Update on the Mysterious case of the throw-ups

For anyone who read my blog back in September (Motion Sickness..and how I am going to fix it) or the Triathlete.com article written by Jene Shaw in October (http://triathlon.competitor.com/2012/10/athletes/sarah-piampiano-finds-her-bearings-in-kona_63910) – I think it was obvious I was in a fairly desperate state to get this little puking issue of mine under control.  Clearly desperate.  I mean – I had sinus surgery weeks before Kona, spoke with a healer and was walking around my apartment doing neck exercises to mimic breathing while swimming – can you get more desperate than that?


I received a lot of responses from people with helpful advice and suggestions (thank you!!) and it was actually because of all of you that I was able to get to the root of the problem – or what seems to be the root cause.  Many have asked where it all stands, and so I thought it was worth a blog to update you on my mysterious case of the throw-ups.


So…people’s responses to my blog in September got me thinking that maybe my issue wasn’t motion sickness at all, but perhaps was more vestibular or even muscular/nervous system related (Ellen Bowden, and all you super smart peeps that suggested I see an ENT and a vestibular specialist – thank you!).  First I went the ENT route, and after several consultations I had sinus surgery in September to open up my nasal cavity.  The purpose for this procedure was that my ENT believed that my severely swollen sinuses were actually pressing on my eardrum and causing motion sickness.  Unfortunately, while the theory sounded great and the surgery did wonders for my ability to breathe, it didn’t do much to solve my problem.  Bummer.


So…I went and saw a vestibular specialist.  For 4 weeks I went to vestibular PT and through these appointments we pin pointed that my nausea was caused by turning my head to the left and right – the exact same motion done to take a breath while swimming.  Boom!  Big progress there!  My problem wasn’t solved, but we knew what caused it.  That was pretty exciting and a big step!


Somewhere in the mix of all of this a close friend, Ellen Bowden, told me that the Vagus nerve runs from the neck to the stomach and that a possible impingement of that could cause nausea.  While I wasn’t sure that was necessarily the case for me, it did beg the question whether my problem was a cervical spine issue rather than a vestibular one.  Between what we determined with my vestibular PT and Ellen’s idea, I was sent for a CT Scan where a slight bulge in my C6 vertebrae was found.  While not significant, the doc speculated the bulge could be causing muscular tightness and a potential impingement in my neck – possible cause for my vomiting.


We decided collectively to try out a Chiropractor and so from September onwards I began seeing Dr. Eric Nepomnaschy at Bay Chiropractic 2-3 times per week.  In each session he gave me an adjustment, and then over time we began layering in stretching, massage of my neck and shoulders, and ultra sound or laser treatment.  We’ve worked closely and monitored how I’ve felt after every swim/bike session and even scheduled appointments directly ahead of swim-bike days.  We have developed a stretching routine to help open up my neck and spine before I get in the water.  And…well…it has worked!  Since Kona I have had zero issues with nausea in my training, and when I raced in Pucon in January, for the first time not only did I not throw up on the bike, but my legs felt great and alive out of the swim.


It is hard for me to be fully convinced – I’ve gone so long with this problem that I just keep waiting for it to come back, but everything we are doing seems to be working and it seems clear that keeping my neck open is critical to keeping me puke-free!


So – fingers crossed this continues, but all signs are pointing up!


Thank you again to everyone who took the time to write or call me and offer help and advice.  I read and listened to everything you had to offer and applied it.  It was because of all of you I have been able to get to this point!


Also big thanks to Dr. Eric Nepomnaschy who has been so dedicated to helping me get over this hurdle.


While I know it just won’t be the same without the token puker out there on the race course, I’m hoping 2013 will be filled with a lot less throwing up and much cleaner bikes post race!


Until next time – Don’t dream it, Be it.





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