The Occupational Hazards of Singing for Your Supper
By Christopher Gray, Fri., Sept. 21, 2001
At Club DeVille's every-other-Tuesday Karaoke shindigs, the average person onstage is thinking about anything but his or her voice. More important is the choreography for "Get Down Tonight," a proper air-guitar solo for "Girls, Girls, Girls," and how ridiculous their co-worker looks fumbling through "Love Is a Battlefield." Being hung over at work the next day has probably crossed a few minds. The potential consequences of slurring "Suspicious Minds," on the other hand, over the sensitive folds of muscle tissue located in the larynx, are probably not too high on the list.
For working singers, however, as well as others whose livelihoods depend on their voice, the situation couldn't be more different. To them, stricken vocal cords mean not being able to eat, or at the very least, the difference between doing something they love -- in many cases something they say they were born to do -- and something they do just to get by. Those who confine their singing to the shower might be surprised at how easy it is for something to go wrong.
In the past decade or so, society at large has become familiar with the term "occupational injuries," which can signify anything from a computer jockey's carpal tunnel syndrome to a wide receiver's blown-out knee. Since the occupation of making music is first and foremost a physical activity, musicians are also prone to any number of afflictions concurrent with bodily exertion -- a guitarist's chronic hand cramps, a drummer's tendinitis, horn players wearing out their lips. Outfits like P-Funk could conceivably keep a clinic in business by themselves.
Even so, singers are a special case thanks to the uniquely hostile conditions under which they're often forced to practice their craft. Very little about a typical Austin nightclub could be considered beneficial to maintaining a healthy voice: Besides being located in Central Texas, acknowledged allergy capital of the western hemisphere, clubs are almost always filled with an omnipresent haze of cigarette smoke, while improper levels in the stage monitors often force singers to push their voices to dangerous levels simply to hear themselves.
Additionally, just about any kind of imbibable or inhalable substance mentioned in a Waylon Jennings song would be a big no-no, as would lack of sleep from long hours on the road, or something as seemingly innocuous as chatting with fans or friends during a break. And forget about spending too much time on the phone. When it comes to breaks, the average singer's vocal cords get precious few.
Time for a quick anatomy lesson. The vocal cords are the lower of two pairs of muscle bands located in the tracheal anteroom known as the larynx. When the brain tells them to contract, air from the lungs moves across the vibrating cords to produce sound. By measuring the amount and speed of air, and how hard the cords contract, humans have a remarkable degree of control over those sounds' tone, pitch, and volume.
Somewhere back along the evolutionary line, our ancestors decided some sounds were pleasing to hear over and over again, and music was born. Vocal problems no doubt followed soon afterward -- just think, some poor Neanderthal might have been stoned to death due to ill-timed hoarseness during the chieftain's favorite tribal chant.
Society's level of understanding and compassion in such situations has increased somewhat in the succeeding millennia, but the study and treatment of voice-related ailments seems to be one of the more mysterious and obscure corners of modern medicine. Granted, our culture continues to put forth the notion that entertainers -- especially the successful, celebrated ones -- are something other than flesh and blood. No less prevalent is the knee-jerk conclusion that if Madonna's voice sounds off-key at a concert, it must be her fault.
Nevertheless, the curious link between inspiration and injury is a topic that's drawn recent university-level interest (and funding): the Texas Center for Music and Medicine opened in 1999 at the University of North Texas in Denton. This experimental arm of UNT's vaunted music program studies everything from the portentously named "focal dystopia" to stage fright. Director Kris Chesky likens the somewhat nascent field's position to that of sports medicine 20 years ago.
As much as musicians' bodies are like anyone else's, their minds are not. The price of those extraordinary talents is a life of constantly subjecting oneself to an unrelenting stream of self-directed analysis, not to mention the performer and audience's shared expectations of peak ability entertainment. Think about how many musical terms begin with the word "perfect": perfect tune, perfect time, perfect pitch, perfect harmony. There's even something called a perfect note.
