20230817 : my hiccups medicine

 ​Warning: reading this may affect your belief and affect you adversely. Read ahead at your own risk.

____________________

Couple of days back, I had my bout of hiccups. I have written earlier about my hiccups after the stroke. It is quite bad.

This time it lasted about 2½ days. Earlier it used to last longer and more continuous and more intense as well.

It has gotten slightly better over the 4½ years. When I am in the "hiccups zone" now, it typically starts soon after I am fed, lasts for about 1½ hrs and stops . Soon it will be next feed time and the cycle starts again.

Usually the nurses quickly become immune to it and they get the pattern.

However, both my current nurses are new and I had not been in a "hiccups zone" after they had started. They both got replaced at around the same time and did not have the benefit of knowledge from the other person.

Naturally, they assumed it would go away as per normal. When they saw it not going away quickly and it was coming back again and again, they got tense​d. They didn't want their patient to suffer under their watch 

I can't do the usual home remedies - like they usually say, gulp down some water quickly, suck on a toffee/ lolly pop, have some sugar in the mouth and swallow the saliva slowly, etc, etc . My mother usually tells me a new thing every time. I don't know why they didn't try to scare me out of it!

Anyway, they knew they couldn't do any of the usual tricks. So they wanted to give me medicine!

They asked me what medicine to give. I replied in my show and actions combo that there we don't have the medicine. Then they asked my housekeeper what medicine to give. They are both not qualified nurses - they are technically "attenders". They don't know what is what. They only follow what they are told to do.

There are a plethora of bottles of different colours and shades in the medicine tray behind me - ​a collection of the past few years. I am sure many might have gone beyond expiry date as well.

Surely it must be one of them. Given the number of nurses that I have had and absolutely nonexistent hand over between any of them, nobody knows what is what. I am sure my wife would know, but she wasn't available. They showed them to me and I said I don't know.

My housekeeper had a very vague idea but was not confident - ​she said that it was a pink liquid. Luckily it is in a dark bottle - can't make it out​ the colour from outside.

I knew exactly what they were looking for - it was a brown bottle with a thick pink tonic called "Mucaine gel" .

When they ​u​sed to give me that tonic, my hiccups would stop. But I didn't want to take it. I have not taken it for almost 2 years - only because it doesn't work anymore. Have I developed medicine resistance? Definitely not. It's a different resistance I have developed to it ​.

It reminds me of the initial days in the hospital. The hiccups would be unbearable and continuous - I was a lot weaker, couldn't move one bit and had a hole in my throat with a pipe running from it. Hiccups used to be unbearable.

Under this condition, when I got hiccups and struggled, ​t​he hospital staff would give me Mucaine gel. It would stop in a few minutes. It would start later that day and I would​ (with whatever ability I could), ask for the medicine and get it - for that is the only remedy that worked ​f​or me.

After I was able to use my phone and browse the internet (about 2+ years after my stroke), I wanted to know why I get so many hiccups. My surgeon had told my wife soon after my surgery that I will struggle for balance and have a lot of hiccups). I was curious to find out why?

I found out both the reasons - both very funny . With the balance as well...

Anyway, coming back to hiccups. It is very fascinating - like everything else about our body!

We all know it's because of the diaphragm. But why does it happen?

I have read a couple of places and found very generic explanations. I also saw something which was specific but I couldn't validate it elsewhere. So out of all that mixture, this is what I have understood and made sense for myself. If you don't subscribe to this, no worries, ignore the explanation...

In a very generic sense, while it is the diaphragm that does the hiccupping, the root cause is nervous not muscular. That - there is consensus everywhere. That it is​ a nervous​ phenomenon.. 

The specific reason - there is something called the ​Vagus nerve - it's like a hotline that the brain has too many​ of the critical organs in the body. I am guessing it was brain's evolutionary solution to eliminate "single point of failure" situations with the central nervous system (the spinal cord and all branches of nerves coming from it)

Now the diaphragm is connected by both the vagus nerve and the nerves of the central nervous system.

The diag​pha​gm gets signals from the brain to do its job - regular expansion and contraction to support breathing. Both nerve networks are connected to the diaphragm. The messages they get have to remain absolutely in sync for the diaphragm to function normally.

Once in a while (for unknown reasons - ​and there is consensus, nobody knows why) they go out of sync. I am talking very very little out of sync (out of phase for electronic buffs)

The result. The diaphragm is expanding to inhale and it suddenly gets a message to contract. It abruptly contracts - squeezing the lungs and a sudden expelling of air - the ​Hiccup!

It remains for sometime (minutes usually) hiccupping - again for electronic buffs, it's like a transistor flip-flop going into a race condition. Flipping and flipping uncontrollably.

After some time, the brain realises something​ is out of sync and automatically and gradually corrects itself (which is why the hiccups start slowing down in frequency and slowly die down).

Now who is the corrector, the part of the brain which maintains this being in sync? It's the Medulla (part of the brain stem) - which is exactly where I had my stroke. Which explains the onset of uncontrollable hiccups for me​ due to the stroke.

Next, I obviously wanted to know how the medicine "Mucaine gel"  addressed this problem. How could a simple tonic bring synchronisation in the brain? I looked it up.

Mucaine gel - I found out, is a common "Antacid". Doesn't do anything to the brain directly. 

However I didn't know that. It was working for me. It was a classic PLACEBO.

Unfortunately for me, the day I found out, it stopped working. The placebo effect was gone!

Hence the resistance from me to simply take Mucaine gel any longer.​ It doesn't do anything for me anymore.

From what I have understood, scaring somebody might work - as it gives a sudden​/ abrupt anxiety to the brain. It may help.

Everything else is just a placebo. ​Sorry if I broke your placebo - whatever else worked for you.

​Best solution - Wait a few minutes and if you have a normal medulla, it will restore normalcy...

Side story: the balance bit of funny​ side to the story.

Many years back, I think it was 2012 or 2013. We were a very small and close knit team in our office. We had gone on an offsite. It was very usual to discuss work related things all day and have some fun activities in the night, followed by dinner where alcohol was always flowing.

I used to consume alcohol. Wine and vodka were my usual poisons. That day i don't remember why, maybe both of them were not available I don't know​, I decided to have whiskey. A very strong single malt.

I overdid it . Downed it quickly and it worked faster than I imagined​ it would. Before it was metabolised out.

Naturally I got tipsy and had no balance . But I was thinking straight.

However, everyone around thought I was saying gibberish. So in my drunk enthusiasm I wanted to explain that I was thinking straight.

I knew how alcohol affected us. I think I wanted to show off that understanding as well.

Now I don't know how I looked to others and what I said, but to me it was all making sense​. ​(reminds me of the scene in "Wolf of wall street" where Lenardo de' Caprio drives a sports car home when high)

I started explaining​:

"See, the alcohol is ethanol, when we digest alcohol, it becomes acetaldehyde, this acetaldehyde gets into the bloodstream and goes to the brian. It affects the "MEDULLA OBLONGATA" which is responsible for balance and hence we lose balance but the logical part of the brain is not affected and we are thinking straight "

As I said earlier, it was perfectly sensible stuff. However I have no idea what I said out​ loud and what physical state I looked like. All I remember is saying​ "medulla oblongata" many times and being supported and walked to my room by 2 guys.

After that, till I had my stroke​ and stopped working, every opportunity that presented itself, we all had a hearty laugh about my "medulla oblongata" story..

The same bloody medulla oblongata didn't let go of me .

Now it probably helps you imagine why I am unable to stand with balance (apart from not having muscle action and strength). 

Because I am heavily drunk all the time without ​needing alcohol​ in my blood...