Okay, we're testing. Oh, we're on. Okay, going to announce our next speaker. Here's I, I've known John Campbell so long. I can't even remember when we 1st met. So, I know John Campbell from 4 rocker that it was a long time ago. I was at record twice. So. I don't know which time what publisher it was the 1st time. So, John Campbell is a U. S. army retired colonel. He was in infantry aviation and a medical officer, 28 years of continuous duty. He served as an infantry officer, Cobra pilot, platoon leader at 4 Campbell. Battalion surgeon and combat and then, of course, he made it to rocker, which is now. Fort Nova still has a date. April 12. oh, okay. That's another story, so he's currently at the U. S. army, air medical research laboratory. He's been he has been the dean of the school of aviation medicine. And a command surgeon, so, of course, he's board certified in aerospace, occupational and environmental medicine. He's been retired since 2009. so John's going to give us 2 talk today. So there's the 1st 1 go for it. Thank you, Warren. And thank you everyone else and now to match David back there a little bit. I need to put on my little bit of virus. I'm only a quarter. We were talking about. 23 and me and all that, so this is my quarter of virus out. We're here for during the lecture. But, you know, it's a privilege for me to be at you. So, I'm now kind of a research scientist subject medical expert there. But what's impressed me we have, as you don't know, it's called the Alabama College of osteopathic medicine in dolphin, which is only a half hour away or so. And recently, over the last year, they developed an agreement with the school to be able to come and do their rotation and hopefully get involved in research again research being a very unique entity there. And a lot of you, I know you said you've done studies and looked at research and things, but to actually do research and so many more. Hoops to jump through, then you never ever realized. But we had a young lady came this past summer, Virginia Thomas that in her prior service before she came into this physician program. She was medical service core and saw a lot of. Patients a lot of movement. She was also at the 82nd in the airborne. But she realized something we call in the army disease, non battle injuries in that motion sickness other issues that had nothing to do with, say, the battle that she was concerned with her soldiers as they were going to jump. Getting very motion sick during the transportation and effectively hitting the ground in their airborne status, but not necessarily fully capable based on the illness. Whether it was sleeping this grogginess your stomach after intestinal issues. So, she kind of composed this study and we'll explain about a little bit. But 1 of the things you can see in the opening there conserve our fighting strength. That's kind of our model at use to say, hey, look, what can we do from a research perspective to give the soldiers airmen. And ground troops a benefit and advantage because as I'll talk. A little more of my next talk where we're looking for future combat issues. We need to gain the advantage and join Campbell's humble opinion. You know, some of our enemies, the bad guys are gaining on us very rapidly as far as tech. I, you know, AI and other things, and we may fall by behind the wayside. We gotta be very careful. So, some of what we do there and again, talk more user later. But it's to give our soldiers him in that that extra advantage to win the fight. And I'll just read the objectives here real quick. I don't have a slide that says that. Again, free, we'll be talking about getting counter measures. So, some of the objections would be to be able to state to organ systems involved in causing slash contributing emotion sickness. Recite the symptoms of motion sickness in there. Conflicting issues for aviation and passengers slash medical evacuees in the aircraft. Associate applying techniques for the future potential to help alleviate motion sickness symptoms. Ultimately describe the preliminary research that I'll be discussing during this lecture. And with that said, how many of you raising hands or whichever, how many of you experience motion sickness? So, a lot of us same way with an aviator a lot of times in querying them asking their past medical history, not their family past medical history. You know, have you are you afraid of heights? And I'm amazed when I have aviators tell me. Oh, yeah, I'm afraid of heights. How can you be afraid of heights and be an aviator? It doesn't jive. And same way with motion sickness, you know, these people show up for flight school. And with some of this is targeted if the 1st flight that they have during at least the army flight school. And they get motion sickness, maybe not bad to complete the flight bomb, whichever during that flight. What happens next? We have ways again, part of our policy letters to allow them to be medicated. Whether