Motion Sickness / Sea Sickness

In another life I worked on cruise ships for a few weeks a year. The longest trip in 2011 lasted 3 months. (Shortly after, I moved to San Luis Obispo and “got settled”.) Ship life planted some of the first seeds in my mind leading to Pre-R, because house calls (cabin calls) were routine. Being able to go with nurses to visit sicker passengers in their own rooms just seemed right. It always gave a better sense for their environments and social support, and felt much easier to just have a chat. Follow up was plentiful, and frequently happened in buffet lines… and sometimes at the bar. For anyone too sick, we transferred to port hospitals and generally got great follow up there as well. Basically, I thought of ships as hospitals where I could admit to myself, and do rounds at reasonable hours… with the goal of helping passengers to survive a few fun weeks at sea rather than forever.

Naturally, the most common topic at sea is sea sickness, which has a variety of approaches, but one therapy that solves all… port. Before labeling as sea sick, however, it’s important to consider problems that can sometimes look similar like strokes, heart attacks, gastroenteritis, intoxication.

Red Flags:

• Past strokes or heart attacks
• Blood thinners like warfarin
• Pacemakers
• Frequent falls
• Cancer
• Diabetes
• Pregnant
• Fevers

Happy Words

• “I get sea sick on every cruise. But my family loves these daggum reunions.”
• “I’m able to keep ginger ale down ok.”
• “The cool air helps.”
• “I felt waaay better after I finally puked.”

More often than not patients tell you their diagnosis, and the next step short of getting back to land, is to take the edge off with some simple tips and maybe meds. Here’s my list:

  1. Head to the part of the ship that moves the least, but that also offers cool outside air. For a ship parked at sea, lower decks, mid ship will move the least like the middle of a see-saw. But under way, the rear of the ship will move least. (This applies to your speed boat on a lake as well. Those up front get bounced all around, while those in back have a softer ride. The jostling is just higher frequency.)
  2. Visual fixation on fixed points in the distance can be helpful as well. So in light of the first point, I consider the best spot to be way back, outside on a recliner, watching the horizon. Just try not to get a nose full of ship or passenger smoke/exhaust.
  3. Ginger in any form seems helpful – ginger ale, ginger beer, ginger tea, ginger candy or straight ginger. No idea why.
  4. Avoid fatty, spicy foods and alcohol. People usually figure this out quick.
  5. No idea if the wrist pressure bands works, but some folks swear by them and acupressure in general.

As for medications, meclizine is over the counter and often found in bins on ships for the taking. It’s also called Antivert and Bonine. Somewhat helpful for vertigo and motion sickness, passengers seem to grab handfulls, with 25-50mg being the recommended dose. Some people prefer over the counter Dramamine (dimenhydrinate). Others prefer Zofran (ondansetron), which doesn’t cause as much sedation, but unfortunately isn’t yet OTC. If those don’t work, on occasion we’ll inject Phenergan (promethazine). From my vantage point, the goal for bad sea sickness is sedation till port. I have the same approach for vertigo and migraines as well. There’s something about sleep itself that’s more therapeutic than any molecule out there.

Treatments for sea sickness can cause problems too. Scopolamine patches make for a great example. Before departing on one trip from Vancouver a couple came to the clinic saying they thought the guy was having a stroke. His vision was blurry, mouth was dry and he felt unsteady. I noticed the scopolamine patch and we removed it. They seemed like good folks and I didn’t want to kill their vacation on day one. So instead we headed to the buffet. Literally 2 hours later he he was back to normal and no problems the rest of the trip. With cruise medicine, as with Pre-R, you get to know people.

Lastly, I’m convinced mindset makes a huge difference. Embrace the waves! Give us a call before your next trip for travel tips or your other last minute medical needs.

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