Ep 211 Motion Sickness: It comes in waves

It comes on sneakily. You become aware of your stomach. You break out in a cold sweat. Your mouth fills with saliva. And before you know it, you’re leaning over the side of the boat (or out of the car, or into the airplane sick bag), barfing up your breakfast. Motion sickness. We’ve all been there, or at least most of us have. Why? What is it about our physiology that breaks down as soon as we travel via water, vehicle, or air? That’s exactly what we’re going to explore in this episode. From how long humans (and other species) have been coping with these debilitating symptoms to what’s actually going on in your brain to trigger the breakdown, from what’s in the most nauseating historical “cures” for motion sickness to why the drugs we have today have some positive effect, we’re covering it all. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:01Speaker 00

  This is exactly right.

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• 1:03Speaker 02

  Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.

• 1:35Speaker 03

  My name is Christina Kupka Decker, and for as long as I can remember, I have experienced motion sickness in cars, planes, boats, trains, and theme park rides. The first time I experienced severe motion sickness, however, was when I was 16 years old on a flight from Los Angeles to New York. As soon as the plane took off, I was hit with intense vertigo and nausea. Within about 15 minutes, I began vomiting, which quickly turned into dry heaving for the remainder of the six-hour flight. The plane suddenly felt Smaller, breathing felt heavier, and my head was spinning so intensely that it felt like it might explode. I felt overheated, overwhelmed,

• 2:20Speaker 03

  and my mouth was either extremely dry or excessively watery. I am now thirty seven, and unfortunately, this has never changed. The difficult part is that I love to travel. So in many ways, traveling means accepting that I will likely suffer through the journey. Over the years, I have seen many specialists, including neurologists and ear, nose, and throat doctors. I have tried vestibular therapy, had CT scans, MRIs, and undergone hearing tests. Doctors ruled out Meniere's disease, which causes symptoms similar to what I experienced. Despite all of these evaluations,

• 3:03Speaker 03

  no one has been able to explain why my motion sickness is so debilitating. Even when I am the one driving, I sometimes experience nausea and vertigo, especially on winding roads or in heavy traffic, which is nearly impossible to avoid while living in Los Angeles. One of the worst happened during a flight with very heavy turbulence. I was vomiting into a sickness bag, only to realize too late that the bag was broken at the bottom. I had to sit there with vomit in my lap and around me for a large portion of the flight. Because the turbulence was so bad, the flight attendants couldn't get up to help me. When I finally reach my destination,

• 3:47Speaker 03

  I usually can't eat anything. I typically need to sleep off the motion sickness before I feel well enough to explore the city I traveled so far to see. The only treatment that has consistently helped me is a combination of Zofran, Meclazine, and a wrist device that uses electrical shock therapy, kind of similar to a TENS machine. Even with this combination, I still experience severe motion sickness, but it significantly reduces my vomiting and makes travel somewhat more

• 4:20Speaker 01

  More bearable.

• 5:06Speaker 04

  Oof, Christina, that, thank you for sharing your story, first of all. That sounds, I mean, that sounds unimaginably.

• 5:14Speaker 01

  I can't.

• 5:15Speaker 04

  Awful.

• 5:16Speaker 01

  It sounds awful.

• 5:17Speaker 04

  But I'm glad that there's finally some, something that you're finding some relief.

• 5:21Speaker 01

  Some modicum of relief.

• 5:23Speaker 04

  Yeah, yeah. But thank you again for sharing your story. We really appreciate it.

• 5:27Speaker 01

  We do. Thank you.

• 5:29Speaker 04

  Hi, I'm Erin Welsh.

• 5:30Speaker 01

  And I'm Erin Allman Updike.

• 5:32Speaker 04

  And this is This Podcast Will Kill You.

• 5:34Speaker 01

  Welcome to motion sickness.

• 5:36Speaker 04

  Welcome, welcome. This is one of the most universal experiences of humans, right?

• 5:44Speaker 01

  I mean, yeah, I guess maybe.

• 5:47Speaker 04

  Or like, the potential for universality is quite high.

• 5:51Speaker 01

  Exists.

• 5:52Speaker 04

  Just to, you know, be precise about it.

• 5:56Speaker 01

  I am really excited about this episode. And when you proposed it, and I think that you have many times.

• 6:05Speaker 04

  Maybe like, three years ago was the first time I was like, we should do this.

• 6:08Speaker 01

  And I was like, absolutely not.

• 6:12Speaker 01

  And I am thrilled that I finally said yes to it because it's really, really interesting.

• 6:18Speaker 04

  That I finally bullied you into it. I was like, we're doing it. It's on the calendar.

• 6:21Speaker 01

  Yeah, I was.

• 6:25Speaker 01

  It's super, super interesting.

• 6:27Speaker 04

  Yeah.

• 6:28Speaker 01

  And I'm really excited about it.

• 6:30Speaker 04

  It is, I, I like, what drove me always to be like, we should do this, it's not because I knew anything about it. It's not because I personally have experienced a lot of motion sickness.

• 6:42Speaker 01

  Do you get, do you get motion sick?

• 6:43Speaker 04

  No, not at all. Like, there was, John and I were fishing off, like, in, in the ocean, and it was a small boat, and the waves were quite choppy, and John quickly, because his eyes were focused on the rod and not the horizon.

• 7:02Speaker 01

  And the fish, yep.

• 7:03Speaker 04

  And the fish, and John was within, I don't know how much time, scream barfing, poor guy.

• 7:08Speaker 01

  Scream barfing.

• 7:10Speaker 04

  Just, you know, just nonstop. And I was, and he was like, you are completely fine. Like, I, I felt nothing. I mean, I felt bad for him, but like, physically, I felt, I felt nothing. So, yeah, I am, I'm, I am one of the ones who can read in a car, on a bus, on a train, whatever.

• 7:31Speaker 01

  Same.

• 7:31Speaker 04

  No problem.

• 7:32Speaker 01

  Same. I, I can remember one time feeling a little bit motion sick, and it was on day two of a 22-day research cruise in the middle of the ocean. And yeah, day two, I was like, a little like, ooh, I don't think I'm gonna eat today as much as usual.

• 7:49Speaker 04

  Yeah.

• 7:50Speaker 01

  And that was it. So I feel very lucky that I haven't experienced a lot of it, because otherwise, I'm like, I'll eat an entire funnel cake and then go on the Tilt-A-Whirl and be like, this was the best day ever.

• 8:00Speaker 04

  Yeah. Roller coasters. I remember, as a kid, the one time I remember really feeling quite nauseous was, like, on a bus, on the school bus, reading a book, because I had no friends, so I would just read books on the school bus. My little Animorphs, yeah.

• 8:18Speaker 04

  And so I remember that, but, but then, ever since then, which is, is interesting, because I feel, anyway, we'll, we'll get there in terms of the age distribution. There's so much to cover.

• 8:28Speaker 01

  There's so much. I'm really excited about it. Maybe we should start and stop just blathering.

• 8:34Speaker 04

  Maybe we should, maybe we should. We have Quarantini Time.

• 8:38Speaker 01

  It's Quarantini Time.

• 8:39Speaker 04

  Quarantini Time. What are we drinking this week, Erin?

• 8:41Speaker 01

  We're drinking motion potion.

• 8:44Speaker 04

  The motion potion. It's ridiculous. And it is ginger based, essentially. However, listen to our ginger episode.

• 8:53Speaker 01

  Yeah.

• 8:53Speaker 04

  This is not curative or preventative by any means.

• 8:56Speaker 01

  There's also like very little data that ginger is helpful for nausea associated with motion sickness, like in particular.

• 9:02Speaker 04

  Yeah. This is also, when I say ginger episode, I mean health myths.

• 9:06Speaker 01

  Our health myth.

• 9:06Speaker 04

  Yeah, we did not do an episode on ginger.

• 9:10Speaker 04

  But it's, yeah, so it's ginger ale, it's lime juice, it's mint, it's candied ginger, it's, you know.

• 9:17Speaker 01

  A tasty little bev.

• 9:18Speaker 04

  It's really, really tasty.

• 9:19Speaker 01

  You can find the recipe on all of our socials, where we are, this podcast will kill you, I think mostly is our socials.

• 9:26Speaker 04

  Maybe T W K Y.

• 9:27Speaker 01

  Maybe T W K Y, who knows? Also, we'll probably post it on our website, thispodcastwillkillyou.com. Have you checked it out? We have a whole bunch of stuff there.

• 9:37Speaker 04

  Out.

• 9:38Speaker 01

  The end.

• 9:39Speaker 04

  The end. Website? We don't need to go into that.

• 9:41Speaker 01

  No, we said it.

• 9:42Speaker 04

  You know the spiel.

• 9:43Speaker 01

  It's there.

• 9:44Speaker 04

  Let's get to the good stuff.

• 9:46Speaker 01

  Okay.

• 9:46Speaker 04

  Yeah, right after this break. Jinx.

• 9:51Speaker 01

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• 10:24Speaker 02

  Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by Miguel.

• 10:42Speaker 05

  My small experience with the discrepancy in the business of music made me angry in the best way, and I wanted to, I wanted to finish. So I started really like leaning into my therapy. Trying to get down to like, what matters now? Somewhere, Miguelito felt like he didn't have a place to say how he felt. And music was the place that I went to, to say how I felt.

• 11:04Speaker 02

  Experience Before the Moment, a Lincoln original series on the iHeart Radio app, YouTube, or wherever you get your podcasts.

• 11:29Speaker 01

  I actually want to start this section with a quote.

• 11:32Speaker 04

  Oh, my God, I do the same thing.

• 11:35Speaker 01

  I was gonna say, like, this is really your vibe, but I'm stealing it a little bit. Okay. This is a quote from a 2006 paper by Shupak and Gordon.

