Hiccups!

Is an involuntary tightening of the diaphragm in the abdomen forcing your vocal cords to close and resulting in the “hic” sound we are all familiar with. For the most part hiccups resolve on their own. If hiccups last more than 48 hours they are called persistent hiccups. If they last longer than a month they are called intractable hiccups, and may present as painful, frequent, and can interrupt breathing, cause GERD, irregular heartbeat, fatigue, difficulty sleeping, and weight loss due to difficulty eating. It may present as a tightening feeling in your chest, abdomen, or throat. Men are affected more than women.

Causes of hiccups include coughing, swallowing too much air, eating fast, smoking, drinking something really hot and then really cold, abdominal hernia, GERD, fast eating, intense emotions, carbonated drinks, dry rice or bread, alcohol, or laughing. Other causes include irritation of the medulla in the brain from kidney failure, stroke, multiple sclerosis, meningitis, cancer, infections, mental health problems, or damage to the vagus nerve after having surgery. From the brain to neck vertebrae C3 and C5 there is a nerve called the phrenic nerve. It is also called the hiccup center. This area allows a person to breathe out or exhale. If this area is irritated in any way the diaphragm may spasm and pulls air into the lungs, closing the wind pipe or trachea, which results in the “hic” sound.

Treatment is usually not necessary as it often resolves on its own. However, for chronic hiccups, the first treatment is the cause. For example, if the cause is GERD, omeprazole may be prescribed to treat the GERD. There is no specific treatment otherwise. Medications used in the past have been Gabapentin, Proton Pump Inhibitors, Reglan, chlorpromazine, and baclofen. Sometimes the phrenic nerve can be blocked temporarily with Procaine 0.5%, or removal of the phrenic nerve can be performed. Lidocaine gel 2% in the ear canal can trigger a reaction from the vagus nerve that may help stop the hiccups. Anti-psychotics, muscle relaxants, and sedatives have provided some help, as well as rectal massage. Home care remedies include swallowing crushed ice or dry bread to stimulate the gag reflex and thereby stimulating the vagus nerve. Holding one’s breath or breathing through a paper bag may help. Drinking something cold fast, eating a teaspoon of sugar, honey, or peanut butter are other home remedies that have been tried.

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Chronic Fatigue Syndrome (CFS)

CFS is a complex set of symptoms the cause of which is unknown. Researchers have identified symptoms of CFS up to the 1930’s. Risk factors include those over 40, although teens have been noted to have overlapping symptoms, and females. Women tend to have more severe symptoms than men. Depression is extremely common. Stress may be a trigger, as well as emotional trauma, and genetic factors. It is non curable, but managed long term.
Overlapping conditions that intersect include Fibromyalgia, multiple chemical sensitivity, eating disorders, chronic headaches, difficulty concentrating, memory problems, bladder pain, irritable bowel syndrome, sleep problems, and jaw pain.

Fibromyalgia is fatigue and muscle aches for long periods of time. It is often confused with CFS. CFS is more severe fatigue, and Fibromyalgia is more chronic pain. Additional symptoms of Fibromyalgia include tenderness to side of the neck, shoulder blade, hips, buttocks, and inside of the knee, sore throat, headache, fever, and depression. It is not curable.

Multiple chemical sensitivity occurs when certain chemical exposures cause specific symptoms.
The chemical products are common everyday items such as fabric softeners, perfumes, and air fresheners. These items may not have affected the individual in the past and symptoms go away once the chemical is removed.

There is no known specific cause for CFS, but may be a combination of viral infections, genes, psychiatric problems, immune or hormonal problems, allergies, or brain anomalies.

Diagnosing CFS is very difficult. According to the center for disease control (CDC), you must have unexplained fatigue for at least 6 months, and is not relieved with rest, and everyday activities are significantly reduced, including work, education, and social activities. You must also have at least 4 of the following during or after the 6 months: changes in concentration, or memory, sore throat, tender lymph glands, muscle aches and pain, joint pain, headaches, poor sleeping, feeling unwell after exertion for more than 24 hours.

Additional symptoms that may be felt include dizziness, nausea, flu like symptoms, and palpitations. There are many blood tests that can be performed to determine cause of fatigue, as well as other medical conditions that cause long term fatigue. These include Mononucleosis, and Epstein-Barr Virus, lupus, rheumatoid arthritis, post-lyme disease syndrome, diabetes, hypothyroidism, cancer, anemia, depression, and bipolar disorder.

If you are feeling the following symptoms without the physical symptoms then it is likely depression: feeling sad every day, weight loss or gain, difficulty or excessive sleeping, very low energy, feeling helpless or worthless, difficulty concentrating, loss of enjoyment or interest in everyday life, or restless.

Due to the severity of CFS, people tend to have difficulty working, and fulfilling responsibilities at home. They often lose their jobs, and often have little support. Memory and concentration is the most difficult symptom for many. Adults often improve or have recovery after about 2 years. Teens tend to miss school frequently, and may take up to 4 years for recovery.

Treatment involves a combination of therapies including eating a healthy diet, antidepressants, physical and cognitive-behavioral therapy, and sleep management.

Cognitive-behavioral therapy involves working with a therapist to change negative perceptions to positive perceptions about themselves and the world around them. It involves setting limits, keeping a diary, pacing activities, addressing negative thoughts, adapting to changes, and developing coping skills. CBT has shown the most successful response compared to other types of treatments.

Additional treatment efforts include balancing times of rest and activity, making tasks more manageable, and avoiding exertion, stress reduction such as deep breathing exercises, meditation, hypnosis, and yoga.

Treatment with medications depends on the individual. NSAID’s (Aspirin, Ibuprofen, etc.) reduce pain and inflammation. NSAID’s are good for a limited amount of time as they can raise blood pressure, and should not be taken by those with kidney disease, or gastric disorders. Other anti-inflammatory drugs, such as, Celebrex, can be prescribed but also have side effects.
Antidepressants can be helpful, but side effects include constipation, and dry mouth. Stimulants, such as, Adderall, and Ritalin, can help with concentration and short term memory problems.

Alternative therapies include vitamins, minerals, and dietary supplements, such as, co-enzyme Q10, Vitamin B12, St. John’s Wort, Melatonin, and Gingko. All of these drugs have been on the investigative end and there is no evidence they are beneficial.