"That self-critical side can push [musicians] into a dark place," says Dr. John Hippel, Senior Staff Counselor at UNT's Counseling and Testing Center, and a Center for Music and Medicine staffer. Hippel, who says one goal is teaching musicians to arrive at "reasonable expectations," adds, "It can really be devastating unless they really keep it in perspective."
When something goes awry with a singer's voice -- an inability to hit high notes, a noticeable loss of endurance, or it simply giving out on them -- as often as not, it's the result of something called a node. Nodes are tiny growths on the vocal cords that bring about a world of grief for any singer who has them; caused by irritation and overuse, they're quite common and easy to dispatch once detected.
"If they're a singer and have been for several years, they probably have nodes," says Austin physician Dr. Donald Counts, who routinely refers such cases to local ear, nose, and throat specialists.
KUT's Paul Ray, DJ behind "Twine Time" and various jazz shows, experienced multiple throat problems in the late Seventies as singer for Texas R&B stalwarts the Cobras. The first of these, an abscess that caused his throat to literally swell shut, was caused by sand he swallowed while playing basketball in a Lubbock dust storm. He developed nodes within a couple of years of that, and says singing with nodes feels like your throat is full of gravel.
"My vocal cords slamming together, the way I sang, the fact that I stood in front of Stevie [Ray Vaughan] and Denny [Freeman] and their volume 11 guitars, all of that played into it," Ray says. When he began having vocal problems, Vaughan took over singing duties for the Cobras and soon left to start up his own band.
Nodes, also referred to as nodules, are basically calluses that develop on the vocal cords over a period of time, frequently years. When the cords rub together, the same thing happens that would to your foot if you walked around barefoot long enough. Priscilla Dickenson, an Austin speech therapist who has treated Ray and a number of other local singers, also points out that stress and the body's general tension level can be major determining factors as well.
"A lot of the people I see come in here, they're talking too loud, and they're tense and wired up," she says. "People who get nodules are not real relaxed, they're not easygoing. Nodules are a hyperfunctional disorder; there's too much energy in the muscles, and that's sort of typical for the person. A real relaxed person is not gonna have hyperfunctional vocal cords."
Dickenson's approach is keyed to her clients' lifestyle as much as anything physical. She takes note of how much exercise they get, what kinds of foods they eat, how much water they drink, if they warm their voice up before singing. Ironically, the greatest threat to singers comes not necessarily from singing, but from everything else. Dickenson reels off a list of circumstances that can jeopardize vocal cords.
"It's the way they talk when they're not singing, the foods they eat, the conditions they live under, the way they clear their throat, the way they speak, how much they speak, how loud they speak," she explains.
She also advises her patients that if they have a day job, to try and avoid ones that require a lot of speaking -- a waitress constantly shouting orders in a crowded, noisy diner would be a perfect example. Don't smoke, obviously, and watch the alcohol and caffeine, because they can dehydrate the vocal cords. And relax. Dickenson recommends the 15-minute massages at Whole Foods and Central Market, and says don't be so quick to scoff at folk remedies.
"Angela [Strehli] said, 'Do what I do,'" remembers Paul Ray. "She put Grand Marnier in a microwave and heated it. That's what I did for about six months. It definitely helped, except I got hooked on Grand Marnier. It's an expensive drink, but it worked."
"I get some Diet Coke," says Austin rapper Tee Double, who says his voice starts getting thin if insufficient monitors force him to overcompensate. "I just go to a bar and sip on that for a while. It usually takes about five or 10 minutes. That's what does it for me, every time."
Patrice Pike, who swears by yoga, zinc lozenges, and slippery elm tea, is also a former patient of Dickenson's. She sought help several years ago after voice problems caused her to cancel a couple of gigs, and can speak firsthand to the resulting tension and uncertainty.
