Seasickness: Prepare for It, Treat It

The Bermuda Race’s medical chair (a race skipper) describes the causes, prevention, and treatment of this all-too-common and potentially dangerous condition.

The medical reports submitted by crews after recent Newport Bermuda Races usually include more than 50 cases of seasickness. I suspect that this number significantly underestimates the actual incidence of this illness. Seasickness may present in a full range of stages, ranging from slight queasiness to severe nausea and vomiting, so it is likely that mild cases were not formally logged and that some of the cases occurred without any thought toward preventative measures.

As a community, we pride ourselves in taking safety seriously. Race participants and organizers spend considerable time preparing for events that are unlikely to happen but that (should they occur) could be catastrophic. Potential problems include such scenarios as dismasting, blown sails, failed through-hulls, sinking, losing one’s rudder, and man overboard situations.

While preparation for the Newport Bermuda Race usually is detailed and labor intensive, there is one problem that sailors do not seem to take as seriously as they should

Make no mistake about it, seasickness can be life-threatening. In the 2012 race, seasickness precipitated evacuation of a crewmember from a competing boat, and another vessel on the return trip was also abandoned with seasickness playing a major role in the event. Seasickness can create a danger not only for the victim but for the rest of the crew, too.

Causes of Motion Sickness

Nobody is completely immune to motion sickness. This sickness occurs when our visual cues are mismatched with what our brain perceives. This is precipitated when we are unable to anticipate or line up visual cues with a particular, or perceived, motion. An excellent example is when sailors have to spend time in the bilge, say, while repairing an engine. Our brain senses a motion (the vessel’s movement) but the associated visual cues are absent. Add the smell of diesel fuel and the rest is readily predictable.

Motion sickness can also affect an individual in the absence of motion, as may occur while viewing an action packed video game. Additional factors that contribute to seasickness include lack of sleep, anxiety, poor hydration, foods difficult to digest, certain smells, and learned behavior. When one crewmember becomes seasick, the likelihood of others on board developing the illness increases. Continued seasickness may lead to severe dehydration, an inability to function, and, if untreated, possible death.

Symptoms and Prevention

Victims might also feel a sense of impending doom.

Symptoms of motion sickness include apathy, inability to focus, cold sweats, anorexia, excess salivation, yawning, belching, headache, pale complexion, and finally, nausea and severe vomiting. Victims might also feel a sense of impending doom.

Although thresholds vary from person to person, given the right circumstances, everyone is susceptible. It is also very difficult to predict who will and will not become ill. The illness may be recurrent during a voyage, although most people will adapt to conditions after 36 to 72 hours at sea.

Before Heading Out

Knowing your limitations and propensity for seasickness is critical. Because seasickness is far more common than the more dramatic disasters we prepare for, you and your crew should plan ahead on how to deal with it. The boat should have a well thought-out management plan that includes careful planning by the entire crew.

I know many well-respected sailors who routinely take preventative medications for the first 24 to 48 hours of a voyage. Try any preventative medications before going offshore to choose the medicine with the most tolerable side effects. Start the treatment before heading out, continue for at least the first few days, and be on the lookout for signs and symptoms of early seasickness even if medication is already being used.

Medications

Anti-seasickness drugs include scopolamine patches as well as medications like Dramamine, Bonine, and Stugeron (cinnarizine). Scopolamine patches may cause dry mouth, headaches, blurred vision, urinary retention, and hallucinations. Dramamine and Bonine can be extremely sedating. Stugeron, a very effective agent (available only in or from Bermuda, Canada, and the UK) also has potential side effects such as drowsiness and tremors.

My personal favorites are scopolamine patches and Stugeron, but they may not be your favorites, too. Before choosing a medication, try several of them out on land prior to the voyage to see how they affect you as an individual. In addition, check with your physician to see if there are any contraindications to any of the drugs depending upon your personal medical history.

I strongly suggest that each crew member and the boat’s medical officer familiarize themselves with the potential side effects of medications, and have that information available onboard in order to recognize a problem, should it occur.

Alternative remedies that have been advocated include the use of ginger, wristbands, acupuncture, and magnets. I believe these interventions are of limited efficacy. So one should not rely on them as the sole source of treatment.

A final thought

For those crews who stubbornly choose to ignore the possibility of seasickness until their time comes, they might take to heart my favorite quote as they look for the silver lining in the storm cloud of this humbling experience: “This is one of the compensations of the seasick. The extraordinary humiliation which accompanies their sufferings is very good for their moral characters.” (James Owen Hannay, 1926)