Medical despair ends in suicide

It didn’t touch his soul as it once had, he wrote to his friends and family. It couldn’t rescue him from darkness.

“Nothing feels the same anymore. Nothing feels like anything. It’s like I’m on one side of the river looking at everything across it, but the bridge is out,” Helling wrote before he killed himself in February.

“I think if I could still listen to and make music, I could survive this thing: but without that, I don’t really stand much of a chance.”

Helling had much more that he wanted to do, the 36-year-old told his friends and family. He wanted to crack wise and play badminton, to struggle over the crossword in the Sunday New York Times. He wanted to sleep on his uncle’s couch in California. He wanted to play the guitar with the hand-me-down strap that he left behind for Preston, his nephew.

In the months before he died, Helling became singularly focused on the fallout from what was supposed to be routine sinus surgery. He lived with the constant sensation that he was suffocating, went days with little or no sleep and complained of pain and nasal dryness.

Helling had been miserable after a couple of years of lingering sinus problems, including infections that moved into his ears, and had the surgery in February 2014, said his older brother, Paul.

Helling saw a surgeon with more than two decades of experience and expected relief following what is considered a low-risk procedure, said his mother, Carol.

In rare cases, people who have had sinus surgery — particularly surgery that includes removing bony structures in the nasal cavity called turbinates — experience the sensations that plagued Helling. A Mayo Clinic doctor coined the term “empty-nose syndrome” in 1994 to describe it.

Although some doctors are skeptical, researchers have published several small studies about the syndrome in recent years, and an increasing number of physicians are thinking more seriously about how to explain and avoid the life-altering condition.

Mrs. Helling said her son’s discomfort began last summer and that, by October, he felt he could not breathe.

He saw ear, nose and throat doctors, including his original surgeon, who told him he was healing fine, she said. He was sleepless, having panic attacks and rarely leaving the Hellings’ home in Worthington.

Mrs. Helling said she’d carry his guitar to him sometimes.

“Everybody has something in the world that is their center. He would always go back to the music,” she said.

But he wouldn’t play.

Helling died frustrated that nobody warned him about empty-nose syndrome. He was convinced that there would be no relief.

“My heart still has a lot of music to make and a lot of love to give. I desperately want to get old,” he wrote. But to breathe was, in his words, “Torturous … Absolute hell.”

Empty-nose syndrome is not well understood, and most of what experts know comes from patients’ descriptions.

You can’t see it on an MRI or pinpoint a spot where a surgeon should never tread. Two people could have similar operations, and one might feel great while the other wishes he never went in for surgery.

And there are those who contend it’s psychological.

“Patients hit a lot of roadblocks. Surgeons say they’ve never seen it. No one has any answers for you,” said Dr. David Poetker, an associate professor of rhinology and sinus surgery at the Medical College of Wisconsin. “You can’t measure empty-nose syndrome like you can bone density.”

Poetker is among those who believe that the syndrome is real and that it wreaks havoc physically and emotionally. Patients should hear about the risk before surgery, he said.

There were 606,000 outpatient sinus surgeries and 196,000 turbinate-removal operations in the U.S. in 2006, the most-recent year for which the Centers for Disease Control and Prevention has data.

“It has such a huge psychological and psychiatric impact on somebody’s health,” Poetker said, comparing empty-nose syndrome to tinnitus — chronic ringing in the ears.

The nose’s job is to warm and humidify air, Poetker said. A rich blood supply ensures that happens. When surgeons remove tissue from the turbinates, which are like shelves inside the nasal cavity, they reduce the surface area inhabited by blood vessels and nerves.

Poetker said that’s where things probably go wrong, but he added: “Nobody really knows exactly what’s going on.

“They say that they are unable to breathe through their noses, but their noses are wide open. It’s very paradoxical.”

Poetker said surgeons must balance the potential benefits of getting that tissue out of the way with the potential harm, adding that he’s conservative about removing turbinate tissue.

