Ever felt like your hiccups would never stop? For Chris Sands, that was his reality for 3 years before the cause of his hiccups was diagnosed. Find out what hiccups are and what causes them, including some rare life-threatening causes.
Following is a rough transcript (Note that errors are possible):
Chris Sands: Then you start to feel the dead-end hitting you, the wall. Where you're like, "Oh no. Is this going to last forever?" Then at one point, probably 4 o'clock in the morning, I still was hiccupping or whatever. I thought, "Well, I'll just write a letter to our local newspaper." Just like, "If there is anyone out there that can, just please help me."
Siobhan Deshauer, MD: Hey, guys. I'm Siobhan a 5th-year medical resident.
Now, we've all had the hiccups that lasted just long enough that it felt like they would never stop. For Chris Sands, that became his reality. He hiccupped for 3 years straight and tried every possible cure. When all hope was lost, he had a surprising opportunity that led him halfway around the world, where he finally discovered the cause of his hiccups. Today you'll meet Chris, hear his story, and learn everything you'll ever have to know about the hiccups.
Before Chris got the hiccups, he was a 23-year-old aspiring musician living in England, playing the guitar and composing for a punk band. Then one day in 2007 he got the hiccups and his whole life changed.
Sands: I didn't know. It was like, once every couple of seconds I guess. Yeah. It was quite severe. Sometimes it would speed up, sometimes it would slow down, and sometimes it would stop for an hour. Or I can feel them coming back and you're doubling over, and trying to resist this kind of nervous internal feeling.
It's that kind of thing. You can feel it coming back all the time, all the time, all the time. Eventually, it gets you, bang, and then you're hiccupping, hiccupping, hiccupping, hiccupping, hiccupping all the time.
Narrator: This is Day 1 of Christopher's diary. He is supposed to have gone for a massage, but he's been 48 hours awake.
Deshauer: These painful hiccups tormented him day and night. When he would try to eat, the hiccups would make him vomit. When he wanted to go to sleep, they would keep him awake at night.
Sands: I was still hiccupping in my sleep. I was hiccupping while I was sleeping and then I would wake up and I'd still be hiccupping.
Deshauer: Before we go any further, you need to understand what happens when your body hiccups. A hiccup is a contraction of the diaphragm followed by closure of the vocal cords. Your diaphragm is a thin, flat muscle right under your lungs. When it contracts, air flows into the lungs until the vocal cords suddenly close, causing that hiccup sound.
What causes the hiccups? Well, anything that irritates the phrenic nerve, which controls the diaphragm. The most common causes are related to the stomach bloating and pushing up on the diaphragm -- things we've all experienced like eating too much, eating too quickly, spicy food, bubbly drinks, or even heartburn.
The phrenic nerve goes from the diaphragm up into the chest and goes behind the heart. That's why it's a rare symptom of heart attack. The nerve then passes up to the neck, and so an enlarged lymph node or thyroid gland can also be a cause of hiccups.
Then finally, the phrenic nerve connects up to the spinal cord and then up to the brain -- and you guessed it. Things like a stroke, brain tumor, and even infection like meningitis can all cause the hiccups. Plus other conditions that generally irritate the nerves like alcohol, other medications, diabetes, kidney disease, or electrolyte abnormalities.
Although most hiccups are harmless, the ones that are persistent can be a symptom of a life-threatening condition and they need to get investigated.
Sands: I have been Googling, as we all do nowadays, what the hell to do and what it could be. You always find, "Oh, it's probably cancer," and AIDS and brain tumors. It's all of the worst things in the world you can imagine being wrong with you. I went to the doctors and they started the process of trying to find what's wrong with me.
Deshauer: Ever since he was a child, Chris suffered with gastroesophageal reflux, also known as heartburn. That's when the stomach acid comes back up into the esophagus, causing this burning sensation in the chest.
His doctor first started by treating him with a medication to suppress his stomach acid. But when that didn't work, they went on to do blood work and a CT scan of his head, his chest, and his abdomen, looking for other possible causes. The scans showed that Chris has a hiatus hernia, meaning part of his stomach has come up through the diaphragm making it much more likely for acid to come up and give you acid reflux.
Now, he has probably had this since birth since he had all these symptoms as a child. Since it's not something new, it's unlikely that this is the cause of his hiccups. With no other leads, Chris' doctors started to wonder if this could be a psychological or emotional problem.
