Friday, March 16, 2007

In Honor of March 16, 2007, National Hiccup Day !

Remember the last time "uck"/"glug" (excuse me), you had these embarassing , as I call them, "blips", in the middle of a great after-dinner conversation , with an even greater after-dinner partner ? And you sort of gulped some water, took a funny breath, and nothing changed ?

Well, hiccups have a funny way of appearing randomly. They dont give you a choice of sound, or a guarantee that they will last just for a short time either. You just have to, as they say, grin (try that while hiccuping), and bear it.

Let me enlightten folks about the fact that March 16th, 2007 is supposed to be National Hiccup Day.

There are various things one can do on this day. You can avidly look for people who are getting hiccups and sympathize with them. Offering them a glass of water would get you a look of wordless gratitude. If you know the person better, you can even rub their back, and pat their heads. Pinch their nose. Offer them a spoon of sugar. Look suitably pained.

Actually the word hiccup is a messed-up transformation of "hicough", which really tells you in an onomatopoeical way, what a hiccup is : a short quick cough.

Scientists have an explanation for what happens when you hiccup. The diaphragm has a spasmodic contraction, typically several times a minute. As a result of the air pressure differences inside and outside the lungs, there is a big rush of air into the lungs, and the space between the vocal chords, or the "glottis", immediately snaps shut, generating the , what else, HICCUP sound.

People have always questioned what purpose the hiccups serve. Is it a remnant left over from perhistoric days, like, the tailbone ? Is there a secret need for it that scientists have yet to find ?

Turns out that, not just people like you and me, but folks like babies still in the womb also get hiccups. Ultrasound scans have demonstratd that babies get hiccups. While one would like to think that these are, in training, for the problems they will face later on in life, thanks to pollution, global warning, inflation, food adulteration, crime etc, the real reason is different .

One theory is that the movements prepare babies' respiratory muscles for breathing after birth; another says, that they prevent amniotic fluid entering the lungs. Dr Strauss at the Pitie-Salpetriere Hospital in Paris, suggests that the contraction of the diaphragm suggests throwing "out" of air as in coughing, and not "gulping in" of air as in hiccups. He points out the similarity in amphibians having gills for breathing , in whom there is this type of glottis-closing (to protect lungs from water entering them), while water passes over the gills.

While, one may not have heard, say, a tadpole hiccuping and/or coughing , this observation of Dr Straus and his team suggests that this entire "hiccup technology", is a remnant from so many millions of years ago, and there is a great similarity in gill ventilation and the hiccuping action. While we have evolved over the last 370 million years into (hopefully) smart, twolegged thinking folks, it seems like although the need for such respiration is not required, the brain circuitry that manages it , still sits quietly dormant , and gets activated every now and then.

Scientists have also suggested that babies hiccuping in the womb, is a sort of a hint or practice for the babies, on what suckling is going to be, and something that would help them suckle easily.

While these things are serious stuff that scientists work on, we humans have hiccuped our way through history, with a plethora of cures and suggestions on how to stop hiccups.

Hiccups are commonly caused by distention of the stomach, which you get if you eat too much, drink carbonated beverages, or swallow too much air. They may sometimes be caused by all kinds of serious medical problems too, and research indicates that hiccups can be caused by people having , drastic problems like skull fractures, epilepsy, dianbetes, myocardial infarction (heart attack to us ignorant types), tuberculosis, meningitis, ulcerative colitis, and most embarrasing f all, bowel obstruction.

Children also get hiccups more oftener than adults. An ongoing myth says that hiccupping children indicates growing children. Actually, it has more to do, with their relative anatomy, size of their stomachs and other organs. Kids imbibing soda, tend to expand their stomachs which puts pressure on the diaphragm, and voila ! we have hiccups ....

There is also a school of thought that says, that a hiccup is a mechanism designed by the body to sort of "shake up" a piece of food which may have got stuck in the foodpipe, maybe due to abnormal size . Actually, our food moves down our foodpipe, due to peristalsis or successive contractions across the foodpipe, as well as due to gravity. This has to do with us humans being bipeds. However, a look back (difficult as that may be ), at human evolution of 370 million years , suggests that this hiccup mechanism would possibly be an important thing for four legged creatures, where gravity really didnt come into the picture, as the food sort of trundled its way, towards the stomach in a more or less horizontal plane.

Be that as it may, we humans are now the species of choice on this planet (at least I hope so), and it would be useful then to enumerate the various cures that are specified for hiccups:

Hold your breath for as long as possible, then swallow when you feel a hiccup is about to come.

Swallow while holding your nose closed.

Drink a glass of water very quickly, while a friend puts their hands over your ears.

Pant deeply.

Bend forward and drink water from the wrong side of a glass.

Pull your knees up or lean forward to squeeze your chest.

Pull your tongue fairly forcefully.

Use a teaspoon to lift the uvula. This is the fleshy tag that hangs down from the back of the roof of the mouth

Use a cotton wool bud to tickle the roof of your mouth, at the point towards the back where the hard roof becomes softer.

Take a teaspoonful of sugar, swallowed dry

Chew and swallow some dry bread.

Hold your breath for 10 seconds.

Breathe into a paper bag for 2-minutes, re-breathing the air inside the bag.

Using your thumb, apply gentle pressure to the space between your teeth and upper lip. Using the index finger of the same hand, apply pressure just below the right nostril on the outside of the lip.

