Help I Don't Want To Puke Again!

[alemaozinho]

I just did my first boat dive off NJ a few weeks ago. I usually take Bonine and I'm fine. Well off NJ, as most of you know the conditions tend to be pretty rough at times, such as on my first NJ dive. Needless to say Bonine didn't cut it, and I fed the fishes!

I'm doing another boat trip this Sunday and hopefully a few more over the summer. If conditions are smooth I should be fine, but if it gets a little rough, I may be paying $80 to do one short stinky dive and then pass out on the boat the rest of the day after chumming the ocean.

I was hoping to get the Transderm Scop http://www.transdermscop.com/site2/ Scopace (the pill form of Scopolamine that is supposed to be as effective as the patches with less side effects).

I've heard that you can usually get a prescription from a doctor for either over the phone, after answering a few quick questions.

Problem is I haven't been to a doctor in a few years, started a new job about a year ago, and have a new primary physician.
The doctor's office staff claim the doctor can't give me a prescription if I've never been there, because it's illegal. Is this true?

Here's where it gets better. I can't go in just to answer the stupid questions either, I have to get a physical. The best part I can't get in for one until August 11th.

Keep in mind I didn't even get to talk to a doctor, and as you all know the girls that work in most doctor's office have personalities comparable to the DMV. I try explaining to them that over the counter stuff didn't work for me last time, that I dive, and that I have trips planned. As you can imagine that got me no where.

So what do I do now? Not dive on a boat until next season or the end of the summer anyway? I don't think so!!!
Novartis isn't far from where I live. Running into their offices and taking hostages in exchange for patches would happen before that.

HELP!

How can I get these things now?

I,ve seen that some divers use skin patches,they cost seven bucks each but they also work for three days in a row,People who used them are happy and satisfied with them.peace,ps the divers who used them got the patches from canada (cheaper)over the internet.take care...

 

[Laurence Stein DDS]

Hi grunzster,

Don't worry, I'm not gonna pick on you again. Sorry for thinking it was a week and a half. I looked at todays date and the date you said your appointment was.

Just hope you realize that the inconvience of a seemingly simple Rx is much more complicated. It's important to realize that it's really no one's fault that you can't get the Rx quickly. There's a lot more to appropriate treatment than convience.

Ain't diesel exhaust nasty stuff! It kind of follows you wherever you go on the boat.

Peace.

Laurence Stein DDS

 

[Diver Lori]

There are two over-the-counter motion sickness preventitives packaged under several names, Bonine, Triptone, Dramamine Original and Dramamine II to name a few. They are meclizine and dipenhydrinate (generic names). Dipenhydrinate is Dramamine Original and Equate (Walmart brand). Bonine, Triptone and Dramamine II are meclizine. Meclizine is the less drowsy of the two. I've also tried a few prescription meds, one reserved for cancer patients undergoing chemo that are supposed to help with nausea (Zofran) and another used as needed for anyone, (Phenergan). I still yakked when on a boat.

Here is what I do and the combination works very well for me.

