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post #1 of Old 03-25-2003 Thread Starter
Liza Copeland
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The Delicate Art of Preventing Seasickness

Boisterous conditions can inspire dread among those suffering seasickness.
The week before the start of the Atlantic Rally for Cruisers in Las Palmas, Canary Islands, was a blur of boat preparations, shopping, school, parties, and specially organized events. There were 209 boats taking part and many were still looking for crew. We were pleased that we had already found a French couple in Gibraltar. They were very enthusiastic about completing an ocean crossing, and had already bought and stowed the provisions for their share of the cooking.

But now we had a problem. The couple had sailed from Gibraltar to the Canary Islands on a friend’s boat and, the woman, Colette, had been desperately seasick, so seasick that she has lost her dentures over the side! It was an embarrassing situation for an attractive girl in her thirties but the local dentist immediately set her at her ease, assuring her that she wasn’t the first and certainly wouldn’t be the last to suffer such a fate. It turned out that her new dentures were a much better fit than the old ones and at only $100, everyone urged her to get a spare set!

The question now was whether we should take her 3,000 miles across the Atlantic. Our friends felt strongly that we shouldn’t because on their two-week trip she had never gained her sea legs and was a liability on board. Being a connoisseur of seasickness myself I quizzed her on the precautions she had taken and found she had failed on every count! Knowing there was a base to work from gave me some hope that and with her positive attitude. "I feel we should give her a chance," I finally said to Andy, "after all, people were very good about taking me!"

By initially modifying her diet, using medication correctly, and organizing her position on the boat, we managed to ensure that she was not ill once on the trip to Barbados. In fact in no time at all she was enjoying with gusto the sumptuous meals prepared by her partner, a highly talented French chef.

The ability to cope with seasickness is a significant factor in making or breaking any cruise, whether coastal or offshore. Anyone can be seasick, although some are more prone than others, and it is important for all on board to have an understanding of the causes and effects. It is particularly hard for those who are not affected by mal de mer to fully realize how frustrating and debilitating it can be. As one who suffers, I say this with feeling!

"After over 70,000 miles on Bagheera, and many more miles running charter yachts and ocean racing, having to deal with seasickness is really just a minor inconvenience in my seafaring lifestyle."

Seasickness is a form of motion sickness and a normal response to sensory conflict about body motion which is received from the receptors (vestibular, visual and body proprioceptors). Fluid in the semicircular canals of the ears, our center of balance, moves with our body motion and stimulates these receptors in the brain. Constantly changing motion causes the signals to be mixed and the resulting confusion can lead to dizziness, nausea, and vomiting.

Motion sickness is rare in those under two years of age and peaks between ages 3-12. Rates are higher in females, 1.7:1 compared to males according to Health Canada, although my experience in the boating world is that men are less honest in owning up! Symptoms can be exacerbated by emotions such as anxiety or fear as well as other illness and medications. The good news is that most people adjust to the motion at sea within 48 to 72 hours, although unfortunately this immunity can change with differing conditions. One can develop sea legs for a downwind motion, for example, but feel queasy again with the winds on the beam or ahead as the boat moves in a very different manner. Once in calm water, recovery is generally rapid, but sea legs can be lost quickly. I might get away with one night in a harbor but seldom two and then have to go through the whole acclimation process again.

Prevention   There are several strategies that can be successful in preventing seasickness, in addition to medicinal remedies. It is worth while trying these out well in advance of a long passage, as it is much easier to avoid seasickness than treat it once it has started.

Stay as close to the middle of the boat as possible to lessen the frequency and intensity of motion. Minimize head and body movements and in particular, don’t overexert yourself. If below decks, lie down. Be sure to have lee cloths on the main cabin berths, generally the area of least movement. Avoid small, cramped spaces and don’t bend over to work in the bilges or lower lockers. And reducing the intake of diuretics, such as tea and coffee, before leaving the dock will lessen visits to the head—a plus in the first critical timeframe of adjusting to life underway.

The right seaberth—located midships where the movement  is least, and having lee cloths to keep sleeping sailors in one place—is a crucial element of life underway.
Focus on a distant object or the horizon when on deck and avoid fixing on a moving object such as the compass. Sitting to windward and facing forward can help. When below decks, lie with your eyes closed and avoid reading.

Most people feeling queasy stay on deck in the fresh air initially and take slow deep breaths. If you have to go below, open a hatch if possible to keep the air fresh. Fans also keep air circulating and are refreshingly cool on the face. Avoid strong odors such as coffee and bacon; in fact don’t ever be talked into working in the galley or going below if you're not feeling well! If possible, minimize working on the engine, as diesel fumes can effect even the most hardy.

Staying interested in the activity on the boat, or in the vicinity, being at the helm or in control of the vessel and generally keeping your mind alert can be excellent diversions.

Read the Signs   Lethargy, yawning, headache, flatulence, hyperventilation, and drowsiness are common signs of mal de mer. Increasing malaise can be accompanied by turning pale, warm flushes, lightness of head, apathy, and shivering. If one does not take measures at this time, vomiting will generally follow quickly. Incidentally, at this stage it’s best not to fight it, as once it's over, you'll feel much better! Be sure to drink plenty of fluids. (Those feeling ill should be given a bucket, it is not safe to hang over the side.)

Should the need arise, don't hang over the side.  These cruisers are actually engaged in a much more pleasantly activity-scouting out snorkeling terrain.

