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Joanna

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  1. just a few points to add: - keep your breathing as silent as possible during aerobics. This intention helps to keep vocal folds far apart and least vulnerable to the fast & vigorous breathing of the cardio exercise, which can otherwise be drying. - during weight-training, be extra-alert to the moment BETWEEN inhale (preparation/recovery) and exhale (exertion). It is common to hold the breath for a moment at that point -- bracing to get perfectly in position -- which means that your tiny vocal folds are helping to balance the weight. Better to begin the exhalation BEFORE you lift or press, or otherwise make a smooth transition from inhale to exhale. -stretch abs after working them out ("cobra" position or lying on your back over an exercise ball). That's the time to relax abs and explore sensations of breath in lowest area, between hip bones. - in any stretching position, before/after other workout activities, practice breathing in really fast and letting it out very slowly = rhythm needed for singing. Doing a few rounds of this with torso (trunk of body) in a variety of positions is an easy way to wake up & strengthen breath muscles you need in singing, sides and back as well as front of body. - if there is a steam room where you workout, use it! This may help some of the dry sensations, which are in your airway and not directly helped by drinking water. My book has a whole chapter on fitness activities and voice, but those are the nuggets! cheers -- Joanna
  2. Helta Skelta: If you can raise or borrow funds to get a private medical exam sooner, DO IT, for your peace of mind as well as quicker recovery. Use reference below to find a clinic where you can be seen by both an ENT and speech therapist who understand voice (not all ENTs really do). Then DO WHAT THEY TELL YOU!! http://www.britishvoiceassociation.org.uk/voice_clinics.htm One of the best UK teacher-therapists is Christina Shewell, www.shewellvoice.com, I think she is in Bristol but check. She might even have ideas on lower-cost ways to get examined. (I don't know her personally but in vocal-arts-medicine world she is highly respected.) Meantime: the most useful approaches are (1) rest your voice when you can, but do 5 min at a time, a few times a day, of very simple trills and hums in whatever range is available. This is just to keep circulation and healing processes active, NOT to test your voice or make it sound better right away. (2) Don't force your voice to do anything that doesn't feel easy. Don't test it constantly, or try to "will" the strong sounds back. (3) Move the high-profile gigs from urgent schedule to 3-6 months later, so you have time for diagnosis AND treatment before putting your abilities on display where you need to be Great. Athletes get injured, so do vocalists, it happens. You need to take mental pressure OFF right now, if you can, so that stress doesn't slow down the body's ability to heal. (4) Educate your singer friends about NOT BEING STUPID like screaming for hours!! As Ron expresses very well, each of us gets one set of vocal cords, and if we want them to perform exquisitely for artistic/career/self-esteem goals, we can not take them for granted in careless social settings. Let non-singers consider you an over-careful "Diva" or "Divo," or a pain-in-a** about quiet activities, less booze, zero cigarettes, etc. Let your experience and example teach others. All the best to you -- Joanna
  3. noticeable heartburn is the tip-of-iceberg; vocal discomfort and cracking, irritability, throat-clearing etc can start long before that. Esophagus (swallowing tube to stomach) has a protective lining designed for stomach acid. Vocal cords are in your airway (breathing tube) and are 100x more sensitive to stomach chemicals. There are 3 main types of heartburn medication. - immediate antacid, main ingredient usually a "bicarbonate" -- Tums, Rolaids, Alka Selzer, Gaviscon (my personal fave). VERY short term, neutralizes acid on contact. Immediate symptom relief. Gaviscon AFTER meals and/or at bedtime does a bit better; its what I recommend at the end of those nights out with alcohol, to decrease risks of refluxing overnight. - "H2 blocker" - zantac, tagamet, pepcid, and generics. Longer-lasting, relatively safe. Follow instructions on box. -"Proton pump inhibitor" - all the new expensive (and heavily advertised) drugs, plus generic Prilosec etc. Effective over time (wasted as occasional-symptomatic use) but with side-effects if taken for years. Use as directed on package e.g. pulsed doses (a few weeks on, then off). BUT ALL THIS is guesswork, much better to get a throat exam rather than self-medicate ... and avoiding those greasy-meals-with-booze evenings is as useful as any chemical repair afterwards. Much more info in my book. If you love your voice invest in it and pamper it! The friends who tease you now will respect you later.
