{"version":"1.0.0","segments":[{"speaker":"Jeremy","startTime":11.699,"endTime":14.564,"body":"This is a voice podcast with Dr."},{"speaker":"Jeremy","startTime":14.564,"endTime":16.694,"body":"Gillyanne Kayes and Jeremy Fisher."},{"speaker":"Jeremy","startTime":21.194,"endTime":25.814,"body":"Hello, and welcome to series five,"},{"speaker":"Jeremy","startTime":21.194,"endTime":25.814,"body":"episode three of this is a voice,"},{"speaker":"Gillyanne","startTime":25.964,"endTime":29.084,"body":"the podcast where"},{"speaker":"Gillyanne","startTime":25.964,"endTime":29.084,"body":"we get Vocal about voice."},{"speaker":"Jeremy","startTime":29.324,"endTime":31.664,"body":"We have a very"},{"speaker":"Jeremy","startTime":29.324,"endTime":31.664,"body":"special episode for you today."},{"speaker":"Gillyanne","startTime":31.694,"endTime":38.218,"body":"Yes, we have our first guest"},{"speaker":"Gillyanne","startTime":31.694,"endTime":38.218,"body":"of 2022 and it is Specialist speech"},{"speaker":"Gillyanne","startTime":38.218,"endTime":44.488,"body":"and language therapist, Tor Spence"},{"speaker":"Gillyanne","startTime":38.218,"endTime":44.488,"body":"of VoiceFit, and Tor loves coughing."},{"speaker":"Tor","startTime":45.418,"endTime":45.648,"body":"I do!"},{"speaker":"Gillyanne","startTime":46.458,"endTime":49.128,"body":"What is it that"},{"speaker":"Gillyanne","startTime":46.458,"endTime":49.128,"body":"you love about coughing?"},{"speaker":"Jeremy","startTime":49.738,"endTime":50.428,"body":"Hello Tor."},{"speaker":"Tor","startTime":50.428,"endTime":51.958,"body":"Hello, thank you"},{"speaker":"Tor","startTime":50.428,"endTime":51.958,"body":"so much for having me."},{"speaker":"Tor","startTime":51.958,"endTime":53.938,"body":"This is really, really exciting to talk."},{"speaker":"Tor","startTime":53.938,"endTime":54.238,"body":"Yes."},{"speaker":"Tor","startTime":54.238,"endTime":58.408,"body":"About a lot about coughing, which"},{"speaker":"Tor","startTime":54.238,"endTime":58.408,"body":"I've found myself working with a lot."},{"speaker":"Tor","startTime":58.958,"endTime":61.169,"body":"And yeah, I just find it fascinating."},{"speaker":"Tor","startTime":61.229,"endTime":65.109,"body":"And it's so linked, closely linked"},{"speaker":"Tor","startTime":61.229,"endTime":65.109,"body":"with the larynx and voice as well."},{"speaker":"Jeremy","startTime":65.109,"endTime":66.588,"body":"And not all coughing is the same."},{"speaker":"Jeremy","startTime":66.588,"endTime":67.278,"body":"Am I right?"},{"speaker":"Tor","startTime":67.818,"endTime":68.928,"body":"You are absolutely right."},{"speaker":"Tor","startTime":68.988,"endTime":69.198,"body":"Yep."},{"speaker":"Tor","startTime":69.228,"endTime":71.778,"body":"So there's many different causes of cough."},{"speaker":"Tor","startTime":71.808,"endTime":76.068,"body":"And the coughing that I end up working"},{"speaker":"Tor","startTime":71.808,"endTime":76.068,"body":"with is patients that have been coughing"},{"speaker":"Tor","startTime":76.068,"endTime":79.668,"body":"for more than eight weeks, normally"},{"speaker":"Tor","startTime":76.068,"endTime":79.668,"body":"for a chronic cough, a cough that's"},{"speaker":"Tor","startTime":79.668,"endTime":83.508,"body":"been refractory to various medical"},{"speaker":"Tor","startTime":79.668,"endTime":83.508,"body":"treatments, which means they haven't been"},{"speaker":"Tor","startTime":83.508,"endTime":85.608,"body":"successful at helping reduce the cough."},{"speaker":"Tor","startTime":86.148,"endTime":90.708,"body":"And normally where all sort of lung"},{"speaker":"Tor","startTime":86.148,"endTime":90.708,"body":"function tests, respiratory, ENT"},{"speaker":"Tor","startTime":91.038,"endTime":93.468,"body":"investigations, all of those are normal."},{"speaker":"Gillyanne","startTime":93.541,"endTime":93.871,"body":"Okay."},{"speaker":"Gillyanne","startTime":93.871,"endTime":96.766,"body":"So it's like coughing for no reason."},{"speaker":"Tor","startTime":98.071,"endTime":99.391,"body":"It is, well in a way."},{"speaker":"Tor","startTime":99.391,"endTime":101.701,"body":"So I tend to think of it as a help."},{"speaker":"Tor","startTime":102.021,"endTime":105.601,"body":"Dividing coughs between what's"},{"speaker":"Tor","startTime":102.021,"endTime":105.601,"body":"helpful and what's unhelpful."},{"speaker":"Tor","startTime":105.931,"endTime":109.531,"body":"So if we think about a helpful cough,"},{"speaker":"Tor","startTime":105.931,"endTime":109.531,"body":"being a cough, that expels something"},{"speaker":"Tor","startTime":109.531,"endTime":113.071,"body":"from the airway that shouldn't be"},{"speaker":"Tor","startTime":109.531,"endTime":113.071,"body":"there, sometimes that's where the"},{"speaker":"Tor","startTime":113.071,"endTime":117.241,"body":"lung condition or disease where"},{"speaker":"Tor","startTime":113.071,"endTime":117.241,"body":"people need to get rid of mucus."},{"speaker":"Tor","startTime":117.631,"endTime":121.861,"body":"Obviously with an infection, you will"},{"speaker":"Tor","startTime":117.631,"endTime":121.861,"body":"be coughing partly to get rid of mucus"},{"speaker":"Tor","startTime":122.341,"endTime":125.899,"body":"and sputum as well, and it protects"},{"speaker":"Tor","startTime":122.341,"endTime":125.899,"body":"the airway, of course, from anything"},{"speaker":"Tor","startTime":125.899,"endTime":128.719,"body":"going down the wrong way, like food"},{"speaker":"Tor","startTime":125.899,"endTime":128.719,"body":"or drink and things when we swallow."},{"speaker":"Tor","startTime":129.245,"endTime":135.865,"body":"But unhelpful cough, essentially as a dry,"},{"speaker":"Tor","startTime":129.245,"endTime":135.865,"body":"tickly cough, that's laryngeal focused,"},{"speaker":"Tor","startTime":136.195,"endTime":141.085,"body":"that's caused or triggered by a sensation"},{"speaker":"Tor","startTime":136.195,"endTime":141.085,"body":"where ideally we want to find something"},{"speaker":"Tor","startTime":141.085,"endTime":145.645,"body":"else to do to help manage or cope with"},{"speaker":"Tor","startTime":141.085,"endTime":145.645,"body":"that sensation rather than coughing."