How to Train Your Dragon: Would a glass of water help?

Cressida Cowell grew up in London and spent the summers on a tiny, deserted Hebridean island off the west coast of Scotland. With no television or other distractions, young Cressida busied herself with reading, writing stories, and drawing pictures. 

If, one hot August day, admittedly rare in those parts, she had hungrily consumed a cold soda, she might have developed hiccups. And maybe that would be the inspiration for Hiccup Horrendous Haddock III, a character she invented for the 2003 book How to Train Your Dragon, which was subsequently adapted for the big screen and became a worldwide success. So in honor of the movie’s global appeal I am going to provide an international flavor to this month’s offering.

In the English language, hiccup (or hiccough) is onomatopoeic, meaning a word that is imitative of the sound it describes. First noted in 1580, the word is thought to derive from old English ælfsogoða, which in turn means “elf heartburn,” as these explosive eructations were deemed to be induced by mischievous elves.

As ever, doctors have fancy words for hiccups, in this case, the Latin singultus, which means to “catch one’s breath while sobbing.” The chest and abdomen are divided by the diaphragm, a muscular sheet that can suffer an involuntary movement known as synchronous diaphragmatic flutter and 35 microseconds later one’s vocal cords close, allowing the eponymous “hic” to be heard. Everyone reading this has, at some point, suffered hiccups and while elves are not to blame, heartburn often is, where stomach acid refluxes into the gullet, causing irritation and subsequent hiccups, or hipos in Spanish, hoquet in French, kwikwi in Swahili, sugits in Romanian, and, for the Trekkies out there, the rather disappointing buh in Klingon!

Not being duly informed about how Star Fleet’s alien adversaries digest their food, I will stick with human causes of hiccups. Aerophagia is a rather grand name to describe what your mother told you not to do, talk and eat at the same time, as it may lead to swallowing air. Once captive, air must escape somehow, and a distended stomach might stimulate the diaphragm to flutter. Of course, air can escape from further down one’s intestinal tract, and either route is why I advise pilots – and aircraft passengers – to avoid carbonated beverages or gas-producing foods like beans prior to flight, because as one ascends, lower atmospheric pressure causes this gas to expand, causing hiccups, burping, other, shall we say, ejections, and possibly severe chest discomfort. Eating an Italian dish while swallowing air and telling fibs can produce impasta hiccups!

It has been said that someone “in their cups” is inebriated, and in common parlance, high achievement might lead to an award such as a shield or cup. Consuming too much alcohol might cause singultus, and if one was very proficient, they might be awarded the Hic-Cup! Similarly, spicy foods can also cause what Germans call schluckauf, to “swallow up” with the resultant ejection of trapped gas.

Emotional stimuli, possibly due to air swallowing, can induce what our Brazilian friends call soluço. That would be a great name for a dragon trainer! A whole raft of medications may lead to hiccups such as various steroids, sedatives like benzodiazepines or barbiturates, certain antibiotics, and opioids including hydrocodone.

The mucus-producing bowel lining can develop tumors that secrete large quantities of sticky goop. While not malignant in the traditional sense, this mucus contains a large amount of potassium, which in turn can lead to disturbances of heart rhythm or, you guessed it, hiccups. Similarly, low calcium or sodium, or disordered sugar levels can also lead to hiccups.

Nervous system problems such as prior traumatic head injury, tumor, multiple sclerosis, or stroke may present with hiccups due to damage to the brain stem or nerves leading to the diaphragm. Structural problems in the ear, nose, or throat can also provoke hiccups, whether that be a cancer or simply a tickling hair inside the ear canal.

Inside the abdomen or chest, irritation of the diaphragm directly produces hiccups, for instance, an inflamed gallbladder, liver, or lung tumor or even an infestation of a rather malicious little tapeworm called Echinococcosis, which causes hydatid disease.

Most hiccups, however, are benign and self-limiting after a short while and may be encouraged to stop by breath holding (but doing that for long enough cures all problems), gargling with iced water, or breathing into a paper bag. There are many other approaches such as being surprised by someone, being hugged tightly, or any one of a hundred other old wives’ tales.

Simply put, hiccups should settle, but if they continue beyond 48 hours, walk, bike, or drive to your doctor. Just don’t use a gas guzzler if you do drive; they call those hiccup trucks! Your physician will ascertain if any of the above causes are likely and will undertake a careful examination and possible tests. If not stopping, there are medications that can help such as chlorpromazine.

As ever, if a new symptom presents, self-ground until everything is back to normal, and if your doctor adjusts any medication or provides new drugs, ensure that the changed therapy is not forbidden by FAA.

In How to Train Your Dragon, our friend Hiccup Horrendous Haddock III, the story’s protagonist, makes friends with an injured dragon. The image of a fire-breathing creature inspires me to think of heartburn, a common cause of hiccups, yet in this tale it is the Hiccup who soothes the beast.

Fly well!

Jonathan Sackier

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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