Tame the Technicolor Yodel: Managing Mal de Mer

by Doc Vikingo

The bane of many, sea sickness is thought to occur when areas of the brain tasked with maintaining balance receive input from the eyes, inner ear, muscles and joints that is inconsistent and unexpected over an extended period.

And don't think that you are immune. Given the proper set of forces on or under the water, just about any diver can be made to call for Ralph.

As with most maladies, prevention is preferable to treatment. Take common sense steps like getting adequate sleep and avoiding fatigue, passing on heavy meals and fatty, spicy or acidic foods in favor of blander fare like breadstuffs, cereals and soups. Acidic, caffeinated beverages like tea, coffee and some sodas should be consumed only in moderation; ditto for alcohol.

On the boat, find a shaded, well-ventilated seat on deck that is set low and in the center of the craft. It should be away from exhaust fumes and other sea sick divers. Face forward, focus on a distant fixed object on or slightly above the horizon and avoid unnecessary movement of the neck and head. Don’t read or look through binoculars. Delay donning your suit until the last minute and, unless there is substantial surge, do get in the water as quickly as possible.

If such measures fail, you can chose from a variety of OTC and prescription medications designed to be taken prior to boarding the boat and getting ill. Among the more effective is scopolamine, which can be delivered through a patch worn behind the ear (e.g., Transderm Scop), orally (e.g., Scopace) and as a gel. The former is the longest acting. The latter two, in addition to not falling off from behind your ear, are faster acting and allow for more flexible dosing. An excellent review of patch vs pill appears in the March/April '04 issue of "Alert Diver."

Popular and effective OTC drugs include Bonine and Dramamine II (both meclizine; in prescription strength as Antivert). Also widely used are Dramamine Original Formula and Chewable Tablets and Triptone, all of which contain dimenhydrinate, a drug with demonstrated adverse effects upon alertness and performance both topside and at depth. A British product, Stugeron (cinnarizine), has also been shown an effective treatment, but is not yet on the market in the US. These OTC medications are most effective if taken at bedtime the night prior to diving, followed by a second dose about an hour prior to boarding the boat.

Both the prescription and OTC drugs have side effects, most commonly dryness of the mouth and drowsiness, but also blurred vision, dizziness and even confusion. However, the adverse effects tend to diminish with use and research suggests that the sedating effect of scopolamine may have been overstated.

A study conducted for NASA evaluating the effects of oral scopolamine on operational proficiency found no significant impact on the selected tasks, and drowsiness and blurred vision were not significantly greater than that for placebo.

Research involving naval crew found that cinnarizine (Stugeron) and transdermal scopolamine were free of adverse effects on the cognitive and motor performance tests, and the only side effect was dry mouth with scopolamine. This study used a large dose of cinnarizine, 50 mg. As another study has shown impairment of psychomotor performance and increased daytime sleepiness as dosage increases, it would be prudent not to exceed 25 mg the night before boarding the boat and 12.5 mg every 8 hours thereafter when necessary.

Another study asked divers on an extended 60' air saturation profile to complete psychomotor tasks several times during the dive and to record perceived side effects. There was no significant difference between the groups receiving either a transdermal scopolamine or a placebo patch, suggesting that modest hyperbaric exposures would not increase the probability of side effects or impair performance at recreational scuba depths.

Despite the easy availability of safe and effective motion sickness drugs, there are always those who prefer, or assert the superiority of, herbal remedies, most popular among them ginger. Kind of reminds me of those who find biological insect repellents like Cactus Juice superior to manufactured products containing DEET even though research is solidly behind that chemical.

So, is ginger effective? Seems it may be. For many reasons the final chapter on the efficacy of ginger in preventing motion sickness has yet to be written, but a number of controlled studies have found that ginger in the one gram dosage range notably reduces vomiting and cold sweating. Nausea and vertigo also are reduced, but apparently to lesser degree. Several articles report that ginger is as, or more, effective than Dramamine Original Formula in controlling motion sickness and produces fewer side effects.

If you're going to do ginger, encapsulated powdered, root or crystallized forms make it easiest to control the amount of active ingredient ingested. Eating ginger snaps, or drinking ginger soda or tea, makes getting adequate quantity and control much more difficult. Be aware that some products contain only ginger flavoring, not the real thing--read the labels. A reasonable daily starting regimen would be 1 gram/1,000 mg of powdered ginger root 4-6 hours before, then another about 1 hour before, boarding the boat. Additional doses can be taken every 4-6 hours provided they are well tolerated.

Others swear by such "natural remedies" as the Sea-Band and ReliefBand, bracelets that are placed to exert pressure/stimulation on an acupressure point on the inner surface of the wrist just above the joint. While the results to date are not entirely consistent, the research seems to suggest these bands do not control motion sickness. Moreover, the ReliefBand, costing $55 to $120 non-refundable dollars, is slightly water resistant but not waterproof.

Even farther out are products such as MotionEaze, an aromatic mixture dabbed behind the ears, and various fragrant essential oils rubbed into the hands and feet. While these might make you smell better while you're praying to the porcelain princess, there is no scientific support for them.

But, never underestimate the power of placebo. Just about every preparation and device for motion sickness has it advocates and believers.

In the final analysis you'll need to discover, probably by trial and error, what works best for you with the least adverse reaction, cost and inconvenience. Whatever pill, patch or potion you may chose, it is strongly recommended that it be given at least a 24-hour trial topside to observe for worrisome side effects and used only according to instructions or slightly more conservatively.

© Doc Vikingo 2005
Reprinted by permission of Undercurrent

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