Acupunture? Or luck?

[kchammy]

To who ever may be interested....

I posted last week about loss of range that I have experienced for over two months. The "shows went on" but I had to call in every friend singer I had in the area and do what little I could manage...which wasnt much.

To summarize...I had gone to an ENT that declared my cords damage free, but thought I had acid reflux. So after a 16 day steroid cycle did nothing for me...he put me on Nexium. Now, I've never quite understood how acid reflux could knock a good amount of notes off my range...I mean, whats the mechanics behind that??

To make a long story short, I tried any and everything...and then last week I tried acupuncture.

Singing last Saturday night, I started about the same...basically crippled....but by the third set, I had gained back a good bit of what I had lost in my natural range. I cant describe how happy I was....I was crushed when this problem began. I dont know if it was an anomoly...I'm too afraid to test my voice so far this week because I may as well rest it.

BUT

If I do have it back, the sad thing is I wont know which of the many treatments might have been "the one" to help me. Nexium? Steroids? Massage? Acupuncture? Meditation? Prayer? ....time?? I never really had time off, but did take it easy and let others do the heavy lifting for 2 months.

I will say the acupuncturist seemed very capable and sure she could help me. Has anyone else tried this, for singing or any other reason? If so. what was the result?

- Kip

[kchammy]

PS: Also, my habits were pretty bad....only since this problem started and I realized I was mortal have I been doing vocal warm-ups before the shows. Toss that in as possible reasons for improvement.

[Open Mic]

First of all, laryngo-pharyngeal reflux is an important cause of vocal problems and empirical (trial) treatment can often resolve voice problems. That being said, without knowing what you were like in the consultation room it is impossible to make any judgment on that treatment regime for you personally. Those that would know are not foolish enough to give personal vocal health advice beyond the generic 'keep your voice healthy' over the internet.

As for your questioning of acupuncture, I can give you the information we currently know about this form of 'treatment'.

The principles of Acupuncture involving the existence of the so called Chi or meridians are biologically implausible and have absolutely no evidence supporting them. Large numbers of trials have been conducted to test whether or not acupuncture is effective. However, most of these trials are methodologically flawed and just not a fair test making them unreliable. If you focus on the high quality trials, there is evidence that acupuncture may work for some types of pain and nausia but there is conflicting good trials. The evidence could be considered borderline at best. If it was categorically effective, more high quality trials would show it is effective.

It would be fair to say that for the vast majority of conditions acupuncture claims to treat, it works no better than so called 'sham' acupuncture (where you believe that you have received acupuncture but in actual fact you have not. This, in medicine, is known as a placebo effect. Despite this, acupuncture does show a large placebo effect and for some people, this effect is worth the high price of this 'treatment'.

[Joanna]

several comments:

(1) Reflux irritation of the cords makes them swollen = heavier, so they don't stretch as easily. This is the simplest explanation for losing notes.

(2) In my experience & reading, very few holistic/ non-western health practitioners, including acupuncturists, have any understanding of the larynx & its physiology. Few enough ENT's are true voice experts! the science is too young & holistic methods very old (not always a bad thing... just not yet integrated well with recent updates in understanding the voice). That said, a small research group in Hong Kong—young Chinese ENTs—has begun to bridge this gap. At the 2008 Voice Foundation Symposium, they had a couple of very nice single-subject reports about treating common voice complaints with traditional Chinese herbs. In 5-10 years we can expect more data.

(3) I personally use acupuncture for muscle-tension complaints. It did a lot to heal some bad tendonitis I suffered 20 years ago, & makes as much sense in this kind of application as trigger-point or shiatsu/acupressure types of massage, of which I'm a great fan. Most voice therapy patients I see with acid reflux ALSO have muscle tension problems, often because of ways they've tried to compensate for the voice problems. Especially since you report not doing regular warmups in the past, it's possible that you were kind of muscling-through performances. So—to link together these hypotheticals—perhaps the acupuncture helped relieve some compensatory tension & improved your voice that way.

