I just can't anymore...

Dear reader,

In many letters from patients to me, a serious problem often emerges “between the lines,” so to speak. I would like to explain this.

Reflux disease, with its many facets, means a "different life" for many patients! Dinner appointments, a glass of wine or a delicious dessert are all particularly challenging. It is better to drink only still water and eat a small snack at most. Otherwise, the evening will take its revenge the following night and often even for several days. The carefree expression on the face of a reflux patient gives way to constant mindfulness and inner observation. The trained eye can quickly recognize this.

Previously lively and sociable people withdraw from society and appear like outsiders. Daily life is also affected by the so-called foetor ex ore . With reflux, unpleasant-smelling gases often rise from the stomach, which can easily lead to bad breath. Many patients notice this themselves or are made aware of it by their partner. A burden not only in the relationship but also at work when in close contact with customers. Out of insecurity, people turn away, avoid eye contact and appear distant even though they don't want to be that way. Understandably, patients develop tendencies towards depression. In addition, every PPI tablet can trigger depression as a side effect.

The situation becomes fatal when the so-called "cause investigation" is carried out. An almost unbelievable number of examinations with CT, MRI, X-ray, ECG, stress ECG, cardiac catheter, laboratory, colonoscopy and gastroscopy, pH measurement, sonography, manometry, inpatient assessment and much more are carried out again. Interestingly, a physical examination of the diaphragm is almost never(!) carried out. The patients get through everything with flying colors in the hope that the cause of the symptoms will finally be found.

The good news: All tests show that nothing "bad" is going on. The bad news: No cure has been found. The patient is left with exhausted helplessness. It is not uncommon for a decisive turning point to occur: Patients are put on antidepressant medication. They go through therapy sessions in psychosomatic and psychosocial rehabilitation centers, and even inpatient psychiatric treatment attempts. Self-doubt arises: "Am I just imagining it all?" Patients lose strength and courage to live. Life becomes difficult with the underlying fear that there might not be a serious form of cancer behind it all, for example, that the doctors have overlooked.

But everyday life does not spare these patients either. They have to go to work, perform well, and manage their life with their family, despite sleepless nights and thoughts circling around their suffering. It is admirable how many patients manage to keep their heads above water and make the best of it!

Others, however, are overwhelmed by the hopelessness of the situation over the years. Thoughts of ending their own lives come up and are then discarded. One patient wrote to me:

"Dear Dr. Löhde, I have been on sick leave for 4 months now because of burnout. Exhaustion, tiredness, concentration problems, forgetfulness... I live alone and I just couldn't do anything anymore and I didn't want to do it anymore. I saw no way out. Always feeling exhausted. Even climbing stairs and walking uphill with my dog (even with the slightest increase) leaves me out of breath at my age. My heart seems to be healthy and so do my lungs. Everything has been examined. But there is always this pressure in my chest! When I wake up, I know it's going to start again today. It's driving me crazy. Lactose intolerance has been confirmed; fructose intolerance too, but probably less severe. But that can't be the cause. I now eat gluten-free and pay attention to everything possible because of my digestive problems with feeling full, burping, always having this gas in my stomach and flatulence. Celiac disease was suspected but ruled out during the gastroscopy. I haven't been able to sleep properly for a long time. This month I have had stomach acid come up twice at night, so that I felt like I was about to suffocate. I jumped out of bed and didn't dare lie down again. It was horrible. I sat in an armchair all night and was scared. I'm home alone with just my dog. I don't dare go back to sleep normally in bed. The next day I had a really bad sore throat and a hoarse voice, as if I drank and smoked every day. My neighbors suspect that anyway. But I haven't had that for ages. I just can't stand it. The palpitations first occurred last year. Very suddenly. Everything was examined in the emergency room and nothing was found. It was put down to a hidden overactive thyroid. Various laboratory tests were done, but they didn't confirm that. Everything seems to be fine. Further heart examinations and X-rays were fortunately still good. I was given heart tablets anyway. I'm currently trying to get back into work, but I don't know how I'm going to manage it. Dr. Löhde, I just can’t do this anymore!”

Many conversations with my patients show the far-reaching personal and social consequences that a diaphragmatic hernia can have: A 15-year-old girl missed an entire school year and spent nine months in a university hospital psychiatric ward because her congenital hiatal hernia was mistaken for bulimia. A 6-year-old boy was mistreated for years until his esophagus was scarred by such severe inflammation that it had to be repeatedly widened by force to enable him to swallow. He spent his school years in bed. There are so many sad life stories that have been brought to my attention over time. From a medical point of view, it is essential to recognize the enormous impact of this disease in adults but also in children and infants and to initiate the right treatment steps.

Yours

Dr. med. Eckhard Löhde