it's or 1 of the anti medics that will help them maybe get through that flight. However, if they're not able to get through that in a week's worth of 7 day time period, then they're essentially eliminated from the flight program. So, are there other ways to do so between your medication? Let's see, Jeffrey warned me that I got to do something before. Okay, again, disclaimers credits. I would like to credit as it says here, thank you. The army aviation era, aerospace medicine lab, and ultimately a calm Albion College medicine and all the participants again, as we get into the study, there were 12. Some were students, some were people with us there that came on a Saturday morning to try to go through this study with us. And 1 of the 1st objectives, obviously, we know about illness and that during travel. I mean, I do pretty well personally until I get on 1 of the wildest carnival rides or went to Epcot this past 2 weeks ago. And none of those rides had gotten me sick or motion sick. However, on a cruise line, depending until you get your sea legs, I would feel a little motion sick. So, again, I'm an aviator and had been subject to lots of different things, but I can see if I was flying aircraft and had any of those symptoms. It would not be a good thing for whether it's for me or anyone else, obviously. So, some of the symptoms again, we look at motion sickness usually goes away when the motion stops. And then some of it, it's fatigue, dizziness and easiness. You know, you're not paying attention. You're not able to function fully. And certainly any of that is not good or conducive to aviation and or any other profession within the military that you're going to have to function and be cognizant of everything going on. So, is there a way we can help me do this? And I kind of bought into the study because anecdotally, when on a cruise with a family, my wife and that, she ended up being more motion sick than I and, you know, you go for the middle of the boat and kind of higher. So, you don't get a little less motion. And I actually, you know, and she got all tense from it, but I did some OMT on her, you know, soft tissue and that, and then constraint and that helped her symptoms. So, I had already just anecdotally used that before Miss Virginia Thomas, you know, an MS2 student came up with this. So, we will continue on. So, once again, the symptoms, as you can see, is a diagnosis, self-diagnosable, typically fatigue, uneasiness, dizziness, sleepiness, all those bad things. Nausea, certainly it doesn't help any. If you're vomiting and trying to fly aircraft, they usually don't do too well together. And then ultimately whole body dizziness and malaise. And then the balance disorder. During our study, we did check from a survey and anecdotal for these students. They did a survey or the subjects, they did surveys to help identify any of this, you know, issue and or motion sickness at all. And so then, obviously, none of this is conducive to flying a pilot or the passenger for that matter. So, what causes it? Again, mentioned two of the objectives, you know, mismatching the inner ear and the eyes, sending signals to the brain. How many of you have experienced vertigo or BPV, benign positional vertigo? Anyone? So, again, for myself personally, the one time, get out of bed, fat, dumb, and happy that morning and boom, immediately thrown to the floor based on the nausea and inability to focus, you know, low crawl to the commode and sobs you wrote for the rest of the day. So, if that occurs in any regard during flying or, again, as passengers or having to perform your MOS, your specialty area in the military, it's not going to happen. So, you got to be extra careful on that. Now, and then ultimately, the signal can be interrupted by the upper body, neck OMT, is our proposed—there was very little literature on this correlating it to motion sickness itself. Obviously, we know there's a lot of OMT that we did, you know, yesterday at the school was great as far as doing that kind of a seated position OMT, looking at relief, comfort, and things. And so, all those help us perform our job or our regular duties. So, again, with this, it's not that—I was thinking initially when she proposed this, we're going to be talking about cranial sacral and that. So, if you think of it doing the temporal bones or moving the temporal bones, I know there's a lot of issues within the ear that you can help relieve or mitigate your air function and otitis medius and things in young children. So, maybe that we did not use count—I mean, the cranial, sorry, on this at all, but that may be something as any good study leads to more studies. So, it'll be something to potentially look at in the future. But again, that, in addition to counter strain and muscle energy, I think would certainly go a long way. So, again, part of our future concerns for the Army is, and all military, is what we're calling LESCO is kind of the acronym, LSCO, so