There is Beauty in the Vocal Breakdown. Reflections for World Voice Day.

April 16th: World Voice Day. This is a very important date that I mark on my calendar every year. World Voice Day was initially created to help raise awareness for laryngeal cancer, and how to notice symptoms for early detection. Being a trained classical/opera singer, private voice instructor, music educator, and an in-training vocologist, and aspiring voice therapist this day is a huge celebration for me. The human voice is a wonderfully unique and beautiful quality that every human possesses, and no two voices are alike.

This year I find the celebration of this day particularly important. Why?.... one might ask. Back in November of 2016 I was doing a heavy amount of singing. I was a featured performer on a colleagues masters recital, holiday caroling rehearsals and gigs were in full force, and I was in the midst of preparing new repertoire for upcoming events/gigs on top of teaching private lessons and my weekly church job. Being a working singer for a good portion of my adult life this type of vocal work-load is quite standard. About a week before my dear friends graduate recital Southern California decided to unleash a "wonderful" Santa Ana winds (or lovingly referred to "The Devil Winds") weather event. Now, for those of you that do not live in SoCal, a Santa Ana wind event features strong, extremely dry winds that originate inland (the desert), and affect coastal Southern California and northern Baja California. The winds are specifically known for producing extremely hot dry weather.

As a singer, I find these winds rather unfortunate because my allergies begin to unleash a furry of symptoms that cause my vocal cords to become extremely dry, which in affect make it difficult to sing well. Typically, during these times, I practically live hooked up to my personal facial steamer and my Alkalol (nasal rinse), which make my husband think I have officially stepped off of the reservation. The joys of being married to a singer. Unfortunately, during this Santa Ana event I didn't steam and nasal rinse like I usually do because I became sidetracked with rehearsals and life.....and I just plain forgot. Life has a way of getting in the way sometimes. I hate that, don't you? Sadly, I wish that I had a better reason, but I do not. I thought that I would be O.K. as I have always been so careful and vigilant in the past with my vocal health and maintenance....

However, I digress. Lets get back to that week before my friends recital. We had a dress rehearsal call in the evening which was scheduled after a long day of teaching for me. I was feeling vocally fatigued, and when I was warming up before it was time for us to sing my cords felt really thick and heavy. This did give me a cause to pause because I knew that something did not feel right, but there wasn't pain, excessive aspiration in my sound, and I had just finished a really long day of teaching, which can definitely make one vocally tired. But it was really taking a whole heck of a lot of effort to sing on the level which I normally can. My friend and I were performing a Bach duet (not easy music) which was only about 5 minutes in length. I thought, Ill be fine!....and I thought I was until I woke up the next morning with extremely swollen vocal cords, and a sore throat to the point where I could barely speak. Naturally, being five days away from a scheduled performance I was very concerned, but I have had bouts of laryngitis in the past. So, I did what any singer would do: gargled with apple cider vinegar and salt water, steamed until I could steam no more, and went on vocal rest as much as I could. This regimen continued for another day with no sign of improvement. On Tuesday evening I started to become quite concerned as the recital was on Friday. The dreaded day was slowly approaching, and this little voice in my head kept saying "what are you going to do?!?"

I called the only laryngologist in Los Angeles that I trust with my voice and vocal health; Dr. Reena Gupta. She is the best of the best, and I have had the pleasure of meeting her at a few vocal workshops in the past. I frantically called her office, and explained to the front desk assistant that I NEEDED to see Dr. Gupta as soon as possible; it was an emergency. Thankfully, she had an opening, and before I know it I am in my car driving 2 hours up to her office in horrid LA traffic.

I walk in and I am a bundle of nerves. Nervous because I don't know what she is going to find, what am I going to tell my friend, and if she prescribes me the controversial vocal steroids: should I use them? A million thoughts running through my head make my five minutes waiting in the waiting room feel like a life time. And I can barley speak. Finally, I am called into my patient room. The vocal nerd in me is having a field day looking at all of the medical eqiupment for the voice, and being really intrigued by all of the state of the art machines. Modern medicine has come so far for the voice in past few years, and these machines provide a temporary respite from the anxious thoughts that have been swirling around in my head. Dr. Gupta comes in, and she is as warm and pleasant as ever. Her demeanor is always on point. I struggle to voice (no pun intended) my symptoms to her, and I try to pathetically phonate sounds to demonstrate my vocal cord swelling. I can see on her face that it was not good. We do a laryngeal stroboscopy exam to see exactly what is going on.

