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Hi Joy-S,
Here's my latest published piece on motion sickness courtesy of Undercurrent (http://www.undercurrent.org/)
"Tame the Technicolor Yodel: Managing Mal de Mer
by Doc Vikingo
The bane of many, sea sickness is thought to occur when areas of the brain tasked with maintaining balance receive input from the eyes, inner ear, muscles and joints that is inconsistent and unexpected over an extended period.
And don't think that you are immune. Given the proper set of forces on or under the water, just about any diver can be made to call for Ralph.
As with most maladies, prevention is preferable to treatment. Take common sense steps like getting adequate sleep and avoiding fatigue, passing on heavy meals and fatty, spicy or acidic foods in favor of blander fare like breadstuffs, cereals and soups. Acidic, caffeinated beverages like tea, coffee and some sodas should be consumed only in moderation; ditto for alcohol.
On the boat, find a shaded, well-ventilated seat on deck that is set low and in the center of the craft. It should be away from exhaust fumes and other sea sick divers. Face forward, focus on a distant fixed object on or slightly above the horizon and avoid unnecessary movement of the neck and head. Don’t read or look through binoculars. Delay donning your suit until the last minute and, unless there is substantial surge, do get in the water as quickly as possible.
If such measures fail, you can chose from a variety of OTC and prescription medications designed to be taken prior to boarding the boat and getting ill. Among the more effective is scopolamine, which can be delivered through a patch worn behind the ear (e.g., Transderm Scop), orally (e.g., Scopace (See #1 below)) and as a gel. The former is the longest acting. The latter two, in addition to not falling off from behind your ear, are faster acting and allow for more flexible dosing. An excellent review of patch vs pill appears in the March/April '04 issue of "Alert Diver." (See #2 below)
Popular and effective OTC drugs include Bonine and Dramamine II (both meclizine; in prescription strength as Antivert). Also widely used are Dramamine Original Formula and Chewable Tablets and Triptone, all of which contain dimenhydrinate, a drug with demonstrated adverse effects upon alertness and performance both topside and at depth. A British product, Stugeron (cinnarizine), has also been shown an effective treatment, but is not yet on the market in the US. These OTC medications are most effective if taken at bedtime the night prior to diving, followed by a second dose about an hour prior to boarding the boat.
Both the prescription and OTC drugs have side effects, most commonly dryness of the mouth and drowsiness, but also blurred vision, dizziness and even confusion. However, the adverse effects tend to diminish with use and research suggests that the sedating effect of scopolamine may have been overstated.
A study conducted for NASA evaluating the effects of oral scopolamine on operational proficiency found no significant impact on the selected tasks, and drowsiness and blurred vision were not significantly greater than that for placebo.
Research involving naval crew found that cinnarizine (Stugeron) and transdermal scopolamine were free of adverse effects on the cognitive and motor performance tests, and the only side effect was dry mouth with scopolamine. This study used a large dose of cinnarizine, 50 mg. As another study has shown impairment of psychomotor performance and increased daytime sleepiness as dosage increases, it would be prudent not to exceed 25 mg the night before boarding the boat and 12.5 mg every 8 hours thereafter when necessary.
Another study asked divers on an extended 60' air saturation profile to complete psychomotor tasks several times during the dive and to record perceived side effects. There was no significant difference between the groups receiving either a transdermal scopolamine or a placebo patch, suggesting that modest hyperbaric exposures would not increase the probability of side effects or impair performance at recreational scuba depths.
Despite the easy availability of safe and effective motion sickness drugs, there are always those who prefer, or assert the superiority of, herbal remedies, most popular among them ginger.
So, is ginger effective? Seems it may be. For many reasons the final chapter on the efficacy of ginger in preventing motion sickness has yet to be written, but a number of controlled studies have found that ginger in the one gram dosage range notably reduces vomiting and cold sweating. Nausea and vertigo also are reduced, but apparently to lesser degree. Several articles report that ginger is as, or more, effective than Dramamine Original Formula in controlling motion sickness and produces fewer side effects.
If you're going to do ginger, encapsulated powdered, root or crystallized forms make it easiest to control the amount of active ingredient ingested. Eating ginger snaps, or drinking ginger soda or tea, makes getting adequate quantity and control much more difficult. Be aware that some products contain only ginger flavoring, not the real thing--read the labels. A reasonable daily starting regimen would be 1 gram/1,000 mg of powdered ginger root 4-6 hours before, then another about 1 hour before, boarding the boat. Additional doses can be taken every 4-6 hours provided they are well tolerated.
