Cisplatin or Decadron? hiccups won't give up...

RogerRN43

I started chemorad this week on Wednesday. One big dose of Cisplatin and given 3 drugs to combat nausea which included Decadron. 3 rads done so far.
It is day 4 today (Saturday) and I have uncontrollable hiccups. I was given Maxeran yesterday instead of Stemetil. It helps a little, so does Gavisocon, but is there anything else I should ask for on Monday? The visiting nurse was here today to give my final day of IV therapy (protect the kidneys from the Cisplatin) and recommended to ask for Losec.

I find it difficult to eat or sleep with these annoying hiccups. They let up 3-4 hours at a time and seem to come up at any given moment.

My Chemo nurse said Cisplatin side effects should subside in a week and perhaps these hiccups could be related to the Decadron. I had one last dose of Decadron today so I hope that's what it is, and not the Cisplatin.
Any suggestions?

Thank you

Hondo

Hi Roger
Sorry I never had problems with hiccups during any of my treatments. I seen other post here with people who did and hope they log on and give you some advice.

Take care
Hondo

longtermsurvivor

probably the cisplatinum
I've had some problems with this. Nothing like you describe. You can be treated with compazine or thorazine as well. Worth pushing for a solution, because I'm sure this is miserable.

docholmes52

hiccups
This info came from wikipedia. Sugar seems to be the best. You choose treatment
Phylogenetic hypothesisResearchers at the Respiratory Research Group, University of Calgary, Canada, propose that the hiccup is an evolutionary remnant of earlier amphibian respiration; amphibians such as tadpoles gulp air and water across their gills via a rather simple motor reflex akin to mammalian hiccuping.[2] In support of this idea, they observe that the motor pathways that enable hiccuping form early during fetal development, before the motor pathways that enable normal lung ventilation form. Thus, according to recapitulation theory (a theory that has lost much of the support it once had) the hiccup is evolutionarily antecedent to modern lung respiration. Additionally, they point out that hiccups and amphibian gulping are inhibited by elevated CO2 and can be completely stopped by the drug Baclofen (a GABAB receptor agonist), illustrating a shared physiology and evolutionary heritage. These proposals explain why premature infants spend 2.5% of their time hiccuping, indeed they are gulping just like amphibians, as their lungs are not yet fully formed. Fetal intrauterine hiccups are of two types. The physiological type occurs prior to twenty-eight weeks after conception and tend to last five to ten minutes. These hiccups are part of fetal development and are associated with the myelination of the Phrenic nerve (which drives the diaphragm).

[edit] Signs & symptomsA single or a series of breathing diaphragm spasms, of variable spacing and duration.
Might show as a brief (less than one half second), unexpected, shoulder, abdomen, throat, or full body tremor.
Might be easily heard as a chirp, squeak, "hupp", or if properly controlled, a quick inhaling gasp, sigh, or sniff.
Victim might complain of brief but distracting or painful, frequent or occasional interruptions in normal breath, with sudden momentary pain of the throat, chest, or abdomen.
If the hiccups are properly controlled there is no discomfort except for the mild distraction of the occasional uncontrollable gasp.
[edit] Symptomatic treatmentThere has been a tradition of folk remedies, usually consisting of odd behaviors to interrupt the hiccups. Because the hiccup is an effect (sign) of a wide variety of neuro-respiratory and vestibular causes, initial treatment should be to mitigate patient distress, by eliminating the pain of tracheal (windpipe) 'stoppering', and if still needed, the anxiety of the diaphragm spasms.
1. Use a "Prevent stoppering" technique for the trachea (windpipe) by vocal cord closure or epiglottis, or the mouth by the lips. (several sources of instruction).
2. Use the "deeply held breath" technique to minimize or prevent the spasm reflex of the diaphragm. Both of these treatments tend to be definitive, by breaking the hiccup cycle.
If after this initial treatment, episodes are persistent, or prolonged, or otherwise cause discomfort, further investigation and assessment can be done.

[edit] FactorsOvereating
Alcohol
Sudden temperature changes
Carbonated beverages, alcohol, dry breads, and some spicy foods.[3]
Laughing
Tobacco use (nicotine)
[edit] Causes of persistent hiccupsMetabolic diseases
Diabetes
Kidney failure
Electrolyte imbalance
Deviated septum
[edit] InfectionsPneumonia
CLD
[edit] CNS disordersStroke
Multiple sclerosis
Tumors
Meningitis
Encephalitis
Traumatic brain injury
[edit] Nerve damage/irritationVagus and phrenic nerve involvement
Laryngitis
Cysts
Goiter
Gastroesophageal reflux
[edit] TreatmentNumerous medical remedies exist but no particular treatment is known to be especially effective.[4] Many drugs have been used, such as baclofen, chlorpromazine, metoclopramide, gabapentin, and various proton-pump inhibitors. Hiccups that are secondary to some other cause like gastroesophageal reflux disease or esophageal webs are dealt with by treating the underlying disorder. A simple treatment involves increasing the partial pressure of CO2 and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag. Vagus nerve stimulation can improve hiccups, done at home by irritating the pharynx through swallowing dry bread or crushed ice, or by applying traction to the tongue, or by stimulating the gag reflex. The phrenic nerve can be blocked temporarily with injection of 0.5% procaine, or permanently with bilateral phrenicotomy or other forms of surgical destruction. Even this rather drastic treatment does not cure some cases, however.

