Everyone does it. Why can’t I?

Summary

Podcast Episode Summary

Unexplainable — "Everyone does it. Why can’t I?"

Podcast: Unexplainable (Vox)
Air Date: February 9, 2026
Host: Sally Helm
Guest: Noelle King (host of "Today Explained")
Featured Expert: Dr. Robert Bastian (Laryngologist)
Description:
This episode dives into the strange, under-recognized world of people who physically cannot burp—a condition only officially named in 2019, and known online as "no-burp syndrome" or, medically, retrograde cricopharyngeus dysfunction (R-CPD). Host Sally Helm reveals her own struggles with the condition, explores its physiological and psychological dimensions, and documents her journey to try a novel, potentially permanent cure.

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Episode Overview

The episode explores the mystery of “no-burp syndrome”: why some people cannot burp, why this condition was ignored by the medical field for so long, how it profoundly affects quality of life, and why a surprising cure—Botox injections—may offer lasting relief for some. The conversation is driven by Sally’s personal experience, interviews with others affected, and insights from Dr. Robert Bastian, a key physician in identifying and treating the syndrome.

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Key Discussion Points & Insights

1. What is “No-Burp Syndrome”? [02:40–06:22]

• Symptom Descriptions: People describe severe bloating, air trapped in the gut, pain, and odd throat noises. Sally shares audio montages of “froggy” or “ribbit” sounds made by those affected.

  "There were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable." — Sally Helm [05:25]

• Revelation: Sally reveals she herself cannot burp, explaining how strange, painful, and isolating the experience is.
• Naming the Syndrome: The condition was only described in the medical literature in 2019 as "retrograde cricopharyngeus dysfunction" (R-CPD). [07:08]

  "It’s really easy to recognize...I can’t burp. That is the problem. It’s very easy to describe. And yet, it was not named for many, many years." — Sally Helm [07:19]

2. Medical System Blindspots [06:35–09:14, 17:09–18:52]

• Undiagnosed for Decades: Many suffer for years, often subjected to unnecessary, invasive tests.
• One Patient's Ordeal: Dorie Gray recounts being recommended colon removal before realizing her true issue was not being able to burp.

  "No one ever said, you know, do you burp? I never thought about not burping. It just wasn’t on my radar as a thing." — Dorie Gray [08:27]

• Medical Specialties Overlapping: The muscle involved sits at the overlap of GI doctors’ and ENT doctors’ domains, so the symptom pattern fell through the cracks.

  "It’s kind of an orphan area...it just gets a little lost." — Sally Helm on Dr. Bastian’s analysis [18:05]

3. Enter Dr. Robert Bastian—Diagnosis and Innovation [09:14–14:22]

• Laryngologist’s Curiosity: Dr. Bastian, open to patient observations, gets an email from a man whose new skydiving hobby made his symptoms unbearable.

  "My mind is one that goes to sort of solutions...I’m a strategic thinker, I’m an optionizer." — Dr. Robert Bastian [09:27]

• Understanding the Physiology: Problem lies in the cricopharyngeus muscle (upper esophageal sphincter) not relaxing to let air out.
• The Surprising Cure: Dr. Bastian proposes injecting Botox in the muscle:

  "You need to have somebody put Botox into your upper esophageal sphincter to help you burp." — Dr. Robert Bastian [13:08]

• Online Patient Community: The "no-burper" community on Reddit and Facebook is pivotal in spreading awareness and self-diagnosis, often ahead of the mainstream medical community.

4. The Odd Cluster of Symptoms [14:22–16:21]

• Beyond Bloating: Excessive gurgling, painful hiccups, high flatulence, and a high rate of emetophobia (fear of vomiting).

  "There are a few random things, like painful hiccups. Are your hiccups painful?" — Sally Helm [15:01]

5. Why Did Medicine Ignore This? [16:55–18:52]

• Measurement vs. Observation: Over-reliance on diagnostics over patient narratives delayed recognition.

  "Measurement gets respect. Observation does not get respect." — Dr. Robert Bastian [09:40]

• Self-Diagnosis is Accurate: Nearly all who self-diagnose online turn out to be correct; the diagnosis is "syndromic," based on classic clusters, not tests.

  "If patients can diagnose themselves accurately 100% of the time, then why can’t we doctors do the same?" — Dr. Robert Bastian [19:48]

6. The Botox Treatment and Why it Might Work [22:41–25:47, 29:16–35:20]

• Expected Temporary, Saw Permanent Relief: Botox (usually lasting 3–4 months) seems to “teach” some patients to burp, leading to permanent results.

  "He mysteriously kept burping...as far as I know, he is still burping." — Sally Helm [22:56] "A single Botox injection fix these people permanently. This does not make sense." — Dr. Robert Bastian [23:08]

• Sally’s Personal Account: She undergoes the procedure herself, initially under general anesthesia (for vocal safety), and narrates the anticipation and gradual success.
  • First Days: "In the 48 hours after surgery, I’m just watching every movement in my throat." [28:19]
  • First Burp: "I was in the middle of talking about something, and suddenly..." [29:41]
  • Learning to Burp: Sally describes awkward, elaborate postures that trigger burping, as she (and others) build this new muscle memory.

    "I discovered that a body posture that worked really well is...when you’re reversing a car...burp city right away." — Sally Helm [33:27]

  • Lasting Change?: The skill may last, but it’s unclear if it’s truly permanent for all.