Large-Scale Combat Operations. What we're expecting, again, I correlated, and this is me more so than others saying this, but to kind of the combat injuries during World War II. There's going to be a lot of them. There's going to be a lot of injury. And, you know, the past wars recently, or the recent wars, have been a lot of injuries. We had good protection, body protection. So, IEDs, talking about traumatic brain injury and that, we had a lot of traumatic brain injury. We had a lot of limb injury in that, but the person survived. So, we had a lot of amputees and things post that. This, they're not expecting people to live. There's going to be a lot of casualties, meaning, again, numbers of World War II-like. So, how do we do a couple things? How do we get them off the battlefield? How do we stabilize them on the battlefield? And just, again, how far do we move them back in that regard? And using a lot of different transportation modes, IED, that patient, whether it's our nation or the crew, what happens? Can they get motion sick and then disable them to be able to function? So, it's something big we're looking at. Certainly, we want to mitigate it. But we, as osteopathic physicians, certainly have that extra tool in our toolkit to do so and help mitigate not just motion sickness, but a lot of injuries. Dr. Birchfield and I, and we were on a committee yesterday while Dr. Neal was talking, and you guys learned all that good stuff about health and that. We didn't, so we went out drinking heavily last night and what else, and eating bad stuff. But we were there talking to the students, and we were telling them, hey, look, as a student right now, you need to get and know about the military. And one of the things Patrick had mentioned, anywhere I'd gone, I'd always had my table, because if you don't know, the HPS students should get an OMT table, part of their money package, besides other things getting paid. So, I said, have that with you. You were never without a patient if you had your table, and even if you didn't, the floor, a table, or whatever it is, you treated your airmen, your crew members, and that right there on the spot. So, I think a lot of times we underuse our skill, and especially in automated, you know, we're calling that, you're doing a lot of the review of end results for patients, but you're not really doing clinical medicine per se to help them. But, you know, we're talking about the respiratory issues and stuff. Why couldn't you use rib raising or that to help some of that prior to or in addition to a bad performance PFT? You know, from his angle, he doesn't necessarily get involved clinically with those patients, but if they came back to you as a family medicine physician or the clinical person, those certainly could be used. So, we were trying to tell the students just that, and I think they hopefully will get that thought process. Now's the time to be using these skills that we either let lapse some or just haven't had the need to use them on a regular basis. And then now I think after me, so that we're going to speak on UASs. So, our evolution of the aircraft looking at, say, the Blackhawk, so now we have something the Army's been looking at the future vertical lift. So, that aircraft itself is going to put the Blackhawk, which has been a champion since 1978 for us in the Army, that maybe that'll be a unmanned vehicle. They've already tested it. They can do that. So, would we be using that to pick up, say, packaged injured patients on the battlefield and then take it off from there? And the answer is yes, we're looking at those things in addition to, again, the future vertical lift aircraft. And there's going to be a few of them that I'll hit it on next lecture that they, the Army, have already selected that next aircraft in that regard. So, lots of different things. Again, talking about the troops, so what can we do to minimize something? You know, if you have a few minutes on the battlefield prior to them leaving, know when they have high susceptibility to motion sickness, do some muscle energy if you have the time. Again, it's going to be a hectic battlefield, and who knows what's going on at that time, but we need to get ready for them. So, part of the study, again, I mentioned the disease non-battle injury of motion sickness being potentially one of them. Has anyone recognized that device there in the picture? I see a lot of people shaking their heads. This is something that we introduce our pilots to, whether they have motion sickness or not, or they know they do, to show them the relevance of motion sickness and whatnot, as well as teach them with your eyes shut and or not be able to see on the outside of the environment, i.e. in IFR conditions where you're fully clouded in, it's dark or whichever else, your vestibular system and that will mess you up big time. So, we use this part of the study down there at UCSAN School of Aviation Medicine at the