Being a singer can be a tough lifestyle and we all need ways to make sure it doesn’t get on top of us. If it does we’re out of action, out of pocket, and without our biggest passion. In this post I share the journey I had, and the advice I received, after experiencing the effects of reflux on my voice. Hopefully it can help you seek out the advice if you’re also suffering from one of the least helpful but most common health issues facing singers today.
How long is your day?
A typical day in the life of a gigging singer is not 9-5. For many it can be a heavy 16 hour slog. Starting at 10am and finishing 3am the following morning with a bit of heavy lifting thrown in there. As a result, routine is frequently irregular. This can have a fair impact on bedtime, sleep quality, eating patterns and diet. Working into the early hours coupled with those long journeys down the M1 (that’s a British motorway, not modal voice!) results in stop-offs for food en-route.
Thankfully motorway services have improved since I began my career back in the mid 90’s, when culinary delights consisted of a cold Ginsters pasty, a bag of Quavers and a bottle of Coke. The small luxury of a latte and quinoa salad with pomegranate seeds simply wasn’t available. Thank goodness for the aggressive business plan of M&S garages!
Laryngeal reflux – the facts
Back in 2010 I was diagnosed with laryngopharyngeal reflux. Sometimes called LPR in the medical world but we’ll call it laryngeal reflux for now. This eventually resulted in a career threatening vocal operation. Thankfully all went well but it was not an easy ride.
Laryngeal reflux is a result of stomach acid coming up into the oesophagus and coating the vocal tract in damaging hydrochloric acid. Although a little reflux happens in everyone, the oesophageal sphincter at the top of the stomach is there to keep the vast majority of acid safely in the stomach. That is, when it’s working properly.
When it’s not working properly, stomach acid can easily come up for a bit of a splash. Often all the way up to your vocal tract. For anyone who’s had it, you’ll know it tastes unpleasant and comes with that burning feeling.
In my case, reflux would frequently decide to present itself while I was mid song on stage. I would literally have to turn my back to the audience, pretend I was dancing and just throw up. Wonderful. Think The Exorcist without the spiny head!
A mixture of on stage excitement, trigger foods and eating late caused the onset of my reflux.
The warning signs
Although not everyone will experience such extreme and obvious symptoms as mine, the warning signs should not be ignored.
Initially, I began to notice a reduction in my ability to sing in my higher register with control. I also developed a very dry throat each morning and a more regular thirst. It wasn’t long before this resulted in coughing and clearing my throat to get rid of what felt like mucus that I just couldn’t shift.
Amongst some others like heartburn, these are common signs that reflux is present. However it’s important not to confuse the onset of a cold with reflux.
Disclaimer: I am not a doctor. Just sharing my experience. A proper diagnosis can only be done by seeing a voice specialist ENT surgeon.
Unfortunately for me, all of this occurred during the recording of my solo album. I had to put everything on hold for many months. After first being wrongly diagnosed in a private practice, I got a second opinion. Upon that examination, I was diagnosed with chronic swelling around my vocal folds along with fibrous scar tissue on the left fold. The scarring was the effect of the constant throat clearing, which causes the vocal folds to smack together rather aggressively. This was an extremely stressful and upsetting time for me knowing that the operation was career threatening. In the end, I was booked into University Hospital Lewisham (London) and the operation was…
… an absolute success!
Vocal rehabilitation and the journey back to health
After my vocal operation I underwent intensive rehab with a speech and language therapist over a three month period. This consisted of starting with nursery rhymes and days of the week. This was so very tedious, as you can probably imagine, but is absolutely necessary after invasive vocal surgery. Just like carefully planned physiotherapy is required after an accident.
The silent treatment
Another thing thrown into the mix is a non-negotiable period of silence. We aren’t just talking a few hours either. In my case it was an entire week…. of total and utter silence. Instead of losing my mind, I thought of it as a silent retreat. It was the only way to get my head around it! It is necessary and actually crucial as a part of the post op healing process. Timescales can vary from anything between 3-7 days normally. Now I love to talk, so this was an interesting week to say the least. During this time I decided to blog my entire experience from pre to post op here.
I communicated that week via a wipe board as well as with lots of waving and rude hand signals!
