November 21, 2015

When Your Body Works Against You

I've been struggling with health problems for awhile now. It's been frustrating on several levels. It started, I suppose, back in 2013 when I got sick with a very bad flu, followed by a very bad cold. Naturally, the flu followed by the cold wreaked havoc on my ability to sing or practice my music while I was in the throes of it, but I never seemed to get better. The cold consisted of a terrible wracking cough every morning, followed by a full day of phlegm and snot. The wracking cough got so bad that I wound up with pleurisy, where the two membranes around your lungs rub a sore spot inbetween them. It felt like someone was ramming a blunt wooden spear between my ribs if I so much as breathed deeply, much less coughed. And even after the pleurisy faded away,every time I tried to sing, a dull pain arose in my vocal chords, more pronouncedly on the left side of my throat. I was worried that I had developed nodes (every singer's nightmare). I saw an Ear Nose and Throat specialist about it, and the prognosis was that I had a sinus infection.

I had a nasal scope, which I keep wanting to call a nasal probe. First, they spray the most horrible-tasting spray up your nose, and have you sniff in swiftly to coat the back of your throat and numb you up a bit. It tastes like what I imagine a monkey's butt would taste like. Then, they thread a tiny camera on the end of a long cable down your throat by way of your nostril, all the way down to just above your vocal chords, and they then have you speak, count, and sing. The numbing spray helps, but it is still quite uncomfortable. The nasal probe (sorry--nasal scope) revealed damage to my vocal chords and the surrounding tissue, but no sign of infection otherwise. My doctor ordered a CT Scan of my head, and that revealed that there was indeed a sinus infection in my maxillary sinuses. I was given strong antibiotics on the off-chance that the sinus infection was bacterial in nature. Some are, but most are viral. A very small percentage are fungal. The antibiotics did nothing. I was also assigned a speech therapist, as the ENT doctor thought perhaps I wasn't singing correctly; she saw a lot of tension when she had the scope down my throat.

So I started going to a speech therapist. She worked with me on things like jaw tension, and showed me massages I could do to my throat to try to loosen it up and make sure I wasn't straining in any way while I sang. I faithfully did all the exercises she taught me, but I still felt that dull ache in my throat while I sang, especially on the left side. I felt like a failure. I did google searches to see if maybe something else was wrong, besides a sinus infection. No other diseases sounded definitive.

At my second nasal scope, the doctor noticed I was pushing my tongue down my throat when I sang, which created a lot of tension and a weird, strangled tone. I think I was doing this subconsciously in an attempt to make my voice sound deeper. I also had a dental appliance attached to the back of my front teeth at the time to dissuade tongue thrusting while my braces worked to fix my open bite. I believe these two conditions combined where I was overdoing things and pushing my tongue in the opposite direction, down my throat. At any rate, I immediately went home and googled how to train myself to stop pushing my tongue down my throat when I sang. One of the methods suggested was to sing with a shelled walnut in your mouth. This forces you to keep your tongue up in your mouth lest you choke. After just a day of practice, I noticed something remarkable - my side and back muscles were sore. This was a good sign, as it meant I was using the proper muscles finally to sing! My tone started to sound better, and my vocal coach at the time, my friend Jessica Lynne, said to keep doing whatever I was doing, as my singing sounded better than ever.

The only problem was...I was still experiencing pain when I sang. It wasn't as bad now that the sinus infection was lessened, but it felt like it never truly went away. Anytime I had to sing for any length of time, such as tracking vocals, my voice felt not just fatigued, but sore. Strained. Damaged. All this, despite my speech therapist saying my tone sounded good and she could tell I didn't have tension while I sang. All I could figure was that the sinus infection was lessened, but never truly eradicated.

Fast forward to this year, and another bad cold in March. The sinus infection seemed to return in full-force. I was coughing every morning,and going through about a box of tissues a week as my nose never seemed to stop dripping. The pain in my throat came back with a vengeance any time I sang; worse than ever, especially on my left side. Which was so curious! Why the left side? Was it something with the way I was singing; holding tension on one side of my throat and not the other? My tone still sounded good, but the pain made me scared that I was doing permanent damage to my vocal chords.