Sands: They seemed a bit nervous asking me, because it's probably a bit of a sensitive subject to say someone might be making it up. Or it might just be kind of a psychological tick. But for me, it was like, "No, if it's that brilliant and then at least I can be..." well, not talked out of it, but at least start solving it. As soon as I know what it is, we can start working on it. Because when you're in those kinds of situations, you're nervous and you're trying not to say anything that might make you sound crazy.
You kind of like go ahead. She said, "How do you feel?" I was like, "Oh, no. I feel absolutely fine." I never think to myself, "Oh, no, it's a bit strange to say I'm fine. Oh, God. What if I'm being strange?"
Deshauer: Chris's psychological testing came back normal. We still didn't have an answer for what was causing the hiccups.
Sands: I came away from that thinking, "Damn. Okay. It's not that. On to the next thing." But then we got back to the doctor and he said, "Well, that's it." He said, "I have done everything I can do. You're on your own." This was 4 and a half months into it.
Deshauer: I can't even imagine how devastating that must have felt. I mean, at this point he can't work. He is not able to even drive a car, go on a date, or play guitar. I mean, his life was on hold and somehow he managed to keep this amazing sense of humor.
Sands: It hurts, it's severe, and it's bad. But the laughter was always around. My friends were there and my family were there and very supportive. They knew I didn't need like, "Oh, are you okay? Are you okay?" all the time. What I needed was them jumping up behind me or punching me in the stomach, or being stupid or ... and that's what I needed. I needed this kind of back and forth of kind of comedy to break the routine of close to depression.
Deshauer: During this time, Chris has scoured the Internet looking for every possible cure and trying every home remedy that he could get his hands on.
Sands: From one of these companies ... there was this copper cup with a rod that sticks out the top that pokes onto the side of your head while you're drinking. I did all the upside-down drinking. I went into an oxygen chamber that like football players used to heal their injuries much quicker.
I mean, it was all completely useless. It didn't do anything for me, but in a way like it did do something for me. It allowed me to continue my journey. Because if at some point those things had stopped, that's it. Like I have got no answers. I have got no cures. I have got nothing to look forward to. As long as these things kept coming through, I still had like a lifeline I could keep trying to find a cure with.
Deshauer: One after the other, every remedy failed and the real possibility of living the rest of his life with hiccups began to sink in.
Sands: Then you start to feel the dead-end hitting you. The wall where you're like, "Oh, no. Is this going to last forever?"
Then at one point, very early in the morning, you're still hiccupping or whatever, I thought, "Well, I'll just write a letter to our local newspaper." Just like, "Hey, guys. This is what's going on with me." I expected it to be in the letter section. "If there is anyone out there that can just please help me."
Deshauer: Overnight Chris became a sensation and his story was picked up by news outlets and magazines around the world.
Sands: Then that was it. Phones were ringing off the hook. I have got the BBC. I'm on breakfast television. I have got French television coming round. I had TV Globo from Brazil come around and film me, and the Japanese coming around. The list continues for a while and it allowed me to kind of continue without hitting that wall again. The wall kind of went back a whole load.
Deshauer: Having run out of remedies and unable to keep food down, Chris had lost over 30 pounds. He was malnourished and underweight.
He went back to his doctor and started talking about getting surgery to fix the hiatus hernia. This prompted a whole new wave of tests including an esophageal pH test. This is where a sensor gets put back through someone's nose and down their throat. The idea is to test how much stomach acid is coming back into the lower esophagus over a 24-hour period.
Sands: The problem is when I was hiccupping and vomiting ... this is going to be quite graphic, I'm sorry, but the tube is up your nose and down into there. At one point, I'm hiccupping, hiccupping, and the tube is in my nose and now out my mouth. I'm like, "Oh God, oh God. This is awful. Oh God." I'm a mess. I don't know what to do and I know I need the doctors to do the test properly. I took it out myself and shoved it back in. I know a stupid idea, but you're desperate at those times and you make stupid decisions.
We got back to the doctors and I told them what happened. They said, "Jesus, you put it back in?" "Yeah. I thought that would be the right thing to do." "You didn't need to do that."
Deshauer: Chris' doctors warned him that the surgery was mainly to help stop him vomiting so much, that it probably wouldn't stop the hiccups. The procedure is called a laparoscopic fundoplication, where they first fix the hernia and then they pull the top of the stomach up and wrap it around the lower esophagus to create a better seal and prevent the acid from flowing back up.
