Home Health Care “Cuz You Know I’m All About That Case, Node Trouble”

“Cuz You Know I’m All About That Case, Node Trouble”

by Kristie Knickerbocker

Meghan Trainor’s song is so popular that excellent covers are popping up everywhere and I think there is a strong possibility of another definition of “bass” being added to the dictionary by next year. Now, while Meghan has no history of voice issues that I am aware of, others in the spotlight have suffered from vocal pathologies so severe that they have had to cancel tours and even rehabilitate their singing voices for years before performing live again.

Voice care has been in the media recently and I think it is important for clinicians to understand exactly what is going on with these popular cases because it will help them answer tough questions. I am always reading whatever I can get my hands on. I know that most SLP’s and AuD’s out there barely have time to dash to the bathroom during a work day, let alone to thoroughly read a peer-reviewed research study. It is our duty as clinicians to have a strong commitment to lifelong learning because our abilities as competent care providers are supported by the information we can synthesize on the spot. It is always okay to say, “I don’t know,” however, I always feel extra special when I can say: “I read about this last week.”

Not having enough information on a topic usually leads to accusations and rash decision making. I had a client recently ask about the procedure that was performed on Joan Rivers, which ended up causing her death. “Don’t you do that?” she asked. I explained that although I do not biopsy vocal cords, I do look at them with a camera and the patient needs to be awake so he or she can say “eeeeee.” I went on to explain that topical anesthetic is sometimes used when the gag reflex is particularly sensitive, but no patient of mine is ever sedated for an exam. Joan Rivers had some unplanned things happen during her procedure and because her healthcare information is private, just like any patient’s, we are left to read and watch news stories compiled with some facts missing.

Most of us know that Julie Andrews had great success with “The Sound of Music” and “Mary Poppins,” but many might not know that she battled with vocal nodules, also called nodes, in the 1990’s. Speech-Language Pathologists know now that vocal nodules usually respond to behavioral voice therapy without needing surgical intervention. Julie had her nodules removed in 1997, but the surgery left her with the inability to sing. We wonder, as we do in Joan’s case, what actually happened. If Julie had noncancerous nodules and her behaviors were addressed, perhaps surgery wouldn’t have been necessary at all. Nodules shouldn’t come back if the vocally abusive behaviors are replaced with efficient vocal production techniques. We don’t know if Julie had any voice therapy, but we can speculate that she most likely had scar tissue develop where the nodes were removed. Scar tissue inhibits the vocal fold tissue’s elastic properties resulting in pitch breaks or periods of aphonia.

Nodes have also been addressed by mainstream media in the movie “Pitch Perfect.” Chloe tells the Bellas she has vocal nodes in a dramatic scene, but reveals she has continued to sing despite the diagnosis because she loves it so much. We can’t be expected to know every movie or pop-culture reference to our profession, but it helps to be aware so we can connect to younger clients. Chloe’s story is all too familiar. Some clients find it very difficult to follow treatments because their jobs depend on voice use or they are passionate about performing. It is essential to communicate the importance of adhering to all voice therapy recommendations. Explain that while you understand their passion for their craft, you know that they will have more heartache later if they don’t take time to correct behaviors now.

John Mayer very recently opened up on Twitter to discuss his long and emotional struggle with a granuloma. He says, “It’s 2 years to the day that I had my vocal cords paralyzed so they could heal. It took about as long to get all of my voice back. I can’t tell you how good it feels to hit those notes. Especially on new songs. I’m free again. So grateful.” Well done, John. As clinicians, it’s important that we educate our clients about the length of recovery time, especially for professional voice users.

Polyps have plagued singers like Adele and Keith Urban. Adele reportedly used an app on her phone to speak for her while she was on voice rest for her hemorrhagic polyp, but I wonder if she knew about this avatar program. Technology is readily available these days to improve success for any clients on vocal rest. Both performers underwent surgery to correct these conditions, and hopefully some voice therapy too, as polyps and hemorrhages are functionally caused vocal pathologies. There are four different classes of voice disorders: Functional, Neurological, Organic and Idiopathic. With Adele and Keith’s conditions falling under the functional category, voice therapy could reverse bad habits and keep them from developing any future lesions.

Have you ever provided therapy to a famous client? I know you couldn’t tell anyone even if you have, but it’s pretty exciting, right? Sometimes we need a reminder that a high-profile client’s plan of care should be given the same attention as any other on our caseload. It is okay to feel star struck, but remember to remain calm and collected. Any famous clients will thank you for your professionalism and remember how your intervention helped them get back to doing what they love. Trust me on this one.

So whether your patient is red-carpet-ready or your average-Joe, be knowledgeable and treat clients with equal respect and care so you can “bring savvy back” and be “all about that case.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

 

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