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Rates are magnified by other environmental factors, such as poor ventilation, odors, fumes, smoke, and carbon monoxide. Differential diagnosis and complications The differential diagnosis includes vestibular disease, gastroenteritis, metabolic disorders, and toxin exposures. At altitude, it also includes mountain sickness. Most symptoms attributed to motion sickness should resolve following termination of the motion stimulus or with adaptation to it. Some symptoms, such as lethargy, take longer to resolve 5 ; . Laboratory studies also show a delay in improvement in gastric motility, electroencephalographic studies, and performance 6 ; . Complications are infrequent, but include hypotension, dehydration, depression, and panic. Methodologies in studies on motion sickness There are numerous methods used to assess medications and other measures, and all have deficiencies that weaken the ability to compare studies or to apply the information to the typical traveller 7 ; . From reviewing the literature, it seems quite possible that for the average traveller there are several options that are of generally equal benefit 8 ; . There are many recommendations that appear to be based upon repeated but anecdotal observations made under real-life conditions. Where laboratory data exist, they are generally consistent with these observations. There are a number of studies that use self-report data obtained by questionnaires. These can have rather large numbers of respondents, but to facilitate obtaining responses the questionnaire is usually simple and the responses are open to divergent interpretations. For example, in a study where 98% of travellers responded 20, 029 respondents ; , there was a significant association between increased motion sickness and use of motion sickness medications, and between alcohol use and decreased motion sickness 2 ; . The investigators were unable to determine the temporal sequence or the effect of confounding factors. Most current controlled studies are conducted under laboratory conditions where healthy, typically young male individuals are subjected to strong stimuli, e.g., a rotating chair, over a short time, with the intention of rapidly inducing some degree of motion sickness. These studies usually have a small number of subjects, and the results may not have full relevance to the typical traveller since they are usually used to study aspects of space sickness or effects under extreme sea conditions. Many older studies 7, 9 ; , but few recent studies, have used more realistic settings, either in induced sea-like conditions, or under real sea-based conditions 8 ; . It almost impossible to control all key variables in these latter studies, but they may provide the most useful information. General measures for prevention of motion sickness The support for the following measures is based on observations from laboratory manipulations and repeated anecdotal experience. Scientific support is generally B II-III see Appendix I ; 10 ; . Minimize exposure: be located in the middle of the plane or boat where movement is least. Jinker from what i've read, cortisone shots to his hip aren't a performance enhancing drug, more of a therapy to prevent more rapid degeneration of the joint, for example, zovirax acyclovir cream.

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