The Voice, Day 1

What happens when the fat lady can’t sing anymore?

Never mind “The X Factor.” What if there is no vibration of the two little pieces of cartilage (vocal cords) that transform air into sound?  

Many famous and not-so-famous singers and voice users have had their enjoyment of singing and speaking halted, or stopped, due to various forms of neurological dysfunction of their vocal folds.

And it seems I am currently one of those people.

February, 2013

So, in Dear Diary modern form, i.e., the blog, I am sharing this part of my life’s journey from a personal and medical perspective, with the intent that someone out there will be helped.  Stories help.  Stories heal.

“I am sitting on the Washington, DC subway, headed downtown to my otolaryngologist’s office on K Street.  I have been in denial for many years about the decline in my ability to sing, but it isn’t as if I haven’t tried to do something about it:  I stopped singing professionally in about 2008 , but continued studying vocal technique, not only with my primary teacher (who recommended an ENT evaluation years ago,) but in consultation with other teachers,  earned a certification in Somatic VoiceWork-tm-The Lovetri Method, studied Somatic Education, and, of course, continued to work as a teacher of singing and voice trainer myself.  Recently I began going up to New York City to work with singing voice specialist Jeanie Lovetri who suspected a vocal fold paralysis of some degree and recommended I see qualified ENT as soon as possible.

Yesterday, after I go through my whole history, Dr. B asks why I have waited so long and  haven’t come in sooner.  What comes out of my mouth surprises me.

I say, “I guess I was afraid of what we would find out.  And I am such a control freak with so little trust that I thought I had to fix it myself because it was something I SHOULD be doing and SHOULD be able to fix myself.” This year has shown me this aspect of myself over and over.   I am learning the hard way how to receive help, how to embrace my most vulnerable places.

Test #1 is a laryngoscopy.  Anesthesia is sprayed into both nostrils and a flexible fiber optic camera is threaded into one side of my nose and down the throat to view the vocal folds as they vibrate. It’s not pleasant, but it doesn’t hurt.   A wide-screen TV is right in front of us, and we can see those juicy little cartilages as I try to phonate various vowels and pitches.

32 years of studying vocal pedagogy lets me know the gist of what we are seeing.  My heart sinks.  Dr. B. looks thoughtful.

Test #2 is conducted by the speech pathologist who works with Dr. B.  I am taken into a tiny room and fitted with a mask with rubber casing over my face.  There is a little plastic tube that goes under my tongue, and I proceed to make a series of “P” and “Z” and “Hiss” sounds to measure air flow, lung capacity and other things.   Then the mask is taken off and I speak and try to sing into a microphone.

The mike picks up signals which are translated to graphs on a computer in front of me.  There are blank spaces on the computer graph as I try to phonate.  The speech pathologist looks thoughtful and scribbles many notes and numbers.

Test #3 is a royal pain in the ass which traumatizes me for the rest of the day.  I’ve forgotten the name of it. Anesthesia is inserted into my neck via a needle, as the neurology that Dr. B needs to test is close to the surface of the neck skin.  He reclines my chair.  Then, he feels my throat and marks little x’s with a pen on the skin.   After a few minutes, a needle is inserted directly though the skin into my neck and there’s a lot of pressure and a stinging pain, and I am supposed to make vowel sounds at various pitches.

He takes his joy stick out of my throat and proceeds to insert it in and out 6 more times.  Hey, I am trying to lighten up the mood here.

I’ve developed an attitude towards medical procedures over the years that helps. I imagine everything in the room, all the instruments, the people, the equipment, bathed in white light.  I remind myself that it is all there to help diagnose and heal, and that God is always present. It is all there for Good. I force myself to breathe low and easy.  And then I try to surrender by remembering the prayers and verses of my childhood faith.  Go under, as it were, knowing I will come back up again.

The computer translates the neurological impulses as pops, crackles, hisses and other cereal noises.   When we are finished, I sit in the chair with a wild, frozen look on my face.   The young intern standing beside me becomes distressed and asks if I am OK.  I want to tell him no, you moron, I am not.

Dr. B gives me a few minutes to compose myself before giving me the results:  the vocal folds themselves look good, but the neurological impulses from the brain to the vocal cords are not getting through. There is bi-lateral paralysis of both vocal folds. In other words, the problem is not the folds themselves, like when people get nodes or bowing of the folds, but the communication from the brain to the folds is on vacation. The range from about E-flat above middle C to high B-flat is mostly, well, gone.  Low voice is still there, which is why I can speak, and also whistle voice. He says that the dysfunction is not due to age, but was caused by any number of things, which he lists.

He orders a cat scan of the brain and neck, and then he proceeds to talk about a few options.  There is much to think about.

As I walk back to the metro, I wonder how everyone can be walking about normally when I have received the diagnosis that I intuitively knew anyway. It does not help to think, “well, at least it is not a life-threatening illness.” Yes, I can speak for now, but when you have sung your whole life, and it is your door to health, inspiration, God, community, work, communion, romance, creativity, what does it mean to live without it?

The rest of the day passes in a haze.  My throat hurts from the procedure.  A new student begins her lessons, and I manage to get through.

We have a few Percosot left over from my husband’s knee surgery and I consider taking one. But I have to be coherent in the morning for a class I am teaching so I won’t.  Although if there ever was a time to not be coherent in class, this would be it.  A bit of a pity party right now.

But Life regenerates.  That is a given.  I will continue to tell the story as it unfolds.

“The laryngeal mechanism is subject to highly complex, extensive neural control; therefore, it is not surprising that disorders of the nervous system have effects on the voice. A wide range of neurological disorders can affect the phonatory function of the larynx, as well as its role in respiration and swallowing. Except for the more common problem of recurrent laryngeal nerve paralysis and the unusual, but disabling, entity of spastic dysphonia, neurologically based voice disorders,, until recently have been a neglected topic for both basic and clinical research in the fields of otolaryngology, speech pathology, and neurology. It is now more apparent that laryngeal dysfunction is a component of many neurological disorders and should be a critical consideration in patient assessment and management.”