• 11:45Speaker 04

  Okay.

• 11:46Speaker 01

  And it describes the constellation of symptoms that we can see in motion sickness. And I really like it because I think it just like sets us up to really like picture what it is that we're talking about today. You ready?

• 11:57Speaker 04

  I feel like I'm gonna get sympathy nausea, which that is something that I do occasionally get with like, am I, is, is the dog gonna barf? Is John gonna barf in the boat?

• 12:07Speaker 01

  Yeah. Then you feel nauseous. If I smell vomit, then it will make me nauseous, but otherwise, yeah.

• 12:13Speaker 04

  Okay.

• 12:14Speaker 01

  Okay, anyways, here we go. Ready?

• 12:16Speaker 04

  Yeah.

• 12:17Speaker 01

  Quote, "The development of motion sickness," sorry, it's kind of a long quote, just so you know.

• 12:22Speaker 04

  Okay, okay, I'm strapped in, I'm ready.

• 12:25Speaker 01

  Quote, "The development of motion sickness symptoms follows an orderly sequence that varies with the intensity of the stimulus and the susceptibility of the individual. The initial symptom is usually discomfort around the upper abdomen, stomach awareness," this is in quotes.

• 12:43Speaker 04

  Okay.

• 12:44Speaker 01

  "which is followed by nausea and increasing malaise. Concurrently, peri-oral," that means around your mouth, "and facial pallor appear, accompanied by cold sweating. With rapid worsening of symptoms, there can be salivation changes, feeling of body warmth, dizziness, retching, and recurrent vomiting. Lethargy, fatigue, and drowsiness can persist for hours after the motion stimulus ends." End quote. I feel like it really walks us through what it looks and feels like to start having motion sickness.

• 13:21Speaker 04

  It does, and I have so many questions now.

• 13:25Speaker 01

  Okay.

• 13:25Speaker 04

  No.

• 13:26Speaker 01

  Don't ask any of them yet.

• 13:27Speaker 04

  I will wait, yes.

• 13:29Speaker 01

  I also want to mention that there's another kind of phenomenon that we see described alongside motion sickness that's called sopite syndrome, I think that's how you say it. And it's this kind of like drowsiness, lethargy, like decreased cognitive motor functions. A lot of times we see it marked by yawning, like an increase in yawning.

• 13:49Speaker 04

  Mm hmm.

• 13:50Speaker 01

  And this can persist, it can start with the motion stimulus itself, and then it can persist for like a long time after, in some cases. People can also get things like eye strain, difficulty focusing, headaches, and things like that. So, motion sickness, overall, is this feeling of unwellness. And a lot of times nausea and vomiting specifically, that we get, that is associated with motion or movement. And like we read in all of that description, while it very classically, like nausea and vomiting and things are like that kind of first part of the symptoms, there's a really

• 14:33Speaker 01

  wide array of how people can present with motion sickness overall. But it's not just any motion that triggers motion sickness.

• 14:44Speaker 04

  It's not.

• 14:44Speaker 01

  It's specific types of motion. Because we don't tend to get motion sick when we're walking, or running, or riding a bike, but we do if we're on a boat, or a train, or sitting in the backseat of a car. And, motion sickness can also be caused by perceived motion, as in, people can get motion sickness from things like virtual reality, or like really immersive 3D movie screens, without moving at all.

• 15:13Speaker 04

  IMAX.

• 15:13Speaker 01

  IMAX. So what in the absolute heck is going on that causes us to get sick from movement, or the perception of movement?

• 15:22Speaker 04

  Perception of movement.

• 15:24Speaker 01

  I'm really excited to try and tell you. That's what I'm gonna try and do right now, just so you know. So, first of all, we don't really know. That's just like, I'm gonna say that at the front.

• 15:34Speaker 04

  Okay.

• 15:35Speaker 01

  Like, we, we think that we know, and the, uh, um, overall consensus hypothesis idea is that there is some kind of sensory conflict.

• 15:49Speaker 04

  Right.

• 15:49Speaker 01

  That's what it's called, between the actual sensations that, that you are receiving into your brain and what your brain expects to be receiving.

• 16:02Speaker 04

  Yeah.

• 16:03Speaker 01

  And these conflicts can happen between a number of different sensory systems, or a number of different of like, ways that we perceive things around us. So, the main sensory systems that are involved in motion sickness, let's dig into them a little bit, are the visual system, the vestibular system.

• 16:20Speaker 04

  Love the vestibular system.

• 16:22Speaker 01

  I know, it's quite exciting, and the proprioceptive system.

• 16:25Speaker 04

  Love that one too. I also love the visual system. I love them all.

• 16:28Speaker 01

  Listen, we're here for our sensory systems, okay? So, our visual system is obviously our eyes, right? These are perceiving the world around us visually, they're sending the inputs that they receive into the visual centers of our brain in order to map out the world. I'm not gonna dig much deeper than that. Our eyes also have quite a lot of reflex movements and things built in that we are totally unaware of. Such that if we turn our head, or experience any kind of motion, our eyes are actually making teeny tiny micro-adjustments in the opposite direction of whatever our movement is, so that our visual field stays steady.

• 17:11Speaker 04

  I learned about this recently when interviewing someone for an episode of Advances in Care on concussion detection, because we do not have a good system right now for diagnosing concussions. And so, one of the thoughts is that like, we can detect it potentially with these small eye movements, because when we get a concussion, sort of all of these little, all of these sensory systems are disrupted a bit, and so can we detect severity, intensity, duration, whatever, of a concussion with these eye movements? It is, there's so much there. It's just really cool.

• 17:44Speaker 01

  It is really cool. So this, like our eyes making these little micro adjustments, and it's part of what is called the vestibulo-ocular reflex. So that means that our eyes are connected to our vestibular system. Okay. And this is the system that detects the position and movement of mostly our head in space. It is a complex system and we don't need to get like deep into the weeds of it, but the peripheral parts are located in our inner ears, where we have these two teeny tiny organs called odoliths that are not just little rocks, but they're actually teeny tiny little organs that detect movement

• 18:27Speaker 01

  specifically in the forward backward and the side to side direction. Not, yeah, not rotating. And then we also have three sets of, on each ear, these things called semicircular canals that are these little fluid filled tubes arranged in different planes. They look like, um, I don't know, like you know those fancy French cookies like palmiers or whatever?

• 18:51Speaker 04

  No, like a grape cluster?

• 18:53Speaker 01

  No, no, no. Google a picture of it, okay? They're like little canals. Anyways, they're in our inner ears as well. They're filled with fluid and they sit at different angles. So they detect rotational movement. Okay, so like looking around you, rotational movement.

• 19:13Speaker 04

  This side to side.

• 19:15Speaker 01

  Side, like looking to your left, looking to your right.

• 19:18Speaker 04

  Yeah, right, okay.

• 19:19Speaker 01

  Okay, okay. And all of these together are semicircular canals or odoliths. They are involved in sensing the position and the movement of our head. And they are obviously connected directly to multiple different parts of our brain. And they are involved in this vestibulo-ocular reflex. So they're connected to our eyes to help with these little movements and something called our vestibulo-spinal reflex, which helps us to maintain head and postural stability, making these little compensatory body movements that again, we don't really notice or recognize when we are moving our head in space. Okay. Some of the parts of the brain that are very involved in this vestibular system

• 20:02Speaker 01

  are our cerebellum, which is the bottom, like back part of our brain. I have a brain, but I'm not going to reach for it because I'll knock it over.

• 20:10Speaker 04

  I have a brain up here, actually.

• 20:11Speaker 01

  Oh yeah, there you go. It's the bottom, the back, you see that little back bit?

• 20:14Speaker 04

  Yeah.

• 20:16Speaker 01

  We also then also have proprioception, okay? proprioception is our ability to know where our limbs and other body parts are in three dimensional space.

• 20:26Speaker 04

  It's such a mysterious sense. I love it.

• 20:28Speaker 01

  Isn't it? Uh, it's mostly gathered from like mechanoreceptors that, again, we don't recognize or notice, but there are things all around our body that integrate into our brain to tell our brain, whether you can see it or not, you know where your hands and feet are.

• 20:42Speaker 04

  Yes, yes.

• 20:44Speaker 01

  So to know and understand where we are in space and how we are moving through space, our eyes, our vestibular system and our proprioception have to all work in concert, and they work based on kind of like maps that we have developed in our brain by existing on the earth thus far. Like, our brain knows that gravity is a force that is always present and whose vector points down towards the earth, right? We don't have to think about it. We literally don't feel it, but it is always something that our brain and our body is responding to because it's a force that we're always exposed to. So when the system is working well,

• 21:28Speaker 01

  for example, we might be walking with our eyes open as sighted individuals. Our eyes are going to perceive that we are moving through the world where the horizon and the stuff around us is remaining relatively fixed, right? Like, it is, it is moving past us. Our vestibular system is perceiving our head moving through space. Little tiny micro-adjustments are being made. And our proprioceptive system perceives that our limbs are propelling us forwards. We're standing upright, gravity is directing downwards, the horizon is there, everything is great, and we experience no sensory conflict whatsoever.

• 22:05Speaker 04

  Uh huh.

• 22:06Speaker 01

  Cool.

• 22:06Speaker 04

  But...

• 22:07Speaker 01

  However,

• 22:09Speaker 01

  if instead we are on a boat on the ocean, and we are sitting inside of our cabin, for example.

• 22:16Speaker 04

  Oof.

• 22:17Speaker 01

  Then our vestibular system senses quite a lot of movement, right? There's changes in velocity, there's changes in direction as this boat is moving upon the waves. But if we're sitting inside of our enclosed cabin, our eyes are perceiving that the world, the cabin inside the boat, or even worse, the book that we're sitting there reading inside of the cabin inside of the boat. The boat around us is too fixed because it's moving the same way that our body is moving instead of our body moving through space, like if we were walking.