hospital at Fort Rucker. They were there on Saturday as well. We put the student in after all the treatment, and I'll explain in a minute, and what induced motion sickness, or best we know, induces motion sickness, and they use some different questionnaires, a questionnaire that tells you about the motion sickness vulnerability and or your susceptibility to it, and then treat. Yes, sir. I'm sorry? My symptoms are kind of sleepiness, kind of grogginess. I'm sorry? You might get it. It's a symptom. So, again, looking at this, how do we alleviate that? So, we had both UCSAN, a very well done collaborative effort, and like I said, we presented this two weeks ago, the full study at the AMOPS, again, showing student involvement, and really, a lot of the students were very interested. How can they get into research during their four years of medical school? Okay, so, which one's up there? So, the study, again, we had 12 healthy subjects, best we knew, kind of, you know, almost 50-50, if you will, five male, five females. Some of them were fellow students of Virginia Thomas, so they knew a little bit about OMT and things. Some of the others did not, you know, know at all. They were people that I worked with at either at UCREL or UCSAN, so if they'd been exposed to it, maybe, but we didn't ask that per se, but there were some students that were second and third years from our school that I know would have been know about OMT. So, what they did prior, they fill out a motion sickness susceptibility questionnaire, the MSSQ, and a lot of crazy questions, when, where, how long, what induced it, have you ever done this, what symptoms did you have, whether it was grogginess, sleepiness, you vomited, nausea, all these things, and it actually scales out pretty good as far as, you know, you can lie to us on this and, you know, say you don't have any symptoms and things. However, we know you're lying, because then what we did just to do that, we had some people that, oh, no, no, you know, nothing ever bothers me, but we also wanted them, you know, physiologically, we had a skin moisture temperature on them, we had heart rate, so we were monitoring symptoms, you know, one of our stalwart, you know, guys are like, oh, never. So, okay, well, how come your heart rate's up here? How come your skin's sweating? I don't have any symptoms, so we knew better, and he actually was one that, you know, again, denial of everything, but he did say in the survey, ultimately, the ONT actually helped him quite a bit, because on the side, he actually had a hell of a lot more symptoms he was willing to reveal, trying to be that manly man. So, again, we had monitored all that, and then they got into the burnie chair, and 20 revolutions per minute is kind of a standard we still use there at Army Aviation to do that for our pilots, as well as any crew members, to, again, get them familiar with and or really hone in that the idea is you want to use your instruments. You don't want to fly blind and don't trust, again, your seat-of-the-pants-type flying. So this is some of the things I said as far as our future that we're looking at. You can see the purpose, transform, we want to ensure our winning readiness. We saw some numbers yesterday as far as 2030 and 2040, I forget which lecture, but just future stuff in medicine we're looking at. So in order to get anything through the military, as Dr. Neal was saying, get stuff through OSHA or anything else, it takes a long time. So like I said, the Blackhawk is 1978 to current. How long for the new one? We have a prototype identified, but when will it actually be fielded? Maybe around 2030 for purposeful use for the military, but then 2040. So we're looking way out there. So all these issues we have to consider because what comes with technology? What comes with when do we, the pilot, become the weak link in the system and we're overloaded with information and or because of potential AI and virtual reality-type helmet gear and that that we would wear, one, does it induce more motion sickness because of the lapse of what I think I'm feeling, what I'm supposed to feel, and what I'm seeing? Virtual reality and it's getting way, way better now. There's very minimal lapse. One of the lectures we actually had at the AMOPS conference was just that. They've almost perfected that. So luckily with some of the virtual reality, there's a very minimal motion sickness, but it still occurs during some of the gaming. I don't know if you have children or grandchildren. I felt weird. I felt dizzy. I felt some of that's because of that mismatch of what they're seeing and physically they're feeling in some of the gamings that they do. So some of the results, again, on the gastrointestinal scale scores, they were improved. What we did with the treatment and the sham, one of our osteopathic teachers, OMT people from ACOM was there. So he was the steady as far as that goes. He did either sham, which he used, counter