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Need Specialist To Diagnose My Mother Is Suffering From Persistant Severe Hiccups
Question: Hi, my mother is suffering from persistant severe hiccups (note that these are not regular hiccups, entire street can hear, its like shouting) from her childhood. She gets exhausted due to these, which affected her health and well-being. Trying to find root cause, all her tests get back normal. Need specialist to diagnose and find the root cause. I can discuss in detail.
Let me know if you need any additional details from me. She has been diagnosed with diaphragm myoclonus by a neurologist and has been prescribed Balcofen, which has worked for a while, but has not been working lately. The main context for this question is I need to know the root cause on why her diaphragm has been getting irritated which is resulting in hiccups. I need Nephrologist opinion as I see a link between possible Kidney health and hiccups.
Let me know if you need any additional details from me. She has been diagnosed with diaphragm myoclonus by a neurologist and has been prescribed Balcofen, which has worked for a while, but has not been working lately. The main context for this question is I need to know the root cause on why her diaphragm has been getting irritated which is resulting in hiccups. I need Nephrologist opinion as I see a link between possible Kidney health and hiccups.
Brief Answer:
Cause to be found out, Phrenic nerve problem may be present
Detailed Answer:
Hi.
Thanks for your query.
Noted the history and understood the concerns.
First of all, I would like to tell you that I am an ENT and General Surgeon (2 postgraduate Specialties) and deal with such patients occasionally as this is a rare condition and would like to help your Mother as much as possible.
Proven kidney diseases with raised urea and creatine can cause hiccoughs, usually are persistent. If the Ultrasound of kidneys (done with Ultrasound of abdomen, which must have been done) and renal function tests are normal then this is ruled out.
If you still want to have an opinion of a Nephrologist you can refuse this answer.
If you want further help you may accept my answer so that we can continue discussion to know the cause. And get her treated accordingly.
Cause to be found out, Phrenic nerve problem may be present
Detailed Answer:
Hi.
Thanks for your query.
Noted the history and understood the concerns.
First of all, I would like to tell you that I am an ENT and General Surgeon (2 postgraduate Specialties) and deal with such patients occasionally as this is a rare condition and would like to help your Mother as much as possible.
Proven kidney diseases with raised urea and creatine can cause hiccoughs, usually are persistent. If the Ultrasound of kidneys (done with Ultrasound of abdomen, which must have been done) and renal function tests are normal then this is ruled out.
If you still want to have an opinion of a Nephrologist you can refuse this answer.
If you want further help you may accept my answer so that we can continue discussion to know the cause. And get her treated accordingly.
Above answer was peer-reviewed by :
Dr. Dr.Raju.A.T
Thanks for the answer. These spasms started at age 15 and now she is 60. There have been multiple tests/scans done through the years which do not point to any anomaly, and hence could not find the root cause.
The recent attempt to find an answer is with a neurologist, and after all these years, he has found that she has diaphragm myoclonus, which is good to find finally an answer in the direction to find a root cause. But, still I do not have the exact root cause is not yet known on why her diaphragm is getting irritated that is resulting in hiccups/spasms. It has been noted that there is no nerve damage as well. I am posting the notes summary/details related to interaction with the neurologist. Please check and let me know your thoughts;
Neurology doctor;
"The only test, which helped in making the diagnosis was- EMG of diaphragmatic muscles, which confirmed the diagnosis of diaphragmatic myoclonus.
MRI of spine was done (it was normal), however, MRI of whole body was not done. X-rays were also not done.
In the EMG, there are minor problems, of hyperexcitability noted in the diaphragmatic muscles and there is no damage of any nerve or muscle. It is a good news.
So, we need to decrease or stop this increased excitability. LIOFEN XL is one such medication"
This is the additional question I have posed to the neurology doctor
Prasuna;
"Do you agree with me that the 'diaphragm myoclonus' may occur due to imbalance of signals from central nervous system (brain and spinal cord) to the muscles(in this case diaphragm).
This imbalance of signals is often found in people with 'cerebral palsy' or 'traumatic brain injury' or 'stroke' or 'multiple sclerosis' or 'spinal cord injury'. Do you think my mother has any of the above conditions."