    "Why are people still burping? My answer...has to be, well, they figured it out." — Dr. Robert Bastian [36:41]

7. On Belching as a Learned Skill [35:31–37:22]

• The Reflex Element: Dr. Bastian theorizes everyone develops some physical "gesture" to produce a burp, often unconsciously; those with R-CPD missed this learning early on.

  "Every person who burps does something just prior to the burp...I don’t like calling it the Belch Reflex because it does have some voluntary input." — Dr. Robert Bastian [35:31]

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Notable Quotes & Memorable Moments

• [05:25] Sally Helm: "There were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable...some of the patients that I see with this condition have what I would call severe daily misery from not being able to burp."
• [08:27] Dorie Gray: "No one ever said, you know, do you burp? I never thought about not burping. It just wasn’t on my radar as a thing."
• [13:08] Dr. Robert Bastian: "You need to have somebody put Botox into your upper esophageal sphincter to help you burp."
• [18:52] Dr. Robert Bastian: "I would imagine that there must have been at least 15,000 major tests done on these 2,400 people before they came to us...and out of those 2,400 people, the diagnostic rate was exactly zero."
• [19:48] Dr. Robert Bastian: "If patients can diagnose themselves accurately 100% of the time, then why can’t we doctors do the same?"
• [23:08] Dr. Robert Bastian: "I have to figure out why on earth would a single Botox injection fix these people permanently. This does not make sense."
• [36:41] Dr. Robert Bastian: "Why are people still burping? My answer to that has to be, well, they figured it out."

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Useful Timestamps

• [02:40] Introduction to patient symptom audio
• [05:11] Sally reveals she cannot burp
• [07:08] The condition officially named in 2019
• [08:02] Dorie Gray’s misdiagnosis, colon removal suggestion
• [09:14] Introduction of Dr. Robert Bastian
• [13:08] Botox as a treatment
• [17:09] Why this condition was missed by medicine
• [18:52] 2,400 self-diagnosed patients, zero test-based diagnoses
• [22:41] Botox’s unexpected permanence
• [28:19] Sally after her surgery, awaiting first burp
• [29:41] Sally’s first recorded burp
• [33:27] "Backing up the car" posture for burping
• [35:31] The voluntary element of burping

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Episode Takeaways

• Many people suffer for years with a seemingly trivial but genuinely debilitating condition: inability to burp.
• The medical profession overlooked this issue due to overlapping specialties, a focus on quantifiable tests over patient narrative, and perhaps social discomfort.
• The solution—Botox injection into a specific throat muscle—emerged not through randomized controlled trials, but keen observation and openness to patient experience, then quickly caught fire via online patient communities.
• For many, the cure is not only rapid but potentially permanent, thanks to newly “learned” muscle control.
• At every turn, direct patient observation, self-advocacy, and crowdsourced knowledge proved more effective than traditional medical pathways.

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Final Thoughts

This episode combines investigative curiosity, personal storytelling, medical insight, and genuine hope. Sally’s openness about her own experience (and some charming awkwardness with new burping skills) makes “no-burp syndrome”—an invisible misery faced by thousands—visible and legitimate. The conversation is warm, funny, and deeply human, reminding us how much patient experience can teach, and how much listening still remains unexplainably important in medicine.

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For Further Listening

• Dr. Robert Bastian’s Laryngopedia: Resource for voice and swallowing disorders
• r/noburp subreddit: Community support and patient data for R-CPD

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If you think you may have R-CPD, self-diagnosis can often be accurate and validated by a specialist; modern treatments may transform your life.

Transcript

[Narrator/Announcer]

Support for this show comes from the Working Forests Initiative. The working forest industry is committed to planting more trees than they harvest. More than 1 billion seedlings are planted in US working forests every year. From biologists to GIs, analysts, hiring managers, accountants, Working forest professionals have dedicated their focus towards sustainability, using their expertise to help ensure a healthy future for America's forests. They say they don't just plan for the future, they plant it. You can learn more at working forests initiative.com.

[Ad Voice]

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[Noelle King]

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The same Monday.comwith an easy and intuitive setup.

[Sally Helm]

Go to Monday.com and try it for free. Okay. All right, are you ready?

[Noelle King]

Yeah. Let's do it.

[Sally Helm]

It's unexplainable. I'm Sally Helm. You are Noel King, here with me in the studio. Hello.

[Noelle King]

I sure am.

[Sally Helm]

Hey, Noelle. You're the host of Today Explained the Vox Daily News podcast. Congratulations. Wonderful show.

[Noelle King]

Thank you.

[Sally Helm]

To me, you are probably better known as that girl who texts me Onion articles all the time.

[Noelle King]

I'd say we have known each other for a very long time.

[Sally Helm]

Yeah. Almost a decade, actually.

[Noelle King]

Decade? No, no, it is a decade. It is a decade. January 2016. Yeah.

[Sally Helm]

Oh, my gosh. Wow. Like this week?

[Noelle King]

This week.

[Sally Helm]

Okay. Well, during our decade long friendship, there is something that I have never told you about myself.

[Noelle King]

There can't be. There can't be.

[Sally Helm]

I think there is. I think there's at least one thing we've never talked about. And I've brought you here today to talk about it. I guess my first question for you is, what is your feeling about medical mysteries?

[Noelle King]

Medical mysteries. So as a person who is a self diagnosed hypochondriac, I do not enjoy a medical mystery. I want everything medical to be instantly known and understood and clear and taken care of. So when you say medical mystery, I'm not gonna lie, I get a little anxious.

