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Gut Reaction

Seasickness. Is it all in your head? We take a ride in the chair of despair and bring up the truth.

April 1, 2002

“Should I wear a lobster bib?” I ask, stomach churning in anticipation.

“Here’s a barf bag,” replies Dr. Joel Ventura, a research scientist at Brandeis University’s Ashton Graybiel Spatial Orientation Laboratory. Before handing it over, he tests the bag’s integrity by inflating it. “Sometimes they’ve got holes,” he explains. “Once a subject got sick in his bag and it went straight through to his trousers. But don’t worry. I’m not planning to make you vomit. That would interfere with the measurements I want to take.”

On a nearby bulletin board, Ventura and his colleagues have pinned a smattering of articles on motion sickness and related topics, including a piece on the challenges of sexual intercourse in a weightless environment. Why couldn’t I have volunteered for that experiment?

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Instead, I’m seat-belted into what looks like a dentist’s chair from hell. Two tennis balls suspended on rods hover 8″ from my temples. Soon I’ll be spinning around at 7 rpm for about an hour, all the while bobbing my increasingly disoriented noggin in a variety of bamboozling directions. The goal: to find out if one of the supposedly most potent seasickness preventatives works.

Spin Doctor

For the past 11 hours, a small adhesive patch behind my right ear has been leaching something into my bloodstream. It might be scopolamine, an anti-nausea agent that could keep my stomach contents where they belong. Or it might be a placebo leaching a whopping dose of nothing.

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Before the torture begins, Ventura explains today’s protocol, which parallels his earlier tests on 78 volunteers. First, he’ll start the motorized spinning of the Bárány chair, which takes its name from the 1914 Nobel Laureate, Robert Bárány, a pioneer on the workings of the inner ear. His chair is one of the most effective ways to produce motion sickness.

After a minute of spinning, my inner ears should adapt to the motion. Then I’ll begin sequential head movements: chin to chest then back to the head rest; right temple to right tennis ball then back; left temple to left tennis ball then back. I must repeat this cycle four times, followed by 50 seconds of rating my possible symptoms-nausea, sweating, salivation, drowsiness, headache, and dizziness.

At the conclusion of the hour, if I make it that long, Ventura will assess how fast my motion sickness “decays” (dissipates).

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“How long,” I ask, “do you think it will take me to decay my way back to normal?”

“It depends on the individual,” Ventura explains. “I had one volunteer who got violently sick after making only 10 head movements, then she threw up for the next half hour. Another guy recovered in six seconds. Ready?”

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During the chair’s acceleration phase, I feel dizzy, but once the chair stabilizes to a steady 7 rpm, my system adapts. Indeed, with my eyes closed, I feel as if I’m not moving at all, which, I’m told, is normal.

Satisfied that I’ve settled in, Ventura begins his chant of prescribed head movements in one-second intervals: Down. Up. Right. Up. Left. Up. Down. Up. Right. Up. Left. Up…. So far, so good. I do feel a bizarre tumbling sensation, but nothing is particularly distressing. After 40 minutes, 20 completed cycles, and some 480 whirligigging head movements, I’m asking Ventura about local restaurants. When the test finally ends 20 minutes later, I’ve swiveled my head 720 times, and my only symptoms are a slightly dry mouth, some grogginess, a relaxed neck, and famishment.

“When we did the clinical trial,” Ventura explains, “I pretested the subjects to make sure they were all susceptible to motion sickness. Only 2 of 80 made it for an hour without getting seriously nauseated.”

“So I would have been the third?” I ask. It’s nice to discover you have a talent for something. Ventura shrugs, adding that he didn’t know if my invulnerability was due to my constitution or pharmaceutical intervention. He removes the patch from behind my ear and explains that we’ll repeat the test in two days with the other patch.

The Old Heave-Ho

“Though it remains nearly impossible to predict if a person will be susceptible to motion sickness without testing, there are some factors that may influence your odds,” says Dr. Michael Gresty, professor of spatial disorientation at London’s Imperial College of Science, Technology, and Medicine.

Sufferers of frequent headaches, especially migraines, as well as lactose-intolerant individuals, seem especially vulnerable. Age appears to play a role, too. Motion sickness peaks from puberty to your 30s, which means the young and the post-middle-age have a small advantage.

Interestingly, people who are symptom-free in one environment can’t count on blanket immunity. Astronauts, for instance, have the right stuff for space but may get hog-whimperingly sick in a dinghy.