• 22:51Speaker 04

  Yeah.

• 22:51Speaker 01

  Does that make sense?

• 22:52Speaker 04

  Yes.

• 22:53Speaker 01

  So those two senses, our vestibular system and our visual inputs, are in conflict and they're not what our brain expects to be perceiving. This causes a cascade of hormones and neurotransmitters and things to be released telling our brain, whoa, whoa, whoa, whoa, something is not right, we should panic. Wah!

• 23:14Speaker 04

  Yeah.

• 23:14Speaker 01

  Motion sickness ensues.

• 23:16Speaker 04

  But...

• 23:19Speaker 04

  Like, okay.

• 23:23Speaker 04

  Why is this a bad thing?

• 23:25Speaker 01

  Why is this a bad thing?

• 23:26Speaker 04

  And this is where, like, and I, I know that it is not, nothing has to be good or bad. It just has to be like, our bodies don't, have not evolved in this space before

• 23:37Speaker 01

  Right.

• 23:37Speaker 04

  to anticipate these changes and

• 23:39Speaker 01

  Yeah.

• 23:40Speaker 04

  to, and then get rid of the conflict, de-escalate the conflict.

• 23:44Speaker 01

  Yeah.

• 23:45Speaker 04

  Um, but why does it result in these nausea, et cetera? But why?

• 23:50Speaker 01

  But why? But why is a question that we absolutely do not have an answer to. Like, we do not know why.

• 24:00Speaker 04

  Okay.

• 24:03Speaker 04

  I, I've, I've read some, and we can talk about it if you want later on, like, the, the hypotheses.

• 24:07Speaker 01

  The hypotheses? I have them, if you'd like.

• 24:10Speaker 04

  Yeah, yeah, yeah.

• 24:11Speaker 01

  So we, yeah, we, we don't know why. There are a lot of hypotheses. Um, there's one that's like, maybe we get nauseous especially and have vomiting as a byproduct of like our toxin defense system.

• 24:24Speaker 04

  I don't, I don't like this one, but yeah.

• 24:25Speaker 01

  No, it doesn't really have any evidence for it. It's this idea that like our vestibular system gets activated by these movements and it triggers the same response that we would have from exposure to toxic substances. It doesn't, it doesn't really make any sense.

• 24:37Speaker 04

  All your sensory inputs, if you have some sort of like neurotoxin that you have ingested or consumed in some way, then it's possible that all these different things would be off, your perception would be off, you would be like, I'd lose your balance.

• 24:48Speaker 01

  It's just like an accidental, right.

• 24:51Speaker 04

  Right.

• 24:51Speaker 01

  But no, it doesn't make sense. We're discounting that one. Most of the papers do too, it's not just us. There's also this idea that we have just this inappropriate activation of like our autonomic system with like our vestibular system interacting with our autonomic system and causing this dysfunction. There's again, not like a really clear evidence of this. There's some thought that maybe it's just a byproduct of the proximity of our vestibular system and these like motion detectors to where our vomiting circuitry also sits. Like we have multiple, sometimes people say we have a vomiting center and that's not quite true, but there are multiple brain areas that are involved in nausea and vomiting.

• 25:35Speaker 04

  I have never heard anyone say we have a vomiting center.

• 25:38Speaker 01

  Oh, it's in a lot of the papers.

• 25:40Speaker 04

  I believe you, I believe you.

• 25:43Speaker 01

  But it's not just one, it's like multiple parts of our brain that are involved. So is it just like this kind of spill over of the inputs happening to be there? I don't know.

• 25:55Speaker 01

  We don't know.

• 25:56Speaker 04

  It's, I, I think that like what, what seems likely is that it's not an adaptive response.

• 26:04Speaker 01

  Right.

• 26:04Speaker 04

  It is just something that like sing, I mean, and maybe that's really unsatisfying. And so we keep looking for hypotheses that make more sense or have more, give us more of an answer or a story, but I think it could just be that it's a maladaptive response to this thing that we did not evolve experiencing.

• 26:23Speaker 01

  Right, and it's just, and it's, it's this response that different people get at different levels, depending on the circumstances in which they're exposed to these potentially nauseogenic movements, which I think is a great word.

• 26:39Speaker 04

  Let's talk about these circumstances.

• 26:41Speaker 01

  Let's talk about them a little bit, because there's some other ones, too. Okay, so we talked already about if you're sitting still, you're sitting and the world is moving around you, but it looks like the things around you aren't moving the way that you expect. So that's one type of mismatch that we might see. Another that we might see would be if you're, again, on a boat, but you're standing out at the side and you're looking over the side of the ship. Your body is moving one way, your eye, your head is moving one way, your vestibular system is saying there's this kind of movement happening, but your eyes are only seeing the waves going up and down across the ship. So that's another way that you might have this mismatch.

• 27:20Speaker 04

  That was poor John, I think, was.

• 27:21Speaker 01

  Yeah, exactly.

• 27:23Speaker 04

  Poor guy. It was, it was, it was brutal. It was awful.

• 27:25Speaker 01

  It sounds, it sounds really bad.

• 27:27Speaker 04

  And then as soon as he was on land, he was like, I'm fine.

• 27:30Speaker 01

  Of course.

• 27:30Speaker 04

  I mean, after a while, but like.

• 27:32Speaker 01

  After a while.

• 27:32Speaker 04

  Yeah.

• 27:34Speaker 01

  But then we also, like we said at the very beginning, can have this conflict if you are sitting completely still but watching an immersive, like VR or 3D movie on a large screen, because then your visual systems are telling your brain, we are moving rapidly through space and your body and your head are sitting still, right? This is sometimes called pseudo-motion sickness, or cyber-sickness, which I think is silly.

• 27:57Speaker 04

  Sounds like it's from the net or something.

• 28:00Speaker 01

  Right, that's completely ridiculous.

• 28:01Speaker 04

  Hilarious.

• 28:02Speaker 01

  So this is the kind of working theory, working hypothesis, really, of how motion sickness happens, that we have these conflicts, or what's sometimes called neural mismatch. And these three systems, visual, vestibular, and proprioception, can all be involved, but the vestibular system in particular is probably the most important and kind of must be involved.

• 28:26Speaker 01

  People who have complete lesions of their vestibular systems, like not functioning vestibular systems bilaterally, it's near impossible to get motion sickness. But people who are blind or lack visual inputs entirely, or sighted people who are blindfolded can still be susceptible to motion sickness, even without seeing.

• 28:45Speaker 04

  That's very interesting.

• 28:47Speaker 01

  Exactly. And so it's in part because, again, we have two different parts of our vestibular system in what is sensing rotational movements and what is sensing lateral and forward and backward movements. And so even if you have a conflict between these two parts of your vestibular system, that alone could be enough to cause motion sickness in some cases. And what kinds of motion is it? Why do we get motion sick on a boat but not on a bike? Right? Part of it is active movement, right? When we are propelling our own bodies, we are less likely to get motion sickness. Why? Is it because our brains are more like ready to accept that this motion is coming from us?

• 29:31Speaker 01

  So even if there's a discrepancy, our brain is accepting it.

• 29:34Speaker 04

  There's like the volition, volitional idea where it's like, oh, if you're driving the car, does that make you less likely? If you're riding the bike, propelling the bike?

• 29:46Speaker 01

  Exactly. It's probably not that when it comes to bikes and things because not all types of motion tend to cause motion sickness. When we think of motion sickness, most of us think of a boat. I've used that as an example a lot. And seasickness is like the most infamous. But on a boat, despite the fact that we are subject to a whole bunch of different kinds of motion, it is only the low-frequency heave motions that you have on a boat, the like, boom, boom. That was not a good example, but. You know what I'm saying? It's the heave motions that are the trigger for motion sickness. We don't see motion sickness walking, bike riding, horseback riding, much less common to have motion sickness.

• 30:29Speaker 01

  Camel riding, elephant riding, much more likely to have motion sickness.

• 30:33Speaker 04

  Glad you mentioned camels. I mentioned it too.

• 30:36Speaker 01

  Camels. And the difference in these types of motions is the frequency of these movements. So lower frequency movements, so anywhere from like point one to point five and especially point two hertz or point two cycles per second. Movements tend to be substantially more nauseogenic than higher frequency movements, especially movements that are faster than one hertz or one cycle per second.

• 31:00Speaker 04

  And so is this, are we talking forward motion or up and down? I don't really understand how these measurements work.

• 31:07Speaker 01

  Honestly, there was so much physics in this that I have a hard time also because it can be movements in any direction. So this could be up and down movements. It could be forward backward translational movements. It could be rotational movements, like coriolist type of movements. But it's all about the, and like different ways, especially when it comes to like horizontal and spinning type of movements. If you do them in a certain way, even at different frequencies, then you could trigger motion sickness. But in general, especially for up and down movements and forward backward movements, it's these lower frequency, like you think of how an elephant moves versus how a horse moves.

• 31:49Speaker 01

  Bouncing up and down a little bit.

• 31:51Speaker 04

  I think, I, I, I think that makes sense where it's like, it's deeper and sort of more like longer.

• 31:57Speaker 01

  Yeah. Longer, longer frequencies, longer wavelengths.

• 32:01Speaker 04

  But I, I assume camels can jog, trot.

• 32:05Speaker 01

  Yeah, maybe you're less likely to get that. I don't know. But is it also that like the way that you're sitting, like it's side to side movement is also different than what you would have on a horse? I don't, it's really interesting and I don't fully understand.

• 32:18Speaker 04

  And thresholds might be different for different people.

