My Journey With a Vocal Bugaboo: Ranitidine, PPIs, Misogyny, Oh My!
Disclaimer: I am not a medical professional, nor am I a speech-language pathologist. This is simply my experience with a voice issue and my own journey with medication and voice therapy, and should not be used as a diagnostic tool. Always consult a medical professional and/or an SLP if you are having issues with your voice.
I've been working out fairly regularly, and it looks like I've done something funky to my wrist. I imagine it's a repetitive motion thing, so now, whenever I'm in a plank/pushup position or I hold a dumbbell in a certain way, it doesn't feel great. The pain's been lingering for a couple of months now, so I figure it's high time to see a sports medicine doctor, where I'll hopefully get some stretches and some tips on how to soothe the inflammation, and maybe some advice about tweaking my form at the gym so that this doesn't happen again. No big deal.
But what if it was a vocal injury? There seems to be this unspoken rule that one has to be cautious about seeking out professional help because you don't want anyone to find out that you're having problems with your voice, because that means you have bad technique and that you can't actually sing, right?
I balk at how absolutely unfair and inaccurate that is. Cue eyeroll into another dimension.
I've had my own experience with a mysterious vocal issue, and while the journey itself wasn't exactly a blast, I learned a lot about vocal hygiene, healthy habits for your voice, and I've also learned to eschew the totally BS stigma that comes with admitting that there's something going on with your voice, and that you're going to see a voice professional to get it sorted. So, buckle up - here's my spiel.
About halfway through the first year of my Masters degree, I started experiencing this weird and uncomfortable feeling of a lump, or something poking me on the left side of my neck. At first, I just ignored it and figured I was probably practicing a bit too much (I didn't really have much else to do), but it persisted, and started getting more and more uncomfortable, even painful at times. The good news is, it wasn't affecting my sound, so it likely wasn't a problem affecting the vocal folds themselves. The bad news was it made singing extremely uncomfortable and put me in a psychological mindset where I was dreading opening my mouth to sing because of how uncomfortable it would be. I spoke to my voice teacher, who was resoundingly supportive, and I started booking appointments with ENTs so that I could get a vocal scope and see if there was anything of interest that might lead to a proper diagnosis.
I saw two ENTs. The first one scoped me and told me my vocal folds looked fine, though "had a bit of a white coating", which led to the garden variety diagnosis of acid reflux. I diligently took the meds and made necessary dietary changes, hoping for improvement, but came back in a month with absolutely no changes. I was prescribed stronger meds (proton pump inhibitors) with, again, no improvement. I went back for the final time and was told that I should maybe see a psychologist to deal with the "anxiety around this issue". Now, don't get me wrong - I will gladly take free therapy where I can get it. However, it looks like the extent of this doctor's diagnostic capabilities was either acid reflux or mental illness, and that seemed a bit too myopic a scope for me (not to mention offensive!), so I quickly moved on from that doctor.
The second ENT told me that I had "forward head posturing", then left me in a room alone to click through a PowerPoint slide about - you guessed it - reflux (what is it with everyone wanting me to have reflux?). After they came back from what I presumed was a coffee break, they tried to sell me their book, which I politely declined, and I got the heck out of there. A truly riveting experience.
Eventually, it occurred to me that I should be speaking to someone who understands the demands of a professional voice user. It's one thing to understand the structure of the vocal folds - how they should ideally look, anatomical variations, potential pathologies - but it's another to really understand the function - how is this person using their voice, what are their vocal demands, what are their daily habits that they integrate into their vocal practices? So, that's the next step I took: I sought out some speech-language pathologists.
It wasn't exactly easy sailing from the beginning. I had one SLP literally ask "Are you sure you just haven't broken up with a boyfriend or something?", which, no, I hadn't, and also, maybe consider for a hot second that my "fragile feminine" emotions just very well might not be to blame for this. However, there were a couple of SLPs I saw that, while they couldn't exactly pin down the problem, gave me SO much extremely valuable info on how to cultivate the most optimal, efficient, and secure instrument I possibly could, despite my annoying symptoms.
I learned about systemic vs surface hydration, and how to keep those vocal folds lubricated in a myriad of ways. I learned a TON about my absolute favourite thing in the world: semi-occluded vocal tract exercises. I continued to learn WAY too much about reflux, but this time in a gentle, non-judgmental way. I learned about intra-oral jaw massage which hurts in a way that makes your entire life flash before your eyes, but works a world of wonders on releasing jaw tension. I learned about portable nebulizers (which have gotten SO fancy and sleek and sexy these days!), portable steamers, how to do straw exercises correctly, doing warm-ups and cool-downs above and below fundamental speech, and the best way to build healthy habits on both the days you have to sing, and the days you don't have to sing.