Others swear by such "natural remedies" as the Sea-Band and ReliefBand, bracelets that are placed to exert pressure/stimulation on an acupressure point on the inner surface of the wrist just above the joint. While the results to date are not entirely consistent, the research seems to suggest these bands do not control motion sickness. Moreover, the ReliefBand, costing $55 to $120 non-refundable dollars, is slightly water resistant but not waterproof.
Even farther out are products such as MotionEaze, an aromatic mixture dabbed behind the ears, and various fragrant essential oils rubbed into the hands and feet. While these might make you smell better while you're praying to the porcelain princess, there is no scientific support for them.
But, never underestimate the power of placebo. Just about every preparation and device for motion sickness has it advocates and believers.
In the final analysis you'll need to discover, probably by trial and error, what works best for you with the least adverse reaction, cost and inconvenience. Whatever pill, patch or potion you may chose, it is strongly recommended that it be given at least a 24-hour trial topside to observe for worrisome side effects and used only according to
instructions or slightly more conservatively.
© Doc Vikingo 2005
Reprinted by permission of Undercurrent "
(1) Scopace has been off the market for some years now, but you can purchase an easily compounded & inexpensive replacement --> http://www.scubaboard.com/forums/diving-medicine/404011-scopace-discontinued-wtf-4.html#post6875844
(2) "Scopace Tablets
Here's An Alternative to "The Patch" for Motion Sickness Relief
By Renée Duncan, Editor
We've all heard about "the patch for divers." In fact, we've profiled it a couple of times in the pages of Alert Diver. And it works beautifully for many divers and travelers who experience motion sickness.
I'm one of those unfortunates who, given a good whiff of diesel and a quick view of a rolling horizon, will be feeding the fish off almost any boat unlucky enough to have me. Actually, I usually take it in stride, but my involuntary actions have dismayed some of my fellow dive travelers at times.
Unhappily, "the patch" is just too strong for me. I'm on the small side, 5 feet 2 inches (1.57 meters) tall, maybe 110 pounds (49.5 kilograms) without my gear. And putting on a patch practically guarantees I won't recall much of my dive, flight or boat ride (short-term memory loss is one of the side effects).
It doesn't have this effect on all small persons; and, by the same token, it may affect larger persons just as intensely - or it may not be enough. As with many medications, it simply works on each of us individually, and some days (and dosages) can be tougher than others.
What to do? Well, I've pondered. Fed some fish. Postponed dives. Or gone diving off the other side of the boat after a good spew.
Then I heard about a pill I could take for motion sickness. The best thing about it is that I can keep my dosages low rather than enduring the fixed dosage of a patch. And although, I haven't had motion sickness in a while, I almost wish I could get sick again, just to try it.
Divers and travelers who suffer from motion sickness, you have a choice: you can use the scopolamine patch or take it in pill form. For many folks, the pill is welcome news. Scopace, a medication for motion sickness, is available through your doctor - in 0.4 mg tablets.
Scopace contains scopolamine hydrobromide, described by the American Hospital Formulary Service (a drug information reference from the American Society of Health-System Pharmacists) as the "single most effective medicine to prevent nausea and vomiting induced by motion."
So, how do these tablets compare to the patch? To begin with, both have scopolamine, a drug well known for its ability to ease motion sickness.
Dosing Flexibility
The patch and the pill differ, however, in dosing flexibility. The patch delivers a fixed dose to all persons who don it. And therein lies the problem. Because a fixed dose is formulated for individuals of average weight, it may be excessive for smaller individuals and not enough for larger persons. This means a small person could encounter side effects from absorbing too much of the drug, while larger individuals may still get motion sickness because they're getting insufficient amounts.
With tablets, you can adjust the dosage to the lowest level you find effective. Granted, this may mean a couple of trial-and-error runs, but it beats the dizziness and blurring of vision if you're sensitive to the patch.
Skin Considerations
Then, there's the issue of skin. Topical absorption of a medication - such as what you find in a scopolamine patch - is dependent on certain skin characteristics. These factors include skin thickness, patch adhesion (that's why instructions tell you to apply the patch to clean skin) and blood circulation within the skin.
If the skin is too thick, the medication may penetrate too slowly. With hairy or sweaty skin, the patch may not adhere properly. If circulation is poor or if blood flow is shunted away from the skin (this can happens in cold conditions or during episodes of extreme nausea), drug levels may remain diminished because of reduced drug passage into the blood.
Ingesting the Tablets
Next, there's speed: in order to work, tablets have to melt. If you wait until you're already ill, you may get quicker relief with the patch.
