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Marc Hughston
Moderator
Username: hughston

Post Number: 719
Registered: 03-2003
Posted on Friday, March 20, 2009 - 12:09 am:   Edit Post Print Post

Seasickness

I want to chime in here with my experience. I have many tales of how it goes when things are not working well, but I have found the information I am attaching here very instructive. To summarize, here is how I think about it now:

* When what your eyes see disagrees with what your body feels, that's when you get symptomatic. This is the absolute key in my opinion. Read on.
* It's not about what you ate, it's about the motion of the vessel and what you are doing on it.
* Symptoms develop when your inner ear tells your brain that you are rocking and rolling, but your eyes see a stable cabin or cockpit. This is why we tell people to get on the helm when they are not feeling well and why we see that it usually works. Then, they look at the horizon and anticipate the rocking and rolling, and that keeps them in synch with what their inner ear feels. So, going below to complete the log entry on a rough day puts you at risk, and staring at the cockpit sole while feeling queasy adds to the trouble.

Here's what I've learned:
* Time on the water helps you "acclimatize" and you actually can build up a tolerance - getting your sea legs.
* Missing the symptoms happens frequently, and the skipper can take action if he/she sees them and prevent a more debilitating episode - read up on the symptoms; skippers, take action.
* What I really need to do is have a forceful talk with crew, prior to departure, about alerting me and the student skipper when any crew are not feeling well – that’s when we can take action and avoid a debilitating episode.
* Yes, I’ve learned that people do not listen and may disappear into the head for extended periods, or say they don’t need to take the helm, and are OK without "riding the waves" as I urge them. Stop that. Convince them.
* If you have to heave, be proud of it. Get up, get out, and get to the leeward rail with your head well clear of the topsides and let it go. Make a noise like an Elephant Seal!

About the treatments:
* Bonine minimizes the symptoms while being less “drowsy” than other remedies.
* You have to take the medication before getting underway.
* I know nothing about those electronic wrist bands that Jeff Johnson says straighten him right out. They sound great to me though.

Below is what we have in the MST 215 class on the subject:

MST 215 Vessel Command and Organization
Marc Hughston, Instructor

8. Common Problems – Prevention & Treatment

Every time we go sea there are problems that must be dealt with. Crew occasionally get seasick, engines sometimes run hot or overheat, the head stops working while at anchor because the holding tank is full, and sometimes we’ll run over kelp at night and get it wrapped around the propeller. The purpose of this section is to provide practical advice and discussion on how to prevent and treat two common problems.

Dealing with Seasickness

Please review Attachment K pages 27-29 for a detailed discussion on the subject of preventing and treating seasickness. Material presented immediately below is a summary of the Attachment K material and a summary of research into the subject by student Toni Monty in the spring 2007 MST 215 class.

Seasickness is a miserable experience but is not usually associated with a serious medical condition, even though some may be completely incapacitated by it. There is no cure for seasickness, only preventive measures and remedies to help alleviate the symptoms.

Cause
Seasickness is now thought to have little to do with one’s stomach. Seasickness is a form of motion sickness characterized by a feeling of nausea, typically brought on by the rocking motion of the boat. The primary cause is a “sensory conflict” that occurs when a fluid filled canal in the inner ear that controls your sense of balance tells your brain that your body is moving, while at the same time your eyes, looking into the cabin of the boat, for example, tell your brain that you are not moving. Vision often plays a critical role in the causes and treatment of seasickness. As the conflict between what your eyes see and the motion you feel grows and is sustained, symptoms of seasickness appear.

Prevention
Avoid situations that cause vision conflict by minimizing the amount of time you spend going below. Part of prevention then, when you know it is going to be rough, is setting things up so that meals underway are quick and easy, and so that basic navigation can be done from on deck.
• Arrive for departure well rested.
• Take appropriate anti-seasickness medication before departure.
• Minimize time below decks.
• Stay back in the cockpit where the boat’s motion is the easiest, or in the aft bunk if possible when off watch.
• Avoid diesel exhaust fumes if possible.

