The daily suffering of the lungs

Dear reader,

It is not uncommon for patients to come to me with a variety of breathing problems. I would like to tell you about an organ that suffers greatly when the aggressive substances from the stomach find their way upwards: the lungs!

Aerosols and the gaseous components of the reflux mix with the air we breathe from below. This means that these aggressive substances reach our lungs with every(!) breath. In contrast to the esophagus, which has to silently endure the acid load, the lungs react differently: the sensitive bronchi try to actively expel the harmful substances by constantly coughing. This generates wind speeds of around 400 kilometers per hour in the bronchial system! With this "hurricane" raging through the bronchial system, the lungs can expel everything that is mistakenly inhaled. This is the protective mechanism of our lungs.

However, patients with gaseous reflux are constantly inhaling harmful substances from the stomach! You can imagine how the lungs suffer. The result: susceptibility to infections, recurrent bronchitis, antibiotic treatments, because bacteria and viruses now use the damaged mucous membranes to implant themselves and make everything worse. Our immune system has to work at full speed day and night to form defense cells, repair defects, kill bacteria and activate lymph nodes in order to protect us from further serious consequences. This weakens the organism enormously, not least because the lungs have an enormous surface area of around 100 square meters that needs to be protected.

Although we know all this, patients unfortunately still wander around looking for help and often only find the right path to treatment by pure chance. I would like to thank my patient for taking the time to write down the many trials and tribulations in the course of his illness in such detail, as we know from many letters from patients. Please read his long and grueling journey through Germany with the goal of finally getting well:

Dear Dr. Löhde, dear Dr. Thomas, dear practice team and dear readers,

I would like to share my "patient voice" here. I took a lot of time to write down my experiences from the beginning. My symptoms were not very typical and were slightly different from the normal diaphragmatic hernia symptoms. I am extremely lucky that I ended up with Dr. Löhde. Perhaps one or two people will take the time to read my story. I hope I can maybe even encourage some people or even point them in the right direction.

My odyssey began at the beginning of 2015. I suffered from occasional coughing fits after eating, as well as heartburn. At first I didn't connect these two symptoms. Unfortunately, my family doctor wasn't there at the time. That's why I ended up with a substitute doctor. He said it was a neglected infection and gave me antibiotics. When this didn't help after a while, I went to the hospital with my mother. There they explained to me that a bacterium had probably over-revived and I was given antibiotics again. He prescribed me an asthma spray for the coughing fits. My symptoms got worse, so that I had to stop my studies in March, hoping to be able to continue in September. However, I didn't take the symptoms too seriously, as every doctor I had seen so far had treated them as an infection. How many antibiotics have I taken! In the meantime, some of them even got a little better, until a major setback came and I had severe coughing fits after every meal, even throwing up. At my first visit to the GP, he prescribed me PPI and a spray for the cough. As the cough and vomiting did not improve, he sent me to a lung specialist. There, they carried out the normal program without really addressing my symptoms. That means: allergy test, lung function test and X-ray of the lungs. It turned out that I have a strong allergy to various pollen and asthma. I have had the pollen allergy since I was a child, cope with it very well and have no problems apart from a few watery eyes in the spring. Despite this, I was strongly advised to undergo hyposensitization, almost forced on it, as I could not live like that. But they said that the pollen allergy was not the cause of my symptoms, but the asthma. I have never been very sporty, although I do go horseback riding, but I was always very exhausted after a short run or something similar. So I accepted the diagnosis as it was. The doctor also prescribed me a strong cortisone-containing asthma spray just for emergencies and a kind of powder spray to take three times a day. There was no precise explanation as to how the asthma was related to food intake. There was no time for that. However, there was no improvement, in fact it got worse. I couldn't tolerate all the medication, after the spray I developed severe circulatory problems and deteriorated completely. After consulting my GP, I stopped taking it. Further visits to my GP with blood tests etc. were unsuccessful. Finally, I got an appointment for a gastroscopy. In the meantime, I was deteriorating quite a bit, I didn't dare leave the house at all. When the gastroscopy finally took place, I was pretty excited and hoped to finally get a result. Finally, it was over and I slowly came to in the recovery room. A nurse was at my side who had very positive news for her. Nothing was found. Everything was fine. For me, as strange as it sounds, it wasn't what I wanted to hear. I had hoped that they could finally tell me that it was... and that you could... do something about it. The feeling of not knowing what was going on was the worst part of the whole thing. The gastroscopy also tested for Helicobacter Pylori, which was also negative.

