The Offshore Voyaging Reference Site

Don’t Pass The Bucket, Please!

We’ve discussed the thorny question of seasickness before here at Attainable Adventure Cruising, and all correspondents agreed that it is one of the most debilitating things that can happen to anyone at sea. As they say of seasickness sufferers, ‘first you don’t want to die, then you think you might die, then finally you want to die’. And having once had to tie a puking, weeping crew member to a cleat for fear that they would actively pursue the third option, I can see where they’re coming from.

Numerous cures have been put forward, and some work for some people some of the time. You need to find out what works for you, and most people find some respite through medication. But for the hard core of really badly afflicted people, up until now there has seemed to be no cure.

New Approaches

But help may be at hand, through two developments in France. The first, Boarding Ring, consists of a pair of glasses with tubes of coloured liquid instead of frames, which are thought to send messages to the inner ear, balancing the information passed via the eye and the ear. These are available either as glasses, or as clip on units that can be attached to your own glasses, and to me at least they look pretty strange, although if you are amongst the 95% of sufferers who’ve tried them who claim benefits from wearing them, I don’t suppose you’d care.

The second is termed opto-kinetic re-education, and stems from work carried out during astronaut training and in the treatment of people with balance problems. Developed over 15 years by Dr Lois Bonne at the Clermont-Tonnerre Military Hospital in Brest, the treatment consists of 10 sessions of 20 minutes apiece over a period of 3 months. During treatment the patient undergoes a range of presentations involving vision and motion that mimic being at sea to the point of being seasick, with the aim of enabling the brain to cope better with that same mental information when aboard a boat. The aim is not an instant cure, but to enable the individual to resist and cope with seasickness, which in turn should allow them to remain involved and active, in itself a good way to keep mal de mer at bay. The centre claims that around 75% of patients benefit from the treatment with an improved resistance to seasickness.

Does It Actually Work?

Dr Bonne has treated many sufferers from all over Europe, and a couple of years ago a professional skipper friend of mine traveled with his partner and a couple of her friends for treatment at the Hospital. Due to the cost and time involved (they are all based in the Mediterranean) they couldn’t stay for the normal three months, and so opted for a dramatically shortened course of treatment. One of them who has suffered from chronic seasickness for years saw no benefit, but some of the others felt that it had made a significant difference to their ability to resist seasickness and keep going. So, a partial success, at least, and if the treatment had been carried out over its normal 3 months, perhaps even the chronic sufferer might have benefited too?

My friend, like most pro skippers has a cast-iron stomach (if you haven’t, why on earth would you take on such a job?) and had no need of a cure. But when he entered the treatment room even he felt decidedly poorly, so clearly something powerful is at work here. And if the brain can be trained to cope, then what a relief that would bring to the many poor souls who love going to sea, but know that it might well end in tears. Having watched so many such poor souls suffering over the years, I know that if it were me, I’d be willing to try anything…or just take up golf, or billiards, or anything but go to sea!

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Geir ove

Our kids did get seasick. When they started to use some rubber armbands with a little ball on that you put on your wrist, they never did get sick. They work, even in the car and on big ferries in heavy seas, and on our old Mono. The name is “sea band”.

John Harries

Hi Geir and Colin.

I have long used the pressure point arm bands. For me, they don’t solve the problem completely, but they sure do take the edge off.

Colin

Thanks for the tip, Geir.

I’ve known quite a few people who have tried these bands, and some swore by them and some swore at them! One friend who was fine in rough weather but hopelessly seasick in light conditions used them when it was calm, and they certainly worked for him, as he was never sick again in such weather.

Perhaps the key thing is to keep trying different remedies until you find one that works for you, whatever method it uses – and get back to enjoying being out on the water.

Kind regards

Colin

Martin

Colin, good to be alerted to new remedies. In respect of the glasses, I see you noted a 95% success rate; that is extraordinarily high for this type of thing. Do you have any more information on where that statistic came from – is it the supplier’s own figure, or a test/review done by a journal or other third party?
Do you know whether it requires good ambient light to work (their web site doesn’t seem to say; or I missed it).
My thinking is – if there’s a 95% chance of it working, it’s easy to justify having one of these aboard somewhere in a drawer.

Colin

Hi Martin

The figure quoted comes from the manufacturer, and are reported to be from clinical trials conducted with the French Navy on both male and female adults. I’d be interested to see what exactly the parameters were that were used to arrive at such a figure, as there seem to be a good few variables beyond just ‘sick or not sick’.