strain, muscle energy, and that kind of from mid-thorax, down, lower back. Again, some of the students may had known, but again, they felt they were getting treated some form of OMT treatment. But the actual that we felt was going to give them better relief was kind of shoulders, teeth, fore and up, looking at muscle energy, counter strain. And he, we use his clinical judgment to determine how much relief was gone. And he has a series of notes per subject that helped us correlate some of this data. And so it went hand in glove. So nothing critical other than relief, some of the tension and tightness in the upper thorax to the back of the neck. And then ultimately, you mentioned sulfite. That's again, sleepiness, drowsiness, none of these being good or conducive to aviation on the whole. Then heart rate, like I said, really was no significant scores other than people that were underreporting. We certainly knew they were just that. They were underreporting because either the results showed differently as far as the heart rate went off. You know, it's not going to go up just from playing around if you're not having any symptoms of a motion sickness type scenario. So in conclusion, the study, again, promising results to use OMT. Again, this and many other disease of non-battle injury on the battlefield. You know, he said as aviation, you're never in lack of a patient from stiff neck, upper neck, because once again, our Army helmets are typically, at least in the rotary wing, heavier than most Air Force and Navy helmets. Also, when we add night vision goggles to them, that's a strain. And especially through combat, wearing the vest that we have forces you into a forward leaning possession. And it's not very comfortable anywhere from 6, 7, even up to 8 to 10 hours of mission duty. So very imperative that we, again, use our skills in this combat scenario in that. Ultimately, we had some limitations. We're going to address the small sample size. Again, do we broaden that? Looking at, you know, a wider range of the group as far as age. Something else we didn't really look at, how long does this phenomenon last? Because we literally went from treatment table, maybe 10 minutes of a survey, right into the chair, inducing motion sickness. And so if it improved, it did. If it didn't, on some people, but we did find good results. But how long? Is that lasting enough to go to the flight line, do your pre-flight, get in the aircraft and fly and be better? Or is it short-lived and they hit the aircraft, they're still sick? So we don't know that. But I said any precluding, or I mean, introducing the study, what else can we do and how can we do it better from that perspective? So again, we looked at, we asked them, the students, please don't drink on Friday night, you know, minimize some of the potentials that would even more so induce potential motion sickness. And then, like I said, part of our stability was we did have an OMT trained and board certified physician from there, you know, helping with the study. Now, references available. Then questions and discussion. You guys hit me up with anything. I know this is kind of short and sweet, but, you know, kind of lunch period, but something we're looking at isn't there. When you say it shows good results or prominent, is it statistically significant or anecdotally? Yeah, no, statistically significant based on then two of the surveys we used for motion sickness. So they did one pre and then post the experiment, and they were reduced again, mostly the gastro intestinal and the sulfite ones, the sleepiness. So that did have significant out of our 12 subjects. Seven reported motion sickness, pretty much to anything. And then the other five, you know, like I said, we had that one stoic gentleman that nothing ever got him. But of those, it was 80% had gotten relief if they had significant. Now, they still may have had a little bit of symptoms, but much reduced. So and then I said, I didn't want to necessarily not bore you with charts and things, but, you know, we do have it all charted out, and it's going to be presented at asthma as well if you're going to asthma this year. Can you go through a day for a subject? Did you spin them and then freedom and then spin them again? Or what? How did you know? Yeah, so the day came, they showed up, we had donuts, whatever else they wanted there for that breakfast on a Saturday morning. But essentially, they were did the surveys, as far as the emotion sickness survey. So that established again, the search, and then they were given treatment. And then they were put on the Bernie chair, and induced emotion sickness. And that was it. We use then the scale to say, post treatment and where your known motion sickness symptoms reduced. And I said, 80% were in that. What type of treatment? Okay. Specifically, it was again, counter strain and muscle energy from T3 up of the T3 neck, some along the, you know, the scoliosis, outer