Jamie’s Kryptonite

Outlander Science Club

OutlanderScienceClub_Facebook

A Dram of Outlander Voyager Read-Along (Listen Here)

Chapter 41:  We Set Sail

Jamie’s Kryptonite:  Help For The Landlubber  – Listen HERE!

     The completest of landlubbers, he was not just prone to seasickness, but prostrated by it. He had been violently ill all the way from Inverness to La Havre, though sea and weather had been quite calm. Now, some six hours later, safe ashore in Jared’s warehouse by the quay, there was still a pale tinge to his lips and dark circles beneath his eyes.
From Voyager by Diana Gabaldon, Chapter 40

“Sailing on the sea shows that motion disorders the body.” – Hippocrates

762px-thomas_buttersworth_-_h-m-s-_victory_in_full_sail_and_in_a_squall_2

Source: Wikipedia Commons

 

What is seasickness?

First described by Hippocrates, seasickness is a group of unpleasant symptoms occurring in response to real or perceived motion.  It is thought that the mismatch between what the eyes see and the movement the body feels. A classic example is a person sitting  in the interior of a cabin on a ship, which seems to be stationary to the eye as one looks about the room, but the body senses ongoing movements of the ship. These conflicting messages to the brain are thought to be cause of motion sickness. This also can occur when when a person is not moving at all, but the eyes see motion, such as when looking at movement on a slide under a microscope or engaging in virtual reality games, though the body perceives no movement.

Symptoms include dizziness, nausea, belching, increase salivation, warmth, sweating, general feeling of malaise, hyperventilation, and feelings of impending doom.  While thought to be due to this mismatch of input from the eyes and from the body, the exact mechanism by which this happens is not fully understood.

sea-sickness_-_published_by_g-s-_tregear_96_cheapside

Source: Wikipedia Commons

 

How does the body perceive motion?

We are able to sense motion via the input of cues from the eyes, the muscles and joints, and the vestibular system. Sensory receptors in the eyes send information to the brain that provide visual cues specifying how the body is positioned relative to other objects (Am I lying flat compared to the room around me? Am I upside down compared to the furniture in this room?).

Sensory receptors in the skin, muscles, and joints are sensitive to stretch and pressure and report back to the brain information about how the body is positioned in space. For instance, cues from the ankles and feet may indicate whether I am standing on solid ground or if I am on a tilting surface (like a boat) requiring the muscles of my ankles and feet to work against the sway of the boat to keep me standing.

Information about motion and balance is provided by the vestibular system via structures in the inner ear including the utricle, saccule, and three semicircular canals.  The utricle and saccule sense linear movement via the movement of tiny hairs within, or cilia, as the head moves.  The semicircular canals contain fluid and as the head moves in a rotational pattern, the fluid within moves, stimulating receptors that sense the movement of the head.

Anatomy_of_the_Human_Ear_en.svg.png

Source: Wikipedia Commons

 

The brain then receives all of these signals from the eyes, muscles and joints, and the two sides of the vestibular system (one in each ear), and must make sense of it. Motion sickness symptoms are thought to arise when the input from these sources conflict with each other, such as when the input from the muscles and joints suggest the rolling movement of a boat while the eyes simply see the walls and furniture of a ship’s interior cabin.  Interestingly, people who are blind can have motion sickness, but people who are completely deaf (and lack peripheral vestibular function in the ear) cannot!  This would suggest that the vestibular system is playing the major role here.  The exact mechanism by which this occurs is not well understood.

Why are some people so much more susceptible to motion sickness?

Motion sickness can be induced in nearly all adults, but certainly under typical situations of travel by boat, air, or car, or rides on roller coasters, not all are affected.  Children under 2 are typically resistant to motion sickness.  Symptoms seem to peak at approximately age 12 and then decrease (though of course this isn’t the case for all).  Women are more commonly affected and pregnant women in particular are quite susceptible, raising the question of the role of hormones in motion sickness.  Interestingly, migraine sufferers are also more susceptible to motion sickness.

Motion sickness tends to improve for most with repeated exposure to the stimulus.  After 36-72 hours of continuous exposure, symptoms typically subside or resolve for most people.  However, symptoms can occur upon returning to the pre-exposure environment (e.g. returning to land after a period of time at sea).

Treatments for Motion Sickness

Environmental Modification

Minimizing the discrepancy between the different cues from vision, muscles and joints, etc. can help. Looking at the horizon from the deck of a ship rather than remaining in an interior cabin allows the visual input to more closely match the other sensory input.  Sitting in the front seat of the car and looking out the window, or better yet – being the person driving – can minimize symptoms.  Self-generated movements don’t cause motion sickness, so those prone to motion sickness can avoid symptoms of car sickness by taking the wheel.

Medications

These are most effective when taken as a preventative before the symptoms start.  The most frequently used medications include antihistamines like Benadryl, Meclizine, and Dramamine and the anticholinergic medication Scopolamine which is available in a skin patch form. Other medications that are used in the prevention and treatment of motion sickness include nausea medications, as well as medications like baclofen and gabapentin which influence the neurotransmitter GABA, thought to play a role in the development of motion sickness.