• 32:20Speaker 01

  And they absolutely are.

• 32:22Speaker 04

  Right.

• 32:23Speaker 01

  And like people have proposed hypotheses again as to like why. Is it that these low frequency movements are the ones that are more nauseogenic? And so it's thought that maybe for some reason that again, is it just this like mismatch type of thing that these frequencies just happen to be where we have more of these errors in signaling between our vestibular systems and our other somatosensory systems? We just have more errors between what we sense and expect in terms of our verticals or in terms of our horizontal movements. Some people propose that this type of frequency, these low frequencies are like the limit of human body motion. So we can't figure out how to maintain stability of our bodies at these frequencies because

• 33:08Speaker 01

  our bodies don't move at those frequencies very often, but I, I don't know.

• 33:12Speaker 04

  I don't know. Yeah.

• 33:13Speaker 01

  And other people say that maybe at these low frequencies, our brain can't interpret these type of accelerations as movement through space. So it's interpreted as a tilt in the force of gravity, which is like our brain going, oh, why are we upside down when we're not really upside down at all? So then that confuses our brain? I don't know.

• 33:32Speaker 04

  Okay.

• 33:33Speaker 01

  It's all quite confusing. And then like, what happens next is also still confusing. So I said that there's like a series of signals that get sent right to our brain via a bunch of different neurotransmitters. Acetylcholine is involved. Histamine is very involved. And we, we still don't really know like, why, like, why exactly is this happening? But in the, the end result is that our autonomic system gets activated. Different regions of our brain involved in vomiting, our vomiting centers get activated. And especially areas of our brain, like our lower brain in our cerebellum, as well as parts of our brain stem end up getting activated. And we see this drop in our stomach fundus.

• 34:18Speaker 01

  We see relaxation of our sphincters. We see gastric stasis. So things are moving slower. And then, you know, vasodilation versus vasoconstriction, which is why we have the pallor and sometimes cold sweating.

• 34:29Speaker 04

  Oh, okay, okay, okay. So, so this is, this is truly a cascade of a multiple different.

• 34:41Speaker 04

  Multiple different signaling pathways.

• 34:44Speaker 01

  Signaling pathways, just not kind of working in concert.

• 34:48Speaker 04

  Yeah, and then that is causing all of these different effects. Like nausea, like pallor, like cold sweats. What is, what are cold sweats? How, what is, yeah.

• 35:00Speaker 01

  Well, like you're not, like you don't have a fever. You like feel cold, but you're sweating.

• 35:04Speaker 04

  Yeah.

• 35:04Speaker 01

  That's a cold sweat.

• 35:05Speaker 04

  Yeah, but like, what is the cause of that? What is the mechanism? Okay.

• 35:11Speaker 04

  I've experienced cold sweats many a time.

• 35:13Speaker 01

  You've never had a cold sweat?

• 35:15Speaker 04

  So like, tell me. But, and, and so pallor makes sense because you're kind of, you're just draining blood. And then that, where's that blood going? What, yeah.

• 35:24Speaker 01

  Well, and some of that is stuff that we just see with nausea in general, right? And so some of that is just like directly involved in the, in the nausea response, even when you get nausea and vomiting from a toxin or from an infection or from chemotherapy or whatever it is. So.

• 35:40Speaker 04

  Okay, so, okay.

• 35:41Speaker 01

  Okay.

• 35:41Speaker 04

  So there are multiple different things. I mean, so there's like nausea and then like the constellation of things that often happen with nausea.

• 35:49Speaker 01

  Yep.

• 35:50Speaker 04

  And then there are other effects that might or may not be closely tied to nausea in like that, that cascading pathway.

• 35:57Speaker 01

  Yeah.

• 35:58Speaker 04

  Medications.

• 36:00Speaker 01

  Medications.

• 36:00Speaker 04

  Preventatives. Do they work on the same root source? Can they control everything? Yeah.

• 36:07Speaker 01

  Excellent questions, Erin. So the best treatment is prevention, and that's often not possible. Most of the non-pharmacologic methods that we have are like behavioral, right? So that's things like looking at the horizon, like.

• 36:25Speaker 04

  Yeah, fresh air.

• 36:26Speaker 01

  Fresh air. There's a lot of things that they market that are focused on the idea of reducing conflicting sensory input or like providing other sensory input for you to like be distracted or, or things like that. Um, you know, whatever, but like the idea of looking out at the horizon is that you're like reducing visual sensory conflict, right? The horizon is not moving. It's fixed the way that you expect it to be. And so then that's going to help reduce some of that sensory conflict. There's a lot of like acupressure like bands that you can wear. And there's very mixed data on whether or not these have any actual effect. But some people find them helpful and there's like no side effects with them.

• 37:10Speaker 01

  And the biggest downside of all of our pharmacologic methods, so like drugs to treat motion sickness or prevent motion sickness do tend to have quite a lot of side effects, especially drowsiness, which is a huge problem if you're the one like flying the plane or driving the boat.

• 37:26Speaker 04

  Yeah, yeah.

• 37:27Speaker 01

  But they do tend to fall in kind of two main classes that work on two of those receptors and neurotransmitters that I mentioned already, which is like acetylcholine and histamine. So antihistamines and specifically antihistamines that can cross the blood brain barrier because they have to be able to get into our brain and central nervous system to have an effect, can block histamine and then reduce a lot of the symptoms that are associated with this because histamine is involved in all of the action going on.

• 38:00Speaker 04

  Okay. So interesting. Okay.

• 38:02Speaker 01

  So that's what Dramamine, if you've heard of the brand name Dramamine, which is dimenhydrinate. That's an antihistamine, not dissimilar to Benadryl or Difanhydramine. And both of these can be effective for motion sickness, but they tend to cause like dry mouth, dry eyes, drowsiness, et cetera. So there, that's a downside. So the other big one that we use is scopolamine. And this acts on acetylcholine receptors, so a different type of receptor. And we think that it acts kind of on both sides. We don't exactly know, but we think that it acts both on the vestibular side and the vomiting center side of the transmission pathway where our vestibular system is talking to vomiting parts of our brain and saying, be nauseous.

• 38:45Speaker 01

  So scopolamine is working on both ends of the spectrum in that way. It tends to have quite a lot of side effects, especially if you give it as an oral medicine. And so we often use it as a patch that you put behind your ear.

• 38:59Speaker 04

  Okay.

• 39:00Speaker 01

  And there's also like a nasal spray formulation, I think, too. The nice thing about the patch, even though it takes a lot longer to kick in, is that if you know I'm going to be on a cruise for the next five days, you put it on a few hours before the start of the cruise and then it lasts for 72 hours, which is kind of nice. Because usually by that time, you've acclimated. And habituation or acclimation

• 39:21Speaker 04

  Yeah.

• 39:21Speaker 01

  Uh huh, is like the best thing that you could possibly do to treat or or deal with motion sickness. And what I think is really interesting about the idea of acclimation is that it, the fact that we can acclimate, that we can get used to these motions over time, kind of also lends support to this idea that it's a sensory conflict to begin with.

• 39:43Speaker 04

  Right, because you're kind of disentangling these conflicts and saying-

• 39:46Speaker 01

  Your brain is getting used to a new normal, right? Where it's like, oh, it is okay that the, that all of my environment is moving along with me. I don't have to worry about this. And if you've ever been on a long cruise, or like people who go to outer space and come back, apparently get this a lot. There's something called mal de débarquement, or like-

• 40:06Speaker 04

  Disembarkment syndrome.

• 40:07Speaker 01

  Yeah. And that's when it feels really disorienting to walk on flat, unmoving ground.

• 40:13Speaker 04

  Yeah.

• 40:14Speaker 01

  After you've been in outer space or on a boat for a really long time. And that's like, you've acclimated, you've habituated to this sense of movement, and now you're back on flat ground. Your brain's like, whoa, whoa, whoa, whoa, this isn't what I expect to happen right now. Isn't that so interesting?

• 40:31Speaker 04

  Yes.

• 40:31Speaker 01

  That usually gets better a bit quicker.

• 40:34Speaker 04

  Okay, that makes sense.

• 40:35Speaker 01

  Yeah.

• 40:36Speaker 04

  I have a few questions.

• 40:38Speaker 01

  Okay, give it to me.

• 40:39Speaker 04

  So habituation, acclimation.

• 40:42Speaker 01

  Yep.

• 40:42Speaker 04

  How long does it take?

• 40:47Speaker 04

  Is, that's one of the questions. I'm saving the rest for after.

• 40:52Speaker 01

  Um, it, it depends on the person, right? Everyone is so differentially susceptible to motion sickness. It depends on the person, but usually like even if you are, let's say, on a cruise, it's the first like 12 to 24 hours that things are probably the worst. And usually within two to three days, you're pretty well acclimated. So if someone, for example, is like in the military and training for like intense flights, you know, with a lot of spinning or whatever, they might need more intensive like habituation therapy. But if you're just like on a boat or something like that, it's usually within a couple of days that you're going to habituate. But there's like regimens that people sometimes use to like get used to something so that even if they're exposed in the future, they don't get as motion sick as they used to.

• 41:35Speaker 04

  So is that, is that some, that was my other kind of like question trying to get at this. Like, can you become less motion sick over time?

• 41:42Speaker 01

  Yes, it seems like yes. By doing these habituation routines, which can sometimes be quite time intensive because you have to be able to like go in a mover jiggle or thingy.

• 41:53Speaker 04

  And have to want to expose yourself to be horribly sick. Yeah.

• 41:57Speaker 01

  Exactly. Yeah.

• 41:58Speaker 04

  Okay. Differential susceptibility.

• 42:00Speaker 01

  Yeah.

