Monday, November 28, 2016

Our Nausea

After the disaster that was Javelina, I thought I might have to give up running ultras.  It's been more than 4 years of this-- the nausea, the vomiting. It was no longer how I wanted to spend my life.

"We just need to get your stomach figured out," Rob insisted.

I wasn't as optimistic. All the reasonable, rational, realistic things have not worked. I don't know what else to do.  I wear anti-nausea wrist bands and take ginger pills, I've tried every possible electrolyte drink and tablet, I've tried gels and real food and liquid-only and high-fat. I feel completely out of ideas.

But Rob has approached this stomach-sorting thing as a kind of science. We'll continue to try different things until we find something that works.  We're not yet out of options.

On Sunday, I left to go run 20 some miles at Lory State Park, and Rob said I couldn't just do the same-old-same-old (Nuun and peanut butter pretzels, which hadn't worked for me during Javelina)-- I needed to make this run count by trying something different.  He suggested I give Tailwind another shot, because even though I have thrown it up before, in theory it seems to be the exact thing I need (a liquid source of calories and electrolytes). He said we could try diluting it a lot, so maybe the taste wouldn't bother me (yes, I think even the "unflavored" version tastes disgusting).

I grudgingly agreed.

I felt terrible from the get-go on that run (after many days of not sleeping or eating properly), and Tailwind did not make me feel any better.  It was all I could do to swallow that wretched stuff instead of gag it up or spit it out.  I don't understand why people like Tailwind.  It tastes exactly like the suero a pregnant Chilean girl gave me after I'd been throwing up for 2 weeks with The Vortex in Nicaragua.

I also took Endurolyte tabs during the run. For the past several years, I haven't taken any salt tabs at all, and Rob thought that this might be part of my problem. At Javelina, I took S!Caps, which are super concentrated, and maybe made the electrolyte imbalance worse. Endurolytes seemed like they would be a nice middle ground.

In addition to about 100 calories of Tailwind, I force fed myself ~500 calories of Wild Friends nut butter and peanut butter pretzels as I ran.  This is the most I've ever consumed during a slightly over 4 hour run, but still lower than the 200-250 calorie/hour recommendation that many ultra runners ascribe to. I've long since maintained that I can get by on 100 calories per hour (or less even). Rob doesn't believe this is true.

My legs held up fine during the run, but my stomach felt awful and my mind followed in a downward spiral. I swear that the Tailwind and Endurolytes induced nausea, because I wouldn't normally have been sick during a 20 mile run in cold weather.

I took a ginger pill after I got home just to survive, but the nausea returned later in the evening when Rob got the great idea to watch the "new" Jason Bourne movie that neither of us had seen yet. By just a couple of minutes into the movie, I was reaching for an emesis basin and wanting to gauge my eyes out I was so nauseous. It was like the time, more than 15 years ago, when my friend Jarrod had to carry me out of the theater during the Blair Witch Project because the shaky camera made me so sick.

I laid face-down on the couch and covered my head with a pillow, and Rob described the movie to me. "Now Jason Bourne has jumped into a car and is driving away," he said.

"What kind of a car, like a sedan?" I asked.

"Yes, a sedan. The bad guy has stolen a swat car and is chasing him."

"You mean the guy who was trying to kill him earlier?"

"Yes, that guy," Rob said.  "Now Jason has jumped the median and is driving the wrong way on a very busy street. The bad guy just plowed into 20 parked cars."

I felt like I was dying of nausea, but I laughed. This might be the only way I can watch movies, especially ones that involve a lot of shaky camera action. Movies make me sick all the time. From now on, I will just close my eyes and have Rob narrate.


When the movie ended and I managed to drag myself up to bed, I was still musing about this nausea. Rob asked me if the way I felt when watching the Jason Bourne movie was the same way I felt when I get car sick. I said yes.  He asked if it was the same way I felt when I get sick while running a race.  I said yes, now suddenly connecting the dots in my head.

All of a sudden I realized-- what if it wasn't about getting behind on eating and drinking during a race and then messing up my electrolyte balance or running out of fuel? I had always assumed that I slacked off on nutrition and hydration first, and the nausea followed after.  But what if the nausea was what started it all off? What if I get motion sick just from running, and then my queasy stomach won't let me eat or drink anymore?

It started to make a whole lot of sense. I've suffered from severe motion sickness my entire life-- in boats, planes, trains, buses, and cars, even while riding a bike. It seems reasonable that whatever causes my motion sickness would be in play while I'm running as well-- especially on trails where I'm constantly watching the terrain undulate and the rocks and roots rise and fall beneath my eyes.  It makes sense that I felt even worse after dark at Javelina.  The heat was less of a factor, but the bobbing headlamp against the darkness of night kept me throwing up. Maybe it even makes sense that in almost every ultra I've ever done, the nausea hits me around the same time-- 7 to 8 hours into the race, or somewhere between mile 35 to 38.  Maybe my inner ear has the power to fight off the sensory onslaught of jagged terrain for that many hours, and then it just snaps.  At least, that is how it seemed to happen at Javelina. Everything was fine until all of a sudden *bam* the nausea slammed me without any warning, even though I thought I had been doing a relatively good job of eating and drinking. It was after the nausea hit me that I shut down on my nutrition and hydration.

So there it is, I think I've figured it out.  It's not about calories or electrolytes. It's just my motion sickness, for which there is no cure.

I'm trying not to feel abysmal about this, but I kind of do.

Rob asked if it would be possible to take motion sickness medication during ultras, like Dramamine, but this would not be a solution. To say that Dramamine makes me "drowsy" is a vast understatement. It makes me catatonic for days on end if I merely lick a tablet.  All of the various motion sickness products have the same side effect.  They do make a "non-drowsy" version of Dramamine, but it is just a ginger pill (less concentrated than the ginger pills I already take) with a gelatin coating. That wouldn't be an improvement, even if I was willing to consume gelatin (I'm not). I did think that my vegan ginger pills offered me some relief during Javelina, it was just that I stopped being able to take them because the capsule is so big and I would gag on it when I tried to swallow.  I've looked around to see if I can find any ginger supplement that concentrated (I'm talking 1,000mg of ginger here) in an easier to swallow version. I haven't been successful yet.  But what I did try today was actually opening up a capsule and dumping the powdered ginger into a glass of water. It didn't taste completely terrible. Granted, I wasn't currently nauseous, but I had no problem drinking it like that. The thing I am actively clinging to at the moment is that maybe I could empty a ginger capsule into my water bottle during an ultra, and possibly survive to the end without nausea. Or maybe there is something else out there for motion sickness that doesn't cause drowsiness, dizziness, blurred vision, etc, as a side effect. I guess I'll keep looking, or else, limit myself to races I can finish in 8 hours if I want to do it without getting sick.


Thanks for reading.


Cara said...

There are medicine pads you can wear behind your ears. Have you tried those? I hope you figure this out!

Anonymous said...

FYI , jason bourne movies make me queasy AND I don't have motion sickness!!!! But!,, I. Certainly know how awful it is for you!! SOOOOOO. many choke bowls as you traveled the highways!, and I agree running could be the exact same motion to your brain!, soooooo it's apparent you aren't going to OUTGROW it!, knowing you , not running ultras is not an option!, wish i had some wise solutions but think you have tried most of the medically and alternative methods with no help!, hope Rob can solve it with his wisdom!, in the meantime! Keep those miles short!,,, i worry!!! Luv you mama

Melissa said...

Thank you so much, Cara! I haven't tried those but now I think I will! Some reviews say they still make you feel drowsy, but others said they don't. Worth a shot!!

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