"How to Stop Hiccups"
Nearly everybody has experienced hiccups,
but what exactly are they?
The idea that a hiccup is just simple muscle spasm
of the diaphragm was apparently disproved
over 40 years ago and instead involves a complex
orchestrated pattern of muscle contractions.
But why?
It may be a leftover from the womb.
During fetal life, hiccups are universally present,
their incidence peaking in the third trimester,
suggesting hiccups might represent
a necessary and vital primitive reflex
that would permit in-the-womb training
of the breathing muscles without choking
on the amniotic fluid.
In adulthood, nearly anything can trigger hiccups.
Case in point:
19 year old woman with persistent hiccups.
Physical exam was normal except,
there was an ant crawling on her ear drum.
The ant was removed and the hiccups stopped.
And there appear to be as many cures
as there are causes.
As the famous doctor Mayo put it,
the less we know about something
the more treatments we seem to have for it.
And perhaps no disease had more forms of treatment
than the persistent hiccup.
There’s drugs of course; there’s always lots of drugs,
from thorazine to apomorphine,
but there’s also a whole slew of nonpharmacological approaches,
from breathing into a paper bag
and drinking from the far side of a glass
to smearing mustard onto your tummy.
You’ll note many of these “remedies”
have not been tested, and some appear to have been invented
purely for the amusement of the patient’s friends.
This first one here, forcible traction of the tongue,
which means pulling on someone’s tongue,
attributed to the great Dr. Osler,
the first chief physician at Johns Hopkins.
But the therapy dates back earlier to,
perhaps not surprisingly, French origins.
Another trick that might work is a modified Heimlich maneuver,
with just moderate pressure,
three thrusts and the hiccups were gone.
In general, though, treatments are disappointing;
hundreds of remedies have been tried,
but none have been found to be regularly curative.
You know doctors are getting desperate
when they start suggesting things like chilling of the earlobe.
And you know doctors are really getting desperate
when they have to tack on to the end: prayer.
This is the paper that started me down the hiccup rabbithole.
I was reviewing the latest research on vinegar
and stumbled across this.
After the failure of common treatments for hiccups,
the patient was given a sip of vinegar
and his hiccups stopped after just a single sip.
Sour tastes, such as vinegar and lemon,
have evidently been used to treat hiccups since the 1930s,
but nonpharmacological remedies such as vinegar
fell out of favor with the widespread use of drugs.
After all, how much can you charge for a sip of vinegar?
Worse comes to worst there’s surgery,
the phrenic nerve crush, which is as bad as it sounds,
but before you go down that route
you’d be surprised how many patients with hiccups
respond to digital compression of the eyeballs,
digit as in finger,
as in like pushing your thumbs into someone’s eyeballs
as a counter- irritation measure.
That will get their mind off of their hiccups.
And if that doesn’t distract them enough,
there’s always digital rectal massage.
27 year old man presents to the ER with intractable hiccups.
They try massaging other places,
they try the digital eyeball compression,
nothing really seemed to do it, so bend over.
Digital rectal massage was then attempted
using a slow circumferential motion—
and it worked!
So before giving people drugs
maybe we should be giving patients a massage.
It’s easy to perform, and may be less dangerous
than sticking your fingers into people’s eye sockets,
which if you’re in medical school
and have to memorize all these stupid names,
it's known as the Dagnini-Aschner Maneuver
(medicine loves it’s eponyms).
Speaking of maneuvers.
How’s this for a pick-up line?
Hey, *hick* wanna help cure my hiccups?
On the fourth day of continuous hiccupping,
with spousal help the patient’s hiccups vanished
at the point of climax.
It is unclear, the doctor wrote, whether orgasm in women
leads to a similar resolution
an issue, he said, that would have to be investigated further…
And it was, back in 1845, in an infamous, disturbing case report
amounting to effectively bragging about sexual assault,
published in what was to be become the New England Journal of Medicine.
A young religious woman with intractable hiccups
fell into the hands of a Dr. George Dexter
who first attempted the best modern medicine could offer–
bloodletting.
She hiccupped, though, until he pressed his hand
on her genitals for a few minutes.
And it apparently worked.
This went on for month after month
frequently calling upon his colleagues to exhibit to them
this singular phenomenon.
Who was this guy?
Although his interaction with the young female patient
would not meet today’s ethical standards,
(you could say that again)
his medical observation was considered valid,
though rectal massage and sexual stimulation may help,
this kind of recommendation should probably be reserved,
this research review concluded,
for carefully selected patients.