This one is going to be long - grab a beer or just scroll down to “My Solution”.
From my first offshore passage I was a puker. Not a one and done puker but I can puke for days and this can be dangerous. I am also an ICU nurse and help patients work through nausea and vomiting (N/V) daily. So, while I’m absolutely no neuro expert on the subject, I have read a fair amount of primary, textbook, and popular literature trying to solve my motion sickness which has dramatically improved in recent years.
So, at the encouragement of my sailing friends, I thought I would share what has and has not worked. And maybe help someone trying to solve this same equation. This has been covered extensively on SA but b/c solutions to the problem are varied I thought I would add my random 2 cents.
As most folks know, motion sickness (ms) is generally thought to be caused when there is a conflict between vestibular (ears), visual (eyes), and somatosensory (neurological body balance) information. “When these three sensory cues are not congruent, a sensory conflict is generated in the brain, and hypothesized that this conflict underlies the symptoms of motion sickness” (1). This uncertainty is why I think it is hard to have one solution.
Over the years I have tried almost every conceivable evidenced based and and non evidenced based medical and complimentary approach to solving ms including various antihistamines, scopolamine (patch), pressure point wrist bands, ginger, etc. Below are the common ones I have tried and found in the literature.
Medications I have tried:
Diphenhydramine, chlorpheniramine, cyclizine and cinnarizine are all antihistamines. This group has been a bit too sedating - making me feel sleepy - so I sit on the rail, get tired, shut my eyes and start to puke. I have also tried these with pseudoephedrine (Sudafed), it is thought the pseudoephedrine counteracts the sedative qualities of the antihistamines but this simply made the whole experience worse.
Promethazine (Phenergan) - also an antihistamine - this is often our go to at work when other options have failed. But it is very sedating. Years ago I tried it with pseudoephedrine and it worked well, but not great. But it also put me to sleep for half a day. We now carry it in oral form on our boat in case someone gets scary sick. It also comes as a suppository, which we need to add to our med kit.
Meclizine- also an antihistamine -the literature suggests it is a bit less effective than the above meds but it is also less sedating so it has become part of my answer.
Scopolamine (scop) patch - Scop is an anticholinergic and for some people it works great and if your trying to deal with ms you may want to give it a try BUT I am not a fan. Its side effects can be absolutely awful and include hallucinations, anxiety, and severe dry mouth. I personally have seen leprechauns dancing on the foredeck. And, I have cared for many patients that have had frightening episodes of hallucinations and anxiety. If you want to give this med a try, chat with your Dr. and do it at home well before departure. This is not a unique heads up – but I have seen the stuff work and I have clinically seen it be a complete disaster. You have been warned.
Ondansetron (Zofran) - a serotonin blocker, this medication often works great for N/V related to oncology and post operative treatments but the evidence suggests it is not effective for motion sickness. However, for me, it has become part of my solution. Yes I believe in evidence – but whether placebo, confounder or an N of 1, I use it.
Complimentary options I have tried include:
Pressure point wristbands – I know people who swear by them (including my mother) but for me they have not been very helpful when used alone, with no other interventions. The evidence suggests they have limited effectiveness. But when I combine them with other interventions they may be helping.
Ginger: pills, candied, and cookies. I now use pill forms and have these awesome triple ginger cookies in bulk for offshore sails. They are like ginger crack. I think they settle my stomach. Why they work I have not researched but I believe they help
Diet: The popular literature, friends, and colleagues have all suggested staying away from fatty foods, alcohol, caffeine, etc. I have tried all these things and what I now believe is sticking to my normal diet before and during trips works. I also think - what if the stuff comes back up. Better soft foods like pasta than 40 grit Doritos.
Posture/Sea legs: Sea legs are for real. Standing (not sitting) and looking at the horizon is for me super helpful. We now have our own boat and when we leave port I will stand and drive the boat as long as my legs will let me. We sleep on the boat the day or two before going out. If you’re crew and feeling green ask the skipper if you can stand while you get your legs.
Medications: I take meclizine b/c its less sedating than other antihistamines and ondansetron b/c it’s a different mechanism of action and I’m trying to approach from many directions
Pressure bands: b/c I respect my mother and anecdotally they work for some people and I paid for them.
Diet: stay with the normal foods I eat every day including caffeine, alcohol, and normal bowel process. Ginger, particularly the triple ginger cookies from Trader Joe’s, and oral ginger pills appear to help.
Sea Legs: sleep on the boat, stand as much as possible and stay on deck for as long as reasonably possible.
FYI when I couldn’t remember a few details I used the resource below. I think you have to pay to access unless you access through your library.
1. Priesol, A.J. (2018). Motion Sickness. UpToDate Retrieved from http://www.uptodate.com
Some links I found on SA that helped me sort it out