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Mal de Mer by Dr Andrew Tagg

mal de mer

 

That rather quaint French phrase makes sea-sickness sound relatively benign but it, and its treatment, can have rather devastating effects on  holiday plans.  Having spent four and half years sailing out of most major ports in the world with an international cohort of passengers I can categorically state that Australians are the worst sailors bar none.  I spent four months sailing out of Sydney to Noumea and Vanuatu and would routinely treat 150 patients within the first day of the voyage, some of them presenting before we had even left port.

 

The gentle rocking and pitching of an ocean liner as it wends its way  through the Sydney Heads was enough to make a dent in beer sales for the first night of the cruise and by the time clinic opened on that first day passengers would be queueing up three flights of stairs, sick bags in hand, begging for relief.  They would be cursing their acupressure bracelets, homeopathic remedies, and ginger biscuits and ruing the day they ever thought of coming on an all-you-can-eat, all-you-can-drink cruise.

 

Our treatment was empiric and not particularly evidence based but we found that 25mg of IM promethazine into the right buttock (providing there were no contraindications) was enough to fix 99% of our population.  The soporific effect of the sedating anti-histamine was enough to knock out the majority so that when they woke up they had made it through to calm waters and were happy to eat, drink and be merry.

For staff members we preferred a non-sedating agent as a sick crew member meant that someone else had to cover their duties.  A dirty, little secret of pre-hospital and retrieval medicine is that doctors’ suffer from motion sickness too.  Back in my ICU days I would inject my left deltoid with cyclizine prior to jumping in the back of an ambulance – I wasn’t going to let anyone else see my pasty white arse – and whizzing around the M25.  But cetitrizine was my constant friend on-board.  After prolonged time at sea I had become acclimatised to the constant movement and had gained my sea-legs. Days spent on board with meant I rapidly lost my land legs though.  Standing dockside in Majorca I was convinced the island was having an earthquake as the world seemed to sway in front of me and it was only until I returned to the safety of my cabin that I realied what was going on

 

Seasoned travellers would bring on their own anti-histamines with the Americans favouring scopolamine patches.  These topical plasters, the size of a 5c piece have been manufactured by the devil himself.  They would put little old men into retention and make their little old wives confused and delirious.  Passengers would present to clinic convinced that they had some impending intracranial disaster as they had blurry vision and a massively dilated pupil. They had forgotten to wash their hands after taking off the scopolamine-hyoscine patch and rubbed their eyes.

So what should you do if you find you’ve left your stomach on land whilst the rest of you is crossing the ocean blue? There have been no RCT’s to date comparing possible effective treatment for motion sickness but that stalwart of US invention, NASA, is developing a scopolamine based nasal spray.  But until that day comes you are going to have to heed the advice of the captain, “Find a nice apple tree to sit under.”

 

Dr Andrew Tagg left the shipboard life in 2009 to settle down and lose weight.  He is currently an advanced trainee in EM working in Melbourne’s western suburbs.  He still has the uniform. Contact him via Twitter @andrewjtagg

 

 

 

 

One Comment Post a comment
  1. James Doube #

    In addition to the antihistamines and anti-cholinergics, ephedrine can be a useful antemetic for personnel who must keep working. When it was available as tablets, these could be used alone or in combination with Phenergan. The same works IM if really needed.

    Interestingly there have a been a couple of studies looking at ephedrine for PONV, where it may be comparable with droperidol (see Anaes Analg 1991;72:58-61), with suprisingly little sympathomimetic effect. I have found it useful for this, but I am cautious with patient selection.

    July 12, 2013

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