},{"speaker":"Tor","startTime":145.705,"endTime":149.841,"body":"Otherwise people get, tend to get"},{"speaker":"Tor","startTime":145.705,"endTime":149.841,"body":"onto a cough cycle that causes"},{"speaker":"Tor","startTime":149.841,"endTime":151.611,"body":"more irritation, more coughing."},{"speaker":"Tor","startTime":151.671,"endTime":153.051,"body":"And that's when people come to see me."},{"speaker":"Jeremy","startTime":153.471,"endTime":156.62,"body":"I just sorry, I just had an image"},{"speaker":"Jeremy","startTime":153.471,"endTime":156.62,"body":"of people climbing onto a cough cycle."},{"speaker":"Gillyanne","startTime":156.676,"endTime":159.543,"body":"I'm going to check in"},{"speaker":"Gillyanne","startTime":156.676,"endTime":159.543,"body":"here because we're very fortunate."},{"speaker":"Gillyanne","startTime":159.543,"endTime":163.651,"body":"We haven't had COVID and I know you've"},{"speaker":"Gillyanne","startTime":159.543,"endTime":163.651,"body":"worked with post COVID patients,"},{"speaker":"Gillyanne","startTime":164.341,"endTime":166.321,"body":"but I can remember swine flu."},{"speaker":"Gillyanne","startTime":166.321,"endTime":167.491,"body":"Do you remember swine flu?"},{"speaker":"Jeremy","startTime":167.491,"endTime":167.621,"body":"I do."},{"speaker":"Gillyanne","startTime":167.621,"endTime":168.471,"body":"And I had it."},{"speaker":"Gillyanne","startTime":169.286,"endTime":171.272,"body":"And you coughed every 12 minutes."},{"speaker":"Gillyanne","startTime":171.282,"endTime":172.682,"body":"That was one of the markers."},{"speaker":"Gillyanne","startTime":173.012,"endTime":177.489,"body":"But once it had gone, eight weeks on,"},{"speaker":"Gillyanne","startTime":173.012,"endTime":177.489,"body":"I was still blooming well coughing."},{"speaker":"Gillyanne","startTime":177.519,"endTime":183.069,"body":"And it was exactly, as you say that little"},{"speaker":"Gillyanne","startTime":177.519,"endTime":183.069,"body":"dry cough, I also was throat clearing."},{"speaker":"Gillyanne","startTime":183.999,"endTime":187.989,"body":"And actually I went to see a laryngeal"},{"speaker":"Gillyanne","startTime":183.999,"endTime":187.989,"body":"osteopath, and he said to me, do you know"},{"speaker":"Gillyanne","startTime":187.989,"endTime":190.419,"body":"that you throat clear every five minutes?"},{"speaker":"Gillyanne","startTime":191.859,"endTime":196.362,"body":"And he did some work on my larynx"},{"speaker":"Gillyanne","startTime":191.859,"endTime":196.362,"body":"and then the coughing went away."},{"speaker":"Gillyanne","startTime":196.362,"endTime":201.215,"body":"So I can relate to what you're saying is"},{"speaker":"Gillyanne","startTime":196.362,"endTime":201.215,"body":"that suddenly we get this, it's almost"},{"speaker":"Gillyanne","startTime":201.215,"endTime":203.358,"body":"a habitual pattern that we fall into."},{"speaker":"Gillyanne","startTime":203.358,"endTime":204.258,"body":"It's is it like."},{"speaker":"Gillyanne","startTime":206.003,"endTime":209.963,"body":"There's an irritant, a sense of"},{"speaker":"Gillyanne","startTime":206.003,"endTime":209.963,"body":"irritant in the larynx and it's"},{"speaker":"Gillyanne","startTime":209.963,"endTime":212.183,"body":"responding to anything that comes by?"},{"speaker":"Tor","startTime":212.753,"endTime":213.233,"body":"Yes."},{"speaker":"Tor","startTime":213.233,"endTime":217.607,"body":"So it is quite common after an infection"},{"speaker":"Tor","startTime":213.233,"endTime":217.607,"body":"or a virus, particularly something"},{"speaker":"Tor","startTime":217.607,"endTime":221.957,"body":"like swine flu or we're seeing post"},{"speaker":"Tor","startTime":217.607,"endTime":221.957,"body":"COVID that people have been coughing"},{"speaker":"Tor","startTime":221.957,"endTime":224.087,"body":"helpfully when they've been unwell."},{"speaker":"Tor","startTime":224.417,"endTime":228.017,"body":"But what they're left with after any"},{"speaker":"Tor","startTime":224.417,"endTime":228.017,"body":"infection or illnesses cleared is that the"},{"speaker":"Tor","startTime":228.017,"endTime":230.987,"body":"larynx has become quite hypersensitive."},{"speaker":"Tor","startTime":231.287,"endTime":236.867,"body":"So it's very, the larynx is obviously very"},{"speaker":"Tor","startTime":231.287,"endTime":236.867,"body":"sensory and it responds to lots of things,"},{"speaker":"Tor","startTime":236.867,"endTime":240.887,"body":"but including environmental triggers and"},{"speaker":"Tor","startTime":236.867,"endTime":240.887,"body":"the air quality in the world around us."},{"speaker":"Tor","startTime":241.367,"endTime":246.497,"body":"And if the larynx is hypersensitive,"},{"speaker":"Tor","startTime":241.367,"endTime":246.497,"body":"think of it as there are too many messages"},{"speaker":"Tor","startTime":246.497,"endTime":250.187,"body":"firing up from the larynx to the brain"},{"speaker":"Tor","startTime":246.497,"endTime":250.187,"body":"telling us that there's something there"},{"speaker":"Tor","startTime":250.217,"endTime":254.74,"body":"that's irritating, or that needs to be"},{"speaker":"Tor","startTime":250.217,"endTime":254.74,"body":"got rid of and people end up getting too"},{"speaker":"Tor","startTime":254.74,"endTime":257.17,"body":"many messages and a strong urge to cough."},{"speaker":"Tor","startTime":257.5,"endTime":259.06,"body":"And of course people will cough."},{"speaker":"Tor","startTime":259.06,"endTime":263.62,"body":"Cause they don't know at that stage that"},{"speaker":"Tor","startTime":259.06,"endTime":263.62,"body":"there's any that they might get onto their"},{"speaker":"Tor","startTime":263.63,"endTime":264.94,"body":"cycle or there's something different."