I wanted to share a bit more about my experience at Philadelphia ENT and clarify the difference between a ENT (or Otolaryngologist) and Laryngologist.

​An Otolaryngologist is a head and neck surgeon, and specialist in medicine for the ears, nose, and throat (which is why they are commonly called ENTs). There are many fantastic ENTs! A Laryngologist has further, specialized training and clinical hours beyond that of an ENT, to focus on the voice and swallowing. They deal with the larynx and surrounding areas. If you are a professional voice user, like a singer or actor, and you are experiencing a voice problem, you should seek out a Laryngologist, not just an otolaryngologist or ENT. Not only did this make a big difference for me, but I have habilitation clients that were misdiagnosed many times before getting in with a laryngologist and receiving the correct diagnosis, and therefore treatment. (more on the difference here)

I feel incredibly lucky that I was able to seek treatment with Dr. Robert Sataloff. His voice team is one of the best in the country and I feel like I am in safe hands. My voice is my livelihood and my art (in singing and teaching). The extra care taken by laryngologists and their teams can make all the difference in your career.

After my initial strobe, I went for my neck CT and the stenosis was easily seen in the imaging. The team in Philly made it a point to get me back up to see Dr. Sataloff quickly, so he could assess the situation and make a plan. I had observed in the clinic for a week, just a month prior to my own initial visit as a patient, so I had a bit of an idea of what to expect. New patients spent almost the whole day there! Initial assessment and strobe by a fellow and/or resident, speech assessment by an SLP (speech language pathologist), main assessment with Dr. Sataloff or one of the other fantastic doctors in the clinic, first round of speech therapy with SLP, first round of singing habilitation with clinical SVS (singing voice specialist). This was sometimes followed by a laryngeal EMG, which I will discuss a little later. Most patients take home information on how to combat acid reflux, and some homework for their speech and singing voice tasks, along with the appointment for their next check-in, surgery, or treatment.

My appointment was bright and early in the morning, so I woke up before dawn to drive from Northern Virginia and get to Philly in time. As a new patient, you have the usual paperwork, but on top of that, there is a questionnaire about vocal behaviors and self-assessment of vocal issues, as well as a few questions about anxiety and lifestyle behaviors. The consultation is thorough and a little intense. He checks your nose, ears, mouth, balance, sensation on the skin of your face, has you vocalize a bit to see how you prepare to sing, asks many questions, then there's the hard scope (which goes through the mouth to the back of the throat) and flexible scope (which goes through the nose and down the vocal tract). If you have a sensitive gag reflex, you get a spray that (doesn't completely) taste like bananas, to numb the back of the throat. There's also a spray up the nose, which tastes even worse than the not-so-banana spray, to numb the sinuses a bit for the flexible scope. The video imagery is incredible! You are asked to do various sirens, high and low vocal tasks, sniffs, etc to see how your vocal folds behave. In my case, they wanted a closer look at what was happening just below the folds, so I focused on staying open and breathing (while a friend who works on the voice team there held my hand), and they moved the scope close to the glottis to get a good look at the narrowing in the trachea. This is not normally done because a quick cough or clearing of the throat could mean bad news bears for the folds! But we made it through and they were able to capture some great images for Dr. Sataloff to take a look.

It was determined that I need a bronchoscopy (out-patient endoscopic surgery) to dilate the narrowing, biopsy to see if a cause can be determined, and give a quick shot of steroid to heal up. The surgery is coming up next month. But while looking at my strobe, Dr. Sataloff also was worried about a bit of LPR (silent reflux) and a bit of asymmetrical movement or partial paresis on my folds. This may have been there for a long time (and can go unnoticed by regular ENT equipment and eyes), or it may be something that has developed over time. I was given the choice of having a laryngeal EMG (electromyography) done to see how my muscles are communicating with the laryngeal nerves. In an L-EMG, very thin needles (similar to acupuncture) are inserted into the muscles of the larynx (TA, CT, and PCA) to record the electrical activity of each muscle (more info here). It turns out my results were not quite normal, so I am now taking a medicine that helps my nerves and muscles communicate a bit better. The great news is, I have noticed significant improvement in my vocal stamina! I had been assuming that any vocal fatigue or instability was due to the chronic cough, but it turns out it may be an autoimmune disease or similar (not that chronic disease is great news, but knowing/understanding and treating the problem is great).

As the numbness wore off on my drive home from Philly that day, I was exhausted and emotional, but I had answers and a plan!

In preparation for surgery, I have done bloodwork (ten vials!!), an hour on the table for MRI and MRA imaging, ultrasounds of my thyroid and vascular system surrounding the area effected. I don't think I've ever felt so poked and prodded, even in two pregnancies, but to me it's worth it to have hope that by the end of the summer or the year, I will be able to sing again without working around "something." I can lecture in class or present in a seminar without sniffing to get oxygen in faster. I won't have to explain to concerned folks that I don't have a cold or COVID. I can ride my bike and run after my children without getting short of breath. I realize it won't be an instant fix, but I will once again have the ability to work up to "optimal from functional," instead of having to accept that my new normal is never going to be what I had hoped for myself. 

