Why do I choke on the air?
The special caseProblems swallowing and breathing
Laudenbach an der Bergstrasse, a small town between Heidelberg and Frankfurt. Forests and meadows, viticulture and fruit growing, plenty of sun in this beautiful region. Anyone who lives here knows no stress - at least almost.
"It actually started when I separated from my husband," remembers the bakery saleswoman Ute Bartmann of a critical phase in her life in 2007. Not only did her marriage fall apart, there was also something wrong with her health.
"The blood pressure was then not so special, and where it got really acute, that was in 2010, I got a new branch again, and I had the feeling that I have something in my body that does not belong there."
That which "does not belong" sits somewhere in the upper abdomen above the stomach. It pushes. It squeezes. It's stuck. Swallowing is torture.
Several functions and organs of the body can be affected
"I was always disgusted with food because I was always afraid, it stuck in my throat, and then I stood up, jumped around so that it slipped better, I had the feeling that way."
But not only swallowing solid food caused problems for the now 60-year-old mother of two.
"With every strenuous work I thought, now I can't breathe anymore, I always had to gasp for air, I had to sit down more often because it couldn't go on, I couldn't sing, for example, that was really bad for me, I had to keep choking, it just wasn't possible anymore. "
Of course, the Baden-Württemberg woman goes to her family doctor, unfortunately without success. The symptoms are clear because several functions and organs of the body are affected, but there are many possible causes, according to Prof. Tsvetomir Loukanov, head of the "Pediatric Cardiac Surgery" section at Heidelberg University Hospital.
"A general practitioner thinks of swallowing problems, esophageal problems, stomach problems, air problems, lung problems, ..."
First gastroscopy with no result
And because doctors first look at the obvious and obvious, Ute Bartmann's family doctor arranges a gastroscopy.
"That is absolutely correct! 99 percent of the doctors would also orientate themselves in this direction."
"Nothing came out of the first gastroscopy."
She dragged herself through life for two more years, avoiding solid meals, physical exertion is not possible at all. Shortly before she collapses, she consults another doctor who arranges a second gastroscopy.
"And then he noticed that something was pressing on my esophagus. Of course, I immediately thought it was cancer!"
Your concern is unfounded. Cancer as the cause of swallowing and breathing difficulties is quite possible at a slightly older age, but it does not play a role for Ute Bartmann. But what is behind the strange symptoms?
"At least half of the patients who come to us and are then treated surgically have been to the doctor and have been treated for asthma or are being treated in a psychiatric clinic."
An aneurysm as the wrong lead
Even in medically highly developed Germany something like this still occurs, according to Prof. Tsvetomir Loukanov. If doctors cannot find a physical cause, the psyche comes into focus at some point. Fortunately, the Laudenbacherin shouldn't get that far. The turning point brought computed tomography to a radiologist.
"He then said to me that it was an aneurysm, five centimeters tall."
A pathological bulging of a blood vessel in the upper part of the abdomen. Aneurysms can be life-threatening and must be operated on quickly if necessary - in this case at Heidelberg University Hospital.
"They examined me, did it and did it and then they said they didn't even know why I was here, I had been there for 50 years."
Another wrong track! However, one that leads to the correct diagnosis in a tortuous way. Dr. Joachim Eichhorn, then senior physician in the Department of Pediatric Cardiology at the Heidelberg Children's Clinic, hears about the case - and has an idea that goes back a long way to the time when Ute Bartmann was an unborn fetus.
"We go through the development of a frog, a reptile, a bird, a mammal and, and, and, and then it becomes more and more differentiated, and in this development phase, when the organs and the vascular system are formed, there is in the early phase also a time when we all have a double vascular system. We have two aortic arches, we have two arteries and, and and, everything is double. "
Via two aortic arches to the solution
Usually, one of the vascular systems regresses by birth, but in very few cases it does not. This is exactly what happened to Ute Bartmann. Two aortic arches extend from the left ventricle and form a closed ring through which the esophagus and trachea run.
"If you now imagine yourself in a ring that is still pulsing, it becomes narrow and wide and narrow and wide so that this ring clamps the windpipe - also known as the trachea - and the esophagus and can cause the patient corresponding symptoms. "
The esophagus and windpipe look like an hourglass, the windpipe had lost two thirds of its cross-section! The suspicion of the pediatrician, today he heads the clinic for children and young people at the Leverkusen Clinic, was correct! And the treatment is now comparably easy, according to the Heidelberg heart surgeon Prof. Tsvetomir Loukanov.
"You have to cut this ring so that there is more space for the trachea and esophagus."
"I'm fine today, I can sing, I can whistle (laughs), that was really great, I've become a completely different person."
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