“Listen to your body,” our diva repeated to herself, “the pain is your body trying to send you a message.” Clutching her sides, she bent toward her thighs. This stomach pain had become much more than an annoyance over the last few weeks. It had finally pushed her into making an appointment with her general physician. It was times like this that she was so grateful that she had health insurance. She was usually so healthy. She couldn’t figure out why this pain was so persistent. Today was finally the day that she was going to see the doctor. “Ugh,” she thought, “appointments for brakes and appointments for stomach issues.” She gritted her teeth and said, “life is so full.”
She had so many things going on right now. The residency at Hail House was less than a month away. Practicing and communicating with her artistic partners was taking up almost all of her non-work time. She thought about just toughing out this stomach pain until after the residency. There would definitely be more time then, she was convinced. It wasn’t that she was trying to deny that there was a problem. She just didn’t think that it was a severe problem. Or, that the stomach problem was terrible enough that she had to deal with it now. Feeling the breath catch in her throat as her insides ached, she was glad that she had decided to seek help. Now, she just had to get herself to the doctor’s office…
The Day 15 challenge on your journey is to guard against GERD.
Finally talking to her physician’s assistant, our diva felt a slight sense of relief even though the pain still waged a war inside her belly. The nurse was writing some things down in our diva’s chart. She was nodding as she responded to our diva, “Yep, that makes sense. The first symptoms could be slight twinges, aches, sharp pains, asthma-like symptoms, things like that. The doctor is probably gonna order some tests. We’ll definitely want to make sure that it isn’t an ulcer. I’ll let her tell you about that. Don’t worry, we’ll get you all fixed up.” The nurse left our diva alone in the exam room. She started to worry that maybe this was more serious than she thought.
The doctor came in and started making small talk. “How’s the singing going?” she asked. “Oh good,” answered our diva nervously.
“I’ve got this residency coming up.” she continued.
“Good, good.” said her doctor without taking her eyes on the clipboard in front of her. “So, I want to talk to you about the pain you have been experiencing. Generally, when we have a suspicion of an ulcer, I’d recommend endoscopy.”
“You really think it’s an ulcer?” the pitch of our diva’s voice rose noticeably.
“Well, not so fast. If the suspicion is for GERD, we’d do a therapeutic trial. A therapeutic trial involves taking prescription acid-reducing medication for a while to see if that controls your symptoms.”
“I don’t know. I’ve been taking Prevacid like it’s my job for a while now.”
“Well, we’d get you something a little stronger than over-the-counter. Depending on your symptoms, we may also need to order a blood test, a barium study, and the endoscopy I mentioned. The blood test will show whether you have been exposed to H. pylori which would mean the ulcer is more likely. With the barium test, also called a GI series, you will drink a liquid and then our radiologist takes X-rays of your esophagus, stomach, and intestine. This can show whether you have ulcers or any structural problems such as an obstruction that could be causing your symptoms. While for the endoscopy, that’s done while you are sedated. We use a thin, flexible tube with a camera and insert it down your throat to look at the inside of your esophagus and stomach. The camera allows us to see ulcers or other problems, like scarring of the esophagus that could be caused by GERD.”
“Oh, okay, like a vocal scope. But farther…” our diva’s voice trailed off as she started to realize or picture scarring of her esophagus.
“Well, yes. So, we’ll get the blood test done today and get you started on some acid controlling medications. Then, you can talk to the ladies out front and they’ll get you on the books for the other tests and the scope.” With that, she patted our diva on the shoulder and whooshed out the door.
Singers and GERD
Our diva started to worry. She knew that many singers suffer from reflux and that it can be painful as well as vocally damaging. She knew that reflux is also called GERD so she didn’t feel totally in the dark during the quick visit with her doctor. But, it was kind of nagging her. Reflux occurs when a small valve between the stomach and esophagus leaks, causing digestive fluids and stomach acid to overflow from the stomach into the esophagus, and back up into your mouth. This acid irritates the esophagus and was obviously the source of the pain she was feeling. The panic started to set in because she knew that the worst case scenario is that it can cause throat cancer. The thought of throat cancer made her wish she had already taken that acid-quenching medication because she could now focus on feeling the stomach acids pour onto her vocal folds, drying and burning them. She started scanning her memory for instances of hoarseness and laryngitis. “This is such a nightmare!” she thought.
The nurse returned just in time to witness this clearly shaken diva. She floated closer, “Hey, hey, don’t worry. This condition is very common…” The nurse tried to soothe our diva a bit. Feeling her heart rate starting to come down, our diva focused her eyes on the nurse. “You’re right. But, I need to do something about this. I’m a singer!” she half-shouted as though she’d been given some dire career news. “Well, you know,” said the nurse, “certain simple concrete behavioral changes can stop reflux from interfering with professional voices.”
How do I deal with reflux?
“Tell me everything. What do I need to do?” our diva pleaded.
“Well, basically, you’ll want to change your eating habits and incorporate a stress management program immediately to see if you can improve your health with and without the drugs.”
“Okay, great, what next?”
“Not so fast, that’s a pretty big step. Are you doing any of those things now?”
“No, but, I get it. Like, I should cut out soda and acidic foods and like not get so upset during rush hour.”
“You know what, let me see if I can refer you to our nutritionist. She’s wonderful.”