So there I was again at my GP's. The results of the gastroscopy were now available. Everything was fine, except for a small aside that I had cardiac insufficiency. According to the gastroenterologist, however, this was harmless, very common and could not be the cause of the symptoms. On the advice of my GP, I also visited the ENT doctor. Again, unsuccessfully and without result. The ENT doctor sent me to the hospital for an X-ray of a swallowed porridge and suspected a fistula between the esophagus and windpipe.

In the hospital, the senior doctor told me that the insurance companies would probably not cover the porridge and that he was of the opinion that no result would be obtained. But that certainly didn't matter to us in this situation. We had been prepared to use all means to finally get a result, as there was no food left to eat and liquid food was not a long-term solution either. But unfortunately he was right and we went home again without a result. Finally, we sat down with the family doctor again. He told me to see the surgeon in our town because they would be happy to discuss my case together. So I got my appointment with the surgeon, who had another detailed conversation with me. When you wait so long for an answer, you start looking for a diagnosis yourself. So my mother knew the term diaphragmatic hernia from the Internet, and the symptoms partially matched. So we spoke to the surgeon directly about a diaphragmatic hernia. He was very unsure, it would have to be clarified first. But it should have been seen during the gastroscopy. He spoke to my mother and me about a subject that still weighs heavily on my mind today - bulimia. While I was sitting in the room, he asked my mother whether it could be something psychological like bulimia. We said no, with a clear conscience. Finally, he sent me to another hospital. During the conversation with the senior doctor from this hospital, I was sent on to make an appointment for another gastroscopy. When I discussed this with an assistant, another senior doctor called me in. He finally canceled the appointment for the gastroscopy because he believed the doctor who had performed it on me before. For him, the cough was only secondary. The heartburn was important to him. I should please not take so many PPIs and instead take Bulrich salt when I had symptoms. That's what he had done in the past. When I asked him directly whether it could be a diaphragmatic hernia, he reacted with some ignorance and a "that's unlikely." He literally told me that we should stop all the tests now. We were shocked and to this day we don't know whether he understood the seriousness of the situation. He made an appointment for me to have my pH checked and sent me home, even though we were already there with our bags packed and acute symptoms. There was no need for us to stay there.

With our nerves at their limits, we went back to the GP to get his opinion before the pH test. By now we had the feeling that we were being passed from one doctor to another. We also had a very bad feeling about the hospital. During the conversation with my GP, the name Dr. Löhde was mentioned for the first time. My GP had a few phone calls with Dr. Löhde and discussed my case. And then the moment came: He said he knew what the problem was and that he could help me.

We finally had a goal in mind. I had reached a point where I just couldn't cope anymore psychologically. Instead of going out with friends, I just sat around at home. Every little walk in public was a big undertaking for me. The fear of coughing fits, throwing up, burping, etc. was too great. I could also forget about starting university in September. During these times, the saying kept coming to mind: healthy people don't know how rich they are.

The day after the operation, I had a conversation with Dr. Löhde. He showed me pictures of my operation, which I was able to take home. He explained to me that my tear in the diaphragm was significantly larger than I had seen. My body had formed a membrane over the hole to prevent the stomach from sliding up. This meant that the gastroscopy could not see the true extent of the hernia. It was already 5cm large and the esophagus was displaced accordingly. My diaphragmatic hernia was congenital, Dr. Löhde explained to me. Looking back, I actually had my symptoms as a teenager: heartburn, rapid exhaustion, shortness of breath, coughing and repeated so-called colds. It's crazy how all of this is connected to the diaphragm and nobody knows about it. Two weeks have now passed since the operation. I have not had any heartburn or cough since then! I don't feel any discomfort in the area of the operation. The initial shoulder pain has gone and the scars on my stomach are healing well. I am confident that it will stay that way. I have already tried a number of foods and feel almost as if I had not had an operation and yet the symptoms have gone. I don't know how Dr. Löhde and Dr. Thomas did it, but I am infinitely happy and grateful. I still get out of breath a little quickly, but you have to remember that I have just had an operation. Finally, I can only say THANK YOU to my family doctor, who believed me to the end after so many visits and negative tests.

All's well that ends well! We are all very happy about that. What certainly made the diagnosis difficult was the simultaneous occurrence of lung problems, heartburn and vomiting against the background of an (almost) normal gastroscopy. I will discuss the special features of a congenital diaphragmatic hernia and the problems of endoscopic diagnostics separately.

What is important is to correctly interpret the body's signs and quickly make the right diagnosis. Then you can end the suffering.

Yours

Dr. med. Eckhard Löhde