Saturday, September 15, 2018

Maryland Lyric Opera - La Fanciulla del West (post 1)

Dear Readers,

Stasera a La Polka, il saloon di Minnie, v'annunzierò Jake Wallace, il cantastorie del campo!!! VENGA VENGA! Alle 19:30!! Sarà l'ultima opportunità di vederla e sentirla!

Thursday, September 13, 2018

On the topic of tongue-tie, Ankyloglossia, and Surgery 3 (Facebook user)

Dear readers,


This is the third of three posts in response to three singers who have reached out to me in the last few months inquiring about my experience with frenotomy (aka. frenulotomy, frenulectomy, and frenectomy - I, of course, know that there are differences in these terms specific to the procedure, please accept my attempt to be as inclusive as possible). As I mentioned in the previous post: I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts. 
Please see my previous blog entries for a detailed and pictorial documentation of my experience 

1)My 1st blog post on the topic: "Ankyloglossia Day 5" DECEMBER 4, 20162)My 2nd blog post on the topic: "Ankyloglossia Day 11" DECEMBER 9, 20163)My 3rd blog post on the topic: "Ankyloglossia 5 Weeks" JANUARY 7, 2017

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.

My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, 
I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to a facebook user who had reached out. I hope this post, as well as my previous posts will be of some help.

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.
My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to a facebook user who had reached out. I hope this post, as well as my previous posts will be of some help.


Singer: Hello Joe... I'm a 48 year old singer and voice teacher with a frenectomy appointment for next week. I'm both excited and scared. I have only two days before I need to teach, and about two weeks before a big Mozart role. Is that enough time for recovery? 

Joe: Glad to give you more information about my experience. Good of you to reach out, sadly there is not a lot of information out there from or by singers who have had this procedure. Since the procedure is localized to that particular connective tissue there will be no change to your vocal chords or production. I was able to speak with relative clarity immediately following the surgery. My ENT explained that I could speak, sing, and eat as my heart desired. The one note of caution is the pain. The pain is the only aspect that prevented me from immediately going back into work. I was consuming 2 Vicodin every 4 hours or so, while I was awake, for about 9 days.The eagerness, and the fear are both natural, normal, expected. I had those feelings as well.

To answer your questions specifically: 1) Is that enough time for recovery?  
>>I can only speak to my own experience, we all have different bodies. I was in quite a bit of pain for the first week and a half. The bleeding stopped with in 48 of the procedure. As long as you do not need to demonstrate much, if you're anything like me, you could be teaching two days after. As for the Mozart role. It's difficult to advise. Is it staged? Semi-staged? What are the rehearsals like? Is it with Orchestra? Is it highly publicized?

I returned to my ENT for a debriding exactly two weeks after the procedure.

Singer: What was the recovery like and how much of a change did you feel? 

Joe: It was fairly simple: go about a normal day consuming painkillers as needed. It is obligatory to do the simple stretches. Any time I wasn't speaking or sleeping I did the tongue stretches that my ENT showed me. Lift your tongue to your hard palette and avealar ridge. Stick your tongue out of your mouth as far as you can. I even started, by my own choice, to add a third stretch: curling my tongue back so the tip could touch the soft palette. Truly, the most painful aspect is the stretching.

HUGE change. Your timbre, and vocal idiosyncracies will not change. The best way I can explain it is: you'll have MANY more options to choose from - where as before you were limited. The only challenge I faced was working new articulations into old pieces. Primarily the consonants L,M,N,R... a little with D and T, too. But it's not really noticeable to anyone else.

Singer: Do you have less tension now? 

Joe: My tongue is free. There is really no way to explain until you feel it for yourself. The best analogy I can think of is like driving a car: If you've only ever driven a low-end used clunker that get's you from point A to B then you're pretty happy just going about your day. If you then drive top of the line BMW your skills as a driver do not change BUT the experience/comfort change.

You will still be the same singer after the procedure, it will not make you a different singer and wont change anything about your voice (at least it didn't for me). The flexibility and new options you have with your free tongue will surprise you (at least it surprised me). There is some, not drastic, SOME vocal freedom because the release of tension in the front of the tongue meant a release of the sympathy tension in the back/base of the tongue.

Singer: So helpful and encouraging. I have been working on tongue tension every day for 30 years and can't believe it's not my fault somehow! I've had a fine career- just got tired easily singing recitative and can't roll my r's or have clear diction with my mouth really open. I'm having it done with a laser and have been working with an orofacial myofunctional therapist who will work with me afterwards on the stretches as well. It sound like the pain will be worth it. You didn't have any nerve damage or trouble with fine motor control afterwards? That's the only part I'm afraid of.

Joe: That all sounds excellent. You're taking all of the right steps. No, I did not have any trouble or damage with fine motor control following. Now, almost three months after, it's still exciting to stick my tongue out, and do exercises. Lasers sounds exciting. My ENT was some what medieval about it, she used scissors and sharper knives. It was simple and took a total of 5 min. Though I waited in the office till the bleeding subsided. I happen to bleed a lot, others do not.

Best of luck, Kerry. If you have any further questions or need to reach out - please do not hesitate.

I hope that dialogue was of some use to readers looking for support.
As ever, I am happy to share my experience, and be a voice of comfort and support.

Keep singing pretty!
Thank you for reading
Joe