Saturday, October 4, 2008

Guest post: Acid Reflux, by Burleytone

Dear Friends,

As I am working diligently on the next two posts, I hate to leave you without material. I am very pleased to post the following story on acid reflux written by Burleytone, a colleague from NFCS.

As you know, I continue to deal with reflux, and I find this story very inspiring. I hope you do too. After I am done with the other posts, I will share some additional information on this subject. Thank you, Burleytone!
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ACID REFLUX

So, I read on Toreadorssongs’ blogspot about some of his struggle with acid reflux. I was interested to see that I have experienced some of what he writes about. I have struggled with its effects for over ten years. This has prompted me to write my story in the event that it could help another reflux sufferer out there. Fortunately, it has a happy ending!!!

I first started having consistent vocal troubles my senior year in college. My singing teacher believed my problems were technical, not physical, because of my ability to accomplish various vocal feats in one instance but not another. After a couple of months of frustrating practice sessions and lessons, we agreed that I should go see a medical professional. The ENT saw redness and swelling at the back of my vocal folds. He indicated that this could be caused by allergies or acid reflux. We treated the two possibilities separately with Allegra and Claritin, and then with Prilosec. There was a possibility that I was getting mild relief from these drugs but not enough for me to be absolutely certain about one or the other.

I moved on to graduate school. Some days were vocally better than others, but I was consistently unhappy because of my lost singing abilities. I gradually seemed to be losing touch with what it felt like to sing well. My new teacher was less knowledgeable as a technician than my previous one, so that seemed to contribute to my vocal decline as well. I went to see a very well-known ENT who prescribed Prevacid. In my follow-up visit, this doctor declared that the texture of my cords was improving. At a later visit, despite my vocal discomfort, the office declared that all was in order with my health. They were no longer capable or willing to do anything for me. They referred me to a gastro-intestinal doctor and a voice therapist. The G.I. couldn’t find anything really wrong and was hesitant to tinker. The therapist believed I was singing just fine but counseled me to back off a bit on my vocal energy—take it easy. This was not what I wanted to hear and I believed there was more to it than that. I could feel something was amiss with my voice and desperately needed someone to accurately pinpoint the problem. I felt that the only choice I had was to continue to take the medication and to be as technically discriminating as possible in my singing.

Upon graduation I managed to get into a year long apprenticeship program. As usual I continued to show good days and bad days of singing. Two years passed since beginning to take antacids, raising my bed, etc. so I decided to pursue the possibility of allergies more aggressively. I’d recently seen Ashley Simpson complain of vocal discomfort on MTV after yelling into a microphone with her band. The ENT told her she had acid reflux (GERD). This, combined with poor response to antacids, brought me to decide that GERD was just an ENT catch-all. Needless to say, I stopped the medication. I began with allergy shots. They seemed to give me mild to significant relief. I had also noticed better health while traveling in different regions—like back home, so I concluded that finding an allergen free region to base myself would be the biggest answer to my problems.

Dealing with the psychological ramifications was probably the greatest difficulty in all of this. I mean, so many times I found a little vocal trick that momentarily fixed my woes and led me to believe that I probably didn’t have a problem after all. Eventually, after many horrible auditions and negative performance experiences, I couldn’t help but believe I was somehow sub-par as a singer. Ironically, I was often among the cynical crowd that was dismissive about other singers’ claims of physical problems hampering their singing. “It’s really their technique,” we coyly respond. I was sure others were thinking the same about me and I was desperate to show they were wrong. This was absurd, of course, but emotions often are.

By now, I found myself in a free-lance lifestyle and miraculously had secured several regional contracts for the year. Mysteriously my voice would come into order just in the nick of time for starting the contract. This only perpetuated the fallacious idea in my mind that my problems stemmed from less efficient vocal behavior. However, there was some hope in this. I had a wonderful year of new roles on which to practice my newly found technique and would thus be ready to advance into the “bigger time” the following year. Unfortunately this pattern would repeat itself down the line as I would find new tricks or rediscover the same trick that had previously stopped working for a time.