A laryngeal stroboscopy exam is a special method used to visualize vocal fold vibration. It uses a synchronized, flashing light passed through a rigid telescope to capture an accurate and clear picture of the vocal cords. It is inserted through the mouth, and localized anesthesia is sprayed in the back of the throat to numb the area in order to dull a patients "gag" reflex. It is more accurate, and effective than a flexible laryngoscopy. A flexible laryngoscopy is an examination that provides a magnified view of the voice using a flexible viewing-tube passed through the patient’s nose to the back of the throat, thus allowing the examiner to view the vocal cords while the patient speaks, sings, coughs, sniffs, etc. Typically a flexible laryngoscopy is what I have done in the past when going to an ENT for allergy complications, and is lovingly referred to as "getting scoped" in the singer community. Both of these vocal exams record the images on video so the doctor and patient can view them after the examination. Usually during the exam I am so focused on having something up my nose, or in my mouth and trying not to regurgitate on my doctors hand, that I am not even looking or paying attention to my voice.

After the exam is completed we go back and look at the images captured. To my surprise we found a small hemorrhage on my right vocal fold. The dreaded word hemorrhage was spoken, and I felt like such a failure because how could I have allowed this to happen? I am supposed to be a trained and knowledgable singer/voice health enthusiast after all! Dr. Gupta could tell I felt badly about this, and she helped me process this information. Her medical opinion was to not sing or talk for at least five days in order to fully clear up the hemorrhage.

And I cried "what about my recital engagement on Friday?"

"Is it a career changing recital?"

"No" I mumbled.

"Than, do not sing." she answered.

That was it. The awful news that I was dreading to hear stung as I let the reality of the situation sink in. I was overcome with emotions. Feelings of fear as a vocal hemorrhage is no joke, and can be quite serious if not handled properly. I was also feeling extremely guilty for having to cancel my involvement in my friends recital after we had spent so much time rehearsing the music ,and it was for the completion of his master's degree. Dr. Gupta could see that I was really upset, and offered to write me a prescription for vocal steroids to use up until the evening of the performance in combination of vocal rest so I would could sing the duet. Followed by an additional 4-5 days of strict vocal rest.

"Even though I wouldn't recommend this path as it is not a make or break moment in your career." she advised.

I knew deep down what I needed to do. I sent a text message to all appropriate parties involved, and waited with anticipated nervousness for their reply. Waiting anxiously for those three dots to appear after my text of ill-timed news was delivered. Luckily, everyone was very supportive in my decision, and made my entire experience of having to pull out of a performance really painless. This was the first time in my entire career that I have ever had to cancel due to illness or injury. My eternal thanks still goes out to my colleague and professors for their support and understanding. It is really important for a singer to feel supported during a time like this. Too many singers do not receive this same support, and are made to feel so guilty about canceling that they push themselves to sing when they know in their heart of hearts that they should not...

So, now what? Braced with my pen and paper, and perfecting the art of speaking with my lips with no sound and using my hands for expressive embellishment: I was ready to take on the next week of operation: The Voiceless Woman. I felt like Ariel from the little mermaid. For the next two weeks I pretty much made best friends with my couch, and watched full seasons of shows on Netflix, knitted up a bunch of holiday orders from my little knitting business, did a lot of reading, and snuggled with my dogs. This sounds like a divine vacation, doesn't it? Not having to be out and about interacting with other individuals, and relaxing at home. Yes and No. The harsh reality of having your money-maker being out of commission is a hard pill to swallow. I had to cancel two paid gigs, all of my private voice and piano lessons, and had to find people to cover my caroling gigs and church job for the next two weeks. I also emailed the opera company that I work for, and explained that I would need to work from home for the next two weeks due to my vocal injury, and needing to be on extreme vocal rest. Ouch. Needless to say my emotions and my wallet were bruised. I mean, how's a girl to pay her bills? Thankfully, I had my husband to help me because without his support I would have been quite stuck.

While I was on vocal rest, it gave me a lot of time to think about my voice, and how fragile these tiny little muscles and ligaments are in our throat. So easily affected by multiple outside factors that are out of ones control. I was feeling quite lousy; sitting on my couch feeling mad and sorry for myself. Well, I quickly told those thoughts to take a hike....this was nothing that I did. Thankfully, my wonderful friend and old colleague Alison Thomas, who is a singing voice specialist and did her fellowship with Dr. Sataloff in Philadelphia, helped me through the most difficult time of my vocal career. She checked in with me several times during my healing period, and continually reminded me that this was not my fault, and sometimes a combination of different events can cause these types of injuries to happen. It is also important to note that I had several singer friends contact me letting me know that they were thinking of me, and checked in to see how my voice was doing. I really needed to hear this, and feel this kind of support. Singers have a horrible way of unleashing the worst kind of self judgement on themselves, and I didn't want to walk down that path. It serves no purpose.