"I really didn't have a choice but to do something about it," says Pike. "I just felt totally helpless, because ultimately, I had to go to work tomorrow and I was losing my voice today, and going to gigs not knowing if I was going to make it through the show."
Luckily, Pike, who spent several years in Black Cat/Steamboat favorite Little Sister (later Sister 7), and now draws good crowds for her new band Black Box Rebellion, got better almost immediately. She says she's only had to cancel a handful of shows in the ensuing seven or eight years. Since she averages several gigs a week, that's impressive, made even more so by the fact that she spends quite a bit of time on the phone acting as her band's manager and booking agent. She still loses her voice, too.
"People ask me how I manage to get through five nights a week and not lose my voice," she chuckles. "They don't know that I sound like Kermit the Frog on Sunday."
Vocal afflictions such as nodes seem not to discriminate between styles of music. Strangely enough, a punk rocker bellowing through a 40-minute set at Emo's puts about as much stress on his vocal cords as a mezzo-soprano at the Austin Lyric Opera winding her way through three to four hours of Verdi. Dickenson adds, however, that classically trained singers, who often work closely with singing coaches, are generally more sensitive to the first sign of trouble than the off-the-cuff rock & rollers.
Actually, there's nothing that limits these kinds of disorders to musicians. Dickenson says she's treated attorneys, real estate brokers, teachers, state legislators, and "a lot of actors." Unlike those occupations, however, except perhaps actors, musicians often don't have a health plan that readily pays for doctor visits and/or therapy. If they can afford it, it's a good idea to have a working relationship with an ear, nose, and throat specialist. Even if they can't, there's little reason to give up hope.
In Pike's case, when her medical problems arose, she simply asked her bandmates to help pitch in for a doctor visit. She also suggests inquiring at the Texas Employment Commission, where evidently a singer may apply for relief on vocational grounds.
Though she normally only recommends surgery as a last resort, Dickenson says it's important for singers to see a doctor, if only to confirm that their condition is caused by nodes and not something more complicated such as polyps. Polyps are similar to nodes, but bigger, fleshier, and with their own blood supply. Usually, they must be surgically removed. Dr. Ron Byrd, an Austin physician who plays in Prescott Curlywolf, points out that nodes can share a number of symptoms with something much graver, such as throat cancer.
If it does come to surgery, the procedure itself is fairly routine. Usually, the surgeon simply goes down the hatch -- no incision necessary -- and slices off the troublesome nodes with a laser. The process can take as little as 20 minutes, after which it's necessary to rest the voice for at least a week afterward. KGSR's Jody Denberg recently had a pair of nodes surgically removed, and is already back on-air supplying Austinites with their daily dose of the "5:01 Blues."
"I've noticed a definite difference in my voice since the surgery," Denberg writes via e-mail. "It had lost its richness and had become thinner and raspy. That's been reversed."
Unfortunately, the situation isn't always cleared up quite so easily. Austin country singer Libbi Bosworth wound up consulting doctors in Laredo, Nashville, and San Antonio before arriving at a satisfactory explanation for her condition. Rather than nodes, she now believes her inflamed vocal cords were caused by a combination of chronic sinusitis and acid reflux, where stomach acids back up into the throat and esophagus. Not knowing why she was unable to sing -- and the doctors' inability to find the cause -- only compounded her frustration.
"There were times when I would play a gig and literally go home and cry," she says. "This is one thing I couldn't lose. I felt like I've always been a pretty good singer, and I felt like a horrible singer. I found myself apologizing at gigs, apologizing to my band."
By cutting down the amount of acids in her diet, and managing her sinusitis and allergies as best she could, Bosworth says she thinks she finally has control of her voice back.
"If I don't, I know I'm going to get it back," she asserts. Bosworth expects to return to the stage later this month, just in time to promote Libbiville, her first CD since 1996.