},{"speaker":"Tor","startTime":264.94,"endTime":266.2,"body":"They can do that safer."},{"speaker":"Gillyanne","startTime":266.223,"endTime":266.763,"body":"Yeah."},{"speaker":"Gillyanne","startTime":266.793,"endTime":270.333,"body":"Talk about the effect on"},{"speaker":"Gillyanne","startTime":266.793,"endTime":270.333,"body":"the larynx of coughing."},{"speaker":"Gillyanne","startTime":270.493,"endTime":274.022,"body":"Obviously it's something that singers"},{"speaker":"Gillyanne","startTime":270.493,"endTime":274.022,"body":"are very conscious of because we're"},{"speaker":"Gillyanne","startTime":274.022,"endTime":278.102,"body":"told that it brings the vocal folds"},{"speaker":"Gillyanne","startTime":274.022,"endTime":278.102,"body":"together very fast and therefore,"},{"speaker":"Gillyanne","startTime":278.149,"endTime":281.799,"body":"there's a potential to cause trauma,"},{"speaker":"Gillyanne","startTime":278.149,"endTime":281.799,"body":"but from your perspective and in"},{"speaker":"Gillyanne","startTime":281.799,"endTime":284.199,"body":"your experience, what is the impact."},{"speaker":"Gillyanne","startTime":284.854,"endTime":285.904,"body":"On the larynx."},{"speaker":"Tor","startTime":286.654,"endTime":289.714,"body":"So when you cough, you bring"},{"speaker":"Tor","startTime":286.654,"endTime":289.714,"body":"your cords together and then you"},{"speaker":"Tor","startTime":289.714,"endTime":292.384,"body":"explode them open quite forcefully."},{"speaker":"Tor","startTime":292.414,"endTime":296.764,"body":"So yeah, there is the can, there is often"},{"speaker":"Tor","startTime":292.414,"endTime":296.764,"body":"an impact on the surface layers of the"},{"speaker":"Tor","startTime":296.764,"endTime":301.491,"body":"vocal chords and the surrounding area"},{"speaker":"Tor","startTime":296.764,"endTime":301.491,"body":"quite often in chronic cough patients."},{"speaker":"Tor","startTime":301.491,"endTime":306.261,"body":"If I examine their larynx, we'll"},{"speaker":"Tor","startTime":301.491,"endTime":306.261,"body":"see that the false cause of"},{"speaker":"Tor","startTime":306.261,"endTime":310.641,"body":"ventricular bands become quite"},{"speaker":"Tor","startTime":306.261,"endTime":310.641,"body":"involved and quite bulky as well."},{"speaker":"Tor","startTime":310.65,"endTime":313.865,"body":"And that creates a tension and"},{"speaker":"Tor","startTime":310.65,"endTime":313.865,"body":"can lead to voice problems."},{"speaker":"Tor","startTime":313.895,"endTime":318.905,"body":"So in allowance, where someone's being"},{"speaker":"Tor","startTime":313.895,"endTime":318.905,"body":"coughing, you will often see redness"},{"speaker":"Tor","startTime":319.265,"endTime":321.725,"body":"inflammation, sometimes a bit of swelling."},{"speaker":"Tor","startTime":321.935,"endTime":324.743,"body":"Now it's quite difficult to prove"},{"speaker":"Tor","startTime":321.935,"endTime":324.743,"body":"that's down to the coughing and not"},{"speaker":"Tor","startTime":324.743,"endTime":329.103,"body":"something else because there's so many"},{"speaker":"Tor","startTime":324.743,"endTime":329.103,"body":"possible abilities and causes for that."},{"speaker":"Tor","startTime":329.103,"endTime":331.608,"body":"Yeah, but some larynx is that"},{"speaker":"Tor","startTime":329.103,"endTime":331.608,"body":"where someone's been coughing"},{"speaker":"Tor","startTime":331.608,"endTime":332.837,"body":"will look entirely healthy."},{"speaker":"Tor","startTime":332.868,"endTime":337.068,"body":"There's no set pattern and there's"},{"speaker":"Tor","startTime":332.868,"endTime":337.068,"body":"actually no set way of us visually"},{"speaker":"Tor","startTime":337.458,"endTime":339.343,"body":"assessing a larynx as well."},{"speaker":"Tor","startTime":339.373,"endTime":343.063,"body":"We're looking at a larynx when on"},{"speaker":"Tor","startTime":339.373,"endTime":343.063,"body":"with our own experience and what we"},{"speaker":"Tor","startTime":343.063,"endTime":345.401,"body":"know of the things that can affect it"},{"speaker":"Jeremy","startTime":345.791,"endTime":348.281,"body":"Well you're looking at the"},{"speaker":"Jeremy","startTime":345.791,"endTime":348.281,"body":"larynx on camera, but you're also"},{"speaker":"Jeremy","startTime":349.061,"endTime":353.411,"body":"questioning the whole person and the"},{"speaker":"Jeremy","startTime":349.061,"endTime":353.411,"body":"whole situation that they're in and what"},{"speaker":"Jeremy","startTime":353.411,"endTime":355.5,"body":"patterns that they've got right then."},{"speaker":"Tor","startTime":355.74,"endTime":355.98,"body":"Yeah."},{"speaker":"Tor","startTime":356.15,"endTime":357.81,"body":"Yeah, absolutely."},{"speaker":"Gillyanne","startTime":358.02,"endTime":360.03,"body":"So what do you do?"},{"speaker":"Gillyanne","startTime":360.03,"endTime":362.79,"body":"How do you help people in that situation?"},{"speaker":"Jeremy","startTime":362.82,"endTime":363.48,"body":"What do you do Tor?"},{"speaker":"Tor","startTime":364.384,"endTime":368.398,"body":"So I work with people who have"},{"speaker":"Tor","startTime":364.384,"endTime":368.398,"body":"been coughing from eight weeks up to 30"},{"speaker":"Tor","startTime":368.398,"endTime":375.568,"body":"years, and it's never too late to look"},{"speaker":"Tor","startTime":368.398,"endTime":375.568,"body":"at changing that response, particularly"},{"speaker":"Tor","startTime":375.568,"endTime":379.888,"body":"if this is someone who's had all the"},{"speaker":"Tor","startTime":375.568,"endTime":379.888,"body":"lung function tests, seen Respiratory,"},{"speaker":"Tor","startTime":379.888,"endTime":384.268,"body":"seen the ENT, absolutely nothing to"},{"speaker":"Tor","startTime":379.888,"endTime":384.268,"body":"worry about from a medical point of"},{"speaker":"Tor","startTime":384.268,"endTime":388.445,"body":"view, but they've got this incredibly"},{"speaker":"Tor","startTime":384.268,"endTime":388.445,"body":"frustrating cough which often has a"},{"speaker":"Tor","startTime":388.445,"endTime":392.812,"body":"very significant impact on quality of"},{"speaker":"Tor","startTime":388.445,"endTime":392.812,"body":"life and affects, like you said, Jeremy,"},{"speaker":"Tor","startTime":392.84,"endTime":396.453,"body":"the whole person there's so much to"},{"speaker":"Tor","startTime":392.84,"endTime":396.453,"body":"consider when it comes to these symptoms"},{"speaker":"Tor","startTime":396.723,"endTime":399.813,"body":"and it might be affecting their voice,"},{"speaker":"Tor","startTime":396.723,"endTime":399.813,"body":"it might be affecting their swallow."