Retired medical assistant Colleen Kennedy was ready to wipe out chemotherapy and radiation for stage 3 lung cancer. She didn’t expect the bouts of hiccups that began midway through her first round of therapy. They triggered her vomiting reflex, causing her to vomit. They were, as Kennedy, now 54, told me, “not quite comparable to what we would consider normal hiccups”.
Hiccups are one of the most common physical experiences humans (and rats, squirrels, rabbits, cats, dogs, and horses) have. Even fetuses get them. When you hiccup, your diaphragm involuntarily contracts and your vocal cords snap shut, producing the eponymous “hic” sound. These spasms usually go away within minutes. Compared to the existential threat of cancer and the brutal reality of treating it, hiccups are harmless, commonplace, and not serious. But these two experiences are strangely related. .as many 40 percent of cancer patients deal with bouts of hiccups during their illness.For a smaller subset – about one tenth—Their spells last for over 48 hours.
Chronic hiccups interfere with almost every aspect of life. It interferes with concentration and conversation. They wake people up. Eating, drinking, or swallowing can make you feel suffocated. Chest pain often persists long after the hiccups have subsided.
And they are difficult to treat. Doctors have some off-label prescriptions at their disposal, but none have been rigorously tested. Kennedy tried to cure his hiccups by taking a deep, forceful breath and drinking water from the rim of his glass. She also trained to exhale before drinking or eating to limit the amount of air she swallowed. “Sometimes it worked, but most of the time it didn’t,” she said. Many people try chiropractic or acupuncture. Others recruit household items such as sugar, lemons, vinegar, pencils and cold spoons. Hers is the only hiccups drug approved by the Food and Drug Administration.
One of the most basic physiological features of human life, hiccups, remains deeply enigmatic and surprisingly lack of study—partly because their fleeting nature makes them difficult to examine, and partly because they seem so harmless. Face how powerless you are against the whims of
In popular culture, hiccups are a joke. Looney Tunes A little from 1942, Daffy Duck’s hiccups cause his hat to bounce. Foster’s house for imaginary friends, Blue tries everything to cure his hiccups—he pours boxes of sugar into his mouth, blows into brown paper bags, drinks hot sauce, eats peanut butter, gets scared, takes small bites and big gobs. Take, standing on his head and brushing his teeth while singing, swallowing lemons. nothing works. in the 1937s Snow White and the Seven Dwarfs, Dopey accidentally swallowed the soap and started having hiccups. 1970s fashionable cat, Uncle Waldo drinks too much and has a hiccup. in the 1975s Monty Python and the Holy Graila guard with hiccups was ordered to get a drink from the king remove he sick of him. In the 1992 episode simpsonsA man with hiccups for 45 years gives this 4-second interview to his local Springfield TV news.
In medicine, hiccups are a conundrum. “As far as we know, hiccups don’t have any benefits. A transient symptom that comes and goes at random, hiccups are almost impossible to study rigorously. Therefore, experiments on treatments are not possible.” , is a nightmare to organize.To date, only a handful of randomized controlled trials have studied pharmacological treatments for hiccups, none of which have recruited more than 40 patients.Most studies have , relies on storytelling: analysis of databases of single-patient case reports, limited case series, and physician notes.
What we do know: Sudden changes in temperature can trigger hiccups, as can drinking alcohol, eating spicy foods, and being agitated or stressed. High blood sugar may be the cause. So are low sodium or electrolytes. Many drugs have been associated with hiccups, including steroids, chemotherapy drugs, benzodiazepines, opioids, nicotine, antibiotics, anesthetics, anti-nausea and blood pressure medications. Some drugs used to treat intractable hiccups include: cause hiccup.of 1 case studyThe patient’s hiccups were caused by a hair hitting his eardrum.of anothersince 1988, the culprit has been ants crawling around the eardrum.
Medical conditions associated with hiccups span the entire upper body: stroke, brain injury, meningitis, multiple sclerosis, ear infections, rhinitis, goiter, sore throat, pneumonia, bronchitis, asthma, tuberculosis, Lung or heart fluid, bloating, gas, pregnancy, hernias, ulcers, liver disease, kidney disease. and cancer.
Experts offer two main explanations for the relationship between cancer and hiccups. One, cancer invading the chest, throat, or head (i.e., along the path of hiccups) triggers them. Prescribed drugs made cancer patients worse. Whether caused by the cancer itself or a side effect of treatment, hiccups are an even more distressing experience.
one study A study published in 2022 showed that hiccups significantly impair quality of life in about 1 in 20 cancer patients surveyed. Nearly one in three people with hiccups said they had trouble relaxing or recreating them. Very few people said they could not enjoy their meal.another study Of the 320 cancer patients, 1 in 10 went to the hospital for help because of hiccups. Other studies suggest that more than three of his four patients with hiccups manage their seizures without medical intervention.and investigation Of the 90 cancer care providers who experienced hiccups, 40% rated the severity of their patients’ hiccups as worse than nausea or vomiting.
Still, experts say hiccups should be put aside for patients and health care workers alike.
Given the speed of the doctor’s visit (about 23 minutes on average), TotalFor cancer patients, hiccups may be too low on the list of concerns worth mentioning, but “I think part of what happens is that patients are a little embarrassed to bring it up.” Or, “Patients may want to be ‘good’ patients, not to complain,” said Jatoi, an oncologist and palliative care specialist at Johns Hopkins University. says Thomas Smith. Negative side effects.
Oncologists do not consistently or directly ask about hiccups in the way they screen for pain, nausea, and difficulty breathing. “I don’t know of a single symptom rating scale in use that has a line for hiccups,” Smith told me. “When I told my doctor that I had hiccups all the time, my doctor shook his head like I was joking,” said one patient. wrote to A hiccups researcher at the Mayo Clinic.
As such, hiccups have been relegated to the category of “isolated” symptoms, common, distressing, and characteristically unaddressed. These include restless legs syndrome, loss or distortion of taste, dry mouth, and sweating. Each hiccup, itch, tingling leg, sweating, or constipation leads the patient into a raw state of consciousness. “It’s a common reminder that you’re on chemotherapy. It’s a constant reminder that you have cancer, a constant reminder that you’re facing death.” Smith said, treating hiccups provides medical relief in the form of escape. “Patients may be able to have a few hours where they don’t think about cancer.”
Jatoi often warns patients about to start regimens that can induce hiccups. “It helps patients speak up,” she said. This is one step toward finding relief. Oncologists can try prescription treatments for muscle spasms. For example, off-label use that may help some patients. They may tweak their chemotherapy regimens and replace them with drugs that are less likely to cause hiccups. , and can have serious side effects, which studies have shown include hypotension and delirium.
In the absence of a clinically proven solution, most hiccups are directed to home remedies: breath-holding therapy. Drink with a non-sucking straw. Swallow a spoonful of sugar, peanut butter, or vinegar. “None of them have been tested for how effective they are,” Smith said. After all, unlike the hiccups themselves, “they are completely harmless.”
