Motion Sickness?

[Bo Criss]

I had a couple of brothers visit Santa Barbara last week. One of them has been trying to get over his air sickness. I wondered if any pilots have any suggestions? John Scott, I've heard you have been dealing with it, any thoughts?

[Southside]

Hey Bo,

The best that guys like me can hope for is prolonging our flights for as long as possible before nausea sets in. But before you brother gets to the remedy that I use he should first start with the basics.

Get a good night sleep.
Stay away from caffiene.
Don't fly on an empty stomach -- but stay way from fatty and spicy foods.
Drive or at least ride shotgun to launch.
Wear contacts instead of glasses (no distortion).
This doesn't work for me, but look at the horizon.

If none of that works --

Ginger and or vitamin B
Over the counter remedies starting with the less drowsy formula stuff like, well, less drowsy formula Dramamine or Bomine. If they don't work try regular Dramamine or meclizine. I've read good things about Cinnarizine but I don't think that it is available here in the States. All of these medications should be taken at least an hour before heading up the hill.

If I have any kind of headache before flying then I might as well volunteer to drive because I usually won't last an hour. Because of that, I always take a couple of Aspirins or Ibuprofen.

If the over the counter stuff doesn't cut it then your brother should go the proscription route. It doesn't work for me, but by itself, the Scopolamine patch is supposed to work the best. His other choice is promethazine (Phenergan), which is what I use.

But studies have shown that a combination of scopolamine and amphetamine to be the best remedy, followed by promethazine and amphetamine. Substituting ephedrine for amphetamine is also effective.

Unfortunately, I can get my wife to proscribe the Phenergan but not the amphetamine or ephedrine. Lately I've been taking Sudafed to counteract the drowsiness caused by the Phenergan. But I just want to point out that amphetamine and ephedrine are supposed to be good for motion sickness on there own and are not just used to counter the side effects of the other drugs.

Lastly, there is an exercise regiment called the Puma Method. You can google it for more information, but basically you do a series of head movements each day to induce queeziness. The theory being that after X amount of days your body becomes inured to it all.

Good luck,

John

From NASA:

...The outstanding finding was the effectiveness against motion sickness of the drug combination promethazine and amphetamine that ranked just below scopolamine and amphetamine, which had been tested also on previous occasions. Ephedrine combined with promethazine was still highly effective although significantly less than the aforementioned combinations. Scopolamine in a ''usual" dose (0.6 mg) was more effective (19%) than half the dose but less effective (29%) than double the dose. Betahistine was ineffective and cinnarizine in the dosage used was of small benefit. AI though in previous experiments both promethazine and amphetamine were shown to be highly effective in preventing motion sickness, it was not expected that these effects would sum when given together inasmuch as the combination of an antihistamine (meclizine) with amphetamine afforded less protection (+20 head movements) than either meclizine (+23 head movements) or amphetamine (+50 head movements) taken singly. The demonstration that the new combination i s about equal in effectiveness to the combination of scopolamine and amphetamine increases the scope of preventative therapy, partly on the basis of individual differences in response to drugs and partly on the basis of differences between promethazine and scopolamine in their side effects. Among antimotion sickness drugs scopolamine ranks high in side effects (4) and its use may be contraindicated, e .g. , in patients with severe glaucoma or urinary retention e Promethazine ranks low both in side effects and contraindications. Promethazine combined with ephedrine, although much less effective than with amphetamine, nevertheless ranked among the best four preventative drugs. The differences in side effects between ephedrine and amphetamine may make the former the more
desirable drug under certain circumstances or in certain cases.
Scopolamine (0.6 mg) alone has consistently been shown to be an effective preventative in our previous studies. Doubling the usual dose provided even more protection but resulted in side effects such as drowsiness. Since the smaller dose of 0.3 mg was only slightly less effective than the 0.6-mg dose, it would appear that approximately
0.5 mg would be a suitable amount of scopolamine when it is used alone.

[Chris G]

Candied ginger! I've been giving it to tandem passengers, and taking it myself in small planes. Works like a champ and it's relatively cheap.

