NUTS & BOATS
The twice monthly newsletter for to-be and already-are cruisers Volume 2, Issue #12 - June 15, 2004
Publisher: Trish Lambert
www.takehersailing.com
(C) P. Lambert 2004
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CRUISER’S EYE VIEW
Dealing with the Ocean’s Motion, Part 2 by Skip Randall Note from Trish: This is Skip's follow up to my "rule of thumb" info in Part 1. As a family practice physician assistant, Skip is far more qualified than I to discuss specific medications, dosages, and other medical strategies. He has provided so much information that this issue (like others in the past) is comprised of this single article. ********** This essay is dedicated to my Aunt Dottie,
certainly the most seasickness susceptible subject I've ever encountered. ********** Ever wonder just what evil stuff goes on inside causing seasickness? Goes something like this: WARNING
Brief anatomy and physiology lesson follows.
Just fast forward if you find this kind of stuff boring Residing in tiny bony caverns, deep inside your cranium adjacent to each ear, lie the organs of balance called the vestibular apparatus ("inner ear"). They are like amazing and sometimes diabolical little biologic gyroscopes in you head that give you your sense of body position and equilibrium. They consist of three fluid-filled semicircular canals lying in three planes: one vertical, one horizontal, and one oblique. The fluid contains microscopic chunks called "otoliths." When you change position, the shifting otoliths stimulate receptors and register the movement and the new orientation. The neurological message is transferred to the brain via the eighth cranial (vestibular) nerve to a part of the brain called the cerebellum, where the input is processed. With certain kinds of motion, the message to the brain can say "tilt", then (often) "toss" (as in "barf"). Remember when you were a playful kiddo, and (everyone I know has tried this) on the playground swing you throw your head back at the top of the arc and.....damn, that must be a taste of what adults call fun when they drink too much. Vestibular overload occurs, and the brain says "tilt." Well, fellow mariners, the undulation, pitching and yawing motion of a boat on the waves can produce this same effect, albeit more subtly. End of physiology lesson. The physical manifestations of seasickness can range from annoying to life-threatening--really. There is the nausea, often vomiting, but also sweating, salivation, repetitive swallowing, headache, hyperventilation, and the "characteristic look" (flushing then pallor). In extreme cases it can be quite debilitating, and if prolonged, even dangerous (due to dehydration, electrolyte loss, and something called "metabolic alkalosis"). So what to do to tame this monster? First, it's a hell of a lot easier to use prophylactic measures than to try to abort the "toss" signal once the brain has registered "tilt." Seasickness is potentiated by lack of sleep, alcohol overindulgence, heavy meals, and the oh-so-vague "psychological factors." It can also be potentiated by obnoxious smell (like diesel fumes or the smelly head) and by decreased visual landmarks (like going below). There are several preventive measures that can be used in addition to avoiding the above factors. The most popular seems to be "the patch." This is transdermal scopolamine ("transderm-SCOP) and comes in the form of an adhesive patch about 1/2 inch in diameter that you apply to the skin. It works best when applied the evening before sailing and it lasts for three days. It is a prescription item, and it comes in packs of four patches. Do not cut them in half. Another popular medication is meclizine, available OTC in most states as "Bonine." It comes in 25mg tablets, and works best if taken an hour or two before sailing. For very susceptible people, 50mg is reasonable. The main side effect is drowsiness. Another preventive I should mention is the acupressure point wrist bands. They seem to work for some folks, and appeal to those who eschew the systemic medications. They have no side effects. I would recommend resorting to a dose of meclizine, however, if queasiness develops in spite of using the bands. So.....you're out there on the swells and you or one of your crew is feeling queasy and developing "the look." First, get them above deck and at the helm (if able) or have them get an eyeball lock on the horizon. This may do the trick. If not, offer them a Bonine tablet (even if they have the patch on or have taken one 25mg Bonine prophylactically). Next, have them sip some ginger ale or ginger tea and nibble on a cracker (like a saltine) or plain bread. Reassure them and be kind. Don't make jokes about what a wimp they are. If they continue to really feel bad and they are up-chucking after an hour or so, then the kindest, nicest thing you can do is turn the boat around (if on a day sail) and return to the dock. On multi-day trips, most sailors who get seasick gradually get better after several days out. This is called "accommodation" and, in a sense, the brain learns to cope with (ignore) the vestibular input without freaking out (tilt, toss, etc.). This is usually the case, but unfortunately, not always. What if you're on a multi-day passage, one of your crew is getting increasingly sick, and turning back is not a viable option? You can increase the Bonine dose to two 25mg tablets every 12 hours. Still sick? Then you probably need to drag out the "big guns." This involves prescription agents, and there is some medical-legal risk if the prescription is not written in the recipient's name. I stock prescription phenergan on board. This comes in 25 and 50mg tablets and 25mg suppositories. The main side effect is drowsiness, but at this point, who cares? If they can keep it down, I'd give 25 to 50mg every 6 hours. If they are vomiting, let's just say "aggressively", then I'd have them use a suppository (that's via the rectum) and repeat it every 12 hours as needed. Encourage sips of water, Gatoraid or apple juice and monitor their status frequently. Worst-case scenario: You're on a multi-day passage, several days out, and none of the above stuff is working. Your afflicted crew is not taking in enough fluids and nutrients, continues to vomit, and is getting progressively weaker and sicker. In this case I would alter course for the nearest port, or if that's not feasible, contact the Coast Guard for advice as to an emergency evacuation. No joke...this worst-case scenario can lead to delirium, coma and potentially, death. On this cheerful thought, I wish you carefree sailing and happy, toss-free times on the water. Good luck, and don't fail to stock at least some Bonine on board. And for those of you who just have to know: Yes, I've been known to get seasick, and I'm thankful it's only been a handful of times. | 