There’s no good way to figure out who is most likely to have complications, he said, and empty-nose syndrome is hard to study, in large part because it affects relatively few patients.

When his symptoms worsened, Helling saw two Ohio doctors who have taken a particular interest in the syndrome: one in Cleveland, the other in Columbus. Both declined requests for interviews.

Helling praised both doctors but wrote that he left their offices without much hope, other than an expensive and experimental implant surgery that he wasn’t optimistic would help.

In his final words to those he loved, Helling said he was terrified, bitter and self-involved. He said he’d lost his empathy.

Helling spent a week at Ohio State University’s Harding Hospital after a particularly bad spell of sleeplessness in October. After his release, he saw a number of specialists, including mental-health professionals, and tried several medications for depression and anxiety, Mrs. Helling said.

“The psychologist gave him a book on how to cope with your pain,” she said.

Mrs. Helling researched homeopathic treatments, including modified diets and humidifiers, and she sought advice from an online community of people who have empty-nose syndrome.

“Please hold on, we’re going to get more help,” she recalls telling him.

Side effects of the psychiatric medications were a problem; some heightened his anxiety, she said. And the pills didn’t take away the sensation that he was suffocating.

He took each prescription for an average of five to seven days, Mrs. Helling said.

It’s impossible to point to one aspect of a person’s life — a firing, a breakup — when trying to explain suicide, experts say.

But chronic illness can inflame pre-existing mental troubles and lead to new ones, said Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention.

Helling had a history of depression, anxiety, obsessive-compulsive disorder and attention deficit, and he “managed it, more or less,” he wrote to his family and friends before he died.

Several of those closest to him characterized Helling’s low points as no more than what you’d expect in times of trouble.

“When your stress system is on alert, that affects your mental health. It affects your sleep, your appetite,” Harkavy-Friedman said.

She stressed that although it might seem as if the suffering won’t ever diminish, “there are things you can do even if it doesn’t take away the condition.”

Routines and tools that give you a sense of control can help, and a good therapist can guide a person to figure out what those might be, she said. Medications can take more than a month to be fully effective, and sometimes it takes awhile to figure out which one, or combination, works.

People with conditions that can’t be measured and aren’t well-understood can feel alienated and dismissed, Harkavy-Friedman said. “Nobody can feel what you’re feeling.”

In his final words, Helling wrote of the support he felt from friends and family, even when the conversation lingered on the same set of complaints.

Helling’s friends said he was at once introspective and a cut-up, someone with a particular talent for developing and maintaining friendships.

In pictures they’ve shared on Facebook, you can see the kind of smile that makes you like a person before he has uttered a word.

In their posts, you learn how much they miss him — at rock shows, when they play albums he gave them, when they drink Bloody Marys that aren’t as good as his.

“He was kind of shy, but the more you got to know him, he could talk your ear off,” said Nick Barger, a friend since kindergarten who played with Helling in the Cabdrivers and the ’80s cover band Fisted Mister. “Music is really where he started finding his own thing.”

But by last fall, “he was just so clouded by what he was experiencing,” said longtime friend Craig Turner.

“It became disturbing and painful for us. The hardest part is there was nothing that could be done. It was very much out of our league as friends and family.”

Eventually, Helling stopped doing the things he loved. He missed work at Natalie’s Coal-Fired Pizza, where he tended bar, and was not spending time with the people he adored. He wasn’t playing the guitar that was like another limb.

“He just totally, totally changed,” said Helling’s dad, Henry.

Brett Helling played in five bands. He played mostly guitar but also was exceptional on bass, said Kyle Sowash of the Columbus band the Kyle Sowashes.

At Sowash’s urging, Helling practiced with the band in early February. They had a special performance coming up, and Sowash wanted him to be part of it.

Although Helling hadn’t been playing for months, “he sounded great. It was like he never put down the bass. But I don’t think that he could hear that. It just wasn’t the same for him.”

A week later, on Feb. 16, they were waiting for him at band practice when they got the call. Helling had jumped off a bridge.

mcrane@dispatch.com

@MistiCrane