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While sailing on the Hokulea as a candidate medical officer for the worldwide voyage, I have observed that seasickness among crewmembers is the greatest cause of missed watches. Seasickness among Hawaii residents and visitors also limits many people from otherwise enjoyable recreational and educational activities on the ocean ranging from an offshore dinner cruise to deep-sea fishing. Increased knowledge on prevention and management of this widespread health issue could benefit the economy.
Dietary considerations:
Seasickness is more likely to occur on an empty stomach. However, overeating increases your risk. Heavy foods, such as fatty and especially deep-fried foods are less desirable. Very spicy and/or complex foods are also more difficult to digest when under way. A balanced meal consisting of protein and complex carbohydrates together with a small amount of fat will be easiest to digest and sustain the system longest. Soda crackers are quite helpful when on board because the soda is calcium bicarbonate, which is alkaline, and will help balance the acidity which rises during seasickness.
Before the voyage:
The only people who really know whether or not they get seasick are those who have had experience at sea. For those people, it is often necessary to treat in advance with prescription medication. The Scopolamine Patch is one option and may be particularly useful for overnight voyages because it lasts up to three days. The patch must be placed behind the ear, ideally several hours before departure. It is essential to clean the area with alcohol or soap and water to be sure that the patch is not being placed on top of greasy, oily skin or skin on which sunblock has been applied. The patch may have side effects and is not for everyone.
Scientific research has shown that ginger is also helpful in preventing seasickness. Ginger is best taken several hours before, and at intervals during the voyage to be most effective. It can be taken in almost any form, including powdered ginger and capsules, candy ginger or fresh ginger. Ginger tea may be made out of fresh or candied ginger.
On the voyage:
When someone starts to become seasick out on the open ocean they are often embarrassed to speak up and suffer silently, hoping it will pass. Seasickness is more successfully treated sooner than later. If the vessel is large enough to have a medical officer, passengers should be encouraged to seek early treatment. It is advisable for a responsible party to check in with each passenger and each new crew member at the two-hour mark.
For people who are clearly beginning to become seasick while under way, there are a couple of medications that will dissolve under the tongue. At the point someone starts retching, it may be too late to take a pill and keep it down and it is definitely too late to put on the patch.
Advanced seasickness:
For anyone who goes on to develop severe seasickness, the most important precaution is to be sure that they do not fall out of the boat while retching. It happens.
Eventually they will become exhausted and ready to sleep it off. A great captain once said that the body figures it out while you are asleep.
In almost all cases, by the next morning, though a bit weak and foggy, the victim is ready to rehydrate, have a meal and rejoin the other passengers.
For those who vomit extensively and are not able to eat or drink, dehydration becomes an issue particularly with prolonged exposure at sea. Remember that, when vomiting, one loses not just water, but also electrolytes such as potassium and phosphorus. Use any type of diluted sports drink in the ratio of one part water to one part sports drink. If it is too concentrated, the sports drink may worsen dehydration.
In summary, early and proactive identification of passengers at risk for seasickness is essential. Once identified, preventive treatment is often the best way to go.
Increased awareness of how best to prevent and manage seasickness will enable residents and visitors to more comfortably enjoy one of the greatest gifts Hawaii has to offer, our vast and wonderful ocean. It will even create jobs.
This column is for educational purposes and not meant to offer medical advice. Please see your health care provider to discuss your unique health needs.
Ira Zunin, MD, MPH, MBA, is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com