[Sally Helm]

Great. You're not in luck because today we have a medical mystery. That is what we are gonna discuss. O and first up, I'm gonna play you some audio of people discussing the symptoms that they're experiencing. You just feel nauseous, you know, after drinking. I guess one beer or one whatever. Even a glass or two of water can do it.

[Dorie Gray]

Really bad bloating. All the CT scans showed a lot of air in my intestines, but no one knew why and why it wasn't moving.

[Sally Helm]

It's almost like a dam is holding everything back.

[Dr. Robert Bastian]

Here in your throat. It's extremely painful, and it's very debilitating.

[Noelle King]

There were moments where, like, I can't really live like this, where I'm lying in bed at night and almost felt like I was in this torture chamber of my own body, you know?

[Sally Helm]

Do you have any guesses right off the bat about. About what's going on here?

[Noelle King]

This sounds digestive to me. This sounds like something in the old. What we used to call the plumbing.

[Sally Helm]

Mm. Mm. You're thinking guts. Yeah, yeah, I'm thinking guts.

[Noelle King]

I'm thinking this is a gut issue. But beyond that, no, I don't know.

[Sally Helm]

Okay, I'm gonna tell you more about it.

[Noelle King]

Okay.

[Sally Helm]

But first, I do have to reveal that I actually have this condition myself.

[Noelle King]

Oh, girl.

[Sally Helm]

That we are discussing today. I'm so sorry. Thank you. Yeah, like the stomach bloating, the weird throat sensations. And there is another symptom that is auditory. People like me who have this condition, we make certain sounds that other people don't make. And I did put together a little medley for you. Some of these are me. Some of these are other people with the same condition. Okay, here's some audio. So what did that sound like to you? How would you describe those sounds? Okay.

[Noelle King]

Fortunately, I laughed through it.

[Sally Helm]

So I can't tell you exactly what I was hearing there.

[Noelle King]

But actually, I will say, nor do I want to. I don't want to tell you what I was hearing.

[Sally Helm]

I mean, so a lot of people compare this to a frog. Sounds like a ribbit. That can happen. I also have heard. I've heard dinosaur. I've heard monster. I've heard I sound, quote, demonic, slash possessed.

[Noelle King]

Frog.

[Sally Helm]

Let's stick with frog.

[Noelle King]

Frog is gentle.

[Sally Helm]

Frog. Frog is good little ribbit. Okay, I do want to reveal. You said you don't like medical mysteries. I do want to assure you that, actually, Noelle, the cause of these symptoms is not, in fact, a mystery.

[Noelle King]

Oh, okay.

[Sally Helm]

The cause of the symptoms is that I cannot burp.

[Noelle King]

You can't burp?

[Sally Helm]

I've never been able to burp. Wow. Did you know that about me? No.

[Noelle King]

No. Yeah.

[Sally Helm]

Can you burp?

[Noelle King]

I can. I'm not gonna do it on tape. Cause I'm a lady, but, yeah, I can.

[Sally Helm]

Yeah. I've never been able to burp. And it's this really annoying problem. It sounds funny when I tell people because it has the word burp in it. But actually, it's like there were weeks of my life where I would have to just lie down all afternoon because it was the only way to get comfortable. Yeah. I ended up talking to a doctor who treats this, and he was like, there is definitely a range, but some of the patients that I see with this condition have what I would call severe daily misery from not being able to burp. Yeah. And, I mean, I would say that I have not had the worst case ever, but, you know, it has been bad sometimes. And yet it was also not something that I really thought to mention to people that often, you know, like, it's weirdly beneath the world's notice. Like, no one ever talks about burping, really. You know, like, when would it come up? You're right.

[Noelle King]

There's not, like, a lot of good options.

[Sally Helm]

Like, you never told me you are a burper. So. All right. The medical mystery is half solved. But, Noelle, do you think that I called you here to solve a medical mystery in one minute? No.

[Noelle King]

No, surely not.

[Sally Helm]

And there are a couple of mysterious things about this condition. So one of them is just, like, why can't I burp? Because I can swallow, and it's the same muscle, you know, so it's like it can go down to let in food. Why can't it go up to let out a burp? Another mystery is why the medical system has, for some reason, been almost completely blind to this condition. It was only named in the medical literature in 2019. Whoa. It's, like, weird to me.

[Noelle King]

That's so weird. So many things were identified by 2019. So many things. And this doesn't sound. I mean, you could tell me. It doesn't sound like it's that uncommon. You have all these people on tape saying they're going through the same thing.

[Sally Helm]

It's really hard to say how common it is. I think it's, like, somewhat rare, but not, like, super, super rare. And also, it's just really easy to recognize. Like, it's like, I can't burp. That is the problem. It's very easy to describe. And yet, yeah, it was not named for many, many years. And that can be, like, a real problem. Like, I talked to this one woman who you actually heard at the beginning. Her name is Dorie Gray. And in her case, the doctors were, like, completely stumped for years.

[Dorie Gray]

I ended up having every test you can imagine having to do with your intestines. Eventually, the doctors were all like, we don't know. We did every test. We can't figure out why this is all happening to you. Go see this surgeon and see what he thinks.

[Sally Helm]

And, Noel, this woman Dori, eventually had not one, but two separate Surgeons suggest to her that maybe she should just remove her colon.

[Noelle King]

Oh, my God.

[Sally Helm]

Solve her problems.

