AND PEOPLE WONDER WHY we singers are such hypochondriacs. Our desire to sing is so strong we’ll rise up out of our graves to do it. We’ll endure low pay, tiring tours and harsh environments to do it. And when we can’t do it, we go bananas.
But, being a secretive race, we all try to hide it when we’re in trouble. Vocal dysfunction is still spoken of in whispers: “I hear she had to cancel her appearances at the Met and take six months out to have her nodules removed,” and so forth. Well, I have decided not to hide it. I’m so old now I have nothing to lose, so I am blabbing.
Every singer hits the wall once or twice in their career. Too much work, singing when it was just too important a gig to cancel, singing with jet lag (DON’T do it!) or talking on airplanes (ditto) can make you crash and burn in a New York minute. It is my fond hope that this confession may help somebody to recognize the signs of vocal trouble and to get help before it’s too late. You can burn out at twenty-five if you work at it, darlings.
I retired from professional singing in 1994. I had been having horrible 8-week colds that led to horrible unstoppable asthmatic coughs, and I was in a constant state of vocal tract distress. I was also approaching menopause, and like many women I was gradually losing my stamina and vocal strength, not to mention my mind. As I lost my chops and had to cancel gigs, I became phobic. For a while I couldn’t leave my house.
I wanted terribly to continue singing into old age, at least for my own fun. I had been examined by ENTs, either with a laryngoscope or stroboscopy almost every year, but they had no answers. I kept trying to sing with worse and worse results. I knew there was something my doctors hadn’t noticed, so I decided to be looked at ONE MORE TIME. But this time, I would sing hard before I went for my exam, so that the doctor could see me in my totally trashed state. And then of course, she said, “You have reflux.” Nobody had ever mentioned reflux before. Had I wasted precious years gargling my own digestive juices?
At Mass Eye and Ear they guarantee career singers total anonymity, and everything you do is strictly confidential. As I sat in the waiting room on the 11th floor I pretended not to recognize the other singers hiding behind People magazines. One singer said hello out loud, because he had just been declared reflux-free. He then went on his way rejoicing, and gloom settled over the room again.
My doctor was reassuring, friendly, and willing to talk the talk. He made an evaluation tape of my vocal folds. First he anesthetized the back of my pharynx (OUCH, I’ll never let him do that again! Cold turkey next time). Then he maneuvered the rigid stroboscopic camera down my throat, and I have to sing “Casta Diva”…just kidding, I just had to make various noises at different pitches and with different attacks while he took pictures of my laryngeal activity.
Afterwards, he showed me parts of the tape. I usually love watching my vocal folds fluttering away in the super-slow-mo made by the strobe. It’s really pretty and interesting. But this time, it was depressing.
“Well, you’ve definitely got reflux.”
Damn, I could see it. The area above my vocal folds is all red and irritated. Little puddles of corrosive digestive juice are sitting in there, cooking my arytenoids. The doctor continues with his unwelcome news.
“Your cords show a bit of stiffness, which I expect from somebody who has sung hard for a long time. You have some varicosities on the right fold, which is fairly common. You have a large posterior chink, which may or may not be acceptable in sopranos. But your folds are not coming together firmly enough.”
[Author’s note: many, many singers get this chink-too-big, folds-not-coming-together diagnosis at MEEI. Several people I know are convinced that when you are sticking your chin up in the air, your tongue is being yanked out by the roots, and a camera is poking down your throat, that your vocal cords don’t close very well. Who could blame them? So don’t get too upset if you hear the doc say this.]
“Could the faulty adduction be from the reflux?”
“That could be. Perhaps tissue around your arytenoids is swollen and you can’t adduct completely. On the whole, for someone your age and with your history, your vocal cords look very healthy.”
“So, fix it, fix it, fix it!”
The doctor went about fixing it, with a vengeance. He prescribed Prevacid, a proton pump inhibitor, in addition to Maalox, morning and evening and before singing, and calcium carbonate pills after meals. He told me to raise the head of my bed on blocks (Like an old car. My life is over!) at least four inches. He ordered a course of voice therapy with the famous voice and speech lab folks across the hall. Who could refuse that?
And of course, he gave me the world’s worst diet.
No coffee, tea, wine or beer. No tomatoes, no citrus, no mint, no chocolate, no greasy food, no curry, no chili, no little snacks before bedtime. No eating lying down while watching TV. No exercise after a meal. When is that?
