Reflux
About 15 years ago, one of my students said “I am not singing well today because I my reflux is bad today.” I had no idea what reflux was. I had heard of “heartburn” and “acid tummy”, for which one used (plop, plop, fizz, fizz, oh what a relief it is) Alka Seltzer, but I did not know that it would affect the voice. I humored the student, not really knowing what she was talking about.
Fast forward 10 years, and I had not only heard more about Reflux than I ever wanted to, I had it. And I had it bad.
The dictionary definition of reflux is “a condition in which acidic gastric fluid is regurgitated into the esophagus, causing heartburn.” That sounds fairly benign, but it isn’t.
The stomach acid is not only regurgitated into the esophagus, it also hits the throat, vocal cords and back of the mouth. It can go up into your nose and sinuses, and drip back down onto your cords. You know that feeling when you throw up? It’s that stuff, from your stomach, that comes up and it is about the worst thing for your singing you can imagine.
It comes on slowly and differently for different people. For me, it was post nasal drip that I could not get rid of. It took forever to warm up, and by the time I was warmed up I was tired from singing too much. Nothing could clear my cords enough, and I felt as if I must sound like Winnie the Pooh. And that was just stage one...
Stage two found me at the ENT, wondering if there was something wrong with my vocal cords. The doctor assured me that my cords were healthy, and that it might be "just a bit of reflux". He told me to take some Prilosec or Tums.
Nothing really worked, but I kept trying to sing, because....that is what I do.. Then, Stage Three happened, and I sat up and paid attention. Stage Three is where I could feel my stomach churning and splashing up into my throat. It was a horrible feeling. This time I went to the gastroenterologist. He put me on Nexium and told me not to sleep lying down as usual, because the stomach acid was most likely to go into the throat when I was horizontal.
I slept sitting up in bed, propped up by three pillows. If you have ever done this, you know how difficult it is to sleep like this, I did it for an entire summer.
Because my income comes entirely from my singing and teaching, I was petrified. Healing from this was very slow, and though I could feel the improvement in my stomach, and the lessening of the sensation that it was rushing into my throat, the damage to my throat was taking a long time to heal.
I went back to the ENT to have my throat scoped. My vocal cords were still in excellent shape, but the back of my throat looked like ground beef. Because the membranes in the throat are always wet, always covered with mucus, they take a very long time to heal up.
The first show of the fall season at SFO I was in terrible shape. I had to mark (sing very softly) a lot of the time, and when I was in a small group, I sang out, but it hurt a lot to do so. The second show I was feeling a little better, but I still had days where my voice would not work for me, and I had to mark some of the time. By the third show of the season, about October, I was starting to have a more reliable tone, and I could sing full voice the entire show. As the season progressed, I got better and better. But it was not for a full year and a half until my voice was back to normal. It was a scary time.
Since I had reflux so badly, I have come to notice that SO MANY other singers suffer from what they call reflux. Everyone's reflux is different from everyone elses, so I wonder if we all have reflux, or a number of different stomach/throat maladies that are similar to reflux.
Mine was definitely cured by a combination of prescription drugs: Nexium and Carafate. Carafate is a drug that heals the esophagus, and Nexium is a drug that seeks to lessen or eliminate acid in the stomach. Everyone has stomach acid, and that is normal, but when it comes up the esophagus and splashes on the throat or up the nose, that is when the acid stops being normal, and starts becoming an issue. Sleeping more vertically helped keep the acid where it was supposed to be, and the medicines helped lesson the stomach issues and healed the damage.
But.
Here is where it becomes personal. Many people I have spoken with who have "reflux" had told me that their cures are very different from mine and many swear by their own remedies. One of my friends swears that having a tablespoon of Bragg Apple Cider Vinegar in warm water keeps reflux away. Another says that keeping gluten free keeps them reflux free. Still another friend uses Gaia Herbs. There are any number of reflux "cures" to be found online. I would not trust those. Go to your doctor. He or she has been studying for years to combat this disease, and though they may consider some herbal remedies like licorice to ease the symptoms, mostly they will give you decades of medical science knowledge to combat your condition. They will be able to tell you if in fact you do actually have reflux, or if you have some other throat or stomach condition which is causing symptoms that are similar to reflux.