In Plato's Symposium, Aristophanes has a case of the hiccups and is advised by Eryximachus, a physician, to cure them by holding his breath, or, failing that, by gargling or provoking sneezing. Compare this ancient recommendation with the vagal nerve stimulation techniques mentioned previously.

An anecdotal medical approach is to install lidocaine liniment 3% or gel 2% in the external ear. Somehow this creates a vagus nerve-triggering reflex through its extensions to the external ear and tympanus (ear drum). The effect can be immediate, and also have lasting effect after the lidocaine effect expires after about two hours.[5]

A solution involving sugar placed on or under the tongue was cited in the December 23, 1971 issue of the New England Journal of Medicine.[6]

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of Jennifer Mee, a 19-year-old girl who, in 2007, hiccuped continuously for five weeks.[7] Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating with sedatives is only appropriate short-term, as the affected individual cannot continue with normal life activities while under their effect.

Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to normalize the potassium-sodium balance in the nervous system.[citation needed] The carbonation promotes quicker absorption. Carbonated beverages, including beer, by themselves may provoke hiccups in some people.[citation needed]

The administration of intranasal vinegar was found to ease the chronic and severe hiccups of a three-year old Japanese girl. Vinegar may stimulate the dorsal wall of the nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (the afferent of the hiccup reflex arc) is located.[8]

Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy."[9]

DrMary

Ditto on the hiccups
Doug had them so severely he couldn't eat. Some of it might have been acid reflux; we blamed the decadron and it might well have been that. He skipped the decadron for the second chemo and didn't have the hiccups as much but the nausea was much worse. The nausea kept up so long (a month or so) that he went back on the decadron, combined with reglan (Maxeran). He had hiccups again for a few days, but then they went away.

Thorazine is supposed to be better for the hiccups than compazine (Stemetil), and it does just about as well with the nausea. The standard hiccup cures don't work.

The suggestion for Losec (Prilosec, or omeprazole) is a good one - the chemo did seem to cause a lot of acid reflux for Doug. Since the Gaviscon works for you, I'm betting acid is much of your problem.

You can take both Maxeran and Stemetil together - the Maxeran takes a few days to really work (it works by speeding gastric emptying but it also seems to improve the tone of your gastric muscles, which can help things from splashing up your esophagus). Stemetil works on different systems - similar to the OTC drugs dramamine or bonine (but much stronger). So ask your doctor if he/she prefers that you only take one, or if you can take both.

Maxeran does have some rare but potentially serious side effects - it can produce Parkinson's-like symptoms, which usually go away when you stop taking it, but not always. Therefore, when you are taking it, be aware of any unusual face tremors or tics (read the drug info for full details) and let your doctor know right away.

Lastly, the first 3 days after chemo are often the best, because of the way the anti-nausea drugs work. If you start to have signs of nausea, don't wait - take whatever they recommended you take "as needed" (likely the Stemetil) and take it regularly for the remainder of the 7-10 days after chemo ("a week" can be optimistic). You likely got similar advice from your doctor (we did) but perhaps didn't heed it at first (we didn't - Doug hates taking pills and so tried to avoid doing so).

Stay hydrated - it sounds like you are doing great so far!

Skiffin16

WOW....
Those are some long explanations...LOL.

I had hiccups as well...more than likely as you mentioned, Cisplatin induced.

My MD gave me some meds for them, never had then again after the first time.

Best,
John

buzz99

Hondo said:

Hi Roger
Sorry I never had problems with hiccups during any of my treatments. I seen other post here with people who did and hope they log on and give you some advice.

Take care
Hondo

Hiccups
Buzz can relate to the hiccups. He had severe hiccups after his first dose of Cisplatin-Taxotere-5FU. Thorazine helped but this worked for him (this is going to sound weird): He would look at the ceiling, extend his tongue as far as possible and try to lick the ceiling. Don't do this in public! Karen

RogerRN43

Just like clockwork
Hiccups are gone after decadron wore off. That was terrible, it was like my stomach was in lockdown, couldn't eat anything.
Hope I get some proper meds next time.
Starting to sip feed cans and eat yogurt.

Thanks all.

DrMary

RogerRN43 said:

Just like clockwork
Hiccups are gone after decadron wore off. That was terrible, it was like my stomach was in lockdown, couldn't eat anything.
Hope I get some proper meds next time.
Starting to sip feed cans and eat yogurt.

Thanks all.

Good for you
Actually, they haven't really come up with anything better than what you probably had (Emend and Decadron for 3 days; Zofran and Decadron for another 2 days; Compazine as needed, or some similar mixture of those). My BIL the doctor called Decadron "an oldie but goodie" - it increases the effectiveness of the Emend quite a bit.

Doug hated the hiccups - but throwing up for over a month was even worse, for him. Everyone is different.

longtermsurvivor

RogerRN43 said:

Just like clockwork
Hiccups are gone after decadron wore off. That was terrible, it was like my stomach was in lockdown, couldn't eat anything.
Hope I get some proper meds next time.
Starting to sip feed cans and eat yogurt.

Thanks all.

variable effect
There is hope. Just had my second course of carboplatin/taxotere three days ago. Prophylactic treatment the same as the first time. No hiccups at all.