After 45 Years of Unexplained Symptoms, Ohio Man Finds Relief at UH

It’s human nature to want to solve a mystery. But when you are a patient who has been suffering for more than 45 years with symptoms for which no medical professional has been able to find the true source, the experience goes quickly from mystifying to incredibly frustrating.

Dan Yung, who is now 70, had been plagued by symptoms – digestive distress and severe coughing - since his late 20s. A Milwaukee resident at the time, Dan consulted multiple gastroenterologists, all of whom diagnosed him with acid reflux and prescribed medications.

They didn't work.

Eventually, Dan, then VP of a textile firm, moved to Northeast Ohio and began seeing different specialists. Most were pulmonologists, who determined that his extreme coughing – which often led to vomiting – came from asthma. For years, he underwent treatments and took asthma medications, but they didn’t help. His lung and stomach problems continued unabated.

Dan describes his life over those decades: “My lungs were very sensitive to smoke, cleaning chemicals and cold weather. I always suffered from fluid in my lungs and I’d have a persistent cough trying to clear it. This would be difficult when I was resting or sleeping. I’d get walking pneumonia. And I could always ‘feel’ my lungs, as if a hand was holding them up, but doctors told me that no one could feel their lungs. I suffered from acid reflux and would vomit two or three times a week. From age 50 on, if I bent over, food would come out.”

In 2013, his primary care doctor at University Hospitals (UH) referred him to pulmonology, because he had developed bronchitis and a CT scan showed spots on his lung. He made an appointment with Shine K. Raju, MD, a UH lung specialist. Dr. Raju asked Dan for the full history of his troubling symptoms.

Dr. Raju then ran a few tests which definitively ruled out asthma. His breathing was fine - in fact, Dan’s lung capacity allowed him to swim two lengths of a pool underwater before taking a breath. Tests also ruled out cancer. But Dr. Raju noticed there was a lot of damage at the bottom of Dan’s lungs, where there was a build-up of fluid and mucus.

“Dr. Raju explained to me there had to be a root problem to my medical issues, and if I was willing to work with him, he would do his best to find the true diagnosis. I told him I was willing to go through any number of tests,” said Dan. “I was so happy. I felt like this time, we were going to find out. The thought of a doctor finally willing to take the time and energy to truly diagnose my medical condition was beyond description.”

Dan had several tests, although more tests were put on hold when COVID-19 closed hospitals to all but emergency patients. But his faith in Dr. Raju was strong.

Dr. Raju had a strong suspicion that Dan’s symptoms might be related to chronic reflux disease. So, he referred Dan for specialized testing, including high-resolution esophageal manometry, a test that measures the force and coordination of the food pipe muscles as they move food to the stomach, as well as 24-hour pH-impedance testing.

The latter involved inserting a narrow flexible catheter through the nose into the stomach opening to measure the amount of acid or non-acid stomach contents that are “refluxed” back into the food-pipe. This flexible catheter is left in place for 24 hours to pick up changes in acidity along the entire length of the esophagus, which it transmits to a computer. “At University Hospitals, we do these types of advanced tests, which are often under-utilized,” said Dr. Raju.

It was these tests that finally shed light on the origin of Dan's symptoms. Dan had a condition called severe non-acid reflux (which means it occurs even when a patient has not eaten) and his cough correlated 100 percent to his episodes of reflux. Dr. Raju told Dan what he saw: “The bottom of your esophagus is wide open, and it is causing the stomach contents to spill into the esophagus.”

Dr. Raju referred Dan to Leena Khaitan, MD, a UH specialist in gastric surgery. Through an endoscopy, she confirmed that Dan did not have a functioning sphincter at the bottom of his esophagus. He was either born without one, or it was somehow destroyed. This was causing the problem of non-acid reflux and stomach fluid going into his lungs, which caused his persistent coughing as well as inflammation and scarring within his lungs. He also had a partial hiatal hernia.

She also saw something she’d never seen before. Dan’s stomach was pushed up against his lungs, which is why he could “feel” them. His stomach had broken through his diaphragm.

During the surgery, Dr. Khaitan brought the stomach down, and refashioned part of it to build a sphincter so that Dan could still swallow, as well as vomit if he became ill. The sphincter would however keep acid from his stomach from extending up into the esophagus. She also repaired the diaphragm and the hiatal hernia.

“The surgery was very successful, and I am now free of acid reflux, persistent coughing and vomiting, and I can eat any foods I wish,” says Dan. “This is because of Dr. Raju’s determination to find the root cause of my medical issue and connecting me to all the right doctors at UH. His dedication, patient interaction and desire to truly help solve this problem makes him the most outstanding doctor I’ve ever been privileged to meet.”

That is high praise, and Dr. Raju is certainly worthy of it. His diligence and determination to find the cause of Dan’s symptoms and Dr. Khaitan’s intricate corrective surgery, show that they are practicing medicine at its highest level – one that elegantly incorporates the science of medicine with the art of compassion.