Professional Singer needing advice - Lap Nissen Fundo, Toupet, or EsophyX

Over the past 6 years, I have been battling vocal injuries due to GERD/LPR. As a professional singer, this has been debilitating, and has also significantly lowered my quality of life in general. I've taken every medication possible... Nexium (2) 40mg tablets twice per day currently... and still not receiving the relief I need. Diet modification, sleeping upright, no alcohol, no caffeine - not enough relief. SO, with 3 different doctor opinions and all the needed testing later, everyone (including me!) seems to agree that surgery is the next step. The issue I'm having is choosing the right one...

In Nov 2011, I was scheduled to have the full Nissen Fundo, but the surgeon cancelled last minute due to a slight issue he saw on the motility study. I will say that I occasionally have an issue getting food to pass immediately out of esophagus, though nothing serious, but after an additional motility study, I was assured that the relief of GERD would outweigh the occasional swallowing difficulty (if any). However, that scared me out of going through with the Nissen at that time, and opted to have the EsophyX this month (Sept 2012). My insurance won't cover it, so I'm back to discussing the Laproscopic Nissen Fundo or Toupet. After returning from tour and being unable to sing for a month (acid reflux!), I can't wait any longer to have surgery. FYI: I've had ENT's say the issue is definitely GERD/LPR too, and not singing incorrectly, etc.

Specifically singers... has anyone had this and successfully recovered (including your voice)? I personally know a professional singer who had Nissen done a few years ago, and although she still has bloating issues, she said she got her life back and it saved her career. However, I've also seen plenty of posts that this is risky for singers and that it was more harmful to a vocalist than helpful. Perhaps swelling to vocal cords? How does this harm the vocal cords or ability to sing, if at all long term?

Is there a preference - Nissen Fundo or Toupet?

I truly appreciate anyone taking the time to respond, as this is a serious decision I need to make in the next week or so. Thank you in advance!!!

Hi Bill,

Thank you so much for your reply. Until I came across a few threads online today about vocalists losing range post surgery, I thought the nissen could only be helpful. It's really great to hear that it helped the quality and stamina of your voice. Thank you for sharing with me!

I'm not sure if you're open to talking about this... but did the esophagus tear occur because of the surgery? It sounds like you've had this procedure done a few times now... do you still feel it was worth it? Any challenges long term? No pressure, if that's too personal :)

Thank you for your reply!!!

1)
Since you are in NYC, have you considered seeing Dr. Jamie Koufman?

She specializes in voice+reflux related issues:
http://www.jamiekoufman.com/2010/01/30/vocal-decompensation-how-and-why-people-get-voice-disorders/

2)
I was going to get TIF myself and because the insurance is not going to cover it, I am considering Toupet. A surgeon that I see - seems to think that Toupet is superior to TIF based on the symptom relief outcome/studies from these surgeries.

Singer-

I don't mind sharing my story at all. It's kind of a strange one. The tear was from an EGD to check on my Barretts.

Here's a link to my story that's at the top of the GERD page.
www.healingwell.com/community/default.aspx?f=45&m=2337138

As for the nissens. If mine needed redone tomorrow, I'd do it without hesitation. It has greatly improved my quality of life. I would still be on my 2nd one today if it wasn't for the esophagus tear. And probably one my 1st one if it would have been done correctly.
I haven't had any issues with having the 2 nissens besides the normal healing quirks. My last redo was a year ago 8/24 and the only thing that lets people know I had it done is the scar.

Take care,
Bill

I have a mild motility problem and I had a 270 degree wrap. I used to lose my voice all of the time for weeks before the surgery.
I sing a high soprano now (almost operetta style).

Thanks Bill, I appreciate the additional info. That's really good to know. Maybe they're talking about singing full strength, but happy to hear I won't be totally out of work the entire 6+ weeks.

Joy, I'm so glad to hear that your voice improved after surgery!!! I appreciate you letting me know!!!

Grateful for the feedback. Thank you all.

Thanks Denise! I'll keep you guys posted as to what I choose. Again, all the feedback, stories, opinions are incredibly helpful :)

Hi Guys,

Sorry for my months of being MIA, but I finally have a surgery date planned for this coming Wednesday 12/5. Very nervous! After the past 2 months of extensively studying my symptoms and redoing all of the pre-ops tests with a new set of doctors, motility issues aside, both specialist and surgeon are saying the full nissen fundo is my only option.