I went back to my ENT doctor, this time determined to nip this stupid recurring sinus infection in the bud. The doctor did another nasal scope, but said she didn't think it was a sinus infection this time. Nonetheless, she assigned me a brutal round of antibiotics just in case. But she suspected what I actually had was something called Laryngopharyngeal Acid Reflux, also called "Silent Reflux." Silent Reflux is a lot like Gastroesophageal Reflux (GERD) in that stomach acid flows backward up your esophagus. But unlike GERD, where the acid causes pain in your chest (heartburn), Laryngopharyngeal Reflux flows all the way up your esophagus into your larynx and pharynx, causing pain in the throat. What makes it "silent" reflux is that the symptoms tend to be sparse and more often attributed to other causes (like a cold). Unlike a severe burning sensation in the chest, Silent Reflux symptoms are more like mild hoarseness, feeling like you need to clear your throat, trouble swallowing, a sensation of mucus sticking in the throat, post-nasal drip, chronic cough, sore throat, and a red, swollen, or irritated voice box.

Yup, those were definitely the kinds of symptoms I was having. I was irritated with the diagnosis, though. It sounded like the kind of cop-out excuse given by singers when they are suddenly discovered to be lip-synching on SNL, and I hated the thought of being associated with that. Another frustration was that there is no real cure for acid reflux. It means your esophageal sphinctors have worn out (usually due to age, overuse, or hereditary) and just can't close properly anymore to keep the stomach acid from going where it shouldn't. Besides being prescribed a Protein Pump Inhibitor (Omeprazole, or more well-known by the brand name Prilosec), there were a lot of lifestyle changes I would have to make in order to control my symptoms. First, I needed to avoid eating big meals, and eating too close to bedtime. I also needed to stay away from spicy and greasy foods, which caused a lot of acid in the stomach. I was also supposed to avoid fatty foods like meat and cheese, as well as alcohol, mint, chocolate, coffee, tea, dairy products in general, and most fruit (including highly acidic tomato products). PRETTY MUCH EVERY ENJOYABLE KIND OF FOOD.

But the doctor said she saw damage to my throat consistent with silent reflux, and that it CAN do permanent damage over time. So after a few weeks of stubborn resistance and denial, I started making changes to my diet and lifestyle. I started taking omeprazole twice a day. And I've cut out nearly all dairy, alcohol, acidic fruits, and mint (not that those were very prevalent in my diet anyway). I am still struggling with spicy food, chocolate, coffee, tea, and fatty meats. My favorite kind of food is mexican. I can wax poetic about bacon and sausage. I sing songs about coffee and tea, and I'm pretty sure I wrote an ode to chocolate in my youth. And it's hard for me to eat smaller meals, as I was taught growing up to clean my plate. I find it easier to fall asleep on a full stomach and very hard to sleep on an empty one. But I'm working on it. I've also started sleeping on a wedge pillow, which props me up about six inches, in an attempt to work with gravity on keeping my dang old stomach acid in my stomach where it belongs.

I suspected the Omeprazole was making me gain weight; about 2 pounds per month. This was alarming, since my weight has held pretty steady over the years. I cut out the Omeprazole for a time, and immediately started dropping pounds, acid reflux symptoms also came back. Boo. The recommendation for this side effect is "watch your weight and exercise more." Welp, I already watch my weight and exercise, so I guess I'm just going to have to be more diligent about that, since I definitely still need the Omeprazole to keep my acid reflux in check.

The good news is that my acid reflux symptoms have all but disappeared. I can sing without pain! And I suspect the reason I was experiencing pain primarily on the left side of my throat is because I sleep on my left side, so the acid damage was worse on that side. And the reason I sleep on my left side is because I'm deaf in my right ear, and my husband snores. So when I sleep on my left ear (my "good" ear) I can sort of block out his snoring. It's such a relief to figure all this out finally, and to have my throat/singing pain figured out at long last. There for awhile, I felt like I was taking crazy pills. Laryngopharyngeal reflux and GERD affect a good percentage of the population, but most people's symptoms are so mild that they don't realize they have it. So if you experience any of the symptoms listed above, please consider seeing an ENT doctor about it. You could be doing permanent damage over time.