Speaker 1: Oh Hi, it's her Bobby Pin under the couch cushion.
Speaker 1: Ali Ward and listen. If you're new around here, we
Speaker 1: usually do not throw so many two parters your way
Speaker 1: at once, but this and the Dreams episode both just
Speaker 1: really deserve them. And we had nearly four hundred questions
Speaker 1: for this one. So yes, a two parter it is. Also,
Speaker 1: this is an ologist I was just thrilled to meet
Speaker 1: after having a patron by the name of doctor Jessica
Speaker 1: Randolph write in to say please, this ologist is a brilliant,
Speaker 1: hilarious surgeon who works on voices. Have her on so
Speaker 1: a voice surgeon, yes, practicing in this field since two
Speaker 1: thousand and eight and specializing in voice disorders and airway issues.
Speaker 1: An expert. So I happened to be in New York
Speaker 1: and I got myself to the Bronx to meet up
Speaker 1: with this MD and fellow of the American College of
Speaker 1: Surgeons who's the director of the Division of Laryngology, ODO,
Speaker 1: Rhino Laryngology and Head and Next Surgery at Montfiore Einstein
Speaker 1: Medical Center. And we met up in the lobby. We
Speaker 1: stayed masked and we ducked into a small conference room
Speaker 1: and I learned so much about the voice, and also
Speaker 1: that we have a lot in common, and that I
Speaker 1: as a person have grown and I've changed. And I'm
Speaker 1: leaving the word mucus unbleeped in this episode. I've bleeped
Speaker 1: it in past episodes because i just can't deal. It
Speaker 1: gags me out, but I'm living it in one thing
Speaker 1: that does not gag me out. Our patrons, thank you
Speaker 1: for joining at patreon dot com, slash ologies and for
Speaker 1: submitting questions for the show. Thank you to everyone in ologies,
Speaker 1: merch Wearing it ologiesmirch dot com has things. Thank you
Speaker 1: to everyone who rates and subscribes and leads reviews for
Speaker 1: me to read. Here's one this week to prove that
Speaker 1: I read them all. It's from Bess Sarah, who wrote
Speaker 1: that this show's quirky sense of humor mixed with science
Speaker 1: is the perfect blend of fun and facts and it's
Speaker 1: great for everyone, kids too, if they're used to a
Speaker 1: little cursing, which reminds me that smologies episodes those are
Speaker 1: trimmed of my filth, and they're shorter and their classroom safe.
Speaker 1: So that's Whatsmology's episodes are for. They're for kids. Anyway,
Speaker 1: Onto the Interview, Part one of it, where we will
Speaker 1: use our voices to discuss your voices, plus Austin's Elvis drawl, hormones,
Speaker 1: deep voices, squeaky ones, Tips for singers, free life hacks
Speaker 1: that will make your skin glow and your brain work better,
Speaker 1: vocal feminization, surgery, turning back time, anatomy you may not
Speaker 1: know you have, and more, And then come back next
Speaker 1: week for whistle Tones Mariah, damage to your voice, box,
Speaker 1: throat singing perfect, pitch stress and voice cracks, and more
Speaker 1: with your new favorite laryngologist, doctor Rohnda Alexander. Oh my god. Okay,
Speaker 1: so here's your mic. There. They're stage mics, so they're
Speaker 1: super hardy, So just kind of get up in it,
Speaker 1: especially since we're masked.
Speaker 2: I'm up in the mic. I'm up in the mic.
Speaker 1: Perfect, Let me see, let me check your levels.
Speaker 2: Recovering theater kid, recovering theater kid, person who loves Broadway,
Speaker 2: person who sings the soundtrack to six in the shower
Speaker 2: and hasn't seen it yet and that's her biggest embarrassment.
Speaker 1: Literally, My first question doctor, is do you sing so done?
Speaker 3: Amazing?
Speaker 2: Wonderful?
Speaker 1: One first question ask if you can say your first
Speaker 1: and last name in your pronounce Yes.
Speaker 2: First name Ronda, are O Nda, last name Alexander. My
Speaker 2: pronouns are she her?
Speaker 1: No extra h in that Ronda, Nope.
Speaker 2: I am the daughter of Ronald and so I am
Speaker 2: our o Nda.
Speaker 1: Oh do any other doctors in your family? How do
Speaker 1: you become a surgeon? That is just something that I'm
Speaker 1: cannot even fathom.
Speaker 2: It requires. There is a delightful mix of ignorance and
Speaker 2: perseverance and encouragement, those three together. So it is one
Speaker 2: of those things where if you knew the full scope
Speaker 2: of the sacrifice and discomfort that it would be, you
Speaker 2: might not do it. But the pathway for me began
Speaker 2: way back in the eighties with first grade, where I
Speaker 2: was very, very fortunate to be in a scholastic environment
Speaker 2: where my teachers and my peers and my family all
Speaker 2: just really encouraged academic talent. Definitely not a situation where
Speaker 2: that was not a cultural fit. They were like, oh,
Speaker 2: this is this is great. We love this. We love
Speaker 2: when you bring home these report cards with all straight lines.
Speaker 2: We love it very much. Good job kid. And then
Speaker 2: you know, high school, I went to university down in Louisiana.
Speaker 2: I went to Zaba University of Louisiana, a historically black college,
Speaker 2: and then I went to medical school. And at that
Speaker 2: point now I am twenty twenty five, about to turn
Speaker 2: twenty six when I finished medical school, and I have
Speaker 2: secured a very coveted spot in the very competitive specialty
Speaker 2: of odo laryngology, head and next surgery. There are only
Speaker 2: about two hundred and twenty jobs in the country when
Speaker 2: you finish medical school. It's gone up a little bit.
Speaker 2: But the time when I was coming out to twenty was.
Speaker 1: It, Wow, two hundred and twenty openings every year to
Speaker 1: join the established ten to twelve thousand laryngologists in the US.
Speaker 1: And for context, I look this up. Every year the
Speaker 1: NBA hires about sixty new players, so your chances are
Speaker 1: only like four times better than getting into the NBA.
Speaker 1: But doctor Ronda Alexander is at the top of her field, so.
Speaker 2: And I was able to secure a position actually right here.
Speaker 2: I trained at this same place where I work. Now,
Speaker 2: you did, I did.
Speaker 1: But you were in Houston for a while as well.
Speaker 2: Yes, I worked down there for a decade. So after residency,
Speaker 2: which is five years of pushing your body and brain
Speaker 2: to the limits, being awake as long as thirty hours
Speaker 2: or so back when I did it, and finding safety
Speaker 2: in that and sacrifice and enjoy all of those things together.
Speaker 2: Then I did a one year FELLA in laryngology which
Speaker 2: had a bent towards NEU laryngology, so nerve based disorders
Speaker 2: of the head and neck and voice box. And then
Speaker 2: I left New York and I went down to Houston,
Speaker 2: and I practiced there for over twelve years before coming
Speaker 2: back to New York.
Speaker 1: And you've said so many ologies in the last minute.
Speaker 2: So our training that first five years is comprehensive odorhino laryngology,
Speaker 2: head and neck surgery. So that's everything from taking tonsils
Speaker 2: out of a small child with breathing problems or putting
Speaker 2: ear tubes in so they can hear well, to taking
Speaker 2: care of cancers of the thyroid or mouth or tongue,
Speaker 2: to taking care of allergies and polyps in the nose
Speaker 2: or heaven forbid, also there can be cancers in there
Speaker 2: that we take care of as well, all the way
Speaker 2: to cosmetic things like using botox to soften wrinkles and
Speaker 2: lines fillers to plump up the face and make it
Speaker 2: even younger looking, and then my part, which is voice
Speaker 2: airway swallowing disorder.
Speaker 1: We do that.
Speaker 2: Did I leave anyone out? Hearing? That's right, so otology
Speaker 2: and neurootology, that's going to be the specialties of hearing
Speaker 2: and balance and restoring that. So we have a broad
Speaker 2: umbrella and our field in general is about how we
Speaker 2: interact with the world. So we're in charge of hearing, taste, smell,
Speaker 2: the way your face looks, and the way your voice sounds.
Speaker 2: So we're really all about how you interact with your environment.
Speaker 1: Oh my gosh, what about now? What would you say?
Speaker 1: A lot of your work now is.
Speaker 2: So my work now concentrates in two main areas, and
Speaker 2: that is voice health and airway health. So voice health
Speaker 2: is going to be are there injuries or developmental problems
Speaker 2: in the voice box, anatomy or the way that the
Speaker 2: person uses it that are getting in the way of
Speaker 2: them being able to present themselves authentically, confidently and in
Speaker 2: a healthful way. And then a lot of I do
Speaker 2: airway disorders, So that's going to be people who have
Speaker 2: had an injury or inflammation or surgery on the voice
Speaker 2: box that has led to a narrow place in particular,
Speaker 2: And so we do lots of reconstructions and things to
Speaker 2: help get them so they can live a tube free life.