AAAAAAGGGHHHHH!!!!!
So OK, I was going to comply. Maybe my vocal stamina would improve enough to sing for fun, and to demonstrate in lessons, and maybe give a small recital in some town library somewhere, just for my own satisfaction. Maybe. Just maybe.
I was both gung-ho and depressed when I left MEEI. Wow, maybe I’ll be able to sing a little again. And, what else can possibly go wrong with my poor voice? At least I’m going to learn new and interesting things, with me in the role of the guinea pig, of course.
Compliance was not that easy. The new drugs upset my digestive tract in unfortunate ways; I slid down to the foot of my tilted bed. I had to change the side of the bed I slept on (you are supposed to sleep on your right side to help your stomach drain into your duodenum, something it had always done without fanfare before), and my husband was even more grouchy than I about switching sides.
Without a couple shots of tea P.D. I got very sleepy and even depressed. It finally occurred to me that the antihistamine I was taking to control the veritable Niagara of my post-nasal drip made me drowsy. “May cause drowsiness. Do not operate heavy machinery while taking this drug,” so I had to go cold turkey on the antihistamine and up my dosage of nasal steroid spray to the legal limit. When I did this, some of the nausea and intestinal malaise went away. I could once again operate that earth-moving machine I keep in the back yard, and once again I could remember my phone number.
After six weeks without touching a tomato or a tea bag, the doctor saw me again and the reflux was exactly the same. Virtue is its own reward? He reassured me that different folks take different amounts of time to clear up. I was already imagining scenarios involving gall bladder surgery or perhaps corrective surgery for a hiatal hernia, stuff like that. I got quite sad, and even the novelty of being able to recall my phone number and where I lived did not assuage my sorrows. Besides, I was having lots of fun in voice therapy.
Therapy: the Early Sessions.
“All singers have reflux, you know,” my voice therapist cheerfully announces at the top of my first visit. “If you use your abs to support with, you are going to pump some acid back into your throat. I might as well tell all vocalists to just take a swig of Maalox before they sing anything.”
After this heartening introduction, she ran a series of tests on me and stuck the camera down my throat and another one down my nose (you do need anesthetic spray with this one). She made me sing and she took notes on the computer and sent me home wondering what she was thinking. Spooky.
But at our next session, we started with useful warm-ups. We did facial massage, jaw loosening and raaaaaaadical tongue stretches. We wiggled larynxes gently back and forth until I could hear mine click as it moved. She showed me neck massage, and I discovered a lot of below-decks knots in the muscles that support the larynx and pull it down.
She showed me the gratifying but painful hyo-laryngeal space massage, to stretch the muscles between my hyoid bone and my cricoid cartilage, which were way too stiff. When she demonstrated (on my, not her, larynx), I swear her fingers met behind my windpipe. Rolfing for singers. It feels so good when they stop.
Actually, I do it to my own neck now, and I like it. After you massage that space you can drag your larynx down and get a nice stretch. Don’t try this without some coaching.
Next on the menu is noticing your breath at rest, then lip-trilling (or tongue trilling for you whiners who insist you can’t lip-trill). This is the best way known to man for assuring a good firm breath-flow. We proceeded carefully to very simple vocalizing, like 5-note scales, first sliding and then with defined notes. We returned to trilling if breath flow slacked off.
We did scales and slides with my tongue sticking as far out as I could get it. It’s surprising that one can still make vowels in that position. Not the loveliest, but recognizable. And very liberating if you have tongue root tension. If you are experiencing vocal trouble, believe me honey, you have tongue root tension.
We hum. We hum and slide. We say words with lots of ms and ns and ls in them, just to orient our ears to the vibrations in the front half of our mouths. She listens for tensions while I read poetry. It’s sad poetry. I cry, because it’s sad and because I can’t sing any more.
The Crux of the Matter
Several sessions of therapy have changed my speaking voice. It’s higher and less constricted. I have begun to feel cautiously optimistic that I may regain enough stamina to sing some songs somewhere. I believe I am stronger. I have more fluidity in my sound. The therapist gets me singing upward arpeggios. She likes the freedom in my sound. She says it sounds beautiful. We vocalize up to a B natural. I lose my voice.
The therapist is puzzled. She thinks maybe my cords have swelled up. She starts to tinker around. Maybe a little more breath, maybe a little more light mechanism, maybe a hair less this, a smidge more that. I get angry and sweaty trying to thread all these needles.