Herbal Remedies

  • Ginger
    • A traditional remedy for nausea, also has been found to be effective in motion sickness.
    • Was found to be beneficial in a study of naval cadets when given as a pre-treatment, resulting in less vomiting and cold sweats than placebo.
    • Thought to affect gastric motility as well as on serotonin receptors in the brain
    • Patients on certain medications, particularly blood thinners, should discuss this with their doctor before taking ginger, as ginger may also increase the risk of bleeding.
  • Peppermint
    • Frequently used to treat nausea
    • Works as an antispasmodic in the gastrointestinal tract
  • Black Horehound
    • A traditional remedy for motion sickness, nausea, and vomiting

Biofeedback and Relaxation Techniques

It turns out that even pilots and astronauts are not immune to motion sickness. Biofeedback and relaxation therapy have been used by NASA to help mitigate the effects of motion sickness.

Acupuncture and Acupressure

Originating in China over 4000 years ago, acupuncture is the application of fine metal needles to particular areas of the body to maintain health and to prevent and treat certain ailments. After a thorough evaluation, a practitioner inserts thin needles into precisely defined points along the 14 main channels (or meridians) along the body associated with specific organs.  Acupressure is similar in principle, involving the application of pressure, rather than needles, to specific points along the body.  In particular, the P6 acupuncture point located above the wrist has been studied extensively and many find the use of this point is effective for reducing nausea and vomiting.  Acupressure wrist bands that apply pressure to this point are widely used to prevent and relieve the symptoms of motion sickness.

 

body
Source: Shutterstock
     His face relaxed slightly, making the slender gold needles that protruded from behind his ears twitch like ant’s feelers.
     “It’s all right,” he said gruffly.  “It’s only some rubbish of the Chinee’s, to cure the puking.”
     Wide-eyed, Marsali came up to him, gingerly extending a finger to touch the needles embedded in the flesh of his wrist below the palm.  Three more flashed from the inside of his leg, a few inches above the ankle.
     “Does – does it work?” she asked.  “How does it feel”
     Jamie’s mouth twitched, his normal sense of humor beginning to reassert itself. “I feel like a bloody ill-wish doll that someone’s been poking full o’ pins,” he said. “But then I havena vomited in the last quarter-hour, so I suppose it must work.” He shot a quick glare at me and Mr. Willoughby, standing side by side near the rail.
From Voyager by Diana Gabaldon, Chapter 41

Jamie’s Experience with Acupuncture

Jamie has regained his sense of humor, a reassuring sign that he is feeling better, alarming though he may look to Marsali with needles protruding from various spots.  Acupuncture needles are described on his wrist and lower leg and behind his ears.

Wrist:

Pericardium 6 (P6), the best known acupuncture point for preventing and treating motion sickness, is located 2cm above the wrist in the inner forearm. Used for treating vomiting, dizziness, and vertigo, motion sickness wristbands apply pressure to this point.
Lower Leg:
Spleen 6 (SP6) is a point in the inner lower leg, about 3 cm above the ankle that is said to help with digestive symptoms and dizziness.
Behind the Ears:
Gallbladder 8 (GB8) is a point on the head directly above the ear which is said to help with ceaseless vomiting.  Other locations in this area also help with dizziness and vertigo.

 

544px-acupuncture_needles

Source: Wikipedia Commons

 

How Does Acupuncture Work?  

In Traditional Chinese Medicine, it is believed there is a universal life energy called qi (“chee”) present in every living being.  This energy travels throughout the body along specific pathways called meridians. Health is maintained when the energy flows freely throughout these meridians.  However, when the flow of energy is blocked, disrupting the system, pain and dysfunction occur.  Acupuncture is thought to restore normal function by stimulating certain points on the meridians to free up the energy.

In Western medicine, some theorize that pain relief from acupuncture is due to the release of endorphins that occurs when needles penetrate the skin.  It is also thought that acupuncture affects gastrointestinal disorders by effecting the parasympathetic and sympathetic nervous systems, promoting gastric and intestinal motility.  Studies involving neuroimaging reveal that acupuncture has the ability to activate and deactivate particular areas of the brain.  Research funded by the National Institutes of Health  has indicated that acupuncture is effective in treating migraines, arthritis, and chronic pain.

Acupuncture was mostly unknown in the United States until the 1970s. When President Nixon’s Secretary of State Henry Kissinger travelled to China in 1972, he was accompanied by journalist James Reston.  Reston developed appendicitis while in China and required an emergency appendectomy.  He reportedly remained awake during the operation, with his pain controlled with acupuncture (though further reports, and Reston’s own account seem to suggest he had an epidural for anesthesia during the procedure, and acupuncture was used for post operative pain 2 days alter).  Word spread, and US physicians began studying acupuncture and its use in anesthesia for pain control as well as other applications.

We will likely see acupuncture become more widely used in the US, particularly as we seek to minimize the use of opiate medications in controlling pain. It is interesting to see that despite our advances in medicine, we still depend on many of the thousands year old remedies, particularly in motion sickness treatment, in the form of acupuncture, acupressure, herbal remedies such as ginger!

seaband
 

The Sea-Band in action – Wearable acupuressure for motion sickness.  (Source: Personal Photo)

 

 

Title Photo: Shutterstock

 

References:
“Acupuncture: In Depth | NCCIH.” U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 08 Nov. 2016.
Grontved, A.,  Brask, T.,  Kambskard, J.,  Jentzer, E. “Ginger root against seasickness. A controlled trial on the open sea.” Acta Otolaryngol. 1988 Jan-Feb; 105(1-2): 45-9.
Hao, Jason J., and Mittleman, Michelle. “Acupuncture: Past, Present, and Future.” Glob Adv Health Med. 4 (2014): 6-8.
Lu, Dominic P., and Gabriel P. Lu. “An Historical Review and Perspective on the Impact of Acupuncture on U.S. Medicine and Society.” Medical Acupuncture 25.5 (2013): 311-16. Web.
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s