Cornell Shalev (74) was plagued by hiccups, usually a minor annoyance that resolves in minutes. After two years of suffering, a multidisciplinary team of physicians at Rambam Health Care Campus (Rambam) determined the elusive cause and implemented a unique solution.
Two years ago, Shalev, a maintenance technician at a plastics factory, was diagnosed with cancer in the lining of his lung. Shortly after beginning chemotherapy combined with immunotherapy, he began experiencing persistent hiccups without an identifiable cause.
“On the surface, hiccups may seem like a minor issue, especially when a patient is facing a serious illness,” says Professor Alona Zer-Kuch, director of Medical Oncology at the Joseph Fishman Oncology Center at Rambam. “But Shalev was suffering, and incessant hiccups significantly affect quality of life.” His hiccups continued for six months, stopped suddenly, and then later returned.
“My physicians said the hiccups might be a side effect of the chemo and immunotherapy and would eventually go away, but a year later, I was still suffering,” recalls Shalev. “I couldn’t sleep, eat, or talk. I was exhausted and frustrated, especially because the cause was still unclear.”
Determined to find a solution, Zer-Kuch consulted with her colleagues at Rambam. They suspected the hiccups were caused by Shalev's various treatments. They tried anti-hiccup agents and other drugs, but nothing worked and it seemed increasingly likely that the hiccups were a neuropathic condition.
According to Zer-Kuch, Shalev’s hiccups were likely caused by the location of his tumors in the thoracic cavity, where the phrenic nerve – responsible for controlling the diaphragm’s contractions during breathing. The tumors likely irritated the phrenic nerve, triggering frequent contractions causing the hiccups. “We’ve seen similar phenomena, though usually on a smaller scale. Cancers in the stomach or esophagus can cause such effects, but to our knowledge, no cases like Shalev’s have been reported in the medical literature," explains Zer-Kuch.
The physicians tried devising a way to stop the phrenic nerve’s abnormal activity and considered a surgical solution. But due to the multiple tumors in Shalev’s lungs, it was impossible to access the nerve without serious risks. Radiotherapy was also not a viable option.
In a case involving a different condition, a promising approach was identified. Zer-Kuch reached out to Dr. Amir Minerbi, director of the Institute for Pain Medicine at Rambam and a specialist in minimally invasive nerve-block procedures that target pain-related nerves. He agreed to take on the challenge.
“We performed a nerve block procedure and monitored the results,” explains Minerbi. “For some patients, one procedure is enough, but in Shalev’s case, a second would likely be necessary.” Unfortunately, his hiccups returned.
During the second procedure, a radiofrequency ablation, using heat generated by radio waves to target and destroy the affected tissue, was performed. “So far, the results are promising, and I’m glad we were able to help him," adds Minerbi.
This was truly a complex and unique case, but brainstorming, teamwork, and thinking outside the box led to a creative solution.
“I’m a member of an American forum for people with persistent hiccups—some have suffered even longer than I did—some for decades,” says Shalev. “I don’t know how they manage. I barely held on, but if my case helps someone, somewhere, someday, it’s worth it.”
Based on a Hebrew article that first appeared on Mako
