No one knows nausea better than those who suffer from
or months of school are not taken as seriously as adults
How does a dysmotility of the stomach cause
digestive motility diseases such as gastroparesis since it
who lose time from work. For this age group, many
chronic nausea? Why do I have nausea?
is their most common complaint and can occur to a
doctors are quick to ascribe this symptom to stress.
debilitating degree. Gastroparesis represents a more
(To understand gastroparesis and the term,
severe form of digestive motility problems.
Variability between test results and the patient's report
“dysmotility”, please see our pamphlet,
regarding symptom severity can increase everyone's
Some gastroenterologists who specialize in motility
frustration. More research is needed to understand better
disorders speculate that nausea may be generated by
the underlying causes of nausea. Our patient community
Your stomach, like your heart, has a rhythm of
altered stomach rhythms (dysrhythmias). These
is in need of more medical treatments tailored
activity. Your stomach even has a “pacemaker”
disrupted rhythms are relayed to your central nervous
specifically for us. Don't allow your suffering to be
region to help modulate its rhythmic, muscular,
system (CNS) by the major nerve of the gut the vagus
minimized, but also understand that, because this area of
pumping action. This overall pumping action
nerve. The brain interprets these signals as nausea.
medicine has been underfunded, specialists lack tools
(peristalsis) of your stomach and digestive tract is called
Besides dysrhythms, overall stomach action may be
and training to provide you with better medical
hampered in a number of different ways, making for a
guidance. A good patient-doctor relationship is essential
complex motor malfunction. Groups like the American
for dealing with this unrelenting symptom. A
With gastroparesis, for whatever reason, your stomach's
Motility Society have scientists pursuing this area of
compassionate medical team goes a long way in helping
rhythm and motility may becomedisrupted and
weakened. What was once functioning normally and
outside your conscious awareness has now become “ill”.
There is Hope!
Suddenly, the dysfunctioning of your stomach comes to
Motility tests -- what can they
the forefront of your thoughts with nausea!
There is Help!
Individuals do not have to have gastroparesis
As the diagram shows, control measures are aimed at
in order to suffer with nausea; but nausea is
five primary areas; each one will be discussed.
the most frequent symptom of gastroparesis
a large role in helping to tame this symptom. For more
detailed information on diet, please see our information
pamphlet, “Gastroparesis”. Generally, a diet should be
easily digestible as well as low in fat and fiber. Coffee,
spices, and alcohol should be avoided, and if you
Nausea is found in association with many
smoke, you must stop! Small, frequent meals with
thorough chewing are important. Late-evening snacks
heartburn or acid reflux, bloating, belching,
are generally to be avoided. An easy walk after eating
and a feeling of fullness soon after eating. Doctors
generally label this collection of symptoms as “motility-
though the patient is debilitated with nausea! A further
test can sometimes help to highlight what is going on;
called electrogastrography (EGG), this study can detect
Nausea can also be found in association with other
abnormal stomach rhythms just as electrocardiograms
digestive and non-digestive diseases. It is important to
reveal heart dysrhythms. Yet the EGG is more of a
Ø When nausea is particularly intense, switch for
have a thorough evaluation by a GI specialist; and this
screening tool than a diagnostic tool and may help to
specialist should include testing to look for abnormal
motility in your stomach. Motility testing often includes:
Watch out for some herbal remedies. They can
actually increase nausea because they increase
refluxing, which is the washing up of stomach
acid into your throat that results in heartburn.
The relief of nausea remains a big challenge. Chronic
Peppermint can greatly increase refluxing. For
nausea is often underestimated and under-treated by the
some people, ginger, too, can increase nausea.
Canadian charitable number: 859541310RR0001
If one or more of the motility tests above have not been
medical community. The situation is even harder for
Try chewing or sucking on a licorice root stick
performed and you are dismissed by your specialist with an
children who suffer with debilitating nausea.
explanation that your symptoms are psychologically mediated, then you need to seek a second opinion.
Unfortunately, children and adolescents who miss weeks
Try tart flavors such as a slice of Granny Smith
Pharmacological classes of drugs:
A popular combination of anti-nauseants used by some
Examples of pharmacological drugs are given here;
GI specialists who specialize in motility diseases like
however, this is not an exhaustive list. Be aware that
gastroparesis is “ZAP” (Zofran and Phenergan). Both
Constant, chronic nausea has a major impact on your
Try sucking on hard candies. Sweet flavors
some of the older classes of drugs such as the tricyclic
come in a liquid and intravenous preparation.
life and can lead to debilitating spells of depression.
anti-drepressants, phenothiazine agents, and Reglan,
This depression is often the consequence of poor
When nausea is very intense, some relief may
may be associated with significant and frequent side
Physical measures to help control nausea may be as
nourishment, disrupted sleep patterns, added financial
be found by sucking on ice cubes, or try ice
effects. Be sure to discuss this with your doctor. Newer
simple as avoiding hot rooms and opening a bedroom
burden, and frequent and discouraging disruption of
medications that are used to control chemotherapy-
window for fresh air; the avoidance of hot baths is also
If your nausea is actually improved after a
induced nausea and vomiting are excellent choices; yet,
suggested since they can often trigger a bout of nausea.
