Intractable hiccups might be due to acid reflux

Dear Dr. Roach: I am a healthy 64-year-old man. I got a terrible rash from poison ivy and needed to be put on prednisone. After a few days, I started having terrible hiccups. They've been going on for two days, and they are constant. I've tried all the home treatments to get rid of them. They haven't stopped for more than 3 hours. I also have a sore throat and some distention in my abdomen.What do you think could be going on? The rash is finally starting to get better. — B.M.S.Answer: Hiccups rarely go on for so long. There are many maneuvers that people swear by that often work. Holding your breath (or just breathing very mindfully with careful control of your breath), lemon and/or sugar, pulling your knees to your chest, sucking very hard through a tight straw, pulling on your tongue, and many others are some suggestions from years of practice and readers of this column. However, when these maneuvers aren't successful and symptoms have persisted for more than 48 hours, it's time for a thorough evaluation.The list of potential causes of intractable hiccups is long and contains some very serious illnesses, so it's not something to take lightly. However, the fact that yours started when taking prednisone, along with a sore throat and abdominal distension, suggests to me that your hiccups could be coming from acid reflux. Systemic steroids are one common medication that causes reflux, even if you've never had reflux before.While you are waiting to see your doctor, you might want to try antacid medication, such as an H2 blocker like famotidine (Pepcid) or a proton-pump inhibitor like omeprazole (Prilosec). These don't stop reflux, but they reduce or eliminate stomach acid so that the reflux doesn't damage your esophagus, larynx and pharynx. It often reduces or stops the hiccups.Dear Dr. Roach: I am a male who is 74 years old and in good health. I have a bunch of cysts in my kidneys that don't seem to be doing any harm and probably aren't due to a polycystic kidney disease. I got an MRI, and they found a 3-cm growth in one kidney. They said it's probably clear cell renal cell carcinoma. I went to a very good urologist who told me it was very small and that I should get it removed. His reason was that it would probably have to be removed some day, so doing it now was better than waiting, since I'm not getting any younger.I got a second MRI about a year later (a couple of weeks ago). Everything is the same, except that it has grown to 3.2 cm. I'm getting an opinion from a second urologist soon. I hate the idea of getting a surgery I don't really need just because I will likely need it in the future and "now is better than later." If I have to, I will. — J.H.Answer: You shouldn't have waited a year. Not only are you not getting any younger, the growth in your kidney, which is more than 90% likely to be kidney cancer, isn't getting smaller. As it gets larger, it's more likely to spread, so if your second urologist gives you the same advice, I recommend getting a surgery scheduled as fast as the urologist can make room for you.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.