1. I premedicate with meclizine the day before and the day of the dive.
2. Bland bland bland breakfast.....dry toast, bagel, pancakes, etc. Nothing greasy! Also no milk....you don't want milk to curdle on your stomach.
3. REAL ginger snaps and saltine crackers in my dry bag. Ginger has a soothing effect on the stomach....some people also take ginger caps...but hey, I like the real thing in cookie form!! Make sure the ginger snaps are real.....the only ones I've found are Hostess brand from the Hostess Thrift store. Most are fakes. Saltines soak up the acid in your stomach....stomach feels better.
4. Water, cold water. Sip it, don't chug it.
5. NO CAFFEINE. Caffeine is a stimulant, why would you want to stimulate the bad way you feel????
6. No alcohol the day before....better for the stomach.
7. Stay away from the stern where you'll find diesel fumes, stay away from topside smokers.....if the boat stops or turns with the stern into the wind, mouth breathe in your towel till the air clears.
8. Keep your eyes on the horizon if at all possible without even a glance at anything fixed in the boat, if you cheat and look inside you'll be sorrrrrryyyyy!!
9. Motion sickness is an argument between your eyes and your ears. By looking at something fixed your eyes think you aren't moving, but your ears say you are.....joila'....you're now seasick. Stomach secrets acids, etc.....and you barf. You can "turn off" the argument by eliminating one of the factors. Can you eliminate the balance mechanism in your ears? NO. But you can eliminate your eyes. If you can't be trusted to look at the horizon AND ONLY THE HORIZON, you'll have to turn off your eyes. Before the boat gets underway, I set up my gear, pull up my wetsuit/drysuit to my waist and get my fins/mask in a neat package ready to grab tucked close to the entry area. (mask strap around fins) I then sit myself in a secure area out of the way in case I need to close my eyes for the trip. (lots of times if we are moving forward I'm okay....it's when we stop that it gets bad)
10. I've already informed the DM/Captain that I have a seasickness problem and ask them for a 10 minute warning for the dive site. They've always been happy to comply and put me in the water first. I've even gotten a quicky dive briefing privately before leaving the dock....leaving the final briefing up to my buddy to get while I'm waiting for him on the downline at 15 feet.
11. I've gotten my 10 minute warning that the boat is going to stop. I pull my suit up and make my way to the entry point to sit and wait for the DM, keeping my face to the wind and my eyes closed except for when I moved. I've got my fins/mask in hand and am ready to don backplate.
12. The DM comes back, helps me gear up and throws me in the water and I deflate as I give the okay....heading down the line.
13. First in, last out. I'm the last one to get out. Even if I have to hang at 15ft waiting for all the others....I'm the last one on.
14. My buddy. This is where my regular buddy comes in handy or if you don't have a regular buddy.....the promise of a well tipped DM will work too. You're last on, the DM or Buddy is waiting for you. He helps you remove your gear....the boat is heaving pretty good......you immediately leave your gear with buddy/well tipped DM and assume a secure position either watching the horizon, or in my case sitting quietly with my eyes closed or a towel over my head. I prefer sitting on the deck in the corner with my knees tucked up out of the way of traffic areas.
15. Your buddy or well tipped DM secures your gear for you and then brings you cold water and your ginger snaps/crackers. You ride out till the next dive site or the dock. If it's the next dive site, you repeat the process.

My buddy happens to have been my buddy since 1997. He takes good care of me. I had a buddy before him that was just as helpful. I've also had the same service from a well tipped DM. If your buddy isn't your significant other, you may have to sweeten the pot with his favorite libation or two that night or maybe pick up the tab for dinner. Something to show your appreciation and gratitude for their help.

I've come to the steps above through trial and error. It's what works for me. Number 8 through 14 were derived from suggestions given me by Cathy Church in Grand Cayman.

I know it seems like a lot, but for me it's the difference between diving or not diving. Once I'm seasick, I'm in the bag for the rest of the day until my feet hit terra-firma. If I can stave off the seasickness with the steps above, I can do my dives with pleasure. I can usually ride it out without problems while the boat is moving swiftly, but if my stomach starts to get that queasy wonky feeling, I go to eyes shut immediately in a tucked posture to head it off at the pass. Once the boat stops and the rocking begins....I am in the water like greased lightening.

I hope something I've written here will help you. Believe me, I've been working on "my remedy" for 17 years.

Lori

 

[DocVikingo]

This is a forum dedicated for diving medicine. It advises posters regarding their health, medical well-being & even their lives, admittedly rather serious matters. As such, it is expected that those responding to questions will answer only when they have something accurate & useful to offer. Just like you'd want your doctor to do; just like you'd like your medical questions answered.

While our board is pretty loose in many forums, as a Medical Moderator of the Diving Medicine area I do not find such looseness appropriate here. Your response contains several statements that I would like to address:

1. "There are two over-the-counter motion sickness preventitives packaged under several names, Bonine, Triptone, Dramamine Original and Dramamine II to name a few. They are meclizine and dipenhydrinate (generic names)."

There is no such chemical as "dipenhydrinate." Dramamine Original, Triptone & Equate all are "dimenhydrinate." Of those you have listed, only Dramamine II is meclizine.

2. "Bonine, Triptone and Dramamine II are meclizine."

Triptone is not meclizine; it is dimenhydrinate.

3. "Meclizine is the less drowsy of the two."

There have been no scientific studies reported that support this claim.

4. "I've also tried a few prescription meds, one reserved for cancer patients undergoing chemo that are supposed to help with nausea (Zofran)...."

Zofran is not "reserved" for cancer patients. It also is indicated for use in preventing & treating postoperative nausea & vomiting and some physicians prescribe it for conditions beyond these.

5. "Motion sickness is an argument between your eyes and your ears."

The exact mechanism of motion sickness is not yet fully understood. However, it is believed to occur when portions of the brain tasked with maintaining balance receive input from the eyes, vestibular system, muscles & joints that is inconsistent and unexpected over an extended period of time.

6. “Stomach secrets acids, etc.....and you barf.”

Stomach acid, while not helping the sensation of nausea, is not the mechanism that triggers vomiting during motion sickness.

This aside, I find many of your suggestions to be excellent.

