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Letters to the Editor
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Hiccups
Social implications of hiccups are important
From Dr E. K. Rosenbloom, MRPharmS
I read with interest the article (PDF 110K) “Dealing with cases
of hiccups” (PJ,
30 October, p647). I have a couple of points to make having reflected
on my experience of supporting my daughter in managing her prolonged
hiccups for the past three and a half years. The article provides an
informative overview but fails to mention two key questions: do the hiccups
occur when the person is asleep and what is the impact of hiccups upon
the quality of life?
If the hiccups occur when the person is asleep then aetiological factors
causing the hiccups should be investigated. If the hiccups are protracted
then certainly the person should be reviewed to ensure that that there
is no underlying medical condition. If all of the routine investigations
do not stop the hiccups episode then the risk benefit equation associated
with any interventions should be considered.
After six months my daughter was still hiccuping at a regular rate, sometimes
15 times a minute, and it was “irritating” enough for her
to try drug therapies. Chlorpromazine was ineffective but haloperidol
did stop the hiccups. It also caused extrapyramidal effects that were
far worse than anything described in the textbooks. Explaining to a 16-year-old
that the fact that she had no control over the opening of her mouth (and
at times sticking out her tongue until it hurt) was a side effect of
a drug that she had taken, and that I as a pharmacist had supported,
was a professional challenge. This caused her to consider the risks of
hiccups and she determined that at present there were none.
It is worth stating that she was assessed at school for the impact of
the hiccups upon her ability to take examinations. The impact of the
hiccups upon her peers, who were very tolerant of her constant interruptions,
was also considered. The only problem that my daughter has ever encountered
is the attitude of some teachers who became stressed at the constant
interruption and who, on occasions, have requested that she leave the
room.
She is continuing her education and will no doubt be reassessed at her
university. I am wondering if this comes under the Disabilities Discrimination
Act, having lasted for over a year and affected her day-to-day concentration.
I hope that describing a case that focuses on the social implications
of treating a long-term condition demonstrates that taking a medical
approach may not always solve patients’ problems. She only has
another 65 years to go to beat the world record. Watch this space!
E. Karen Rosenbloom
Loughton,
Essex
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Pharmaceutical Journal