Diet   For most people, diet is the most important factor in preventing seasickness. Rich and spicy foods eaten even the day before can trigger the process. Coffee should not be taken and, in fact it will almost guarantee seasickness. If you drink tea, it should be weak and hot chocolate should be made with water. When you're feeling ill, bland foods such as crackers or bread nibbled slowly work best, with sips of carbonated drinks. Interestingly, while actually eating you generally won't feel ill. It is important to keep hydrated, but avoid citrus juices.

Alcohol can have an extremely negative affect, even if it's as little as one beer or glass of wine. Sadly, one of the worst scenarios comes from what we all are likely to do before a long trip; to go out for a sumptuous dinner ashore, accompanied of course with wine. One of my worst days at sea was in the Bay of Biscay after a magnificent dish of ‘fruits de mer.’ At the time, we hadn’t planned to leave the next day, but a weather window had unexpectedly appeared and it's hard to give up such an opportunity.

Eating ginger, preferably raw or in capsule, or even gingersnaps, is an ancient remedy for settling the stomach. We always complete a meal with crystallized ginger and it has become a regular item on board.

After over 70,000 miles on Bagheera, and many more miles running charter yachts and ocean racing, having to deal with seasickness is really just a minor inconvenience in my seafaring lifestyle. Although the remedies (see below) may appear grueling, they are not as demanding or inhibiting as they sound when combined with some common-sense practices, they can significantly improve life aboard. Being in the best position on the boat soon becomes second nature and we generally have simple meals the first two days anyway, so time spent below is kept at a minimum except to sleep. Watch schedules can also be organized to allow sufficient time for me to gain my sea legs. Although I am always on deck to lift the anchor when we depart a port, Andy, who doesn’t suffer from seasickness, takes the first watch. This gives me time to take medication and have it take effect while I’m sleeping, before coming on watch three hours later. After living it up in port and stowing the supplies, I do a lot of sleeping during the first two days at sea. By this time I am rested and have gained my sea legs, so I can thoroughly enjoy the rest of the passage as well as planning our next exciting landfall.

Remedies for Mal de Mer

Seasick pills are commonly used both by novices and circumnavigators, but you should take them well in advance. Being alert on watch is imperative, it is important to find a brand that controls nausea but does not cause drowsiness. There are many types on the market and trying out different ones is really worthwhile. Once you find a brand that suits you, buy a large supply as you might not find them in the next port let alone the next country! Always check dosages and restrictions carefully. Here's a list of the most common treatments available:

Cinnarizine (Stugeron®)   Manufactured in Britain, this is probably the most popular and sucessful medication among cruisers. It is also sold in Mexico and in many ex-British protectorates such as the British Virgin Islands. We also found it in Australia and South Africa under different generic (brand) names. It is not available in the US or Canada. The dosage guidelines call for 30 mg taken one to two hours before exposure, and 15 mg every six to eight hours thereafter. It appears to be effective in all conditions and most users claim that they find it as effective as a scopalamine patch.

Dimenhydrinate (Dramamine® ,Gravol®)   Most in-house brands of these over-the-counter preparations come as regular tablets, chewable tablets, long-acting capsules, liquid preparations, suppositories, and injectable preparations. Although popular among travelers, the main disadvantage for cruisers is the tendency to cause drowsiness, feelings of vertigo, and the fact that it may not be as effective as other medications in extreme conditions.

Meclizine (Bonamine,® New Dramamine®)  This has long been used by cruisers for less-severe conditions, but make sure that you test it for drowsiness before heading over the horizon. It is available in a tablet that can be chewed, swallowed, or dissolved in the mouth.

Cyclizine   Commonly sold as Marzine® in the US and used as an oral preparation, it is only available as an intra-muscular preparation in Canada. This also does not seem to be as effective in rough conditions.

Promethazine (Phenergan®)   Available in tablet and syrup form, Promethazine is often used in severe conditions, but due to its disadvantage of causing extreme drowsiness, it may be taken with an amphetamine-like agent. Such is the ‘Navy cocktail’ of Phenergan and Ephedrine, which was developed for the astronaut program and now used by cruisers. Available in tablet and syrup form, once nausea has begun, Phenergan® suppositories can be used.

Dextroamphetamine (Dexedrine®)   Although amphetamines have significant effects on motion sickness, as with Promethazine, their main use appears to be only for severe situations when they are used in conjunction with other medications, (available in short or long lasting preparations).

Scopolamine Patch (Transderm-V®)   Scopolamine is very popular among cruisers for long trips in preventing seasickness as well as reducing irritability produced by a constantly moving, hot, humid environment. The Scopolamine patch is placed behind the ear at least eight hours before exposure and is replaced after 72 hours. Only the concurrent use of two patches is recommended. (As the transderm V relies on a controlled release, the whole patch should be used.) Although the long period of coverage is convenient for cruisers, the delay in effectiveness is a disadvantage if a decision is made to leave without advance warning. If departing port earlier than expected, taking another medication to ‘tide you over’ is not recommended as mixing drugs can cause a severe case of malaise. In many places, Scopolamine patches are only sold under prescription for this reason. Conversely, a delay in departure, with much of the patch being used up while still in port, can make this an expensive resource.  Like most medications, Scopolamine patches can have side effects, typically dryness of the mouth and temporary blurring of vision, so check this out in advance of an ocean passage.

Pressure-point bands  Commonly sold in drug stores ‘travel bands’ or Dea pressure-point wristbands, developed from Chinese acupuncture principles, are very successful in suppressing seasickness for some cruisers.

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