Speaker 2: So most of those folks are going to have a tracheostomy,
Speaker 2: which is an artificial whole from the skin down to
Speaker 2: the windpipe or trachea, and so finding ways to get
Speaker 2: that out because most people just don't want them.
Speaker 1: Is There are a part of your job too that
Speaker 1: deals with why someone can sing or not sing, In
Speaker 1: particular me, why can't I sing?
Speaker 2: So that ends up being in vocology or phoneology. So
Speaker 2: that's going to be the province of professional singing teachers
Speaker 2: and coaches. So we work oftentimes in collaboration with them
Speaker 2: and another discipline called speech language pathology, and together I'm
Speaker 2: in charge of the anatomy and the medical health. The
Speaker 2: singing teacher is in charge of technique and maybe style,
Speaker 2: and the speech language pathologists also overlaps with technique and
Speaker 2: also breathing health and reducing things like coughing. And they
Speaker 2: do a lot of coaching on things like reflex habits
Speaker 2: to collaborate with us as well. And you sing, I've
Speaker 2: been known to sing.
Speaker 1: Sing did not have any did performance have any influence
Speaker 1: in which field you went into?
Speaker 2: So I think it did earlier than I originally remembered.
Speaker 2: It definitely played a role in medical school where the
Speaker 2: patient's problems made sense to me when everyone else was like,
Speaker 2: who cares if they're missing a half step? And I
Speaker 2: was like, that makes a difference between whether they get
Speaker 2: a role or not, and if they don't get that role,
Speaker 2: that's whether they eat or not. And so like for me,
Speaker 2: it was a very practical thing, even though it's esoteric
Speaker 2: and high level and people think, oh, it's only on Broadway,
Speaker 2: But same for teachers, same for professional parents. If you
Speaker 2: can't use your voice with your child, are you able
Speaker 2: to do your job effectively? No, So everyone who uses
Speaker 2: their voice as a part of their job is a
Speaker 2: professional voice user as I consider them. They may not
Speaker 2: be performance voice users, but they are professional voice users.
Speaker 2: So heaven forbid to to if Ali gets a voice disorder,
Speaker 2: which I've heard you have, You've had colds and whatnot,
Speaker 2: and thought through it done it's pad anyway, lady, It's true.
Speaker 2: But like, if you can't do your job without your voice,
Speaker 2: you're a professional voice user and you deserve the best
Speaker 2: voice health.
Speaker 1: And you mentioned a half step, and I have no
Speaker 1: idea what that tho. Well musically, okay, is is that
Speaker 1: like an octave or.
Speaker 2: So it's one sixteenth of an octave?
Speaker 4: Okay?
Speaker 2: Active is eight notes and a half step would be
Speaker 2: in between.
Speaker 1: Okay. See already learning so many things. Obviously I'm not
Speaker 1: a singer. It's okay, But how does a person make
Speaker 1: words and sounds like? I don't even know what a
Speaker 1: voice box is? Is that the Adam's apple or what
Speaker 1: do we call a voicebox?
Speaker 2: So the larynx, which the Adam's apple is a part
Speaker 2: that you can feel, is composed of a few paired cartilages.
Speaker 2: Cartilage is kind of that scrunchy version of bones, squishy, flexible.
Speaker 2: So the single unpaired cartilages are the thyroid cartilage. And
Speaker 2: that's the one that in people who have had testosterone
Speaker 2: driven puberty, they're going to get a big prominence that
Speaker 2: comes out. We call that the thyroid prominence. And that's
Speaker 2: the Adam's apple.
Speaker 1: But just a side note, you can also call it
Speaker 1: a prominentia laryngia if you're fancy. But don't feel bad
Speaker 1: about ditching Adam in the Adam's apple name, because since
Speaker 1: it was likely just a bad translation from some Hebrew
Speaker 1: term meaning the swellings of a man. But if neither
Speaker 1: an Adam's apple or a prominentia laryngia are just not
Speaker 1: striking a chord for you, just call your throat cartilage
Speaker 1: a goozle, and yes, I will use it. In a
Speaker 1: sample sentence provided by an online dictionary quote, they served
Speaker 1: real good cold beer in those days. It almost froze
Speaker 1: your goozle pipes. But it pains me to tell you
Speaker 1: that goozle is a term that actually has its dance
Speaker 1: card pretty filled with meanings, because, according to another word
Speaker 1: origin site, a goozle can be any substance with the
Speaker 1: consistency of thickened gravy, not necessarily going down your goozle,
Speaker 1: but moving on moving downward.
Speaker 2: Below that is another cartilage called the crichoid cartilage, and
Speaker 2: that one is like the strong beam of the airway,
Speaker 2: keeping it nice and open for all the parts that
Speaker 2: need to move about. And now paired cartilages are going
Speaker 2: to be the a retinoids. These are like sailboats, sail
Speaker 2: shaped cartilages that do a lot of the moving. The
Speaker 2: vocal cords are actually strung from them. Oh, they have
Speaker 2: a complicated series of pulleys muscles make them move in
Speaker 2: several different directions to allow the voice box to achieve
Speaker 2: closure and opening.
Speaker 1: And your vocal cords are pretty much right where your
Speaker 1: head meets your neck, in the front, just below the
Speaker 1: hyoid bone. What the fuck is a hyoid bone? No
Speaker 1: one ever told me I had this bone. It's in
Speaker 1: the front of my neck. It's floating in my neck.
Speaker 1: A hyoid apparently means you shaped in Greek. And this
Speaker 1: thing does look like a horse shoe or half a
Speaker 1: bread crust right under your jaw. Why didn't you tell
Speaker 1: me I had a floating toast bone that anchors my
Speaker 1: tongue to my skeleton. Anyway, that bone is just upstairs
Speaker 1: from the vocal cords.
Speaker 2: So where does the voice come from? It comes from
Speaker 2: three different parts. The lungs of the power source they
Speaker 2: send up the air. The vocal folds do the vibrating.
Speaker 2: That's the base sound, and then the resonators are the throat,
Speaker 2: the mouth, the lips, to tongue, the teeth, and that's
Speaker 2: how you shape the sound to be like you. So
Speaker 2: we'll often describe the act of vocal production that we
Speaker 2: are an instrument to. So in a piano you have
Speaker 2: the body of the piano, that's your resonator. The power
Speaker 2: comes from when the hammer inside hits the strings, and
Speaker 2: you're the source when you're banging on the keys. And
Speaker 2: so similarly in us we have those same three things,
Speaker 2: a power source, a vibrator, and resonators.
Speaker 1: So when people say that my voice is my instrument,
Speaker 1: they're not. They're they're not dicking around. That's real.
Speaker 2: No, it's totally real. Yeah, absolutely, maybe my mom.
Speaker 1: And what about different qualities of a voice over time? Obviously,
Speaker 1: if a kid calls you on the phone, you're like,
Speaker 1: I know, this is a kid, you know. And then
Speaker 1: if your grandpa calls you on the phone, it's gonna
Speaker 1: sound like your grandpa. So what is it about age
Speaker 1: that changes the quality of a voice.
Speaker 2: So, yes, our voice box and our resonators change over
Speaker 2: the course of our lifespan. When we're young, everything's tiny,
Speaker 2: and so you'll hear people say children have small voices.
Speaker 2: It's because they do. Their resonating system is small, and
Speaker 2: they tend to just be up here. They also haven't
Speaker 2: gone through any of the hormonal changes which might which
Speaker 2: will when puberty hits impact the shape of the voice
Speaker 2: box and the vocal folds themselves. We actually have hormone
Speaker 2: sensitive tissues inside of our voice box, and depending upon
Speaker 2: which hormones we get more of during puberty, the vocal
Speaker 2: folds make it's thicker and wider, and then the voice
Speaker 2: box stretches as the thyroid cartilage changes. For those folks
Speaker 2: who get testosterone proberty, and.
Speaker 1: Then if you are, let's say, going through menopause or
Speaker 1: if you are taking testosterone for you know, gender affirming therapy,
Speaker 1: how does that change what's going on there as well?
Speaker 2: So for my fems who are going through it, durynus
Speaker 2: down there is associated with dryness up here, really, so
Speaker 2: your overall moisture levels are going to change as you
Speaker 2: approach I like to think of that as like the
Speaker 2: last puberty, as I head into it myself.
Speaker 1: Agonizing and agonizing surprise, exciting.