[Noelle King]

Oh, my God.

[Sally Helm]

No, I know. And thank God she did not do it, because now she is pretty sure that the root cause was not like having a colon, but it was actually the fact that she could not burp.

[Dorie Gray]

No one ever said, you know, do you burp? I never thought about not burping. It just wasn't on my radar as a thing.

[Sally Helm]

Dory did eventually do something to try to solve this problem at its root. And that brings us to mystery number three, which is a really good one because for some people, there is now a mysterious but possibly permanent cure. Oh. And I have just recently tried it in an attempt to finally learn to burp. Okay, so I'm going to tell you that story today. Are you ready?

[Noelle King]

Yeah. Let's hear it.

[Sally Helm]

Our main character today is a hero to all. No burpers everywhere. And his name is Dr. Robert Bastian.

[Noelle King]

Okay.

[Sally Helm]

He is a laryngologist in Illinois. And I'm gonna play you a little. A little tape to help you get to know him better.

[Dr. Robert Bastian]

My mind is one that goes to sort of solutions. And so I've done some of those online inventories, you know, StrengthsFinder and Colby.

[Sally Helm]

Noel, you know that I love a personality test.

[Noelle King]

Oh, I love a man who looks for solutions.

[Dr. Robert Bastian]

I've learned that about myself, that I'm a strategic thinker. I'm an optionizer, and I'm also a physician who leans to the observational side. You know, the scientific method is to test a hypothesis based in observation or measurement. And so what I would say about the medical profession is that it leans heavily towards measurement. So sometimes I say, when I teach, I say, you know, measurement gets respect. Observation does not get respect.

[Sally Helm]

But Dr. Bastian is a real listen to the patient kind of doctor. Like, he doesn't like to get bogged down in unnecessary details. He doesn't want to run a zillion tests if that's not necessary. I mean, not that he's not interested in facts. He does also run a website called Laryngopedia, which is a voice and swallowing disorder encyclopedia. And one day, Noel, he gets an email from a guy in Texas who says, can you help me, Dr. Bastian, because I cannot burp. It has been a lifelong problem. But he is moved to send the email at that moment because he had also picked up a new hobby that was making not burping especially difficult. Do you want to guess what it is?

[Noelle King]

Drinking soda.

[Sally Helm]

Good guess. Totally wrong. The new hobby was Skydiving.

[Dr. Robert Bastian]

So he said when he goes up in the airplane, he just becomes incredibly uncomfortable. Other people are burping, and he couldn't burp. Huh.

[Sally Helm]

Wait, he mentioned. This is now a tangent, but when you go up in an airplane to skydive, that causes you to burp for some reason.

[Dr. Robert Bastian]

Well, have you ever noticed that the potato chip bags get really puffy when you go up in the air? So because he had a lot of air in his stomach and he needed to burp it out, he couldn't do that. He said he became incredibly uncomfortable because his stomach became like that potato chip bag.

[Sally Helm]

Over the years, he's seen all these doctors. No one can figure it out, but now he wants to be a skydiver. So he really goes deep, and he finds his way to laryngopedia and to Dr. Bastian, who, it turns out, is, like, the perfect person to talk to here, because he works a lot with this particular swallowing disorder that has to do with the muscle that is clearly involved here, which is the upper esophageal sphincter muscle, also called the cricopharyngeus muscle. It's like a circular muscle that opens and closes. And, you know, for normal people, you're probably familiar, air will come up your throat, it will present itself to this muscle, and then the muscle relaxes and the air comes out. And for this person and for me, that is not happening for some reason. So our problem is that the muscle is not relaxing properly and maybe even is clamping up. So Dr. Bastian, he's familiar with this muscle, and he also, as we've discussed, has this very particular personality and this, like, particular medical style where he leans towards observation. And so just getting this email where this guy is describing his own observations very clearly, here is my problem. The problem is I cannot burp. Here's what it feels like. Here's what happens to me. And Dr. Bastian, like, that is giving him a lot of information. He's like, okay, it sounds like this guy knows what the problem is. Tick, tick, tick through the possible solutions in his mind. And, like, he actually pretty immediately comes up with an idea.

[Dr. Robert Bastian]

I said to him, well, you need to have somebody put Botox into your upper esophageal sphincter to help you burp.

[Noelle King]

This actually makes complete sense to me.

[John (Friend)]

But.

[Noelle King]

Because when you think about it, Botox, they use Botox to freeze all kinds of things, right?

[Sally Helm]

Exactly. Yes.

[Noelle King]

Yeah, yeah. Okay. Smart man.

[Sally Helm]

You know, you use it between your eyebrows or whatever so that you don't get wrinkles there because the muscle can't move. Right. And so. Exactly. He's like, this will paralyze the muscle, and. And then this man will have no choice but to burp because the muscle can't clamp up in this. In this way. And in fact, he has actually injected Botox into a nearby part of the body, the larynx.

[Dr. Robert Bastian]

I do 100 injections a month for a rare neurological condition of the voice.

[Sally Helm]

Wow. Does that work for that disorder?

[Dr. Robert Bastian]

Oh, it works beautifully. Beautifully for that disorder. Just beautifully. And so in all those people, they come two to three to four times a year and repeat the treatment.

[Noelle King]

He's done it before. It's not like it's dangerous, right?