  4. Totally agree. Larynx is a 3D mechanism, complex relationship to many muscle groups, breathing, etc. verbal descriptions on a forum are gonna be limited. Some voice therapists such as myself work via Skype. I also can recommend a colleague in Tel Aviv -- excellent singing teacher and speech therapist -- so contact me off-list if either one would be helpful. Joanna
  5. Sometimes the urge to clear-throat is a false-alarm: cords are uncomfortable or unhappy but don't have much "vocabulary" to specify what's wrong. So we clear, and that sensation grinds over the discomfort, gives temporary distraction (not quite 'relief').. If one keeps clearing more & more vigorously the body will produce more lubrication, so eventually one gets "proof that something was in there." Alternatively it just keeps feeling dry ... like yours . So while I'm a great believer in humidifiers, if that doesnt seem to make much difference, I'd get curious about what else might be going on. In my experience with more than a thousand voice patients: when throat-clearing is the primary complaint or symptom, problem is either -mild acid reflux (just enough to get the cords 'jumpy', but might not be felt as heartburn); - a generalized fatigue or discomfort from talking too low in one's range (best approximate level being 4-5 notes up from absolute physiological bottom) - subtle weakness in the cords related to normal aging (in guys this can hit around 50, or even earlier, as one's decline in testosterone starts to decrease muscle mass throughout the body. SORRY fellas I hate to mention it). Usually in this last situation, the sound changes as well -- high notes feel more effortful; voice generally not quite as robust. - dry mouth feeling from a variety of medications can lead to dryness in the throat, again making the cords uncomfortable and asking to be cleared. Humidifier helps some; extra-moisturizing mouth care products can also help a little. This would be a main suspect if throat-clearing started within a few weeks of starting a new medication. last possibility-- least likely -- would be a subtle infection of some kind such as a fungal coating on the cords, again causing just enough atypical sensation that the conscious mind starts to pay attention. as for solutions (other than getting a throat exam to confirm one or another of the above) -- try sipping ice-water right after you clear. Then sip ice-water whenever you get the URGE, e.g. sip instead of clearing. The ice-water briefly shocks/distracts the throat & if you clear less, cords will be free of THAT source of irritation. Over time the urge-to-clear can decrease. This works best, of course, when combined with adjustments to help any underlying problem with health or voice technique. OK -- them's my more-than-2-cents -- best wishes from yer friendly rehab gal -- Joanna
  6. Sun - THANK YOU for sharing the whole story. there can definitely be connections between vocal soreness or muscle; and nearby regions such as SCM spasm, neck/jaw misalignments, etc. Its very common for someone to strain a few fibers during fitness workout, but FEEL them only when they sing -- and sometimes in a different place (aka "referred pain") this is a great community of support and information, I think the level of knowledge these past few years is really growing. Coolio! Joanna
  7. THANK YOU for being so diligent in voice care. Have you seen a laryngology doctor recently? A checkup would make sense at this point. Your symptoms sound like a possible vocal weakness (cords don't meet fully or internal strength doesn't engage). Best to get a videostrobe exam, however, and a few sessions of speech therapy with a voice expert who can help "tune-up your equipment." If you're no longer near the medical team who helped you previously, www.ncvs.org has a good referral list for USA clinics. Meantime I would be careful NOT to push too much air through your voice; the standard recipe of "relaxed throat and more breath" does NOT work for everyone especially those who feel stuck in falsetto. Feel free to contact me off-list or schedule a Skype consult, I'm happy to trouble-shoot further. all the best -- Joanna
  8. Progesterone does change the fluid balance in the body, so this might be a connection. I haven't actually seen voice patients with this exact complaint but it makes some sense. Its also possible that the Pill has somehow changed your subtle awareness of lower body (bloating more/less?) so that you're breathing differently. Obviously the nodules need to be treated: by partial voice rest ("half as much half as loud"), and DON't try to squeeze voice to sound "normal" unless you're being paid a lot, as this will prolong the problem -- Steam treatments, humidifier, and Mucinex (over the counter) may help keep you more lubricated now and in the long run. contact me off list FMI or ask the person who diagnosed your nodules for a referral to speech therapy with a voice specialist. take care -- Joanna