Speaker 2: Life is exciting, That's one way. Yeah, So which hormones
Speaker 2: you're getting are going to influence everything from the texture
Speaker 2: of your mucus to the thickness of the tissue itself,
Speaker 2: which kinds of proteins and carbohydrates. It's to be tending
Speaker 2: to secrete, how thick your vibration layers are going to
Speaker 2: be all of those are going to be impacted by
Speaker 2: the hormones that you're experiencing. Wow, And to go back
Speaker 2: to the whole lifespan. As we age the same way,
Speaker 2: our pectorial may muscles and our arm muscles begin to
Speaker 2: droop and what we call atrophy or lose the body.
Speaker 2: The vocal folds can do that as well, So older
Speaker 2: voices will tend to be maybe a little thinner, you
Speaker 2: may describe it. We call it esthenic because they've lost
Speaker 2: muscle bulk. And we have things that we can do
Speaker 2: to help folks who are in that situation, who still
Speaker 2: need to use their voice because they may still be working,
Speaker 2: or just to feel more confident as well.
Speaker 1: Yeah, you know, my dad was really sick recently. My
Speaker 1: dad just passed away. But as he was getting sicker,
Speaker 1: he was losing a lot of weight and his voice
Speaker 1: changed a lot, And I never was sure what that
Speaker 1: was about. And it's interesting to think that his muscles
Speaker 1: were maybe atrophine.
Speaker 2: But also like loss of power. Yeah, that's another thing
Speaker 2: we have in common. It was my mom in June,
Speaker 2: my Aloma. Really yeah, no, absolutely, absolutely, we're like little twinkies,
Speaker 2: the two of us.
Speaker 1: Holy shit, up, So sorry. How long was she sick for?
Speaker 2: Oh? So she actually was diagnosed when I was a
Speaker 2: chief resident, so back in two thousand and seven. So
Speaker 2: we've had we had fifteen bonus years.
Speaker 1: Yeah, we had ten with my dad. I'm so sorry.
Speaker 2: We're just together in heart.
Speaker 1: So to learn more about this cancer I hate, you
Speaker 1: can listen to the hematology episode on Blood and for
Speaker 1: my Loma patients, the uncut hematology file on my website
Speaker 1: has a lot of extra questions I asked for patients
Speaker 1: and that'll be linked in the show notes. And an
Speaker 1: extra donation for this episode will go to myloma dot
Speaker 1: org in memory of doctor Alexander's mom, the late and
Speaker 1: wonderful Reverend Barbara Alexander. I'm so sorry you lost her though.
Speaker 2: Oh yeah, it's had it totally. Had a therapy appointment
Speaker 2: about this morning. So you know, we just we keep
Speaker 2: doing stuff.
Speaker 1: I've got one on Friday.
Speaker 2: Yeah yeah, yeah. It's the rest of our lives and
Speaker 2: we just we live it.
Speaker 1: I'm sure she was so proud of you.
Speaker 2: Oh yeah, she's a character.
Speaker 1: And my dad are somewhere right now, just like going,
Speaker 1: hey nice.
Speaker 2: She's probably bosting him around too. Yeah, yeah, I'll take it. Yeah,
Speaker 2: because Grandpad was gentle.
Speaker 1: Yes, he was a very Grandpad was a very gentle guy.
Speaker 1: It was it was interesting not to hear that, you know,
Speaker 1: as you get weaker and even if you're sick, or
Speaker 1: you're tired, or you know, is that something that people
Speaker 1: ever come to you wanting to turn back the clock on?
Speaker 2: Absolutely?
Speaker 1: Really yeah.
Speaker 2: Yeah. They want to get their young, robust voice and
Speaker 2: the same way they want to get their young robust face.
Speaker 2: And hopefully we can get them to get their young
Speaker 2: robust hearing by just wearing the hearing aids. So we
Speaker 2: can do procedures either under general anesthesia full sleep, no pain,
Speaker 2: no memories, no moving, or under local anesthesia mild discomfort,
Speaker 2: with lots of coaching through the event that we that
Speaker 2: can actually just plump up the vocal cords with injections.
Speaker 1: Wow, this is called a voice lift. Who knew, not me,
Speaker 1: but the gravelly, raspy the grip of time can be
Speaker 1: plumped up and then the song of youth returns, if
Speaker 1: that is what you want. And I watched some videos
Speaker 1: down the glottal hatch of people's vocal chords before and
Speaker 1: after a voicelift. I don't know how to describe this delicately,
Speaker 1: but my first impression of it, it looked the atrophied
Speaker 1: older vocal folds looked kind of like a vadge that
Speaker 1: was open wide, and then the rejuvenated ones kind of
Speaker 1: look like of a gene that was caught midwink, kind
Speaker 1: of closed up. Speaking of voice and crotches and changes,
Speaker 1: we're gonna talk a lot more about puberty and gender
Speaker 1: and vocal matters later on in this episode.
Speaker 2: Yeah, they can last anywhere from six weeks to around
Speaker 2: two years to some that are quasi permanent, but those
Speaker 2: are usually going to be understurgery because we have to
Speaker 2: do a little bit more work and you shouldn't be
Speaker 2: awake for that.
Speaker 1: Yeah, yeah, that's a lot. I'm sure the recovery time
Speaker 1: is at least a few weeks, right.
Speaker 2: Well, most of them, I get them talking within two days,
Speaker 2: and I just give them three rules. No whispering, because
Speaker 2: whispering is actually really bad for your voice box because
Speaker 2: you're putting a lot of pressure and squeezing to bank
Speaker 2: that quiet but strong voice. That was exhausting even just that.
Speaker 2: No talking on the cell phone outdoors because people forget
Speaker 2: that they're competing with the noise in the background, and
Speaker 2: so they're actually talking louder than they think. And then
Speaker 2: the third rule is if you can't touch them, you
Speaker 2: can't talk to them. So no shouting through the house.
Speaker 1: Wow, oh my gosh. Okay, now what about coughing. What
Speaker 1: is happening when you're coughing to your vocal cords? Is
Speaker 1: it chaos down there? It is?
Speaker 2: It's misfortune. Absolutely. They are experiencing a forceful slamming shut
Speaker 2: followed by an air eruption. And so because we rarely
Speaker 2: cough once, they're slamming together pretty hard. And we have
Speaker 2: seen people who just from a coughing disorder, whether it's
Speaker 2: pneumonia or unfortunately recently COVID being a coughing disorder, or
Speaker 2: from even if really hardcore throat clearing, where the banging
Speaker 2: together actually destroys part of the lining and puts them
Speaker 2: at risk for a thing called a granuloma, which is
Speaker 2: an irritation that grows and it kind of makes like
Speaker 2: a popcorn looking thing and stops your vocal cores from
Speaker 2: closing really well. And it's a cycle because having it
Speaker 2: there is an irritant which makes you cough and coughing
Speaker 2: makes it worse, and it getting worse makes you cough,
Speaker 2: et cetera. Et cetera.
Speaker 1: Is that how a cough from an illness can become chronic,
Speaker 1: Like even though you're not infectious or anymore, or you're
Speaker 1: not infected with say, you know, pneumonia or bronchitis, that
Speaker 1: cough becomes chronic from that irritation.
Speaker 2: Chronic cough comes from a few different kinds of things.
Speaker 2: It can come from the after effects of an infection,
Speaker 2: like if you had a sinus or nose infection and
Speaker 2: it's dripping gross, that'll make your cough. But also there
Speaker 2: can be nerve based coughs cough from the original issue.
Speaker 2: But then also we kind of get into the habit
Speaker 2: of cough and it ties closely to throat clearing where
Speaker 2: we're all the time, and we actually have certain kinds
Speaker 2: of rehab where we basically teach you to ignore that stimulus,
Speaker 2: to extinguish the stimulus. When you feel like you want
Speaker 2: a cough, you take a drink of water, or you
Speaker 2: do a different thing, or you say something, or you
Speaker 2: just let the air out gently. So instead of going
Speaker 2: they just go and let the air out so that
Speaker 2: they're not giving that irritating stimulus again so that we
Speaker 2: can help break the cycle of the coughing. She's got
Speaker 2: this incredibly grotesque throat clearing tick.
Speaker 3: It's like.
Speaker 2: It's like she's sticking for clams.
Speaker 1: Well, what's happening with a cough drop?
Speaker 2: So, cough drops are doing a couple of things. They
Speaker 2: often contain menthol, and menthol just kind of like opens
Speaker 2: up all the passages in the nose, does a little
Speaker 2: bit of shrinking of how much mucus you're making, so
Speaker 2: there's less irritant going on when you're breathing it in.
Speaker 2: It's also soothing and doucing some of the mucus in
Speaker 2: the throat. And then the third part is you put
Speaker 2: any candy in your mouth, you're gonna make more saliva,
Speaker 2: and so you're getting wetter saliva instead of the thick
Speaker 2: MUCUSI one that the mental is drying up, and so
Speaker 2: your throat is just happy that you're getting a little
Speaker 2: bit more saliva to help soothe it.