Doctors response on the above question;
"I agree with the first part of your statement that diaphragmatic myoclonus may occur due to imbalance of signals from brain to the muscle.
However, she does not have any of the conditions listed in the second part of your mail. That is very reassuring.
The root cause of this problem is not known."
The recent attempt to find an answer is with a neurologist, and after all these years, he has found that she has diaphragm myoclonus, which is good to find finally an answer in the direction to find a root cause. But, still I do not have the exact root cause is not yet known on why her diaphragm is getting irritated that is resulting in hiccups/spasms. It has been noted that there is no nerve damage as well. I am posting the notes summary/details related to interaction with the neurologist. Please check and let me know your thoughts;
Neurology doctor;
"The only test, which helped in making the diagnosis was- EMG of diaphragmatic muscles, which confirmed the diagnosis of diaphragmatic myoclonus.
MRI of spine was done (it was normal), however, MRI of whole body was not done. X-rays were also not done.
In the EMG, there are minor problems, of hyperexcitability noted in the diaphragmatic muscles and there is no damage of any nerve or muscle. It is a good news.
So, we need to decrease or stop this increased excitability. LIOFEN XL is one such medication"
This is the additional question I have posed to the neurology doctor
Prasuna;
"Do you agree with me that the 'diaphragm myoclonus' may occur due to imbalance of signals from central nervous system (brain and spinal cord) to the muscles(in this case diaphragm).
This imbalance of signals is often found in people with 'cerebral palsy' or 'traumatic brain injury' or 'stroke' or 'multiple sclerosis' or 'spinal cord injury'. Do you think my mother has any of the above conditions."
Doctors response on the above question;
"I agree with the first part of your statement that diaphragmatic myoclonus may occur due to imbalance of signals from brain to the muscle.
However, she does not have any of the conditions listed in the second part of your mail. That is very reassuring.
The root cause of this problem is not known."
Also, on a separate occassion, an MRI/CT scan of the brain are done as well, and there are no issues noted here as well
Brief Answer:
As detailed
Detailed Answer:
Thanks for your feedback.
First of all, MRI/CT brain is normal is most reassuring.
The Phrenic nerve that supplies the diaphragm Originates from cervical vertebrae 3, 4 and 5 - mainly C4.
Path
The phrenic nerve descends vertically in the neck, passing in front of the anterior scalene muscle
It enters the chest between the subclavian artery and vein
It runs close to the root of the lung, the pericardium, and the internal mammary artery, goes down to supply the inferior part of the diaphragm.
Hence if this nerve gets irritation, compression, pinching in its course the problem may arise.
Hence a dedicated MRI and other investigations of cervical spine around C 3, 4, 5 and along the whole courses of both the phrenic nerves down to the diaphragm may help to find the cause and hence have a definite treatment.
For example: Cervical (extra ribs) Scalene syndrome, any diseases or anatomical variations of the lungs, heart, mediastina area Enlarged thymus etc and obviously the diaphragm.
# are both the domes of diaphragm affected or only one of the two?
Also to know whether this is akin to a condition called tics of muscles (like fascial tics), something like tetany - Tetany of the diaphragm, characterized by involuntary contractions and spasms, is most commonly caused by hypocalcemia (low calcium levels in the blood), but can also be triggered by hypomagnesemia, hypokalemia, and alkalosis.
I hope you understand this is an exhaustive list of reason to be found out from time to time like having blood tests during the attach of myoclonus.
I am hopeful that your Doctors help you to find the cause. It is challenging diagnosis but can help the patient. Please discuss with your Doctors and get the things done if not already done.
I hope this answer helps you further.
Be in regular touch with me, as I can write to you only if there is follow up from you. Feel free to give me feedback.
If everything is negative other cause like stress and anxiety also to be looked upon a cause.
In some patients acupressure and reiki can help (incidentally I also do these too) As I told you I am an ENT as well as a General Surgeon hence could tell you details.
Awaiting for details.
Dr T Chandrakant. XXXXXXX MP
As detailed
Detailed Answer:
Thanks for your feedback.
First of all, MRI/CT brain is normal is most reassuring.
The Phrenic nerve that supplies the diaphragm Originates from cervical vertebrae 3, 4 and 5 - mainly C4.
