Terminal Hiccups

I had two right-side wisdom teeth extracted ten years ago when one of them was beyond saving. I did not get the other two out at the same time, thinking they caused no problems so why mess with them?

Unfortunately, the left-side wisdom teeth had to come out after one of them cracked and got infected, so not going for the complete removal ten years earlier was a mistake. It turns out they are not really useful with modern man’s more refined diets and they do cause more problems than they are worth for most people.

I wasn’t looking forward to the visit to the oral surgeon — the last experience was not fun, and I have a note in the back of my mind telling me that general anaesthesia is very risky no matter how routine it seems to be, with unacknowledged damage to brain and body.

I was waiting for the anesthetic to take effect, then they added an oxygen feed, and then… nothing, until I realized someone was asking me if I was seeing double (I was). All proceeded as planned and a friend took me home. Felt decent, but…

I started hiccuping in the evening, 11 PM or so. Sleep was difficult — deep sleep would turn off the hiccuping, but then getting back to sleep got harder as the hiccuping resumed. Next day I researched the problem — not unusual, 2-5% of patients hiccup for some period of hours to days after the extraction of wisdom teeth, no one knows quite why. And my notes about the last time mention hiccuping for two hours. But few cases last longer. So I waited through 48 hours of off-and-on hiccuping, finding clever tricks to get to sleep – like the discovery that a packet of Splenda left on the tongue would suppress the hiccups for a few hours. One night I ate 5 Splenda-sweetened yogurts to relieve the hiccup long enough to get back to sleep.

So by Sunday I was ready to ask for help, and the oral surgeon prescribed Chlorpromazine (Thorazine), an antipsychotic my schizophrenic father no doubt overdosed on. It is one of the two commonly used drugs to stop bouts of hiccups, and even though I asked for the other, that’s what he prescribed.

It did seem to help but while the strength of the diaphragm spasms diminished, the frequency did not, soon becoming 3-5 in a one-second pulse, going on for 10-15 minutes at a time, noticeably worse after eating; and by this time I realized solid food was making me sicker, so I stayed with the liquid diet recommend to avoid damaging the extraction site.

Monday I sought out a GI specialist at Palo Alto Medical. He was a B-grade fellow — we were looking at the same pages online to try to figure out what to do. He suggested doubling the dose of Chlorpromazine and trying the other drug if that didn’t work, so I have both now. I tried to explain to him that the real problem was not hiccups but stomach emptying slowly if at all, and he did not take it very seriously; his strategy (typical of managed care these days) was to spend no time trying to find the real cause, but to try those drugs which statistically have relieved others first, then if the problem continued, go on to more extensive tests like an endoscopy (in which a small tube with a camera on the end is snaked into your stomach to check out things.)

Today the doubled dose of chlorpromazine left me in a zombie state — sleepy, not thinking fast. ideal for patient management at your local loony bin. The spasms continued, and eating my usual sandwich for breakfast made me not want to eat again until 1 PM.

So I’m getting care, but not enlightened care. Turns out “motility” is a specialty for GI docs, and the first doc was not one of them, but there is another nearby. Stanford has a GI motility lab which can do some tests. Or it could all get better tomorrow!

But it has felt like the end of the world, or the end of life as I knew it, as I got weaker and weaker and lost 5 pounds in 3 days. I have not been fun to be around and turn down all social invitations — I’m not a good dinner companion when dry-heaving after the meal (the one saving grace, I suppose, is that nausea and vomiting typical of gastroparesis haven’t happened.)

This is another reminder that we don’t have all the time in the world to do the things we need to do before going. An illness like this, which can grow to take up all of your time and energy in pale and uncomfortable survival, is not exactly what I had in mind — I thought having these wisdom teeth out was the last thing needed before I could buckle down and get some real work done, and now I can’t concentrate at all.

Later Note: After a week thinking I’d be crippled for life, I started to get better — returning to the gym seemed to help regularize the system and I started to be able to eat normally again. But I partially dislocated a shoulder doing dips, the injury I suspect due to side-effects of the abnormal diet and drugs. And that injury took months to recover from.

Moral: Most people should have their wisdom teeth removed all at once, when they’re young. The old interventionist advice turns out to be correct. And cocktails of multiple anaesthetics commonly used in minor surgery are surprisingly dangerous.

Meta-moral: Our bodies have many complex systems that keep us going, and when any one of them starts going haywire, living becomes a struggle to survive. Good health and smoothly-functioning systems don’t last forever, so don’t waste time on unimportant things — do your creative work first.

A story of suffering.

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