[Sally Helm]

Yeah. So Dr. Bastian is like, okay, like, I'm gonna inject this guy with Botox. That'll get him burping. And then when it wears off. Cause it wears off in, like, three months. I'll just do it again, and he can just burp for the rest of his life. So he does this. He sends him on his way. And then, Noel, other people start showing up in his office, because unbeknownst to him, this guy has been posting about his experience on the Internet. And there is this thriving no burper community on Reddit and Facebook where people are being like, I can't burp. The doctors are telling me to remove my colon. Like, what do you guys think we can do? And these patients have a very particular symptom cluster that Dr. Bastian starts to recognize. So obviously can't burp. Chief among them, bloating, the gurgling. A lot of people experience a higher level of flu flatulence for obvious reasons. Oh, no, there are a few random things, like painful hiccups. Are your hiccups painful?

[Noelle King]

No, they're annoying, but not painful.

[Sally Helm]

Yeah, mine have always been painful. I did not know until college that that was, like, not normal. Another interesting thing is that more than the general population, we know, burpers tend to have emetophobia, which is a fear of throwing up. What do you make of that? I.

[Noelle King]

My sister and my niece have emetophobia. It is not a game. I am.

[Sally Helm]

I mean, you should check if they can burp.

[Noelle King]

You're giving me all kinds of ideas right now.

[Sally Helm]

Yeah, yeah. Well, so, okay, so I saw one study that raised the idea that people who can't burp might be subconsciously tensing this muscle. So I was like, maybe you're tensing that muscle because you're scared to throw up. And, yeah, you don't Throw up, but also you can no longer burp. But Dr. Bastian told me another theory, which is that throwing up can actually be painful if you have this condition. So maybe, maybe it goes the other way, where early on you had a painful experience of throwing up and then that actually causes your emetophobia, not the other way around. Isn't that interesting?

[Noelle King]

That is incredible. It is. And also babies throw up. So it does strike me that you could very early on be a baby. Babies throw up a lot. You're having this reaction you're feeling as a baby, pain. And so you're, you know, you get older. You're not putting two and two together. Why am I afraid of throwing up?

[Sally Helm]

Totally.

[Noelle King]

Because I don't remember being an infant. Yeah. Wow.

[Sally Helm]

I mean, that's basically Dr. Bastian's theory. Although he's like, I don't know. Like, I don't know if that is true. I will say some of us, no burpers could not burp as babies. Like, there's stories of you just like, can't burp at all. I know I had colic as a baby, so I was like crying all the time. And Dr. Bastian was like, you were probably an inadequate burper. Like you probably could burp, but not quite. Right.

[Noelle King]

Yep.

[Sally Helm]

Okay. So anyway, so he's getting this sort of symptom cluster. He's trying to figure it out as best he can, but eventually he's like, I should go read the literature on this. Like, I should just go see what people have written.

[Dr. Robert Bastian]

And to my great surprise, there was essentially nothing. I was astonished. I thought, I didn't think there was anything left to discover or, you know, once you know about it. It's so obvious.

[Sally Helm]

Totally.

[Dr. Robert Bastian]

But that's the problem with a lot of things in life. Things aren't obvious sometimes until they're obvious.

[Sally Helm]

Dr. Bastian does publish a paper on this in 2019. He names the syndrome, and I call it no Burp Syndrome. That's what the Reddit is called, but its official name is retrograde cricopharyngeus dysfunction.

[Noelle King]

RCPD I have mixed feelings about Reddit, but in this case you have a bunch of people who are all suffering from the same thing, and it's not like there wasn't anything.

[Sally Helm]

And he actually had some interesting specific theories about why medicine missed this. And one of them is like, interestingly logistical. He was basically just like, I mean, your first instinct was this is a gut related thing. And a lot of people end up with GI doctors if they have this condition. But this muscle is at, like, the top of anything a GI doctor would think about, but it's at the bottom of anything an ear, nose, and throat doctor would think about.

[Dorie Gray]

So he's like.

[Sally Helm]

It's kind of an orphan area. He called it, like, just. It just, like, gets a little lost. No one's really thinking about it. And then the other thing I thought was so interesting, it goes back to his whole thought about, like, observation being a little bit maligned or, like, not taken seriously because, like, this is what he would call a syndromic diagnosis. So there's no, like, one test that you can just do when someone walks into your office, it's just, like, you talk to the patient. Do they have this cluster of symptoms? Which, again, is, like, pretty obvious. And at this point, the year 2026, his practice has treated about 2,400 people who can't. Wow. Wow.

[Dr. Robert Bastian]

Just as a wild guess, taking it out of the air, I would imagine that there must have been at least 15,000 major tests done on these 2,400 people before they came to us.

[Sally Helm]

Wow.

[Dr. Robert Bastian]

So they've had barium swallows, they've had bolus intigraphy, they've had stool cultures, they've had upper GI scopes, they've had colonoscopies. They've had everything imaginable. And out of those 2,400 people, the diagnostic rate was exactly zero. All that testing and nary one single diagnosis.

[Noelle King]

Wow.

[Sally Helm]

And on the other hand, every single person he has seen who has diagnosed themself as a no burper on the Internet has been correct out of this, like, 2,400 people. Except he did say there was literally one guy who just seemed to have, like, not really paid Jack. He was like, no, you don't have it.

[Noelle King]

Different issue.

[Sally Helm]

But, like, basically 100%.

[Dr. Robert Bastian]

So when I teach on this subject, I say to doctors, if patients can diagnose themselves accurately 100% of the time, then why can't we doctors do the same?

