Avra Weiss is a 64-year-old sales auditor from Southfield, Mich., and a professional singer. She first started having symptoms of gastroesophageal reflux disease (GERD), such as sore throat and heartburn, about 20 years ago. She made some serious changes to her diet and lifestyle to try to relieve the pain, but still her symptoms persisted. By 2007, she was fed up and opted for a type of surgery known as laparoscopic fundoplication. She expected the GERD to get better, but it got worse. After a long painful recovery, she had only a two-week respite from acid reflux before her symptoms returned. A second opinion showed that her surgery wasn't as smooth as she had hoped.
Twenty years ago I started having persistent sore throats, nausea, and heartburn. I was singing professionally, so I needed to find out what was causing my pain. I saw several ear, nose, and throat specialists; one suspected I had acid reflux and suggested I see a gastrointestinal specialist. The specialist performed an endoscopy, a procedure in which a lighted tube is inserted into the nose and used to examine the stomach. At the time, doctors often performed endoscopies without sedation, so the procedure felt like five minutes of torture. (Sedatives are routine with endoscopies now.) The test showed I had gastroesophageal reflux disease, a condition in which stomach acid backs up into the esophagus, damaging tissue and causing pain.
Heartburn-Easing Foods That Fight GERDChoosing foods wisely is key View slideshowMore about GERD
After my diagnosis, the doctor told me to eliminate all fruit except bananas from my diet. However, I cheated occasionally and had a few grapes or strawberries once in a while. I had already given up coffee, tea, and carbonation at the age of 19, when I was diagnosed with a duodenal ulcer. I never drank alcohol and I never cared much for spicy foods, but I cut out other types of potentially problematic food, such as tomatoes and onions. I started sleeping with my bed elevated, which seemed to help my acid reflux a little, but it hurt my back and neck tooboth of which are aggravated from past car accidents. I haven't slept well in 20 years.
I've tried many medications to control my GERD. At one point, I was even going to Canada to get a medication that isn't available in the United States. But it was extremely expensiveit wasn't covered by my insurance and it had to be co-prescribed by a Canadian doctor (for an additional fee)so after a few years I stopped making the trip. Propulsid (cisapride) was somewhat helpful, but that drug was taken off the market in 2000 because it was causing heart arrhythmias in some people. And years before I had started using proton-pump inhibitors. All of the medications helped a little, but not enough.
I avoided surgery for a long time
My doctors recommended surgery for GERD, but I did my own research and learned there was only about a 50% chance that it would be successful. In the meantime, I saw a voice therapist who discovered the cartilage around my vocal chords was red and inflamed due to the acid irritation. I signed up for experimental procedures to treat my GERD at nearby universities and hospitals. However, the researchers had to stop in the middle of one because I had started to bleed; they were only able to complete about 85% of the procedure.
I also saw a holistic doctor, who said that I am sensitive to wheat (in addition to being lactose intolerant). So I cut out bread, pasta, and baked goods almost entirely, along with dairy and the other GERD "problem foods." If I stuck to this diet, ate six very small meals, never lay down after eating, never ate a late dinner, and kept my weight below normal, my symptoms were less severe.
However, I just couldn't live like that anymore. After 18 years of this strict regimen I started thinking about GERD surgery again; I thought it must have improved since I first discussed it 18 years before. My doctors told me the success rate was more like 80% now, so I decided to take my chances.
On October 30, 2007, I had fundoplication, which means the upper curve of the stomach is wrapped around the esophagus and sewn into place so the lower portion of the esophagus passes through a small tunnel of stomach muscle. This strengthens the valve between the esophagus and stomach to stop acid from backing up into the esophagus. I had the procedure done laparoscopically so the doctors wouldn't have to make a large incision and the recovery time would be shorter.
Next Page: After surgery, I was in unbelievable pain
[ pagebreak ]After surgery, I was in unbelievable pain
Instead, the recovery was horrible. I wasn't able to swallow and experienced unbelievable pain. I stayed an extra day in the hospital and still couldn't swallow when I got home. I was worried about dehydration and felt like I was starving to death. It was six weeks before I could eat normally again; my doctors said it would take only two.
During the last two weeks in December, I felt great. I could eat whatever I wanted and my symptoms were gone. But by the beginning of January 2008 my symptoms were back. I figured the surgery had failed, but I didn't know exactly how or why. I was so disappointed in my recovery that I didn't bother to see a doctor. I was fed up with the whole medical profession. I kept taking omeprazole (generic Prilosec) and over-the-counter Zantac, and gargling with Maalox to help my throat.
I also had another problem. A common problem after surgery is a build-up of gas in the lower gastrointestinal tract. Let's just say it's pretty anti-socialI didn't want to be around people, and I certainly didn't want to be performing in front of people when the gas-bloat syndrome was acting up.
Two months ago, about 15 months after my surgery, I finally got up the courage to see another doctor. After another dreaded endoscopy, the doctor told me that one of the surgical clips used in my procedure had come loose. I was flabbergasted because I didn't know they had used clips! When the surgeon explained the procedure to me I was shown a picture indicating I would have stitches that would eventually dissolve. To hear that I had clips that would stay in there was a big surprise, although it seemed to explain a few things. There's no way to be sure, but I believe the clip came loose right around the time my symptoms returned.
I don't know if I had a terrible surgeon or just bad luck, but I'm back to square one. My throat hurts every morning, and I sometimes have heartburn so bad that it radiates into my shoulder and up into my jaw. I take Nexium twice a day and I alternate monthly between ranitidine and famotidine, the generic versions of Zantac and Pepcid.
I could have another operation, but sometimes a second surgery can do more damage than good. My doctor advised me to go to the most experienced surgeon at the Mayo Clinic if I ever consider another surgery, but I can tell you that's not going to happen anytime soon.
Now my voice always sounds scratchy, and because GERD causes increased mucus, I clear my throat a lot, which is the worst thing you can do for singing. I wasn't misusing my voice; all the damage has come from acid reflux. I can't do solo work anymore, so I just sing in choirs now. I was a cantor for several synagogues until my throat got really bad. Now I just don't trust my voice.
Through it all, I try to just keep going with my life as best I can. I just can't believe that in 20 years they haven't come up with something bettersomething quick and easyto cure this nasty illness.