Recognizing Symptoms
The key is to recognize and react to the earliest symptoms. A typical progression of symptoms is shown below.
• Yawning and drowsiness.
• Abnormal fatigue and lethargy.
• Stomach awareness.
• Nausea.
• Face becomes pale, hands cold and clammy.
• Belching, salivation, flatulence.
• Concentration is difficult.
• Vomiting.

Treatment
React to the earliest symptoms.
• Take anti-seasickness medication or apply wrist bands if you have not already done so.
• Get on deck so you can view the horizon, and anticipate the motion with your posture – “ride the waves.”
• Ask if you can break into the rotation on the helm – being able to see the horizon and anticipate the waves greatly reduces the vision conflicts at the root of your symptoms.
• Replace nutrients and liquids if vomiting.

Other Concerns
Normally, sleep for the off-watch is not a problem. When conditions are rough and some crew are symptomatic, the off-watch will resist going below. What do you do?
• If not Small Craft Advisory conditions and you can safely operate the boat, consider allowing seasick crew to remain on deck – but they must wear a harness
• In storm conditions send seasick crew below for rest, medication, and food. Incapacitated crew can get washed overboard or injured if they remain on deck. Get seasick crew wedged into a berth with emesis bags, towels, juice, water, candy, etc.

seasickness 1

seasickness 2

seasickness 3
 

Kendall Bailey
Senior Member
Username: bucky

Post Number: 75
Registered: 03-2003
Posted on Wednesday, March 18, 2009 - 11:14 pm:   Edit Post Print Post

ReliefBand is my favorite: Drug free, I use this and I've seen it work in as little as 5 minutes on some and longer on others. Sailing on many trips with up to 35 people on board, I have personally seen it work well on many people. And I've observed it to be not the cure-all on some.

Another interesting product is an audio sound method called "Nevasic". Don't have a clue but found it for sale at http://www.relief-band-watch.com/index.html. If anyone has info, pass it on.

Bucky B.
 

Sandra Jean Gilman
Intermediate Member
Username: sandyjgilman

Post Number: 18
Registered: 02-2004
Posted on Wednesday, March 18, 2009 - 03:00 pm:   Edit Post Print Post

Dave,
The best way to prevent sea sicknessness
much of the time is to eat light, be well
rested, STAY DRY AND WARM!
Over and over again on our Saddleback night
crossings people were warned of the above,
but especially did not stay warm. They
often dropped like flies.
I personally just pop a Bonine 24 hours
before departure. It's easy to get and
inexpensive. The only side effect is one
sleeps more soundly. That's not a bad
thing!

Sandy
 

David Sheriff
Board Administrator
Username: admin

Post Number: 322
Registered: 01-2004
Posted on Wednesday, March 18, 2009 - 01:55 pm:   Edit Post Print Post

The Practical Sailor January 2009 issue contains a detailed roundup of seasickness solutions. It contains a few drugs I did not mention. After reviewing the article, I have not changed any of my views expressed here. Still Stugeron for me, as long as I can get it.

The article claims that Stugeron "takes two to five hours to become effective, significantly longer than other antihistamine antiemetics." This is not my experience and I stand by what I wrote a few years ago, although I have a very small sample in my experience base.

In the February issue, a physician writes in to recommend a combination of Dexedrine and dextroamphetamine. He recommended Googling "Dexedrine and Scopolamine for motion sickness."

He says the combination was developed by NASA to treat motion sickness in Astronauts. The definitive expert, he remarks, is Dr. Charles Oman who is director of the Manned Vehicle Lab at MIT and a sailor.

To keep my reputation as a troublemaker intact, I wonder how the Coast Guard reacts when Dexedrine shows up in a urine test, assuming it does.
 

