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Former baseball and football star Bo Jackson has had the hiccups for nearly a year and is undergoing a medical procedure this week to treat the unexplained phenomenon.
"I'm busy at the hospital having shine lights down my throat and probing me every way they can to find out why I have these hiccups," the former professional football and baseball player told the hosts of the radio show "McElroy and Cubelic in the Morning" on WJOX 94.5 FM. "I have done everything -- scare me, drink water upside down, smell the ass of a porcupine -- it doesn't work!"
Chronic hiccups are rare, but unfortunately for Jackson, they are largely a medical mystery.
Josh Silverman MD, PhD, an otolaryngologist at Northwell Health in New York, has only seen six to eight cases of the maddening condition in the decade that he's been practicing medicine.
Possible root causes for chronic hiccups could be tumors in the brain, chest, or lungs that press on the diaphragm. "A fair amount of time when someone is having hiccuping episodes for a while, it's the body telling that person that something is going on either in the chest, lungs, or abdomen," Silverman said.
"It's something that's been with humans for a long time and puzzling doctors forever," Silverman said. "The fact that Jackson is having a procedure means that this is truly debilitating for him and that essentially all other root causes have been ruled out."
After someone has had the hiccups for a few days without relief, most people end up going to the emergency department, Silverman said. At this point, people have already tried the common tricks of holding their breath or getting scared, both of which alter the respiratory pattern and hopefully stop the contractions. The ED usually checks labs, looking for electrolyte imbalance, and often does ultrasounds, CT scans, or MRIs to see if any tumors or other conditions could be causing the hiccups.
But if those all turn up negative, the patient is referred to a specialist -- often an otolaryngologist like Silverman.
Specialists can treat patients with hiccups using medicines ranging from pills designed to treat gastrointestinal issues to those for anti-anxiety or psychiatric purposes. Silverman said the dopamine receptor antagonist metoclopramide (Reglan) is one possible treatment.
The last resort is surgery. One surgical option involves placing Botox on the top of the esophagus or voice box. Another involves stopping the vagus nerve from overstimulating.
The most common surgery, phrenic nerve ablation, comes with a price, Silverman said. "When you ablate that nerve, you hopefully stop the process of hiccuping but you're also paralyzing half of your diaphragm. That's a big deal from a breathing perspective," he said. "Especially since Jackson is an athlete, that's an extreme scenario."
About two-thirds of people respond to one of the surgeries, Silverman said.
He noted that chronic hiccups can wreck a patient's life. One of his own family members had chronic hiccups for months following a brain tumor.
"When I see these patients who have had this for multiple months, they are distraught," he said. "They're afraid to go in public, they're embarrassed, it's painful because of the muscle contractions, and yet we don't truly understand what causes it or how to fix it."
In the radio interview, Jackson expressed similar frustrations at how his hiccups interfered with his ability to live his life as usual, even preventing him from attending events.