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arganoidAs I write this (18th Nov 2008), I have a tube going up my nose and down my throat. On one end is a sensor, on the other end is a monitoring device. This is a test called 24 hour pH monitoring, which checks to see whether any acid is escaping from the stomach into the oesophagus. I've had it in for just over an hour, and it's more uncomfortable than I was expecting. I'm already looking forward to 11:15 tomorrow when it is due to be removed. I also had a test called stationary manometry, which measures the pressure level inside the oesophagus. This also involved putting a tube into my throat, and again was pretty uncomfortable.
Anyway, I'll rewind a bit to where I left off last time (mid August). During the previous few months, I had been looking forward to my sister's wedding, but was concerned that I might have difficulty speaking to people there. When the event actually happened in late August, I was relieved to find that I had no problems socialising. This isn't to say that I had no throat soreness or voice strain at all, though.
Clearly my condition was better than it had been a few months previously, but as always it fluctuated a lot - there would be good times and bad times. I was going to write days instead of times, but that would imply that the fluctuations in my condition took place over fairly uniform periods of time, or that good days were easily distinguishable from bad days. As ever, my symptoms went up and down at seemingly random times. Usually the changes were gradual rather than sudden.
I still had no idea what had caused this improvement. Of the approaches I listed in the previous part, the only ones I felt I could rule out of having caused any improvement were the voice exercises and the chewing gum, since I had stopped doing both of them some time ago. That's not to say that voice exercises are not helpful in general. I may well have got more benefit from them if I had done them more frequently - as it was, I was quite poor when it came to actually remembering to do the exercises I had been given. When I did remember to do them, I found some of them quite difficult to do (more on the specifics in a future post) and didn't feel I was getting much benefit from them. Indeed, sometimes it felt like they could make things slightly worse, just like how things would sometimes get worse with talking. However, the number one reason for me giving up on these exercises was that it was becoming increasingly clear that reflux was a major factor in my voice problem, and it seemed pointless to be doing voice exercises while acid was still damaging my larynx. Bear in mind that I am not an expert in this field, and that what I just said is likely to be factually incorrect. Just because a larynx is being damaged by acid, it does not automatically follow that voice exercises will be of no benefit.
I finally returned to work on 4th September 2008. Even though I was back to typing with my hands rather than my voice, I was very unsure as to whether my voice would be able to cope with the amount of talking I would need to do, which wasn't a lot, but a lot more than I had been doing while I had been off work. Three months on, it has been a story (as always) of inconsistent symptoms. At times, my voice has seemed almost completely normal. Other times, it's been pretty bad - up to a 3 on the scale I've talked about previously. These days I track my symptoms by writing down three numbers to represent it per day, based on how bad it was in the morning, afternoon and evening. Most of the time I rate my symptoms as 2 or 2.5. I have also had to ask to be excluded from certain tasks which involve a lot of talking in a short space of time.
In the previous part I talked about the uncertainty I had over whether acid reflux (LPR) was contributing to my symptoms. As time went on, I became more and more sure that this was the case. In late September and early October, there were a number of occasions when my reflux symptoms were unambiguous. These symptoms included heartburn for the first time. This change only lasted a short time - since then, heartburn symptoms have gone back to being rare and subtle.
In mid October I switched from lansoprazole to omeprazole, in an attempt to stop the side effects I had been experiencing. This worked to a certain extent, but it did seem like my symptoms worsened slightly after this switch. After a short while, I started taking two 15mg omeprazole capsules per day (morning and evening).
I also asked to be referred to the Royal National Throat, Nose and Ear Hospital in London. This is meant to be the best place in the country when it comes to voice problems. Initially, I had another nasal endoscopy. You may recall that the first one had been way back in March, and resulted in what appeared to be a misdiagnosis. The new doctor seemed a bit more sure of what he was talking about. "You have muscle tension dysphonia", he told me at the end of the examination. He didn't see any clear signs of reflux - I'll talk more about that in the next part.
At the new hospital, I saw two new speech therapists, who were trained in the art of laryngeal manipulation (i.e. massage of the larynx and the surrounding areas). This is a technique I had read about months earlier - I had been particularly interested to read that some patients with voice problems had experienced immediate and total relief from their symptoms after receiving this treatment. For me, this was not the case. I've had this done twice (each session was very brief), and I did feel a slight improvement each time, but it was very subtle, and is outweighed by the usual daily fluctuations in the severity of my symptoms. I have also been given some more voice exercises to do.