David Sheriff
Board Administrator
Username: admin

Post Number: 162
Registered: 01-2004
Posted on Sunday, August 03, 2008 - 09:00 am:   Edit Post Print Post

I inverted the order of these posts to bring the most relevant toward the top. Still use Stugeron, still works fine.
 

david (david)
Posted on Wednesday, August 06, 2003 - 12:43 pm:   Edit Post Print Post

This information regarding seasickness was originally posted for the 2003 MST Spring class. It has been edited significantly here. Last updated 2/13/04.

Regarding seasickness, this is just about everything I know, presented as a public service

Most of this information is from the "Safety at Sea" seminar at OCC 3/15/03 or from direct personal experience. All the medication and dosage recommendations are from the MD who conducted that class or from information published by the supplier of the drug.

Get a prescription for Transdermal Scopolamine from your Doctor if you think you might need it. It is the most powerful seasickness med you can get in the US and it really works. I have used it. It lasts three days. Ok, those of you who never "pollute" your body with as much as an asprin, you can just be seasick. Or try acupressure or ginger.

1000 mg of ginger is recommended for seasickness, if you like to try herbal stuff.

Stugeron (cinnarizine), a European pharmaceutical (Janssen)not available in the US, was recommended as the very best product available in the world (by the MD who was conducting the lecture). It is available in Mexico and from several internet pharmacies. Dose recommended by above cited MD: 30 mg the night before departure, 15 mg every 8 hours. From the literature I have seen, Stugeron is available in 25 and 75 mg tablets, so the good doctor may have been thinking of something else or my notes are not accurate. Among other places, Stugeron is manufactured in Pakistan by Johnson & Johnson under license from Janssen Pharmaceutica in Belgium. Just because it is not available from pharmacies in the United States does not mean a medication is either unsafe or ineffective. (Clicking on the first word in this paragraph will take you to the South African package insert.)

Direct quotes from package inserts:

"motion sickness:

Adults: 25 milligrams may be taken two hours before the start of the journey" ("peak plasma levels occur one to three hours after intake") "and 12.5 milligrams to 25 milligrams may be repeated every eight hours during the journey when necessary.

Children 8 to 12 years: 12.5 milligrams (half a tablet) three times daily when necessary.

Children 5 to 7 years: 6.25 milligrams three times daily when necessary."

"Stugeron should preferably be taken after meals." (the medication can cause gastric distress)

"The maximum recommended dosage should not exceed 225 milligrams(nine tablets. . .)daily. As the effect of Stugeron . . . is dose-dependent, the dosage should be increased progressively."

As with all self-medication, the responsibility and risks are entirely your own. I'm just passing on what I've learned. There are a few contraindications, drug interactions and side effects. Notably, Stugeron may cause sedative effects which "may diminish after a few days." if you are contemplating taking Stugeron, I highly recommend reading the package insert linked above.

Taking meclizine, 25 mg tablet, (Bonine, Antivert, Dramamine "less drowsy formula", not the original formula) works well for me. My formula: two tablets 1 to 12 hours before departure, longer is better, one tablet every 12 hours thereafter. I do not find that Meclizine makes me drowsy, but some might have to supplement their dose with a little coffee.

The MD at the seminar recommended taking one or two the night before and then continuing on the normal dosage schedule through the voyage. May be taken as often as every 6 hours if needed. I have used this for years and it has always worked for me.

Meclizine is not enough for those who are EXTREMELY sensitive, as I can also attest, having had such a person along on a Catalina trip. If you get seasick on a cruise ship, this may not work for you. Try the Trans Scop or get some Stugeron.

Promethazine is available in suppository or injectible form. Available for those who are really sick and cannot keep anything down. The considerate skipper should make an effort to carry this on board for international races. As it is a US prescription drug, it would not be legal to get a prescription for yourself and give it to someone else, at least not in territorial waters.