“You know I can’t sing like that! Every sound I made before I crashed was a sound I would have used in a recital, on purpose. They were all within the parameters of healthy vocalism!”
“I know, I’m just casting around for ways to maximize what you have—you sang about ten minutes and then got hoarse, right?” Let’s strobe you before and after next time, and see what we can see.”
“Are you beginning to think that this is all psychosomatic?”
“No, really, it’s physical. I just don’t know what thing or combination of things—the reflux, the allergies…”
“And don’t forget the estrogen. I’m on the minimum dose. Maybe it’s not enough to sing on. It’s barely enough to flirt on.”
Yes, Virginia, estrogen is important in soprano singing. I hate to mention sex in this heretofore sober article, but voice is a sex-linked phenomenon. Boys sing way down low and girls sing way up high, because of hormones. If a woman ingests testosterone, her vocal cords thicken, and her voice drops—permanently—into a raspy growl. Stay away from the stuff, girl singers. It’s death.
In middle age, women’s estrogen levels drop. Singers are advised to take estrogen replacement or hormone replacement therapy if they wish to continue singing. Because of the risks of breast and ovarian cancer, the lowest possible doses are given, enough to prevent hot flashes and bone density problems. [editor’s note: future article on the topic of hormone replacement therapy will present new studies that show evidence to the contrary.] These doses may not be enough to maintain one’s voice, and dysphonia and lack of stamina can result.
I attended a NATS conference at which Dr. Jean Abitbol (France) gave a paper on this topic. It was the first time that many of us had heard about estrogen and voice. I can tell you there were a lot of surprised middle-aged ladies in that room. The angry talk and the weeping went on for the whole conference. Why weren’t we told? Because nobody really knew until recently.
Will The Faded Queen of Song Find Happiness Singing Easy Repertoire in A Church Basement?
Stay tuned! Watch this space to see what happens to me next! Even I don’t know what happens to me next. I get so interested during all the sessions I have had at MEEI. It’s quite exhilarating to mess around with your voice and their electronic toys. But my trip home is always haunted by sober thoughts. Vocal health is not within my reach. I still get laryngitis after 15 minutes, even when I am functioning well, and my clock is ticking.
The Strobe Again
My therapist got permission to play with the strobe equipment during my next visit. We did a baseline “before” tape, singing low and mid-high notes, and my closure looked good. No chinks (there goes the popular theory). Then we did warm-ups throughout my range. After that she left me to trash out during ten more minutes of vocalizing. Then, when I was pretty husky sounding, we went back to the strobe and did the same experiment on the same pitches to see what differences there might be.
She was looking for edema, extra fluid and puffiness in my vocal folds. But there wasn’t any. Then she came to attention; I could tell, even though I had assumbed the rigid strobe Position- leaning forward, chin up, head back, tongue held out of my mouth by a firm and unyielding therapeutic hand.
“Interesting,” she said, and stared for many seconds at the screen.
“EEEEEEEE,” I said. “EEEEEEEE”
She was lost in thought, still clutching my tongue, which I really wanted back. I waved my arms to signal pain and distress, and she let go of it.
“Look here,” said she. “The right fold isn’t working as hard. It’s not meeting the left one in the center. The mucosal wave on the right one seems to stop in the middle near the varicosity.”
“Oh Lord, you think the red hickey is where the weakness is?”
“I don’t know, maybe.”
I went home. I felt as low as I had felt in all this process. It’s the injury. I am permanently crippled. I thought of other things to do to replace singing in my life. Basket weaving. Water color painting. Perhaps knitting potholders. Let’s face it, darlings, if you have sung and transcended yourself singing, nothing else compares with it. Then I thought about my grandchildren and family and felt a little better. Life is about working with what you have left, I reminded myself. It sort of helped.
Diagnosis Again
My therapist put the DVD in her computer. She had reviewed it with my doctor. She showed me my vocal folds in stop-action. “Your arytenoids are doing their job. No big posterior chink, see? But look down here (at the thyroid end) how your right cord is almost bowing? It’s flabby. The doctor thinks this is a motor unit failure. Either a neurological signal is not coming, or the muscle is not responding to the signal.”
“So the red hickey is not the culprit? This isn’t because of trauma?”
“No, this may be like muscle burn-out, or it might be, as I said, neurological.”
“Rats. And it’s probably not fixable, right?”
