By the end of the spring semester of 2012, my voice was trashed. With a full voice studio, two lecture classes, and a busy performance schedule, my voice was completely spent. Incessantly hoarse and crackly, my speaking voice sounded more like a contralto than a lyric coloratura. My main goal for the summer? Figure out what the heck was wrong with my voice. And who knew that this journey would lead me down a path of consulting nearly half a dozen doctors and specialists, receiving conflicting diagnoses, paying staggering medical bills, and still being left with unanswered questions.
I began my pursuit with a visit to an otolaryngologist who came highly recommended. After sitting in the waiting room for two hours, I was ushered into a tiny examination room. The doctor’s assistant prepped me for a fiber optic laryngoscope, although the doctor’s equipment was far from modern. Her machine took only pictures, not video. After a whirlwind five-minute consult with the doctor, she declared that I had acid reflux and handed me a photocopy of a pamphlet about acid reflux (which was full of typos) and was about to rush off to the next patient. I told her that I had a few questions, and she reluctantly sat down. “Should I be on medication?” I inquired. She nonchalantly responded, “Oh, Tums should be just fine, and watch your diet.” Duh! I taught the undergraduate vocal pedagogy class at my university, so I knew a fair amount regarding acid reflux, its causes, and solutions.
What concerned me more from looking at the picture, however, was the odd looking red line on one of my vocal folds that the doctor had not even addressed. “Oh, that?” She casually remarked, “That looks like a burst blood vessel.” A what?! Red flags and fire alarms immediately went off in my head as I digested this new information. Now I was clearly agitated. “And what does that mean?” I pressed. “Vocal rest? Medication? Speech therapy?” Her response, which was still quite offhand, “Oh, it’s fine—probably a result of your acid reflux.”
I left the office with more questions than answers and I was incredibly frustrated at the lack of care and information I had obtained. My irritation only worsened when a few weeks later I received a bill for nearly $300 for my 5-minute office consult. It was then that I decided to seek a second opinion, starting with my primary care doctor.
I was at least relieved to know it was only acid reflux. I had suffered from mild cases of acid reflux in the past but, honestly, I had no clue that acid reflux was the culprit behind my vocal woes. I felt I handled my stress fairly well (apparently not) and, at barely 100 pounds, I was definitely not overweight. Perhaps my routine of late-night meals of pasta with spicy meat sauce and the occasional glass of red wine was the culprit? Alas, most likely. Although I felt no acid reflux symptoms prior to my doctor’s appointment, immediately after my diagnosis, I was acutely aware of every little symptom I perceived, including a painful burning sensation in my throat and constant nausea.
My next step was to check in with my primary care doctor, whom I truly admire, trust, and respect. Although I received more detailed answers about my condition and a plan of action, I emerged from this appointment with even more questions. This, I eventually learned over the course of the next eight months, would be a recurring theme. I also embarked on my annoying expedition of tests, tests, and more tests—and doctors prescribing a myriad of medications.
During this first visit with my primary doctor, I had blood drawn for a basic workup; I blew into a bag, called an H-Pylori test, to screen for ulcers; and I made the unavoidable trip to the bathroom with a little plastic cup in tow. I was referred to a lab for further tests and was prescribed two medications—Pantoprazole, for acid reflux, and Cholestyramine, a medication in powder form that helps remove bile acids from the body. I soon lovingly referred to this latter, 10-day medication as “chalk.” Although it was mixed with water, it tasted horrible and very much like what I imagined chalk would taste like. Finally, I received referrals for a second otolaryngologist and a gastroenterologist.
My visit with the second otolaryngologist was a much more positive experience. He discussed options with me in detail and had more up-to-date technology. The best part about this consult was that he assured me that the ruptured blood vessel on my vocal fold would eventually heal and would not cause any long-term damage. I scheduled a follow-up appointment for several months later and left feeling slightly less panicked. Unfortunately, the gastroenterologist specialist could not fit me into his schedule for three months.
In the meantime, I dutifully completed the additional tests my primary care doctor had recommended. This included X-rays and an ultrasound to check for any blockage in my stomach, and a HIDA scan to check gallbladder function. The HIDA scan is a nuclear imaging procedure to evaluate the health and function of the gallbladder. For this test, I had to lie still for 90 minutes positioned under a large contraption while radioactive fluid was injected into my body, circulating to the liver, moving into the biliary system and, finally, traveling to my gallbladder.
Soon thereafter, my health quickly started to deteriorate as my symptoms became alarmingly more severe. By August, eating was utterly unpleasant, and my voice was still not completely back to normal. Although I had altered my diet using the fabulous book Dropping Acid: The Reflux Diet Cookbook and Cure by Drs. Jamie Koufman and Jordan Stern and master chef Marc Bauer, now every time I ate I felt like I was eating poison. I was constantly nauseated, and my stomach was in knots. I love food, but food became toxic. When I began to rapidly lose weight, I knew I needed some concrete answers. I went back to my primary care doctor to learn about the results of all my tests.