If you think you might need the suppositories because you have a history of bad seasickness, see your physician. The list of contraindications, side effects and drug interactions listed in the drug information sheet are long and complex enough that I, personally, would not take this drug or give it to someone else without the advice of a physician even if I could obtain it without prescription.
Promethazine Drug Info

Bucky swears by the wrist electro-acu-pressure-stimuli-whatever thingie. Never tried it. Suspect it helps better if you believe it works, but thats just my natural skepticism. Whatever works for you is fine by me provided you can still function on the boat. This would rule out high dosages of central nervious system depressants like barbiturates or narcotics.

Caveat: The information presented in this post is accurate to the best of my knowledge but I am not a physician and could be in error, as usual. As with many things in sailing, the decision to do it is yours and you are entirely your own if anything bad happens to you. Do not rely solely on my advice if you decide to take any medication described here. This qualifying paragraph applies to the entire document.

EVERYTHING works better if you stay topside, look at something fixed like the horizon or a distant boat, actively "ride the waves" with your body, let the skipper know you feel badly so he/she can help. The old saying "have the sickest person take the helm" actually works. THIS "STAY TOPSIDE" IS MORE IMPORTANT THAN YOU FIRST-TIMERS WILL BELIEVE.

Do NOT: be hung-over, eat heavily, stay below, attempt to read, cook, repair the engine, unstop the head, etc. if you may be susceptible. These activities are only recommended for the iron stomached or the heavily medicated.

It is very good if you can go to sleep when the seas are tough. You do not get seasick in your sleep. Really. Just being in your bunk half-awake does not count. You may still get sick unless you are really out. Being sick in your bunk is to be avoided as it is impolite in the extreme to everyone else. So maybe sleeping preparations are an alternative if you are just a passenger, not working crew. I know people who like being at Catalina but not the sail over, so this is what they do. Good "significant other, non-sailor" strategy.

The first signs of seasickness are usually yawning and drowsiness, followed by abnormal fatigue and lethargy. This proceeds nausea. So watch your shipmates. The faster you do something about impending seasickness, the more likely you are to get it under control. I have taken Meclizine as soon as I started to feel fatigued or queasy. If I go above and let it pass, it usually works, but its nowhere as good as taking it some hours before departure.

If you are going to heave, it is most polite to do it over the leeward side of the boat. Emesis bags are available superior to what are found on airliners, but I don't have any, yet. If you have to heave belowdecks, you have ignored instructions to go topside, but anyway, do it in the head or in a bucket. Hanging your head over the bowl will probably guarantee that you throw up, given you will be hypersensitive to the fragrant ambience of the head. Throwing up will make you feel better, eventually.

In summary: Pay attention and let the skipper know you do not feel well and then follow the instructions you are given.
 

David Sheriff
Board Administrator
Username: David

Post Number: 151
Registered: 10-2002
Posted on Thursday, August 05, 2004 - 09:30 am:   Edit Post Print Post

I recently purchased a bottle of 100 generic Meclizine tablets 25 mg for my wife, who has been going through an episode of vertigo. Meclizine, as noted below, is the active ingredient in Bonine and "less drowsy" Dramamine. To my surprise, the drug was available on a non-prescription basis at my local pharmacy (Safeway) at a cost of less than $.10 per pill. So, you can pay five dollars, or whatever, for 8 tablets of Bonine (25 mg) or you can pay $.80 for the same thing.
 

David Sheriff
Board Administrator
Username: David

Post Number: 152
Registered: 10-2002
Posted on Thursday, August 05, 2004 - 09:41 am:   Edit Post Print Post

Reading through the seasickness compendium below, I realize that I have not commented on my personal experience with Stugeron. Stugeron is excellent. I believe it controls the symptoms of seasickness better than Meclizine. Best of all, it works fast. I had a student on last winter's cruise who developed reasonably severe seasickness. The crew did not tell me about it immediately, so she suffered for several hours. Within an hour of taking Stugeron, she was much better.

