September 25th, 2020

Doctor Game: Are hiccups a nuisance or a medical problem?

By Gifford Jones on December 30, 2019.

Hippocrates, in 400 B.C., counselled that, “Sneezing will stop a hiccup.” But for centuries the hiccup also triggered laughter when it happens while talking to friends. But medical reports show there are occasions when a hiccup is no laughing matter.

We all know that everyone encounters hiccups at some time in their life. Most of the time they’re completely harmless and eventually stop after a brief period.

Hiccups happen when the diaphragm, the muscular structure separating the chest and abdominal organs, experiences a sudden involuntary spasm. This spasm is followed by closure of the slit-like opening between the vocal cords causing the hiccup.

Dr. Timothy Pfanner, assistant professor of medicine at Texas A&M University College of Medicine, says persistent hiccups may last more than 48 hours, and intractable, longer than 30 days. He prescribes medical help if hiccups change from occurring once in a while to becoming more persistent.

Pfanner adds hiccups are seen more frequently in smokers, who are constantly swallowing air which distends the stomach. It’s also a problem for those who consume excessive amounts of alcohol. This triggers hiccups when stomach acids back up into the lower end of the esophagus (food pipe). Other cases may be due to ear infections.

Sometimes hiccups are trying to tell you and your doctor something. One 68-year-old man decided to get medical attention after being plagued with hiccups for four days. Examination revealed nothing serious, so he was prescribed a muscle relaxant to calm the annoying reflex. Two days later the man returned with the same symptom. This time doctors did more tests and discovered he had suffered a coronary attack.

Pfanner says doctors should start worrying when patients have intractable hiccups. In these cases something serious may be causing the problem such as cancer of the brain or a malignancy of the stomach. In fact, he says, hiccups may even point to a tumour in the neck or goiter. And since repeated hiccups convulse the muscles that control the diaphragm, patients who experience persistent spasms, can develop damage to the nerves that control these muscles.

But I must repeat, don’t panic if you have hiccups, as they’re usually more of a nuisance than a signal of a life-threatening condition.

To see how hiccups are treated I looked at old medical texts. One gave the best advice, do nothing. They fade away. If they don’t, several home remedies were suggested which involve increasing the amount of carbon dioxide in the blood. This can be achieved by holding the breath and counting slowly to 10 or by breathing into a paper bag for a short period of time. But in both cases, stop before you get dizzy.

Another old medical text suggested gently massaging the eyeballs, but being gentle so as not to injure the eye. This same book said that pulling out the tongue with a clean handkerchief for 20 seconds often worked, but to do it yourself. Or try swallowing a tablespoon of sugar. And if all else failed, one doctor suggested standing on your head.

Why do I mention old rather than new remedies? It’s because with hiccups not much has changed. For most hiccups, holding your breath is as good as any prescription.

I enjoyed the advice of another old medical text. It suggested that if hiccups bother you too much, “Take a good shot of whisky and go to sleep. If you can’t sleep, can’t rest, can’t eat, then see a doctor.”

This reminded me of Dr. William Osler’s advice for a cold, “Go to bed, put your hat on the bedpost, start drinking whisky, stop when you see two hats.”

Sometimes, old advice is still the best advice.

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