“Yes, has spent the last 15 years working in functional healthcare. I think you’ll like her. She has an integrative approach – both scientific and intuitive insight – to best help our patients just like you. She does things like healthy lifestyle design, meal planning, customized coaching, elimination/anti-inflammatory diet education. She even does specialty cooking classes and grocery tours. Isn’t that neat?”
“Umm, I guess, sure.”
The Reflux Plan for Classical Singers
Our diva spent the next few days in a blur. The acid reducing medication had calmed down the threat-level-red pain in her body, but now she felt herself just kind of processing things through a fog. She knew that GERD wasn’t that big of deal, but she had all these things coming up and she just didn’t need this to be getting in the way. She found herself sitting in the nutritionist’s office at the clinic before she knew it. The nutritionist was surprisingly, to our diva, incredibly helpful. She had already helped calm our diva down and they were making plans to tackle this issue together. They were already making a list. Our diva was writing them down as they went:
- Eat smaller meals. Non-aggravating foods.
- Avoid spicy and fatty foods, tomato and citrus fruits and juices (no orange or grapefruit juice), garlic, onion, chocolate, mints, coffee, tea, diet soda, regular soda, wine, beer, and mixed drinks – so basically everything!
- Almonds are among the easiest of nuts to digest so that’s okay.
- Some people are sensitive to dairy. Sensitivities play a role in what foods are best to eat.
- Eliminating reflux fast – two most aggravating items are alcohol and coffee. Start here. Start slow.
Eliminating alcohol and coffee? Was this woman insane? There was no way our diva would have imagined, even a few short days ago that this was in her future. The nutritionist told her that many people also have undetected allergies to dairy, soy, wheat, corn, nuts, or yeast. Some reactions could be from the common foods our diva was eating regularly. She told her that they would likely start with an elimination diet. Essentially, she would eat the suspected food in the morning on an empty stomach and observe her body for immediate and delayed responses. The nutritionist advised our diva that some foods may immediately effect the throat and some reactions may occur later with emotional or physical effects. She cautioned that our diva might have reactions such as headaches, irritability, or stomach pain. Our diva heaved a deep and exhausted sigh but kept writing:
- Before a performance/gig eat light.
- Combining protein, fat and carbohydrates anything not included on list number 2 above.
- In between sets or at an intermission, an apple is a good snack if you need to eat something because it is not acidic and gives lift from natural sugar and fiber.
- Do not eat late at night.
- Avoid eating, drinking, and talking loudly over music at parties or gatherings.
- Stop eating three to four hours before bed. Do not eat anything (not even a snack!) before bed or in the middle of the night. Also, avoid lying down after eating at any point in the day — important to remember for naps!
- Try elevating the head of your bed 2 to 6 inches with wood blocks or bricks.
Our diva felt better when they got to the no smoking suggestion. As every good little diva knows, smoking is like burning dollars bills in front of your face — both dollar bills you’ve earned and dollar bills you’ve yet to earn. Her self-satisfaction was quickly squashed when they got to the next item which was, “Limit all coffee to 1 cup a day or not at all.” That one was gonna be very challenging and potentially more challenging than the alcohol part. She just couldn’t even see herself as an herbal tea drinker.
- Do not mix dairy and alcohol. Small portions of reflux-free food for the win!
- No alcohol! As you approach an important performance eliminate or reduce alcohol.
- Antacids can be taken before or 30 to 60 minutes after a meal.
- No tight clothing. Tight belts and pants increase the pressure on the abdomen. Supportive singing activates abdominal muscles. Tight clothes will increase the pressure on the stomach and digestive system even more.
- Do not exercise immediately after a meal.
Then, they started to talk about weight loss and avoiding stress. Our diva knew that excess weight increases the amount of pressure on your stomach. She knew that even small amounts of weight loss would be helpful. But, that just felt like so much work to figure out. Whenever she was at the gym she was always thinking about how she should really be using that time to practice. How could she add healthy exercise into her already crazy, busy schedule? That last bit made her nutritionist lean into her and give her a look that meant, “here’s where stuff gets real.” She started in on avoiding stress and how that is far easier said then done. Stress management and performance anxiety is another area her nutritionist found very worthy of investigating. “Stress is a big contributor to your reflux!” she kept telling our diva. “Have you thought about yoga? Yoga is an excellent way of aiding digestion and relieving stress.”
Is this who I am now?
Our diva left the appointment with her nutritionist feeling relieved that she had all of these strategies to combat reflux. But, she couldn’t help but feel a little cautious or leery about changing so many things about her life — about herself. Would she really become a yogi? Would she really start meditating? Would she give up certain foods? Would she really give up alcohol and COFFEE so that she could be a better singer? She realized that it actually wasn’t only about singing. This was her body trying to give her a message. She needed to listen.
29 Days to Diva: The Worksheets
Want some help completing your Day 15 challenge? 29 Days to Diva is all about tackling the big issues of our careers through micro-actions. Our bodies are our instruments. We are not allowed to swap out one voice for another. We need to care for them like a rare Stradivarius. Use today’s worksheet to help you identify some potential physical, mental, and overall well-being trouble spots.
Hey divas! I could really use your help. If you liked today’s post or any of the 29 Days to Diva posts so far in this series, will you please share it on your favorite social media channels? It would really help me out. Thanks! You can find me @mezzoihnen or feel free to use the hashtag #29DTD or #29DaystoDiva.