Speaker 1: Is that cool? Is it cool to have cough drops
Speaker 1: if you need them?
Speaker 2: So they're okay, okay, I just want to like that's
Speaker 2: one of those things where it's like follow the package
Speaker 2: directions you shouldn't have a cough drop every hour on
Speaker 2: the hour for several days. That's like, okay, well, what's
Speaker 2: really going on here? And examine? Am I drinking enough water?
Speaker 2: When am I eating? And what am I eating? Am
Speaker 2: I eating a whole turkey dinner? And then laying straight
Speaker 2: down and giving myself reflex which is gonna burn my
Speaker 2: voice box? Oh hello, fast paced people who work in
Speaker 2: these jobs.
Speaker 1: Yes, indeed, I mean, is there something that is better
Speaker 1: for reflex? Is it better to eat at like seven
Speaker 1: pm if you're going to bed at eleven and just
Speaker 1: give your body time to not burp up acid?
Speaker 2: Right, So you're gonna transit the food that you put
Speaker 2: in your belly within three to four hours. And so
Speaker 2: I try to folks a window. You can eat almost
Speaker 2: whatever you want. Pay attention to your body and how
Speaker 2: it responds to different foods, but you want an empty
Speaker 2: belly and went into bedtime. So last food must be
Speaker 2: done for my beginners. I tell them two hours because
Speaker 2: they got to get in the habit and it's so hard.
Speaker 2: Where it used to there's always a snack at the
Speaker 2: side of the bed, there's cookies. I went to bed
Speaker 2: with toast. I went to bed with the fruit. But
Speaker 2: especially if you have symptoms of cough, voice trouble, or
Speaker 2: specifically heartburn, you got to tighten it up empty belly.
Speaker 2: So really three hours I would love to see before
Speaker 2: you lay down at all. Now, going thinking back to
Speaker 2: like my medical school and residency days, if I got
Speaker 2: home at nine or ten pm, I'm not staying up
Speaker 2: till one because I have to get up the next
Speaker 2: morning at five. So that meant making modifications, which we
Speaker 2: recommend to folks all the time. So I for years
Speaker 2: slept in a recliner. Oh if I was having a
Speaker 2: late day, so I would have my meal and I
Speaker 2: would have to go right to bed, and so I
Speaker 2: would just make sure I was at a little bit
Speaker 2: of an incline, give your head some support. And that's
Speaker 2: just a modification. Just like you would modify an exercise
Speaker 2: for your own health. You can modify the things you
Speaker 2: have to do. You don't always have to sleep in
Speaker 2: a bed.
Speaker 1: I would never have thought of that as like a
Speaker 1: as a fix for that. You know there are because
Speaker 1: there have been times when I have come home with
Speaker 1: my purse still on and microwaved a frozen dinner it's
Speaker 1: been like this is the picture of like such a
Speaker 1: just a haggard career woman.
Speaker 2: You know it's glamorous. We're both living glamorous sides.
Speaker 1: What about does sleep apnea fall under your like surgical
Speaker 1: interventions at all or so?
Speaker 2: In the broader umbrella fields sleep sleep surgery is also
Speaker 2: a part of odoran alaryngology head next surgery, and so
Speaker 2: there are surgeries that can be done to reduce the
Speaker 2: resistance in the nose and also to keep the tension
Speaker 2: in the tongue and throat at a level that keeps
Speaker 2: it open. Because sleep acne is really about collapse. Sometimes
Speaker 2: that's nerve based, sometimes it's bulk based. But regardless of
Speaker 2: weight bm I, whatever measure you want to choose, it
Speaker 2: can happen to anyone having that sleep apnea. So it's
Speaker 2: the answer is not always just lose weight. Yeah, there
Speaker 2: are certain that you may need to be done to
Speaker 2: help reduce the resistance in the airway. Rarely we involve
Speaker 2: the voice box, but we can do that if they
Speaker 2: have a condition called Larringo Malaysia Space LA r y
Speaker 2: g O m A l a CIA Space for editing
Speaker 2: Loringo Malaysia Laaringo Malaysia is a condition where the voice
Speaker 2: box collapses under the pressures of breathing in and can
Speaker 2: contribute to the sleep acnea. So we can make some
Speaker 2: modifications to help it stay open and more strong, but
Speaker 2: mostly for sleep acnea. My concern is again you're breathing
Speaker 2: against resistance. What happens the chest pressure goes down and
Speaker 2: the belly pressure sucks up more reflux. So folks who
Speaker 2: sleep acne is not treated also have more reflux symptoms
Speaker 2: very commonly.
Speaker 1: So double whammy and not good whammies either one of them,
Speaker 1: but not all. Snoring is related to bulk in the
Speaker 1: throat and also, as we have discussed on this podcast,
Speaker 1: BMI is a very loose and kind of shady metric
Speaker 1: for determining body composition. It was invented by an Austrian
Speaker 1: astronomer was not even a medical doctor, but even a
Speaker 1: legit MD can tell you that. Of course BMI does
Speaker 1: not tell the whole story at all, and it's not
Speaker 1: fair to bodybuilders or to me. The day after I
Speaker 1: have ramen, I'm like a juicy, salty sham wow of
Speaker 1: a person. But the condition lo Ringo Malaysia, which she mentioned,
Speaker 1: can also show up in babies who have floppier vocal cords,
Speaker 1: and it leads to something called strider or noisy breathing, which,
Speaker 1: out of all of the loud things that a tiny
Speaker 1: baby can do from either end of their little soft bodies,
Speaker 1: I never knew that just breathing could be a loud thing,
Speaker 1: these poor little babes. What should people do if they
Speaker 1: have sleep at near their sleeping like shit? They feel
Speaker 1: like shit? They go to a doctor the doctor's leg
Speaker 1: just loose some weight and get back to me and
Speaker 1: it's not that's not the problem. Like, are there any
Speaker 1: diagnostic things that people should should make sure that they
Speaker 1: get checked out?
Speaker 2: Yeah? So the gold standard testing to diagnose sleep apnea
Speaker 2: is what we call a polysum nogram or a sleep study,
Speaker 2: And those can sometimes you're done at home as a screen,
Speaker 2: or they can be done in a lab where we
Speaker 2: are checking what are your brainwaves doing to make sure
Speaker 2: you're a sleep and what stage of sleep you're in.
Speaker 2: They've got a little band around your chest to see
Speaker 2: are you making the effort to breathe. They've got all
Speaker 2: kinds of heart monitors and blood oxygen monitors to see
Speaker 2: if you are getting air and then sometimes there'll be
Speaker 2: a little monitor that kind of is hanging out in
Speaker 2: the throat to see what the pressure is. And so
Speaker 2: obstructive sleep apnea, which is the kind that most folks have,
Speaker 2: is the kind where you're trying to breathe but there's
Speaker 2: a blockage, and so the sleep study is what's going
Speaker 2: to diagnose it. And so if you specifically ask for
Speaker 2: a sleep study and your doctor will not refer you
Speaker 2: for that, unfortunately, I would say break up with that
Speaker 2: person because healthcare is about teamwork. Like I'm the content
Speaker 2: subject matter expert and you're the expert in your life,
Speaker 2: and so together we got to sort out what we
Speaker 2: can do to make your life better.
Speaker 1: Who doesn't love to dump an asshole? So don't sleep
Speaker 1: on that good advice, Say goodbye, find someone better, cut banks,
Speaker 1: text a crush. We're all gonna die, doctor's orders. What
Speaker 1: is snoring then, because if clearing your throat and coughing
Speaker 1: is not good for your vocal cords, snoring's got to
Speaker 1: be bonkers because you sound like a muppet. It's just
Speaker 1: like it's the like, what is happening in there?
Speaker 2: So snoring is a vibration, usually of the soft palate,
Speaker 2: the little hang down dingly the bell that we call
Speaker 2: the uvula.
Speaker 1: I don't even know what that does.
Speaker 2: So that is it's a part of the throat. We
Speaker 2: don't we don't really know why we have the hang
Speaker 2: down bit there, but it is. That part of the
Speaker 2: palette is a part of closing off the nose so
Speaker 2: when you swallow food doesn't go up your nose. But
Speaker 2: that part vibrating is usually what's going to give you snoring.
Speaker 1: Really, the uvula vibrating.
Speaker 2: Oh yeah, and the whole soft palette. Wow, yeah, yeah, yeah,
Speaker 2: it's bonkers.