areas that just, again, we left it to Dr. Fotopoulos, it was his name, as far as the treatment process, he identified the tension or that area that he felt, you know, to work on to help alleviate just upper neck, upper back tension. So the premise was, where does that doesn't help, you know, pulling on your neck, just the tension. And it's a thought process, not much on it. But we get some results to say, hey, maybe use this. Yes. So did you question there? And you say you treated them in it for the moment, or did you treat them afterwards? They did an initial questionnaire as far as just a generic motion sickness symptom, you know, on a roller coaster, back of a car, reading in the back seat, and a different question. So yes or no, they had it or didn't have it based on the questionnaire. Either way, they were treated sham and or the real treatment focused along T3 and up along the neck and cranial area. And then ultimately were put in the burning chair, which we know induces motion sickness. And where the symptoms post questionnaire, relieved, reduced to whichever. So some of the issues there weren't, but the two that stood out again, 80% of the patients were on the sulfite and then the gastrointestinal. So they got relief. From the norm of the very original survey. Yes, correct. Yes, sir. So there wasn't a crossover where everybody everybody got the treatment. They got 1 of the other. Yes, correct. And so he did it 50, 50 subs on the ones that had gotten the sham. If they were came out high on the questionnaire, and then we're induced, they kind of was still high. You know, there were very little difference at all of the motion sickness again, doing the sham, which was kind of T4 and below along the lower back area. Yes, sir. Look at this. How do you know you've been just there? There is a problem. This doctor, any question? I didn't know they're going into this. Good question. So something we don't know, but Patrick, as an example, he didn't know how bad he was yesterday till we started treating each other. So, you know, you don't know what you don't know. But again, we're just looking at potential foot ways on medicated to help reduce to allow that pilot to continue on. Potentially, an osteopathic physician could treat them prior to their flight line endeavor, and it reduces it. They can survive the flight. Then again, it's projecting them forward, but we got results saying it reduced it on a question survey. I think why don't you just give everybody an adjustment before that sort of that area of employment, they fly. I'm sure they would like that, but not everyone has. As opposed to you're saying this is directed towards motion sickness. Well, it would be directed specifically when we when we have a pilot that either. Falls out of the training program and or is now going to need medication to continue the program. So at least it's a potential extra modality to offer that pilot so we don't have to wash them out and we'll save them. So it's not necessary. Hey, it's going to treat everyone in motion sickness. At least it's an identified population that we, as flight surgeons there could use to help. Now, it's going to work for everyone. No, but it showed us 80% that it was effective against statistically on the people we did. Yep. Under any of the techniques that they could self administer. Other than your stills, as he told us, taking the range of his hospital or the horse and leaning your head back. Conceivably, because that's helping reduce again, just attention. Because I don't know how many of you, like you said, a lot of you raising in motion sickness. Guess what? You get tight from here up because you're puking. You're kind of masking you. So. Maybe we didn't look at that, but just thinking outside and there's no reason. Couldn't tuck a pillow or a towel or something under there that morning before you go to your flight, maybe give me some relief in the upper neck area. Yes, what I hear you saying that a limited time basis for a student level research, you discovered some promising results that probably need more in depth research later. Are there plans at Israel or anywhere that you know to do a much more rigorous research project in this? Yes. So thank you for summarizing that, Patrick. And so, yeah, the same person is going to be with us for the next 2 years because she was an MS to finish it out. So, yes, we've already put some monies forward to looking at a bigger population and more of a variety of broader age range as far as that goes. And then ultimately, another thing that we are looking at again at usual is the virtual reality and motion sickness. So how we're not necessarily implying to this particular 1, but just what is the extent of motion sickness during virtual reality? And a lot of that has to do, you know, they're going to be monitoring pupillometry and that how the eyes are moving. And so it's a whole new industry that we've got to be trying to stay with