[Sally Helm]

There have now been a couple of studies that do testing to confirm that this condition is real. They put a, like, fricking catheter through your nose and do like, a pressure sense down your throat to see if you're burping. And. And I emailed with one of the authors, and he was like, yeah, I really. I didn't think this was a thing. But then our study did confirm it.

[Noelle King]

Incredible.

[Dr. Robert Bastian]

And so two studies have said, wow, these people can't burp. To which the patient would respond, yes, I told you that already.

[Sally Helm]

Right. That's why I'm here.

[Dr. Robert Bastian]

But it is nice we've got now proof of the disorder. But my comment is, okay, thank you very much for proving this for us. But now, don't hassle people. You don't make new individuals, Patients submit to that test, that very obnoxious test.

[Noelle King]

That feels right to me.

[Sally Helm]

And, like, this thing about observation and measurement, like, it does make sense to me. Like, what are your just off the cuff theories of why doctors are generally ordering tests?

[Noelle King]

Okay, so I have two theories. One of them is that doctors know that there are people like me who diagnose themselves on the Internet, come in and say, I have this very rare disease. And they're like, no, Noelle. As a matter of fact, it's. You don't. You're paranoid. You're a hypochondriac. So that's one. The second thing is I imagine there is some. Imagine there is some financial incentive here when it comes to testing people. People pay for tests, et cetera, et cetera. And I don't want to be cynical or suggest that, like, you know, the medical profession is out to get us, but whenever there's money involved, I get curious about, like, who's making it and who's paying it.

[Sally Helm]

Sure. Or even just, like, the prospect of getting sued is something I was thinking about, like. Like, I'm sure if you get sued one time, then you're like, oh, my God, I'm never gonna. Not like you just right. I will say Dr. Bastian did seem pretty sympathetic to the Internet diagnosis thing in general. Like, I think it's true that sometimes people get themselves into a lather, but he's also like, you know, it's kind of great you got a little further on your own diagnosis. It's usually pretty clear to me whether you're right or wrong. Like, so it takes me one second to, like, talk to you about that. He did also say, though, he was like, I do think medicine, like, over indexes on fact finders. Just people who really want to pin down all the details. They're like trees people, not forest people. And med schools really like that. You know, it's like this, like, fire hose of facts. And he's like, maybe it just kind of draws people who are into that. But he's putting in the plug for observation. You know, like, it's part of the scientific method, too, and people should respect it.

[Noelle King]

People know themselves.

[Sally Helm]

Mm. And, Noel, do you remember our Texan skydiver who got the Botox?

[Ad Voice]

Yes.

[Sally Helm]

And Dr. Bastian was expecting him to come back in a couple of months for another round. But Noel, he mysteriously kept burping.

[Noelle King]

Like it worked and then just kept working.

[Sally Helm]

In fact, it did. And as far as I know, he is still burping.

[Noelle King]

Huh.

[Sally Helm]

And all these other patients who Dr. Basham was treating, a huge number of them also kept burping beyond the three to four months.

[Dr. Robert Bastian]

So I thought, all right, well, now I have to figure out why on earth would a single Botox injection fix these people permanently. This does not make sense.

[Sally Helm]

It does not make sense.

[Noelle King]

It doesn't make sense. Yeah.

[Sally Helm]

And yet, obviously, if you're me, you want to try it, right?

[Noelle King]

Oh, yeah. Immediately today.

[Sally Helm]

So in November, I went to get the Botox to see if I am among the pretty large group of people for whom it is. It might be a permanent cure.

[Narrator/Announcer]

Wow.

[Sally Helm]

And that is after the break.

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[John (Friend)]

To the new Melania movie. Here are some important numbers to remember. 40 million. That's how much Amazon paid Melania Trump's production stud for the rights to the film. It's the highest price ever paid for a documentary. 35 million. That's about how much Amazon spent marketing the film. 28 million. How much went to the first lady. And 7 million. That's how much the Melania movie made on opening weekend. Which is honestly pretty good and certainly more than many box office insiders projected. So how did this movie get made? Who's it for? And if this is finally Melania Trump's side of the story. What did she have to say? That's coming up on Today explained from vox. Listen, weekday afternoons, wherever you get your podcasts.

[Sally Helm]

What happened to the car? Don't ask me, ask him.

[Noelle King]

Hi.

[Sally Helm]

Excuse me.

[Noelle King]

I'm so excited. I'm so excited.

[Sally Helm]

You're getting the talks. I'm getting the talks. You did say you would go for this immediately.

[Noelle King]

Yes.

[Sally Helm]

I dragged my feet on this for years. What? But eventually I was like, look, there is no single other problem in my life that I can solve with one injection, and I'm gonna do it. So in November of last year, I went for it. It's about 4:30am My alarm just went off. So I did do this in the operating room under general anesthesia. I'm not supposed to have any food or water. This is a reminder to myself. They also told me that I had to take two showers. Noelle. I guess for germs. In the operating room, it was intense. You can just do it in the doctor's office. The needle just goes in through your neck. But that is not as precise. There can sometimes be voice related side effects, which wouldn't be great for me. So anyway, I ended up doing the operating room, which means, you know, got to the hospital, went up to the surgical floor. Third floor, going up. I got my gown. All right. They took my vitals. Heading in soon. I didn't have my phone with me for the surgery, obviously, but the vibe was like, really jolly. The anesthesiologist was this funny guy. I go to sleep, I wake up. It takes five minutes. They did intubate me to protect my airway. Yeah. And then they just inject Botox into this muscle at the top of my esophagus. Okay, I'm out. It went well. I'm in the recovery room. Little sore throat. But everything seems good. I'm not even that groggy. Hopefully burps soon. What questions do you have at this moment?