• 42:00Speaker 04

  Why? Is, are there genetic links? Is it run in families? Uh, and then age ranges? All of that stuff. Give it to me.

• 42:09Speaker 01

  I can't wait. So anyone can get motion sick, given the right set of circumstances, we think. Like even astronauts, like you think an astronaut has to go through so much training, but some of the papers that I read said that like 70% of astronauts going up for the first time will have some degree of space sickness, the first 24 hours that they're up there. So everyone, under the right set of circumstances, you could probably provoke motion sickness. But some people, like Christina and our firsthand account, get really severe motion sickness with things that other people don't feel motion sick at all. We don't really know what it is about one person that makes them more susceptible

• 42:50Speaker 01

  than another person. And we don't have tests or things that we can do to try and guess, are you going to get motion sick or are you not? There does seem to be a big heritability component. So twin studies have like 70%. So it's estimated like 50 to 70% concordance. Especially in childhood and age ranges. Usually susceptibility to motion sickness doesn't really develop until age like six to seven. Babies are like considered immune entirely. We don't know if it's just because they lay there flat like a potato.

• 43:25Speaker 04

  I was also wondering if it's, well, first of all, their sense, their senses are still being developed.

• 43:29Speaker 01

  Right. Their cerebellum is a disaster. They can't see like, yeah.

• 43:33Speaker 04

  But also they're being carried around a lot. And so I wondered if that was that like, but then it's a human, it's a human footstep.

• 43:40Speaker 01

  And they were in the womb for so long, like the in your uterus floating around in fluid. So they're just all leaping to bop.

• 43:45Speaker 04

  Right. They're like, oh, they expect motion.

• 43:48Speaker 01

  So I don't know, but it tends to not develop until age six to seven. And then it actually peaks in like age nine to 11. So like kids tend to be the most motion sickness.

• 43:59Speaker 04

  Reading Animorphs on the bus.

• 44:03Speaker 01

  But obviously many adults still experience motion sickness, though the like rates of it does decline and the severity tends to decline into adulthood. People who are assigned female at birth are much more susceptible, we think, than people assigned male at birth, but we don't know why. Like, there's not any clear reasons why. And like I said, like sight is not required for motion sickness. So people who are blind can still get motion sick. We do know that there's some associations with like migraines and some other, especially vestibular migraines, but also some other like vestibular disorders and an increased susceptibility to motion sickness. But we don't really know why, like, is it overlapping pain pathways? Is it overlapping autonomic reactivity?

• 44:46Speaker 01

  We don't really understand these associations, but we just see that they exist in the population.

• 44:50Speaker 04

  Yeah.

• 44:53Speaker 01

  There's some like, I think one paper found like 35 possible single nucleotide polymorphisms that might be associated. So like, we have no idea what the genetics of motion sickness are. We just know that there's probably some kind of heritability component. So, that's motion sickness, Erin.

• 45:08Speaker 04

  That's very interesting.

• 45:10Speaker 01

  I know, right? It's so weird. It's so weird to think about how, like, why do some of our brains, if it's this sensory conflict, why are some of our brains so like, on edge about this conflict and making us so sick?

• 45:24Speaker 04

  Yeah.

• 45:24Speaker 01

  Whereas other people can tilt a whirl after a funnel cake and be like, no prob, I'm not even a little bit nauseous. That's so weird.

• 45:31Speaker 04

  It is very weird. Weird is, is the word for this.

• 45:37Speaker 04

  Motion sickness. It's weird.

• 45:39Speaker 01

  It's weird.

• 45:40Speaker 04

  Yeah.

• 45:41Speaker 01

  So can you tell me about like, how we got to this point? Like, I'm assuming it's just human. I can't wait to hear about other animals. Do you talk about that at all?

• 45:48Speaker 04

  Very, very minorly.

• 45:50Speaker 01

  Okay.

• 45:50Speaker 04

  But there is.

• 45:51Speaker 01

  Tell me.

• 45:52Speaker 04

  There is some fun stuff to cover, so I'm excited about it.

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• 46:54Speaker 02

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• 47:13Speaker 05

  Man, I'm a Black and Mexican kid from San Pedro, and I grew up in Inglewood as well. I never liked to be boxed in. Both of my parents colored outside of the line. I mean, even them being together at the time in L.A. was just not typical. And so I think that has always been a part of my DNA. There's a defiant something in me that feels like what we get to do with what we're given that's greater than us is to maybe connect people to ideas that they wouldn't naturally, you know, connect to. That's really me. I'm just kind of like defiant with love, though.

• 47:49Speaker 02

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• 48:10Speaker 04

  I can think of no better way to start the history of motion sickness than with this quote. I had to do a quote. "Whenever we relinquish our intended status as self-propelled animals and step aboard some vehicle or device that transports us passively, we incur the risk of motion sickness. This wretched and debilitating condition has always been intimately linked with man's technological efforts to improve and extend his natural powers of locomotion."

• 48:45Speaker 01

  That's a great quote, Erin.

• 48:46Speaker 04

  Isn't that a great, great quote?

• 48:48Speaker 01

  It's really good, yeah.

• 48:49Speaker 04

  So those two lines are what kick off the prologue of this book called Motion Sickness by J.T. Reason and J.J. Brand.

• 48:57Speaker 01

  Okay.

• 48:58Speaker 04

  And it really gets straight to the heart of the matter.

• 49:01Speaker 01

  Mm-hmm.

• 49:01Speaker 04

  Motion sickness is a problem of transportation.

• 49:05Speaker 01

  Yeah.

• 49:05Speaker 04

  Specifically being transported by something other than yourself.

• 49:09Speaker 01

  Yeah.

• 49:10Speaker 04

  And we might use different names to refer to the sickness caused by the specific mode of transport, so like sea sickness, car sickness, air sickness, space sickness.

• 49:19Speaker 01

  Space sickness?

• 49:20Speaker 04

  Cyber sickness.

• 49:22Speaker 04

  But they all signify an external source, an almost, almost uniquely human experience, unless you're a dog on a road trip, for example.

• 49:33Speaker 01

  Or a fish in a fish tank.

• 49:34Speaker 04

  Or a fish in a fish tank. Does happen.

• 49:37Speaker 01

  Does happen. I learned that and I was like, fish can get motion sick?

• 49:41Speaker 04

  I know, I know. It is amazing. It is amazing.

• 49:44Speaker 01

  It's ridiculous.

• 49:45Speaker 04

  I love it. But given how, given how the vast majority of us are susceptible to motion sickness and our wide array of transportation options, it's safe to say that we've been dealing with this for quite some time.

• 50:01Speaker 01

  Mm-hmm.

• 50:02Speaker 04

  How long? How long?

• 50:03Speaker 01

  I mean, forever.

• 50:05Speaker 04

  Forever. I mean, yes and no, right?

• 50:07Speaker 01

  Okay.

• 50:08Speaker 04

  Because our, so our written record on motion sickness extends back to ancient Greece and ancient China at the very least, but is that when the first transportation devices were used? If for humans, we have to have some sort of external transportation.

• 50:24Speaker 01

  Yeah.

• 50:24Speaker 04

  When was that?

• 50:26Speaker 01

  Yeah.

• 50:26Speaker 04

  It was before ancient Greece and ancient China. So I started to look for when the earliest boats were built, thinking, okay, that's a likely candidate for the oldest method of artificial transport.

• 50:37Speaker 01

  Okay.

• 50:38Speaker 04

  But then I realized that it wasn't about the boat necessarily, boat, raft, whatever. The real question was not about how ancient humans spent time on the water, but when they did.

• 50:49Speaker 01

  Mm-hmm.

• 50:49Speaker 04

  That likely dates back to at least 50,000 to 60,000 years ago.

• 50:56Speaker 01

  Seriously?

• 50:57Speaker 04

  Seriously, seriously. So it was then that early modern humans migrated over water from Southeast Asia to a landmass called Sahool, which is Australia and New Guinea joined with a land bridge because water levels were a lot lower then.

• 51:14Speaker 01

  Okay.

• 51:15Speaker 04

  Kilometers of ocean had to be crossed with seaworthy vessels.

• 51:21Speaker 01

  So they had to have gotten seasick.

• 51:23Speaker 04

  Yeah.

• 51:24Speaker 01

  Yeah.

• 51:24Speaker 04

  And prior to this, it's thought that all other hominid migration had been over land. And it's unclear what, as far as I could tell, it's not clear exactly what types of boats were constructed. And it's probably the case that it wasn't like, let's build a boat and immediately go. Like, people were using it for coastal exploration.

• 51:46Speaker 01

  Exactly, fishing and things like that, local. Yeah, yeah.

• 51:48Speaker 04

  Yeah. And so, but that is at least like, I think, a pretty hard line is when humans had to spend extended time on the water.

• 51:57Speaker 01

  You know, they didn't talk about this in Moana at all.

• 52:00Speaker 04

  Motion sickness?

• 52:01Speaker 01

  Yeah.

• 52:04Speaker 04

  It's been a while.

• 52:08Speaker 04

  No points for accuracy. Points for great songs? Zero for accuracy. But yeah, so my, my guess is that there were, there was at least a barfing human or two aboard this watercraft.

• 52:23Speaker 01

  Yeah, there must have been.

• 52:25Speaker 04

  There must have been. But humans, like, like we've touched on briefly, they're not the only animals to experience motion sickness. Dogs, fish, amphibians, primates, and many other animals are also susceptible. And so this points to a deep evolutionary origin of the physiology that makes us all susceptible to motion sickness. And that is primarily our, not primarily, but like, a big chunk of it is our vestibular system.

• 52:52Speaker 01

  Yep.

• 52:53Speaker 04

  And so while those early humans crossing to Sahool might have been among the first of our species to get seasick, they likely weren't the first organisms overall. As an example, did you know

• 53:08Speaker 04

  what the leading hypothesis for how New World primates got from the Old World is?