Path
The phrenic nerve descends vertically in the neck, passing in front of the anterior scalene muscle
It enters the chest between the subclavian artery and vein
It runs close to the root of the lung, the pericardium, and the internal mammary artery, goes down to supply the inferior part of the diaphragm.
Hence if this nerve gets irritation, compression, pinching in its course the problem may arise.
Hence a dedicated MRI and other investigations of cervical spine around C 3, 4, 5 and along the whole courses of both the phrenic nerves down to the diaphragm may help to find the cause and hence have a definite treatment.
For example: Cervical (extra ribs) Scalene syndrome, any diseases or anatomical variations of the lungs, heart, mediastina area Enlarged thymus etc and obviously the diaphragm.
# are both the domes of diaphragm affected or only one of the two?
Also to know whether this is akin to a condition called tics of muscles (like fascial tics), something like tetany - Tetany of the diaphragm, characterized by involuntary contractions and spasms, is most commonly caused by hypocalcemia (low calcium levels in the blood), but can also be triggered by hypomagnesemia, hypokalemia, and alkalosis.
I hope you understand this is an exhaustive list of reason to be found out from time to time like having blood tests during the attach of myoclonus.
I am hopeful that your Doctors help you to find the cause. It is challenging diagnosis but can help the patient. Please discuss with your Doctors and get the things done if not already done.
I hope this answer helps you further.
Be in regular touch with me, as I can write to you only if there is follow up from you. Feel free to give me feedback.
If everything is negative other cause like stress and anxiety also to be looked upon a cause.
In some patients acupressure and reiki can help (incidentally I also do these too) As I told you I am an ENT as well as a General Surgeon hence could tell you details.
Awaiting for details.
Dr T Chandrakant. XXXXXXX MP
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the detailed information, really insightful. Which speciality doctor conducts all these tests that you have mentioned to identify possible phrenic nerve issue? She went to neurologist but has only been diagnosed with diaphragm myoclonus.
Brief Answer:
Where is your Mother staying at the moment ?
Detailed Answer:
Hi.
Thanks for your appreciation.
Where does your Mother stay? India/ US?
Where is your Mother staying at the moment ?
Detailed Answer:
Hi.
Thanks for your appreciation.
Where does your Mother stay? India/ US?
Above answer was peer-reviewed by :
Dr. Dr. Nagamani N.G
She stays in XXXXXXX XXXXXXX Travels once in a while to XXXXXXX to visit relatives.
Brief Answer:
Try to find a XXXXXXX and sincere Doctor in XXXXXXX or nearby
Detailed Answer: XXXXXXX is far away from me. Try to find out any good post graduate Doctor preferably a Surgeon and a Radiologist who can get the things done as I suggested. Any relatives in XXXXXXX Madhya Pradesh?
Try to find a XXXXXXX and sincere Doctor in XXXXXXX or nearby
Detailed Answer: XXXXXXX is far away from me. Try to find out any good post graduate Doctor preferably a Surgeon and a Radiologist who can get the things done as I suggested. Any relatives in XXXXXXX Madhya Pradesh?
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
She can visit your clinic as well, please share over the location and address for visitation. Thanks for all the insights.
Curious did you encounter this kind of case before, as I see that you have mentioned in that sense that you have seen this before?
Curious did you encounter this kind of case before, as I see that you have mentioned in that sense that you have seen this before?
Brief Answer:
Yes, seen such and similar undiagnosed patients.
Detailed Answer:
Yes, obviously yes.
I have seen patients like this and the once not diagnosed at other places. I am practicing for the last 40 years.
Patients with such problems may need to see different Doctors till a proper diagnosis is done as well as proper management is done.
Do you have anyone in XXXXXXX Madhya Pradesh?
Dr T Chandrakant.
Yes, seen such and similar undiagnosed patients.
Detailed Answer:
Yes, obviously yes.
I have seen patients like this and the once not diagnosed at other places. I am practicing for the last 40 years.
Patients with such problems may need to see different Doctors till a proper diagnosis is done as well as proper management is done.
Do you have anyone in XXXXXXX Madhya Pradesh?
Dr T Chandrakant.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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