I asked my gastroenterologist about these remedies and he rolled his eyes. He said he didn't know about herbs, but he said that gluten could not possibly cure reflux, and could not possibly be something that causes it. He said that any kind of vinegar will only increase stomach acid, and should never be used. He suspects that the people who are "cured" of reflux by these remedies do not have reflux.
What causes the acid to rise into your throat? There is a little valve at the top of your stomach (the esophageal sphincter) that opens to let food into your stomach, and closes to keep the stomach contents from coming back up. When this sphincter fails, that is when you have reflux, and that is the cause of the reflux, not the acid itself. If the sphincter muscle fails you can either lessen the amount of acid that is available and take steps so that it does not rise up, or have an operation to wrap the top of the stomach around the esophagus and to cuddle the failing muscle to keep it more closed. This is kind of extreme, so I recommend trying the other options first.
In addition to the medicines he prescribed to me, he told me to avoid certain foods. This was the hardest part for me, because some of them are my favorite foods. :( Tomatoes, Citrus fruits, eggplants, green and red peppers, Wine, caffeinated coffee and tea, chocolate and fats were the main things. Fats include deep fried food, fatty meats, whipped cream and butter, cheesecake, many desserts....All the things that are delicious, I thought.
When I started on my reflux diet I lost 15 pounds immediately I was so desperate to heal my throat and get back my singing mojo. I was not patient, and wanted to be better immediately if not sooner. As I said before, I did not feel like I was singing up to my full potential for a year and a half. I was not patient, but my throat did not care, and took its time healing. I am on the Nexium for life. I am avoiding wine and chocolate and other reflux "triggers" (everyone is different-- your triggers and mine may not be the same. Lucky you if coffee and chocolate do not cause reflux for you!) Best of all, I can sing up to my full potential.
With good medical care and some food sacrifices you too can control your reflux. Go to the doctor! Don't waste your time doodling around with your friends favorite herbal remedies-- they may have something entirely different than you do and their useless remedies may just prolong your own reflux symptoms. You want to get it over with as fast as possible, before you have damage that costs you engagements, time and money.
About 15 years ago, one of my students said “I am not singing well today because I my reflux is bad today.” I had no idea what reflux was. I had heard of “heartburn” and “acid tummy”, for which one used (plop, plop, fizz, fizz, oh what a relief it is) Alka Seltzer, but I did not know that it would affect the voice. I humored the student, not really knowing what she was talking about.
Fast forward 10 years, and I had not only heard more about Reflux than I ever wanted to, I had it. And I had it bad.
The dictionary definition of reflux is “a condition in which acidic gastric fluid is regurgitated into the esophagus, causing heartburn.” That sounds fairly benign, but it isn’t.
The stomach acid is not only regurgitated into the esophagus, it also hits the throat, vocal cords and back of the mouth. It can go up into your nose and sinuses, and drip back down onto your cords. You know that feeling when you throw up? It’s that stuff, from your stomach, that comes up and it is about the worst thing for your singing you can imagine.
It comes on slowly and differently for different people. For me, it was post nasal drip that I could not get rid of. It took forever to warm up, and by the time I was warmed up I was tired from singing too much. Nothing could clear my cords enough, and I felt as if I must sound like Winnie the Pooh. And that was just stage one...
Stage two found me at the ENT, wondering if there was something wrong with my vocal cords. The doctor assured me that my cords were healthy, and that it might be "just a bit of reflux". He told me to take some Prilosec or Tums.
Nothing really worked, but I kept trying to sing, because....that is what I do.. Then, Stage Three happened, and I sat up and paid attention. Stage Three is where I could feel my stomach churning and splashing up into my throat. It was a horrible feeling. This time I went to the gastroenterologist. He put me on Nexium and told me not to sleep lying down as usual, because the stomach acid was most likely to go into the throat when I was horizontal.
I slept sitting up in bed, propped up by three pillows. If you have ever done this, you know how difficult it is to sleep like this, I did it for an entire summer.
Because my income comes entirely from my singing and teaching, I was petrified. Healing from this was very slow, and though I could feel the improvement in my stomach, and the lessening of the sensation that it was rushing into my throat, the damage to my throat was taking a long time to heal.