All of that information above has worked wonders for me in being able to confidently take care of my instrument and get a good gauge on when something feels right vs. when something is wrong. Throughout all the thinly-veiled, kind of incredibly sexist comments, the dismissal, the condescending pats on the head, it almost didn't matter that I didn't have an official diagnosis (and to this day, still don't). Things started to get better the more I upped my vocal hygiene, and my mind started to relax a bit too, knowing that I had tangible tools I could use to help up the ante of my vocal performance and protect myself from further vocal harm.
Eventually, after months and months of discomfort and pain, the weird lumpy sensation subsided. However, it did make an unwelcome reappearance when I flew back to Vancouver last week, and the lump mysteriously hung around for a few days. I'm not sure if it's just the way I was sitting on the plane (with my jaw clenched so tightly it could have shattered concrete), or if I'd slept funny, but it was such a strange thing. After years of relief, it reappeared out of the blue, back in the environment in which it had first appeared. Only this time, I was prepared. Some gentle stretches, lots of hydration, and keeping my vocal use at an everyday, neutral level was enough to send it packing again.
So now, you must be asking: "Well, Thera, that was a really long-winded and somewhat convoluted story you just hammered out. What is the takeaway from all this? Was this just an excuse to whine about incompetent medical professionals in the field?"
...Only a little. The main takeaway is this: there is NOTHING to be ashamed of if you're having trouble with your voice and you feel like you need to see a professional to help you out. And the best, most empowering, and most informative way for me personally to do that has been to enlist the help of SLPs, trusted vocal coaches and teachers, and a strong support network of friends and family. I learned so much about my own instrument through my vocal bugaboo, and while the experience itself sucked majorly, I am truly grateful for the knowledge I've accumulated.
I know this comparison has probably been way too overused (and is a little elitist in my opinion), but I'm going to do the whole pro/Olympic athlete and opera singer cliché. Opera singers (and any pro singers, in my opinion) sing at an extremely high level. Opera singers in particular rely on our teeny tiny vocal folds creating some massive sounds. We aren't amplified, we move around the stage like we're being paid for it (and hopefully we are!), we sing, act, sometimes dance, do quick changes, and make it look effortless. We are as tough as it gets. Many describe opera singers as the Olympians of singers.
The thing is, Olympic athletes have an entire team of resources around them, constantly. They have coaches, personal trainers, dieticians, sports psychologists, sports medicine doctors, you name it. And if someone gets hurts, we don't typically say things like, "Well, they must not have been a very good player if they tore their ACL, maybe their technique is just kind of shoddy, right?" I would venture to say that, typically, we feel bad for them, we support them, and we wish them a speedy recovery, and their cushion of support is right there behind them, leading them towards the best and swiftest healing possible.
The over-arching attitude I have heard surrounding singers who get vocal injuries is that they "don't have very good technique", or that "if they were better singers, this wouldn't have happened", which is about the most unempathetic, hoity-toity, judgmental hooplah I could ever imagine. We singers strive for mastery of the coordination of these miniscule muscle groups that are often being pushed to extremes in order to make the sounds we do, and we have the audacity to blame it on the inherent ability (or apparent lack thereof) of our colleagues? That does not, and has never, sat right with me.
This is a fundamental rhetoric that needs to change, in my opinion. If your colleague is hurt, support them. End of story. If they have things that they might consider implementing into their vocal technique that might help to mitigate vocal stress, then that's great! I think we all do. But vocal injuries don't necessarily occur because someone isn't "using their voice properly". Some people have predispositions to injuries (especially with hemorrhages, if there are susceptible blood vessels in the folds themselves, which is literally GENETICS, mind you). Some people work jobs where heavy voice use is required, and sometimes it's a freak accident that just happens out of nowhere and is totally unpredictable. None of these things make you a bad singer, and they certainly don't mean that you deserve to feel ashamed and too afraid to seek out help for fear of what your colleagues and professors/mentors might think.
Vocal injuries suck. But they are normal. Just like a torn ACL, just like a sprained ankle, just like a broken finger, a concussion...whatever happens out there in the world of sports. The difference is how we address these injuries. Do we do it in a way that's degrading, blaming, condescending, and invokes fear-mongering? Or do we come at it from the standpoint of compassion, empathy, a listening ear, and a focus on the fact that these things happen, and are certainly not career enders, and that things will get better? I happen to like that last option a lot better.
It's OK to be injured. It's OK to feel scared. It's normal, it happens, and there are solutions. It might be a scary process, but there are excellent voice professionals and resources out there, and you will learn a TON about your own voice and your own artistry. You are a valuable singer, and you belong here. Now, go have fun with those SOVTs.