• 53:15Speaker 01

  I don't know, were they like, holding on to a coconut or something?

• 53:18Speaker 04

  Basically.

• 53:19Speaker 01

  Yeah, like on to, floating?

• 53:21Speaker 04

  I, I have, I keep checking this, because I'm like, this can't be real. It's thought that they crossed the Atlantic Ocean on some sort of big vegetation-containing rafts.

• 53:30Speaker 01

  Mm-hmm, mm-hmm.

• 53:31Speaker 04

  They crossed an ocean, Erin. How did they, how did they do that?

• 53:38Speaker 01

  I, I don't know, and I mean, enough of them to like, establish new lineages, so not just like, one.

• 53:44Speaker 04

  Yeah, was it multiple times?

• 53:45Speaker 01

  Yeah.

• 53:46Speaker 04

  Yeah, and so that, but that is our current best guess, based on fossil evidence, and what the oldest fossils seem to be related to, what primates in Africa, yeah.

• 53:56Speaker 01

  So they probably got motion sick?

• 53:58Speaker 04

  Yeah. They had to cross a distance of around 1,500 to 2,000 kilometers.

• 54:06Speaker 01

  Wow.

• 54:06Speaker 04

  I don't know how they all didn't, like, where was the water coming from? Again, I guess, giant vegetation raft, if there was enough fresh water in the vegetation, and they were consuming that, I, I don't know.

• 54:15Speaker 01

  Or like, rain, fall.

• 54:17Speaker 04

  Yeah, maybe there was an island stopover in between.

• 54:20Speaker 01

  Wow, this is so fascinating, Erin.

• 54:22Speaker 04

  So if that's how it went down, definitely, motion sickness on the table for these primates. Little adventurous primates.

• 54:31Speaker 04

  But, yeah, so, motion sickness was not an unfamiliar experience to, well, at least those primates, at least some early humans, but the same goes for ancient humans. So by 800 BCE, humans had come a long way, in boat, in both boat-making and livestock domestication, which enabled the use of carts. And as a result, motion sickness had become a common occurrence, occasionally known as the plague at sea. There are so many to choose from.

• 55:01Speaker 01

  I know, right?

• 55:02Speaker 04

  There's typhus, there's scurvy, there's tuberculosis, I think was, you know, at least happened in

• 55:08Speaker 01

  There's actual plague.

• 55:10Speaker 04

  There's plague, yellow fever, I mean, anyway. But various explanations were proposed as to what the cause of motion sickness was. In ancient Greece and Rome, of course, we've got the humors blamed. Humors were out of balance. The stomach and your yellow bile, of course, playing an outsized role, wasn't always thought to be bad, the barfing. Because like, sometimes emetics were prescribed to be like, we've got too much yellow bile.

• 55:36Speaker 01

  It means you've got to get rid of this.

• 55:37Speaker 04

  Get it out. Yeah. And in ancient China, it was thought that motion sickness was due to an improper or impeded flow of qi, or life force, with some liver involvement.

• 55:47Speaker 01

  Okay.

• 55:48Speaker 04

  Whereas in China, the illness was broken down into the mode of transport. So it was called cart influence or ship influence.

• 55:55Speaker 01

  Okay.

• 55:56Speaker 04

  In ancient Greece and Rome, the focus remained primarily on sea vessels. Hence, the etymology of the word nausea, which comes from the word for seasick, nau, like N-A-U, for ship, like nautical.

• 56:10Speaker 01

  Like nautical, nautical nausea, seasickness.

• 56:13Speaker 04

  Cool. I had no idea.

• 56:17Speaker 01

  Nausea comes from ships. That's just how intertwined they are.

• 56:22Speaker 04

  Yeah.

• 56:23Speaker 01

  Wow.

• 56:24Speaker 04

  Yeah. The description of symptoms from these ancient texts, spot on, right? We've got dizziness, nausea, vomiting, loss of hunger, exhaustion, anxiety. And while there was no consistent pattern seen in terms of predisposition, some writers would try to make a link between disposition and susceptibility. It was generally observed that people could become acclimated to transport and over time, they would be less likely to get sick. Another way to avoid getting motion sick was, of course, by concocting various remedies or choosing certain diets.

• 56:56Speaker 01

  Oh, dear.

• 56:57Speaker 04

  So for instance, grinding up wormwood and mint and then mixing it with oil and vinegar and rubbing it into your nostrils.

• 57:05Speaker 01

  Oh, okay. An odor thing. People have tried a lot of those in modern days. There's no evidence for odor things, just so we're clear.

• 57:13Speaker 04

  It's, there's a long history of this sort of a thing. Yeah. Others claimed that, quote, "seasickness will not be able to torment him who drinks vermouth mixed with wine before setting off." Not true. Don't give it a whirl.

• 57:32Speaker 01

  Doesn't sound great.

• 57:34Speaker 04

  You could also take a bit of earth from your kitchen hearth and hide a bit under your hair, or write the character for dirt on your palms, kind of as like a grounding stability. That was another, another common practice.

• 57:46Speaker 01

  Oh, I kind of like that.

• 57:47Speaker 04

  I know. If all else fails, fast. Just don't, nothing, nothing.

• 57:54Speaker 01

  I mean, that is like still a recommendation today is like, don't eat heavy meals, et cetera, so that you just have less food to barf up, so you feel less nauseous.

• 58:02Speaker 04

  Yeah.

• 58:02Speaker 01

  Yeah.

• 58:03Speaker 04

  But the sheer variety of remedies or preventatives points to just how big a challenged motion sickness posed. More than a temporary setback or period of discomfort, it could mean life or death, particularly during war. Julius Caesar wrote that in 48 BCE, when his troops landed on enemy shores after a stormy voyage, they were too exhausted to do anything other than surrender, and they were promptly massacred.

• 58:33Speaker 01

  Oh, whoa.

• 58:34Speaker 04

  Yeah. Writings describing the Battle of Red Cliff, which took place in China in 207 CE, mentioned that seasickness was a big problem, and so the ships were tied together to increase stability. That meant that when one ship was set on fire, they all went up in flames.

• 58:51Speaker 01

  Oh, no.

• 58:52Speaker 04

  That's at least what some texts suggest.

• 58:55Speaker 01

  Whoa.

• 58:56Speaker 04

  The plague at sea proved to be a predictable and unwelcome companion to any war since ancient times that involved ships or camels. Apparently camel sickness became an issue for some of Napoleon's soldiers in the late 1700s.

• 59:11Speaker 01

  Really?

• 59:12Speaker 04

  Yeah.

• 59:13Speaker 01

  Camels, camels, who knew?

• 59:15Speaker 04

  But, but its predictability did nothing to help with prevention or treatment or understanding why it happened.

• 59:21Speaker 01

  Yeah.

• 59:21Speaker 04

  And as transport grew more common beyond wartime, many people had an opportunity to experience it firsthand, such as famous Charles Darwin.

• 59:32Speaker 01

  Charles Darwin, yeah, he was super, super susceptible to motion sickness, apparently.

• 59:36Speaker 04

  Yeah. So he spent nearly five years onboard the Beagle, actually more like three years on. Sure, two years, like three, three fifths of his time was spent on land.

• 59:45Speaker 01

  Okay. I need recovery time, y'all.

• 59:49Speaker 04

  Yeah.

• 59:49Speaker 01

  I'm just looking at birds here, wink, wink.

• 59:53Speaker 04

  Oh, that's a really interesting specimen. Let me just spend two months.

• 59:58Speaker 04

  But, uh, yeah, so this is the, the time then he collected all those observations to, to develop the theory of evolution by natural selection. And during much of his time, he horribly, horribly suffered from motion sickness. So I have a couple quotes from his letters.

• 1:00:13Speaker 01

  Okay.

• 1:00:14Speaker 04

  In one, he wrote, quote, "I hate every wave of the ocean with a fervor which you, who have only seen the green waters of the shore, can never understand."

• 1:00:28Speaker 01

  You have no idea.

• 1:00:29Speaker 04

  You have no idea.

• 1:00:30Speaker 01

  What I've been through.

• 1:00:32Speaker 04

  I hate every wave. And then, quote, this is a little more measured, not really, quote, "If a person suffer much from seasickness, let him weigh it heavily in the balance. I speak from experience. It is no trifling evil which may be cured in a week," end quote. And he probably had something else going. There have been so many different hypotheses about what afflicted Darwin, but he had a terrible motion sickness.

• 1:01:00Speaker 01

  Seasickness, yeah.

• 1:01:02Speaker 04

  Yep. Uh, but this didn't mean that people didn't try to cure motion sickness. There was always, there was always the will to explore new options and to understand what was actually happening. And so by the late 19th century, scientists and sailors had accumulated heaps of explanations and remedies for motion sickness. Uh, things like, in terms of hypotheses, cerebral anemia or cerebral hyperemia, basically irregular blood flow to the brain of some sort. Others believed that disturbed vision or respiration played an outsized role. Maybe it was the, maybe it was the digestive system that experienced too much mobility, too little mobility, all things out of balance.

• 1:01:42Speaker 01

  Everything, yeah.

• 1:01:43Speaker 04

  Yeah. One guy was certain that it was an infection, just like yellow fever or bubonic plague. And so he wrote this paper and in response, a reviewer from The Lancet wrote, this is like an 1850, by the way, quote, "It is a pity that people should so cruelly waste their time and trouble."

• 1:02:00Speaker 01

  Oh, that brings you right back to grad school, doesn't it?

• 1:02:02Speaker 04

  I know. Reviewer three right there.

• 1:02:05Speaker 01

  Exactly.

