Dive Medicine: The Diver's Scourge

Screaming at the submarines, chumming for sharks, tossing the belly confetti - whatever you call it, seasickness is no fun.

By Samuel Shelanski, M.D.

First you feel like you're going to die, then you pray that you will. If you've ever been seasick, then you know exactly what I mean, and if you haven't, then consider yourself lucky.

Unfortunately, as divers, we spend a lot of time in planes and boats where we are more likely to get motion sickness. Therefore, it is important to arm ourselves with the necessary information to avoid it, or failing that, to combat this unpleasant ailment.

What Causes Motion Sickness?

Balance and equilibrium are controlled by the brain, which interprets information from the inner ears, eyes and various sensors on the body to come up with a final decision on where the body is in space. If the information doesn't jibe, the ears say right while the eyes say left, then the brain revolts and the result is revolting.

There is some evidence from a 1988 study which suggests that the up-and-down motion of a vehicle is more likely to make a person sick than side-to-side motion. Other factors that can contribute to a person feeling ill are anxiety, fatigue, being overheated or any coexisting ailment.

Drug-Free Tips for Avoiding Motion Sickness

1) Position yourself smartly. That outer cabin on the top deck may have the best view, but it's also going to move a lot more. The lower down and closer to the middle of a boat you get, the less you will pitch and rock.

2) Avoid fumes. Nothing will tip you over the edge faster than the stench of diesel. If you're feeling ill, then it's usually better to be on deck with the fresh air (it's also a shorter trip to the rail).

3) Face forward and fix your eyes on a stationary object close to the horizon line - a cloud, oil rig, palm tree, ship, etc. This way you help ensure that your eyes will see the same motion that your body is feeling.

4) Get into the water. You know the feeling - you've just scrambled around getting your gear on, and now you're perched on the gunwale of a pitching skiff, in the sun, with your wetsuit feeling sort of tight around the neck, getting a whiff of idling engine fumes and the dive briefing goes on and on and on ...

Most people will feel much better as soon as they get in the water and off the surface. It is also advisable to avoid long surface swims in choppy waters, if possible. Take a compass heading, and set off at about 15 feet where there is likely to be less surge.

5) Eye of newt, hair of dog. Everyone has some home remedy for seasickness. Some of these, like taking ginger pills, come up frequently enough that there is most likely something to them. Many people swear by the Sea Bands that use acupressure on the wrists to relieve symptoms. However, one woman I met said that the wristbands were most useful for wiping her mouth after she was violently ill. Whatever the remedy, if it works for you then use it.

Eating for Success - Foods That'll Stay Put

If you are prone to motion sickness, you may decide that it is better not to eat, or to eat very little before climbing aboard a boat. If you do eat, here's a checklist of foods to eat and to avoid.

Don't:

• Load up on bacon, hash browns and eggs. Heavy, greasy foods can make you feel queasy without a boat ride.
• Rush down to the dock with arms full of gear and a Danish hanging out of your mouth. Give yourself a chance to digest.
• Drink a lot of coffee, tea or, most importantly, alcohol. You won't get much sympathy from fellow divers if you're hanging your head over the rail after a night of carousing.

Do:

• Eat simple, bland foods. The breakfast burrito buffet may look tempting, but you should settle for toast, fruit and juice.
• Eat a small meal at least one hour, preferably two, before getting on a boat.
• Stay well hydrated with water, juice, sports drinks or caffeine-free sodas.

If you're already nauseated:

• Eat saltines and dry toast.
• Drink small sips of noncarbonated beverages or flat soda.

The Pharmacist's Solution

Several medications are available both over-the-counter and by prescription that help prevent and relieve the effects of motion sickness. Common brand names include Dramamine, Bonine and Marezine. They work, but the problem with almost all of the medications on the market is that they can cause significant drowsiness. This makes them fine for the flight down to Roatan, or the 30-hour crossing to Cocos, but they should be used with caution on the day of diving.

What about taking half-doses? Taking one-half doses of these medications may reduce the drowsiness side effect, but may also reduce their effectiveness in squelching motion sickness.

Will taking them help if I'm already seasick? Although you may have already become nauseated, taking Bonine or Marezine can reduce your symptoms.

What Ever Happened to Scopolamine?

Many people swore by scopolamine, delivered through a transdermal patch, to control their motion sickness symptoms. Then, in August 1994, it was pulled from the market, and has not been available since.

There have been many rumors as to why Transderm Scop (trademark name) was pulled, but according to the manufacturer, Ciba, a routine quality assurance check in 1994 revealed crystal formation in the patch that resulted in only 85 percent efficacy of the patch. The company voluntarily halted shipment of that batch of patches. This then obligated Ciba to undergo an FDA review of the production, labeling and packaging of the product.

This review has just recently been completed, and the company has the go-ahead to bring Transderm Scop back to market. However, it will be some time before you can find it at your local pharmacy. Updates on availability date can be obtained by calling (800) 452-0051.

Questions for Dr. Shelanski should be addressed to RSD, Dive Medicine, 6600 Abercorn St., Suite 208, Savannah, GA 31405; e-mail: RSDmgzn@aol.com.