VIDOR, Texas -- Suffering a stroke is bad enough. Suffering three strokes in a row is worse. But the aftermath of three strokes was worst of all for Shane Shafer: The strokes triggered a case of hiccups so vicious that doctors had to operate on him in a landmark surgical procedure.
Hiccups are caused by sudden, involuntary contractions of the diaphragm, the large muscle that separates the abdomen from the chest cavity and plays a key role in the breathing process. When a person hiccups, the diaphragm contracts suddenly and the vocal cords in the throat snap shut to stop a sudden influx of air into the breathing tract, making the hiccupping sound. Hiccups usually go away quickly in most people. But in some people, they become intractable--they last more than a month.
Shafer's case was so severe--he hiccupped about once a minute--that he could barely eat or sleep. "At night, his body would get so tired, it would just give out, but our bed was like the one in The Exorcist, jumping up and down," his wife, Lori Shafer, told the New Orleans Times-Pacayune.
Richard England, Shafer's family physician, tried treating the hiccups with an analgesic, a drug that deadens pain. Each injection of the drug worked for a short period of time, but Shafer built up a tolerance to the drug and needed stronger and stronger doses, eventually costing him more than $100 a day, which his health insurance did not cover. Shafer began to fear for his life.
Unable to help him any further, England phoned Bryan Payne on a hunch. Payne is a neurosurgeon in New Orleans who has successfully stopped tremors in patients who have Parkinson's disease. Payne said he would try to help Shafer.
Payne guessed that the strokes had short-circuited Shafer's vagus nerve, causing it to stimulate the diaphragm repeatedly, The vagus nerve, which measures 56 centimeters (22 inches) long, passes from the brain to the face, trunk, and abdomen. In late June, Payne implanted a small electrical device beneath Shafer's collarbone. Payee hoped that by delivering repeated shocks to the vagus nerve, the device could break the faulty connection.
A day after the surgery, Payne activated the implant. The hiccups stopped. "It was just amazing to watch," said Lori Shafer. "Something we had fought for all these months had gone."
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