Sands: That was one of the worst ... that was one of the most painful moments actually, waking up from that surgery. I woke up in a hospital bed about 4 o'clock in the morning, hiccupping right after having stomach surgery. I was in excruciating pain. Every hiccup was like someone stabbing you in the stomach.
Deshauer: This is a surgery that used to be really popular, but we don't see it much anymore, because we have really good medication to suppress stomach acid. With time, his stomach healed and although it didn't impact the hiccups at all, it really improved his quality of life.
Sands: That was quite a revelation for me because during the hiccups I was just vomiting everything. I was skin and bone. After that operation, I could eat again. I was still hiccupping and I was still bringing up some stuff, but I was keeping mainly my food down. Really, it made a big difference to how I was during that time.
Deshauer: A few months later, Chris was contacted by a doctor of East Asian medicine from Japan. He had seen him on the news and contacted him offering to help cure his hiccups.
Sands: "Because I want to fly over to see you and stay with you and your family for 7 days, and I'll try and cure you." "Okay. Yeah, that's very kind of you. Okay."
Deshauer: He brought with him a secret manual of medical cures that had been passed down in his family from generation to generation.
Sands: Acupuncture. He did the cupping. He had this ... it looked like a cigar, this burning stick, which he would hold close to each of these different points in my body. He would tread on me. Lay me on the floor just tread on all my muscles.
Deshauer: Sadly, none of the cures worked. But it wasn't long until Chris got his next big break. The Japanese TV show called The World's Astonishing News! contacted him for a follow-up interview in Japan.
Sands: I said, "That's great. That's amazing. Yeah. I'd love to go to Japan, so why not?" I don't think I had ever been on a plane before. I don't really travel that much.
Deshauer: Chris was taken to see an anesthesiologist ... and the entire thing was being filmed by the Japanese TV crew. While he was there, he had more tests and more scans including an MRI of the brain. The next day the TV crew showed up at Chris' hotel room.
Sands: The television crew say, "Oh, [the doctor] wants to see you again. He wants to do another scan." I said, "Oh, I don't really want to do another scan. I'm claustrophobic." At this point, it had been 2 and a half years of hiccupping with people saying they have got the answer when they don't. I thought, "I don't want to go back there."
The television crew were quite like insistent. They said, "Well, let's just go talk to him. Let's just go talk to him." Okay. We went and talked to him and he said, "Look, I know you don't want the scan, but I found something." He said, "Can you take the television crews out of the room?"
He put the scans of my brain and he said, "Look, I found what I think is a tumor in your brain." He said, "It's in a bad place. I don't know much about tumors. I'm just an anesthesiologist." He said, "You need to speak to a neurosurgeon, but I want to do a more high resolution scan to confirm it."
At that point I'm in tears. I'm like, "Oh, I'm going to die."
Deshauer: The second MRI confirmed that he had a 1.2 cm tumor in his brain stem. I know you're probably wondering, but didn't they scan his brain right at the beginning of this whole story? The answer is yes, but they did a CT scan. MRIs have a much crisper picture, better resolution, especially in the back of the brain where Chris has his tumor.
This was the missing piece of the puzzle. Armed with these MRI scans, Chris flew back to England and met with a neurosurgeon to discuss surgery. While he was there, Chris confided that his symptoms had become much worse recently.
Sands: At that point, I had actually started passing out from the hiccups. I would hiccup, hiccup, hiccup, wake up on the floor, hiccup, hiccup, hiccup. He said, "You're lucky you haven't died yet."
Deshauer: The brain stem is only a small part of the brain, but it's absolutely critical for life. Chris' brain tumor is found in the medulla oblongata, part of the brainstem that controls your breathing, heart rate, and blood pressure. Very literally your vitals. As the tumor grew bigger, it put more and more pressure on these nerves. threatening Chris' life. The only way to stop this is by cutting into this really delicate part of the brain.
Reflecting back on this uncertain time, Chris recalls what he felt just moments before this risky surgery.
Sands: "I don't want to die, but I don't really feel anything. I feel very strange." It was like I had accepted what was going to happen and whatever happens happens. "Just knock me out and get on with it," kind of thing.
Deshauer: The surgery lasted 5 hours and the goal was to remove as much of the tumor as possible without damaging Chris' brain. They managed to take out over 60% of the tumor and sent it off to pathology.