Best regards.

DocVikingo

 

[DocVikingo]

Before recommending Triptone & Dramamine Original formula (both dimenhydrinate), please read "The Psychometric and Cardiac Effects of Dimenhydrinate in the Hyperbaric Environment" which appears in Pharmacotherapy 20(9):1051-1054, 2000.

It concludes: "Dimenhydrinate adversely affects mental flexibility. This effect, when added to the adverse effect of depth on memory, may contribute to the dangers of diving."

Best regards.

DocVikingo

 

[goodknight411]

i've heard that taking ginger befor you dive and when you get sick really helps. I don't have personal experience with this, it's just something i've heard on the dive boat.

 

[Queen]

i've heard that taking ginger befor you dive and when you get sick really helps. I don't have personal experience with this, it's just something i've heard on the dive boat.

I'd heard that as well and tried it out...on the plus side, it made my barf very gingery. :2tongue: On the down side...I still barfed.

 

[DocVikingo]

Ginger has been studied & a number of findings show it has a beneficial effect on nausea, vomiting & seasickness. And, a number of divers use it and many say that they find it effective.

Ginger in powdered, root or crystallized form is probably the easiest to control in terms of the amount of active ingredient ingested. Eating ginger snaps, or drinking ginger soda or tea makes dosage control more difficult, and some of these products use no real ginger at all, just artificial flavorings. Make sure that you know what you are getting.

Truth is many of the guidelines for the use of ginger in preventing nausea, vomiting & seasickness come from herbal lore. One pretty solid study found 1 gram/1,000 mg of powdered ginger to do the trick, although other sources variously recommend anywhere from 1/2 gram/500 mg to as much as 4 grams/4,000 mg. As with any drug or supplement, one is generally better off using the smallest effective dose. This may involve some trial & error.

As to when to start taking it, estimates range from several hours to 20 minutes before boarding the boat. The matter really hasn't been studied sufficiently to say with any precision. Truth is, many of the guidelines for the use of ginger in preventing nausea, vomiting & seasickness come from herbal lore.

If it was me, I'd start experimenting with an initial dose of 1 gram 1/2 to 1 hour prior to boarding. As for the period of effectiveness, again there are the same problems as above, but studies that involved repeated doses used intervals of 4-6 hours.

Sometimes ginger will precipitate heartburn. Antacids can be used to minimize heartburn & abdominal gas if they occur, although these generally aren't a problem.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

 

[tg54]

Paula,

I wrote on this board 06.29.04 and mentioned my use of Dramamine (non-drowsy). Thought I’d update you. I used the same method when I went on a boat (smaller) for my Nitrox Certification. I got SO SICK, I was in tears. I think the fuel fumes added to it. We were planning a trip to Maui in just a week, and had 2 boat dives scheduled (a 6 passenger & a 12 passenger). I did not want to miss them.

Well, I decided to buy a “Relief Band” to see if it would help with the nausea. Gotta tell you, it is the best $110.00 investment into scuba I made. I used it in conjunction with the Dramamine (non-drowsy) and it really helped A LOT. When I was a bit nauseous after the first dive during the SI, I put it on, and in a few minutes felt so much better, and in a while longer, at 99%.

I liked this solution, as I was not taking additional drugs, and me head was clear. Additionally my breakfast on all dives was low fat protein and complex carb shake (1 egg + 1 egg white + ½ cup juice + water and a ½ a fresh fruit). I found that carbs alone (oatmeal, dry toast, etc) did not sit well at all, and high fat did not work (2 whole eggs in a shake) or peanut butter and fruit, or solid protein (meat, cheese, yogurt, etc).

Hope you’re finding some of the suggestions helpful.

tg

 

[grouchyturtle]

Sorry, I've been meaning to post a follow up.

Did my second boat off NJ on the 4th. Wasn't as choppy as the first one, but was a little choppy.

I didn't really follow most of the diet advice:
pancakes, juice, coffee for breakfast
cheese steak and a coke for a late lunch
did make sure I drank plenty all day and took one Bonine when I first woke up that morning and another when we got to the boat around 5:30.

I had a few problems and actually called the first dive, but that's a whole other story. But no fishes were fed. During the SI it started to get worse so they called the 2nd dive and we started to head back.

I didn't get to dive, but where we were you could see the fireworks in NYC and most if not all of the NJ coast!

I didn't feel that great heading back and laid down most of the way...but I was also probably tired from a long weekend, lots of time baking in the sun over 2 days, and although I ate something on the boat I didn't really have a REAL diner. Also it was pretty late (didn't get to the dock until after 11:00 or home until 2:00AM).