Serious Health Implications of Hiccups (by Dr JB Lim)

The Blogger's note:

Further to the simple explanation on short-term hiccups that last for a few minutes or at most a few hours as reproduced in the previous post, Dr JB Lim continues to elaborate on the case of chronic hiccups that continously last for days as follows:

Wednesday, 30 March, 2011 6:44 PM

Dear and all,

I really do not know the causes of your 5-6 days of continuous hiccup as I did not see you. So there is no reason for me to make guesses. What I described earlier was for short-term hiccups lasting just a few minutes or a few hours at the most. As I said, the most common cause for short duration hiccup is just due to a compromised perfusion (blood flow) and temperature changes around the pharyngeal region.

Vagus stimulation:

But it could also be due to anything that irritates or stimulates the vagus nerve such as an over distension of the stomach walls (remember, the 10th cranial or vagus nerve is the longest of the 12 cranial nerves which also supplies branches to the stomach.). Any stimulation anywhere along the vagus nerve will be referred all along the path of this nerve, including to the pharynx.

So the stimulus of an over-eating (distension of the stomach) can be referred up to the pharynx and even SOB (short of breath) and difficulty in breathing (dyspnoea) by transmitting stimulation of the phrenic branch of the vagus nerve.

Low blood and oxygen perfusion:

Gases from drinks, and flatulence in the stomach, as well as alcohol have a similar effect. But the most common cause as I have already explained is still due to a compromised perfusion and a lowering of temperature in the laryngeal-pharyngeal region which can easily be corrected by merely drinking warm water slowly to warm up the throat region. The ‘cure’ is instantaneous.

How a warm drink works:

Any heat applied to the region of the throat has two main actions:

· Heat dilates the blood vessels (vaso-dilating effect), and sends warm blood to permanently take over.

· Heat inhibits the stimulation of the glossopharyngeal, sympathetic, and external laryngeal and hypoglossal nerve (the pharyngeal plexus) – branches of the vagus nerve that causes the numerous constrictor muscles in the pharynx to contract in hiccups.

'Chronic’ hiccups:

But if you have continuous hiccups lasting 4-5 days, then other causes need to be investigated, such as infection and inflammation of your throat, any tumour, growth, goiter in the neck, or in the ear – all of which serves the same effect – stimulating the accessory 11th nerve, an offshoot of the 10th cranial nerve (vagus or pneumogastric nerve). Smoking may also cause the same effect, especially first time smokers.

Summary:

In short, any form of stimulation of the vagus nerve – whether due to compromised blood flow, lowering of temperature, tumour, goiter, infection and inflammation -whatever the cause(s), a sore throat or laryngitis, gastric juice regurgitation from the stomach up into the gullet (gastroesophageal reflux), or anything at all – can cause hiccup short or long term.

However, if the stimulation is continuous, prolonged, and over stimulated, as in your case, that part of the nerve and body (motor response) will undergo sensory fatigue and then go into exhaustion.

This means it can no longer respond to any neurological stimuli, and your hiccup disappears automatically (Local Adaptation Syndrome –LAS). Your hiccup will thus disappear automatically when it sinks into the exhaustion stage. This I believe was your case if you do not have the more serious underlining causes I have described.

Not possible to diagnose:

So it is not possible for me to identify as to why your hiccup last for days when I have not even seen you. I need to see and examine you, question you, and take a lot of history to look into any one of the root causes before making an inference. That’s the proper way.

A simple self examination:

But what you can do without even the need to see a doctor is to take your heart rate at that time. If your vagus nerve was stimulated, your heart rate will be slowed down – less than 60 beats per minute (bradycardia). Just feel your resting pulse rate and time it. Do this many, many times before waking up from bed in the morning. This is your basal or resting pulse rate. Compare the data during your period of hiccups, and after they mysteriously disappeared.

Statistical analysis:

Next, analyze the data statistically for the mean, standard deviation, and perform the valuable ‘t-test’ and see if there was actually a real statistical difference within a 95 % confidence level between the two sets of data. That will tell you scientifically if the difference was real - due to vagus stimulation or something else.

If you do not know statistical mathematics, just pass the data to me for analysis. I will do the job for you (free-of-charge). This is what we call medical research.

It is as simple as that - just like I now type ABC here or count 1,2,3.

I hope I have answered your question.

Regards

juboo lim

*********************

On the lighter side:

Man: Doc, what is the best method to stop a hiccup?

Doc: (He walked behind the man and gave him a big slap on his back)

Man: Doc, why did you do that?

Doc: You don't have any hiccup now, do you?

Man: Yes. I don't have any hiccup now. But my mother outside in the car does.

(Courtesy of forwarded mail from Joseph Ng Moo Eng)