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HICCUP RUNNETH OVER

On Christmas Eve 1992, at the advanced age of 64, Carlos Contreras hiccupped for the first time in his life.

Sixteen months, four dozen doctor visits, thousands of dollars in medical bills and more than two and a half million hiccups later, the retired Phoenix postal service employee was still going strong. "Looking back, I don't know how I ever got through it," says Contreras, who finally beat his strange problem last June. "It was unreal. This is something I wouldn't wish on anyone."

Although most people have suffered through short-term hiccupping bouts that can seem to drag on for eternity, mercifully few will ever experience a long-term siege lasting months or years, like the torturous ordeal that drove Carlos Contreras to the brink of suicide and tossed his life into limbo for a year and a half. But Contreras was a lot luckier than the late Charles Osborne, an Iowa farmer whose lifelong hiccupping jag earned him a place in the Guinness Book of Records. In 1922, at the age of 28, Osborne was butchering a hog when he inexplicably began hiccupping at the rate of 40 times a minute. Just as inexplicably, he stopped hiccupping in 1990, nearly 70 years later. After enjoying one hiccup-free year of life, the twice-married father of eight died in 1991.

Called intractable hiccups, this mysterious malady occurs so rarely that the medical community has no formal way to track the frequency of the ailment. Even were such numbers available, low as they'd be, some observers suspect the figure would almost certainly be overreported: In their quest for relief, career hiccuppers often see more than a dozen different doctors and specialists. Like Carlos Contreras, they've probably also resorted to every folk remedy under the sun.

"Hell, if I heard about anything that might work, I'd try it," explains Contreras. Having exhausted all the usual "cures" (breathing into a paper bag, gulping spoonfuls of sugar, swallowing dry bread), the retiree even subjected himself to a few treatments that wouldn't be out of place in a fraternity hazing ceremony--like wrapping his stomach in hot olive oil and plastic, and zapping himself with a laser ray used by horse doctors.

Explaining how he once even fired ice cold water up his nostrils with a plastic syringe, Contreras smiles. "You get desperate," he says. Now 66, but looking almost a full decade younger thanks to his rigorous fitness regime, the otherwise healthy Contreras was forced to virtually put his life on hold for a year and a half. With the exception of his frequent medical appointments, the tennis enthusiast rarely left the comfortable tennis-court patio home he shares with wife Barbara.

"I was desperate, just desperate," says Contreras, a second-generation Phoenician who headed up the training department for the greater Phoenix postal system before retiring several years ago. "Whatever I was doing that might have triggered the hiccups, I stopped doing. I stopped drinking, I stopped taking vitamins and I even changed my high-blood-pressure medicine. I even tried acupuncture and transcendental meditation. Nothing helped." Contreras hiccupped so frequently and so violently--his hics clocked in at the rate of once every 15 seconds--that he had trouble eating, losing 20 pounds in the process. At night, his hiccups actually shook the bed, forcing him to take refuge on the sofa out of concern for his wife.

"I was hiccupping so much I couldn't even finish a sentence," explains the loquacious Contreras, who is finally back to his old chatty self. "My temperament was, at best, terrible. I had a short fuse--and a long explosion."

Contreras' wife of 47 years smiles weakly. "He didn't handle this well at all," says Barbara Contreras. "He's an A-type personality, and I'm not. I'm more laid-back. And it's a good thing, too. If we'd both been A-types, we'd have both gone up the wall over this thing."

Prescription sedatives brought temporary relief, but at a cost. "He was almost like a zombie," remembers Contreras' wife, an employee in Phoenix College's alumni relations office. "He'd sit in that chair and just stare into space. He was so lethargic, he couldn't function. He couldn't play tennis, he couldn't even carry on a conversation. And, remember, this is a man who had always been very outgoing all of his life."

The hiccups from hell left a bad taste in Carlos Contreras' mouth in more ways than one. "Every time I'd hiccup, it'd send up this horrible gas into my mouth," reports Contreras. "It was awful."

The same description could probably be applied to his initial attempts at lovemaking after he began hiccupping. In the midst of whispering some intimate endearment, he went on one of his hiccupping jags, causing his wife to burst out laughing. "What a sight!" says Contreras, recalling how the "buck naked" pair collapsed in hilarity over the ridiculous situation. "I went completely limp." Although Contreras claims he was eventually able to work around his hiccup-related boudoir problems, the chronic hiccupper was not nearly as successful in adapting to other aspects of day-to-day life. That inability to cope was to some extent the result of nervous exhaustion and trouble focusing his thoughts, side effects commonly experienced by sleep-deprived hiccuppers.