},{"speaker":"Tor","startTime":400.173,"endTime":403.04,"body":"They've got these constant"},{"speaker":"Tor","startTime":400.173,"endTime":403.04,"body":"irritable feelings that might..."},{"speaker":"Tor","startTime":403.04,"endTime":404.82,"body":"Maybe made worse every time they talk."},{"speaker":"Tor","startTime":404.91,"endTime":409.13,"body":"So I think of my treatment on a Seesaw."},{"speaker":"Tor","startTime":409.495,"endTime":413.095,"body":"So the patients I see on one side,"},{"speaker":"Tor","startTime":409.495,"endTime":413.095,"body":"they'll have heightened laryngeal"},{"speaker":"Tor","startTime":413.095,"endTime":415.025,"body":"sensitivity on this side of the Seesaw."},{"speaker":"Tor","startTime":415.585,"endTime":419.386,"body":"And on the other side, they've got"},{"speaker":"Tor","startTime":415.585,"endTime":419.386,"body":"an impaired, conscious cough control"},{"speaker":"Tor","startTime":419.386,"endTime":423.3,"body":"because the more we cough, the more we"},{"speaker":"Tor","startTime":419.386,"endTime":423.3,"body":"want to cough and that, that sort of"},{"speaker":"Tor","startTime":423.3,"endTime":425.07,"body":"mechanism of control becomes impaired."},{"speaker":"Tor","startTime":425.07,"endTime":426.9,"body":"So you've got this very"},{"speaker":"Tor","startTime":425.07,"endTime":426.9,"body":"off-balance seesaw."},{"speaker":"Tor","startTime":428.07,"endTime":433.23,"body":"Therapeutically by trying to reduce"},{"speaker":"Tor","startTime":428.07,"endTime":433.23,"body":"the sensitivity on one side and then"},{"speaker":"Tor","startTime":433.23,"endTime":438.87,"body":"improve their conscious understanding"},{"speaker":"Tor","startTime":433.23,"endTime":438.87,"body":"and control of what they can do instead,"},{"speaker":"Tor","startTime":438.87,"endTime":443.1,"body":"how differently they can respond to"},{"speaker":"Tor","startTime":438.87,"endTime":443.1,"body":"that urge by balancing the Seesaw, or"},{"speaker":"Tor","startTime":443.1,"endTime":448.62,"body":"you do start to see some improvements"},{"speaker":"Tor","startTime":443.1,"endTime":448.62,"body":"to the severity of the cough, and then"},{"speaker":"Tor","startTime":448.77,"endTime":452.49,"body":"hopefully the frequency of the cough"},{"speaker":"Tor","startTime":448.77,"endTime":452.49,"body":"and the urge people get to cough."},{"speaker":"Gillyanne","startTime":454.17,"endTime":458.838,"body":"It must affect their quality"},{"speaker":"Gillyanne","startTime":454.17,"endTime":458.838,"body":"of life and also social interaction."},{"speaker":"Gillyanne","startTime":458.888,"endTime":463.443,"body":"I know sometimes if I've been on a,"},{"speaker":"Gillyanne","startTime":458.888,"endTime":463.443,"body":"a train or something and somebody is"},{"speaker":"Gillyanne","startTime":463.443,"endTime":469.243,"body":"coughing, apparently for no reason, and"},{"speaker":"Gillyanne","startTime":463.443,"endTime":469.243,"body":"it can be quite loud that kind of cough."},{"speaker":"Gillyanne","startTime":469.823,"endTime":472.274,"body":"And the cough and then a few"},{"speaker":"Gillyanne","startTime":469.823,"endTime":472.274,"body":"minutes later to the cough"},{"speaker":"Gillyanne","startTime":472.274,"endTime":473.924,"body":"again, and then they cough again."},{"speaker":"Gillyanne","startTime":473.963,"endTime":478.196,"body":"As a, someone hearing that"},{"speaker":"Gillyanne","startTime":473.963,"endTime":478.196,"body":"it can impact on you as well."},{"speaker":"Gillyanne","startTime":478.196,"endTime":480.874,"body":"And you know that's not because"},{"speaker":"Gillyanne","startTime":478.196,"endTime":480.874,"body":"I'm not, me, I'm not a mean"},{"speaker":"Gillyanne","startTime":480.874,"endTime":483.934,"body":"person, but it must impact on them."},{"speaker":"Tor","startTime":484.954,"endTime":488.164,"body":"And can you imagine if the last"},{"speaker":"Tor","startTime":484.954,"endTime":488.164,"body":"couple of years as well with the added"},{"speaker":"Tor","startTime":489.304,"endTime":496.219,"body":"component of COVID as well and how,"},{"speaker":"Tor","startTime":489.304,"endTime":496.219,"body":"to be honest, all of us do view cough,"},{"speaker":"Tor","startTime":496.339,"endTime":497.779,"body":"or have done a little bit differently."},{"speaker":"Tor","startTime":497.779,"endTime":501.739,"body":"And when you hear someone cough,"},{"speaker":"Tor","startTime":497.779,"endTime":501.739,"body":"people's sensitivity that have been"},{"speaker":"Tor","startTime":501.739,"endTime":504.713,"body":"really heightened haven't they and"},{"speaker":"Tor","startTime":501.739,"endTime":504.713,"body":"what people are thinking about it."},{"speaker":"Tor","startTime":504.713,"endTime":508.767,"body":"Yeah, the patients I work with"},{"speaker":"Tor","startTime":504.713,"endTime":508.767,"body":"who cough frequently, obviously,"},{"speaker":"Tor","startTime":508.767,"endTime":510.387,"body":"you know, home life is disrupted."},{"speaker":"Tor","startTime":510.417,"endTime":515.367,"body":"Work is disrupted and now particularly"},{"speaker":"Tor","startTime":510.417,"endTime":515.367,"body":"kind of social interactions are"},{"speaker":"Tor","startTime":515.367,"endTime":519.264,"body":"disrupted and they worry when they go"},{"speaker":"Tor","startTime":515.367,"endTime":519.264,"body":"out in public it's can be quite lonely."