Just One More Question by Niall Tubridy

Author:Niall Tubridy
Language: eng
Format: epub
ISBN: 9781844884582
Publisher: Penguin Books Ltd
Published: 2019-01-22T16:00:00+00:00

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MORE THAN JUST A HICCUP

Something as mundane as a hiccup, which we all experience, can be a case of food going down the wrong way or it can herald a cataclysmic brain injury. So while most normal people will wait for an episode of hiccups to blow over, or hold their breath to stop them, a hiccupping neurologist will worry about his brainstem. No wonder we seem weird to many people.

A hiccup is an involuntary spasmodic contraction of the diaphragm followed by the rapid closure of the vocal cords. Hiccup, hiccough or singultus are interchangeable terms used to describe this phenomenon. What causes them and what function they serve in evolutionary terms is not clear. Generally people can get a brief bout of hiccups after consuming particularly spicy food, alcohol or even hot drinks, but they can arise as a result of any condition that irritates the nerves that control the diaphragm (the muscle that controls breathing).

As we all know, hiccups only usually last for a few minutes, or at worst a few hours. Most commonly, they stop suddenly for no obvious reason and some attacks can be stopped by blowing into a paper bag or drinking cold water. Hiccupping that goes on for more than two days is labelled ‘persistent’, and hiccupping that lasts more than a month is ‘chronic’.

The vast majority of cases are benign, but hiccupping can be associated with lung diseases like pneumonia, with kidney failure, and with disorders of the stomach and bowel. Hiccups can also be due to neurological damage in the lowest part of the brainstem, called the medulla. Such conditions include strokes, cancers and infections. So, for example, I have seen people present with hiccupping for days on end as the first sign that they’ve torn an artery in their neck, which has led to a small stroke.

I was called to Casualty to see Joseph, a 38-year-old Scot who was having difficulty swallowing. Earlier that day he had been doing the front crawl in the swimming pool and after getting out of the water he complained of some pain in his neck. He did not put too much store by it. He had been a rower and had had a fair few neck injuries in his time. But at home an hour or so later he started choking on his evening meal. He could not swallow the roast potatoes, however small he cut them. Then he started to hiccup, and did not stop.

Joseph’s hiccupping was the first sound I heard when I approached his trolley in a pretty chaotic Casualty. He and his wife both looked exhausted and troubled. I explained that I had been asked to have a look to see if there was a neurological cause for his swallowing problems and persistent hiccupping.

His speech was very slurred and I found it hard to understand him, so I proceeded with the examination. The combination of the neck pain, the sudden onset of his symptoms and the slurred speech suggested

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