Motion sickness is a disturbance in the vestibular (balance system of the inner ear) system as it relates to the visual and proprioception (position sense in space) systems of the brain. Some people only get sick when their eyes are focused on close work, such as donning gear, or when working on navigation in an enclosed compartment. Some people associate diesel fumes with being sick, most likely a psychological stimulus.

The most common hypothesis for the cause of motion sickness is that it functions as a defense mechanism against neurotoxins. The area postrema in the brain is responsible for inducing vomiting when poisons are detected, and for resolving conflicts between vision and balance. When feeling motion but not seeing it (for example, in a ship with no windows), the inner ear transmits to the brain that it senses motion, but the eyes tell the brain that everything is still. As a result of the disconcordance, the brain will come to the conclusion that one of them is hallucinating and further conclude that the hallucination is due to poison ingestion. The brain responds by inducing vomiting, to clear the supposed toxin.

All in your mind?
There are those who will tell you that sea sickness is really a state of the mind - when you and I "know" that isn't true! Actually, the Israeli navy has done studies that show that suggestion plays an important part in producing sea sickness. They also have shown in very good studies that the best drug for mal de mer is scopolamine, recently placed back on the market by the FDA in transdermal form. Scopolamine has many side effects, is difficult to regulate with each individual and may be dangerous to the diver with glaucoma or prostate trouble.

They found that the next best drug was cinnarizine (Stugeron in the U.K.), less effective but with many fewer side-effects. Stugeron is not available in the U.S.

The best medications have been found to be "Meclizine", "Bonine", Dramamine and Scopolamine, in the form of the TransDerm patch or in tablet form.

SCOPACE (tablets) contains scopolamine hydrobromide, "the single most effective" medicine in preventing nausea and vomiting induced by motion.(1) The typical prescribed dose is 1-2 tablets taken an hour before travel. Each dose comforts up to eight hours.

Comparing SCOPACE tablets to the scopolamine patch in non-divers, please note the following important differences noted in the web site at http://www.hopepharm.com/motion/versus.html

1. Dosing Flexibility
2. Greater Efficacy
3. Lower Incidence of Side Effects
4. Faster Onset of Action
5. Shorter Duration of Action
6. Cost Effective

REFERENCES FROM HOPE PHARMACY
1. AHFS Drug Information 1996. American Hospital Formulary Service
2. Wood, M.J. et al Comparison of Dosage Routes for Antimotion Sickness Drugs. Aviation, Space, and Environmental Medicine. May 1987; 504.
3. Doweck, I. et al. Rate of Absorption of Scopolamine After Application of Scopoderm-TTS. Aviation, Space, and Environmental Medicine. May 1994; A24.
4. Advertisement. CIBA Pharmaceuticals.
5. Parrott, A.C. The Effects of Transdermal Scopolamine and Four Dose Levels of Oral Scopolamine (0.15, 0.3, 0.6, and 1.2 mg) Upon Psychological Performance. Psychopharmacology. 1986. 89: 3; 347-354.
6. Dobie, T.G. and May, J.G. Cognitive-Behavioral Management of Motion Sickness. Aviation, Space, and Environmental Medicine. October 1994; C1-C20.
7. 1998 Redbook. Medical Economics Company. Oradell, New Jersey.
8. Graybiel, A. et. al. Prevention of Experimental Motion Sickness by Scopolamine Absorbed through the Skin. Aviation, Space, and Environmental Medicine. 1976; 47: 1096.

Wrist bands
The ReliefBand® NST(TM) device is indicated for use in the treatment of nausea and vomiting due to chemotherapy, motion sickness and pregnancy. The Food and Drug Administration has approved its electronic ReliefBand for postoperative nausea.

It is the first such commercially available device to receive FDA clearance, the Carlsbad, California-based company said in a news release.

According to Woodside, the ReliefBand uses electronic signals to stimulate nerves in the wrist. It is believed that those signals stimulate natural nerve impulses in the body, causing them to interfere with nausea messages en route to the stomach, the company explained.

Woodside Biomedical, Inc., is a privately owned, venture-financed company.

Ginger
Ginger in its various forms can also help--when taken 12-24 hours in advance.

Stomach bolus?
Oatmeal, bagels, crusty bread or any food that forms a bolus in the stomach can be helpful.

My best treatment is keep your eyes on the horizon, stay on deck and keep yourself well hydrated with non-alcoholic beverages. There is some evidence that the use of an artificial horizon in glasses might be beneficial. Try antacid tablets or lemon drops and if diving ,try to be the first diver in from a heaving boat. Emmetrol may be effective.

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