These last few paragraphs have been written in late December - so I no longer have that tube up my nose. In the next part, I'll talk about what (if anything) has been learned from the pH monitoring test, some more thoughts on reflux, and a summary of what my condition is like at the moment.
Anyway, I'll rewind a bit to where I left off last time (mid August). During the previous few months, I had been looking forward to my sister's wedding, but was concerned that I might have difficulty speaking to people there. When the event actually happened in late August, I was relieved to find that I had no problems socialising. This isn't to say that I had no throat soreness or voice strain at all, though.
Clearly my condition was better than it had been a few months previously, but as always it fluctuated a lot - there would be good times and bad times. I was going to write days instead of times, but that would imply that the fluctuations in my condition took place over fairly uniform periods of time, or that good days were easily distinguishable from bad days. As ever, my symptoms went up and down at seemingly random times. Usually the changes were gradual rather than sudden.
I still had no idea what had caused this improvement. Of the approaches I listed in the previous part, the only ones I felt I could rule out of having caused any improvement were the voice exercises and the chewing gum, since I had stopped doing both of them some time ago. That's not to say that voice exercises are not helpful in general. I may well have got more benefit from them if I had done them more frequently - as it was, I was quite poor when it came to actually remembering to do the exercises I had been given. When I did remember to do them, I found some of them quite difficult to do (more on the specifics in a future post) and didn't feel I was getting much benefit from them. Indeed, sometimes it felt like they could make things slightly worse, just like how things would sometimes get worse with talking. However, the number one reason for me giving up on these exercises was that it was becoming increasingly clear that reflux was a major factor in my voice problem, and it seemed pointless to be doing voice exercises while acid was still damaging my larynx. Bear in mind that I am not an expert in this field, and that what I just said is likely to be factually incorrect. Just because a larynx is being damaged by acid, it does not automatically follow that voice exercises will be of no benefit.
I finally returned to work on 4th September 2008. Even though I was back to typing with my hands rather than my voice, I was very unsure as to whether my voice would be able to cope with the amount of talking I would need to do, which wasn't a lot, but a lot more than I had been doing while I had been off work. Three months on, it has been a story (as always) of inconsistent symptoms. At times, my voice has seemed almost completely normal. Other times, it's been pretty bad - up to a 3 on the scale I've talked about previously. These days I track my symptoms by writing down three numbers to represent it per day, based on how bad it was in the morning, afternoon and evening. Most of the time I rate my symptoms as 2 or 2.5. I have also had to ask to be excluded from certain tasks which involve a lot of talking in a short space of time.
In the previous part I talked about the uncertainty I had over whether acid reflux (LPR) was contributing to my symptoms. As time went on, I became more and more sure that this was the case. In late September and early October, there were a number of occasions when my reflux symptoms were unambiguous. These symptoms included heartburn for the first time. This change only lasted a short time - since then, heartburn symptoms have gone back to being rare and subtle.
In mid October I switched from lansoprazole to omeprazole, in an attempt to stop the side effects I had been experiencing. This worked to a certain extent, but it did seem like my symptoms worsened slightly after this switch. After a short while, I started taking two 15mg omeprazole capsules per day (morning and evening).
I also asked to be referred to the Royal National Throat, Nose and Ear Hospital in London. This is meant to be the best place in the country when it comes to voice problems. Initially, I had another nasal endoscopy. You may recall that the first one had been way back in March, and resulted in what appeared to be a misdiagnosis. The new doctor seemed a bit more sure of what he was talking about. "You have muscle tension dysphonia", he told me at the end of the examination. He didn't see any clear signs of reflux - I'll talk more about that in the next part.
At the new hospital, I saw two new speech therapists, who were trained in the art of laryngeal manipulation (i.e. massage of the larynx and the surrounding areas). This is a technique I had read about months earlier - I had been particularly interested to read that some patients with voice problems had experienced immediate and total relief from their symptoms after receiving this treatment. For me, this was not the case. I've had this done twice (each session was very brief), and I did feel a slight improvement each time, but it was very subtle, and is outweighed by the usual daily fluctuations in the severity of my symptoms. I have also been given some more voice exercises to do.
These last few paragraphs have been written in late December - so I no longer have that tube up my nose. In the next part, I'll talk about what (if anything) has been learned from the pH monitoring test, some more thoughts on reflux, and a summary of what my condition is like at the moment.