 

Contreras now admits he wasn't thinking clearly the day in September 1993 when he drove out to the desert north of Phoenix. Fortunately, he still was cogent enough to realize that his chronic hiccups could never damage his life as much as the 9mm pistol lying on the seat next to him. Contemplating his near-disastrous flirtation with death, Contreras shakes his head. "I looked at that damn gun and those huge bullets and I chickened out," he says. "Looking back--geez. But that gives you some idea how distraught I was. Unless you've gone through that period of time where you're unable to communicate with other people, you can't begin to realize what that was like."

The withdrawn Contreras may not have seen much of his family or friends, but he did meet a lot of new doctors. Looking through stacks of medical bills he accumulated throughout his ordeal, the former hiccupper estimates that x-rays, diagnostic tests and doctor visits (including forays to the local Mayo Clinic and the Scripps Clinics in San Diego) cost his insurance company well over $10,000. Yet outside of prescribing medication that, at best, put his hiccups on hold for a few days, the medical world didn't have many answers. Although doctors understand the mechanics of a hiccup--it's a simple spasm of the diaphragm that seems to serve no useful purpose--they're still in the dark as to what triggers them. Spasms of brief duration are generally chalked up to wolfing down food too rapidly or overindulging in alcohol. But the causes of long-term hiccupping binges have been traced to everything from chronic indigestion and recent surgery to swallowing disorders and even tumors. In one well-documented case, the culprit appeared to be a single hair rubbing against, of all things, the patient's eardrum. Chronic hiccupping is "a relatively rare bird," says Dr. James Dearing, a family physician practicing in the Valley. "I can count on one hand the number of times I've heard of this, much less seen it. This is something that just doesn't happen very often." Intractable hiccups are so infrequent, in fact, that in ten years of practice, Dearing reports he's personally only treated one patient plagued by the condition--a middle-aged man who'd been hiccupping for five months. After a number of visits, the doctor eventually discovered that the patient was constantly chomping on Nicorette, a prescription gum whose high nicotine content was irritating his diaphragm.

"We don't know what causes hiccups, so we don't know what we're really treating," confesses Dr. Charles Daschbach, director of medical education at St. Joseph's Hospital. "It's a lot of black magic. We're kind of flying by the seat of our pants. If you called ten doctors in a row and asked them what's the first thing they'd try for somebody who'd been hiccupping for three or four months, I'm willing to bet that out of the ten, you'd get six or seven different modalities."

As such, treating the condition (which unaccountably strikes men four times as frequently as women) has been likened to shaking the cord on a faulty television set. If it works, it works.

Dr. Kevin Parent, a gastroenterologist at Scottsdale's Mayo Clinic, agrees. "There's not a heck of a lot of research going on in this area," he says. "Hiccupping doesn't kill anybody, so it's really an orphan illness."

That sad fact of life became painfully apparent to Carlos Contreras as he trekked from doctor to doctor, seeking the quick fix no one seemed to have. "It was like no one realized the seriousness of this problem," says Contreras. "Some of these doctors wouldn't even see me for six weeks. I damn near cried one time and the doctor's receptionist still wouldn't give in and get me an earlier appointment."

For what it's worth, medicos sympathize with Contreras' anger.
"I understand this guy's frustration because it's a frustration on our part, too," says Dearing. "Chronic hiccupping is not an easy thing to come up with a good answer on."

St. Joseph's Daschbach echoes those sentiments. "It's troubling for patients to think that we can put a man on the moon and we can do a heart transplant, yet no one can understand why they're hiccupping," he says. "Most physicians would probably have a great deal of sympathy for the patient--as well as having a great deal of empathy for the physician who's faced with someone dealing with a chronic problem like this."

 

Contreras' hiccupping marathon ended last summer when a doctor at the Mayo Clinic prescribed baclofen, a muscle relaxant often used for patients with multiple sclerosis. Noting that the drug was the 49th hiccupping prescription he'd had filled, Contreras wonders why doctors didn't cut to the chase 17 months earlier. "I don't understand this at all," he says, fuming. "I can't be the only person in this country who was hiccupping like this. Why couldn't one of these doctors just go over to the computer and type in the word 'hiccups' and see that baclofen worked on someone else?"

But at least one doctor suggests that Contreras isn't really ready for the answer.

"I don't want to upset him, but there's a possibility that the baclofen didn't stop his hiccups, anyway," says Charles Daschbach. "Maybe he tried 17 things, and on the 17th month they just stopped by themselves. With hiccups, we just don't know.


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