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6/20/2022

A Voice Teacher with a Voice Problem, Part II

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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.)

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4/26/2022

A Voice Teacher with a Voice Problem, Part I

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Here I am, making a career out of teaching vocal health, the art of subtle risk in performance, and breathing techniques….and half of the time I am having trouble breathing.

I am a voice teacher with a voice problem. (*gasp*...trust me, I know)

BODY - I have respiratory issues.
MIND - I am anxious about it, which makes them worse.
VOICE - This affects my voice.
STUDIO - And the imposter syndrome kicks in…

My chronic cough journey started almost a decade ago. I was singing on a cruise ship, the last of seven contracts full of high belt and re-circulated air. I was Vocal Captain, and while reviewing show videos and taking notes, I noticed that you could hear a whistle almost every time I inhaled. I knew it was happening, but didn’t realize that it was that audible and being picked up by the mics. At the end of my contract, we moved back to Oklahoma City so I could finish my masters degree. I saw an ENT and had a scope of my vocal folds to find out what was causing this wheeze. I had been coughing a bit, but wasn’t sick. It was a productive cough, but prolonged coughing is not good for the vocal folds, so I wanted to also be sure there was no damage. Luckily, my vocal folds were in great shape. They noticed a bit of redness in my trachea, which was unusual. They put me on PPIs, ruled out acid reflux, and sent me on my way with an inhaler for exercise-induced asthma. 

Fast forward - still coughing and the inhaler doesn’t seem to do anything. I went back to the ENT. Luckily, vocal folds still happy. He sent me to get tested for allergies (all of those little x’s on my arm) and asthma (which I don’t have). They ordered a CT, but my insurance said no (multiple times). Thanks USA.

Fast forward - still coughing, but now coughing in Japan. I went to an ENT in Tokyo, who ruled out reflux again by putting me on PPIs, then stronger PPIs. He sent me to a pulmonologist who tested for all kinds of things…all negative. I had an MRI of my sinuses, which came back negative for chronic rhinitis. The pulmonologist gave me an inhaler, which didn’t do anything.

This was my story for almost a decade…starting over and over again, being tested for reflux, asthma, allergies…because those are the three top causes for chronic cough 95% of the time!
I am in the 5%.

This year, in my DMA studies, I am doing an internship with various Singing Voice Specialists. I spent a week observing in Dr. Robert Sataloff’s clinic in Philadelphia. While there, I mentioned my chronic cough (because I didn’t want them thinking I had COVID every time I coughed) and asked if I might have a strobe done while visiting. One afternoon, Dr. Lyons, one of the other wonderful doctors there, did a quick strobe and discovered that it looked like there was some narrowing in my trachea. I had just met with a local pulmonologist in Virginia and he asked me to schedule a chest CT and pulmonary function tests (all normal). Dr. Lyons advised that I ask for a neck CT as well. And this is where the pattern changed…

If I had just gotten the chest CT, the pulmonologist would have sent me back to an ENT or told me it’s probably reflux/asthma/allergies, etc. Because the chest CT was normal.

The neck CT shows a 50% narrowing of the trachea just below the vocal folds, a sub-glottic stenosis. This is why I have difficulty inhaling while singing. This is likely why I have a productive chronic cough as my body tries to deal with this irregularity.

THIS IS WHY SINGERS NEED TO SEE LARYNGOLOGISTS and not just any ENT doctor.

Stay tuned for Part II...


Picture
Super cool image taken from my scans and adapted by Dr. David Meyer to show the negative space of my vocal tract and trachea, . The part that looks like someone is pinching my trachea is where the stenosis is. This makes it feel like a suction every time I breathe, and makes it hard to get enough air to sustain longer phrases in singing.

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3/25/2022

The Benefits of Play

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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.

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2/3/2022

Find Your Tadasana

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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!

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1/23/2022

Welcome to My "Why"

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**If you're in a hurry, feel free to skip to the recipe. Look for the "-----" ;)

At a couple different points in my life, I've had family members mention to me that I'm scattered or have been randomly passionate about what I'm doing as a career...or that career option...or this other one. In the moment, that was hard to hear, and not because it was true, but because I have never felt that any part of my journey has been random our scattered.

I started dancing at a very young age. I spent most of my days at the dance studio after school, was on my studio's competitive team, did the Nutcracker every winter at Ballet Austin, and went to every convention I could to learn from as many teachers as possible (I don't know how my parents did it.) In fifth grade, we had the option of orchestra at my elementary school, so I wanted to learn to play the cello, but the next year all of my friends were joining band, so I HAD to play the flute! Did I switch from one to another? No way....I was now spending all of my evenings at the dance studio, my early mornings practicing cello, and my lunch period practicing flute. No one was pushing me to do this. It was all I wanted to do.

My eighth grade year, I didn't make it into The Nutcracker. I was devastated. I think it had something to do with it being around the age that the pre-professional classes began for the academy and/or the fact that I was a bit curvier than your typical ballerina. But it just so happened that that same year, a new equity theatre was formed in Austin and they were running a summer camp before kicking off their first season. My middle school drama teacher (yes, I did that too) suggested I try it out, and that's where my true passion for musical theatre began.

