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A hiccup cure that really works

How far would you go to cure hiccups? Dr Karl puts his finger on a technique that really works.

Last time, I introduced you to a certain Dr Francis M Fesmire, and his patient who'd been hiccupping for at a rate of 30 per minute for some 72 hours.

Dr Fesmire came up with what is still one of the best hiccup cures around. But, before I explain what it is — let me give you a quick refresher on the nuts and bolts behind how hiccups pop into their ever-so annoying existence.

A whole bunch of muscles have to fire off around the body during a hiccup, and one special nerve, the vagus nerve, is deeply implicated.

The Latin word 'vagus' meaning 'wandering' — and the vagus nerve truly wanders over the body. ("Vagus" also gives us the English words, "vagrant", "vague" and "vagabond").

The vagus nerve starts in the brain, and then leaves the head. It travels into the chest cavity where it is involved with the lungs and heart, and deep into the gut cavity from the very top (near the mouth) to the very bottom (near the bottom). The vagus nerve coordinates swallowing and breathing, and it even runs the vocal cords.

The hiccup starts in the spinal cord in what seems to be a hiccup reflex control centre between the third and fifth cervical segments.

The vagus nerve comes into this hiccup reflex control centre, and another nerve leaves it. Electrical impulses travel down this second nerve to the diaphragm and tell it to contract, making you breathe in. Other electrical impulses go to muscles that are involved in breathing out, and switch them off. About 35-thousandths of a second after the air starts flowing in, an electrical signal is sent to the vocal cords, making them snap shut. And voilà, a hiccup is felt and heard.

One moderately reliable treatment for hiccups involves deliberately overstimulating the vagus nerve, which will block other signals to the vocal cords.

So, knowing this, our Dr Fesmire started trialling a repertoire of manoeuvres well known to stimulate the vagus nerve. The first one was setting off the gag reflex by touching a tongue depressor to the back of the throat — unfortunately, it did nothing to help his patient's hiccups. Neither did pulling on his tongue.

The next step was the Valsalva manoeuvre — where you try to blow air out from your lungs while you block your mouth and nose. This actually did slow the hiccups down from 30 per minute to 15 per minute — but only while actually performing the manoeuvre. As soon as the patient finished the Valsalva manoeuvre, the hiccup rate went back to 30 each minute.

It was the same tantalising result for both massaging the carotid sinus in the side of the neck, and for physically compressing the eyeball with the fingers. In each case, there was a brief slowing, followed by return to the original hiccup rate.

But then Dr Fesmire sudddenly remembered reading a paper the previous year with the title of Termination Of Paroxysmal Suprventricular Tachycardia By Digital Rectal Massage. (Paroxysmal suprventricular tachycardia involves the heart accelerating up to 200 beats per minute, and it can be very uncomfortable — shortness of breath, chest pain, dizziness, loss of consciousness, etc).

Now both the heart and hiccups are affected by the vagus nerve. Dr Fesmire decided that if this unconventional treatment (digital rectal massage) worked for the heart, it might work for hiccups.

As Dr Fesmire writes, "Digital rectal massage was then attempted using a slow circumferential motion. The frequency of hiccups immediately began to slow, with a termination of all hiccups within 30 seconds. There was no recurrence of hiccups during the next 30 minutes and the patient was discharged without further work up".

Why did this work?

According to Dr Fesmire: "The rectum is supplied with an abundance of sympathetic and parasympathetic nerves, and the digital rectal massage would lead to increased vagal tone and potential termination of hiccups".

Sensation from the rectum travels through these parasympathetic nerves — and they are very sensitive to pressure.

After reading this report, Dr Odeh from the Bnai Zion Medical Center in Haifa, in Israel found that this same technique worked to fix the hiccups of a 60-year-old man with acute pancreatitis. He then went on to use this technique successfully in five other patients with intractable hiccups.

In 2006, Dr Fesmire was honoured for his discovery with the IgNobel Prize in Medicine at a ceremony at Harvard in Boston.

He later told the New Scientist magazine of another treatment likely to be more popular with the hiccuping patients. "An orgasm results in incredible stimulation of the vagus nerve. From now on, I will be recommending sex — culminating with orgasm — as the cure-all for intractable hiccups."

But first, check with your health insurance provider to see if you're covered…

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