Fortunately, the initial blood, urine, and H-Pylori tests all came back normal. According to these results, I was in perfect health. I wish! The lab outcomes from the more detailed tests revealed that in addition to acid reflux, my gallbladder was functioning at only 9 percent. Normal function is 35 percent and over. The odd point about this is that most people who suffer from a slow gallbladder are in their 60s, consume a high fat diet, and are overweight, which did not describe me at all.
The implications? Possible gallbladder removal, which meant another referral, this time for a surgeon. In addition to learning of my test results and receiving yet another referral, I requested a blood test for Celiac disease out of desperation for some answers. That test came back negative. Because of my quickly deteriorating physical symptoms, my primary care doctor made a phone call and was able to get me into the gastroenterologist almost immediately.
My initial visit to the gastroenterologist was both encouraging and discouraging. The specialist was excellent and took nearly 45 minutes to thoroughly discuss my symptoms and possible solutions with me. He felt that I did not need gallbladder surgery in the near future, but also felt that taking medication to control my acid reflux was just going to be a part of my new reality, despite the fact that I hate taking pills. His warning was that even if I managed my symptoms from altering my diet and exploring homeopathic options, my chances for esophageal cancer would increase exponentially if I stopped taking Pantoprazole. That certainly was enough to scare me into compliance. He also recommended more tests. Of course! This time, an EGD, also known as an upper endoscopy.
This examination analyzed the lining of the esophagus, the stomach, and the small intestine. Since it is performed with a small camera via a flexible endoscope that is inserted down the throat, the EGD has to be performed at a hospital. Although the test takes only 5 minutes, it has to be done under anesthesia. Of course, as a singer, I was immediately concerned about anything being inserted down my throat through my vocal folds. Thankfully, the anesthesia was administered through an LMA, a laryngeal mask airway, and not through intubation. The biggest shocker, though, came that morning when I checked into the hospital before the procedure. I had to pay $1,000 up front before they would admit me, as my insurance was covering only $800.
My follow-up appointment with the gastroenterologist reviewed the results of my EGD. It confirmed my previous issues and also uncovered a few more complications including a slow colon, a hiatal hernia, a cyst on my liver, and gastritis. The biopsy revealed that I did not have cancer or an ulcer. Being cancer free was obviously good news, but what about the other symptoms? The liver cyst and slow colon were more than likely typical for my age, so the doctor was not worried about those issues. Additionally, the hiatal hernia was not causing any symptoms, but apparently is often a package deal with acid reflux.
Gastritis, which is an inflammation of the stomach lining, can be caused by many issues including excessive alcohol consumption or prolonged use of aspirin, or it can develop after major surgery or traumatic injury. Curiously, none of those situations fit me. But gastritis can also be caused by having acid reflux or high amounts of stress. Maybe I needed to re-evaluate my stress levels? I did not think I was that stressed out, but maybe my body was telling me something different. It did account for my symptoms of severe abdominal pain and incessant nausea. The treatment? More medication and the avoidance of hot and spicy foods. My gastroenterologist prescribed another acid reflux medication, Famotidine, in addition to continuing the Pantoprazole.
Next was my consult with a surgeon to address my slow gallbladder. His recommendation was that I did not need surgery immediately. My primary care doctor, however, felt I should have it removed, and my gastroenterologist argued for both cases. Since I had already subjected myself to an inordinate amount of tests, procedures, and doctor visits, I decided to hold onto my gallbladder and forgo the surgery, especially if three different doctors could not come to any kind of consensus.
One of my final doctor visits was my follow-up appointment with my otolaryngologist. Thankfully, my most current fiber optic laryngoscope revealed perfect vocal folds with absolutely no vestiges of a broken blood vessel. At last, some good news! And my two acid reflux medications were finally starting to kick in as I regained more normal health and vocal function.
A year later, my acid reflux and gastritis woes are manageable through medication and diet changes. My overall health and singing voice are back to normal. I do have to completely avoid extremely spicy foods and late-night snacking, however. Two of the most frustrating aspects of this journey are that I never received any real solution for eradicating my symptoms entirely without the aide of medication and, for the most part, I did not fit the profile of people who typically suffer from these conditions.
Prior to this nightmare, I was healthy and was incredibly physically active as an avid long-distance runner, Bikram yogaholic, and Pilates devotee. I also ate fairly healthfully. I have never been attracted to salty, greasy food and I cannot remember the last time I drank a Coke. And although I am in my 40s, I am not that old. But the stress levels in my life? I truly do not feel that stressed out, but I do maintain exceedingly high expectations for myself. Perhaps my body was telling me to slow down. Although no amount of yoga can completely eradicate my type-A personality, this is an area of my life that I continue to evaluate.
My condition is something that I just have to live with, which is probably the most disturbing of all. My gastroenterologist’s parting words at my last check-up appointment were “You need to stay on your meds, and you’re just going to have to learn to deal with it.” Reassuring indeed.
Eating Myself Sick – Dealing with Acid Reflux