},{"speaker":"Jeremy","startTime":519.377,"endTime":522.497,"body":"Is there anything specific"},{"speaker":"Jeremy","startTime":519.377,"endTime":522.497,"body":"that we can do to, cause you"},{"speaker":"Jeremy","startTime":522.497,"endTime":524.507,"body":"know, that the cough is triggered?"},{"speaker":"Jeremy","startTime":524.777,"endTime":528.287,"body":"Is there anything that you can do to stop"},{"speaker":"Jeremy","startTime":524.777,"endTime":528.287,"body":"that trigger or replace it with something?"},{"speaker":"Tor","startTime":529.217,"endTime":534.587,"body":"So I tend to focus people on the"},{"speaker":"Tor","startTime":529.217,"endTime":534.587,"body":"smaller coughs where there's more warning"},{"speaker":"Tor","startTime":534.587,"endTime":539.237,"body":"that the cough is coming first because"},{"speaker":"Tor","startTime":534.587,"endTime":539.237,"body":"with chronic cough, not everyone gets"},{"speaker":"Tor","startTime":539.237,"endTime":541.007,"body":"a lot of warning the cough is coming."},{"speaker":"Tor","startTime":541.007,"endTime":545.477,"body":"So there are some more explosive"},{"speaker":"Tor","startTime":541.007,"endTime":545.477,"body":"coughs that feel involuntary."},{"speaker":"Tor","startTime":545.537,"endTime":551.257,"body":"But if we really tap into what is that"},{"speaker":"Tor","startTime":545.537,"endTime":551.257,"body":"feeling you get just before you cough."},{"speaker":"Tor","startTime":551.707,"endTime":556.117,"body":"Cause if there's a feeling before,"},{"speaker":"Tor","startTime":551.707,"endTime":556.117,"body":"generally speaking, there is some"},{"speaker":"Tor","startTime":556.117,"endTime":560.017,"body":"voluntary control that we can get in"},{"speaker":"Tor","startTime":556.117,"endTime":560.017,"body":"there between the feeling that we get"},{"speaker":"Tor","startTime":560.017,"endTime":561.727,"body":"and the response, which is the cough."},{"speaker":"Tor","startTime":562.237,"endTime":566.767,"body":"So I spend a lot of time with people"},{"speaker":"Tor","startTime":562.237,"endTime":566.767,"body":"focusing on that and keeping diaries"},{"speaker":"Tor","startTime":566.797,"endTime":570.577,"body":"and even sitting with me for half"},{"speaker":"Tor","startTime":566.797,"endTime":570.577,"body":"an hour, just if they're a frequent"},{"speaker":"Tor","startTime":570.577,"endTime":574.597,"body":"cougher, just feeling what they're"},{"speaker":"Tor","startTime":570.577,"endTime":574.597,"body":"feeling, tapping into that, being"},{"speaker":"Tor","startTime":574.597,"endTime":577.237,"body":"mindful, thinking about the sensations."},{"speaker":"Tor","startTime":577.607,"endTime":581.376,"body":"And then we try and come up with"},{"speaker":"Tor","startTime":577.607,"endTime":581.376,"body":"strategies and techniques for what to"},{"speaker":"Tor","startTime":581.376,"endTime":585.539,"body":"do instead that's not a cough, that's"},{"speaker":"Tor","startTime":581.376,"endTime":585.539,"body":"just a different response because"},{"speaker":"Tor","startTime":585.539,"endTime":587.099,"body":"that starts to break the cycle."},{"speaker":"Tor","startTime":587.309,"endTime":591.359,"body":"So you might start with just a gentler"},{"speaker":"Tor","startTime":587.309,"endTime":591.359,"body":"cough and then you might introduce"},{"speaker":"Tor","startTime":591.359,"endTime":595.743,"body":"techniques, like for example, a sip"},{"speaker":"Tor","startTime":591.359,"endTime":595.743,"body":"of water and a swallow sounds really"},{"speaker":"Tor","startTime":595.743,"endTime":600.273,"body":"simple, but by swallowing your sort"},{"speaker":"Tor","startTime":595.743,"endTime":600.273,"body":"of blocking that cough and you're"},{"speaker":"Tor","startTime":600.273,"endTime":603.918,"body":"closing the vocal cords, which can"},{"speaker":"Tor","startTime":600.273,"endTime":603.918,"body":"give them people, some relief from"},{"speaker":"Tor","startTime":603.918,"endTime":605.898,"body":"the sensation without that force."},{"speaker":"Gillyanne","startTime":606.978,"endTime":609.888,"body":"I love that you used"},{"speaker":"Gillyanne","startTime":606.978,"endTime":609.888,"body":"the word mindful and I'd actually"},{"speaker":"Gillyanne","startTime":609.888,"endTime":612.318,"body":"already written down mindful coughing."},{"speaker":"Gillyanne","startTime":612.348,"endTime":612.768,"body":"Yes."},{"speaker":"Jeremy","startTime":613.428,"endTime":613.921,"body":"Yeah."},{"speaker":"Jeremy","startTime":613.95,"endTime":614.04,"body":"Yes."},{"speaker":"Jeremy","startTime":614.46,"endTime":617.43,"body":"And you're raising awareness"},{"speaker":"Jeremy","startTime":614.46,"endTime":617.43,"body":"in a particular area, which is"},{"speaker":"Jeremy","startTime":617.43,"endTime":622.27,"body":"that moment between feeling that"},{"speaker":"Jeremy","startTime":617.43,"endTime":622.27,"body":"you need to actually coughing."},{"speaker":"Gillyanne","startTime":622.29,"endTime":625.62,"body":"The firing, and it also"},{"speaker":"Gillyanne","startTime":622.29,"endTime":625.62,"body":"helps put that person in control"},{"speaker":"Gillyanne","startTime":625.62,"endTime":630.45,"body":"because otherwise you've got the sense"},{"speaker":"Gillyanne","startTime":625.62,"endTime":630.45,"body":"that the cough is in control of you."},{"speaker":"Tor","startTime":631.2,"endTime":631.41,"body":"Yeah."},{"speaker":"Tor","startTime":632.43,"endTime":634.53,"body":"Oh, I talked so much"},{"speaker":"Tor","startTime":632.43,"endTime":634.53,"body":"about that with people."},{"speaker":"Gillyanne","startTime":634.8,"endTime":635.31,"body":"Yeah."},{"speaker":"Gillyanne","startTime":635.49,"endTime":635.94,"body":"Yeah."