Speaker 1: If you want to know where is my so palette? Exactly,
Speaker 1: run your tongue along the roof of your mouth toward
Speaker 1: the back until it starts feeling squishy. There you go,
Speaker 1: that's your soft palette. So snoring can happen when the
Speaker 1: root of your tongue and your soft palette kind of
Speaker 1: flappity flap onto the back of your throat, and so
Speaker 1: you're vibrating your airway by skimming air sometimes through your
Speaker 1: mouth because your mouth goes into the windpipe without having
Speaker 1: to do with that roadblock of that flappity flap palette.
Speaker 1: But obstructive sleep apnea takes things a step further with
Speaker 1: these blockages that pause your breathing for seconds, sometimes in
Speaker 1: some people minutes at a time, holding your breath while
Speaker 1: you're asleep and you're gasping and snorting yourself awake for
Speaker 1: air so many times a night, Which is why that
Speaker 1: machine that forces air into your lungs but it looks
Speaker 1: like a space octopus is preferable to actually suffocating on
Speaker 1: your own throat meat. But your it's not doing damage
Speaker 1: to your vocal cords.
Speaker 2: Not necessarily, but having untraded sleepna is just setting you
Speaker 2: out for a whole host of troubles. Yeah, and what.
Speaker 1: About performers, opera singers, Shakespearean actors who are using their
Speaker 1: whole diaphragm, which to me, whenever someone is like, just
Speaker 1: use your diaphragm, I'm like, I don't really fully understand
Speaker 1: what that means. Is that just an expansion of your lungs.
Speaker 1: What's happening when people are projecting? Ah?
Speaker 2: So, projecting is maximizing both the power source and your
Speaker 2: resonators and aiming them the right way for the audience,
Speaker 2: which is why, like when you're watching stage plays that
Speaker 2: are not miked, or when you're watching opera that's not miked.
Speaker 2: It's very unnatural because I'm singing to you about you,
Speaker 2: and I'm facing the other way towards the audience, because
Speaker 2: we have to aim the sound our resonator towards who
Speaker 2: we want to hear it. And since you're in the cast,
Speaker 2: you already know what I'm saying. You don't need to
Speaker 2: hear it. The audience needs to hear it. So to
Speaker 2: understand your diaphragm better, We're gonna put one hand on
Speaker 2: your toumube tum right below your ribs and just take
Speaker 2: a natural breath, and what happens to your tum tum?
Speaker 1: Thankfully, my tumtumb wasn't already distended with coleslaw or beans
Speaker 1: or anything.
Speaker 2: What do you feel does it go in or out?
Speaker 1: I feel like it goes out a little bit.
Speaker 2: Yeah, so that's normal. The diaphragm is the muscle that
Speaker 2: separates your belly cavity with your guts in it, from
Speaker 2: your chest cavity, which has your lungs in your heart,
Speaker 2: and so in its relaxed state, that's breathing out exhaled
Speaker 2: when you breathe in that muscle because it's like a
Speaker 2: dome the muscle contracts so it gets smaller, and that
Speaker 2: actually pulls your chest cavity bigger. And so to do that,
Speaker 2: your tumtum actually should come out to make room for
Speaker 2: your guts to be that way, and so a good
Speaker 2: breath has your tummy coming out. And that's why costume
Speaker 2: designers are really smart, because almost all of those gorgeous
Speaker 2: fem opera costumes have an on pure waist because their
Speaker 2: belly has to move. There is no hourglass shaped opera
Speaker 2: costume because you gotta breathe.
Speaker 1: Wow, I never thought about that. Okay, So there's a
Speaker 1: difference between using your chest muscles to fill the upper
Speaker 1: part of your lungs versus expanding your belly with your
Speaker 1: diaphragm and having your diaphragm do the work to fill
Speaker 1: the lower lung too. And singers want to get as
Speaker 1: much air in so they can have more power and
Speaker 1: they can take fewer breaths too. But on the chill side,
Speaker 1: several studies are on top of it when it comes
Speaker 1: to researching the whys of that deep diaphormatic breathing and
Speaker 1: how it switches your brain out of panic mode. And
Speaker 1: in one twenty nineteen Frontiers and psychology paper titled Pulmonary
Speaker 1: afferent activity patterns during slow deep breathing contribute to the
Speaker 1: neural induction of physiological relaxation. The authors note that recent
Speaker 1: evidence suggests that breathing at six breaths per minute promotes
Speaker 1: behavioral relaxation. Hope we love that and barrel reflex resonance
Speaker 1: effects and appears to elicit resonant and coherent features in
Speaker 1: neuro mechanical interactions that optimize physiological function, as well as
Speaker 1: support the expression of slow cortical rhythms to induce a
Speaker 1: functional state of alert relaxation and via nose breathing, recruit
Speaker 1: hippocampal pathways to boost memory consolidation. I had to do
Speaker 1: diaformatic breathing just to get through that sentence. But I
Speaker 1: know you don't know what that means, and that's okay,
Speaker 1: because neither do I. But guess how much it costs
Speaker 1: zero dollars. It's to feel more chill air. It's free.
Speaker 1: So deep belly breathing is not just for your sister's
Speaker 1: Lululemon obsessedro made. It also does science things that are
Speaker 1: great for the brain area. And yeah, it's why you
Speaker 1: don't see a lot of opera stars lacing their rib
Speaker 1: cages into bone filled sausage shapes like a lot of
Speaker 1: period costumes, less their hearts. I mean, that's their hearts corsets.
Speaker 2: I won't do it. I won't do it.
Speaker 1: Nope. What about when let's say that you're a sing
Speaker 1: say you're a professional singer. I remember hearing like Adele
Speaker 1: having nodes, and it was the worst thing that a
Speaker 1: singer can ask for. What are those? And why does
Speaker 1: vocal rest help? So?
Speaker 2: Vocal fold nodes or nodules fall under a category of
Speaker 2: voice box injury that we call phono trauma, or injuries
Speaker 2: that come from producing sound. It also includes things like
Speaker 2: polyps and cysts, all of which have to do with
Speaker 2: the part of the voice box. I gets the most
Speaker 2: of the energy delivered to it from the vibration effects,
Speaker 2: and nodes or nodules are on both sides, and they
Speaker 2: are kind of like a callous that forms. So I
Speaker 2: think about if you do manual labor, or if you
Speaker 2: play a sport. When I was a kid, I played baseball,
Speaker 2: and so I had horrifying callouses after I had blisters
Speaker 2: because that's where all the force was going. Now I
Speaker 2: got good coaching, and my coach said, put on some batting.
Speaker 1: Gloves, get yourself some gloves.
Speaker 2: Right and are soft again. And so vocal fold nodules
Speaker 2: are often a sign of not having had enough good
Speaker 2: technical coaching, and you're kind of pushing through and so
Speaker 2: you're getting callouses instead of finding where your natural range
Speaker 2: is and having the right support again from your breath
Speaker 2: and from your resonators. So those are treated with therapy
Speaker 2: where we work to improve your technique. Almost never need surgery,
Speaker 2: almost never need surgery. But also fem luringies sometimes just
Speaker 2: have a little bit of a shape like that, And
Speaker 2: so we've learned that they're not always a problem, not
Speaker 2: always a disease, not always a pathology. If we looked
Speaker 2: at a thousand femme lringies, we might see six hundred
Speaker 2: or so with kind of an hourglass shape where they
Speaker 2: meet early in the middle. And in maybe fifteen twenty
Speaker 2: years ago, we just said, oh my gosh, you have nodules.
Speaker 2: But if they don't have a problem with their voice,
Speaker 2: they don't have nodules. Really, they have a fem voice.
Speaker 1: Aha, what about surgeries to feminize a voice?
Speaker 2: Yeah?
Speaker 1: Is that shortening the width of the vocal cords.
Speaker 2: So when we do feminizing voice surgeries, the goal is
Speaker 2: to increase the pitch. Right around two hundred cycles per
Speaker 2: second is the inflection point where we kind of culturally say,
Speaker 2: at least in the US, we say, this is a
Speaker 2: mask voice, this is a fem voice. And so we
Speaker 2: want to get our particular transpatients, we want to get
Speaker 2: them above two hundred so that their voice is concordant,
Speaker 2: similar in line with their physical presentation and their internal sensation.
Speaker 2: So to do that, what we end up usually doing
Speaker 2: is shortening the length of the vocal fold so that
Speaker 2: that same power is going through a shorter space, so
Speaker 2: it has to vibrate faster, and so that takes the
Speaker 2: frequency higher. So shortening the voice box usually by about
Speaker 2: one third to half while maintaining breathing space, is what's
Speaker 2: going to get that pitch to go up.
Speaker 1: That can help a lot with the dysphoria, with feeling
Speaker 1: like you're not sounding like you you feel absolutely yeah.
Speaker 2: Misgendering is a psychologically harmful experience that isn't always even intentional.