Though it's generally accepted that singers will experience some sort of trouble with their voices at one point or another if they do it long enough, the exact numbers are harder to pin down. Byrd says he doesn't see nodes that often; the only patient he's diagnosed recently is the sister of a musician who "got them from screaming at his gigs." SIMS Foundation director Peyton Wimmer says he can only recall a couple of times musicians have called seeking assistance for such problems.
Still, the condition is common enough that Austin ear, nose, and throat specialist Dr. Trey Fife says he sees several patients a week. And while several musicians approached for this story said they'd heard of someone who had had nodes, actual confirmed cases were somewhat harder to flush out. This isn't exactly something people run bragging to their friends about -- or, in many cases, even know they have.
"I think there's a lot more people with nodules walking around than we know," posits Dickenson, "but we have a very wide range of acceptance for the voice. If you're not doing something like that, using your voice out in front of people, who cares? It sounds kind of cool to a lot of people to have a slightly hoarse voice, or a slightly raspy voice."
Naturally, this begs the question of what musicians -- especially those who haven't had to seek medical attention -- do when their voice threatens to go south. Because it will happen.
Rock & Roll Sacrifice "Everybody I know goes through periods where they can't sing," says Davíd Garza, who still practices the warm-up exercises he learned as a wind player in his school band. If worst comes to worst, he says, "You just turn up the guitar and sing through it."
Freddie Krc of longstanding South Austin barroom rockers the Shakin' Apostles employs a number of strategies, including zinc lozenges, throat spray, and common sense.
"I try not to overdo it," he says. "Since I quit smoking cigarettes, that's really helped. I sang six hours the other day and my voice was fine."
Jason McMaster, frontman for local heavy-metal thunderers Gahdzilla Motor Company, seemingly tears his voice to ribbons every time he takes the stage. Yet he reports no significant problems, which he attributes to a sensible warm-up routine, allowing himself two or three songs in the set before opening up his full vocal capacity, and more than anything else, bringing his own monitors to gigs.
"Seven years ago I decided I was going to have my own monitor system every night, and that's really saved my ass," he says.
Venerable country crooner Don Walser is another who's managed to avoid any significant vocal maladies.
"He's been really blessed with that," says his wife Pat. "[His only problem is] allergy season, when his allergies act up."
And if anyone's vocal cords might give them problems, a logical first guess would be former Skunk and True Believer Jon Dee Graham. His songs come out in an abrasive croak that makes Tom Waits, to whom he is frequently likened, sound dulcet. "God only knows what's going on with my vocal cords," he laughs.
Graham says that while recording his new album in Los Angeles, his voice did shut down on the third day and there was "no coaxing it back." When he was a member of onetime Austinite Michelle Shocked's band, he remembers snickering at her elaborate warm-up procedure. Now, he heads out behind the club before his set and readies his voice for 15-20 minutes. Beyond that, he says, if he's "in the vicinity" of the note, he's happy.
"I feel like the demands I make on my voice don't really require any fine-tuning or preparation anyway," he adds.
As might be expected, the prevailing attitude is that singers must be prepared to do whatever it takes to keep their voices in working order. This is growing easier as more and more useful information comes to light, and as musicians realize there's no more stigma in seeking help for such problems than with any other work-related disorder.
Further good news comes from the relative ease and speed with which most such problems can be solved; Dickenson says most of her patients see a significant improvement in anywhere from six weeks to three months. Still, for any singer, taking proper care of their voice involves taking a serious look at their lifestyle, and more than likely, foregoing some of the more familiar rock & roll indulgences. If they're serious about their art, it's a sacrifice they're more than willing to make.
"I want to be a singer, and being a singer is more important to me than being cool, or being a rock star, because I'll be a singer forever," says Patrice Pike. "It's all I've ever done and it's all I'll ever do, and if I lose my voice I lose that.
"That's definitely an issue, being embarrassed because you didn't go out and party with your friends or your fans afterward, or you didn't stay up and drink a fifth of Jack Daniels with your buddies in the band, or whatever. You just have to make a choice."