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Miscellaneous - Seasickness

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Hi is it possible to contract sea sickness?

I have spent most of my working life and childhood on the sea. I have been a continental truck driver for 20 years and been on ferries in the roughest of conditions and still had the breakfast in the morning even the crew looked sick.

So, never any problem with sea sickness, until I went out in the sea off the Norfolk coast. All was ok and feeling great until I had to gear up then breakfast over the side.

On the second dive that day the same plus again when I got to the car. So now I am thinking that I could have contracted sea sickness as an old age problem or was it just tummy bug?

A - It is impossible to contract sea sickness, so no worries on that count. It is possible, though, to have a bad day, a one off where it all goes wrong. I get that rarely, and like you I come from good stock. Naval parents, and on rare occasions, out of the blue, I will paint the decks with bile. Luverly.

So it is probably that, but also a dose of food poisoning will cause this too. Give it another go, and if it keeps happening, then go for all the cures.

Q - Firstly, thank you for your excellent monthly feature in Sport Diver Magazine. I am returning to Egypt this summer with my family for a diving holiday and we wish to spend most of our days boat diving. Unfortunately, my daughter suffers from motion-sickness, which (understandably) puts her off a little. I have heard the advice to use sea-sickness tablets, but am aware that not all are suitable for use when diving. Please can you advise which ones get the diving green-light and which do not.

A - I have stuck a whole lot of info about what are the best sea sickness tablets on the e-med diving pages. Basically they must be ones that do not cause drowsiness. This would slow reaction time underwater to certain events.

Likewise they must not cause other overt side effects like a really dry mouth. In all I normally recommend Stemetil or prochlorperazine. It needs a scrip and should be used in 5mg oral doses.

Q - Hello - medical advice urgently needed please. Anxious mum here....

We've booked to go to Egypt next week, mainly so my daughter can enjoy the lovely waters for diving there. She's 14 years old, a PADI Jnr. Rescue Diver and has 25 dives to her credit, the most recent being a couple of weeks ago. We learn that the dive club we're planning to visit does boat dives which will require her to be on the boat all day 8:30 till 16:30hrs. She gets travel sick. Once she has been ill, she's absolutely fine, but it would be better not to reach that point. As you can imagine, I would very much appreciate your advice, so that the trip does not become a disappointment.

Is there any medication, either off the shelf, or via doctor, that she could take without affecting her diving capabilities? She's very fit - does about 10 hours of dancing a week.

A - Bless, sweet youth. I used to do 10 hours of dancing in my college days, but mainly on car roofs. Still got it on my record. I think she will be fine. These Egyptian day boats are big mothers, not your rolling RIBs that bob with every ripple. For her it's best to sit at the bow if she can and watch the waves coming. That makes the brain predict the oncoming movement from the swell, and the brain tells the inner ear balance centres what to expect. Result, no nausea, and no embarrassing knocking on the only loo door from the other divers trying to get in.

As for preventatives if it's a well rough day, I suggest ginger. Nice and natural. Breakfast on ginger nut bikkies. Ginger beer all day for rehydration. A picture of Chris Evans in her pocket and chant a mantra to Chris Fairclough, legendary Liverpool super-sub before each dive. That'll do it.

Q - Hello ! I've recently returned from a short diving holiday to Spain.

For the first dive we stayed above 10mtrs but after 45mins I felt bad indigestion and had a build up of saliva. I heard my buddy trying to attract my attention (to check out a cuttlefish!!) and turned around quickly, I swam towards him but suddenly realised I was going to be sick!

I took out my reg and was sick, I was able to make a slow, controlled ascent and continued to be violently sick at the surface (and for a good 20 mins afterwards!). The following day, while finishing a 35mtr, 30min dive, at the bottom, I felt bad indigestion and saliva again. Realizing an ascent was my last option, I was sick numerous times at the sea bed and all the way back up the line, even when we had got back onto the RIB! The nausea stopped as soon as we were within 20mtrs of the shore!

I had no feeling of spinning, dizziness or any other warning signs apart from indigestion and saliva.

Although I was able to be (quite violently!) ill without panicking, its not an experience I wish to repeat (or to repeat on me!) and I wonder if this is something you have come across before?

I was unable to hold down any food for 24 - 36 hrs after but was able to do another dive two days later without any problems?!? I had recently returned from a weeks diving in Scapa Flow without incident and am going on a liveaboard in the Red Sea next Month - although it provides a feast for the wildlife, its not something I want to do again, can you help?

A - I can indeed. But first things first. If you're going to be sick underwater, do not take out your reg in any circumstance. The pressure of vomiting is not enough to prevent water entry into your mouth and upper respiratory tract. Most regs will allow the passage of bits out of them, and even if it did block you can switch quickly to your alternate.

Most reasons to be sick on a dive can be attributed to 3 areas.

Middle and inner ear problems for starters, i.e if there was unequal air escape from the middle ears on ascent, you can get vertigo, nausea and this can lead to a vomit. But as you had no spinning feeling, we can rule this out.

Secondly, sea sickness presenting late, and hitting you underwater. This is more likely but as it was late and at depth with just the vom and no nausea then forget that one.

Lastly, and most likely, some kind of bug, virus or food poisoning. This can cause a vomit alone with few other symptoms, and you feel better once it's all out. But why this should get you at depth and at no other time is a mystery.

I go with option 3, as you have never had it before, it stopped suddenly as you dove ok later. And not holding down food it more symptomatic of some food borne bug.

So I reckon you should be fine and dandy for the live aboard.

Q - I have been diving for over 10 years now and do suffer from sea sickness. 18 months ago I went on a live aboard and was taking Sturgeron. I had to seek medical advice in Egypt after a reverse block on ascent ruptured my L tympanic membrane. I was told that it was the medication that contributed to block and so to the rupture. I am now diving again with no problems (other than sea sickness) but am going on holiday and need some advice about what medication I can take, as it can be misery without it but obviously do not want to scupper the holiday or my ear again.

A - This is a very interesting point you have brought up here, and one which I have been asked a lot. Exactly what is the best treatment for seasickness when you're diving and what other preventative measures you can take.

Stugeron, or cinnarizine as it is known medically is an antihistamine. It stops seasickness by stabilising the inner ear's balance centres, however as an antihistamine it also decreases any mucous production too. What could have happened to cause your eardrum to blow is an increased mucous production if the drugs effects wore off.

This could have blocked your Eustachian tube thus stopping the air from escaping down it as you ascended. Result .blown eardrum.

The other thing about cinnarizine is that it's antihistamine properties are sedating. The makers don't recommend you drive on them, so I don't think you should dive on them either. Doziness underwater can only lead to errors of judgement so best leave them alone.

So where does this leave the seasick diver?

Well I would recommend you try one of the homeopathic alternatives, such as Nelsons Travella which don't sedate, or even those acupressure wristbands to start with, as at least there are none of the side effects of antihistamines.

If someone does need something a little stronger then I've found prochlorperazine a good non-sedating medication. Its prescription only though and you need to see a doc to get it.

(other dive medical questions)



   


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