Speaker 2: When you're in the drive through or on the phone,
Speaker 2: we make assessments based on that frequency, and you know,
Speaker 2: on a bad day, I get misgendered. But because overall
Speaker 2: I'm aligned and cys like I can throw that off
Speaker 2: one time, but if it's happening all day, all the time,
Speaker 2: it can wear on a person.
Speaker 1: Yeah. So feminization surgery can address the length of the
Speaker 1: vocal folds themselves, but there are other factors in affirming
Speaker 1: a voice, and that can include the shape and the
Speaker 1: depth of the larynx itself. And a twenty twenty paper
Speaker 1: titled Vocal Feminization for Transgender Women, Current Strategies and Patient
Speaker 1: Perspectives notes that the first voice feminization surgery may have
Speaker 1: been performed by the Catholic Church, which prohibited women from
Speaker 1: singing in services and instead performed castration on boys to
Speaker 1: preserve their child pitch for singing in the higher registers
Speaker 1: in the Cystine Chapel. Not sure what the consent was
Speaker 1: back then, but either way, the voice box has a
Speaker 1: lot of androgen receptors, so the onset of puberty and
Speaker 1: a flood of testosterone means that the length and the
Speaker 1: thickness of the vocal chords increase, as does the diameter
Speaker 1: of the lynx. So think of a flute turning into
Speaker 1: a trombone. But if you're a person with ovaries but
Speaker 1: you have a hormonal condition that increases your testosterone, you
Speaker 1: can also experience deepening of the voice. And if you're
Speaker 1: signed female at birth but are on testosterone, your voice
Speaker 1: box will likely respond to that extra testosterone and deepen
Speaker 1: your voice. But if you don't have access to testosterone
Speaker 1: injections or vocal feminization surgery, which can cost up to
Speaker 1: fifteen grand, there is the non invasive option of vocal therapy,
Speaker 1: and that's practicing and modulating your voice using your throat
Speaker 1: and tongue and vocal chords to change the pitch and
Speaker 1: even the patterns of your voice. And I was doing
Speaker 1: some research and found an app called Eva that has
Speaker 1: video instructions and lessons in pitch and they have a
Speaker 1: tune tracker and exercises. For trans people who want to
Speaker 1: modulate their voice without hormones or surgery or just want
Speaker 1: to practice, there is this app called Eva. It costs
Speaker 1: around eighty bucks, but she within surgery will it stick?
Speaker 4: Though?
Speaker 1: I don't know? Why don't you ask Elvis or rather
Speaker 1: Austin Butler, or really just asked doctor Alexander about Austin Butler,
Speaker 1: which I did yesterday I texted her. I was like, hey,
Speaker 1: if a person were to say, train himself to speak
Speaker 1: like Elvis for a few years, could his voice get
Speaker 1: stuck like that? Or is it really more of a
Speaker 1: brain habit? And doctor Alexander wrote me right back. She
Speaker 1: was like, brain body habit, and the way we speak
Speaker 1: is part anatomy and part learned. So sweet, Austin Butler
Speaker 1: could unteach himself his current voice, but we should ask ourselves,
Speaker 1: should he? And then she put a smiling emoji with
Speaker 1: a halo, So perhaps he spent so long learning the
Speaker 1: voice his muscles have really internalized those patterns. If you
Speaker 1: want a deeper voice with less effort, you could also
Speaker 1: just get a cold, which causes vocal fold inflammation and thickening.
Speaker 1: But don't do that. No one needs it. And do
Speaker 1: you find that I'm always so interested that when we
Speaker 1: have a cold or we sound a little husky, we're like, ooh,
Speaker 1: I'm like Demi Moore, I'm sul trium whatever, Kathleen Turner.
Speaker 1: But obviously people who are a mask because of just
Speaker 1: internalized misogyny. Also just in general, being perceived as having
Speaker 1: a femme voice is almost like insulting it.
Speaker 2: Is because femininity is an insult.
Speaker 1: And how have femmes or people assigned female at birth
Speaker 1: responded to that subconsciously or consciously? A little something we
Speaker 1: talked about in the twenty eighteen Phonology episode with doctor
Speaker 1: Nicole Holiday, but you may have heard it on like
Speaker 1: countless reality programs, et cetera.
Speaker 2: Oo, all right, vocal fry. We're gonna go there. Oh yeah,
Speaker 2: it's super controversial because vocal fry has been kind of
Speaker 2: like the straw Man argument for aging men hates young
Speaker 2: woman's voice on radio.
Speaker 4: Yeah, something called vocal fry that is creeping into the
Speaker 4: speech patterns of young women.
Speaker 2: Is there anything equivalent in men?
Speaker 3: No, there isn't.
Speaker 2: But there is harm that's coming to your voice because
Speaker 2: if you're not using enough air to support, then you're
Speaker 2: going to be doing a lot of that squeezing and
Speaker 2: you're putting yourself at more risk for the phono trauma,
Speaker 2: the injuries to the vocal fold from trying to push through.
Speaker 2: You would not try to keep running the marathon if
Speaker 2: you hadn't eaten anything the day before, And that's what
Speaker 2: it is. If you're trying to talk without any air power,
Speaker 2: that's how you get into this zone with the fry,
Speaker 2: and it's literally asking the car to keep going with
Speaker 2: no gas. Just take a breath of people.
Speaker 1: Ah okay, that's actually very very that's so good to know.
Speaker 1: Too much vocal fry, which is your vocal cords flapping
Speaker 1: a little more chaotically than rhythmically, could possibly damage them
Speaker 1: in the long term. Most doctors say it's probably not
Speaker 1: going to happen. And also, just today I saw the
Speaker 1: headline the doomsday clock reveals how close we are to
Speaker 1: total annihilation. So I'm just going to urge you to
Speaker 1: worry about other things, especially if it's just because some
Speaker 1: guy farting into a leather recliner left a comment on
Speaker 1: your social media telling you that you sound like a
Speaker 1: valley girl. Just keep moving, babies. In the topic of
Speaker 1: sounding the way that we want to be perceived, obviously,
Speaker 1: if our whole face is a resonator in our neck,
Speaker 1: why do we sound so different on recordings than we
Speaker 1: are hearing day to day.
Speaker 2: Ah So we both never see ourself and never hear
Speaker 2: ourself outside of a photograph or a recording, because when
Speaker 2: you're hearing your voice, you're hearing the vibrations up through
Speaker 2: your own head, and so you're not hearing what other
Speaker 2: people are hearing. You're not necessarily hearing that through the
Speaker 2: entire mechanism of your ear until it's played back. And
Speaker 2: that's why it sounds foreign, because when you're talking and
Speaker 2: learning to talk, you're hearing actually the vibrations directly to
Speaker 2: your cochlea from your temporal bone inside your head, which
Speaker 2: is why you can hear yourself hum and it hasn't
Speaker 2: really gone anywhere, and we only ever see ourselves in
Speaker 2: mirror image, which that extremely disturbing phenomen on to those
Speaker 2: filters where they're like, this is how people see you.
Speaker 2: I'm like, no, thanks, yeah, no, it's it's I'm like,
Speaker 2: who's that lady? Or does she look like a Picasso
Speaker 2: painting straight? Like you know what it's because it's like off,
Speaker 2: but it's ten percent off, Like what is that?
Speaker 1: It's like Uncanny Valley with your own head.
Speaker 2: That sucks me, But it's also you know, exploring that,
Speaker 2: Like listening to this episode is going to be an
Speaker 2: exploration of accepting myself the way others perceive me and
Speaker 2: hearing my voice the way others hear me because I
Speaker 2: rarely hear it.
Speaker 1: Yeah, it's a trip for me every time. It's so difficult,
Speaker 1: even as someone who professionally uses their voice, and as
Speaker 1: someone who professionally uses their voice and is not so
Speaker 1: smart about it. I have a question about ice. I
Speaker 1: have a problem with ice that I love it too much,
Speaker 1: too much. I have an industrial ice machine in the
Speaker 1: garage because I was constantly running out the ice in
Speaker 1: the freezer. Okay, And I also do some voice over
Speaker 1: work on the side, and it occurs to me that,
Speaker 1: like I'm in the booth drinking ice water, they can
Speaker 1: probably hear the ice clink, and that is probably super unprofessional.
Speaker 1: What is up with temperatures and what you're drinking? Is
Speaker 1: ice bad? Is hot coffee bad?
Speaker 2: Like?
Speaker 1: What are we doing to ourselves?
Speaker 2: So the range of temperatures that don't cause you pain
Speaker 2: are all okay?
Speaker 1: Okay.