I began traveling for auditions and noticed that it would take me one to two days after airplane travel to feel vocally normal. This was an expensive problem. After returning from one grueling concert experience, I had finally had ENOUGH! Something beyond my technique was definitely wrong—no doubts this time. I hadn’t seen an ENT in years so I decided it was time. I found recommendations from singers in the area and quickly got myself an appointment. Of course, you’d never believe what they told me: I had GERD. I relayed my suspicions to them and asked them if the cause could be anything else—like pressed phonation. They were convinced about reflux as the problem. They explained that the swelling at the back of my cords was preventing them from getting full closure front-to-back. A small gap would remain at the front of the cords. This would make high notes particularly difficult, they explained. To boot, they found two beautiful ulcers in the fleshy area just behind my cords. These didn’t seem to pose any immediate and direct threat to my singing, however were further evidence of GERD. “Okay!” I was convinced along with them and had no choice but to follow suit with their protocol. The ENT commented that Prilosec was merely “placebo, plus one” and said that Nexium was the latest drug of choice. I was to take it twice a day.

Wow! Within a week of taking Nexium I was feeling so much better. I started to remember what my voice used to feel like! I started a summer contract and despite some occasional inconsistency, was very pleased to have my voice back after years of its absence. I didn’t think much of the problems that did periodically upset my voice because, on the whole, I was feeling so much better.

Lo, and behold, after less than a year, this vocal high came to a grinding halt. I had a week where I could not get my voice going to save my life. It felt constantly dried out and foggy—in retrospect, I had lots of dryness, fogginess, and frequent headaches, but since my voice seemed so much better, I ignored this. At that point I had to be honest with myself and admit that the occasional vocal discomfort that I had been experiencing throughout my summer contract and since was a problem. I couldn’t just assign it to the “ups and downs” of every day voice use. “Stop kidding yourself man!” I decided to accept a personal maxim, “You truly do have the technical knowledge to be a successful singer. If your singing is not right on the money, effortless (a loaded term, I know), and able to do what you know it is capable of, there is an outside problem that must be addressed. Do not settle for less than the best in your singing!”

Some of my family members happened to have some neighbors that were alternative doctors (naturopathic and nutrition). Despite my family’s lack of credence in such methods they couldn’t help but be impressed with the results this family was getting with their own children (allergies and such). Being a typical westerner, I had reservations about the alternative crowd as well. However, I was backed up against a brick wall and felt desperate enough to give it a try. Of course insurance wouldn’t cover such treatment but fortunately the initial consultation was to be gratis. Upon learning this, I jumped at the gamble and made a visit.

Sure enough these doctors’ method of testing was as whacky as I had suspected.
However, their discussion and explanation seemed logical. I tried my best to keep an open mind. I knew that the proof would be in the pudding anyhow, so I would let the results of the treatment speak for themselves. After testing me, they told me that my problems probably stemmed from the following: a Candida yeast overgrowth, and sensitivities to wheat (gluten) and dairy. They prescribed that I get off sugar (which feeds the yeast), most grains (including corn, excluding rice), and all milk products. They then sent me home with several supplements to fight the yeast and aid my digestion: probiotics and amino acids. They explained that the Candida yeast overgrowth was only exacerbated by the antacids I had been taking. You need the right acidity level for digestion and I was suppressing it by taking Nexium. Constipation and this yeast overgrowth were named as symptoms for my acid imbalance.

The prospect of my life to include this new diet was, to say the least, overwhelming. The nutritionist assured me that things would be better after I had some time to allow my digestive tract to heal. In all likelihood, I would be able to reintroduce certain foods into my diet.

I did learn that there are things to eat that don’t include gluten, dairy, and refined sugar. My diet consisted of mostly fruit, vegetables, meat, eggs, nuts, rice, and soymilk (almond and rice as well). I have found gluten free pastas and crackers. I learned to carefully inspect labels of products such as sauces and candy (when I would occasionally break my diet for a sugar fix). I discovered Rice Chex with soymilk and 100% juices for breakfast. The trick to sticking to this diet was getting rid of all the temptation (in the form of food) out of the house.

