DEAR DR. GOTT: I am a 48-year-old female who has suffered with debilitating nausea for about 15 years. I have been to many doctors and have had many tests. They still can't find the reason for my nausea.

I saw your article about slippery-elm bark and am thinking of trying this herb. At this time, I am taking ondansetron and domperidone. Some days I get a little relief. I also take oxycodone, tizanidine, amitriptyline/perphenazine, lorazepam and sometimes lansoprazole. I was wondering if I could also take the slippery-elm bark and would appreciate an answer as soon as possible.

DEAR READER: There are countless causes of debilitating nausea, including Addison's disease, pancreatitis, depression, medication side effects, gastroesophageal reflux disease, chemotherapy and other possibilities. The condition can be physical or psychological in nature — induced by pain, medications and non-gastrointestinal diseases of several organs.

While you list your medications, you don't specifically state why you are taking them. For example, ondansetron is used to prevent nausea and vomiting caused by medications for cancer, but it can be prescribed for other reasons. Domperidone treats nausea and vomiting caused by drugs to treat Parkinson's disease. Tizanidine is a short-acting muscle relaxant, but can be prescribed for other reasons. This medication is prescribed for muscle spasms, spinal-cord injuries and for patients with multiple sclerosis. Amitriptyline/perphenazine is prescribed for anxiety, depression and agitation, as is lorazepam. Lansoprazole decreases stomach acids and is taken for ulcers and gastroesophageal reflux disease (GERD). Oxycodone is a narcotic pain reliever.

From all of this, I could guess you might have cancer, Parkinson's disease, MS, a spinal-cord injury, pain of unknown origin or any combination thereof. However, I think your prescribing physician is attempting to cure your nausea by recommending drugs for a reason other than what they were originally designed to help. This is a common practice that has been met with a great deal of success.

Has your doctor considered alternatives, such as the slippery-elm bark, or a scopalamine transdermal patch used to prevent nausea and vomiting experienced with motion? How about a tablespoon of apple cider and a tablespoon of honey mixed in cold water and consumed at bedtime, or consuming a few slices of crystallized ginger, or taking ginger pills daily? Do you have a food allergy? You may be experiencing a cross-reaction with your many drugs. Is the same physician prescribing them all? Or are you seeing more than one doctor who doesn't know what another has ordered?

You need to get to the bottom of the problem so you can be relieved of your symptoms and get your life back on track. I recommend that you document a relatively brief accounting of what caused the nausea originally, what medications were prescribed, and what, if anything, provided relief or didn't. Does it occur before breakfast, during the workday, when in the shower or grocery store? There may be a history you are overlooking that can solve the problem. Because of the length of time involved and the number of medical contacts you have made, something is definitely being overlooked.