What is the CSMR! CA Bear The California State Military Reserve is the official state defense force, and enables the Golden State to do more. It is a part of the California Military Department, along with the state’s National Guard and Air National Guard. Its mission is to augment the National Guard in a variety of support roles, and to specialize in homeland defense and emergency management missions. READ MORE ....


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(Note to reader: This article is not about contraception.)

The diaphragm is a thin sheet of muscle stretched under the lungs, adhering to their bottom surfaces and the eleventh and twelfth ribs The diaphragm expands (inhale) and contracts (exhale) with impulses from several nerves, mainly the phrenic. The diaphragm continues pumping during sleep or inattention but is also under conscious control, enabling breath holding, under water swimming, getting through a cloud of Sarin, latrines.

Fig. 1 Anterior view of diaphragm.

You might think nothing much can go wrong with a flat muscle attached to lungs and upper abdomen. But if the esophageal hiatis in the center is enlarged, partially digested food may enter the stomach, causing gastro-esophageal reflux, also termed hiatal hernia and GERD.

Hiccups, Singultus (Latin)

Usually no more than a nuisance, probably an evolutionary remnant of a reflex which enabled infants to consume more milk, then burp. A hiccup is a sudden spasm of the diaphragm. Hiccups usually subside in less than a half hour. There are no sure cures, but, theoretically, increasing the carbon dioxide level may work. This may be done by breath holding or breathing into a paper bag. Other methods include drinking and gargling cold water, biting a lemon, and arranging to be frightened.

Fig 2.  An outline of the diaphragm’s shape and position.

Fig 2. An outline of the diaphragm’s shape and position.

Medications include chlorpromazine (Thorazine), haloperidal (Haldol), and metoclopramide (Reglan). Intractable hiccups may go on for weeks interfering with eating, sleeping, work, social life. It may cause weight loss and significant fatigue. A last resort is to cut the phrenic nerves, stopping stimulation of the diaphragm.

P & O’, a story by Somerset Maugham, tells of an Irishman in Malasia who jilts and abandons his native girl friend, Nurmala. She puts a curse on him. When his ship starts for Galway, he begins to hiccup. The ship’s doctor cannot cure him. He wastes away, dieing before they make port.

So be good to Suriani.

COL (CA) William Goldsmith M.D

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