Meclizine takes awhile to achieve a therapeutic blood level. You really have to take it the night before. Stugeron seems to become effective in less than an hour.

I would not recommend waiting until you are sick to take any seasickness medication. Take it ahead of time. I have not personally experienced any side effects of Stugeron.

I ordered my supply of Stugeron through an online pharmacy in Australia. It was shipped by mail direct from Pakistan, where it is manufactured. The cost was quite reasonable.
 

David Sheriff
Board Administrator
Username: David

Post Number: 168
Registered: 10-2002
Posted on Wednesday, July 06, 2005 - 06:23 pm:   Edit Post Print Post

The following letter was published in "Latitude 38" November 1999:

"Caution on Stugeron!

"I'm reluctant to write this, but it may help some of your readers. We also heard that Stugeron was a good cure for motion sickness. We read a little bit of anecdotal information on the Internet that portrays it to be a safe drug with no known side-effects. Since friends of ours had used it for two years without side-effects, we purchased some in Mexico for use while sailing.

"Anyone opting to take Stugeron should be careful when purchasing the product. We, for example, were not aware that it comes in 75 mg tablets and 150 mg capsules. Because of the language barrier in Mexico and our own ignorance, we assumed that Stugeron was a motion sickness medication - like Dramamine. Consequently, we wound up taking the capsule. One person in our group of six became very ill and another was drowsy for eight hours. The rest of us felt a little queasy.

"Because of these reactions, we decided to do a little more research on the product to learn more and determine the proper dose. What we learned has caused us to rethink the use of such a powerful drug for just motion sickness. The reason stronger doses of Stugeron are available is because it's used in the treatment of epilepsy, Meniere¹s Disease, migraine headaches, vestibular irritation, labyrinthine arteriosclerosis, arteriosclerosis, vasospasm, vertigo - and a host of other serious disorders. It is a powerful calcium channel blocker, a strong antihistamine, and a vascular spasmolytic. It also reduces motion sickness. Your readers should give careful consideration to whether motion sickness is a sufficient illness to warrant the use of such a powerful drug.

"In addition, we subsequently found that Stugeron is not a 'new' drug - as had been our impression. Cinnarazine, the generic name, has been around since the '70s - although the United States Food & Drug Administration has yet to approve it for use. We contacted Janssen, the manufacturer, directly and a researcher, who shall remain nameless, suggested that for casual sailors other remedies might be more prudent choices for combating motion sickness.

"Stugeron may eventually prove to be a good choice for treating motion sickness, however for the moment we have opted to return to taking approved over-the-counter medications. Should the USDA eventually give Stugeron the green light for use in treating motion sickness, we'll then be the first in line. In the meantime, we'd suggest that everyone heed Latitude's advice of talking to their doctor before taking Stugeron.

"I'm not interested in getting into a debate on this, so please withhold my name.

N.W."

--------------------------------------

Note that the subjects above took 150 mg capsules and experienced some uncomfortable side-effects. I take 25 mg tablets (that is TWENTY-FIVE milligrams), one at a time, 8 to 12 hours apart. This is consistent with the drug package insert for treating the symptoms of motion sickness. Works great for me.

If you are going to take pharmaceuticals of any kind, its your obligation to follow recommended dosages. You OD, bad stuff happens. No surprise.

Also no surprise that the manufacturer recommended caution casually taking a drug that is not even available by prescription in the US, although it is widely available in much of the rest of the world. Duh.

Again, I am simply reflecting on my personal experience. No medical advice intended. But no scare tactics either.

One might wonder why the FDA has not approved Stugeron. Probably because the drug has little profit potential in the US so the manufacturer has no reason to push it. Its not an expensive drug.

The FDA doesn't just approve things just because they might be helpful to you. It takes lots of money to get anything through the process. The process is designed to ensure that our supply of pharmaceuticals are safe.

It does not logically follow, however, that pharmaceuticals only available in other countries are not safe.

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