Quality guidelines published by the United States Pharmacopoeia, an organization that works closely with the Food and Drug Administration (FDA), the pharmaceutical industry, and the health professions to establish authoritative drug standards, specify that scopolamine tablets must disintegrate within 15 minutes. According to Craig R. Sherman, M.D., Medical Director, Hope Pharmaceuticals (the manufacturer of Scopace), ongoing testing confirms that Scopace tablets meet or exceed this standard.
Whichever method you prefer, remember to dose yourself at least an hour before you dive, travel or go boating.
Side Effects
The incidence of side effects associated with the two dosage forms of scopolamine can differ. If you have experienced any negative effects with the patch, you may want to give the pills a try, or vice versa.
The primary side effect of scopolamine tablets at the intended doses is reduced salivation, says the manufacturer. That's dry mouth in diving terms, and it's not fun. But it's not dangerous, either. More serious side effects can always happen with any medication. The manufacturer points out, however, that the more serious side effects with the tablets tend to be infrequent because you can adjust your dose to the lowest level you need.
Another consideration is the duration of possible side effects. If a side effect occurs after you ingest a tablet, you can suspend subsequent doses while your body metabolizes the pill. In contrast, side effects associated with topically applied medicine may be prolonged after it is removed because of continued absorption into the blood from the skin.
To reinforce the drug's safety, Hope Pharmaceuticals also provided this study result for the scopolamine tablet:
A study conducted for NASA evaluated whether oral scopolamine impacted operational proficiency. Scopolamine was tested in two doses - 0.25 mg and 0.5 mg. The researchers concluded that neither dose produced any loss of proficiency performing selected tasks. Furthermore, the incidence of drowsiness and blurred vision associated with the drug did not exceed that associated with placebo.
Just like the scopolamine patch, Scopace can cause inability to urinate in men with enlarged prostate glands, and can exacerbate certain types of glaucoma (excessive pressure in the eye). It can also cause drowsiness, which could be dangerous while performing certain activities such as driving a car.
It's Your Trip
No one wants motion sickness to spoil a trip. At the same time, you don't want to over-medicate yourself: it's just as bad. If you have a tried-and-true method of dealing with motion sickness, stick with it. If you're not happy with your present solution, perhaps you'd like to discuss a prescription for Scopace with your doctor.
For other, non-medical ways to prevent motion sickness, see Dan Orr's July/August 2003 Incident Insights report on "Mal de Mer."
Pay attention to what your body's telling you about motion sickness or drugs."
Best of luck.
DocVikingo
Here's my latest published piece on motion sickness courtesy of Undercurrent (http://www.undercurrent.org/)
"Tame the Technicolor Yodel: Managing Mal de Mer
by Doc Vikingo
The bane of many, sea sickness is thought to occur when areas of the brain tasked with maintaining balance receive input from the eyes, inner ear, muscles and joints that is inconsistent and unexpected over an extended period.
And don't think that you are immune. Given the proper set of forces on or under the water, just about any diver can be made to call for Ralph.
As with most maladies, prevention is preferable to treatment. Take common sense steps like getting adequate sleep and avoiding fatigue, passing on heavy meals and fatty, spicy or acidic foods in favor of blander fare like breadstuffs, cereals and soups. Acidic, caffeinated beverages like tea, coffee and some sodas should be consumed only in moderation; ditto for alcohol.
On the boat, find a shaded, well-ventilated seat on deck that is set low and in the center of the craft. It should be away from exhaust fumes and other sea sick divers. Face forward, focus on a distant fixed object on or slightly above the horizon and avoid unnecessary movement of the neck and head. Don’t read or look through binoculars. Delay donning your suit until the last minute and, unless there is substantial surge, do get in the water as quickly as possible.
If such measures fail, you can chose from a variety of OTC and prescription medications designed to be taken prior to boarding the boat and getting ill. Among the more effective is scopolamine, which can be delivered through a patch worn behind the ear (e.g., Transderm Scop), orally (e.g., Scopace (See #1 below)) and as a gel. The former is the longest acting. The latter two, in addition to not falling off from behind your ear, are faster acting and allow for more flexible dosing. An excellent review of patch vs pill appears in the March/April '04 issue of "Alert Diver." (See #2 below)
Popular and effective OTC drugs include Bonine and Dramamine II (both meclizine; in prescription strength as Antivert). Also widely used are Dramamine Original Formula and Chewable Tablets and Triptone, all of which contain dimenhydrinate, a drug with demonstrated adverse effects upon alertness and performance both topside and at depth. A British product, Stugeron (cinnarizine), has also been shown an effective treatment, but is not yet on the market in the US. These OTC medications are most effective if taken at bedtime the night prior to diving, followed by a second dose about an hour prior to boarding the boat.
