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Seasickness — How to Avoid it & Treat it

Friday, August 19th, 2016

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Plan on sailing this summer and fall? Before you do, check out this post from Adventure®  Medical Kits’ marine medicine consultant Dr. Michael Jacobs for tips on dealing with that common ailment that afflicts many boating enthusiasts — seasickness.

Seasickness (mal de mer) is the sailor’s most common and dreaded ailment; susceptibility is virtually universal. Untreated, seasickness leads to rapid physical and mental deterioration, posing a major hazard to crew health, safety, and morale. Every year, seaworthy yachts are abandoned because their exhausted, seasick, and despondent crews have lost their collective will to persevere. Unfortunately, mariners frequently consider seasickness a medical emergency, and summon unnecessary and potentially hazardous medical evacuations; at the very least, seasickness can ruin a good day on the water for any boater. It is clearly an illness to be reckoned with.

CAUSE

Seasickness results from a mismatch of sensory input processed in the brain’s balance center, which orients the body’s position in space. Place someone in the cabin of a heeling and rolling boat, and you immediately invite “mal de mer.” Below decks, the eyes oriented to the floor and ceiling detect no tilt from vertical, but fluid in the inner ear (the vestibular apparatus) constantly shifts with the boat’s motion, sending a different position signal to the brain. Positions sensors in the neck, muscles, and joints relay additional information to the brain depending on how the person moves to maintain balance.  The conflict of sensory data from all these sources ultimately activates a series of responses, which we recognize as seasickness. Sensory conflict and the loss of spatial orientation can impair ones ability to think and reason clearly. Seasick sailors often lose short-term memory and the ability to solve problems and make sound judgments.  Confusion is also a side effect of many medications used to treat seasickness. Astronauts who suffer from motion sickness in space call this condition the “space stupids.” The equivalent condition for seasick boaters might be called “sea stupids.” The trick to preventing seasickness is to avoid sensory conflict by coordinating input, especially from your eyes and ears. Simply put, if your eyes are seeing what your ears are feeling, you will have a great day at sea!

PREVENTION

  1. Start your trip well hydrated, and avoid alcohol.
  2. Eat a light meal low in fat and high in starch.
  3. Pre-trip preparation should be designed to minimize time spent below decks while underway. Prepare a few simple meals ahead of time, and have personal belongings easily accessible.
  4. Avoid close-focused visual tasks such as reading.
  5. Stay in the fresh air, away from engine fumes, and near the center of the boat where motion is less pronounced.
  6. Munch on saltines, granola, or energy bars, and sip fluids.
  7. Look at the horizon to provide a stable reference point; sit or stand upright with your head and upper body balanced over your hips, and anticipate the boat’s motion as though “riding” the waves. Standing and taking the helm will help you accomplish this.
  8. Steer the boat by reference to the horizon, clouds, oncoming waves and distant marks; this is extremely effective in reducing seasickness. It may take as long as three days to adapt to the boat’s motion and get your “sea legs.”

MEDICATIONS

Medication is generally more effective in preventing symptoms than reversing them during this period of adaptation; therefore, if you anticipate you may become seasick, begin medication the night before departure.

MARINEBonine® (Meclizine), and Phenergan® are effective as well as other medications (see page 114 in A Comprehensive Guide to Marine Medicine for more info on medications). Sudafed®, or Nodoz®, can counteract the drowsiness caused by the antihistamines. The popular drug Stugeron® (Cinnarizine), although not sold in the United States, is available over-the-counter in Europe, Bermuda, Mexico, and Canada. It can also be obtained from www.canadadrugsonline.com. The prescription Transderm-Scop® adhesive patch, applied behind the ear two hours before departure, may cause less fatigue, and the benefits will last for three days. Review the many potential (and serious) side effects before using scopolamine with your physician. Scopace® tablets allow sailors to regulate the amount of scopolamine, which helps reduce side effects.