I went back to the ENT to have my throat scoped. My vocal cords were still in excellent shape, but the back of my throat looked like ground beef. Because the membranes in the throat are always wet, always covered with mucus, they take a very long time to heal up.
The first show of the fall season at SFO I was in terrible shape. I had to mark (sing very softly) a lot of the time, and when I was in a small group, I sang out, but it hurt a lot to do so. The second show I was feeling a little better, but I still had days where my voice would not work for me, and I had to mark some of the time. By the third show of the season, about October, I was starting to have a more reliable tone, and I could sing full voice the entire show. As the season progressed, I got better and better. But it was not for a full year and a half until my voice was back to normal. It was a scary time.
Since I had reflux so badly, I have come to notice that SO MANY other singers suffer from what they call reflux. Everyone's reflux is different from everyone elses, so I wonder if we all have reflux, or a number of different stomach/throat maladies that are similar to reflux.
Mine was definitely cured by a combination of prescription drugs: Nexium and Carafate. Carafate is a drug that heals the esophagus, and Nexium is a drug that seeks to lessen or eliminate acid in the stomach. Everyone has stomach acid, and that is normal, but when it comes up the esophagus and splashes on the throat or up the nose, that is when the acid stops being normal, and starts becoming an issue. Sleeping more vertically helped keep the acid where it was supposed to be, and the medicines helped lesson the stomach issues and healed the damage.
But.
Here is where it becomes personal. Many people I have spoken with who have "reflux" had told me that their cures are very different from mine and many swear by their own remedies. One of my friends swears that having a tablespoon of Bragg Apple Cider Vinegar in warm water keeps reflux away. Another says that keeping gluten free keeps them reflux free. Still another friend uses Gaia Herbs. There are any number of reflux "cures" to be found online. I would not trust those. Go to your doctor. He or she has been studying for years to combat this disease, and though they may consider some herbal remedies like licorice to ease the symptoms, mostly they will give you decades of medical science knowledge to combat your condition. They will be able to tell you if in fact you do actually have reflux, or if you have some other throat or stomach condition which is causing symptoms that are similar to reflux.
I asked my gastroenterologist about these remedies and he rolled his eyes. He said he didn't know about herbs, but he said that gluten could not possibly cure reflux, and could not possibly be something that causes it. He said that any kind of vinegar will only increase stomach acid, and should never be used. He suspects that the people who are "cured" of reflux by these remedies do not have reflux.
What causes the acid to rise into your throat? There is a little valve at the top of your stomach (the esophageal sphincter) that opens to let food into your stomach, and closes to keep the stomach contents from coming back up. When this sphincter fails, that is when you have reflux, and that is the cause of the reflux, not the acid itself. If the sphincter muscle fails you can either lessen the amount of acid that is available and take steps so that it does not rise up, or have an operation to wrap the top of the stomach around the esophagus and to cuddle the failing muscle to keep it more closed. This is kind of extreme, so I recommend trying the other options first.
In addition to the medicines he prescribed to me, he told me to avoid certain foods. This was the hardest part for me, because some of them are my favorite foods. :( Tomatoes, Citrus fruits, eggplants, green and red peppers, Wine, caffeinated coffee and tea, chocolate and fats were the main things. Fats include deep fried food, fatty meats, whipped cream and butter, cheesecake, many desserts....All the things that are delicious, I thought.
When I started on my reflux diet I lost 15 pounds immediately I was so desperate to heal my throat and get back my singing mojo. I was not patient, and wanted to be better immediately if not sooner. As I said before, I did not feel like I was singing up to my full potential for a year and a half. I was not patient, but my throat did not care, and took its time healing. I am on the Nexium for life. I am avoiding wine and chocolate and other reflux "triggers" (everyone is different-- your triggers and mine may not be the same. Lucky you if coffee and chocolate do not cause reflux for you!) Best of all, I can sing up to my full potential.
With good medical care and some food sacrifices you too can control your reflux. Go to the doctor! Don't waste your time doodling around with your friends favorite herbal remedies-- they may have something entirely different than you do and their useless remedies may just prolong your own reflux symptoms. You want to get it over with as fast as possible, before you have damage that costs you engagements, time and money.