},{"speaker":"Gillyanne","startTime":636.03,"endTime":637.87,"body":"So what would be a gentle cough?"},{"speaker":"Gillyanne","startTime":637.89,"endTime":637.95,"body":"Yeah."},{"speaker":"Tor","startTime":639.515,"endTime":642.095,"body":"So just pulling right"},{"speaker":"Tor","startTime":639.515,"endTime":642.095,"body":"back on the force, maybe"},{"speaker":"Tor","startTime":642.095,"endTime":643.385,"body":"turning it into a throat clear."},{"speaker":"Tor","startTime":643.385,"endTime":644.055,"body":"So I might try it."},{"speaker":"Tor","startTime":644.082,"endTime":648.122,"body":"Our huffy cough, hopefully"},{"speaker":"Tor","startTime":644.082,"endTime":648.122,"body":"the sound picks that up."},{"speaker":"Tor","startTime":648.143,"endTime":654.173,"body":"Or just a very gentle throat clear"},{"speaker":"Tor","startTime":648.143,"endTime":654.173,"body":"because yes, we don't want people to"},{"speaker":"Tor","startTime":654.173,"endTime":657.563,"body":"throat clear regularly and replace"},{"speaker":"Tor","startTime":654.173,"endTime":657.563,"body":"coughing with throat clearing, but"},{"speaker":"Tor","startTime":657.563,"endTime":659.273,"body":"it is less forceful than a cough."},{"speaker":"Tor","startTime":659.303,"endTime":663.473,"body":"And we're just trying to work down"},{"speaker":"Tor","startTime":659.303,"endTime":663.473,"body":"those steps and finding less forceful"},{"speaker":"Tor","startTime":663.473,"endTime":665.663,"body":"responses and different responses."},{"speaker":"Jeremy","startTime":665.873,"endTime":669.203,"body":"It's really interesting listening"},{"speaker":"Jeremy","startTime":665.873,"endTime":669.203,"body":"to you doing your gentle cough because you"},{"speaker":"Jeremy","startTime":669.203,"endTime":673.133,"body":"are basically doing a gentle glottal stop."},{"speaker":"Jeremy","startTime":673.943,"endTime":678.388,"body":"And then this slightly it's a slower"},{"speaker":"Jeremy","startTime":673.943,"endTime":678.388,"body":"speed of air and a slightly more air."},{"speaker":"Jeremy","startTime":678.388,"endTime":684.088,"body":"So it's slightly less voiced in that"},{"speaker":"Jeremy","startTime":678.388,"endTime":684.088,"body":"makes it both softer and more diffused."},{"speaker":"Gillyanne","startTime":684.164,"endTime":686.383,"body":"It's something that's,"},{"speaker":"Gillyanne","startTime":684.164,"endTime":686.383,"body":"cause singers often talk about"},{"speaker":"Gillyanne","startTime":686.413,"endTime":690.613,"body":"I've got guck, I've got guck on my"},{"speaker":"Gillyanne","startTime":686.413,"endTime":690.613,"body":"vocal folds and Jeremy, you have a"},{"speaker":"Gillyanne","startTime":690.613,"endTime":692.533,"body":"technique don't you where you just say."},{"speaker":"Gillyanne","startTime":696.298,"endTime":698.698,"body":"And I'm doing it with nasal breathing."},{"speaker":"Gillyanne","startTime":698.698,"endTime":701.548,"body":"And I know we're going to talk"},{"speaker":"Gillyanne","startTime":698.698,"endTime":701.548,"body":"about that later, but there must be"},{"speaker":"Gillyanne","startTime":701.548,"endTime":704.678,"body":"something where, forgive me if I'm"},{"speaker":"Gillyanne","startTime":701.548,"endTime":704.678,"body":"preempting where you want to go,"},{"speaker":"Gillyanne","startTime":704.678,"endTime":706.296,"body":"but you're triggered by the cough."},{"speaker":"Gillyanne","startTime":706.796,"endTime":709.086,"body":"Course, then you take a"},{"speaker":"Gillyanne","startTime":706.796,"endTime":709.086,"body":"breath in, so you can do that"},{"speaker":"Gillyanne","startTime":709.086,"endTime":711.936,"body":"forceful, closing, and opening."},{"speaker":"Gillyanne","startTime":711.966,"endTime":716.946,"body":"Whereas if we do it with nasal breathing,"},{"speaker":"Gillyanne","startTime":711.966,"endTime":716.946,"body":"I think that might make a difference."},{"speaker":"Gillyanne","startTime":716.946,"endTime":722.166,"body":"And I know we hope to go there later,"},{"speaker":"Gillyanne","startTime":716.946,"endTime":722.166,"body":"but Ooh, I'm really geeking out here."},{"speaker":"Jeremy","startTime":722.226,"endTime":723.426,"body":"That's so interesting."},{"speaker":"Jeremy","startTime":723.426,"endTime":727.216,"body":"And you're breaking it, breaking down"},{"speaker":"Jeremy","startTime":723.426,"endTime":727.216,"body":"all the components of the cough and"},{"speaker":"Jeremy","startTime":727.251,"endTime":728.781,"body":"the sequence that you go through."},{"speaker":"Tor","startTime":729.861,"endTime":733.311,"body":"So if you imagine when you've"},{"speaker":"Tor","startTime":729.861,"endTime":733.311,"body":"got a sensation of a tickle, what"},{"speaker":"Tor","startTime":733.311,"endTime":736.131,"body":"normally people will do is take a"},{"speaker":"Tor","startTime":733.311,"endTime":736.131,"body":"big breath in through the mouth."},{"speaker":"Tor","startTime":737.436,"endTime":739.986,"body":"And then lock the vocal chords"},{"speaker":"Tor","startTime":737.436,"endTime":739.986,"body":"and then explode them open."},{"speaker":"Tor","startTime":740.346,"endTime":745.079,"body":"So it's, yeah, it's breaking down that"},{"speaker":"Tor","startTime":740.346,"endTime":745.079,"body":"that cycle, that process, and just,"},{"speaker":"Tor","startTime":745.177,"endTime":748.247,"body":"people have caught, people aren't"},{"speaker":"Tor","startTime":745.177,"endTime":748.247,"body":"going to realize what they're doing."},{"speaker":"Tor","startTime":748.247,"endTime":751.517,"body":"It feels like a natural response to"},{"speaker":"Tor","startTime":748.247,"endTime":751.517,"body":"getting rid of something in the airway."},{"speaker":"Tor","startTime":751.517,"endTime":755.267,"body":"Well, there isn't a person on the"},{"speaker":"Tor","startTime":751.517,"endTime":755.267,"body":"planet who hasn't coughed at some"},{"speaker":"Tor","startTime":755.267,"endTime":760.097,"body":"point in response to an irritant of"},{"speaker":"Tor","startTime":755.267,"endTime":760.097,"body":"some kind or a feeling in the throat."