A Singer’s Struggle with Acid Reflux and Hiatus Hernia: Surgery and lessons learned

It’s taken some years for me to write this. Admittedly, a depressing and long-winded period of time where I had little-to-no voice is not something I always like to reflect on. However, that part of my life is in the past and I am a far better singer and person because of these experiences. I firmly believe that if I did not go through this, I would not be professionally engaged as a singer now.

It started as a child

I was a highly anxious child growing up. I would fret about tiny details that nobody else bat an eyelid at. The idea of having to be around too many people at lunch-time, or having to get into groups

with other people petrified me! Having my whole time-table dictated to me by teachers felt very suffocating. Eventually, I developed chronic reflux when I went straight from high-school to law school, with a massive chip on my shoulder and very little concept of the real world.

I never really thought a lot about my reflux. I felt a cold, peppermint like sensation crawling up my throat. I would scull some Gaviscon and forget about the cold, spicy sensation crawling up my throat. I was 18, enjoying the freedom of the halls, the alcohol, the sleepless nights, the 2-5 strong coffees before that 8am legal studies lecture. I was still at an age where I did not care much for my vocal health. Singing was a hobby for me; a pipe dream, something I could pick up on after law school.

Singing picked up at an amateur level (2008-2011)

I would audition for lead roles in various shows for fun; starting with a smaller role in Caberet, singing and winning various competitions, playing an ‘aged’ Artful Dodger in Oliver!, and eventually, Tony in West Side Story. I was getting bored of law-school and decided I want to perform. You can probably tell by now that I had very little clue as to what I wanted to do: not serious enough to be a singer, but not studious enough to want to continue law school. I dropped out of law school after being offered a theatre scholarship and spent the next few years learning how to direct, how to act and how to sing, more so than I had in the past as a hobby.

As a teenaged Artful Dodger in Oliver!

I decided against further study in theatre after completing my under-graduate study and decided that I would focus more on vocal study full-time. I left to Auckland to see a teacher who was specifically suggested for me. At the time, my voice was overly protected and I produced a very unique falsetto: One that was too dense for the sound of a counter tenor, but not one that would ever eventuate in a career as a tenor. It did, however, carry me through musical theatre as a young man.

 

After wanting to take singing more seriously, I started realising that something was affecting my voice (2011-2013)

I was taking all the steps to prevent acid flow: cut out coffee, eat lower portions, avoid eating near bed-time, take Losec. I knew I needed to sort out my reflux before moving to Auckland as I was starting to feel my voice giving out and becoming unreliable in practice situations. At this point, I just thought it was because I was a young singer without a proper technique behind me.

Tony in West Side Story

I went and got it checked though. An Ear Nose and Throat specialist (ENT) said that I had ‘cobble stoning’ around my larynx – this is when acid from the stomach burns the mucosa in your throat and creates a red-patchy pattern. I was then referred to a Bariatric surgeon who looked down my esophagus to find that my stomach was literally poking above my diaphragm. This is called a Hiatus Hernia. I had little-to-no tightness around lower-esophageal sphincter, so acid was just pouring out at night!

I elected to have surgery before studying

I underwent a surgery called the Nissen Fundoplication. Basically, My stomach was pulled down beneath the diaphragm, my diaphragm was held together with a mesh-lining, and the top of the stomach was tied around itself to form a tighter-sphincter.

The Recovery from my first surgery

Recovery from this first surgery was excruciating. I had never experienced pain quite like this. Furthermore, I found that the Tramadol I was given caused me to become highly paranoid and spooked about every noise. After you have had the surgery, your entire gut is in pain from all the gas they pump into you.

A few days later, the inflammation around the internal surgery sites kicked in and it was very difficult to take a full breath without a lot of pain. My neck started becoming highly strained due to the referred pain from the surgery. I thought it would never end!

Every day, however, got a little better. The best part? I had NO reflux at all. Yes, I couldn’t burp or vomit (burping returned after a month or so), but it was heavenly to be able to lie down horizontally without having to scoff Gaviscon and Losec.