[oj]

Second that. Myth Busters did an episode on motion sickness and ginger proved to be the most effective, readily available prevention. The taste of candied ginger isn't the greatest so I've started drinking a bottle of "Reed's Extra Sharp Ginger Brew" on launch. So far, so good.

[andy]

Hey Bo, John pretty much summarized what I know. There are a couple of other medications that we use, Metaclopramide it is sold as Reglan, (10-20mg oral) it is used to increase stomach emptying but does have an anti-emetic effect, also odansetron-Zofran ( 8mg orally) is very good.

The physiology of motion sickness stems from an imbalance of the parasympathetic and sympathetic actions of the autonomic nervous system. The parasympathetic becomes "stronger" and the action is nausea, (among others). So the drugs that decrease parasympathetic-scopalamine, promethazine, etc, and drugs that increase sympathetic tone, amphetamine, ephedrine, sudafed, caffiene, should all theoretically work. However most of them have strong effects on cognitive function-level of alertness so be careful.

Ginger and hydration are a good combination. I have found in my patients that mental imagery is also very powerful. Don't let the thought of getting sick enter the conversation. Fear is a great initiator of nausea, so a thorough pre-op interview and discussion has been shown to decrease anxiety and the need for nausea medications by 70%, so a thorough pre-flight discussion should in theory do the same.

If you need some articles let me know.

Andy

[Skippy]

Hi Bo,

I have always been very prone to seasickness, carsickness, airsickness (and lately severe morning-all day-sickness...). While flying, I've found it different if I'm the one flying, rather than being a passenger; I guess being more in control of what's going on helps.

This said, I've been airsick a number of times while flying my own HG. I've taken a few steps to minimize the onset of nausea:

1) What worked for me was making sure I ate a good breakfast, and flew on a full stomach (not too full though). An empty stomach topped with the usual pre-flight nerves were often a good recipe for nauseousness. I also tried the candied ginger, and that seemed to help, although a good breakfast or half a sandwich just before launching seemed to work better for me. I guess keeping your protein level up helps avoiding those lows that get you in late morning/lunch time, which is usually when we end up in the air.

2) Driving to launch, I always make sure I look straight at the road, and if I can't sit on the front row, I still have a good field of vision of where we are headed, so that I can anticipate every turn, so that I don't get carsick going up. If I'm carsick going up, then you can bet I'll get sick while flying...

3) I also make sure I don't drink any alcohol the night before, not even one beer or glass or wine, as I can feel it the next day, and this wouldn't help the nausea while flying.

4) I also make sure that I remain hydrated while flying, as I have found this helps too. I force myself to drink occasionally even if I'm not thursty. A dry mouth doesn't help.

5) Another thing that might work is accupuncture. It has cured my pregnancy-induced sickness, where no medication worked fully, or only supressed some of the symptoms. I don't know if it would work for airsickness, but I would certainly give it a shot if other simple remedies don't work, and you want to stay away from drugs and their side-effects. It can however get expensive if you have to see one on a regular basis though, and your insurance doesn't cover it.
Short of seeing an accupuncturist, you can use accupressure wrist bands. I have used them sailing, and they have worked. I also have flown with them, with relative success, but it's worth trying.

I hope this helps,

Skippy

[faoro]

There is a newer drug out, maropitant (Cerenia - by Pfizer - for dogs!), that is far more effective than any prior medication for motion sickness. It works on the central nervous system as an antagonist to substance P, a neurokinin receptor activator that induces vomiting. It has been shown to be 93% effective in eliminating nausea and vomiting in even the most aggravated cases. Data show it to be about 30 - 60% more efficacious than anything previously on the market.

I would be interested in knowing if it has had any human applications. Fortunately, I'm not affected by the problem; so I can't check it out.

[drwheeler]

I'd try this drug, but does it make you lick your balls and hump the paraglider bag? ...

I find that looking at the horizon, or just below, and to the inside of the turn helps a lot. Basically, keep most of your attention on the direction you are flying. Avoid looking straight down and never turn your head to look outside the direction of turn - that gets to me right away.