So...I say, very optimistically (and anxiously)...to be continued...

(This is only Part II of my little "Teacher with a Problem" series, so I will update about my surgery and long-term results of the nerve medication later this summer.)

I can still vividly picture and hear Florence Birdwell leaning back on the piano bench, kicking her feet up, and giggling like a small child as she asked me to approach a scary passage of a song with the freedom of a five-year-old. "Kids don't worry about how they sound. They just do. Like this!" When she cracked herself up, it was a joy to witness. This stuck with me because it has been so useful in getting out of my head, whether I'm singing or teaching.

A handful of years later, I found myself making a day job of multi-generational, accessible circus in New York City. The name of this organization started at CircusYoga and morphed into its true from, The Human Art of Play (spearheaded by Erin Maile and Kevin O'Keefe, two absolutely brilliant and inspiring humans). We even had the slogan "Now Must Play", our own version of "namaste." We taught yoga, accessible acrobatics, clowning, juggling and other ground circus in schools, parks, and retreats. It was a blast! I was making my living by playing!

In my yoga studies at The Breathing Project, I learned Embodied Anatomy and Kinesiology from Leslie Kaminoff and Amy Matthews. They stepped out of the framework of the yoga world, Leslie from his work under an osteopath and Amy from her work in Laban/Bartenieff and Body Mind Centering. I found myself thinking of the same concept of play as we worked through the muscles and bones and discussed their function in movement. They got me out of the mindset of "the perfect pose" and into looking at what the body needs from a pose. I found myself turning the goal of my practice into  "finding what feels good" (to quote Adriene Mishler, Yoga with Adriene). This was play.

I spent months in the Jen Waldman Studio, working on my repertoire in ways I never would have imagined. I was asked to sing my pop ballad like a honky tonk country song or make up new lyrics on the spot for The Light in the Piazza. We used Viewpoints to play with the room and chose our songs weekly based on themes like the weather. This was play.

My career has bounced around, a seemingly random ride, but through this ultimate act of play, I find myself bringing every tangential adventure into my teaching on a regular basis. I am a life-long student, an eternal five-year-old, grabbing every stick, colorful bottle cap, movement practice, seashell, vocal exercise, or funny-shaped rock that might decorate my studio/castle and make it feel like a safe place for my students to explore and play.

In yoga, we try not to stretch in stillness, we stretch within a movement. We strengthen within the movement. In acting, we try on many shapes and shades until we find the perfect vessel for communication of a moment. In singing, we might play with a subtle vowel change, a breath, the way we stress or articulate a word, the amount of vibrancy in the sound. We play so we can find ourselves on our mat, on the stage, in our song.

This hippy dippy, woo woo blog post is an invitation. 

We can't know what's possible until we try. Put yourself out there like a five-year-old with nothing to lose but the daylight hours. If something doesn't work this time around…well then you know, and you can try something else. Keep playing.

I find my yoga-teacher-self creeping into lessons all of the time. In fact, today, in the middle of a lesson, my student said "Do you teach yoga? Because if not, you should!" 

Aside from the more obvious applications in the voice studio, like stretching and breath-work, one of the biggest yoga concepts that I find helpful for singing is the idea of "finding your tadasana in every pose."

Tadasana is Mountain Pose. It's usually the starting and ending pose of most yoga sequences or flows. If you see the pose from the outside, it may just look like "standing." But it's much more than that. It is mindful standing. Balance. I practice and teach tadasana with feet slightly apart (mostly because I have wider set hips than those ancient yogis --- men), arms resting down and palms facing outward/forward. I'm not sure where I picked it up, but I sometimes cue a heavy dinosaur tail and a hot air balloon head. You are grounded, yet buoyant. Open and ready to receive or give, shift or move forward. Balance.

So if we are finding tadasana in every pose, we are finding balance and readiness. We are grounded and buoyant, whether we are in chaturanga (push up-like) or eagle (my favorite arm balance) or warrior three (my least favorite pose of all time....tadasana is still usually distant for me in warrior three.)

In singing, we hear a lot about posture and alignment. Posture is (thankfully) becoming a bit of a dirty word, and the focus is shifting to alignment. The problem is, when we are performing, we are not usually able to brace ourselves and stand in one place...park and bark, if you will. The commercial artist behind a microphone is not stiff and soldier-like (and may have a guitar or piano). The opera singer is just as emotive and fluid as the actor. The musical theatre performer is often tap dancing, cartwheeling, and playing the accordion these days. There's just not a whole lot of stillness in singing. Another great yoga cue/dharma of mine is that balance is not stillness, but constant small adjustments. But that's another blog post.

Instead of discussing alignment with my students, I find myself cueing tadasana (with dinosaurs and balloons) and then inviting them to move while they sing. Can we find our tadasana, no matter where we are on stage and what kind of storytelling we are involved in? Like everything, it is a practice, and sometimes it will be more difficult than others (cough cough warrior three). But it can definitely be a starting and ending point to find a place of center. A moving balance, grounded and buoyant, ready for anything.

Thank you for reading. Happy singing!