},{"speaker":"Tor","startTime":760.177,"endTime":763.554,"body":"But these people with cough"},{"speaker":"Tor","startTime":760.177,"endTime":763.554,"body":"hypersensitivity are people where that"},{"speaker":"Tor","startTime":763.554,"endTime":765.924,"body":"threshold of response has really lowered."},{"speaker":"Tor","startTime":765.924,"endTime":770.094,"body":"So I walk into a room where someone's"},{"speaker":"Tor","startTime":765.924,"endTime":770.094,"body":"just sprayed deodorant and yes, I"},{"speaker":"Tor","startTime":770.094,"endTime":773.514,"body":"might smell it I'll or perhaps feel"},{"speaker":"Tor","startTime":770.094,"endTime":773.514,"body":"it in my throat a bit, but it's not a"},{"speaker":"Tor","startTime":773.514,"endTime":778.073,"body":"bother, know, these people with cough"},{"speaker":"Tor","startTime":773.514,"endTime":778.073,"body":"hypersensitivity, one tiny spray of"},{"speaker":"Tor","startTime":778.183,"endTime":782.903,"body":"perfume or an aerosol or cleaning"},{"speaker":"Tor","startTime":778.183,"endTime":782.903,"body":"product and it sets them off immediately."},{"speaker":"Gillyanne","startTime":782.903,"endTime":784.753,"body":"Deodorants used"},{"speaker":"Gillyanne","startTime":782.903,"endTime":784.753,"body":"to do for me, didn't they?"},{"speaker":"Gillyanne","startTime":784.803,"endTime":786.537,"body":"That's that's really interesting."},{"speaker":"Gillyanne","startTime":786.559,"endTime":790.759,"body":"It sounds like when you're talking about"},{"speaker":"Gillyanne","startTime":786.559,"endTime":790.759,"body":"the vocal fold behavior, that it's the"},{"speaker":"Gillyanne","startTime":790.759,"endTime":796.469,"body":"explosion open that is more problematic"},{"speaker":"Gillyanne","startTime":790.759,"endTime":796.469,"body":"than cause I got in my mind, I'd got oh,"},{"speaker":"Gillyanne","startTime":796.489,"endTime":798.022,"body":"we're bringing the vocal folds together."},{"speaker":"Gillyanne","startTime":798.032,"endTime":802.768,"body":"The speed of closure is quite high"},{"speaker":"Gillyanne","startTime":798.032,"endTime":802.768,"body":"which we know can cause shearing of"},{"speaker":"Gillyanne","startTime":802.768,"endTime":808.079,"body":"the, the outer layers, but it's the"},{"speaker":"Gillyanne","startTime":802.768,"endTime":808.079,"body":"exp the force is greater outwards."},{"speaker":"Gillyanne","startTime":808.109,"endTime":809.099,"body":"Is that what you're saying?"},{"speaker":"Gillyanne","startTime":809.729,"endTime":810.479,"body":"Interesting."},{"speaker":"Tor","startTime":812.879,"endTime":813.279,"body":"Yeah."},{"speaker":"Tor","startTime":813.279,"endTime":815.361,"body":"People's coughs will vary hugely."},{"speaker":"Tor","startTime":815.391,"endTime":818.721,"body":"And it's very interesting when you've got"},{"speaker":"Tor","startTime":815.391,"endTime":818.721,"body":"a clinic full of chronic cough patients."},{"speaker":"Tor","startTime":818.811,"endTime":823.117,"body":"And it's on a Monday morning, I see"},{"speaker":"Tor","startTime":818.811,"endTime":823.117,"body":"lots of cough patients coming through"},{"speaker":"Tor","startTime":823.117,"endTime":826.037,"body":"from the respiratory team and they've"},{"speaker":"Tor","startTime":823.117,"endTime":826.037,"body":"done a they've had all their tests done."},{"speaker":"Tor","startTime":826.074,"endTime":829.505,"body":"And the medics feel that no, this"},{"speaker":"Tor","startTime":826.074,"endTime":829.505,"body":"is a chronic refractory cough."},{"speaker":"Tor","startTime":829.505,"endTime":831.785,"body":"This is something that can"},{"speaker":"Tor","startTime":829.505,"endTime":831.785,"body":"therapeutically be worked at."},{"speaker":"Tor","startTime":832.175,"endTime":835.415,"body":"And the differences in cough, there's"},{"speaker":"Tor","startTime":832.175,"endTime":835.415,"body":"lots of similarities, but there's also"},{"speaker":"Tor","startTime":835.415,"endTime":837.526,"body":"lots of different types of coughing."},{"speaker":"Tor","startTime":837.526,"endTime":839.828,"body":"And people get into patterns"},{"speaker":"Tor","startTime":837.526,"endTime":839.828,"body":"of coughing as well."},{"speaker":"Tor","startTime":839.888,"endTime":842.468,"body":"I don't know whether you've ever"},{"speaker":"Tor","startTime":839.888,"endTime":842.468,"body":"noticed particular people will cough"},{"speaker":"Tor","startTime":842.558,"endTime":844.428,"body":"in and very much a habitual pattern."},{"speaker":"Tor","startTime":844.638,"endTime":847.968,"body":"It might be two or three or four"},{"speaker":"Tor","startTime":844.638,"endTime":847.968,"body":"coughs in the same pattern each time."},{"speaker":"Tor","startTime":848.018,"endTime":850.717,"body":"So that's quite an interesting"},{"speaker":"Tor","startTime":848.018,"endTime":850.717,"body":"task of tapping into individual"},{"speaker":"Tor","startTime":850.717,"endTime":854.947,"body":"people's patterns and why that is"},{"speaker":"Tor","startTime":850.717,"endTime":854.947,"body":"and how we can break the patterns."},{"speaker":"Tor","startTime":855.307,"endTime":859.627,"body":"But yes, it's the forceful nature of"},{"speaker":"Tor","startTime":855.307,"endTime":859.627,"body":"the explosion open when you cough."},{"speaker":"Tor","startTime":861.227,"endTime":862.607,"body":"Causes the most problems."},{"speaker":"Gillyanne","startTime":863.237,"endTime":864.282,"body":"That is so interesting."},{"speaker":"Gillyanne","startTime":864.882,"endTime":866.592,"body":"You mentioned the word huffing."},{"speaker":"Gillyanne","startTime":866.652,"endTime":866.892,"body":"Yes."},{"speaker":"Gillyanne","startTime":867.302,"endTime":869.232,"body":"I happen to know what huffing is."