ALTERNATIVE THERAPIES

Alternative therapies, which appear beneficial for some mariners, include ginger capsules, one gram every six hours, supplemented with other ginger products. BioBand® and Sea-Band® are elastic bands with a plastic stud that applies pressure to the Neiguan P6 acupuncture site in the forearm.       The variety of medications, devices, and other remedies may work for some people and not for others. Therapies are subject to the placebo effect, and there are no well-controlled trials confirming the effectiveness of many products or comparing different treatments. The protection conferred by drugs is a matter of degree; there is no magic bullet to prevent seasickness in everyone.  If one drug fails to work for you, try another; try different medications or modalities on land to see if there are any unacceptable side effects. If you discover a safe regimen that works for you, stick with it and believe in what you use.

SIGNS, SYMPTOMS & TREATMENTS

The earliest signs and symptoms of seasickness are yawning and drowsiness, progressing to dry mouth, headache, dizziness, and extreme listlessness. Some people initially experience an unsettled stomach, slight sweating, mild blushing, and a feeling of warmth. Untreated, the person becomes pale, cold, and clammy. Nausea later comes in waves with belching, salivation, and then uncontrollable vomiting. Recognize and begin treatment with prescription anti-nausea medication (e.g. Phenergan®) when early signs appear. Phenergan® taken as a pill, but preferably a suppository, will prevent vomiting and subsequent dehydration. During treatment, lie down and try to sleep. Take small amounts of fluid, crackers, and hard candy.

Sailors now have many options to manage seasickness. It is no longer necessary to follow Samuel Johnson’s 18th century advice: “To cure seasickness, find a good big oak tree and wrap your arms around it.”

Dr. Jacobs is the co-author of A Comprehensive Guide to Marine Medicine, and the author of numerous articles and chapters on medicine for mariners and safety at sea. He is the founder of MedSail, and consultant to Adventure® Medical Kits. He practices medicine on Martha’s Vineyard.

To find a great line of medical kits pack with the medication you need out at sea go to www.WestMarine.com  or AdventureMedicalKits.com

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Cold Water Immersion Survival

Friday, April 23rd, 2010

Spring boating season may be here, but water temperatures are still cold enough to cause problems for boating enthusiasts. Adventure Medical Kits’ marine medicine consultant Dr. Michael Jacobs provides tips for surviving cold water immersion.

Comp Guide to Marine Mediciine

AMK's A Comprehensive Guide to Marine Medicine inlcudes tips for treating hypothermia.

Don’t fool yourself into thinking the cold water you sail over is dangerous only when it contains pancake ice and glacial runoff; you could be dead wrong. In fact, water temperature as high as 60ºF can kill you just as easily. Fall into cold water without a personal flotation device (PFD; see sidebar below), and you could drown in the span of a few minutes, often within 10 feet of safety. Statistics indicate an incapacitating response that is rapid in onset and prevents individuals from swimming 10 feet to save their lives. Swimming ability does not improve survival.

We now appreciate that sudden immersion in cold water (less than 60ºF) initiates a series of incapacitating reflexes that increase the risk of drowning. Indeed, the most common cause of death from accidental cold-water immersion is drowning, not hypothermia.

The initial response, which affects breathing, heart function, and muscle strength, is called the Cold-Shock Response. This is a series of reflexes that begin immediately upon sudden cooling of the skin following cold-water immersion. The initial phase of the cold-shock response peaks during the first 30 seconds, and lasts just 2 to 3 minutes. During this time, blood pressure, heart rate, and the workload of the heart all increase, making the heart more susceptible to life-threatening rhythms and heart attack. Simultaneously, gasping begins, followed by rapid and deep breathing. These reflexes can quickly lead to accidental inhalation of water and drowning. This rapid and seemingly uncontrollable over-breathing
creates a sensation of suffocation and contributes to feelings of panic. It can also create dizziness, confusion, disorientation, and a decreased level of consciousness.

It is important to realize that this initial phase of the cold-shock response is brief and that your actions during this time can vastly improve your chance for survival.

If you fall into cold water, it is imperative you try to bring your breathing under control while keeping your head above the water; your life depends on it! Try to calm yourself, do not panic, and realize these reflexes will pass. Just keep your head above the water and consciously slow your breathing. Swimmers experience difficulty synchronizing their swim stroke with these breathing changes and can easily inhale water and drown, even in calm seas. It is safer to tread water and maintain airway freeboard – distance from the water level to the mouth and nose. Breath-holding time is also reduced in cold-water immersion, making escape from beneath a capsized vessel more difficult; kayakers have less time to set
up and roll their craft upright.