Time to Audition for University, and perform in HMS Pinafore, and take up 3 day jobs! (2013)

I am infamous for over-committing. After a month of recovery, I was back working two of my day-jobs. I was teaching Theatre at my old university (while barely standing), teaching speech and drama at a Primary School and I was cast in HMS Pinafore about 2 months after surgery because they couldn’t find someone with the right range for the role – I wouldn’t have auditioned for it otherwise. Admittedly, I was having the time of my life. I was proving to the world that I could do many things so soon after surgery.

I knew that for about 3-5 months after surgery, I wasn’t meant to do any heavy lifting, so I didn’t take the job at the chiller until 6 months after surgery (which involved HEAPS of lifting). While this went on, I was committed to a few acting gigs too, and auditioned successfully for the University of Auckland.

Bronchitis, voice study, Phantom of the Opera and the undoing of the surgery (2014)

During Christmas of 2013, I was delirious after working so many hours at the chiller, so I sang my heart out in the freezer! A few days later and I was in bed with Bronchitis. I could not physically stop coughing all night for two weeks! A left-over cough remained for two weeks after.

My voice was not returning at all, it had disappeared… And it only just came back in time for the start of my voice studies. Something wasn’t right however. My voice didn’t quite feel as reliable as it had done the previous year. I put it down to Bronchitis.

I was cast as Piangi in a production of Phantom of the Opera: Not a role I was entirely built for, but my forte at the time were high notes! So I guess I was cast for that reason. While driving back home after the final dress rehearsal, I felt something give internally and that night I had reflux again. My stomach sank… Or in this case it rose. I knew what had happened.

I managed to get through Phantom of the Opera, but a week later and I had no voice to do my first exams at Uni.

After 5 minutes of singing, my voice gained a second tone, like that of a Tibetan throat singer

When I tried to sing, I would go for about 5 minutes before a physical ‘block’ would occur in my throat. It was a little like someone putting their finger lightly on a guitar string. The resulting tone would croak, like someone whose voice is giving out after smoking, or like a Tibetan throat singer.

I knew instinctively that this was not a problem I’d come out of easily, even after I had scheduled a second surgery.

The second surgery and the LONG road to recovery (2015)

My surgeon noted that my lifestyle, ongoing singing coupled with the heavy lifting and bronchitis must have torn the stitches I had internally. He decided to use an older method of the surgery, which relied on stitching the stomach around itself, rather than using the wall of the abdomen as a ‘hook point’, which is a newer version of the surgery.

The recovery for this surgery was far, far easier. Maybe I was more psychologically ready for this. My body was in far less pain and I refused Tramadol. I had at least 2-3 months of recovery at my parents’ home in Hamilton before attempting to sing again.

There were a few ‘scares’ in the meantime. Oddly reflux-like symptoms returning, but I put this down to just a different physiology from the surgery.

A trip to the ENT revealed something worse

The ENT determined that my reflux was gone. Before I could rejoice, however, she noted that I had a granuloma above my cords – possibly from either the reflux or a surgical station tube.

Furthermore, I noticed that my double-tone problem had not gone away. I started back at university, but I had no voice. It was devastating. While I was on a very strict vocal recovery plan, with speech therapists and very specific vocalises, I could not shake the feeling that my vocal problems would never go away.

I could barely leave the house without bursting into tears, but the recovery did occur slowly

Eventually, using my old falsetto technique, my teacher and I found a sweet spot that I could sing some limited repertoire in. There was no doubt that my voice was a larger instrument for a tenor, so it was very difficult to co-ordinate my recovery while singing any kind of standard young-tenor repertoire.

The return of most of my voice was ‘miraculous’

There was a point, after all my exams, that my voice miraculously seemed to come back. The double-tone issue only ever occurred if I was particularly irresponsible with my voice (e.g. singing completely cold), but I was able to sing newer repertoire that I hadn’t studied before.

As my teacher had moved overseas, I sought out a new teacher. As my voice was no longer in ‘recovery mode’, she was able to take me out of my falsetto technique and into a proper full-voiced technique.

This technique did come with its difficulties, however, as I had not been used to singing in a less-protected sound for some time. If I wasn’t careful, my voice issues would return and I would croak. On other days, the voice was impressive to listeners, and I started gaining attention from people who had never given me a second thought in the past.