I spend my high school years honing in on what I really wanted to do. I found myself performing with Austin Musical Theatre as a professional dancer in the ensemble of their shows and joined their junior company of triple threat high schoolers from all over the Austin area. I joined the high school choir so I could become more comfortable with singing, and quickly found a love for choral and classical vocal music. My world had shifted so much, that when the time came, I applied to colleges for voice, instead of dance. I chose Oklahoma City University because, at the time, it was the only school that offered a musical theatre degree within the music program, allowed you to level into the dance major's classes, and I could play my cello and flute in the symphony and philharmonic for extra scholarship money. Again....not letting go of much.

Fast forward...(past some incredible years with my friends at OCU, working with my beloved voice teacher Florence Birdwell, taking on opera and musical roles with equal enthusiasm - something I never expected - and traveling the world on my first cruise ship contract of many)...to living in New York City and finally putting my shoes to the pavement. I found my balance, mentally and physically, by attending donation-based yoga classes. I got so excited about it and wanted to know more, so I did my 200hr RYT training at a studio right by the theatre district. I spent my NYC years bouncing on and off cruise ships and tours (thank you cello and flute and the onslaught of actor-musician musicals), teaching yoga and circus, and studying embodied anatomy and kinesiology at a wonderful studio called The Breathing Project. So I guess it's not surprising that I came to my family one Christmas trying to decide whether to take a job as the manager of a yoga studio or go back on a cruise ship OR go back to school to finish my masters degree. "I thought you wanted to be on Broadway? How is this going to get you there?" (fyi Broadway would be nice, but has never really been at the top of my list) "You're always a bit all over the place. You're excited about this now, but what will change next month?" I love my family so much. They are incredibly supportive of everything I do, which is why I have been able to do so much! But this was the moment I realized that I am the only one who truly knows the depth of my experience along my journey, what touched me deeply and what was just fun and temporary. So the decision was: I did one more cruise ship contract to save the money, then I went back to school to finish my masters.

Back at OCU, I asked if I could tailor the remaining courses within my curriculum to look at voice pedagogy instead of opera or musical theatre performance. They let me run with it! During my year there, it became apparent how much I longed to bring my experience as a yoga teacher and life-long student into my passion for musical theatre and voice pedagogy. I continued to teach both yoga and voice, and found myself merging my experiences along those separate paths into a "technique" or approach to pedagogy that felt very authentic to me. After completing my degree, I was asked to teach dance and acting majors as adjunct voice faculty. I could relate to both the speakers and the movers because of my past "journeys", and I kept searching for more understanding of why this approach works so I could better see every student that crossed my door.

My first full-time teaching job took me and my family to Tokyo. I served four years as an Associate Professor of Music at Senzoku Gakuen College of Music, within their musical course. No strangers to international travel, my Italian husband and I met on cruise ships, so we were excited and intrigued by the idea of spending time in a part of the world that neither of us had ventured to yet. It was one of the best decisions of my life. I was teaching voice lessons, voice classes, scene study, and ensemble work, creating curriculum and directing large-scale showcases for the department twice a year. It was a sort of bliss. Everything I taught had to be translated, which was tricky. And the language was definitely not easy even with the immersion. I loved having a playground to try my approach to musical theatre singing and voice pedagogy. I was able to create lectures in Anatomy and Function, English diction, Musical Theatre History, Analyzing Stephen Sondheim, and exploring other various composers and shows. The school even allowed me to travel to Salt Lake City one summer to attend the Vocology Institute and study with Ingo Titze and Kittle Verdolini! For that and so much more, I am forever grateful.

After four years in Japan, and we longed for family and wanted our daughter to start school in the states (the pandemic being a straw on the back of an already temporary, but wonderful, situation), so we're back in the US. I miss Japan and my colleagues and students. But I just had the most blissful holiday season, surrounded by family, some of which we hadn't seen in years.

So here I am. Back in school to study for my doctorate in Voice Pedagogy with a concentration in Voice Science, at the only school (as of now) that has a DMA in Voice Ped that looks at CCM (commercial music) genres in addition to classical. It's my dream program, with inspirational teachers and an amazing cohort of graduate students, and it has been highlight after highlight of learning and processing. I decided I can't wait until I graduate to start something that feels like me. This is me. Starting.

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Body Mind Voice Studio brings together all of the practices that I think are important in the journey to find your inner artist and your unique voice. The voice is used for expression. Expression comes from feeling and opinion. Feelings come from the mind and are felt in the body. I believe that in order to safely and sustainably express ourselves in an authentic and organic way, we need to have an awareness of the body and the ability to take care of ourselves, physically, mentally, and vocally.

Body: Empowering connection through awareness of breath, movement, and support.
Mind: Preparing for practice and performance with mindfulness, mental wellness, and creativity and play.
Voice: Helping you exceed your own expectations by understanding the mechanics of the voice, and journeying to find your unique perspective and sound.
Studio: Giving you a safe and engaging place to explore community, playful practice prompts, and performance feedback.

Why?: Because the body, mind, and voice are so intricately and beautifully connected, and sometimes we just need to create the space to figure it all out.

I'm hoping this can be that space for whomever need it.

Thank you for reading. Happy singing!

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​© 2022 Body Mind Voice Studio, Marita Stryker
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