<p>CoachC - you had told me to PM you about my D's vocal problems for a referral to a specialist in NYC. I did, but have not heard from you. Can you PM me with the name please? Thanks for your info and help.</p>
<p>My D saw Dr. Bastian, mostly because she has asthma issues (exercise-induced). We felt VERY confident with the appointment and feel his diagnosis was helpful to understand what is going on with her.</p>
<p>However (and this doesn't diminish what Dr. Bastian said), when we returned to her pulmonologist and happily reported that Dr. Bastian only saw very, very minimal vocal cord dysfunction (so minimal that most ENTs would not pick up on it), the pulmonologist (as highly respected in this area for asthma issues as Bastian is for vocal cord issues) shared that his impression is that my D could still have what is called exercised-induced vocal cord dysfunction, which can happen concurrently with exercise-induced asthma. The only way to test for exercise-induced vocal cord dysfunction is to do the vocal cord exam immediately after one has done aerobic exercise, or during a treadmill test. He had just returned from a conference at National Jewish Hospital, and predicts that accurate diagnosis of vocal cord dysfunctions in the future will also require an exercise-based exam so the physician can see how the cords are working during aerobic movement - obviously this is important as MT students often must sing while dancing (or at least moving). It will be interesting to see if this new push in how people are evaluated results in new findings that might lead to different treatments that aren't exclusive to exercise-induced asthma, or vocal cord dysfunction. He's not saying that exercise-induced asthma or vocal cord dysfunction are always inclusive with exercise-induced vocal cord dysfunction, but that it's actually a third possibility for people who have been diagnosed with the either of the previous two, but whose management is difficult.</p>
<p>teriwtt -</p>
<p>Hope your D is doing well! :) At the UPittsburgh Voice Center, we see a lot of patients with exercise-induced VCD (also known as PVFMD, or paradoxical vocal fold motion) as well as VCD that occurs under other circumstances. In evaluating our patients who report exercise-induced shortness of breath, we do what you describe - have the patients exercise, come back, and immediately get their vocal folds scoped - and it's amazing how that sequence can help to determine whether the patient is having VCD rather than lung issues during exercise. However, some exercise-induced VCD (or what we suspect is that) occurs only intermittently and randomly, so we aren't always able to "make" those patients symptomatic - but even in that case, we proceed with a special kind of therapy designed to help breathing at the level of the vocal folds, with the idea being that those patients will learn strategies to control the vocal fold valving of their airways when they ARE symptomatic. </p>
<p>Reflux can actually be a big factor in VCD, b/c the irritation caused by reflux often makes the vocal folds react as if there is a threat to the airway and constrict abnormally.</p>
<p>P.S. All of you reading this thread now know more about these topics than I did when I was in grad school - lol. ;)</p>
<p>P.P.S. dancermom- I'm not ignoring you - so sorry!!! - I'm double-checking with some colleagues that my referral in NYC is amenable to the demands of musical theatre singing and isn't anti-MT, as some voice specialists are.</p>
<p>Sorry...not me!</p>
<p>In response to over-diagnosing...</p>
<p>When I was 14 I had severe heartburn and went to see a GI doctor. I was his youngest patient by decades. After listening to my stomach, he said it was clear that I had GERD. I was given a mild prescription which helped at first, but I eventually grew immune. Sick of taking pills, I eventually didn't renew it.</p>
<p>Ten years later, it was growing worse and worse. I hadn't really changed my diet much save giving up truly acidic things like citrus juices and pickles. I saw a 2nd doctor who performed an endoscopy and discovered it wasn't just GERD, it was a hiatal hernia. I have a new prescription now and eat mostly well (sometimes you need pizza!) and it's a world of difference. But it will never go away, and perhaps things would have been different if I had eaten better as a teenager or simply sat up straight!</p>
<p>So if you or your child thinks they have GI problems, it's worth the investigation. To not feel sick before a performance unless you ate something you know you shouldn't have....such a relief.</p>
<p>My $.02 since I have been there, done that, bought the t-shirt. :)</p>
<p>Thanks CoachC, we are patiently waiting! All the info on this thread is amazing, and my D is starting to preventatively put some of it in place right now, in case she has GERD. Her father has it, so I guess it would not be a big surprise if she does. As I just said to her, at least we have some avenues to explore, and she is taking some proactive measures now, which have all helped. Thanks to all for posting your experiences!</p>
<p>Wait, is CHEESE off limits with Acid Reflux? I work at a Deli and... well, i LOVE cheese. But I figured since it's very high in fat, and fat seems to be a no-no, I would have to cut cheese out of my life.</p>