Speaker 2: Ice for some people is about the chewing okay, And
Speaker 2: for other people is about just getting the water in
Speaker 2: a more controlled way since it has to melt as
Speaker 2: opposed to just gulping down water. Also, when we give
Speaker 2: ourself any cold stimulus in the head and neck and
Speaker 2: in the mouth, it actually activates the calming part of
Speaker 2: our nervous system. So you may be oh, treating yourself
Speaker 2: in a way that's very helpful. By putting cold in
Speaker 2: your mouth, it's going to slow your heart rate, it's
Speaker 2: going to slow your breathing, and so any jitters or
Speaker 2: nerves you have are going to be suppressed by your
Speaker 2: nervous system. It's the parasympathetic system.
Speaker 1: Wow. So it's like, show me you have an anxiety
Speaker 1: disorder without showing me an anxiety sort having a big
Speaker 1: gulf And if you do, it's like, welcome to the club.
Speaker 2: But we're all not doing fine.
Speaker 1: Yeah, third year of a pandemic and reading headlines about
Speaker 1: the apocalypse anyone else but yes, I edited this episode
Speaker 1: during a rainstorm while drinking a thirty two ounce iced
Speaker 1: tea that was mostly just teed ice. There was so
Speaker 1: much ice. But next to that iced tea, I also
Speaker 1: had a mug of hot tea because I'm a chaotic
Speaker 1: little bitch like that.
Speaker 2: And for other folks, like the super hot sensations are stimulating.
Speaker 2: It gets them going because warmer will tend to push
Speaker 2: you a little bit more towards the sympathetic the amped
Speaker 2: up body system in addition to the caffeine.
Speaker 1: Does the cold water cause more mucous production or congestion,
Speaker 1: or does it freeze up your muscles and your larynx.
Speaker 2: So it won't freeze the muscles, but it will tend
Speaker 2: to give you kind of a thicker mucus just because
Speaker 2: it has less energy in it, and so it's going
Speaker 2: to be an energy sink. It's going to take heat
Speaker 2: out of the body, and so that's endothermic reactions. Because
Speaker 2: I also really love I miss chemistry and math and
Speaker 2: all that stuff. So it's pulling energy and warmth out
Speaker 2: of you. Whereas warmer things, particularly steam, as it's going
Speaker 2: from liquid to gas, it's a big energy jump, and
Speaker 2: so it has a lot more energy in it, and
Speaker 2: it's going to be able to thin the mucus secretions
Speaker 2: that are in your throat. So steaming is fantastic for
Speaker 2: the skin of the face. The voice box and the
Speaker 2: airways love it as well. So you know, everybody who
Speaker 2: does your nightly facial steaming your body is really pleased
Speaker 2: with that.
Speaker 1: For more on steaming your yoni, you can see the
Speaker 1: gynecology and urology episodes. Friends. But of all the things
Speaker 1: you can do with your genitals, doctors report that exposing
Speaker 1: them to scalding hot gases should be at the bottom
Speaker 1: of your list.
Speaker 2: So we want steam to be something that you can
Speaker 2: put on this thin skin of the inside of your
Speaker 2: wrists and it's comfortable. That's going to still be appropriate.
Speaker 1: Do you have any hacks for if you don't have
Speaker 1: a like seventy five dollars facial steamer from ben Bath
Speaker 1: and beyond.
Speaker 2: Yes, it's something that most of us who are housed
Speaker 2: are going to have. And it's a cup of hot water, legit.
Speaker 2: Like so, my folks, So we're here in the Bronx
Speaker 2: and this is of the sixty two counties in New
Speaker 2: York State. This is number sixty two in health outcomes
Speaker 2: and economic opportunities. And so I am not recommending go
Speaker 2: buy one hundred dollars thing to almost any of my patients.
Speaker 2: And so I'm like, boil water on the stove, put
Speaker 2: it into a mug that is safe, Maybe wrap a
Speaker 2: towel around it and just hold it under your face
Speaker 2: and breathe it in. And that's a steamer.
Speaker 1: Nice.
Speaker 2: So if you're on the go, get a cup of
Speaker 2: just hot water from the deli and that's steaming too.
Speaker 1: Oh wonderful. I'm going to start steaming my face. What
Speaker 1: about I used to drink a lot of your mamate
Speaker 1: because it is like legal drugs and it is so hardcore.
Speaker 1: I would drink a cup of your ramonte and be like,
Speaker 1: I'm going to go run a half marathon I've never
Speaker 1: run before, Like, I don't know what's in it. There's
Speaker 1: some catakins anyway. But I read that some studies correlated
Speaker 1: to people in South America who drink it having higher
Speaker 1: rates of esophageal cancer and throat cancer, and they determined
Speaker 1: it was maybe the temperature of the water. Are there
Speaker 1: any things having to do with throat cancer that are
Speaker 1: we should or shouldn't be doing?
Speaker 2: So I wouldn't put your mamate or hot things on
Speaker 2: that list. We've I mean, we've had millions of years
Speaker 2: of us drinking hot things because they've been important and useful,
Speaker 2: particularly in the in the edges and the higher latitudes.
Speaker 2: But the number one thing you shouldn't do to the
Speaker 2: throat to prevent cancer is inhale a thing that's on fire,
Speaker 2: got it. So, whether that's to back marijuana, any of
Speaker 2: the other things that people smoke, we don't want to
Speaker 2: be breathing in hot combusted on fire fumes into our
Speaker 2: voice box. And because we know tobacco is the one
Speaker 2: that we've studied the most, and that one it can
Speaker 2: cause cancer from the lips all the way down to
Speaker 2: the tips of the lungs, and so we just don't
Speaker 2: want to get We want to stop kids from starting.
Speaker 2: As far as vaping is concerned, it's good as a
Speaker 2: transition to nothing as much as possible. The other big
Speaker 2: contributor to throat cancer kind of higher up around the
Speaker 2: tonsils in the back of the throat. It's going to
Speaker 2: be human papaloma virus. And so I'm going to put
Speaker 2: in a plug to get your gardasil. Get your HPV vaccine,
Speaker 2: boy girl, or in between, get your HPV vaccine. I
Speaker 2: think I just made them a slogan.
Speaker 1: You literally did.
Speaker 2: I'm going to put in a plug to get your gardess,
Speaker 2: soe get your hpvvceine, boy girl, or in between, get
Speaker 2: your hp bvceine, boy girl, or in between.
Speaker 1: I mean, because there are some places that girls in
Speaker 1: certain states were being dissuaded because they thought it would
Speaker 1: make them sexually active.
Speaker 2: Yes, and if they.
Speaker 1: Got a vaccine that can prevent cancer. No one who's
Speaker 1: ever had a paps mirror was I'm sure advocating for that, right.
Speaker 2: There are some people in this country who are in
Speaker 2: systems of bondage which they did not actively choose, and
Speaker 2: a lot of their identity is wrapped up in it,
Speaker 2: and attachment to community is wrapped up in it, and
Speaker 2: it includes some harmful teachings that have come to them
Speaker 2: from people who even represent my same faith, and I
Speaker 2: get upset about it. But like the existence of apples
Speaker 2: does not mean you have to have an apple, so
Speaker 2: the existence of sex does not mean you have to
Speaker 2: have sex. And so no amount of medical care is
Speaker 2: going to make you have sex before you are ready,
Speaker 2: and so at least it shouldn't. It shouldn't, and so
Speaker 2: protecting your child or yourself from a viral mediated cancer.
Speaker 2: The other activities come from conversation, not from an injection,
Speaker 2: not at all. And if an injection is enough to
Speaker 2: set your kid off doing anything, they were going to
Speaker 2: be doing it anyway. And so maybe it's time to
Speaker 2: examine the relationship and open up and have some talks
Speaker 2: with them about what they're thinking and experiencing. Because no
Speaker 2: vaccine has ever made me do anything. And I just
Speaker 2: got a couple in the past couple of years, I
Speaker 2: didn't change much.
Speaker 1: Yeah, and what a breakthrough to have that gardisil vaccine
Speaker 1: available because that's something that is so HPV is so
Speaker 1: prevalent in so many people. It can be transmitted in
Speaker 1: so many ways, that's right. And yeah, it can be
Speaker 1: lethal for people. So I know several people who have
Speaker 1: gotten cancer cervical and esophagal. Great news. If you are
Speaker 1: over nine years old, you can get this vaccine. If
Speaker 1: you're over twenty six, though, doctors are kind of like,
Speaker 1: don't bother, you've probably already been exposed. But folks of
Speaker 1: all genders can be vaccinated. And if you've got a
Speaker 1: cervix and have the vaccine, you are seeing a seventy
Speaker 1: eight percent reduction in cervical cancer. Thank you very much.
Speaker 1: So ask your doctor and at the very least get
Speaker 1: your paths yearly. If you can't get the vaccine. Now,
Speaker 1: we're going to take a quick break. But when we're back,
Speaker 1: a free tip that will improve your life and your skin.