Well, how did I fare? I was instructed to gradually go off Nexium so I knew the results of my singing would have to potentially wait a couple of weeks. However, the immediate effects on my body were eye-opening. Within just a couple of days I recognized that I had indeed been constipated the bulk of my life. I also came to understand that I was bloated after meals due to wheat and/or dairy. I hadn’t known what it was like NOT to feel bloated after a meal so was thus unaware. I had more energy all around, especially after meals. I didn’t feel so tired and beat down in the late afternoon and at the end of the day. I didn’t require as much sleep as I thought I did. Whether or not this would in the end affect my singing, it was clear that this was a good change in my life.

I had heard that getting off antacids could have a temporary back-lash so I kept waiting for that to happen as I monitored my voice each day. Strangely enough, that backlash never happened. My voice began to feel healthy. In fact, it continued to feel healthy day after day but in an indescribable way and marked difference than when on Nexium. Was this a placebo effect? Time would only tell.

My six month follow-up appointment with my ENT happened three months after I made this diet change and followed the supplemental protocol. By then I had lost at least fifteen pounds by virtue of my diet. I was happy as a clam with my singing and was curious to see the improvement on my vocal folds from the laryngoscope.
The last six month follow-up showed a significant reduction in redness and swelling as well as retreat of the ulcers. This time, shockingly, the scope showed that those symptoms had returned. What?!!! I explained that I felt exceptional and told the ENT and Voice Specialist about my treatment and lifestyle changes. They were as perplexed as I was but were nervous about the ulcers hardening over time. They said that hardening could affect my adduction/abduction abilities. They begged me to take at least one “purple pill” a day. I tried to dialogue with the ENT about what the alternative crowd was telling me but he simply admitted that he had no knowledge of such information. He knew how to “recognize a symptom and then treat it.”

Naturally, I feared for my long-term health and decided to go ahead and take Nexium again. I immediately relapsed into the way I felt months ago with the dryness and fogginess. It was not enjoyable to sing. I felt that I needed to address this with the naturopath so made an appointment.

My naturopathic doctor explained that some persons suffer from acid reflux not because they have too much acid but because they have too LITTLE. He further explained that the esophageal sphincter’s cue to close off related to having enough acidity. He suggested I try a formula (Glutamic Acid HCI, Betaine HCI, Pepsin, Gentian Root) that would stimulate the hydrochloric acid of my stomach. He also had me add Slippery Elm bark powder (of necessity the powder, not the syrup) to the mix. VOILA!!! My voice was back, up and running, within a couple of days. Now the true test would be through the laryngoscope in a few months. That appointment happened just last month.

During an opera contract last month, the board president’s husband happened to be an ENT, so I opted to have him examine me. He could find no evidence of acid reflux or ulcers.

Now, rest assured that I will get scoped again in another few months. But you can also be certain that I have put my bulk bottle of Nexium away for good.

Further testing at the lab has allowed me to reduce my supplement intake as well as eliminate one of them all together. The nutritionist tells me that I have in all likelihood reached a maintenance level so not to anticipate reducing their quantity (at least for a while). I take: Gastro (Transformation brand), Multi-Probiotic (Original Medicine brand), Slippery Elm bark powder, and GastrAcid (Xymogen brand; the acid stimulator discussed above) with each meal.

I decided that the Candida yeast is at bay so I have been eating sugar off and on for quite some time. This has opened up the possibility for home baked goods. I just use rice flour, tapioca flour, potato starch and flour, sorghum flour, and xanthan gum for wheat flour substitutes. With a little research you will find plenty of recipes. Life is a little more expensive this way, but it’s definitely worth being able to sing again (and I haven’t gained the weight back).

Now, I don’t think that I am now a perfect singer. I am still subject to my own vocal foibles and have to constantly work to stay on track. The difference now is that I am in control, not my stomach acid. Fortunate for me, I now feel like I am dealing with the same voice each day--as opposed to several different behavior tendencies because of over compensation due to reflux.

Post Script:

I have listed two source links (pro and con) that discuss the concept of too little stomach acid as the cause for GERD.

http://www.evitamins.com/healthnotes.asp?ContentID=1037005

http://www.revolutionhealth.com/blogs/nothing/the-myth-of-hypochlor-9430

© 10/04/2008

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