This New Years I was the onboard physician for an “expedition” to Antarctica. I joined roughly over 200 luxury travelers and staff on a “modern, stable super-yacht” to the last continent. Our trusty ship is listed as having an “ice-strengthened hull”, but not as being a true “ice-breaker” (you would additionally need to have an ice clearing shape and the power to push through sea ice to nab that distinction). Our itinerary was to navigate through the unpredictable waters of the Drake Passage and cruise around making stops at highlights in the Antarctic Peninsula, Antarctica’s most north region (I could only get 2 weeks off, after all). You guys may have seen the pictures, but now you get the salacious medical backstory!
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Drake:
A pair of fun older Midwestern ladies had gotten T-shirts that simply read “Drake.” from their local Iowan university in anticipation of the Antarctica hazing ritual that is cruising through the Drake Passage. The Drake (or Mar de Hoces depending if you’re on Team Spain or Team England) is the water path between the southern tip of South America and the South Shetland Islands of Antarctica, where the Atlantic Ocean meets the Pacific. The waters can be quite rough. For that reason I was asked to make a quick sea safety announcement at cruise orientation and hold a seasickness clinic later in the evening.
Basic sea safety: Keep hands out of door frames (swinging doors=broken fingers), wear shoes with traction, avoid alcohol.
A few pearls (pearls! Sea-stuff!) on sea-sickness:
What is seasickness?
Naus: Greek for ship!
-Spectrum includes nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches.
-Caused by repetitive angular and linear acceleration and deceleration due to different modes of travel, amusement rides, or viewing movies or virtual reality.
-Theorized to be due to the mismatch between the sensory perception of movement received via the eyes, vestibular system, and muscles and joints and the expected internal model of movement.
-More intense when acceleration is in a direction perpendicular to the body and with up and down motion.
-Slightly higher incidence in women
-Peak incidence between ages 3 and 12 years
-Less of a risk on larger, more stable vessels
-One study cited the incidence of seasickness on cruises at 8%
How can it be avoided?
-Questionable whether reduced incidence depending on location on cruise ship
-Avoiding alcohol, large heavy meals
-Focusing on the horizon
-Don’t read
-Preventive medications
What are some traditional treatments?
-Anti-cholinergics, anti-histamines, sympathomimetics and opiods. biofeedback modification.
-Inhalational isopropyl alcohol and other aromatherapies
-Anticholinergics disrupt the transmission of vestibular input to the CNS.
-Acupunture or acupressure to the inside of the wrist (point “P6”), available as wrist bands.
What is in the sack of pills and patches given to passengers by their physicians? How do we recommend they use them?
-Pills are logically better at prevention than treatment, start your therapy 12-24 hours prior to anticipated “motion”.
Our infirmary’s supply of Phenergan and Meclizine was robust. The patients had mostly brought their own stuff. Dramamine. Balance bracelets. Meclizine. Phenergan. Zofran. The cutting edge in motion sickness management seems to be the scopolamine patch, which is great! But also not great because information about it wasn’t in the ship’s copy of Tintanelli or my Epocrates, and, boy, did passengers have questions about the medication that was already seeping into their bloodstream. The patches are applied behind the ear prior to embarkation, are effective for up to three days, effects can last up 24 hours after premature removal, and side effects include drowsiness, disorientation, dry mouth, blurred vision, dilated pupils, confusion, hallucinations, difficulty urinating and rash.
The trip back had a few cases of seasickness, but no one required parenteral treatment, and we returned to port feeling fine!
Ask me in person why penguins are suited up in black and white (warning, my response is from answers.com)!!
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Ten Tips to Prevent Motion Sickness - Medicinenet.com
15 Tips for Avoiding Seasickness - SportDiver.com
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