  9. Jennifer - I'm a speech therapist specializing in voice problems and I've seen a couple of cases like yours. The nerve stimulator goes into the same pathway that controls voice ("cranial nerve X", vagus nerve) so no one should be surprised that your voice has been compromised. I hope someone at least mentioned this to you before the surgery -- not that seizure control is less important, but just for a fully-prepared informed consent! I also understand your not wanting to invest time & money in solutions that would not help -- but seeing an ENT who truly understands singers, in a team with skilled speech therapist, may be worth while. A comprehensive list of voice-specialty clinics in the USA is at http://www.gbmc.org/home_voicecenter.cfm?id=1551. If the closest one to you is a few hours away, it is still worth it -- you are a vocal athlete, and these clinics offer the most specialized "sports medicine" for voice. As to why lower pitch works better: when one cord is paralyzed, it has trouble closing fully against the other cord. In a lower pitch, the cords get short&fat, and that extra "bulk" probably helps your cords to meet. Some voice-specialist doctors now use injectable material that similarly "bulks up" a paralyzed cord; there are also voice therapy exercises that you can learn that might help. In fact, at the end of this week I will be doing a workshop on this exact topic at the biggest voice-medicine conference in the country! Please feel free to contact me privately if you like, especially if you're anywhere near Los Angeles. I also consult by Skype. There is hope -- so I'm really glad you reached out through TMV. all the best -- Joanna
  10. Croaky-cracky voice for the first hour or two is VERY common with reflux irritation, kind of a signature. Other most-common throat-related symptoms are unstable midrange (register break gets harder to maneuver); and there's a lump-in-throat-feeling or sensation of extra phlegm, like an itch that clearing-throat doesnt quite scratch. And I see lots of patients who have no symptoms of acid reflux OTHER than changes in the voice. So I would recommend going to a good voice doctor (someone other than Dr. Google) to get your throat looked at. Meantime do NOT push to sound/feel normal when voice is not working right. That only trains you in straining more effectively e.g. bad habits go deeper ... Try a long hot shower (steam inhalation) in the morning, and cut out alcohol and most coffee—The Biggest Culprits for reflux, in my experience. Tolerate a couple weeks of that experiment (while waiting for your MD appointment), and see if you notice any difference vocally. And hey everyone my book on self-care is now available on Kindle, at least in the USA. lots of info there -- thanks & be well
  11. Hi - regarding vocal rest immediately after surgery: the surgeon will advise her if this is necessary and for how long. because the surgery is on the outside of voice box, rather than inside, it's a different situation than when people get nodules or polyps removed and have to absolutely shut-up during acute healing. regarding the gig four months out: it is very hard to estimate recovery time in advance. If there is some nerve damage, however, recovery will probably be slow. I would advise postponing the gig if possible. The risks are not so much about hurting the voice, but of not sounding her best in public, and carrying the mental pressure/anxiety about it while medical and hormone status are already unsteady. 6 or 8 months might be safer, but much depends on the exact surgical outcome. So your friend might wait until after the surgery to make this decision.
  12. I would recommend seeing another doctor, a real voice specialist (laryngologist, not just a general Ear-nose-throat doc). Be sure you get the type of exam called "video-stroboscopy" where your vocal folds are seen on a big video screen and in slow-motion. If you're in the USA, here is the best list I know of, for voice clinics where the folks know how to take care of singers: http://www.gbmc.org/home_voicecenter.cfm?id=1551 I could make guesses about what would be helpful to you, but really it starts with a good diagnosis. Save, borrow, beg, travel, do whatever it takes to be seen at the right kind of clinic. Anything else is a waste of time and money and will just keep you frustrated. wishing you the best - Joanna
  13. Hi - As a speech pathologist (& singer) I have worked with a good number of people with "collateral damage" to the voice from thyroid surgery. One of the vocal nerves is located right under the thyroid gland, so even though surgeons generally take care to protect it, sometimes there is unavoidable damage. Usually the nerve is just bruised or stretched and it WILL eventually recover -- but recovery takes time, months, up to a year, because the cells just grow back very slowly. If this kind of problem occurs, the voice is typically weak, effortful, breathy, and/or restricted to low pitch range. In most cases, speech therapy with a voice specialist can be of great help. I have helped people to regain full voice use including falsetto/head voice. So YES there can be positive recovery. BUT one must be very patient. If thyroid hormones are also unstable after the surgery, it can be tricky to figure out what symptoms are caused by mechanical changes (nerve) versus chemical (feeling depressed or not-like-myself). Or, a temporary hormonal depression can increase worry and blues about voice changes even if both will prove to be temporary. Occasionally the nerve is permanently injured. Much depends on individual anatomy, and the detailed "geography" can't be known until the surgery is underway. so your friend needs to know this is a possibility -- but not the most likely outcome. Strongest recommendations are to be sure the surgeon knows that she is a singer and that preservation of the laryngeal nerve is extra-extra important; consider getting a second opinion about the necessity for having surgery; and start NOW identifying a voice-savvy speech therapist who can provide rehab after the acute post-surgical period. If I can help in any way, please feel free to contact me directly: joanna@voiceofyourlife.com all the best to you both -- Joanna Cazden