small snack such as crackers, then it would be
If possible, avoid strong emotions; your emotions do
Nausea may leave individuals housebound for extended
advised to have this before retiring in the night.
not cause your nausea, but they certainly modulate the
periods, affecting their interaction with others. Fear of
symptom. Excitement can actually diminish your
food may also be a problem since overwhelming waves
symptoms, only to have your nausea rebound with even
of nausea triggered an hour or more after eating may
greater intensity hours after all the excitment. This
build to an episode of vomiting, or the patient may be
holds true for physical activity as well. Try slow, deep
left in intense nausea limbo just wishing for the some
gastroparesis poses a real challenge. Medications may
breathing in cycles of 10 breaths with normal breathing
relief an episode of vomiting would bring.
have mixed results. Prolonged use of some medicines
interspersed. This can help you get through a severe
may show a waning of effectiveness. Altering
Doxylamine (Diclectin) only available in
wave of nausea with impending vomiting. Try raising
Vomiting is recognizable as a serious problem.
medication regimes, then revisiting old regimes may be
the head of your bed six inches with books placed under
However, it is the exhaustion of unrelenting, “hidden”
the bed legs, and only wear loose-fitting clothing.
nausea that takes its toll emotionally and spiritually. The severity of such debilitating nausea is underestimated
Promotility medications that help to re-establish the
Serotonin (5HT3) antagonists:
is biofeedback with guided
by the public at large since it is hard for even family and
motility of the stomach may help to combat nausea since
imagery is a method used to treat motion sickness
friends to comprehend this endless cycle.
some promotility drugs are also anti-nauseants.
experienced by astronauts in space. This approach is
However, these are usually only partially effective.
now being applied to help control severe nausea in
Psychological treatments are varied and can be an
upper digestive motility diseases like gastroparesis.
adjunct to the medical management of nausea.
Acid-suppression medication may also play a very
Techniques such as visual imagery, deep breathing and
helpful role in nausea control and preclude the need for
relaxation, or biofeedback can be of benefit.
prescription anti-nauseant medications. Discuss this with
device is revolutionizing the treatment of severe nausea
Finding the right psychologist is valuable and
and vomiting of gastroparesis. Called “Enterra
(s)heshould be an integral part of your medical care
For more severe nausea, specific medications called
”, this device (similar in appearance to a heart
anti-nauseants may be required, and often two different
pacemaker) for many patients, significantly reduces or
pharmacological classes of anti-nauseants may need to
halts nausea and vomiting. Your specialist can
Your psychologist should play a supportive role. But
be prescribed. Taken in combination, these drugs help to
Side effects are frequently reported.
determine if you are a candidate for Enterra Therapy.
caution: if you find yourself uncomfortable or perceive
combat episodes of debilitating nausea or nausea that
Also, a method of temporary gastric electrical
that the psychologist has adopted an exclusive approach
can build to a crescendo of vomiting. Your doctor may
stimulation is used by some centers to help evaluate
of “fixing the problem in your head” to fix your nausea,
actually advise you to take your anti-nauseant
who is a good candidate for a permanent device.
you may need to find another psychologist.
medications on a regular schedule instead of on an as-
injections into the lower valve (pylorus) of the
Finally, patient-support groups help tremendously. Ask
stomach may provide temporary relief of nausea for a
your doctor’s nurse for assistance to see if (s)he can
When possible, try to get medications in either a liquid
period of from three to nine months. Another method
or sub-lingual (under the tongue) preparation since these
that works on the same principle is a dilation of the
are absorbed better by people with delayed gastric
with a balloon. A few specialized centers
Also, on-line support groups are available. See:
Have a back-up of medications for use rectally if
Low dose, Tricyclic Antidepressants (TCA)
As well, an on-line forum is available on our
for controlling nausea. Pressure or massage applied to
GPDA web site.
key points on the wrist can help with short-term
Some medications can also be taken by Sub-Q injection
(like a diabetic needle), which helps to regain control of
* (Also act as pro-motility medications)
Introduction A consensus statement conference was organized by the IAAF to “help shape the priorities of the IAAF medical and anti-doping committee and of the IOC working group on nutrition over the next few years”. The conference was a follow up of the 1995 conference also held in Monaco. A lot of progress in the field of sports nutrition has been made over the past 12 years, so it
LA CUESTIÓN DEL EXTRANJERO EN “LOS RÍOS PROFUNDOS” DE JOSÉ MARÍA ARGUEDAS Leticia Alle Este artículo analiza Los Ríos Profundos de José María Arguedas a partir de la figura del extranjero. Se propone una hipótesis de lectura basada en la idea según la cual Ernesto, el protagonista de la novela, se encuentra atravesado por una doble condición de extranjería. De un l