Both the prescription and OTC drugs have side effects, most commonly dryness of the mouth and drowsiness, but also blurred vision, dizziness and even confusion. However, the adverse effects tend to diminish with use and research suggests that the sedating effect of scopolamine may have been overstated.
A study conducted for NASA evaluating the effects of oral scopolamine on operational proficiency found no significant impact on the selected tasks, and drowsiness and blurred vision were not significantly greater than that for placebo.
Research involving naval crew found that cinnarizine (Stugeron) and transdermal scopolamine were free of adverse effects on the cognitive and motor performance tests, and the only side effect was dry mouth with scopolamine. This study used a large dose of cinnarizine, 50 mg. As another study has shown impairment of psychomotor performance and increased daytime sleepiness as dosage increases, it would be prudent not to exceed 25 mg the night before boarding the boat and 12.5 mg every 8 hours thereafter when necessary.
Another study asked divers on an extended 60' air saturation profile to complete psychomotor tasks several times during the dive and to record perceived side effects. There was no significant difference between the groups receiving either a transdermal scopolamine or a placebo patch, suggesting that modest hyperbaric exposures would not increase the probability of side effects or impair performance at recreational scuba depths.
Despite the easy availability of safe and effective motion sickness drugs, there are always those who prefer, or assert the superiority of, herbal remedies, most popular among them ginger.
So, is ginger effective? Seems it may be. For many reasons the final chapter on the efficacy of ginger in preventing motion sickness has yet to be written, but a number of controlled studies have found that ginger in the one gram dosage range notably reduces vomiting and cold sweating. Nausea and vertigo also are reduced, but apparently to lesser degree. Several articles report that ginger is as, or more, effective than Dramamine Original Formula in controlling motion sickness and produces fewer side effects.
If you're going to do ginger, encapsulated powdered, root or crystallized forms make it easiest to control the amount of active ingredient ingested. Eating ginger snaps, or drinking ginger soda or tea, makes getting adequate quantity and control much more difficult. Be aware that some products contain only ginger flavoring, not the real thing--read the labels. A reasonable daily starting regimen would be 1 gram/1,000 mg of powdered ginger root 4-6 hours before, then another about 1 hour before, boarding the boat. Additional doses can be taken every 4-6 hours provided they are well tolerated.
Others swear by such "natural remedies" as the Sea-Band and ReliefBand, bracelets that are placed to exert pressure/stimulation on an acupressure point on the inner surface of the wrist just above the joint. While the results to date are not entirely consistent, the research seems to suggest these bands do not control motion sickness. Moreover, the ReliefBand, costing $55 to $120 non-refundable dollars, is slightly water resistant but not waterproof.
Even farther out are products such as MotionEaze, an aromatic mixture dabbed behind the ears, and various fragrant essential oils rubbed into the hands and feet. While these might make you smell better while you're praying to the porcelain princess, there is no scientific support for them.
But, never underestimate the power of placebo. Just about every preparation and device for motion sickness has it advocates and believers.
In the final analysis you'll need to discover, probably by trial and error, what works best for you with the least adverse reaction, cost and inconvenience. Whatever pill, patch or potion you may chose, it is strongly recommended that it be given at least a 24-hour trial topside to observe for worrisome side effects and used only according to
instructions or slightly more conservatively.
© Doc Vikingo 2005
Reprinted by permission of Undercurrent "
(1) Scopace has been off the market for some years now, but you can purchase an easily compounded & inexpensive replacement --> http://www.scubaboard.com/forums/diving-medicine/404011-scopace-discontinued-wtf-4.html#post6875844
(2) "Scopace Tablets
Here's An Alternative to "The Patch" for Motion Sickness Relief
By Renée Duncan, Editor
We've all heard about "the patch for divers." In fact, we've profiled it a couple of times in the pages of Alert Diver. And it works beautifully for many divers and travelers who experience motion sickness.
I'm one of those unfortunates who, given a good whiff of diesel and a quick view of a rolling horizon, will be feeding the fish off almost any boat unlucky enough to have me. Actually, I usually take it in stride, but my involuntary actions have dismayed some of my fellow dive travelers at times.
Unhappily, "the patch" is just too strong for me. I'm on the small side, 5 feet 2 inches (1.57 meters) tall, maybe 110 pounds (49.5 kilograms) without my gear. And putting on a patch practically guarantees I won't recall much of my dive, flight or boat ride (short-term memory loss is one of the side effects).
It doesn't have this effect on all small persons; and, by the same token, it may affect larger persons just as intensely - or it may not be enough. As with many medications, it simply works on each of us individually, and some days (and dosages) can be tougher than others.
What to do? Well, I've pondered. Fed some fish. Postponed dives. Or gone diving off the other side of the boat after a good spew.