<p>Well, I didn't read the whole thread, because I don't have time. However, I want to offer my advice on this subject. I have serious allergies, ulcers, and resulting from that, acid reflux. Generally, I feel acid reflux is becoming more prevalent due to the type of foods Americans are eating, societal pressures, and overall poor living habits. </p>
<p>I have considerable experience with mucus in the throat, unfortunately. I used Mucinex as well, although I was advised not to by a vocal coach. I found marginal success with it, but realized I was only treating the symptom of a much larger problem. </p>
<p>I saw my allergist and gastroenterologist. My allergist did a couple allergy tests to check for food and environmental allergens that might be causing this mucus build up. After the testing, I soon realized I was allergic to MANY things I was ingesting. This not only caused mucus build up, but in return the mucus increased the acidity in my stomach. Thus, in combination with other factors caused ulcers to form in my stomach and acid to erode my esophagus. I then saw my gastroenterologist; he recommended some medicines for me and scheduled some tests. One took an x-ray of my throat and stomach to check for blockages. There is also a common bacteria associated with ulcers/acidity; I had a biopsy done to check for the bacteria. Luckily, I did not have the bacteria. </p>
<p>Today, all of my problems are not solved and I am not cured from this disease. Hopefully, some day I will be. </p>
<p>If you can, see your allergist asap. He or she might prescribe you a different or stronger allergy medicine. Let him or her know you have auditions for college. Take the recommended dosage of Mucinex D, and drink LOTS of hot water. Tea is great and all, but you don't know if what is in the tea is causing further allergy problems. Breathe, it might sound simple, but breathing really does help reduce stress that causes acidity in the stomach. On the audition day take some Tums and saltine crackers; they are a life saver. Also, in certain cases milk of magnesia helps, but I would contact your doctor before taking it. </p>
<p>No matter what I say, I can't replace the guidance of a qualified health care physician. So, be sure to follow the appropriate channels.</p>
<p>I hope this helped, best of luck with your college auditions and digestion woes.</p>
<p>I've been following this thread closely because we have worked long and searched wide in order to heal this particular malady for my d. </p>
<p>She also, out of nowhere, developed a chronic sore throat/ high mucus syndrome following an arduous rehearsal period and the opening of the run of a professional musical she was in.
Our emergency came when she opened her mouth to sing one night on stage, and NOTHING emerged. Every singer's worst nightmare, Right? Well she was 12 going on 13 at the time and being paid to perform. Like a trooper she regrouped on the spot and dramatically spoke her part, still dancing and acting with little notice by the audience. It was heartbreaking for her. </p>
<p>After treating this as a "virus" by our internist, w/o any improvement, we sought the help of a ENT VOICE Center connected to the University Medical Center in our area. The director/ENT is an opera singer and his staff is comprised of singers as well. They evaluated her situation, and thank g-d they were singers and so empathic to my little girl's crisis. But they were unable to give us much more than the generic diagnoses folks here received as well. She improved a bit with vocal rest, hydration, daily mucinex and an antibiotic. Yet after a few weeks, all of her symptoms resumed. </p>
<p>We as a family are quite open to holistic/alternative health practices and through a colleague, we steered to a wonderful holistic allergist who was eager to help and had a comprehensively different orientation to understanding the underlying issues here. She tested my d for multiple allergens both food and environmental causes, accentuated by stress. </p>
<p>What we learned was startling. The theater itself was an ancient building which had been gutted and renovated prior to this show's opening. The level of dust from new construction, chemicals commonly used in new construction plus my d's costume were all my d's allergens. The building itself was making her sick.
Our allergist was then able to treat my d and to teach her how to treat herself when she may be reactive/sensitive to chemicals or "bad air" in her environment. It is 4 years later and my d has the tools to help herself in these situations.
We have learned that so many of us have chemical/environmental sensitivities. So many of our environments are compromised and unhealthy. Singers require breath and good air to perform well and stay in good vocal health.
Common food allergens like dairy, wheat, fats, sugar can effect mucous production and vocal health. For anyone who is struggling with these concerns, it may be helpful to discern environmental or food allergens contribution to vocal health issues.</p>
<p>mamalu, I am curious: how did the holistic allergist test your daughter? Did she use drops on the tongue (as some holistic/homeopathic practitioners do) or did she give your D the traditional "scratch test?"