To back track a bit... I know there's a lot of debate whether or not people who suffer from LPR will see significant enough relief from surgery for it to be worthwhile, but all the specialists I've gone to agree that my symptoms and level of acid are too extreme (after 7 years of medication not doing the trick), and nissen is my last and final option. As reflux has been a big issue for me over the past 7 years as a professional singer, I'm excited to think that this is close to being a thing of the past.

With that being said... having 5 days to mentally prepare for this surgery is making me a bit of an anxious wreck. Has anybody on here had complications after surgery of stomach going into chest or things of that nature? That's probably my biggest fear at the moment. My surgeon told me today that my days of doing crunches at the gym are over. Is that true? I'm truly unprepared, and would love a realistic view on what to expect during recovery, but also long term life changes (sports, future pregnancy, success rates). Also, how long should I plan on having help after coming home from the hospital? Lots of questions, I know!

Last bit of info: Dr. Siegel (G.I) and Dr. Koufman (Voice Institute NY) have sent me to Dr. Edye (Mt. Sinai NYC) for surgery. I know these are top docs and the surgeon has extensive experience, but if anyone has worked with any of these guys, please let me know how your experience was!

Thank you all again for listening, and I appreciate the support.

Hi Guys,

Tomorrow is my 4 week mark post-nissen. Just to recap, I do have motility issues, but minor, so with the level of GERD and LPR I was experiencing, the full nissen was the only way to go.

Firstly, I'd like to start off saying that I'm extremely happy that I've gone through with this surgery, and my vocals (a week and a half post op visit) were already almost 50% less inflamed than pre-op. I saw the pictures, and it was pretty incredible how much better my vocal cords, sinuses, etc looked so soon after surgery. Vocalists suffering with the same issue, I highly recommend having this done. Please also check in with Dr. Jamie Koufman at the Voice Institute of NYC, as she is one of the best voice specialists in the country. She also specializes in LPR/reflux, as I found most specialists do not.

With that being said, this has definitely been a tough recovery for me, worse than I was anticipating, and that's largely in part to being uninformed and having unrealistic expectations getting on with my life post-op. I've read a million times on this website that most surgeons, even the most experienced ones, don't take the time to really explain what to expect (if at all) until you're in recovery. Please do yourself a favor and ask as many questions that you can think of to ask, browse this website and other people's experiences, and also mentally prepare yourself that your recovery time might not realistically be 6 weeks. It's also important to note that everyone heals differently, so you need to be prepared to truly sit back and recover for awhile. Originally, I was told to expect a 6 week recovery, but that's not the case. Now, I've been told to expect 3+ months before I can swallow food properly and a year for full recovery. Again, just be realistic because this is a very real surgery. **I'd love to hear other's experiences on this, though, as I'm only a month in**

I feel like it's also important to note that even with one of the most highly recommended and experienced surgeons in NYC, I did have serious complications post surgery, and wound up back in the hospital for an extra 2 days after initially being released. Most people go home and are fine, so my experience with this was a bit out of the ordinary. However, at 4 weeks, I can truly look back and say this has been worthwhile, despite the ups and the downs. I live alone and have been taking care of myself and things around the house for at least 2 weeks now, but it was definitely necessary having someone here with me the first week and a half. If you do live on your own, this is totally feasible, so don't let that delay you in getting this done. I'm still very careful as to what I lift (usually no more than 6-10 lbs max), but I seem to be getting by just fine.

On a very positive note: I can drink coffee!!!!! Yayayay!!!!! It's been ages since I could carelessly drink a cup of coffee and not worry about my voice. Even simple things, like drinking water, are less stressful because there's no worry about it coming back up. I can still burp a tiny bit, but certainly nothing like before. Gas is an issue and my stomach definitely gets swollen and irritated easily, but I can already see the bigger, healthier picture as to how much better my life will be after full recovery. I used to have to wait hours and hours before laying down after consuming anything to eat or drink. Now, I do what I want and seem to be fine. Last night, I even had a half glass of champagne for NYE (my belly did not like those bubbles), and my voice is fine today. In the past, one sip of alcohol would damage my vocal cords, so this is a huge milestone for me. Again, recovery hasn't been a walk in the park and certainly not as easy as some of the journals I've read, but sooo worthwhile to enhance your quality of life (and career, in my case).