Over the next 30 minutes, the muscles and nerves in the extremities cool. Swimming becomes arduous, weak, and ineffective. Loss of muscle strength makes it difficult to perform basic survival procedures. Boaters who fall overboard are often too weak to reboard their craft, get into a life raft, climb the ladder of a rescue boat, or simply grasp a rescue line. Victims in cold water quickly lose the ability to rescue themselves or assist in their own rescue. In icy water, you have only 10 to 15 minutes of effective
muscle strength.

If you fall into cold water, be prepared for violent shivering and intense pain. You can help slow your rate of cooling, and increase your survival time, by following these guidelines:

Do not undress. The added weight of clothing and boots will not impair your ability to float. Clothing traps water next to the skin where it is warmed, retarding heat loss; this is similar to the protective effect of a diver’s wet suit. Clothing also traps air, which provides some insulation and buoyancy. If a short swim is your best chance of survival, then remove any extra clothing and footwear to reduce drag and improve agility.

HELP. If wearing a life jacket, assume the Heat Escape Lessening Posture: cross your hands over your chest and press your arms closely to your sides; draw your knees up toward your chest and cross your ankles. This position facilitates maximum heat retention by protecting the most vulnerable areas of the body.

Tread Water. If you don’t have a life jacket, move slowly and tread water using slight movements. Exercise wastes precious energy and accelerates the rate of cooling by increasing blood flow to the extremities. Activity also flushes cold water through protective clothing, increasing heat loss. Avoid long swims. You have a 50-50 chance of successfully swimming half a mile in 50º F water. If you must swim, pace yourself with an easy stroke, such as the breaststroke, that keeps your head and face out of the water.

Get out of the water. Always reboard or climb on top of a swamped or capsized boat and await rescue. Once out of the water, stay out, no matter how cold the air temperature or how chilled you may feel. You’ll survive longer out of the water because the rate of cooling in water is 25 times greater than in air at the same temperature.

Wilderness Medical Society (WMS) member Dr. Gordon Giesbrecht, a noted hypothermia expert, summarizes the sequence of events and how much time you have after sudden unplanned immersion in frigid water:

ONE-TEN-ONE

ONE minute of gasping, when you need to control your breath.
TEN minutes of meaningful strength to pull yourself out of the water.
ONE hour before you lose consciousness.

Sudden immersion in cold water need not be a fatal event. Understanding the physiology and exercising appropriate actions for self-rescue will greatly improve your chances for survival. Do not be intimidated by cold water, but respect the challenge it presents.

Treatment
Victims who avoid drowning still face the risk of acute hypothermia as the body’s core temperature decreases. If the victim is fully awake and shivering, then treatment for mild to early moderate hypothermia is reliably effective and evacuation is unnecessary. The victim is capable of generating internal rewarming heat by sustained vigorous shivering if given fluids and carbohydrates, but fuel is required for continued shivering. If dry, and insulating clothing is not available, provide an extra windproof vapor barrier by dressing the victim in foul weather gear to minimize heat loss. When practical, wrap the victim like a burrito in blankets, sleeping bag, sails, or sail bag.

Treat hypothermic victims by wrapping them in blankets

Treat hypothermic victims by wrapping them in blankets.

After prolonged cold-water immersion, generally more than 2 hours, it is prudent to evacuate the victim to a medical facility. These patients are perilously close to losing both consciousness and the shivering reflex. They are incapable of rewarming themselves, and they require more aggressive and sophisticated rewarming methods. Careful monitoring is required because of the many metabolic complications arising from advanced hypothermia. Some sailors have been rescued at sea after prolonged cold-water immersion in an apparently stable and conscious state, only to later collapse while walking around the rescue craft or while taking a hot shower. These people are severely hypothermic and have low blood pressure. Their condition will rapidly deteriorate with activity and during any attempt at external rewarming. They must be kept still, in a supine position, and handled gently in order to avoid physically stimulating the heart to change its rhythm or stop beating. During helicopter evacuation, use a litter with straps so the person can remain horizontal and securely bundled. The rotor blades create a wind-chill from the downwash and can increase the level of hypothermia. Dress and wrap the victim properly during transfer.