Then I heard about a pill I could take for motion sickness. The best thing about it is that I can keep my dosages low rather than enduring the fixed dosage of a patch. And although, I haven't had motion sickness in a while, I almost wish I could get sick again, just to try it.
Divers and travelers who suffer from motion sickness, you have a choice: you can use the scopolamine patch or take it in pill form. For many folks, the pill is welcome news. Scopace, a medication for motion sickness, is available through your doctor - in 0.4 mg tablets.
Scopace contains scopolamine hydrobromide, described by the American Hospital Formulary Service (a drug information reference from the American Society of Health-System Pharmacists) as the "single most effective medicine to prevent nausea and vomiting induced by motion."
So, how do these tablets compare to the patch? To begin with, both have scopolamine, a drug well known for its ability to ease motion sickness.
Dosing Flexibility
The patch and the pill differ, however, in dosing flexibility. The patch delivers a fixed dose to all persons who don it. And therein lies the problem. Because a fixed dose is formulated for individuals of average weight, it may be excessive for smaller individuals and not enough for larger persons. This means a small person could encounter side effects from absorbing too much of the drug, while larger individuals may still get motion sickness because they're getting insufficient amounts.
With tablets, you can adjust the dosage to the lowest level you find effective. Granted, this may mean a couple of trial-and-error runs, but it beats the dizziness and blurring of vision if you're sensitive to the patch.
Skin Considerations
Then, there's the issue of skin. Topical absorption of a medication - such as what you find in a scopolamine patch - is dependent on certain skin characteristics. These factors include skin thickness, patch adhesion (that's why instructions tell you to apply the patch to clean skin) and blood circulation within the skin.
If the skin is too thick, the medication may penetrate too slowly. With hairy or sweaty skin, the patch may not adhere properly. If circulation is poor or if blood flow is shunted away from the skin (this can happens in cold conditions or during episodes of extreme nausea), drug levels may remain diminished because of reduced drug passage into the blood.
Ingesting the Tablets
Next, there's speed: in order to work, tablets have to melt. If you wait until you're already ill, you may get quicker relief with the patch.
Quality guidelines published by the United States Pharmacopoeia, an organization that works closely with the Food and Drug Administration (FDA), the pharmaceutical industry, and the health professions to establish authoritative drug standards, specify that scopolamine tablets must disintegrate within 15 minutes. According to Craig R. Sherman, M.D., Medical Director, Hope Pharmaceuticals (the manufacturer of Scopace), ongoing testing confirms that Scopace tablets meet or exceed this standard.
Whichever method you prefer, remember to dose yourself at least an hour before you dive, travel or go boating.
Side Effects
The incidence of side effects associated with the two dosage forms of scopolamine can differ. If you have experienced any negative effects with the patch, you may want to give the pills a try, or vice versa.
The primary side effect of scopolamine tablets at the intended doses is reduced salivation, says the manufacturer. That's dry mouth in diving terms, and it's not fun. But it's not dangerous, either. More serious side effects can always happen with any medication. The manufacturer points out, however, that the more serious side effects with the tablets tend to be infrequent because you can adjust your dose to the lowest level you need.
Another consideration is the duration of possible side effects. If a side effect occurs after you ingest a tablet, you can suspend subsequent doses while your body metabolizes the pill. In contrast, side effects associated with topically applied medicine may be prolonged after it is removed because of continued absorption into the blood from the skin.
To reinforce the drug's safety, Hope Pharmaceuticals also provided this study result for the scopolamine tablet:
A study conducted for NASA evaluated whether oral scopolamine impacted operational proficiency. Scopolamine was tested in two doses - 0.25 mg and 0.5 mg. The researchers concluded that neither dose produced any loss of proficiency performing selected tasks. Furthermore, the incidence of drowsiness and blurred vision associated with the drug did not exceed that associated with placebo.
Just like the scopolamine patch, Scopace can cause inability to urinate in men with enlarged prostate glands, and can exacerbate certain types of glaucoma (excessive pressure in the eye). It can also cause drowsiness, which could be dangerous while performing certain activities such as driving a car.
It's Your Trip
No one wants motion sickness to spoil a trip. At the same time, you don't want to over-medicate yourself: it's just as bad. If you have a tried-and-true method of dealing with motion sickness, stick with it. If you're not happy with your present solution, perhaps you'd like to discuss a prescription for Scopace with your doctor.
For other, non-medical ways to prevent motion sickness, see Dan Orr's July/August 2003 Incident Insights report on "Mal de Mer."
Pay attention to what your body's telling you about motion sickness or drugs."
Best of luck.
DocVikingo