If they do work as suggested, then at the price I’m sure they would be worth carrying aboard, as you suggest.

My view remains that trial and error to find what works best for you, and with the least number of side effects, is the way to go. For example, many people highly rate transdermal patches based on scopolamine, but I’ve seen more people suffer side effects from these than any other remedy. But for those who find them effective, then nothing else will do.

Best wishes

Colin

Enno

Hi Colin
My wife and a friend of hers tried those french glasses. Both did not notice any effect on seasickness. There was however a significant effect on the remaining crews happiness 🙂

Nick Kats

Man barfed onto my boat. I told him what he had for lunch, and he was amazed: “How did you know?”
I find most barfers chuck it up once, then they’re fine for the rest of the trip, good color & energy within half an hour.

John Harries

Hi Nick,

That is certainly the case for me: barf, feel better, eat, repeat as necessary, usually for about 24 hours.

However, I have also had one or two crew members that never did stop being sick, to the point that in one case on a six day passage I feared for the person’s life due to dehydration. When that happens you need to have powerful drugs aboard to stop the vomiting. In this case, a Gravol suppository stopped the vomiting and put the sufferer to sleep for 12 hours.

We also carry IV fluids and the means to administer them if the dehydration gets too bad.

Gerben SYD

Wow, IV fluids, that is advanced. I stick to remembering this ‘Sweet 16’ re-hydration recipe:
One Litre of clean drinking or boiled water and then cooled
Six (6) level teaspoons of Sugar
Half (1/2) level teaspoon of Salt
I call it Sweet 16 because of the 1 Litre of water, 6 tsp of sugar and you just have to remember the 1/2 tsp of salt. Tastes great and works great for re-hydration.

John Harries

Hi Gerben,

If someone is truly dehydrated sugar can actually make the problem worse, ditto so called “sports drinks”, because drinking a lot of sugar water will wash out the important electrolytes like potassium.

I tend to suffer from dehydration at sea, particularly if I’m seasick and have found that the best answer is unsweetened coconut water. You can get it in any health food store these days and we always have some aboard.

Gerben SYD

I could not agree more, sports drinks and all sugary drinks are the product of the food industry devil that is based on high fructose corn syrup. In contrast, this Sweet 16 recipe is the result of decades of ORT (oral rehydration therapy) research, led by the WHO. Yes, it would be nice to have all ingredients such as potassium and trisodium citrate, but this simplified recipe (water, sugar, salt) is well recognised as a good alternative that can be made in almost any kitchen or galley. The resulting drink is nowhere near as sweet as ‘sports drinks’, in fact, it tastes like tears – a little bit sweet, a little bit salty. Please see the WHO website for the background in the research on ORT. I have personally survived some dreadful ‘travel belly’ sickness high up in the Atlas mountains in Morocco and on a dive boat in Vietnam, greatly helped by myself remembering ‘Sweet 16’ and being able to cook this up even whilst being terribly sick, without speaking the same language as the chef/cook and in somewhat dire hygienic conditions. Once this basic re-hydration kicks in, you can add salts by eating small amounts of safe food, such as small bites of banana (potassium), etc. All this is very Attainable, just when and where you need it most – when you are sick – unlike IV equipment (I am a trained/advanced first aid provider and a Australian surf patrol, but I would not attempt IV unless in extreme circumstances), drugs/medications or fancy and perishable drinks like packaged coconut water. Packaged coconut water is warned against by the FDA as misleading, as the contents of primary electrolytes are not particularly high, nor balanced. My primary re-hydration medication would be a product such as Dioralyte, which are complete and balanced as they are made for the purpose. If I don’t have those to hand, I would make my own Sweet 16 as recommended by the WHO.

John Harries

Hi Gerben,

I don’t claim to be an expert on rehydration, and I’m sure you are right about the WHO and sweet 16. Having said that, I am, unfortunately, an expert on seasickness, through experience—I’m sick for the first 24 hours of most every passage.

What I have found is that when sick, simple carbohydrates and particularly anything that is just sugar is a very bad idea indeed and accelerates exhaustion, at least for me—since I’m the skipper, that’s not acceptable. Also, with sugar drinks, all that happens is that I get into a cycle of drinking a lot and then immediately peeing it out, with no rehydration benefit. I can’t tell you why this is, but my guess is that motion plays a part, and it is something that I have noticed many other seasick sailors, particularly males, seem to suffer from.

For the same reason, too much sugar, I have found bananas a poor idea too.

