In the last two months my teeth have deteriorated dramatically. The dental cost so far is over €5,000. That is more than my monthly survival budget. I brush, I floss, I have done both consistently for years. The damage comes from stomach acid that should not be where it is, and the reason it is where it is connects all the way back to the medications I take to keep myself functional in a country that has refused to make any other accommodation.
From outside I look like someone managing. What the managing costs inside, nobody sees. The letters that decide my disability, my residency, my recognition see only the surface.
What I take, and why
The medications are prescribed and covered by Austrian insurance. They address the conditions in my medical file; without them, those conditions deepen to a point that is itself dangerous. Each one has its own side-effect profile, and some of those side effects reach the stomach in predictable ways.
What no part of the system provides is a single clinician who looks at the whole picture. Each prescription comes from its own specialist, in its own department. The regimen as a whole has never been reviewed by an integrated treatment team, because integrated care for adults in my situation does not exist here.
The cascade, mechanically
The combination affects how my stomach works. Certain medications relax the lower esophageal sphincter, and the result is reflux, repeatedly. Stomach acid reaches places it should not reach, and tooth enamel is the most visible casualty.
In the last two months the deterioration accelerated. Over €5,000 in dental work has gone into stopping the immediate damage. There is no fund this is coming from, and no insurance category that fully covers acid-erosion damage when the underlying cause is medication-related rather than caries.
So I am paying, in money I do not have, for the consequence of a regimen I take because nothing else exists.
Even the dentists can't see it
The cascade does not stop at the body. It continues into the system that is supposed to identify and stop the damage. In the last month alone I have been to dentists about ten times. Each visit I describe the symptoms clearly: the thinning enamel, the pain increasing week by week, the mechanism of silent acid reflux from the medications and the GI cascade.
Each visit they prescribe something for pain, or a different rinse, or another medication to try. None of it works. The teeth keep thinning, the pain keeps increasing, and the symptoms keep matching what I keep describing.
The frustrating part is the response: maybe that is not what is happening, maybe it is something else. I am the one telling them what it is, and they don't know what to do with it, so they default to: it must not be that. They don't recognize the pattern, so the patient must be wrong about his own body.
This is the same dynamic that runs through every other part of the case. A disability assessor saw someone who "speaks German well" and overrode a ten-year hospital report. The residency authority said if you can study, why can't you work. A dentist hears the patient describe silent reflux and decides it must be something else. Every time, what people see in a few minutes counts more than what I am telling them directly.
So I wait, and the only thing that will settle the disagreement is more damage.
What you can't see from outside
This is the part an autistic life makes you understand without anyone explaining it: the gap between what other people see and what your own body is registering.
From outside, I am managing. I show up, I speak, I get through the interaction. The medications are part of the reason the surface looks the way it does; they are what make the showing-up possible.
Inside, while the surface holds, the reflux continues, the fatigue continues, the damage collects in places nobody sees until something fails. And my concentration swings with the medications, not with my personality.
And the surface doesn't hold forever. Sometimes, without warning to anyone outside, the overwhelm comes. The masking that has been doing the work for hours or days simply stops. People who have not been on this side read that collapse as sudden, out of character. For me it is the least surprising thing in the world.
None of this shows up in the first impression a clinical assessor has of me, or in the photo on a residency form. Only my body keeps the record, and nobody reads that one.
The choice the system pretends doesn't exist
When you don't have a therapist who actually understands autism in adults, when no integrated treatment team exists and no one in any of the systems you have asked can construct a coherent plan with you, the choice in front of you reduces to two:
Take the medications. The symptoms stay manageable and the surface holds. The side effects continue, and the last two months of them cost €5,000 in dental work.
Don't take the medications. No side effects, and the conditions themselves get deeper and more dangerous.
Both options are harm. The second is the more dangerous one, so I take the first, every day.
What would have made this unnecessary
It is worth being specific about something the medical model usually flattens: the medications do not treat autism. They treat secondary conditions that, in my case, are largely produced by the conditions of an unsupported life. A peer community here, other autistic adults to talk to without translating myself first. Real support and understanding from the people and systems around me. Rights that had not been taken away one assessment at a time, the disability denied, the residency refused, the case turned away by every inclusion body it touched. A daily life where being read as foreign first was not the constant background. Less of the isolation I currently live in. Nothing in that list is extraordinary. It is an ordinary life. With even some of them in place, this regimen, and the cascade it produces, would not be necessary, or would be necessary only in far smaller doses. The medications stand in for what an ordinary life would have provided: people, recognition, a place that takes you as you are.
Why this article exists
The cascade is invisible from the outside. My teeth are a dental problem, the psychiatric symptoms are psychiatry, the cognitive load is no one's department, each one filed separately. None of it connected to: this person is autistic and ADHD, late-diagnosed, alone in a country, refused at every institutional door, and left with a treatment that no one coordinates, because coordinated care was never offered.
This is what happens when every door is closed. At some point I stopped knocking and carried the treatment alone. The costs show up in my body, in the teeth and the gut. And what I actually needed, support, scaffolds, people, is still missing.