[Noelle King]

What are you wondering? Well, first I heard you say it was 4:30 in the morning. And I feel bad because I know you don't like to get up early. Second, I will say you are one of the least decisive people I've ever.

[Sally Helm]

So actually, it does.

[Noelle King]

It totally tracks to me that you learn about this and then years later you're like, I get this done. But now. But now you did it. You did all the things you needed to do, and now I just want you to test it out. I'm like, but do you know? One question I have genuinely is do you know how it works? Do you know that you have to, like, kind of, like, gulp air in and then, like, do you know how to do that?

[Sally Helm]

That is such a great question. So, okay, we're gonna get to that, basically. I mean, my question is, I was like, am I gonna be burping uncontrollably immediately? Cause I've never done it, you know? And I'm like, it's embarrassing. I'm gonna be like, can I go to work? Like, what's gonna happen? And I did read a. I read a Johns Hopkins, like, explainer about it, and it was like, in the first couple of weeks, you will be burping exuberantly. I was like, oh, no. But it is not immediate. It does take a few days usually. Okay, so, like, in the 48 hours after the surgery, I'm just watching every movement in my throat. And so I left my phone running while I was working. Yeah. Here's some sound. Oh, my God. What does that sound like to you?

[Noelle King]

I mean, it's the croaking from the beginning.

[Sally Helm]

We're gonna say frog. Frog is gentle, right? I was still. It was still frog sound. But, like, I could feel that it was, like, getting ready. So. Okay, so it's two days after the surgery. That night, I had had dinner with my friend John. I was walking down the street. I was in the middle of talking about something, and suddenly. John, you. What just happened?

[Dr. Robert Bastian]

I heard a belch.

[Sally Helm]

You. You did? Like that?

[John (Friend)]

Yeah.

[Noelle King]

A legit belch?

[Sally Helm]

That was one.

[Noelle King]

Yes.

[Sally Helm]

Oh, my God. Really? Yes. It came from deep inside you. Oh, my God. But it was, like, while I was talking. Yeah, like, that kind of.

[Noelle King]

Oh, my God.

[Sally Helm]

That was kind of a burp.

[Noelle King]

No, Now I think you're looking too hard for it.

[Sally Helm]

Noel, what do you think? John is so game. He's so game.

[Noelle King]

He's like, I'm here for you, girl. I'm proud. What I feel right now is proud. I feel like you did it.

[Sally Helm]

Thank you so much. I mean, it's so funny to listen back because I. Obviously, I cannot hear whatever things I was experiencing as burps in that moment. But, like, it felt like I kept burping while talking. And that was really a feature of the next couple of days because to me, any burp seemed so loud and surprising in my head. I had never experienced this. So, like, the next night, during dinner with friends, I kept burping. But what it looked like to them was that I was just stopping in the middle of talking and, like, making this incredibly surprised face. Okay, so tell me about. That was a burp to me. Was it to you guys?

[Noelle King]

It was really. It wasn't perceptible on any level.

[Sally Helm]

It was just a look of shock on your face. But there was no sound or movement. All right, There was a little sound, I promise. But that's great to know. You guys have been having this experience the whole time. Yeah, it's crazy. I just did it.

[John (Friend)]

I just burped and nobody was aware.

[Noelle King]

Because I think what happens is, like, you feel it coming and you like, either. Either you, like, finish saying what you're.

[Sally Helm]

Gonna say, or you go, excuse me.

[Noelle King]

And then you continue. Like, I feel like we do this all the time. Like, in, like, interviews and podcasts and stuff.

[Sally Helm]

People will, like, pause for a second because they're burping. That was.

[Noelle King]

That was real. No inhibition.

[Sally Helm]

I have no control. Right? Well, if you didn't catch it, I said, I have no control, and I burped on the word control. Just.

[Noelle King]

You have a very supportive community.

[Sally Helm]

I really do. Thank you. One thing, it really was so interesting to me that everyone has just been secretly burping around me all this time. Like, have you burped while we've been talking?

[Noelle King]

I have. Not while we've been talking, but like, when your friend said, like, if you're doing a podcast interview or something, like, you just sort of like, say, excuse me or.

[Sally Helm]

Hold on a second.

[Noelle King]

Yes, of course I talk for a living. I do that all the time.

[Sally Helm]

It's so funny because I actually, I had the experience a bunch of times where I would be telling people about what I was going through burp wise, and they would be like, oh, I never burp. And then later in that conversation, they would be like, oh, I just burped.

[Noelle King]

Like, I think you don't pay attention to it. You don't realize it until someone brings it to your attention and tells you, like, I can't actually do this. And then you're like, oh, wait, no, I do this all the time.

[Sally Helm]

Exactly, like, all the time. So in the weeks after the surgery, I was burping a lot. I was not in control. Like, for example, three weeks after the surgery, I was out to dinner with my sister and my college friend Margaret, and I burped.

[Noelle King]

Okay.

[Sally Helm]

But then I started laughing, and then the laugh became burped.

[Noelle King]

That's him laughing. What do you think?

