When motion of the ocean causes despair

Quite simply, it's a vestibular malfunction that results in gastric dysrhythmia.

Although only about 5 percent of people who take cruises on modern liners ever suffer symptoms of seasickness, many more travelers use the possibility as a reason to avoid going to sea. That's a bad excuse, because a lot can be done to avoid the discomfort or lessen the severity of this first cousin of motion illness.

According to some estimates, one person in three is prone to motion sickness, but even experienced sailors sometimes get a case of mal de mer, especially when the ocean really gets rough. The problem occurs when rolling waves stir up the fluids in the inner ear that control the sense of balance.

The source of the suffering may be in your head, but its symptoms are more widespread. Your complexion pales, then flushes before you break into a cold sweat. Your hands may get cold, your mouth dry, or you may begin to perspire profusely under your arms. That's followed by a queasy stomach and perhaps an urge to vomit that doesn't recede even after the stomach has been emptied. "Green around the gills" is putting it mildly.

Of seasickness, it's been said that at first, you're afraid you're going to die, then you're afraid you won't.

In most cases, symptoms fade once the sea settles, although sensitive travelers can suffer throughout an entire voyage.

Here are strategies to quell those inner storms. First, select the right ship. Small sailing craft are the most problematic, while modern cruise liners, especially the latest mega-ships, have internal stabilizers that can dramatically dampen the effect of the waves. Ships built for transoceanic passage, such as the QE2 and the Norway, usually have deeper drafts than ships designed for Caribbean cruises, and they perform better in rough seas. Same for twin-hulled, catamaran-style liners, such as the Radisson Diamond.

Then select the right itinerary. Sheltered cruising grounds, such as Alaska's Inside Passage, tend to make for calmer voyages than those across open ocean. Also rough are places where major currents converge, such as Mexico's Cabo San Lucas, the North Atlantic, the South China Sea, or the Aegean in the summer.

Next, since the motion of the waves is the primary cause of seasickness, select a cabin where the ship is most stable, most often the middle, or amidships. For purposes of avoiding seasickness, cabins on lower decks are usually better than those on the upper decks, although having access to fresh air is also important. Shipboard balconies, such as the one Judi Dash describes in her article in this Sunday's travel, make excellent retreats.

At the first sign of queasiness, don't eat or drink anything for four to six hours. If you do become dehydrated, sip on flat cola, ginger ale, or sports drinks like Gatorade.

Since fresh air helps, sufferers often gravitate to the upper decks, where unfortunately a ship's pitch and roll tend to be more pronounced. When on deck, facing forward and focusing on the horizon is the best direction, assuming the weather isn't too bad. Otherwise, find a spot on the side of the ship that is out of the wind. Try to nap, or if that's not possible, divert your attention from the nausea by reading or playing cards. Snoozing is an ideal way to pass the time.

Once the initial nausea passes, eat light, starchy snacks, such as dry cereal or crackers. Avoid fried or spicy foods, which tend to make the stomach work harder.

There are also a number of preventative medicines a traveler can take.

Most commonly sold chemical cures contain antihistamines that tend to repress sensitivity of the inner ear. Over-the-counter drugs such as Dramamine, Benadryl, Marezine, Triptone and Bonine are generally considered safe and can prevent or lessen the severity of attacks if taken in advance or provide short-term relief if taken afterward. Some shipboard doctors even prescribe Dramamine injections, which work more quickly than tablets.

All of these cures, however, can have unintended consequences in some individuals. Drowsiness, which under the circumstances may not be so bad, is the least of the issues. Other adverse reactions include dry mouth, disorientation and loss of memory.

Chronic sufferers can ask their doctor about scolpolamine skin patches. Once hailed as the perfect cure, these patches dispense medicine over several days. They were taken off the market several years ago, amid persistent reports of travelers suffering severe psychological reactions and even hallucinations while wearing the patches. Reformulated patches have recently become available but only by prescription.

As is often the case, some medicines which are not sold in the United States. Chief among these is Sturgeron, which is widely available in Europe, Canada and several Caribbean islands. It's reported to be very effective against the symptoms but without the side effects associated with the other drugs.

Natural remedies, such as sucking on ginger root or nibbling on ginger snaps also can help. Other travelers rely entirely on Sea Bands, simple cloth wristlets with a small bead sewn into them which supposedly stimulate an accupressure point in the center of the wrist, specifically the P6 (Neiguan) point. Another product, which works on the same principle, provides the stimulation with a slight electric pulse.

All these cures are most effective if taken before the first symptoms of nausea appear. That way, if you follow the prescription and don't get sick, you can be sure it worked just like the doctor ordered.

Of course, other medical mishaps can befall a traveler at sea, ranging from sloppy shipboard sanitation to communicable diseases, sunburn and all the other natural shocks the flesh is heir to no matter where they are, let alone miles from land.

And there are not even any international standards for on-board medical care. Most cruise ships do have a doctor, but many are not U.S. trained or licensed. They may be able to handle minor emergencies but lack the expertise or equipment necessary for severely distressed patients, such as cardiac defibrillators. Medical evacuation from a ship at sea is an expensive consideration which probably won't be covered by medical insurance plans.

The 25 ship lines that participate in the Cruise Lines International Association (212-921-0066 or www.cruising.org), have agreed to maintain minimum medical standards, but it's always wise to investigate a specific ship's medical facilities before making a booking.

And twice a year, cruise ships that carry 13 or more passengers and call on American ports are subject to sanitation inspections by the Centers for Disease Control. The CDC considers 21 different criteria and rates the ships on a 100-point scale, with a score of 86 being considered the minimum acceptable. Every other week, the CDC produces a "Green Sheet" showing the most recent scores. We regularly publish a selection of these scores in Sunday travel; complete listings are available on the CDC's Web site (http://www.cdc.gov/) or by calling the Vessel Sanitation program at 770-488-7070).

These precautions are intended to encourage rather than dissuade travelers from considering a cruise vacation. Despite some recent, well-publicized problems, most cruises are entirely uneventful, at least as far as passenger convenience and comfort are concerned.

But it is always wise to be aware of potential problems, take appropriate steps to avoid them and know how to deal with them if they occur. An ounce of prevention...