Operation Cures Chronic Hiccups

After months of constant, bark-like hiccups, a first-of-its-kind operation has returned normal life to a 50-year-old Texas man.

Shane Shafer's speech is now a hoarse whisper — a side effect of the electronic device that cured him, one generally used to treat epilepsy and recently approved for major depression.

But for the first time since November, he can eat. He can sleep. He no longer has to make himself gag to make the hiccups stop. He can talk without a bark-like hiccup every three to four seconds.

"Even something as simple as a kiss is now performed without a hiccup," said his wife, Lori Shafer.

Surgeons implanted the device — a "vagus nerve stimulator" — in Shafer's chest June 23 in New Orleans. It was activated June 24.

On Wednesday, the Shafers were back home in Vidor.

"I don't hiccup any more," Shane Shafer said in a telephone interview. On a scale of 1 to 10, he said, the relief is definitely a 10.

The Shafers married in May 2003, on the first anniversary of the first of three strokes that Dr. Bryan Payne of the LSU Health Sciences Center said apparently damaged Shane Shafer's brain stem, leading to the hiccups.

"We had just recently started dating when he had his stroke. We tried to take the negative day of the stroke and make it positive, so the next year we got married," Lori Shafer said.

Then, around Thanksgiving, the hiccups began. They got worse with the new year.

Their local physician, Dr. Richard England of Beaumont, and other doctors tried a number of drugs, including tranquilizers and seizure drugs. They didn't work.

A technique England had used on himself to stop an attack of hiccups lasting several days in 1983 — making oneself gag by sticking a nasogastric feeding tube down the nose and into the throat — relieved Shafer's hiccups for up to 90 minutes.

Then Lori Shafer noticed that after her husband got an opiate injection for pain in his left leg, he'd stop hiccuping. England checked that out, and wrote a prescription.

England said that probably saved Shafer's life — noting that he regained the 30 pounds he had lost before using the drug.

But because it was an opiate, Shafer had to take more and more to get the same effects. Since hiccups aren't a government-approved use, insurance would not cover that $100 daily cost.

England asked a surgeon friend if he would cut the nerves to Shafer's diaphgram — an operation he'd found described in one medical book as a last resort. The surgeon said no, he'd never done such an operation before, and it would be too risky.

Lori Shafer called 15 doctors. The few who called back, weeks later, said they couldn't help.

An aunt of Shafer's read about Payne, a neurosurgeon who had operated on people for Parkinson's disease. England called.

"I was asked to see a fellow that had been hiccupping for about 8 months," Payne told Dave Cohen of CBS radio affiliate WWL-AM.

Payne talked with several neurologists and another neurosurgeon. They decided to start by seeing whether the hiccups were affected by stimulating or blocking the phrenic or vagus nerves.

Each phrenic nerve sends signals from the brain to one side of the diaphragm. The vagus nerves, almost two feet long, communicate with a number of organs.

The vagus block stopped hiccups for about four hours.

"Most of the folk remedies that are actually effective are different forms of vagus nerve stimulation," Payne said. Those include holding your breath, coughing, bending over and drinking water upside down, and even making yourself gag.

The vagus nerve stimulator, the doctors decided, could disrupt the miscommunication causing Shafer's hiccups just as it does to control seizures that can't be stopped by drugs.

In about 4 percent of patients, the device itself can cause hiccups. That wasn't really a worry, Lori Shafer said: "Nothing could have made them worse."

When Payne turned on the battery-operated device in his Shafer's chest, he tried several settings before finding one that stopped the hiccups.

He said Shafer will be back in New Orleans in a couple of months. "If he hasn't hiccupped at all, we'll try to lower his settings as much as possible," Payne said.

That will help the battery last as long as possible — about five to seven years are expected — and could reduce the effects on Shafer's vocal cords, he said.

"It's not as unusual as I thought," Payne said. "We've had about a dozen patients call at this point with similar stories."