I’m not sure what the criticisms of coconut water are, or are not, all I know is that it works well for me. The other food that is absolutely vital to me when at sea is hard boiled eggs. Even a small amount of this high protein snack will keep me going. The secret is to get a bit of both down immediately after being sick. Even if I lose it a few minutes later, I seem to derive benefit.

Also, I agree that IV’s are not easy. (I have practiced for real.) But we do carry them since on several occasions I have seen people get very close to the point where they can’t take anything by mouth and if that happens IV is the only thing that will save the situation.

Rob Gill

Another vote for coconut water from me – I was on “death row” from 24hr food poisoning whilst working in Brazil about 7 years ago and I can vouch for its near miraculous affect on me, in re-hydration. Within 1 hour of drinking a pack, I went from barely being able to stand, to being back on my feet and delivering the course I was running. And whatever the dieticians say about it, apparently every Brazilian mother (and there were several on the course) knows this is what you take after sickness or diarrhoea – coconut water just reaches parts other drinks don’t!
As importantly, it also seems to be easy to hold down, being neutral in flavour and ph.
Rob

Coen

A fairly old technique that is gaining new acceptance, is subcutaneous rehydration. This very simple and easy to perform following basic training and is very well established in palliative care. The cannula would be easy to place in even rough conditions. As an Emergency Physician, l would a lot more comfortable having a subcutaneous cannula inserted by a less experienced person (or even inserting it myself), than trying to get an IV inserted when the boat is moving around in heavy weather. The equipment and fluids are probably what you carry already, although some studies have been done with the co-administration of an enzyme that promotes the quicker absorption of the fluid into the circulation. I am not aware of any studies of this technique in seasickness, but would think it a very reasonable approach, should a crew member become so dehydrated that IV fluids are being considered.

John Harries

Hi Coen,

A very good point, thank you. The training I received was to just place the standard IV needle into the fatty part of the thigh and let the fluid form a pouch in the area and then let the body slowly absorb it.

Is that still an approved technique? I will also look into getting a cannula.

John Mardiat, MD

From a physicians perspective, there is “dehydration” from loss of body fluids, for example from vomiting, or diarrhea or extensive sweating from exercise. And there is “dehydration” from a lack of water.

In the first case, the lost fluid as well as electrolytes needs to be replaced. The sports drink Gatorade, which was originally developed by exercise physiologists at the University of Florida, is an ideal replacement for lost fluids. The glucose, sodium and potassium concentrations are such that they allow for active transport through the gut, facilitating rapid absorption. It’s like oral IV fluids. Other “sports drink” knockoffs may have marketing but without a real scientific basis.

In the second case where there has been a lack of free water, additional sodium and potassium are detrimental. Incremental doses of free water or any drink that doesn’t contain sodium will be helpful. Glucose in a drink doesn’t have an effect on electrolyte balance and therefore isn’t harmful in this setting unless of course you are diabetic.

Regarding sea sickness prevention, I have found Scopolamine (Transderm) patches to be extremely effective for the first three days of a voyage. They are prescription only but they should be easily obtainable from your local physician. I cut them in half for children or crew of slight build. They must be placed 12 hrs prior to leaving port!

John Harries

Hi John,

Thanks for the information o dehydration, both interesting and good to know. One note on Scopolamine, I, and others have had very bad side effects from this drug, to the point that we have banned its use on Morgan’s Cloud. I know it works for some people, but we have also seen crew so spaced out on the stuff that they were a danger to themselves and anyone around them, as well as the safety of the boat.

Sarah Brown

Hi Colin,

I have been using the electronic version of the pressure points wrist band for a few years. As another person said, it takes the edge off, it doesn’t cure it. Staying on the helm is the only good way for me; as soon as I go below I have to close my eyes to keep a steady stomach, not terribly useful for chartwork but I can now get cockpit to bunk without the aid of a bucket!

Colin

Hi Sarah

I’m not sure I’ve seen an electronic version of the pressure bands – just the elastic ‘standard’ ones. Do you have a name for these, so others can check them out?

And it’s good to hear another vote for these bands, as I’m sure many people would prefer to use a ‘natural’ remedy rather than a chemical product, although, ultimately, I’m sure many would try anything if it worked for them!

Best wishes

Colin

John Harries

Hi Sarah,

Interesting that you have had a good result with the electronic pressure bands. I tried them and actually felt worse, see this review. But the static bands work well for me. Just makes the point, as Colin says, that we sufferers just have to keep on trying things.

Although, having said that, in some 40 years of trying seasickness remedies I have found that most of the time, for me at least, the side effects of most of the drugs are worse than the problem.