• 1:02:07Speaker 04

  Completely devastating.

• 1:02:09Speaker 01

  Wow.

• 1:02:11Speaker 04

  A tentative breakthrough arrived in 1881 when a couple of researchers noticed that motion sickness produced very similar symptoms as a condition called many years' disease. So it turns out, our stomach wasn't to blame, our blood wasn't necessarily to blame. It was our vestibular system that helps us balance and sense our body's position in space. And so as the vestibular hypothesis grew in support, overtaking the blood and guts ideas, others still emerged, such as the psychological explanations, believing that motion sickness was all in your head, in like a, well, you just have a nervous disposition sense, not in like a, this is disrupting your vestibular system sense.

• 1:02:53Speaker 01

  Right.

• 1:02:55Speaker 01

  That, by the way, there actually, I found that there have been papers that have very clearly shown there is no, like, personality

• 1:03:02Speaker 04

  No.

• 1:03:03Speaker 01

  component to motion sickness.

• 1:03:05Speaker 04

  I mean, and to show you how clearly there is no link, there was a paper I read from, I think, 1949, that was like so disparaging of this idea. They were like, this is utter garbage. It was, it was kind of great.

• 1:03:22Speaker 01

  Even in, even in the 40s.

• 1:03:23Speaker 04

  Even in the 40s, yeah. When that was still in vogue.

• 1:03:25Speaker 01

  Right.

• 1:03:26Speaker 04

  But yeah, so supporters of this idea would point to stories of sailors who were completely wrecked by seasickness and then suddenly recovering after hearing that the ship was under fire, or the fear of motion sickness becoming a self fulfilling prophecy, or the claim that some people's sickness was effectively treated with placebo. And so, under this hypothesis, it was like mind over matter was the only way to go. These stories were primarily anecdotes, possibly invented, and in general, this neurotic, quote unquote, neurotic theory of motion sickness did not gain a lot of traction, in large part because, yeah, it did not hold up to any scrutiny, even then, even then.

• 1:04:08Speaker 01

  Yeah.

• 1:04:08Speaker 04

  So, research had shown that almost everyone was susceptible to motion sickness, but not everyone had a nervous constitution. So, checkmate.

• 1:04:17Speaker 01

  Whatever that means.

• 1:04:18Speaker 04

  Whatever that means, yeah. Motion sickness again became a pressing issue when war was on the horizon, specifically World War II. You've got tens of thousands of soldiers about to be transported over water and spend extensive periods on ships or in the air in airplanes. And so, motion sickness posed a substantial threat to wartime efforts. We gotta have our soldiers in, you know, fighting, fighting. Shape? Shape, that's.

• 1:04:48Speaker 04

  Can't, my brain. But, so despite the attention paid to the condition in the century before, little progress had been made in understanding or treating it. To quote this 1948 paper, the same one that was like disparaging of the psychological links by Taylor and Bard, quote, "The literature on motion sickness, which appeared before World War II, contains amazingly little factual information concerning this common disorder. Like the extensive folklore devoted to the subject, most of the publications were replete with uncritical considerations of a number of possible ideological factors and with accounts of uncontrolled and statistically deficient excursions into the field of prevention and cure." End quote. Cutting. Just brutal.

• 1:05:33Speaker 04

  Like, no one has done anything useful. Thanks a lot, y'all. This is a waste. You all wasted your entire careers studying this. But they weren't wrong, really. Like, there still was not any way to effectively manage motion sickness. Although people still had their pet remedies, ranging from the sensible fasting, dry toast, you know, food choices that are often still recommended. Or to the confusing, even barf-inducing, nausea-inducing, certainly, quote, "Soup made of horseradish and rice seasoned with red herrings and sardines." End quote. I actually kind of want to try that, it sounds, I love horseradish and sardines, but like... I do not.

• 1:06:18Speaker 04

  I know. But that is not something that I would want to gorge myself on prior to getting on a book. Prior to a ship voyage? Yeah. No, thanks. Uh, that though, I don't even think that was, uh, maybe it's in contention for as bad as the suggestion to feast on pickled onions, which I also love, don't get me wrong. But the idea was to eat so much of them that you had a tremendous amount of gas so that your stomach maintained a steady pressure, thinking it was like a atmospheric pressure thing. I don't know.

• 1:06:50Speaker 01

  That sounds so uncomfortable.

• 1:06:52Speaker 04

  I know. And then all of these were to be washed down with your beverage of choice. You know, top recommendations included coffee, brandy, but the top fave was champagne.

• 1:07:02Speaker 01

  Champagne?

• 1:07:03Speaker 04

  Yeah.

• 1:07:06Speaker 01

  The idea of champagne to prevent motion sickness is hilarious.

• 1:07:11Speaker 04

  I know. I know. It's, it's great. There's, there's a-

• 1:07:15Speaker 01

  So fancy.

• 1:07:16Speaker 04

  I know. Not sparkling wine. Champagne.

• 1:07:20Speaker 01

  Champagne.

• 1:07:20Speaker 04

  Champagne. Uh, that motion sickness book that I, where I started the quote from in the beginning of this has a table, they put together a table of motion sickness preventives and the number of citations for each one in like historical times. So ranging from warm salt water to opium, chloroform to nitrous oxide.

• 1:07:42Speaker 01

  Jesus.

• 1:07:43Speaker 04

  Cayenne pepper to atropine, which is actually kind of funny because that was used, um, a little bit later on. But none of these had enough support to actually do anything in a major world war. So in the words of one writer from the period, quote, "I am convinced that the only real and complete cure is to sit under a big tree." End quote.

• 1:08:05Speaker 01

  Get off that boat.

• 1:08:07Speaker 04

  Get off the boat.

• 1:08:08Speaker 01

  Just go sit down on the earth.

• 1:08:09Speaker 04

  Just sit. More statistically organized trials on compounds like belladonna derivatives and barbiturates were conducted during the war. And it's hard to know if the cure was worse than the disease. So on the one hand, you've got soldiers reporting that D-Day, quote, "had resulted in the greatest mass vomiting ever known in the history of mankind." End quote, which makes sense. Think about, think about that. Yeah. And on the other hand, you've got a war correspondent describing that the seasickness pills prescribed by the army, quote, "not only put us to sleep, but they constricted our throats, made our mouths bone dry, and dilated our pupils until we could hardly see." End quote. Yeah.

• 1:08:52Speaker 04

  Turns out those guys had taken the twice the recommended dose. So that could have been partially to blame. Maybe a little bit of user error there. Might be. But also complicating drug development for seasickness was that during this time, it was common for the placebo pill to be a lactose pill, which I would imagine could cause symptoms mimicking motion sickness in those with lactose intolerance.

• 1:09:19Speaker 04

  It was like, well, we tested this against the lactose placebo. And I was like, excuse me, what? Why? Why?

• 1:09:26Speaker 04

  So, yeah. Unfortunately, true relief for many would not arrive until the war was over.

• 1:09:35Speaker 04

  We love a serendipitous discovery in science. We do. Makes for great storytelling. So in the case of motion sickness, that story involves a pregnant woman who had severe allergies and hives. You can probably tell where this is going. So in 1947, she had been prescribed an anahistamine, which was effective in relieving her symptoms. But she was also surprised to find it had another consequence. Her entire life, she had gotten carsick really easily. But while she was taking this drug, she found that she could ride in cars with no problem at all. Wow, even while pregnant? Even while pregnant, yeah. So she told her medical advisors about this, who had her try it out against a placebo. No dice, still got carsick.

• 1:10:20Speaker 04

  And they began to plan a larger study testing whether this drug could prevent seasickness in a group of sailors. And it worked, I mean remarkably, remarkably well. It was like such a clear relationship. It wasn't like, oh yeah, some people found relief. It was like, no, the vast, vast majority

• 1:10:37Speaker 04

  were completely either prevented or alleviation of symptoms. Wow. Trade name, Dramamine.

• 1:10:44Speaker 04

  German mean. Uh, as the 1950s closed into the 1960s, space travel provided new motivation to understand the site, the physiological impact of unnatural motion on the human body. And finally, some plausible mechanisms began to crystallize, explaining both what is happening and why. And you already went through both the what and the why. But I think that, yeah, it seems to come down to our brains get overwhelmed by all these confusing and contradictory sensory inputs. And then we get nausea, pallor, cold sweats, vomiting, et cetera. Basically.

• 1:11:22Speaker 01

  So, so interesting.

• 1:11:23Speaker 04

  Yeah, I mean, like I've said a couple of times now, we humans did not evolve under non-self-propelled transport.

• 1:11:31Speaker 01

  I feel like that is such an interesting part of the story, Erin. It's like that, but especially in the context of, of all animals, not all, but so many animals being susceptible under the right conditions. And it really is just like, we're just doing this to ourselves. But like, now we can't not, right? Like, you can't not go in a car or a train or a plane or a boat. Like, you have to get around somehow.

• 1:11:57Speaker 04

  Yeah.

• 1:11:58Speaker 01

  So interesting.

• 1:11:59Speaker 04

  Right. And so it is, yeah, like, I, I think it, it is, shows that we don't know, like, we evolved under conditions of how to interpret the world around us. And we don't know what to do when that world moves out of our control.

• 1:12:17Speaker 01

  Right, in a way that just doesn't make sense for our brains.

• 1:12:20Speaker 04

  Yep.

• 1:12:21Speaker 01

  Based on what our body can do. Oh, that's magic!

• 1:12:25Speaker 04

  And so we, we have, you know, recent advancements in our understanding of, of the physiology and underpinnings of motion sickness. And we have some different drug formulations. Like, like you said, this is an unavoidable consequence of our technological prowess as a species.

• 1:12:42Speaker 01

  Yeah.

