Q: I'VE HAD chronic hiccups since March 2021 - generally every three days, lasting for three days and keeping me awake at night, leaving me exhausted. The attacks only stop when I get a spasm that cramps my jaw, forcing me to breathe through my teeth until it abates. My consultant suggests it might be related to my diagnosis with sensory motor axonal neuropathy.
RP
A: HICCUPING IS caused by a sudden, involuntary contraction or spasm of the diaphragm, the domed horizontal sheet of muscle that separates the chest from the abdomen. The intercostal muscles, between the ribs, are also involved.
The spasm causes a sudden drawing in of air, causing the glottis (the area between the vocal cords that connects your throat to your lungs) to close, resulting in the ‘hic’.
This involuntary contraction is due to a reflex action, involving several nerves, in particular the phrenic (which causes your diaphragm to contract, allowing you to breathe) and the vagus (involved in key body functions such as digestion, and breathing and reflexes such as coughing).
Hiccups are typically caused by benign factors such as a large meal, or fizzy drinks.
When it comes to prolonged hiccups there are many possible triggers, although it’s usually linked to irritation or damage to the vagus or phrenic nerves - for instance, after surgery, as a complication of stroke, diabetes or chronic reflux (stomach acid can irritate the nerves).
In your longer letter, you mention that your gastroenterologist has carried out detailed investigations including an MRI scan and a gastroscopy, an examination of the upper part of the gastrointestinal tract.
From what you say, it sounds like neuropathy - or nerve cell malfunction - is the likely cause in your case. The effects on your health shouldn’t be underestimated, as the interruption to eating, drinking and sleeping can lead to fatigue and low mood.
The standard first-line treatment for chronic hiccups is a four-week trial of a proton pump inhibitor drug, such as omeprazole, to suppress stomach acid secretion.
If hiccups persist, the next stage is a two-week trial of baclofen, an anti-spasticity drug, or gabapentin, an anti-convulsant.
And if that fails the next option is metoclopramide, an anti-nausea drug (also helpful for hiccups), for another two weeks.
If the hiccups persist after that, the next step is chlorpromazine (a tranquilliser, this is thought to have a local effect on the irritable diaphragm, or produce a calming effect in the brain). A number of other medications have been reported as helpful for this complaint, including other anticonvulsants and antidepressants (at lower doses than for treating mood, these can calm nerve activity).
Most recently, a study reported that a combination of olanzapine (an anti-psychotic, with an effect similar to chlorpromazine on hiccups) with baclofen is effective.
All these options are prescription-only medicines and must be taken under the supervision of your GP or your gastroenterologist. Careful trials of these drugs, with support from your doctor may provide the relief you seek.
Q: MY MUM, who is 92, is bedbound after failed hip surgery 18 months ago. She’s too frail even to be hoisted from the bed to a chair. Add in glaucoma and Alzheimer’s and it is amazing how sunny and bright she remains every day. I’m her full-time carer. Before her surgery Mum regularly attended eye hospital, dentist and chiropody appointments, plus a visit to the memory clinic. Now it’s a case of if you can’t attend in person, we can’t help you. Maintaining Mum’s health is vital - why does it feel like she’s already been written off?
GE
A: YOU HAVE a hard task being a full-time carer and nurse for your bedbound mother: I admire your resilience.
There was a time when a GP would visit a patient in your mother’s position on a regular basis and galvanise such services as necessary to maintain the quality of her life. The pressures that are now so evident in the NHS have meant that degree of care has become almost non-existent.
I have no doubt that your mother is eligible for chiropody and eye testing at home on the basis of her immobility. It’s within her GP’s remit to organise for her chiropody needs to be assessed at home, and future visits should follow. Similarly all patients over the age of 60 are entitled to free eye testing on the NHS. There are criteria for assessing the need for a home visit and undoubtedly your mother is eligible.
And given her history of glaucoma, she must have her eye pressure checked regularly to ensure she’s on the correct treatment. It’s worth visiting a local optician and asking about this.
Talk to your GP, and if your request for these essential services is dismissed I would advise you to complain.
© Solo dmg media
