Nauseous?

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If you mention chemotherapy, our first mental response is often:  Nausea.  If I ate potatoes, I’d say it’s like “meat and potatoes”.  But, just like I avoid potatoes, there are folks trying to insure that chemo is NOT a hand-in-hand companion to nausea.  And, while they’re at it, eliminating morning sickness for pregnant ladies would be another tremendous benefit.

I know there are drugs that are supposed to work.  But, for starters, I’m not sure they are what we would want in pregnant ladies systems.  And, besides, Zofran (generically known as Ondansetron from Glaxo SmithKline) only helps about 1/2 the folks to whom it’s administered.  Which means that many pregnant ladies are subject to dehydration- and may even require hospitalization.

There actually is a textbook that discusses nausea (Oxford University Press), written by Drs. R. Stern (Penn State, Psychology), K. Koch (Wake Forest, Gastroenterology), and P. Andrews (St. George’s Hospital and Med School, Physiology).  These authors have been collaborating for years- and combining their knowledge to understand and manage nausea in patients.

Nausea is actually a protective control mechanism;  a function of the CNS (Central Nervous System), the ANS (autonomic nervous system), the endocrine system, and gastric rhythm (actually, it’s more like dysrhythmia).

Dr. Koch has been using a gastroenterogram, which monitors electrical signals manifested by the stomach and intestinal tract.  (This device is akin to an electrocardiogram that we use to monitor our heart’s electrical activity, except this one is used for our stomach.)  This concept has led to our knowledge that the stomach controls its churning action via electrical signals, normally cycling slowly at 3 per minute.  If that cycle accelerates or slows down (when the cycle is disrupted), then the patient manifests nausea.  So, that means we should be considering methods to control and maintain this cycle as a first means of defense (or is that offense?).

Drs. Kuo and Napadow (Mass General, Boston), along with Drs. Sheehan, kim, LaCount, Park, Kaptchuk, and Rosen have been studying nausea from a different cause- motion sickness, and they employ MRI (Magnetic Resonance Imaging).  With test subjects in the device, they project fast moving lines (simulating a spinning room), which causes their brain to “light up”.   The projections then continue until the subjects hit the “panic button” – right before they vomit- when the researchers cut the video signals.

Interestingly, the brain regions that manifest fear, pain, emotions, and decision-making are just those lit up when we manifest nausea.  And, knowing this led Drs. Kuo and Napadow to administer antidepressants or pain medications to see if and how those doses attenuate the feelings of nausea.

But, these causes may not be the issue associated with morning sickness. That may be related to the presence of hCG (human chorionic gonadotropin) and estrogen that are normally cleared by the body- but, for some women during pregnancy, this elmination process fails somewhat.  At least, that seems to be the case with the condition of hyperemesis gravidarum (HG)- which also seems to be genetic in origin.

Dr. M. Fejzo (UCLA) got interested in this disease because she suffered from it during her pregnancy.   She discerned the genetic component (she found that related folks suffered the disease) and reported same in 2008.  Her more recent study warns against the use of antihistamines (which had been one of the drugs of choice), which lets the pregnant mothers sleep through nausea- because it leads to below optimal weight babies or premature births.

She is now pursuing a new study, involving some 1700 women, of which 1000 have HG and 700 who manifest no nausea.  She plans to examine their saliva to determine what genetic differences may exist among the subjects.

Those suffering from cancer, pregnant women, and those who develop motion sickness can only hope these groups will come up with a solution- soon.

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