by Howard Frankel
I’ve always been a hypochondriac. I always thought I had whatever I was afraid of. A little cough? Must be cancer. A few sneezes? Must be severe allergies. Itchy skin? Scabies! And here’s a really bad one…I remember being concerned (at a young age before I learned about sex) that I just had AIDS because I knew I liked boys and somebody, somewhere connected gay men with AIDS. Thus, my young mind jumped to horrible conclusions all the time. Ask my Mom, who had the utmost patience with me and reminded me (every time) that I was totally fine. Oh yes, I spent many of the younger years worrying. A hypochondriac worrywart when every other kid was out playing sports and having a good time.
Fast forward to my teenage years when I first started singing- my passion. As soon as I heard about vocal nodules and polyps, I figured I would just get them. I never screamed or abused my voice, but I just expected “the worst possible thing” to happen because I knew that I wanted to be a singer for the rest of my life. I even convinced myself (around age 16 or 17) that I was having vocal problems and my Mom took me to an ENT to get my cords checked out. It’s a little embarrassing to admit this now, but I find it necessary and a critical part of my story. Of course, everything checked out just fine then.
Let’s jump now to almost present day and time. My partner Jason and I moved to Copenhagen in the beginning of 2013 for his new job. It’s no secret to most friends and family and everyone else who lent me their ear that I had a rough time. A really, really rough time. Homesickness was an understatement to the anxiety that took over my life. Panic attacks, breakdowns…it all came flying at me and I didn’t know how to handle it. Nor did I really quite understand it. This life in Europe was a temporary thing. Why couldn’t I just sit back and enjoy the ride? No matter, I still had my music and my voice. Well, for a while at least.
A very scary thing began happening to me around last August. I started to notice things happening to my voice. About half way through any given day, whether I had done some speaking or singing or nothing at all, my voice was tired. Tired may not be the best word for it. It was exhausted. It was as if I had given a 4-hour lecture or sang nonstop for 2 hours straight. Sometimes it was bad enough that I avoided phone calls and didn’t even bother to say a basic sentence to Jason because I just felt it wasn’t worth the physical effort. Naturally, my mind jumped once again to that old fear of vocal nodules. I immediately scheduled an appointment with an ENT. He used the scope to check out my cords and said nothing looked damaged. I was told that this was probably just a basic “viral thing”. I heaved a sigh of relief and went on my way. Three weeks or so went by. Nothing changed. In fact, things got worse. I had a sensation of extreme tightness and tension in my neck that wouldn’t ease up. Onto a different ENT. Diagnosis? Maybe it was a “bacterial thing”. Pill given. Nothing. Next diagnosis? Some sort of “vocal trauma” that happened because of one reason or another, so I was put on steroids. Nothing. Next? Acid reflux. Nothing…except for a scope being shoved down into my stomach (without me being “twilighted”…is this legal?) and me gagging and crying as a nurse held my head down to the table so I couldn’t instinctively pull the scope out and run away feeling absolutely violated. You ever want to make a criminal talk? Put them through that experience.
Next, things got ridiculous and I was already dealing with my issue for well over 2-3 months. I ventured into the wild world of ENT and regular doctor visits in both Denmark and the United States. Some of them were/are extremely reputable professionals and have seen their share of vocal issues before and specialize in helping singers, actors, and public speakers. I was told by almost every single one of them that I was causing the problem myself and just had to relax. Anxiety anxiety anxiety anxiety anxiety. If I had a dollar for every time I heard that word as the diagnosis, I could have easily paid off every doctor’s bill from this world tour of visits. One doctor in Denmark even told me that maybe this was just something I’d “just have to get used to and deal with”. My jaw dropped at that one, and then I cried. 2014 had come by now and I was absolutely sick of dealing with this problem. The worst part was that my anxiety got worse and I was just crumbling day by day. I lost a significant amount of weight and felt (and looked) terrible. I had crippling panic attacks and couldn’t get out of bed to go to my job. When some of the best doctors tell you that you’re fine, what else can you do? I was sent to every other doctor known to man. Radiologists, chiropractors, general practitioners? Oh yes. Way too many. And I always got the same answer: “We found nothing wrong with you. I think it’s just your anxiety.”
Needless to say, I was fed up. I felt like I was doing SO much to figure out this problem and getting absolutely nowhere. One thing I made sure to do was to keep in contact with my voice teacher from Philadelphia, Jody Applebaum. I also worked as much as possible with my teacher in Denmark, Eva Hess Thaysen, at the Royal Danish Academy of Music. Both were incredibly supportive and tried in every way to do what they could for me. Jody helped me see her own laryngologist when I was home for a visit and suggested many other exercises that could help me. Eva was patient in lessons and pretty much went back to basics and did simple vocal exercises with me to try and ease my voice back into some form of normalcy. I coupled this with doing yoga and trying in every way to lessen my anxiety by reading self-help books and trying to remind myself to BREATHE.
(Just to keep you aware of the time frame…we’re in March by now. That’s half a year that this problem has been rearing its ugly head.)