• 1:12:42Speaker 04

  At least for now, like, we, we have to, this is what we are dealing with. And so for anyone who has experienced motion sickness or who has witnessed it firsthand, it is clearly both wretched and debilitating, which is what the first quote, those words I was, I read that quote to John and he was like, "That is exactly, it is exactly it. Debilitating is the word that I would choose."

• 1:13:06Speaker 01

  Yeah.

• 1:13:07Speaker 04

  And in some respects, we have come a long way in the past few decades, but in others, we're still completely at the mercy of the waves or the camel that we're riding. So, tell me, Erin, I guess, how many of us can expect to be motion sick? Do we have promising research on the horizon? What's going on today?

• 1:13:29Speaker 01

  I'd love to tell you, Erin.

• 1:14:02Speaker 01

  No.

• 1:14:05Speaker 01

  We, I mean, like I said already, all of us could get motion sick. It really just depends on if we're exposed to the right sort of stimulus. And we know this from looking at like different scenarios. On large planes, like the commercial airlines that most of us fly on, it's usually less than 1% of people that tend to get motion sick. Whereas in little planes, like a Cessna or a little plane, up to 25% of passengers might get sick. And even on commercial planes, while it's usually less than 1% that are getting sick overall, on a particular flight where people are getting sick, it can sometimes be up to 8% of people.

• 1:14:46Speaker 01

  So it really depends on the amount of turbulence and like what you're experiencing on that particular flight.

• 1:14:51Speaker 04

  Right.

• 1:14:52Speaker 01

  Up to one-third of people can get sick on long-distance car rides. On cruises, motion sickness is the most common reason for physician consultations, more than infections, more than injuries.

• 1:15:04Speaker 04

  I was like, what about norovirus there?

• 1:15:05Speaker 01

  Exactly, including norovirus. So more people go to the doctor, and that's just the people who didn't already come with Dramamine and Scopolamine and have the medicines that they need so that they don't need to see the doctor, right? And that's on huge cruise liners. On life rafts, it's like 50 to 60% of people who are going to get motion sickness on something like a life raft, especially in more, what's the word? Bad seas.

• 1:15:30Speaker 04

  Choppy waters, yeah.

• 1:15:31Speaker 01

  Choppy waters. Adverse conditions.

• 1:15:34Speaker 04

  They both work.

• 1:15:36Speaker 01

  So, any of us could.

• 1:15:39Speaker 04

  Yeah.

• 1:15:39Speaker 01

  Where do we go from here? I have no idea. I did not see anything about like, new medications, new treatments. There is a lot of, and maybe, maybe a lot is even a stretch, but there will be changes in who is experiencing and how people are experiencing motion sickness with an increase in the use of things like virtual reality. There's some papers out there that are like, what about self-driving cars?

• 1:16:09Speaker 04

  Oh, interesting.

• 1:16:10Speaker 01

  Right? Because in a self-driving car, you're obviously not the driver. And we do see that people tend to get less motion sick if they are not just the one like driving the thing, but even if they're engaged in certain types of tasks. So like, having to use your brain for certain types of tasks but not others can help to reduce your susceptibility to motion sickness, which is super interesting.

• 1:16:33Speaker 04

  Like, like being the car DJ or the math reader?

• 1:16:36Speaker 01

  Yeah, or like, maybe not reader, because then you're looking at your papers. But like, people who had to do, I think, mental arithmetic were less likely to get motion sick than people who were just supposed to think about not getting motion sick or something like that.

• 1:16:50Speaker 04

  Whoa, that's weird. Okay, okay.

• 1:16:52Speaker 01

  So anyways, but again, we don't really know, like, why, why is that? Is it just because your brain is having to focus on other things, so it's not bothering to interpret these sensory discrepancies or something? Like, we really have no, we don't know. We do not know. But there probably are going to be more of us that are getting sick in different situations, right? Because of the changing ways that we do technology today versus how we used to in the past. And that's all I got for you, Erin, about motion sickness.

• 1:17:20Speaker 04

  It's so interesting that there's not more about like, research for either pharmaceuticals or because like-

• 1:17:28Speaker 01

  And maybe I just missed it. So if someone's working on it, please tell me and I'll apologize. But I didn't see anything. It was hard to find recent papers in general. Most of my papers were old.

• 1:17:38Speaker 04

  I think it's, it is, it is really striking to me that like, it seems that placebo effect, which we were talking about before we started recording and how interesting it is and we should do an episode on it.

• 1:17:47Speaker 01

  We should.

• 1:17:48Speaker 04

  Doesn't seem to be there for motion sickness.

• 1:17:51Speaker 01

  It can be. There's some, there's some, there's some papers, I mean, especially when you think about like, some of the, there are some papers that show that things like these sea bands, or that might be a brand name, so sorry about that, but like the motion sickness bands, or other, and like, is that a placebo or is that actually doing something? Who knows? But some papers seem to show that there's an effect and others don't. And similarly with placebos, like there's some that show that there might be a placebo effect and others that don't really show much of a placebo effect. So it's all just, it is really, I mean, motion sickness is a really interesting, weird and debilitating-

• 1:18:29Speaker 04

  And debilitating.

• 1:18:30Speaker 01

  -condition that any of us could experience.

• 1:18:32Speaker 04

  Yeah. Oh, it's, it's interesting that I didn't know about that, about the current research. It seems like historically, there was not a lot of placebo effect observed. Maybe it's because they're using lactose pills. I don't know.

• 1:18:44Speaker 01

  Maybe.

• 1:18:45Speaker 04

  How much lactose was in the lactose pill? That's a story for another time.

• 1:18:49Speaker 01

  Another day.

• 1:18:49Speaker 04

  Another time.

• 1:18:50Speaker 01

  If you want to read more-

• 1:18:51Speaker 04

  We've got some sources.

• 1:18:53Speaker 01

  We do.

• 1:18:53Speaker 04

  We've got a bunch. So, let's see. I'm, I have a bunch, but I'm shouting out two in particular. One is that book by Reason and Brand, Motion Sickness, published in 1975. And then, there was a great overview of the history, like historical writings on motion sickness called, by, by Huppert et al. from 2017, called A Historical View of Motion Sickness: A Plague at Sea and On Land, Also With Military Impact.

• 1:19:23Speaker 01

  It's very descriptive.

• 1:19:24Speaker 04

  Yeah.

• 1:19:25Speaker 01

  Um, I really enjoyed actually a textbook chapter from the Handbook of Clinical Neurology. I think it was chapter 27 called Motion Sickness by Golding, uh, from 2016. Also, all of the papers, even the more recent papers, looking at the mechanisms and this idea of like, uh, sensory conflict and neural mismatch, cite this paper from 1978, uh, by Reason.

• 1:19:47Speaker 04

  Oh, yeah.

• 1:19:48Speaker 01

  That was called Motion Sickness Adaptation: A Neural Mismatch Model. They all still cite that paper, like, there's not been more data to show it.

• 1:19:56Speaker 04

  That's, that's the author of the book, yeah.

• 1:19:58Speaker 01

  Oh, yeah. So anyway, so that's a great paper. It's actually a really great paper. Um, and then there's a bunch of other ones as well, too, all about, you know, the treatment, the pathophysiology, et cetera. You can check them out on our website, thispodcastwillkillyou.com. I also have some extra reading if you want about like our vestibular system.

• 1:20:14Speaker 04

  Yeah.

• 1:20:14Speaker 01

  And, uh, our proprioceptive system and little, little, little fun bits like that.

• 1:20:18Speaker 04

  Little tidbits here and there, yeah.

• 1:20:20Speaker 01

  Thispodcastwillkillyou.com under the episodes tab.

• 1:20:23Speaker 04

  Uh, thank you again to Christina for sharing your story with us. Thank you so much.

• 1:20:28Speaker 01

  It means so much.

• 1:20:28Speaker 04

  It really does mean a lot.

• 1:20:29Speaker 01

  Thank you. Thank you also to Blood Mobile for providing the music for this episode and all of our episodes.

• 1:20:34Speaker 04

  Thank you to Leanna and Tom and Mark and Jessica and Sabrina and everyone else who works on the network.

• 1:20:44Speaker 01

  There's so many of you.

• 1:20:45Speaker 04

  It's amazing, yeah, yeah.

• 1:20:45Speaker 01

  Thank you.

• 1:20:46Speaker 04

  Our, our list is growing ever longer.

• 1:20:48Speaker 01

  We keep probably missing people.

• 1:20:50Speaker 04

  Yeah.

• 1:20:51Speaker 01

  Uh, thank you to you, everyone, listening and watching. Hello.

• 1:20:54Speaker 04

  Hello.

• 1:20:55Speaker 01

  Um, thanks. We like, did you like this episode? I liked it.

• 1:20:59Speaker 04

  Let us know. Do you get motion sick? Let us know.

• 1:21:01Speaker 01

  Do, do you? We all do, to some degree.

• 1:21:04Speaker 04

  We do.

• 1:21:04Speaker 01

  Could, have you yet?

• 1:21:05Speaker 04

  Have you?

• 1:21:06Speaker 01

  Do you need to go to space?

• 1:21:08Speaker 04

  Ooh, alright.

• 1:21:09Speaker 01

  To, to get motion sick.

• 1:21:10Speaker 04

  Next on the list.

• 1:21:10Speaker 01

  Anyways.

• 1:21:11Speaker 04

  Thank you to our patrons also. We appreciate your support. It really means the world to us.

• 1:21:16Speaker 01

  It does.

• 1:21:16Speaker 04

  Uh, we, we love you. Thank you.

• 1:21:18Speaker 01

  Thank you.

• 1:21:19Speaker 04

  Okay, until next time, wash your hands.

• 1:21:22Speaker 01

  You filthy animals.

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