Also, it sounds from what you wrote above that the practitioner diagnosed your daughter with multiple chemical hypersensitivity. Is that the case? If so, short of not putting herself in environments loaded with chemicals (and theaters are generally loaded with them!) how does she deal with the situation? I have interviewed a number of people who self identify with that complex of symptoms and several had to live very proscripted lives: one had to have a special house built for herself. Of course, it's not that severe for most people, thank goodness! I am just glad your daughter is doing well. :)
One more thing: I have read quite a few legitimate medical studies that reveal that consumption of dairy products does not lead to increased mucous production. However, perhaps if a person is legitimately allergic (IgE) to dairy products, then maybe it does.</p>
<p>No my d is not "Multiple chemical hypersensitivity". She does not require a bubble to dwell in, just the normal environment most of us reside in.</p>
<p>She was dx'd with very specific allergens through a number of different evaluation modalities utilized by the allergist. Her treatment was individualized and developed by the allergist and her colleagues. </p>
<p>and yes stress + food allergies = excess mucous for many people
that said, I would not recommend a bowl of ice cream prior to an audition for ANYONE as exercising good judgement.</p>
<p>mamalu, I fear that my post somehow offended you. If that was the case, please forgive me! I am honestly very interested in the whole issue of multiple chemical hypersensitivity. As I said, some years ago, I spent about three months interviewing people who suffered from this in various ways, only to have the metaphorical "plug" pulled on the series of stories because evidence-based physicians and scientists stated (at least back then!) that no such ailment existed. (I do know that I get violent headaches if I am around people who douse themselves with perfume, for instance.) I also did more than a few stories on holistic practitioners, particularly homeopaths, including one very well-known homeopath (in my area, at least) who allergy tested children and adults by administering drops on the tongue and then watching for symptoms. Some parents/patients adored him and swore that he helped their children/them. So I am quite interested in these issues.
Re: mucous and dairy. It makes sense that if someone is truly <em>allergic</em> to dairy productions, they would cause mucous production. But scientific studies apparently reveal that for people without those allergies, eating a milk product doesn't cause mucous. In fact, people studied who drank soy milk -- which has no lactose -- perceived the same things as those drinking cow's milk:
<a href="http://www.jacn.org/cgi/content/full/24/suppl_6/547S%5B/url%5D">http://www.jacn.org/cgi/content/full/24/suppl_6/547S</a></p>
<p>Hi,</p>
<p>I have suffered from reflux for a long time, but never like this. I would have times when I refluxed, but as long as I immediatly got on top of it it would go away pretty quickly. Lately however this is not the case. It won't stop. I was on protonix for a long time but very recently I was switched to Nexium. I take it twice a day. I really don't feel like it is doing anything... though its only been a week. This recent reflux session has been a 4 month one, i went back on protonix and it didn't seem to help which is why we are now trying nexium. But basically I havn't been able to REALLY sing for the past four months. I'm experiencing huge range reduction, inability to increase volume and project my voice. I have recently begun taking afew professional singing jobs and I feel like an idiot in these rehearsals because my voice is a mess right now. . . When i went to the ENT she expressed to me that I had huge ammounts of tension caused by the reflux. great... </p>
<p>This is driving me crazy...its embarrassing but reading through this thread and thinking about my own problems with this I just started sobbing. I can't seem to get this under control. Websites say don't eat 3 hours before bed... i feel like I can't eat 6 hours before bed. Yesterday I did everything right... but again woke up this morning feeling like I'd refluxed.</p>
<p>anyway... here are my questions:</p>
<p>1.) Someone had mentioned something about a 4am acid surge? Could you explain this more? Often if I awake up on my own too early I notice that my throat feels fine... if I let myself go back to bed though and awake a couple hours later suddenly i feel all mucked up again. </p>
<p>2.) Also somewhere it was mentioned that you dont' want to have an empty stomach... is this true?</p>
<p>3.) Apples.. i've heard they help but apple juice I swear is a trigger food... why would apples help and not apple juice...</p>
<p>I have reflux myself, and have learned the following from my doctor -- hope it helps:</p>
<ol>
<li><p>The nighttime problems may be a result of sleeping flat. Try elevating the head of your bed by at least 6 inches -- not just with pillows, but the whole bed. I did this by putting blocks of wood under the legs.</p></li>
<li><p>I haven't heard anything about an empty stomach being bad. But I have found that yogurt is soothing and non-acidic -- just make sure it has no fruit in it, because most fruit is acidic. Try having a small amount or plain or vanilla yogurt before you go to bed.</p></li>