(4) The placebo effect is very real, and lots of research demonstrates that if both doctor & patient believe something will help, they're more likely to get better. Body tends to align with the mind's belief system, consciously or not. If patients don't believe in the treatment, or health provider unconsciously communicates a negative belief, treatment is not as effective (& patients less likely to follow-through). The reverse applies if the health practitioner shows warmth, caring, & a genuine desire to help. The simple fact that you've begun to take your issue seriously ("no longer immortal"), and spent time getting personal attention and concern from the acupuncturist—who in turn believed in the treatment—may have triggered your body's own heaing response.

(5) finally, the ENTs I trust, who are experienced with singers, with would never start reflux treatment just with steroids! And nexium & its cousins take time to work. There might have been a coincidence in time between getting acupuncture, and the right medication finally starting to kick in.

Most likely you got better from a little of each of these. and the most important thing now is to take voice care seriously. Over time you'll find the combination of lifestyle changes, medications, warm ups, and 'alternative' treatments that best suit your own mind & body & circumstances.

BTW I've just fixed a bunch of broken links on my website & invite folks to check out the health-related articles.

best wishes -

Joanna

www.voiceofyourlife.com

[kchammy]

Thanks to you guys who responded. I'm moving my personal issue to another thread because I feel I started off wrong here...

[WebAndNet.com]

The question is asked how does acid reflux affect singing highs and why a particular singer found that acupuncture worked for him. See themodernocalist.com’s discussion forum http://www.punbb-hosting.com/forums/themodernvocalist/viewtopic.php?id=447

Acid reflux doesn’t just affect the vocal cords, but the entire vocal tract. Just a little bit of acid, and I would even suggest acidic fumes, can weaken the entire vocal tract. This means that acid reflux affects the resonace control and vocal cords.

My opinion is: if you have major acid reflux, you’ll know quickly–you’ll lose the entire vocal tract control–can’t sing in tune. Minor acid reflux affects the quality of the control. Remember that the vocal cords alone sound tinny, and that your resonance creates the full sound, and then you’ll better understand how acid reflux works.

Knowing this, here’s how Nexium and other proton inhibitors work. These reduce the amount of acid and possibly acidic fumes that weaken your vocal tract, and hence improve your singing quality control.

One can also reduce acid by changing diet (eat less, less fatty foods that require more digestion time), losing weight (my guess is less pressure on the stomach and vocal tract), and other well-known methods.

Lesser known–one can reduce the acid by manipulating your body posture. Don’t lie down horizontally (even when sleeping; sleep at an incline), sit straight, try to strengthen the lower esophageal valve, and also the upper esophageal valve (I hope I said these correctly). These are described in my blog www.vocalposture.com. Lift up the entire rib cage–not by a deliberate mental lift, but by relaxing and toning the entire spine and thorax and abdomen muscles and myofasica. Much of vocalposture is about this process. You’ll sing better and relieve acid reflux at the same time.

As for acupuncture, massage, etc., as mentioned in the modernvocalist.com question These can work as well. How, precisely? One of the comments said earlier is that there is no “scientific proof” that these work. Indeed, there is little “scientific proof” these don’t work either. Just because something isn’t proven, doesn’t mean it’s false; though it may be suspect.

Remember though that there are usually more false methods than true ones, so suspect is suspect. However, it is not true that suspect is false–some suspect methods may very well work.

There is abundant evidence that acupuncture and massage do affect the circulatory, nervous, and muscular-tension systems. If one accepts these, then one can view one’s relief through these therapies sensibly.

Acid reflux is primarily due to too much pressure causing the stomach contents to go up to the throat.

Acupuncture, massage, etc. may be helping by relieving tension (thereby reducing pressure), by relaxing your vocal tract (which may be tense from continous exposure to acid reflux), or by simply improving your vocal tract muscular performance. Anyhow, all these make sense by understanding the posture of the vocal tract, which is what www.vocalposture.com is about.

I hope this helps.

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