I get calls for advice …

Though I have been retired from the practice of medicine for some time,  it is not unusual for me to receive calls for advice.  I welcome them because it is reassuring to know that I might be able someone through the health care system which, at times, can be difficult.  Common questions I am asked are: “who is a good doctor for …; can you get me an appointment; should I get another opinion; I cannot reach my doctor, can you help, etc.”

Many apologize, “I am afraid I am bothering you.” My reply, “If you think you are bothering me, that’s your problem.  I value your confidence in me.”

Last week I received a call from a dear friend who had unrelenting hiccoughs (hiccups). Because he was unable to speak, I chatted with his wife. By the time she called, he had been hiccupping for two hours. His problem jogged my memory, as I had given a lecture about hiccupping some years ago.

Hiccups (singultus) are involuntary and usually temporary spasms of the diaphragm. The distinctive hic is caused by a fast tightening of the vocal cords that follows the sudden diaphragmatic contraction. Hiccups typically start for no apparent reason and disappear after a few minutes.  However, there are cases where hiccups can get out of control, lasting for days, weeks or even months. In some, the hiccups may occur up to sixty times per minute and may limit breathing.

We’ve all had the ‘hics’. While they can be amusing when they afflict others, they can be embarrassing, painful and sometimes dangerous.  There are many causes suggested for hiccups lasting more than forty-eight hours, but none have been verified. A hair in the ear, a neck tumor, gastroesophageal reflux, sore throat, some neurological disorders, excess alcohol, and some medications are among the many.

I had given a lecture on the topic some forty years ago, so I had to dig deep into my memories of home remedies before I suggested he go to the emergency room. I told his wife to try stretching his neck with head back, a hot water bottle on his upper abdomen and sucking mints which facilitate belching. A good belch sometimes works. The tried and tested breath holding may relax the diaphragm to stop the spasms.

Some remedies I had forgotten but remembered when I searched the internet were: dissolving sugar in the mouth, sticking the tongue out, pressing the thumb of one hand into the palm of the other, singing fast, laughing out loud, sticking fingers into the ears,  pressing gently while rapidly sipping water, gulping ice water, and breathing into a paper bag. Oh well.

My friend’s hiccups persisted, so I had his wife call the emergency squad to transport him to the hospital. He stayed the night where after a series of tests and a fair amount of medication, his hiccupping stopped.

When I spoke with him the next morning, he was headed for a well-deserved nap.  As was, I trust, his wife.

** Published in yesterday’s GoLocalProv