<li><p>Apples are an acidic fruit, although not as bad as citrus fruits. I'm not sure, but my guess is the juice is more of a trigger because there is no fibrous material to absorb the acid? Anyway, the important thing is -- if it triggers your reflux, don't eat it. </p></li>
<li><p>AR is a treatable condition -- give the medication a little more time. You may have to severely restrict your diet at first, but once you have things under control, you can probably relax your dietary restrictions somewhat.</p></li>
</ol>
<p>Hi there - </p>
<p>I am a medical voice therapist and I know a lot of general info about acid - and on Tuesday, when I am back at work, I can ask our reflux-specialist nurse. (No joke, we have this, b/c reflux is SUCH a big factor in many voice difficulties.)</p>
<p>What I can answer now:</p>
<ol>
<li><p>I don't know about a 4am acid surge, but if you experience severe nighttime acid, you should add another kind of reflux med, called an H2 blocker, designed to deal with this, and taken before bedtime. Zantac is the one we usually prescribe.</p></li>
<li><p>The empty stomach thing is controversial - the idea is that if you wait too long w/o eating, then the acid producers (proton pumps, which aid in digestion) in your stomach go NUTS when you finally do eat, since they have gone so long without doing their job.</p></li>
<li><p>Apples are definitely acidic, and therefore a trigger food for some people. They are actually more acidic than citrus fruits, as are strawberries. I have a paper that details the acid content but it is not with me - we give it to all of our patients, and I can share that info here when I return to work on Tuesday.</p></li>
</ol>
<p>There is an urban legend that swallowing apple cider vinegar helps reflux - but our doctors say it doesn't work...I'll press them more about that!</p>
<p>Also - </p>
<p>Your Nexium may take up to TWO MONTHS to full work - do NOT stop taking it, unless it's making your naseous! (Some reflux meds have this effect on certain people.) And you should take it 1/2 to and hour before you eat - it's by far most effective when you follow this guideline.</p>
<p>My D had gastric issues last year, as a junior...after an IV contrast CT scan and an endoscopy, it was determined that she had nonerosive reflux disease, or NERD, which is hilariously appropriate for her. She took Prevacid, elevated the head of her bed (paint cans are good for this), tried to snack a lot, and carried protein bars just in case she wasn't near food. She felt better after a few weeks of this and after several months, she was able to wean herself off the med. For college auditions this year, though, she started the Prevacid because of the stress, and it helped her. I do think that stress is her trigger.</p>
<p>About acidic foods...yogurt is WAY acidic! I have a bladder disease where I have to avoid acids, and it is darned tedious. Nonacidic fruits are blueberries, honeydew, watermelon, pears, and Gala apples. No salad dressings, no condiments like ketchup, mustard, mayo. No marinades. Nothing with vitamin C in it, either...check your cereal boxes. UGH.</p>
<p>Hi Alf!</p>
<p>If you dont mind me asking. When you took the NEXIUM did it work for you? and did you have any side effects from it?</p>
<p>This question is not just for Alf if anyone else has taken it please give me your feedback as well. </p>
<p>Thanks!</p>
<p>DD started on nexium last year and it was great. No side affects. It takes a while but does work. She is on 1x per day now. She has silent reflux and the pamphlet said besides raising head of bed, to limit what she eats of red meat, fried food, caffeine (she liked tea), sodas, chocolate, citrus juices, mints, and a few other things. She is very careful the week before an audition or performance, less so other times. She seems to be managing it fine, now. No more burger, fries and a coke however. One of them at a time, not all at once. Reversed the damage and the congestion is under control.</p>
<p>Jade326 -- I tried Nexium, Prevacid, & Prilosec and developed chronic stomachaches. Had to discontinue those types of medications, and now take only Zantac. It works very well for me.</p>
<p>All of these varied responses just prove that this condition can vary widely. I can eat some foods that are supposed to be triggers -- while others that should be OK give me all sorts of problems.</p>
<p>See this is the thing about reflux that i'm starting to find really frustrating, while much of the advice is similar raising the head of the bed and all that some of it directly conflicts. </p>
<p>For example I've heard people say to stay away from yogurt because of acidity, but I've heard others tell me to eat it because its Probiotic and helps break down food. </p>
<p>Has anyone tried apple cider vin... i keep reading about this all over the web... does it actually work? </p>
<p>I'm not reading reports on some web sites that perhaps these PPI's actually make the problem worse... by stoping your stomach from pumping in acid the food then just sits there and rots. The pills slow down digestion to the point that your stomach doesn't empty as quickly thus when you then go to sleep you have all this stuff in it that you can reflux up.... Do people have thoughts on this. </p>
<p>How long does Nexium usually take to work... i'm on day 9 and have no relief...</p>