Speaker 1: But first will donate some money to worthy causes. First
Speaker 1: toomiloma dot org, which has amazing resources for folks affected
Speaker 1: by this blood cancer. And that is in memory of
Speaker 1: Reverend Barbara Alexander. And also a cause of theologists choosing
Speaker 1: this week is the Laryngology Education Foundation Health Equity Grant Program,
Speaker 1: which supports endeavors that increase understanding and awareness of how
Speaker 1: racial disparities impact laryngology and speech language pathology care in
Speaker 1: the US, specifically for patients of the black diaspora, and
Speaker 1: it supports initiatives that address these disparities in our communities.
Speaker 1: So those donations were made possible by sponsors of the show. Okay,
Speaker 1: back into it. What about hot water lemon honey? What's
Speaker 1: that doing?
Speaker 2: So again, the steam is the main actor in hot
Speaker 2: water honey soothes the top parts of the throat, but
Speaker 2: it's not ever going to touch the larynx in a
Speaker 2: healthy person because the larynx is the airway. And this
Speaker 2: is another fun tidbit about the lringopharyngeal complex. This upper
Speaker 2: throat area, it's the only part of the body we
Speaker 2: ask to do three things. Other parts to get two responsibilities.
Speaker 2: But this area needs to breathe, speak, and safely handle foods.
Speaker 2: And so the foods go around the side, the air
Speaker 2: go downs, goes down the middle, so nothing you're drinking directly.
Speaker 2: Is ever going to go directly into your voice box
Speaker 2: if you're in a healthy state. If it does, that's
Speaker 2: a condition called aspiration, where the food and drink is
Speaker 2: going into the lung direction, and we end up treating
Speaker 2: that as well. Aspiration. Is anything going into the lung
Speaker 2: that would that's not.
Speaker 1: Air, Yeah, anything which is pretty much you just want
Speaker 1: air in.
Speaker 2: There, only air and some lightly humidified air. So we
Speaker 2: want it to be warm and moist like the lung
Speaker 2: likes it to be. And so that's actually one of
Speaker 2: the functions of your nose is to warm and moisten
Speaker 2: the air, which is why nose breathing is preferred, because
Speaker 2: the air has time to pick up all the energy
Speaker 2: and molecules and moisture. But yeah, anything that's not air
Speaker 2: or humidified air going into the airway is a no.
Speaker 1: No, that's a no. Let's talk about Mariah Carey.
Speaker 2: Oh, let's me me.
Speaker 1: How does she do it? How does she make noises
Speaker 1: that some humans can't even hear?
Speaker 2: Right, So the whistle tones which I'm going to say
Speaker 2: that she is the air. To Minnie Ripperton, who's Maya
Speaker 2: Rudolph's mom from SNL Fame, I did not know. Minnie
Speaker 2: Ripperton listened to the song loving You. Okay, it's easy
Speaker 2: because you're beautiful, and then she does those whistle tones also, right, Yeah,
Speaker 2: that's right. So most of us have at least three
Speaker 2: registers or form of the voice, so just basically we're
Speaker 2: usually using our chest voice when we go into what
Speaker 2: we call falsetto. That's kind of the head voice, and
Speaker 2: that would be the difference between one two three and
Speaker 2: one two three. Like I went up in my falsetto,
Speaker 2: that's like lower lower pressure and I'm letting it just
Speaker 2: kind of resonate up higher. My vocal folds are tenser,
Speaker 2: and they're vibrating faster to do those higher pitches, and
Speaker 2: I'm not pushing and squeezing. I'm just letting it come out,
Speaker 2: so it's naturally quieter, okay. And then the whistle tones
Speaker 2: are an entirely different thing where they've tightened the voice
Speaker 2: box so much and they've positioned the vocal folds in
Speaker 2: the right manner where they're doing a frequency that's just
Speaker 2: on a next level higher, and so then the resonators
Speaker 2: are really just shaping it, which is why when people
Speaker 2: are doing their whistle tones, they're usually just going to
Speaker 2: do a single phoneme. It's usually just e or oh,
Speaker 2: because your articulators are focused on just getting really narrow
Speaker 2: and letting that sound out, and you can't do a
Speaker 2: lot of shaping of the sound because everything is squeezing
Speaker 2: to get it tight enough so that you can do
Speaker 2: those rapid vibrations at a high frequency that gets up
Speaker 2: into those whistle notes.
Speaker 1: Nice pipes. By the way, do you watch the national
Speaker 1: anthem and are you like you got this? You got this?
Speaker 1: You got this? You know, because it's such a difficult
Speaker 1: thing to sing. Yeah, yeah, And it has to happen
Speaker 1: before every ball game, every you know what I mean,
Speaker 1: whenever anyone goes up there. I was like, you got this,
Speaker 1: you got this? Come on, you got this.
Speaker 2: I mean, Fredgie did a great job.
Speaker 3: No sad, just dance star spaying.
Speaker 1: It was a choice. It was a bold choice, and
Speaker 1: I'm not going to leave a comment from my party
Speaker 1: recliner about it now.
Speaker 2: So that is one of the most difficult songs because
Speaker 2: of the range of notes that it covers, and I
Speaker 2: just I wouldn't recommend it as an audition song for
Speaker 2: just about anything.
Speaker 1: I have so many questions from listeners. Can I ask
Speaker 1: you one million, one million in two yes, we got
Speaker 1: them literally at present, three hundred and seventy seven questions.
Speaker 1: Not a big deal. Thank you, thank you. So that
Speaker 1: is why this is a blessed two parter. We will
Speaker 1: be back next week with so many answers to questions
Speaker 1: you'll be so glad patrons asked. But until then, take
Speaker 1: a big, deep belly breath or six and ask magnetic
Speaker 1: surgeons unsmart questions because your life will never be the same.
Speaker 1: And you can find doctor Alexander at your Voice MD
Speaker 1: on Twitter or your Underscore Voice Underscore Physicians on Instagram
Speaker 1: and say hello there. We are at Ologies on Twitter
Speaker 1: and Instagram, and I'm Ali Ward on both with one L.
Speaker 1: I'm Ali Underscore Ologies on TikTok now say hello. You
Speaker 1: can join patron at patreon dot com slash Ologies, where
Speaker 1: we have discussion threads each week about the episode. I
Speaker 1: love to read your reactions and chime in. Ologies Merch
Speaker 1: is available at ologiesmerch dot com. Thank you Susan Hale
Speaker 1: for managing that and so much else. Thank you Noel
Speaker 1: Dilworth for the scheduling. Aaron Talbert celebrates a birthday this week.
Speaker 1: Happy birthday, my sister friend. I love you forever. We
Speaker 1: have known each other since I was four and she
Speaker 1: admins Theologies podcast Facebook group with assists from Bonnie Dutch
Speaker 1: and Shannon Feltis. Emily White makes our professional transcripts and
Speaker 1: Caleb Patten bleeps them, and Zegredriguez Thomas and Mercedes Maitland
Speaker 1: of My Gym Media work on Smologies kid friendly shorter episodes,
Speaker 1: and Kelly ar Dwyer makes the website. She can make
Speaker 1: yours too. Mark David Christiansen and Jarrett Sleeper did additional
Speaker 1: editing on this episode alongside lead editor Mercedes Maitland, who
Speaker 1: has her own Maitland Audio. You can check that out.
Speaker 1: Nick Thorburn did the music and he is in a
Speaker 1: band called Islands. And if you stick around to the
Speaker 1: end of the episode, you know I tell you a
Speaker 1: secret this week. I'm gonna be real with you. I'm
Speaker 1: recording this from bed, and I've worked from bed all
Speaker 1: day and I don't know why I'm so tired. I'm
Speaker 1: getting over not feeling great, still not feeling great. COVID
Speaker 1: tests are negative, that's good, but yeah, either way, I'm
Speaker 1: like missing a spark plug or two but a better
Speaker 1: secret is that Jarrett got falafel as he was driving
Speaker 1: back from the gym, and for four days our car
Speaker 1: smelled just ripe, just inexplicably so. And then at a stoplight,
Speaker 1: I reached under the driver's seat and I found a
Speaker 1: cold moist and a pretty sizable onion right under the seat.
Speaker 1: It was like the size of an earthworm and sticky
Speaker 1: in that way, but stink here, and I was just
Speaker 1: so relieved. I've never been so relieved to touch something
Speaker 1: so smelly, and just to close that stinky chapter. But okay,
Speaker 1: enough out of my voice. I'll shut it for now.
Speaker 1: More voice boxes next week they'll come back.
Speaker 4: Okay, bye, bye, Focus on your diaphram.
Speaker 1: That was a diaphraend