Eva had a suggestion one day. Almost a “last resort” kind of thing. She knew of a woman in Denmark named Dorthe Kirkebække who did something called laryngeal massage and suggested I pay her a visit. I was two steps away from acupuncture and witch doctors, so I was more than willing to try this method out. Before the appointment, I researched laryngeal massage and found that it was a common thing for some singers to receive. One reason given for the massage stood out at me, however. It was something called muscular tension dysphonia. This is why…
Muscle tension dysphonia (MTD) is one of the more confounding and misunderstood conditions of the voice. With this condition, the vocal cords and supporting structures may be healthy but they are working too hard. MTD is caused by the throat muscles being too tight and out of balance with the rest of the voice production system. The person with MTD may feel that it takes more effort to talk and their voice gets worse the more they talk. Many patients may feel a soreness of their neck, throat and often their shoulders. Sometimes MTD may develop in trying to compensate for a weak vocal fold or a vocal fold lesion. (Joanne Fenn, Speech Language Pathologist at the Swedish Medical Center).
By george, this sounded too familiar! I mean, this had to be it, right? There was nothing left to attribute my symptoms to. And the perplexed minds of all of the doctors I had seen had to equal “misunderstood conditions of the voice.”
I walked into Dorthe Kirkebække’s office, shook her hand, and sat down in the consultation chair. We had already conversed via phone before the appointment and she had already confirmed that she was aware of MTD but that she preferred to check me out first, obviously. Onto her massage table I went. She began doing her work. The pain I felt as she massaged parts of my throat I didn’t realize existed was incredibly intense. At the same time, it felt good because I knew that these spots were areas that needed some major TLC. As she pressed and kneaded and caused me to wince on several occasions, she made the comment that my muscles were “so tight that they felt like bones,” which I don’t think I need to clarify to you, dear reader, is not a normal thing. She said that the tension she felt in all departments of my muscles/throat/ribs/everywhere else seemed to be a problem that had been building up long before I moved away. The intense stress and anxiety that overcame me while living away from home just kind of put everything over the edge and caused the problem to intensify and reach extreme heights. After I left (and rescheduled a follow up), I was very sore. At the same time, I was incredibly relieved to feel like a verdict had finally been approached and toyed with. I knew I still needed to have patience and continue with the massages and voice lessons.
I bring you to right here, right now. I still have MTD. Some days are worse than others, but usually I can contribute that to how much stress I have that particular day. I focused on singing more and doing vocal exercises to make up for the many occasions of remaining silent to avoid this problem. Almost immediately after two or three massages, both Dorthe and Eva noticed remarkable differences. Dorthe noticed how much looser the muscles were now becoming and Eva noticed my voice opening up again. I noticed my voice opening up again. I started to feel…normal. I forgot what that felt like.
A few other remarkable things happened in the process of this mess- I learned very quickly how to listen to my body and soul when anxiety becomes overwhelming. I can also look back and laugh now at how I learned that I was healthy everywhere else in my body thanks to the endless visits to doctors. No acid reflux. No lung disorders. No heart issues. No cancer. No this, no that. Just an oddball disorder that may or may not have been caused by anxiety. Maybe that truly was the culprit and this disorder will dissipate. Everyone knows that we can cause strange things to happen to our bodies when we worry or have an overload of stress. Maybe it was just my lack of constant speaking and singing like I was used to back home. Some famous voice coach somewhere said something along the lines of: “for every week you aren’t constantly using your voice, you lose two weeks.” It made sense, anyway. It’s like working out. When you don’t work out for weeks at a time and you’re eating a lot, what do you normally say? You say you’re out of shape, right? Well, I’ve observed that it’s the same case with the muscles that control the voice. Whatever the true, actual cause of my disorder, it still happened and I need to respect that. Eva said to me at one point- “what a great thing to be able to RE-discover your voice. That’s quite a gift.” And she was right. Even though I was ten thousand steps behind where I wanted to be with singing and speaking, it was something that could be addressed and fixed. I wasn’t damaged. Thank God. I just needed to “work out” a bit more.
Oh, and I wrote an album. This was a blessing in itself because I was suffering from extreme writer’s block. You’d think with everything happening to me that the words would be spilling onto the pages. Not so. Then again, I’ve always needed to heal from pain before I could focus on writing. And so, my forthcoming album, having stung moves on… is a culmination of what I’ve experienced (not just the MTD) over the last couple years. No, this article was not one major shameless advertisement for the album. However, the music was and is an incredibly important part of the healing process for me, so I do encourage you to take a listen when it’s out sometime before the end of the year.
I wanted to write this article/blog/journal entry and put my experience out there. Mostly, I’d like for it to be a resource or reference point for anyone else (speakers, singers, actors, teachers, etc.) who may go through what I went through and to understand that, although doctors may not see a problem, a problem may still exist.
I’d like to thank each and every person (you know who you are) who helped me through this incredibly hard time. I know it was frustrating at times when you didn’t have answers to make me feel better. There was a ton of hair-pulling and teeth gritting and tear-streaming and hearts-breaking that was, in short, not fun for anyone. But then, the light at the end of the tunnel was seen.
A special heartfelt thanks to the professionals that helped me get to the bottom of this- Jody Applebaum, Eva Hess-Thaysen, and endless gratitude to Dorthe Kirkebække for physically pushing the pain out of my body several times and making my muscles feel like muscles again.
A very special amount of gratitude and undying love goes directly to Jason, my partner, who spent the most time going through this with me. His patience, support, and love are mind-blowing.
“I’m working my way back to me again…” (Tori Amos, “Oysters”)
Some helpful resources on larynx massage, MTD, and other points of interest:
What Is Muscle Tension Dysphonia? (via Swedish Medical Center)
With A Quick Throat Massage, A Voice Returns (via NPR)
Massage technique helps ease tension of voice disorder (via Vanderbilt University Medical Center)
Dorthe Kirkebække Voice Clinic