  14. Hi - These changes are not just due to weather! Singing better after a really long warmup or a day of heavy singing is not a good sign; when the voice is healthy, 5 minute warmup should be enough to stretch things out & get you mentally prepared to work on songs. Pain in tonsil area might be related to the voice (muscle strain as your voice mechanism compensates for whatever is going on with the cords; or a sign of infection, or neck strain), but most likely it's a separate problem. Nodules and other specific injuries to the vocal cords don't typically hurt in a sharp/local way, but the muscles in the area can get achey. I would strongly recommend that you see a GOOD larynx doctor as soon as you can, and in the meantime rest your voice when possible. Its also better to tolerate the cracky-unstable sound rather than squeeze and push past it, unless you're being paid a lot!! Continuing to sing around the problem will only make it worse, and you'll have to unlearn all those muscle habits down the road. To find a USA clinic, with throat doctor and voice therapist working together, I like this list: http://www.gbmc.org/home_voicecenter.cfm?id=1551 cheers - Joanna
  15. Hi - I'd be more than happy to consult with you, I see folks in Burbank (singing studio environment) and at Cedars-Sinai (outpatient clinic, takes insurance, just need your ENT to send a prescription.) Email me privately and we'll figure this out. Joanna
  16. There are some infections that create this kind of soreness in the mouth, Possibly something fungal, especially if you've taken antibiotics repeatedly for the sinus issues. You'd feel the pain every tie you swallow, & worse when food ha sharp edges (crackers, chips, toast) or is strongly flavored (spicy-hot, or very sour). Please see an ear-nose-throat MD and tell them that you're in pain -- federal law requires people to take pain complaint seriously. If one MD doesnt seem sure of what you have, ask for a referral to another. Joanna
  17. hi Everyone, just want to give a shout-out announcement that my book on self-care & voice repair, new edition, is available from Hal Leonard publisher and on Amazon. "Drawing from her experience as a singer, theater artist, and a licensed speech pathologist who has treated more than 1000 voice patients, Cazden integrates up-to-date medical information with common-sense suggestions and a clear understanding of the demands of contemporary life. Chapters on food and drink, cold remedies, loud parties, fitness routines, and when to see a doctor are complemented by notes on alternative healthcare and the spiritual side of vocal rest." FMI : www.tinyurl.com/everyday-voice-book Lets stay healthy out there! best regards, Joanna
  18. Steven - 6 weeks of absolute rest is considered extreme by the ENTs I work with; and is rarely possible for people with jobs/kids. Very conservative use—no singing, quiet talking <50% of normal amount—combined with careful therapy can usually resolve nodules in about 8 weeks if they are caught early. One of my jobs as therapist is to "negotiate" what works for each person, prioritize usage while reworking technique. People I've seen whose MDs recommended—or who put themselves on— weeks or months of total rest, can develop a set of secondary problems, the "if I use it, it will break" syndrome. For sure, patterns of care do vary from place to place, and each MD has the last word in each individual case. I just don't want people to avoid going to an ENT for fear that they'll be told to do something impossible! regards, Joanna
  19. The best way to check if your voice is alright is to see a voice doctor --true specialist--who can look at your vocal cords. Best referral list in USA is here: http://www.gbmc.org/home_voicecenter.cfm?id=1551 My guess would be that your coughing bruised some blood vessels in the vocal folds. Vocal fold hemorrhages are not permanent damage, but continuing to sing hard -- or even talk a lot--while you're in the midst of this is a bad idea, could lead to permanent scarring or other problems. Think of Miles Davis. This is an acute injury and you need to take it seriously. If money is a problem, call the voice clinic nearest you & find out about cash rates, charity care, whatever. Blood will get their attention. best wishes -- Joanna
  20. warning: rant coming on -- Sometimes "tension" and pain are not the main problem, but a symptom of desperate muscle-overwork, because other muscles are weak or congenitally small, and unable to do their job! Many times in my voice-rehab practice I see people who've been beating themselves up for being in pain; unwilling to seek even 'alternative' health help because of the cultural meme that muscle problems are our own damn fault. Singing teachers will too often compound the problem, telling you to "relax" but not able to actually trouble-shoot and rebalance-forces of the muscles involved. Things to try: chiropractice work on the neck; deep-tissue (myofascial release) work on the neck and jaw; a thorough oral-motor exam by a speech pathologist (like me), or physical therapy. The last two would need a referral from an MD, but most MD's will say "huh? no clue" and happily send you on to speech or physical therapy if you ask for it. Unless you're in a big city there may not be a really good "detail person" ... and yes, I know that money is always an issue and healthcare financing sucks. The first step though is to let go of two things: personal self-blame for your suffering; and anger at the systems that haven't yet helped. Back off of exercises that hurt (if lip trills make jaw ache, do tongue trills or kazoo-through-a-straw instead. Same physics, same vocal benefit.) then start saving money & figuring out who can help you. You're human, you deserve it.
