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Seasickness - Coping with Mal de Mer
MARITIME MEDICAL ACCESS
Keith Boniface, M.D. Assistant Professor of Emergency Medicine, The George Washington University Assistant Medical Director, Maritime Medical Access

Seasickness is a result of conflicting information being transmitted to the brain from the body's sensory organs. Visual, inner ear, and musculoskeletal position sensors usually "agree" while on land, but in the pitching/rolling environment of a vessel at sea, their input can be contradictory to one another. This causes stimulation of the brain's vomiting center, and we know what happens next! While not life threatening by itself (although the person suffering may feel like they are about to die!), in severe cases, seasickness can lead to dehydration, loss of judgment, and crew overboard situations. Any one of these have the potential to be fatal.

The key to managing seasickness is to recognize the symptoms early, in order to intervene before it is too late. Early symptoms include yawning, drowsiness, headache, dizziness, and dry mouth, By the tune cold sweats, pallor, belching, nausea, and vomiting occur, any treatment will be less effective than if given at first onset of symptoms (or before leaving port).

Prevention

• On the day before and the day of departure, eat moderate amounts, avoid greasy or heavy foods, and avoid alcohol.
• While on board, avoid cramped spaces, engine fumes, and strong odors.
• From amidships to the stern has the least amount of pitching - avoid the bow of the ship.
• Spend as much awake time as possible above decks and where fresh airflow is greatest - if you must work below decks, pace yourself and allow for time on deck at regular intervals.
• Gaze at the horizon, using your peripheral vision. Anticipate the motion of the vessel and consciously move to "ride" waves - this will allow your brain to adjust to the motion mere quickly. The person at the helm typically is the least seasick because they can focus on the swells and look into the distance.
• Minimize close visual tasks - reading, writing, looking through binoculars, and navigation are the jobs that are most nausea-inducing.
• If you are prone to seasickness, find a remedy from the list below (trial and error to determine what works best for you with the fewest side effects) and take it early.

Treatment

In the interest of minimizing side effects, non pharmaceutical treatment options should be tried first:

• Wristbands - the ReltefBand (electrical stimulation of acupressure zone, costs -$45), BioBand (elastic band with plastic knob stimulation of acupressure zone, costs -$10), and others. These provide stimulation of the P6 (Neiguan) point, located three finger widths above the wrist crease between the tendons of the flexor surface of the forearm. These have the advantage of no side effects/interactions with other medications, so give them a try.
• Ginger - available in various forms, including candied, powdered, 500 mg capsules, gingersnap cookies, and (non-alcoholic) ginger ale and beer. The usual dosage of the ginger capsules is 1000 mg every 6 hours. Again, ginger has the advantage of having no side effects and being available without a prescription.

The following medications should not be taken without consultation with a physician. Most of these medications can cause drowsiness and they should be tried on shore first to make sure that any side effects will be well tolerated. Also, the majority of them have the potential to cause problems in patients with glaucoma or prostatic hypertrophy (can cause urinary retention).

• Stugeron (cinnanizine) - not FDA approved in the US but available overseas. Dosage is 30 mg 2 hours before travel, then 15 mg every 8 hours. Reportedly causes less drowsiness than the other antihistamines.
• Transderm Scop (scopolamine transdermal) - 1.5 mg patch worn behind the ear, placed- several hours prior to departure, Wash hands carefully after applying patch, because if the medication gets into the eyes, blurry vision, redness, and discomfort (usually temporary) can result. Dry mouth and drowsiness are the most common side effects. Contraindicated in patients with glaucoma and prostatic hypertrophy. Available only with prescription.
• Dramamine (dimenhydrinate) - 50 mg every 4 to 6 hours. Drowsiness is the most common side effect. Available without prescription.
• Antivert, Bonine, Dramamine II (meclizine) - 12.5-25 mg every 4 to 6 hours. Available without prescription. Drowsiness is the most common side effect.
• Phenergan (promethazine) - 12.5-25 mg every 6 hours, available in pill, rectal suppository (useful if unable to keep anything down by mouth), or injectable form. Available only with prescription. Drowsiness is the main side effect. If you have someone onboard trained to give injections, this is an extremely useful medicine to have in your medical kit.
• "Navy Cocktail" - 25 mg each of promethazine and ephedrine. Pseudoephedrlne 60 mg (Sudafed), available over the counter, may be substituted for the ephedrine. Used to help limit the drowsiness of the promethazine, however the addition of a second drug increases the chance of side effects/drug interactions.