The determining factor is what goes on in our vestibular system, the complex inner ear organs that tell us how we’re oriented in space. If you close your eyes and tilt your head, it’s this system that lets you know without looking which way you’re pointed.

Studies have been done on how the stomach reacts to sickness. The results show that heave-the up and down movement of a boat-accounts for 95 percent of the problem. “The stomach and intestines are loosely tethered to the rest of the body, meaning these organs stay put while the rest of our frames go up and down,” says University of Pittsburgh Medical School researcher Dr. Carey Balaban. Moreover, the most provocative frequency of heave for many people is about 0.2Hz, or one cycle every five seconds. According to Balaban, this is close to our breathing rate and a common rhythm of waves at sea.

“Our bodies are accustomed to sensing a regular, natural range of movements,” Balaban theorizes. “When you put a person on a boat that’s moving rhythmically up and down near the breathing rate, this triggers sensory feedback that’s different than what we’re accustomed to. The nervous system concludes there’s something wrong with the viscera. The body interprets these weird signals as some sort of sickness, then orders us to purge.”

To be sure, there are a host of other variables. People with normal vestibules, for instance, may become seasick on a visual simulator-that is, in the absence of any motion whatsoever. To researchers like Ventura, Gresty, and Balaban, teasing out the exact cause and cure of the disorder remains a daunting challenge.

Ralphing Redux

With my new patch securely in place, I’m strapped once again into the Bárány chair, highly fearful I’m wearing a placebo this time. My stomach roils its ill-advised breakfast contents: two lemon Danish each washed down with a cup of café au lait.

“Remember, you were nervous the first time, too,” Ventura points out. “And that didn’t turn out so bad.” He hands me a fresh barf bag, which I inflate myself. After all, I’m now a veteran of the chair.

“When we ran the original trial,” Ventura continues, “the percentage of placebo responders was almost as high as those who benefited from the actual drug. And when we asked the volunteers to say which patch they thought they were wearing, their guesses proved no better than chance.” So the bottom line is: I might be receiving scopolamine this morning, and the lemon Danish might not resurface.

Ventura cranks up the chair. After the fourth cycle, I feel a little worse than last time, but not horribly so. Other than a mild headache and drowsiness, it’s hard to quantify any difference. After 10 cycles, I’m still feeling fine, though the grogginess is growing. After 20 cycles, my stomach feels slightly upset, which is pretty much a normal state for me. The drowsiness, on the other hand, has become impossible to ignore. Whenever I initiate head movements, I can’t refrain from yawning. I don’t have the same dry mouth I experienced my first time, but I am considerably more sleepy. Then again, this might be the Sopite Syndrome kicking in. This is the technical term for motion sickness-induced fatigue, a syndrome parents have unknowingly relied on to rock an infant to sleep.

Finally, an hour later, my second test ends, mercifully without any sign of the Danish. Ventura comes clean: It turns out that the first time I was on scopolamine and today I got the placebo. The only difference in symptoms were a minor increase in queasiness, dramatic increase in grogginess, and slightly longer recovery time.

“In our study,” Ventura explains, “about 50 percent of the volunteers got relief from the scopolamine, but 40 percent got relief from the placebo. There were subtle differences in the two groups, though. As the test wore on, placebo responders seemed to have a slight increase in symptoms, which would recede toward the end. Scopolamine responders seemed to have the sickness suppressed from start to finish.”

Mathematical minutiae notwithstanding, the bottom line here is when all is said and done, more than two-thirds of us can keep seasickness at bay, thanks to either real medicine or a real belief that something we’re taking will work. All this, of course, presupposes the conditions aren’t too Perfect Storm-ish-when the sea gets rough, only the genetically gifted are likely to escape with their stomachs intact.

To find out if I’m, in fact, barfproof, I ask Ventura if he could try to make me sick just so I can experience what lesser men feel like. He smiles and says that he’ll run me up to 25 rpm to see what happens.

By the time I’ve executed my third head motion, my skin starts to prickle and sweat seeps out of every pore. But the worst is the nausea. “Better stop,” I yell. Ventura brings the chair to a halt, which inaugurates a new round of nausea. Somewhere in my gut, two lemon Danish-like shell-shocked soldiers-try to decide which way to march. Finally, after much indecision, they continue heading south. Thank goodness.

“You’re going to be more vulnerable to other causes of motion sickness for a while,” says Ventura, “since your vestibular system has been stimulated so much.” He advises me not to read on the plane home, but to take a nap instead.

His words prove prophetic. It’s now three weeks and multiple naps later, and I feel nearly normal. And I can almost say “Bárány chair” without gagging.

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