Close your eyes and apply slow, gentle pressure to the outside of the eyelids, over the eyeballs.

Besides the above popular remedies, serious doctor types have specific remedies , say, in Acupressure, Homeopathy, Imagery, Reflexology, and even Meditation. It is suggested that folks trying for cures under these categories, make it a point to consult medical professionals before taking any medicines.

There is a yet another category of hiccups called "persistent hiccups". These are hiccups that just refuse to stop within decent intervals, and where, none of the above mentioned sensible cures work. These kind of hiccups often arise from some serious problem somewhere else in the body, and sometimes even surgery ends up being part of the solution. Persistent hiccups are more likely in men than women and, usually, decrease or disappear during sleep, but resume when the person wakes.

A typical cause for persistent hiccups could be, say, some conditions that irritate nerves near the diaphragm. This condition, could possibly be something like an enlarged thyroid. Sometimes, blood pressure medications such as methyldopa and some tranquilisers are also known to induce such hiccups. Very low levels of salt in your body may sometims serve as a trigger for persistent hiccups.

On a more serious note, the various medical conditions that can act as triggers may include but may not be restricted to : (take a deep breath, and here goes....) : skull fracture, closed head trauma, surgery, aneurysms, tumours, goitres, diverticuli, subdiaphragmatic abscess, cholecystitis, pleurisy, meningitis, encephalitis, heartburn, spicy food, gastritis, peptic ulcers, pancreatitis, achalasia, gastric distension, oesophageal rings and strictures, multiple sclerosis, cerebrovascular accidents, psychogenic, uraemia, and finally, what else , drugs. (I am surprised they left out tooth pain, chicken pox, fractured limbs, .....:-).....)

(Above study published by PETER J KAHRILAS, GUOXIANG SHI, of Northwestern University Medical School, Division of Gastroenterology and Hepatology, in a journal with the amusing name of GUT, November 1997 issue).

The tricky thing here is a thing called the Phrenic nerve. Together with the Vagus nerve , these two nerves often play havoc with a persons comfort level. When these nerves get irritated, particularly the phrenic, messages flash back and forth , to and from the nerve center in the brain, and the result is probably a command that says "BEGIN HICCUP". Basically these nerves are everywhere, so you are never sure just where you are antagonising them to throw them into a tantrum.

The cure is then based, obviously, on the original cause, and the identification of the body part , which could be the culprit.

And so we have the case, of a 16-year-old girl who began hiccuping after receiving a blow to the jaw. A brain scan found that a blood vessel was pressing against the vagus nerve in her neck. Surgeons inserted a Teflon spacer between the nerve and the blood vessel, and the hiccuping stopped. When the spacer later fell out the hiccuping resumed. Hmm.

And then there is the 27-year-old man who complained that he'd been hiccuping for four days. The doctor looked into the guy's ear and saw a hair tickling the eardrum. The hair having been washed out, the hiccups stopped.

When all else doesnt work, doctors may try drugs like chlorpromazine, or , say, tickling the pharynx (thats in your neck, just in case you get strange ideas), with a catheter stuck through the nose, sometimes even hypnosis, or acupuncture.

In India, when someone hiccups, they say that someone is remembering the hiccuping person. This is always the cause of much mirth and teasing; one has sometimes suspected whether the resultant laughter was part of a naturally and brilliantly designed solution , to get the hiccuping to stop.......

Back in 1833, with the concept of anaesthesia still to sink in, and bloodletting, leeches, and similar terrorising tactics being the order of the day, the choice treatment of persistent hiccups was, that you blistered or burned the skin above the phrenic nerve on the neck and back . (It has occured to me several times that back in the 19th century, doctors took an unusually enhanced interest in very dramatic , war-like, and violent, screaming solutions, to simple things like hiccups. The problem in those Victorian days was probably the complete inability to say "excuse me" as the hiccups kept coming everytime you thought of apologising. Perfectly revolting, hmm ? )

With the advent of the 21st century, life has become slightly more civilised.

Well, almost.

There was this 60 year old man who was hiccuping for two days, non stop. The man was being treated for a disease of the pancreas, and had a tube inserted in his nose, which kind of triggered the hiccups. They tried the obvious solution of removing this tube. No luck. The phrenic nerve never forgets. The hiccuping continued unabated. What they then tried, was , if you think about it, a very embarrasing but completely logical thing.

Logical, because if you tried inserting things thru the mouth, it would aggravate trouble in the already troubed area; if you tried inserting through the ear, you would pierce the ear drum and make the man deaf for life. The only other apertures were below the waist. What the doctors tried was a "digital rectal massage". (Those wallowing in confusion, at realising their gross ignorance of human anatomy may consult their doctors).

SHAZAM ! THE HICCUPS STOPPED. Severeal hours later they started up. Another D.R.M. was performed. And that was the end of the poor 60 year old man's hiccup problem, (and in addition, the problem of being subject to massages in embarrasing places).

In case you think I made it up, please see:

The Journal of Internal Medicine, 1990 Feb;227(2):145-6.
Termination of intractable hiccups with digital rectal massage.
Odeh M, Bassan H, Oliven A.
Department of Inernal Medicine, Bnai Zion Medical Center, Haifa, Israel.

Simple solutions for simple problems ?

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