Although this was a scary decision, and I spent over 2 years seeing various specialists and getting second and third opinions, I am so grateful to be going into the New Year with this behind me. I'm only mid 20's , but I've been struggling with these issues for about 10 years. It's almost like I had surgery and am getting my life back in return. As long as you have an experienced surgeon and are well informed, I highly, HIGHLY recommend the nissen fundo. Especially for vocalists, the agony of what you go through with your voice on top of all the other side effects with GERD or LPR, makes surgery and recovery - not only necessary - but a walk in the park.

I'd still love to get some additional information from those of you further along or fully recovered post-nissen on gym and exercise. Are crunches really out of the question forever? What time frame did any of you get back to the gym? I've been walking and staying active in that way, but I'd love to get back into some sort of aerobic activity soon. Any feedback would be greatly appreciated :)

Best of luck to anyone reading this post for advice. DO IT, get it done and over with, and get your life back! Even just a month in, I give this surgery a thumbs up!

Hi Bianca,

I'm sorry to hear that you're not feeling well, but you are in the best hands. Dr. Koufman is the best of the best of the BEST. Did I mention that she's amazing? LOL. In all seriousness, though, I want to stress that this is a major surgery, and only you can decide if it's the best way to go. In my experience, recovery was quite difficult up until about the 3.5 month mark. I've also had an additional surgery since my Nissen in Dec, but as I am currently just past 4 months post nissen, I am really starting to see how necessary it was for my overall health and especially for my career. I've also heard stories (one from another of Dr. K's patients) who at 6 weeks was in perfect health and had a perfectly quick and easy recovery from day one. Everyone heals differently, so you have to prepare yourself for both extremes (but stay positive)! The most important factor in having this surgery done is making sure you've chosen a very experienced surgeon. Dr. K recently performed a throat surgery on me, which has gone flawlessly, as well as helped nurse me back to health post nissen (as my surgeon moved out of country 2 weeks after my procedure). I can confidently say that she will only send you to the best surgeon, and you will always have her to lean on as well.

I hope this info helps, and I am happy to answer any additional questions you have.

Good luck and Happy Healing,

Toni

Hi Bianca,

It really only took a week and a half before I noticed a difference with my voice/throat. I had LPR for years that diet and medication barely helped to control. Aside from vocal issues, I had breathing problems and sinus problems due to acid coming ALL the way back up (and then some). Almost immediately after surgery, I stopped using an inhaler that I previously needed on a regular basis. The jury is still out on whether an inhaler will be needed for intense exercise (I haven't recovered enough from both surgeries to push myself like I used to yet), but I would be happy with the result either way. Life for me is much better post surgery.

Surgery makes everyone nervous, but if you think you've tried all you can try without adequate result and surgery is your next and best option, then I would recommend it. My candid response is this: Surgery sucks, but living in pain is far worse. Once you've done all your research, testing, and have chosen an experienced and competent surgeon, you sort of have to let go and just DO it. The anxiety before the surgery is worse than the recovery, and I believe that if Dr. K recommended it, than you'll do just fine.

Bianca,

I'm glad I'm able to help. Eating is still a bit of a challenge. I can't eat everything I used to eat prior, but it doesn't bother me much. One thing you'll absolutely want to stay away from is bread. I wasn't on as much of a restricted diet as some people are put on (I was off liquids after the first week), but make sure you get clear cut directions from your surgeon about that BEFORE you have surgery. The nurses at the hospital gave me total opposite directions than my surgeon (but they aren't the experts). A little pre planning will go a long way too. My last thought on diet changes is to always pay attention to your body. If you start feeling pain at any point, it probably means you're eating food too challenging and you should keep it simpler. My surgeon's advice was "if you can eat it without any pain, then it's safe to eat."
Nausea pills were my best friend the first two weeks, so keep them on hand. I haven't needed them since, though :) My second best friend (and now my enemy haha) is Ensure. Get the plastic bottles and not the metal because there's no yucky after taste.

Ok, good luck! Keep us posted on what you decide!

Thanks Denise! As I mentioned, I'm just past my 4 month mark, and although I am definitely still recovering, the worst is certainly behind me.

All very positive, and I have no regrets! Was so necessary for me! Looking forward to that 6 month mark, although, I'm already feeling great. Thanks again for sharing your experience with me :)