Personal tragedy struck, making me realise that failure doesn’t matter

I know this seems a bit dramatic and I do not want to sensationalise anything. There was a point where I came to a realisation: My own ego and fear of failing was getting in the way of my last step towards releasing the instrument. My Grandfather passed away in front of me and I was asked to sing for his funeral. It was the best singing I had done in a very, very long time. As I sang, I didn’t care for my ego, for failing, for embarrassing myself, I just cared that my Grandfather loved the songs ‘Oh Danny Boy’ and ‘Amazing Grace’. I realised later that I was in the way of my instrument. For many years, I was absorbed with how bad my voice would be affected by my health, and that it would always hit a roof. I could no longer sing to my Grandfather like I had in the past. I decided then that I was no longer going to let self-absorption get in the way of making music for the love of it.

Things just started to unexpectedly become ‘professional’

Out of no-where, after doing some free performances in my new voice, I started being offered gigs for money. I got to return to the Auckland Civic stage as Piangi in another installment of Phantom of the Opera, this time on the largest stage in New Zealand! This was quite a foreign concept to me, having only done a few professional gigs in the past. I could hardly believe that after so long of doubting the recovery of my voice, I would ever get a professional gig again.

3 years later: Maintaining a post-surgery and vocal-recovery lifestyle

This section deserves its own section, but I will briefly discuss post-surgery and recovery lessons here.

From time-to-time, if I do not treat my voice well, I can experience the odd croak, but this is an anomaly for the most part. I am lucky that the voice has become an extremely professionally viable instrument with a preference for slightly heavier repertoire. What did I need to do to achieve this?

• I don’t lift anything heavy ever again. As a rule, if I have to make a grunting sound to pick it up, I won’t pick it up
• I taught myself to swim well for exercize (since I could not lift weights). This took a long time, but even when I was swimming poorly, I was still keeping my heart-rate up and getting fitter. Swimming is much easier now and I’m glad I have made this my exercize
• I avoid highly spicey food simply because enough of it can cause abdominal pressure to build up and some acid gets through.
• I sing about 3-4 times a week and I make no excuses for not singing – with the exception of sickness
• I avoid going to loud concerts or talking in spaces where I have to raise my voice
• I always warm-up before a lesson. If the teacher begins with vocalises, you do not want to be worried about having the writing sensation or sound quality while still warming up. If you have ever had a station tube down your throat, you may have to take this extra step to ensure that the cord behave.
• Believe in myself and my career always. Even on bad days, I simply said “it will get better and it will happen.”
• I found a teacher who believed in my voice even with its history. She understands that sometimes, if I come into a lesson without having warmed up, the voice will get crackly for about 5 minutes. She does not give up at that point and just lets the issue run its course.
• I check my throat with an ENT once every year. Even though I always get the green light after being checked, it’s good for peace of mind and to ensure that you’re doing all the right things.
• I only sing the songs that are right for me at the time. In my late 20s, my growing spinto-tenor voice has allowed me to venture into one or two spinto-arias, but for the most part, like Brynn Terfel when he trained, I’ve had to learn a lot of Lieder, Folk song and lower-tenor operetta. My voice simply did not have the right tone and lightness for Rossini or lyric repertoire, but the easy top Bb-C indicated that I was still a tenor, not a baritone.
• I do not over-eat: Over-eating does cause reflux – there’s truly nothing that can stop an overly full stomach.
• I avoid eating foods that could make me sick: Why? Because it’s almost impossible to vomit after the Hiatus hernia surgery.
• I sing for the love of singing and nothing more. The more you think like this, the more you will land professional gigs. Why? Because you don’t care whether you fail, you just care about the music. The audience sees this, and your body recognises this and will work for you effortlessly (assuming you’ve done the hours of practice at home!).

To do or to not do the surgery

If you are considering this surgery for your own problems, do not let me story put you off. I would not have been able to sing just by fixing my diet – I had a physiological problem that had to be fixed with surgery. If you’re scared of pain, don’t worry, at the time of experiencing post-surgical pain, you DO NOT fear that pain, you just experience it, while watching your favourite tv shows. It is completely worth it in the end.

If you have any questions, please do not hesitate to contact me (thecompletesingers@gmail.com).

Michael