Types of PFDs

I: Off Shore Life Jacket: Turns most unconscious people face up in the water even in rough seas, often found on ocean-going boats and commercial watercraft.

II: Near Shore Buoyant Vest: Turns some unconscious people face up in the water in calmer water.

III: Flotation Aid: Common for all purpose boating but will not turn unconscious person face up.

Requires treading water to keep face/head out of water; often these are kayaking, waterskiing, or fishing vests.

IV: Throw Device: Usually a boat cushion or life ring.

V: Special Use: This includes devices that don’t fit in other categories, such as some kayak
or windsurfing vests not approved as Type II or IV.

Special note: for kids, vests should have a groin strap to prevent vest flying off when jumping in water. They should also be sized correctly.
For more info: http://www.uscg.mil/ or http://www.usboating.org.

Michael Jacobs, M.D., is the Medical Consultant for AMK’s Marine Series of medical kits. He is also the MedSail Founder and Program Director: Safety at Sea and Medicine for Mariners Conferences; Medical Director, Vineyard Medical Services, Martha’s Vineyard, MA; a USCG Licensed Captain; co-Author of A Comprehensive Guide to Marine (included in most Marines Series kits) and author of MedicineSurvival at Sea, Textbook of Wilderness Medicine.

Solo Sail – Which Kit Should I buy?

Thursday, December 18th, 2008

Question:

I am 73 and solo sail. I have sailed from Oakland, CA to Mexico, to Hawaii, and am now heading out into the south pacific.I am not sure what medical kit to order.
Thanks, Susan M.

Dr. Jacob’s Answer:

I commend you for solo sailing at your young and vigorous age of 73- Probably the most important element in maintaining your health at sea is a good physical exam, female exam, blood work, possibly an exercise stress test, and a review with your physician of any possible medical problems that might arise during your trip. You need to review your medical history in detail.

For a solo sailor on an extended trip, the  Marine 1000 would be ideal, supplemented with medications (antibiotics etc) necessary for a prolonged cruise.

You may want to read a paper I wrote on marine medical kits (view in browser or download Word Document), which might be helpful in expanding your basic supplies.

Good luck and safe sailing,

Michael Jacobs, M.D.

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24hr Medical Call Resources

Friday, November 14th, 2008

Question:

I noticed your comment on this service and you referenced an article in Sail magazine. Could you give me that info. to find this coverage for an upcoming long distance sailing trip. Thanks

Answer:

Here are the resources:

Telemedicine Organizations World Clinic 276 Newport Road New London, NH 03257 (1-800-636-9186) www.worldclinic.com

Maritime Medical Access George Washington University Medical Center Department of Emergency Medicine 2150 Pennsylvania Ave., N.W., Washington, DC 20037 Phone: (202)-741-2919/2918 Fax: (202)-741-2921 www.gwemed.edu/maritime.htm

MedAire/MedLink 80 East Rio Salado Pkwy. Suite 610 Tempe, AZ 85281 480-333-3700 Fax 480-333-3592 www.medaire.com

Emergency / Remote medical advice services?

Saturday, December 29th, 2007

Q:
Hi there, My husband and I are preparing for cruising in our sailboat – expecting to leaven in April 2008. We have been planning our medical kit / supplies for the last 3 years, and both have some basic medical training. (We also have your Marine Medical 3000 as a good base) What we are looking for now is a good 24/7 medical contact service – are you aware of any? If an emgency situation does arise that we feel we can’t manage/ don’t understand – it would be most reassuring to know (in advance) we can contact an expert and always expect an answer (we have a Satallite phone, and email) Many thanks Maryanne Webb

A:
HI Maryanne- you question was forwarded to me- enclosed is an article I wrote for SAIL magazine last summer- the contacts should be correct- You’ll need to decide which company is both afordable and gives you the service you need- You also should make sure your sat phone has full coverage for your cruising area- If it is Iridium, it should do fine- let me know directly if you have any questions, good luck and fair breezes – Michael

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