or ahead of because we know there's going to be issues there already is. And some of it, like I said, it was the technology of the mismatch of what you're seeing and moving. But now most technology is combining that. And I think they were saying, like, 0.07 seconds of a mismatch now between what you're feeling and seeing a lot of this virtual reality. Is that related to simulator sickness? Yes. And same way with simulated sickness in that we have very good simulators now. But early on in Warren and I's days there at Fort Rucker, we were trying to do everything within the simulator. You know, we said, oh, yeah, we can do similarly. But back when we had a terrain board that the gimbal of an eye went along the terrain board is what we were flying on is what we would receive in the cockpit. That was early. But you literally could crash the eye into the surface of this terrain board and you'd have to reset it. Well, once again, in the infinite wisdom in the military, if, in fact, simulators are good for flight time and getting you there, well, let's put NVGs on you too. So we would have our NVGs on doing simulator flight and we get sick as dogs because it was such a huge delay in the expectation of your flight and the movement of then this camera on this big gimbal system. And so we would go up just literally say, OK, go up in motion. So they said freeze it, wait two hours and come off motion because invariably we everyone got sick because of that mismatch. The sensor neural systems and your vision. So if we can minimize that, reduce that, go further on the research, which is expected right now that we're looking at. So again, promising. Is it going to be the cure all? I don't think so. But even in using a combination of the medicine and some OMT, is that going to help them to be able to get through that first week of training till they get familiar enough so they don't wash out of the program? Yeah, it's big. You know, we brought those lots of candidates and all, and we can't get past motion sickness. Good luck. Yeah, well, thank you. Yes, Liz. Well, I just for those of you that aren't military, so when they get a pilot slot and then wash out, you know, there's nobody that goes in that slot. So you've lost over a million dollars. Right from the get-go, yeah. So when that person washes out, you've lost a million dollars. Plus, you don't have that pilot. And the reason I'm so passionate about it, I'm on a station in Del Rio, which is by the way, and motion sickness was a huge big deal. And I don't know, the Air Force does a bunch of like a six-week program with a baritone chair, and they spin these guys and spin these guys and spin these guys. And so what they do is they over-protein the air, so when they go to fly them, they fly without getting sick. When I found out while I was down there, two years there, I lost one pilot. And what was happening was I was seeing a lot of outings that we hadn't been to, you know, on the ground, you know, in flight for X number of days, if you have to take outings. Once those days went away, we were able to treat more folks for allergy. And for the folks that were having problems, although they didn't come in and complain about it, I'm like, well, we'll try, you know, more flurries. Yeah, fair. Topical, yeah. Most of the nurses, but it was something they required every now and again, because once you lose that spot, that's it. And that's the same thing. Like you said, how do you end up desensitizing them? That is a way, like you said, but it's a long treatment process and they feel miserable. They're puking pretty regularly. And then the other is just like, you know, vertigo, benign positional vertigo. Anyone have the treatment from an ENT person at all? They drop you on like a Trendelenburg position, tilt your head simultaneously to try to, you know, reset, if you will, the little ossicles and you get sick as a dog. So treatment isn't necessarily wanted and or it's a long process. So if we have something from our expertise that can contribute or minimize either of those to save pilots a lot and save them, but also Liz didn't mention, but National Guard and Reserve, they save money up for years to try to send a pilot. And if they come down there, same thing. We try to do everything in our powers to save them and salvage them. But sadly, this is something that's fairly minimal, you would think. But obviously, look at all the symptoms of that. It's not good for flying. And if they can't get used to it, then they wash out. So every time I lost a pilot, I lost. So when you start looking at. Like that, no, it's not like, oh, there's a bunch of these people who need to slide in that slot. So any other questions? Well, thank you. And hopefully that was a little bit entertaining. Thank you.

osteopathic manipulative treatment

motion sickness

military aviation

John Campbell

U.S. Army Aeromedical Research Laboratory

non-pharmacological method

pilot washout rates