lie down with your head still, close your eyes, and try to sleep. Closing your eyes eliminates one of the conflicting sensory inputs, and most people who fall asleep before vomiting wake up later feeling better. If you can't sleep, then keep your eyes closed, drink small amounts of liquid, and suck on candies such as Queasy Drops, which are made partially from ginger.

There is also a prescription anti-seasickness suppository called promethazine hydrochloride. It has powerful side effects and, well, administering it may be about as unpleasant as the dry heaves themselves.

If all else fails, grab the bucket and try to remember that you're not going to die. Even the worst cases of seasickness tend to abate after 36 to 72 hours.