For those two weeks I stuck to Dr. Gupta's medical advice like I was going to win an award for being the best voice patient. When it comes to my vocal health I don't mess around. You only get one voice in this lifetime, and it is irreplaceable. I started thinking about what I was going to tell my students. Surly they were all going to ask if I was OK, as I have never cancelled so many lessons in a row due to illness. How was I going to tell my students that their teacher, the same teacher who teaches them about vocal health and proper use of the voice every week, had a vocal injury? Would they think less of me as their teacher? I decided that I was going to say that I had a cold and leave it at that. But I thought long and hard about what purpose that would serve? Perhaps I could use my vocal injury as a teaching opportunity for my students, and let them know that it is not as scary as it can sometimes be, and totally reversible with the proper treatment and support. So that is what I decided to do.

After my five days of complete vocal rest, I gingerly started to talk to see if I felt better. To my happiness the vocal swelling had completely gone away, along with the sore throat, tender muscles in my neck and throat, and vocal raspiness. My voice was back! However, I did not immediately run and hit a practice room. I started to do some slides, and light humming to see the state of my voice for a couple of days. After that, I started to vocalize on a five note scale using [i], [a], and [u] to evaluate my phonation on vowel sounds. Luckily, my voice seemed to be in really good shape. Pretty much good as new.I realize that I bounced back quite fast in comparison to other folks I know that had struggled with vocal hemorrhages. For this, I was extremely thankful, and sent major love to my little vocal cords. Everyday I slowly started to sing more and more until I felt completely fine to begin singing and practicing in my normal routine. I began teaching again, and shared my story with all of my students. They were all very interested in what happened, and asked questions about the injury: what were the symptoms, how did I know when to go to the doctor, what did it feel like, etc. Really smart and intuitive questions. I wouldn't expect anything less from my students as they are all pretty smart cats. This made me really happy that I was able to use my minor vocal injury and set-back as a teaching tool about voice health, and what to look for when something is not right. A beautiful teachable opportunity came out of my injury, and THAT is what I remind myself of everyday going forward. There was light that came out of a pretty scary situation.

I learned a lot about myself as an artist and singer, and I became a better teacher and educator because of it. Truthfully, I could have done without the vocal hemorrhage, but life has a funny way of throwing us curve balls every now and again. One has two choices when something like this happens : feel sorry for yourself, not follow your doctors advice, and let your ego get in the way, OR you can use the perceived obstacle as a learning experience. Learn how to be a humble artist, and when to say 'NO'. Often in this crazy business of the performing arts/music industry one feels the need to always say 'yes' to everything, and if you can not do something you will automatically be banished to the land of ex-singers; never to work again. This couldn't be farther from the truth. You have to put your ego on the back burner, and your health has to take the spot light. I thought "what is worse?" Singing a handful of gigs when I knew I was injured and causing more injury and/or serious permanent damage because I felt I couldn't say 'no', or take off a coupe of weeks, rest, listen to my doctor, and know that everything will pick right back up when I return? I chose door number two. I hope that if you ever find yourself in a similar situation as I did you choose the second door as well.

My main message of this blog post is to listen to your body, know when you need to take a break and/or see your doctor, and never EVER let other individuals force you into doing something that you know is not right for you. And lastly, but definitely not least: to bring awareness to the beautiful, unique, irreplaceable, wonderful, natural primal sound that is the human voice. Because for me I wouldn't be Amanda without my voice, and I believe that the human voice is the most magical part of our body. It is the source of all communication and interaction, and that is an important thing. Sending love and light to all of you vocalists, voice teachers/coaches, vocal pedagogues, professional voice users, laryngologists, otolaryngologists, ENT's, speech language pathologists, voice therapists, singing voice specialists, vocologists, and voice and throat cancer survivors for all of work, discovery, support, and development that you do for the human voice in celebration and observance of this year and every year's world voice day.

- Amanda Boudreau, MM in Voice Performance

Opera/Classical Singer

Private Voice and Piano Instructor

Education and Engagement Manager and Education Artist at Long Beach Opera

*** Dr. Reena Gupta does a weekly Vocal Curbside Consult where she answers all questions related to the voice, voice health, and vocal injury to help spread awareness of the voice, and open up dialogue about common misconceptions or fears about the voice. Its pretty amazing. It just so happens that she posted this wonderful article on vocal recovery after illness, and she talks about vocal hemorrhages!

Here is the link to the article : Vocal Recovery After Illness (I suggest you read it)


The Voice Foundation:

The Osborne Head and Neck Institute:

#vocalhealth #voicehealth #worldvoiceday #voicehealthandscience #vocalinjury #vocalhealth #vocalhealthawareness

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