Within a couple of days I’d smashed the wipe board in frustration. I also had an underlying fear that I’d wake in the middle of the night after a bad dream and call out. Thank goodness that never happened. However on one occasion my partner asked if I wanted a drink and I forgot to write on my wipe board and blurted out “I’d love a GnT please!”. Priorities.
I had to seriously address my diet and daily routine around my performances at this point. Coincidentally, I had a wonderful opportunity present itself to feature in a groundbreaking series for Channel 4 called The Food Hospital (see video below). During the series, my laryngeal reflux was treated successfully with a change in diet over a twelve week period. Despite the seemingly long period, I began to see substantial changes after just six weeks.
My advice on food
Some of the foods that were particular bad in connection with my reflux were:
Spicy food, chocolate, coffee, foods high in fat, citrus fruits, tomatoes, alcohol and fizzy high sugar content drinks. These are pretty common on reflux advice sheets, although everyone is different. It’s important to find out what may be YOUR ‘trigger foods’.
The advice given is to not eat past two hours before you go to bed. This is because some sufferers experience silent reflux; stomach acid coming up while you are asleep. Because you’re blissfully snoozing, you often don’t know it’s happening. A sign that it’s happening in some sufferers is waking up with a dry throat, a bad taste in your mouth and/or a tickle and cough.
My reflux check list
There are very simple changes that can reduce the symptoms of silent reflux. Here’s my checklist:
- Raising your bed head by six inches – This uses gravity to keep the acid down during the night.
- Laying on your left side – Because your stomach is on the left side of your body, sleeping on your right side will tip your stomach up and acid is much more likely to pour out. Stick to the left from now!
- Gaviscon Advance taken before bed – This was prescribed to me by my surgeon and helps to keep the contents of the stomach where it should be. The NHS’s advice on Gaviscon is here, but always get advice from your doctor or pharmacist on which heartburn product would be best for your symptoms.
- Eating slowly to give your food time to digest – chomp, chomp, chomp.
- Regulating your eating times – as mentioned in the ‘bedtime’ section
- Watching your weight gain – being overweight is commonly linked with reflux.
- Sips of water before and during a meal – This was advised in place of downing masses of water after you’ve eaten. We need to avoid creating an even bigger food bath in your stomach and avoid diluting the digestive properties of your stomach acid.
- On gigs when loading in equipment, try to avoid lifting and bending. This can aggravate the symptoms by causing gastric back flow.
Out of the checklist, the area that helps most for me is to eat regularly and slowly. For example, three smaller meals per day with snacks such as nuts, natural yoghurt or a piece of fruit in-between. That means you’ll be eating something easy to digest every three hours.
In order to facilitate these dietary changes in my gig schedule, I took my own food with a special consideration for lower carbs and higher protein and vegetable content. I also started putting nuts and seeds in my breakfast and including bananas and avocados as a regular staple each day. These force you to eat slowly due to the amount of chewing you need to do in order to break seeds and nuts down. In turn, this puts less strain on your stomach and reduces reflux. Bingo!
Support for singers
After my own op, I discovered that there was literally no post-op support beyond the rehabilitation process. Disappointed by this, I decided to set up a support group to fill this huge, gaping hole in the world. And so, VoxOp was born. The UK’s first and only support group for singers with vocal problems.
I co-founded it along with my vocal coach and my speech and language therapist in 2011. It became a free, monthly meet-up service where singers could openly discuss their vocal issues and share their problems and gain information and advice. Following on from that, I have set up a private Facebook page for VoxOp which anyone can join who wants to join the discussion.
What has become very clear to me since the birth of VoxOp is that, like me, many singers are severely impacted by voice trouble. Not only physically but emotionally and financially. The taboo is slowly lifting and people beginning to appreciate that we cannot place our instruments in a box and get it out each time we need to use it. Unlike any other instrument in the world! WE are our instrument. Our entire identity is wrapped up in our voice and it cannot be separated, it is the very essence of who we are.
You are not alone
I am committed to helping all singers and voice users in VoxOp forums and discussions. If you are suffering from a vocal injury or are worried about your vocal health, please come and join us below or contact me at firstname.lastname@example.org.
Facebook – VoxOp private group set up especially for singers with vocal issues to share and get support.
To seek out your nearest professional (UK only), check the British Voice Association directory.
The British Association of Applied Nutrition & Nutrition Therapy is also a good place for singers to find information.