The pathologist diagnosed the tumor as a pilocytic astrocytoma, which is a benign, non-cancerous tumor that grows really slowly and doesn't travel anywhere else in the body. Which explains why Chris was able to live with this for over 3 years.
Sands: The moment I open my eyes, there is a lady in front of me and she has got a sponge on a stick, a wet sponge on a stick. She is just dabbing it on my lips and it was like the best thing in the world. You just wanted water. Your whole throat was dry. Your mouth was dry. But they have to be careful because you don't? have a gag reflex at this point.
Anyway she is dabbing in the water and dabbing on my lips, and eventually she says, "Oh, do you want to do it?" I said, "Yeah." She puts the sponge with the stick in my hand and I go to put it in my mouth, and I just smack it straight into my eye, and we both burst out laughing.
But at this moment, I realized I don't have control over my arms. Not real control. She said we'll try that test where you took your finger to your nose. With my right hand, I took my finger to my nose just about. With my left hand, I smacked myself in the face, and we burst out laughing again.
But you couldn't ... at this point I wasn't hiccupping. I woke up and I wasn't hiccupping. I wasn't even thinking of that. I was just thinking of things in the moment.
I couldn't feel anything from the neck down. It felt like when you fall asleep on your arm for far too long. When you touch it, that kind of fuzzy feeling. It was like that. But every time I breathed, my whole chest felt like that. Everything from the neck down felt like that.
It wasn't until a few hours later that I'm laid in the hospital bed and I'm like, "I'm not hiccupping. I'm not hiccupping." It's fantastic, but I really can't enjoy this right now. My whole body feels awful and I couldn't enjoy the aspect I wasn't hiccupping because all my mind was thinking was like, "Am I going to get my arms back again? Will I ever walk again?" I couldn't walk.
Then I had a little MP3 player and I was listening to my compositions and things. I'm thinking, "Am I ever going to play piano again? Am I ever going to play music again?"
Deshauer: Chris went through a really long recovery phase. It took at least a year before he could even try to start playing the piano and guitar again. What's so amazing to me is that he used playing music as a way to improve his dexterity and fine motor skills. Then he actually challenged himself to compose a new song every single day for a year.
Sands: I was able to craft these absolutely terrible pieces of music, but music nonetheless that I could still compose.
The feeling of creation completely outweighed the disappointment of not being able to do it. It just gave me a push to try harder. As soon as you feel that sense of progress and you can kind of clutch on to it, and keep on dragging yourself forwards -- whether it's dragging yourself forwards on your knees or whether you're running -- at least you're going forward.
That was a real sense of accomplishment, and it was lovely. At 365 songs, it's like a musical diary of the year. It's incredible.
Deshauer: Today, Chris has made a full recovery, although he still has a little bit of numbness in some of his fingers since the surgery. But the tumor hasn't grown back, he hasn't got the intractable hiccups back, although he will occasionally get the normal hiccups. Personally, that would just freak me out, but it seems like Chris isn't really bothered by it.
Sands: Yeah. Now I get hiccups like a normal person. It doesn't make me nervous because, me being me, I have got quite good knowledge of how to get rid of them. I am quite good at it. I studied them for a long time. I have got all the cures and I know how to get rid of them better than anyone else.
Deshauer: Listening to Chris' story, I have such conflicting emotions because on the one hand I am just amazed by his resilience and positive mindset through everything that he has been through. On the other hand, I feel outraged for him. I mean, 3 years he had to make a plea to the news. He had to go to Japan before he got an MRI. It's so disappointing.
Sands: The neurosurgeon told me, "You should have been scanned within 48 hours of having that. The cause of hiccups, if it's lasting that long, is either in your stomach or in your brain. If it's not in your stomach, it's in your brain. Get an MRI scan. Just get it straight away. If your doctor says no, get a different doctor because they don't know what they're talking about."
Deshauer: I think Chris's story really highlights the importance of advocating for yourself. To me, it also shows how powerful social media can be because people can share their experiences and we can learn from each other, especially when it's an unusual symptom or it's a really rare disease.
Sands: All I can say is that I felt very, very lucky. I feel very lucky to have had the people around me that I had around me at the time. To still have people that I love and adore around me all the time.
Deshauer: I really cannot thank Chris enough for sharing his story with us and allowing us to learn from his experience.
I am really excited to hear what you think. Let me know in the comments below what were your reactions. What were you thinking? Is it what you expected?
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Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why is called Violin MD.