[Sally Helm]

I'm so proud of you, mama. I'm so proud of you. Okay, so I did start to get a little bit better at it. Like, get a little bit more Control. I discovered that a body posture that worked really well is, you know, when you're reversing a car and you put your arm out over the passenger seat and you, like, turn your head over your shoulder. So I did that, and it was just like, burp city right away. Backing up in the car.

[Noelle King]

Oh, my God.

[Sally Helm]

Why is it like this? I literally didn't even know I had to burp. Okay. So also, often during this time, I would, like, get into this really weird position. Like, I would. I would do the basically, like, backing out in the car thing, but I would put my arm on the wall, and then I would, like, turn my head around and, like, dip my chin and crank my head. My family was very supportive, but they were also confused. Like, I burped while I hanging out with my sister and my dad. Are you proud of me? That was a real burp. I just did a little sputter burp. And you heard you proud. Oh, my God.

[Dr. Robert Bastian]

Yeah.

[Sally Helm]

But why did you have to do it in that weird contortion?

[Noelle King]

I have to.

[Sally Helm]

To make them come out. Wow.

[Noelle King]

That was such a weird one. Did it come out?

[Sally Helm]

Yeah. Well, look at this.

[Noelle King]

What I am sort of shocked by, in all honesty, is that you went. We're not gonna age ourselves, but you went 30 some odd years without being able to do this one surgery and, like, fixed.

[Sally Helm]

Yeah. I mean, so number one, it might not work permanently for me. Like, it doesn't work for everyone. And also, it's only been around for about 10 years, so it remains to be seen whether it can last forever. But as of now, there are a lot of people who did the Botox and can still burp. So I did talk about this with Dr. Bastian, right. Because I was like, what is going on here? Right. Like, why is this happening? I did actually burp on the call with him.

[Noelle King]

Good.

[Dr. Robert Bastian]

That was a good one.

[Sally Helm]

Thank you, Dr. Bastian.

[Dr. Robert Bastian]

You just turned a little bit, so.

[Sally Helm]

So that's good. So I'm good.

[Dr. Robert Bastian]

And you opened your jaw, but that lowers your larynx, I think. So think about lowering your larynx. Work on that one.

[Sally Helm]

Okay. So this was very interesting to me. He was really adamant that I needed to be, like, consciously practicing. And I'm supposed to, like, find the little posture that makes me burp.

[Dr. Robert Bastian]

So every person who burps does something just prior to the burp. So there's a gesture, there's a fidget, there's a. I don't know what to call it, but I don't like calling it the Belch. Reflex because it does have some voluntary input. So that's the idea. It's like, I need to figure out what can I do not to force it, but to invite it.

[Sally Helm]

Do you have one of these, Noah? Like, does this resonate for you?

[Noelle King]

I don't think so. But I will tell you that it's not something that I've ever thought about.

[Sally Helm]

I mean, this is interesting. He said he was like, many burpers are not aware of it. Like, they feel like they're doing something without any involvement of theirs, but actually they are doing something. Like, there's like a ab thing or, like, move your shoulders. And basically his theory is just like, everyone actually needs to do this to, like, invite the burp. And for whatever reason, some subset of human beings, which includes me, just early on in their lives, like, didn't learn how to do this or they learned it wrong. And that is basically also his theory for why Botox might be able to permanently cure the problem.

[Dr. Robert Bastian]

Why are people still burping? My answer to that has to be, well, they figured it out.

[Sally Helm]

So his theory is that, you know, Botox paralyzes this muscle, and that gives you the opportunity to learn the skill of burping, and then that learning sticks. And Noelle, I am now about 11 weeks out from the surgery, so I am coming to the end of this window where Botox is helping me burp. The training wheels are about to come off, and I really gotta hope that all the practicing that I have been doing is gonna carry me through. I have been drinking a seltzer while we've been talking. Should. Should I. Should I give it a try?

[Noelle King]

Yes, you absolutely should.

[Sally Helm]

Okay.

[Noelle King]

It's so good. It is so great.

[Sally Helm]

I really hope it lasts. Here's hopin'. I'll let you know. Really big thanks today to Noelle King, host of the podcast Today Explained. And if you are not listening to that podcast, what are you even doing? You should go subscribe to it right now. Another very, very special thanks today to everyone from R. No Burp who sent me their stories and their gurgles and who agreed to be interviewed about rcpd. You heard the voice of Anders Birkness, Dorie Gray, Matthew Dahl, and Elina Lynn. I so, so appreciated hearing from absolutely everyone who wrote to me. Thank you so, so much. This episode was produced by me, Sally Helm. It was edited by Jorge Just with help from Joanna Solotarov. Joanna also runs the show. This episode was sound designed by Christian Ayala and fact checked by Melissa Hirsch. Noam Hassenfeld did the music. Amy Padula, Meredith Hodnot and Julia Longoria all know how to burp and Bert Pinkerton was like what White Room station Sun doesn't shine, but the shadows run from themselves. She had no idea where to find Eric Flapton, but then she remembered Flapton was a bird and she had a beak beeper thanks as always to Brian Resnick for co creating the show along with Bird and Noam. And if you have any thoughts about this episode, we are@ unexplainableox.com I will say if you think you might be a no Burper, you are probably right and I would love to hear from you. If you want to support the show and help us keep making it, please join our membership [e-mail] members. You will get ad free podcasts and other perks and unlimited access to Vox Journalism. You can also support us by leaving a nice rating or a review or by telling people you know to check out Unexplainable. Unexplainable is part of the Vox Media Podcast Network and we will be back in your feed very soon.