  21. Hi Carney: I posted a blog in TMV on weight-training for singers. http://www.themodernvocalist.com/profiles/blogs/weights-amp-measures Jeannie Deva also has one on exercise tips generally. You might like my new book, "Everyday Voice Care" (http://ow.ly/dzfOF) which has a full chapter on food and another on exercise -- not weight-loss specifically, but things to keep in mind to treat your voice well when making choices in these other lifestyle areas. cheers -- Joanna
  22. When folks at my clinic complain of a shart throat pin that seems to "cut", slice, or feel like sandpaper: culprit is usually acid reflux and/or neck tension. Rigidity and muscle-fiber changes in the support muscles at sides of the neck ("lateral straps", scalenes and sterno-cleido-mastoid, to be precise) can trigger what is called "referred" pain inside the throat. Alternatively, you might have a fungal infection (treated with swishy mouthwash, by prescription). See a laryngologist when you can, (a real voice expert, not just run-of-mill ENT) and meantime try to stretch-and-relax both internal and external muscles (yawn, jaw & neck massage, chiropractic or other bodywork.) hope this helps --
  23. Kuroneku: in my experience, cracking in the midrange typically correlates to chemical changes in the vocal cords, such as reflux irritation, dry environment, or side effects of drying medications (like allergy pills). Nodules might be present but would more typically bring a husky-breath sound quality throughout the range, plus loss of high notes and general flexibility. the cost of a voice exam in L.A. varies widely. You can contact me off-list for suggestions of MDs; I provide voice therapy in two LA-area offices and am acquainted with a number of good ENTs in the area.
  24. Hi from your friendly speech-pathologist-for-singers: If there were a true spasmodic condition, the ENTs would have seen it. When I hear this kind of description, it often goes with a feeling of dryness in the throat that is NOT relieved by drinking more water. If you've started taking a medication (for some other condition) that brings dry-mouth as a side-effect, the same effect can make the vocal folds creaky and less reliable. Try adding humidity to your environment (vaporizer or humidifier, or even potted plants); see if you sing better in the shower (Steamy!); and try some of the Biotene line of mouthwash etc products, which help throat "hold on to moisture." For instance, gargle with it right before you sing & see if perhaps voice lasts longer. Mucinex might also be helpful, as it adds lubrication to the throat, but you need to drink extra water while you're taking it. These products are non-prescription and quite safe. Hope this helps -- jc
  25. someone looking in your throat with a flashlight will see NOTHING useful. This could be anything from a pulled muscle (yes, the teensy little guys that pull& stretch& close your vocal cords can get sprained like any other), to a weakened nerve, to a small hemorrhage (broken blood vessel) on one cord, or a dozen other things. All sound scarier than they are for the long run, but in the short run (next few weeks) it is imperative that you sing/talk very little and lightly, and get to the best throat doctor you can afford. You might gradually recover without medical help/rehab, but there is a huge risk of making things worse by learning subtle compensations in your technique, so that you limp through summer gigs but face a much bigger set of problems (aka career crisis) later on. If you are in North America, please visit the national voice referral database to find a singer-friendly clinic. http://www.gbmc.org/home_voicecenter.cfm?id=1551 Everyone else - bookmark that page! best regards & please take good care, TMV's voice/speech therapist.
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