Apple #302: Hiccups

Last night I had the hiccups for quite a long time. I was hoping they'd go away on their own, but they kept happening. So finally I took my usual remedy -- which has never failed me, not once -- and they went away.

I'll tell you my never-missed-yet cure for hiccups in a bit. But first, I want to find out more about what hiccups are.

• Hiccups happen when your diaphragm gets spasms.

• The diaphragm is a wide sheet of muscle that stretches across your abdomen below your ribcage. It's the muscle that makes your lungs expand and contract so you can inhale and exhale.
  

• When the diaphragm spasms, it contracts downward, making your lungs expand and pull in air. At the same time your vocal chords (glottis) are also drawn closed, and that makes the vocal sound. But instead of exhaling through your vocal chords which is what you usually do when you speak, you are inhaling, and that's why the vocal noise sounds funny -- and even sometimes unexpectedly loud.

What normally happens when you exhale is on the right. What happens during hiccups is shown on the left.
(Diagram from Humanillnessess.com)

• A bunch of nerves (phrenic nerves) at the base of your neck in your spinal cord are what control the diaphragm. When those nerves get tripped in a certain way, they tell the diaphragm to start spasming. And you start hiccuping.

• Various events can make those nerve endings freak out and get your diaphragm spasming. Some of those triggers include:

• Eating too much food too quickly
• Swallowing too much air (chewing gum often makes this happen)
• Drinking too much alcohol
• Smoking
• Changing the temperature in your stomach too quickly (drinking something hot and then something cold immediately thereafter)
• Getting really excited or shocked or stressed out about something

In 2003, one month before this photo was taken, Christopher Reeve had surgery that allowed him to breathe without a ventilator, though he still needed it for speaking. This was possible because his phrenic nerves were still intact to his diaphragm, though the connection between the nerves and his brain was severed. The surgery implanted an electrode device which sent the signal to the phrenic nerves, which in turn told his diaphragm to function. Reeve had been paralyzed from the neck down in a fall from his horse in 1995.
(Photo from Wikipedia)

• Some techniques for getting rid of hiccups work, scientists think, because they calm down those freaked-out phrenic nerves in your neck. Specifically, if you increase the amount of carbon dioxide in your blood, that extra CO2 sort of dulls those nerve endings, your diaphragm stops spasming, and the hiccups stop.

• Some hiccup-relieving techniques that increase the CO2 include

• Holding your breath for 10 full seconds

• Breathing repeatedly into a paper bag for a minute or so

• Slowly sipping a glass of water without pausing to breathe

• Drinking water from the opposite side of the glass (I've never understood how to do this)

• Other techniques that people say are effective include

• Placing a teaspoon of sugar or honey on the back of your tongue and swallowing it

• Pulling on your tongue with your fingers (how delightful)

• Rubbing the roof of your mouth with your index finger

• Biting into a lemon

• Sitting down and leaning forward so that your chest and diaphragm are pressed against your knees

• Having someone startle you (this one has never worked for me)

• About 50 more suggestions are described here

• Those suggestions have all probably worked for some people at one time or another. But the ones in that list that I've tried have not worked for me.
  

• But this technique I read about several years ago has never failed me:

• Fill a drinking glass with water and put a spoon in it. Make sure the spoon is tall enough so that the end stands above the rim of the glass.

• As you bring the glass to your mouth, make sure the end of the spoon rests in that spot between your eyes and above your nose.

This is essentially what my cure looks like. The girl in this photo is Jennifer Mee, who had the hiccups for several weeks in 2007. Apparently, this is how she finally got rid of her hiccups, but I can't get the video from the TODAY show to work, so I'm not certain that this is what did the trick for her.
(Photo from MSNBC TODAY)

• Hold the spoon in that position while you drink the water in the glass. Don't allow the spoon to move and drink all the water, or as much as you can without stopping.

• When you put down the glass, your hiccups will be gone.

• I have done this enough times -- and with success each time -- that now, I no longer need to put the spoon in the glass. It is enough if I press my finger to that spot on my forehead between my eyes while I drink the water. But if I just drink the water without doing that, it doesn't work.

• If your hiccups last longer than 48 hours no matter what you do, these are called persistent hiccups, and it is time to go to the doctor.

• If the hiccups last longer than a month (this is very rare), you have what's called intractable hiccups. It is really time to go to the doctor if you're hiccuping this long. Not only would this drive you out of your mind, but intractable hiccups are often related to more serious health problems, such as

• Major illnesses that affect the central nervous system, including cancer, stroke, injury, or infections

• Metabolic dysfunction or decreased kidney function

• Damage or disruption of the vagus or phrenic nerves due to surgery, anesthesia, or injury

• Mental health issues

• In cases of persistent or intractable hiccups, the doctor can try other techniques to stop the hiccups, such as

• Using a spoon to lift the uvula (the thing that hangs down at the back of your throat and that gets drawn in cartoons a lot)

(Diagram showing the uvula from Just Janet's blog)

• Applying pressure, electrical stimulation, ice, or anesthetic to the back of the neck

• Emptying the stomach
  

• Stimulating the pharynx by inserting a tube through the nose or mouth

• Massaging the diaphragm using a "digital rectal massage"

• Conducting surgery to interrupt the phrenic nerves

• Men get persistent hiccups more often than women do.
  

• When women do get the hiccups, it tends to be during the first two weeks of their menstrual cycle. Women who are pregnant (and not ovulating) get the hiccups far less often.

• Premature infants spend 2.5% of their time in the womb hiccuping -- which is way more often than babies do once they're born and breathing air out here with the rest of us.

This woman is eight months pregnant, and her fetus has the hiccups.
(Video from YouTube)

• All of us tend to get hiccups more often when we're tired. That means hiccups happen more often in the evening, and as we get older.

• Nobody is sure why we get the hiccups. But one anatomist, Neil Shubin (University of Chicago), noticed that hiccups are very similar to what happens when fish breathe through their gills. So he thinks that hiccups are an evolutionary left-over from when human bodies used to be fish bodies.

Sources
WebMD, A to Z Guides, Hiccups
Healthscout, Health Encyclopedia, Hiccups
Howstuffworks, How Hiccups Work
Neil Shubin, "So who are you calling fish-face?" The Guardian Observer, February 10, 2008