“Probably not. I’ll give you the Stemple vocal function exercises (VFE) to see if they can help balance the action of your folds. Bulk up both muscles equally. Sometimes we get great results with this. If you were a speaker only, you probably wouldn’t notice the difference, it’s so subtle. I would also like to continue working on some of your compensatory tensions. But try this regime and we’ll see if we can get better performance.”
“Great news,” I said. The handwriting was plainly on the wall. My nose began to run, and my larynx doubled in size and was struggling to get out of my mouth.
Nevertheless, We Soldier On.
The Stemple exercises are to improve thyro-arytenoid muscle function. They are done softly (because as any singer knows, soft singing is more difficult and gives the muscle a more refined workout. Two of them involve singing for as long as you can, say 40-45 seconds, on low-middle notes. This exercises the TA muscle. Then there are TA stretches, where you slide up and down your range on a kazoo or lip-trill sound. You have to monitor for wavers, breaks, and breathiness.
This technique has also been used to improve vocal function in normal healthy voices—that of course would be you, you lucky bum—so I will describe them. They make good warm-ups if you find yourself in a place where you can’t yell, like for instance backstage—or onstage for that matter. There are four, and they won’t give you brain cramps.
Sustain an [i] vowel on an F-4, above middle C. Men, an octave lower. You can change the pitch up or down one or two notes if you need to, but F-4 seems to be the blessed note. You sing as softly and as thinly (like a mosquito) as possible, with a touch of twang and no breathiness. Time your sustained note, which should be 30 seconds or more. Do it again.
Glide from your lowest note to your highest note on the word “Knoll.” A very closed [o] in other words, with a little “kazoo” buzz of air on the lips. The goal is no breaks. If you break, keep gliding on up. The glide uses all the laryngeal muscles in an isometric way. You can do this on a lip trill, tongue trill or the word “oops” if you get bored. Two reps.
Glide from highest to lowest on the word “knoll”—or “boom” lip trill, etc. can be used. No breaks again. Keep your pharynx open, no constricting, need I say? No growling or frying on the bottom. Downward glide brings about a gradual engagement of the TA muscle. Two reps.
Sustain the notes C, D, E, F and G, softly as long as possible on the vowel of “knoll” [o]. Small mouth opening, big not-constricted throat. Two reps. Time it and keep records. This is an adductory power exercise. Even though it is done softly it is quite strenuous. Two reps. Monitor for breaks, wavers, and breathiness.
Now that I am in this sort of didactic mode, I also want to mention Larson’s rules for healthy singing, which I have stolen from various sources over my years as a teacher and performer.
The Sparks Fly Upward
So I did the VFE exercises. I can’t say I did them religiously, because I was so down in the dumps. Singing has always been such a source of happiness for me, and doing nothing but kazoo buzzes and mosquito whines sent me into a tailspin. I could hear myself getting husky doing the damn things.
When a singer loses his or her voice, for whatever reason, permanently or temporarily, it feels as if it will never come back, and it was never there—no, I never did sing, I can’t sing now, and I never will sing. Talk about living in the moment. Another reason why we are so good when the spotlight is on us, and so gaga when we are indisposed. Now after several years of wondering, I know that it’s over, it’s really over.
I wander around some days feeling empty, wondering whether to bag it, or keep trying, holding on to the last filament of hope;, and wondering who am I anyway,, and do I still want to teach if I could barely use my voice for modelling or demonstrating? Will I teach my students to sing lop-sided?
I had my penultimate session with the therapist where I tried to sing, but my voice gave out like wet tissue paper early into the hour. I lost all my will to continue. I lost all my will to take the last session, although my HMO approved it. For that reason alone I should do it, I guess.
Well, at least I have my memories. Old press clips, photographs of when I was thin, and so forth. I have a family and grandchildren. I’m not starving and I’m not freezing. Who is going to feel sorry for me but me?
This is a test. Can you sympathize? Light up your collegial empathy centers, and I’ll tell you one last story.
A fellow journalist told me this one. She was conducting an interview with a famous singer who had retired and gone on to be a successful teacher, lecturer and administrator. “Do you still miss singing now that you have moved on?” my colleague asked.
The diva’s eyes filled. “I miss it every day. Every hour of every day.”
Sing while you can, darlings. Take good care of that nice thing you were given. Share it around. Do these things with joy and love and gratitude. Because you never know.
Love to all,
Susan.