},{"speaker":"Gillyanne","startTime":869.502,"endTime":872.792,"body":"What are the benefits of"},{"speaker":"Gillyanne","startTime":869.502,"endTime":872.792,"body":"huffing, maybe in this situation?"},{"speaker":"Jeremy","startTime":872.792,"endTime":874.752,"body":"Well first of all we"},{"speaker":"Jeremy","startTime":872.792,"endTime":874.752,"body":"should say what is huffing?"},{"speaker":"Gillyanne","startTime":875.172,"endTime":875.932,"body":"Yes, true."},{"speaker":"Tor","startTime":876.462,"endTime":876.792,"body":"Yeah."},{"speaker":"Tor","startTime":876.792,"endTime":881.912,"body":"And so half a Huff cough is letting"},{"speaker":"Tor","startTime":876.792,"endTime":881.912,"body":"the air out without too much..."},{"speaker":"Tor","startTime":882.882,"endTime":885.621,"body":"without full closure of the"},{"speaker":"Tor","startTime":882.882,"endTime":885.621,"body":"vocal cords, essentially."},{"speaker":"Tor","startTime":885.633,"endTime":889.553,"body":"So you're not getting the"},{"speaker":"Tor","startTime":885.633,"endTime":889.553,"body":"forceful adduction and explosion"},{"speaker":"Tor","startTime":889.553,"endTime":890.683,"body":"open of the vocal cords."},{"speaker":"Tor","startTime":890.683,"endTime":894.475,"body":"So you're protecting the layers"},{"speaker":"Tor","startTime":890.683,"endTime":894.475,"body":"of tissue on the vocal cords"},{"speaker":"Tor","startTime":894.475,"endTime":895.615,"body":"and the surrounding area."},{"speaker":"Tor","startTime":895.652,"endTime":900.567,"body":"The air movement through the glottis"},{"speaker":"Tor","startTime":895.652,"endTime":900.567,"body":"can then help expel a little bit of"},{"speaker":"Tor","startTime":900.567,"endTime":902.427,"body":"sticky mucus that might be there."},{"speaker":"Tor","startTime":902.877,"endTime":906.627,"body":"So in my experience, people do"},{"speaker":"Tor","startTime":902.877,"endTime":906.627,"body":"often say to me, there's something"},{"speaker":"Tor","startTime":906.657,"endTime":908.187,"body":"there that needs clearing."},{"speaker":"Tor","startTime":909.087,"endTime":913.737,"body":"However, if you were to look and"},{"speaker":"Tor","startTime":909.087,"endTime":913.737,"body":"examine the larynx with all those"},{"speaker":"Tor","startTime":913.737,"endTime":916.407,"body":"people at that given moment, yes."},{"speaker":"Tor","startTime":916.407,"endTime":920.487,"body":"Some would have a little bit of a"},{"speaker":"Tor","startTime":916.407,"endTime":920.487,"body":"stringing mucus perhaps across the"},{"speaker":"Tor","startTime":920.487,"endTime":924.987,"body":"glottis when they're breathing or a"},{"speaker":"Tor","startTime":920.487,"endTime":924.987,"body":"little bit of sticky patches of mucus,"},{"speaker":"Tor","startTime":925.287,"endTime":929.877,"body":"but not, by no means would everyone have"},{"speaker":"Tor","startTime":925.287,"endTime":929.877,"body":"anything visual to actually look at?"},{"speaker":"Tor","startTime":930.237,"endTime":933.627,"body":"So sometimes that feeling of that,"},{"speaker":"Tor","startTime":930.237,"endTime":933.627,"body":"being something there can be a"},{"speaker":"Tor","startTime":933.627,"endTime":938.77,"body":"sensation perhaps of dryness or of, a"},{"speaker":"Tor","startTime":933.627,"endTime":938.77,"body":"bit of muscular tension that's caused"},{"speaker":"Tor","startTime":938.77,"endTime":940.57,"body":"that feeling of Globus, for example."},{"speaker":"Tor","startTime":940.591,"endTime":945.264,"body":"And a huff, the breath moving through"},{"speaker":"Tor","startTime":940.591,"endTime":945.264,"body":"the larynx can sometimes be enough just"},{"speaker":"Tor","startTime":945.264,"endTime":948.024,"body":"to give a person that feeling of relief."},{"speaker":"Jeremy","startTime":948.594,"endTime":951.864,"body":"I'm glad you talked about this"},{"speaker":"Jeremy","startTime":948.594,"endTime":951.864,"body":"because we've been talking quite a lot"},{"speaker":"Jeremy","startTime":951.864,"endTime":957.278,"body":"about and the dispelling of the mucus,"},{"speaker":"Jeremy","startTime":951.864,"endTime":957.278,"body":"but actually it isn't always mucus is it?"},{"speaker":"Jeremy","startTime":957.298,"endTime":959.458,"body":"You can have really dry vocal folds."},{"speaker":"Tor","startTime":959.818,"endTime":960.088,"body":"Yeah."},{"speaker":"Tor","startTime":960.538,"endTime":961.468,"body":"Yeah, absolutely."},{"speaker":"Tor","startTime":961.496,"endTime":965.396,"body":"mean, People sometimes are absolutely"},{"speaker":"Tor","startTime":961.496,"endTime":965.396,"body":"convinced there's something there"},{"speaker":"Tor","startTime":965.876,"endTime":967.706,"body":"or the must be mucus to clear."},{"speaker":"Tor","startTime":968.156,"endTime":974.186,"body":"And when a chronic refractory cough is"},{"speaker":"Tor","startTime":968.156,"endTime":974.186,"body":"dry in nature, because there's nothing to"},{"speaker":"Tor","startTime":974.186,"endTime":979.046,"body":"clear it's unproductive, but some people"},{"speaker":"Tor","startTime":974.186,"endTime":979.046,"body":"will say to me, but it is productive."},{"speaker":"Tor","startTime":979.046,"endTime":981.636,"body":"I can feel something moving or loosening."},{"speaker":"Tor","startTime":981.689,"endTime":985.289,"body":"If any of us cough enough, we're"},{"speaker":"Tor","startTime":981.689,"endTime":985.289,"body":"going to produce a little bit of mucus"},{"speaker":"Tor","startTime":985.289,"endTime":986.849,"body":"because of the forceful nature of it."},{"speaker":"Tor","startTime":986.849,"endTime":991.331,"body":"Again, there is mucus in the linings"},{"speaker":"Tor","startTime":986.849,"endTime":991.331,"body":"of the airways below and a strong"},{"speaker":"Tor","startTime":991.331,"endTime":992.831,"body":"cough is going to displace that."},{"speaker":"Tor","startTime":992.925,"endTime":995.205,"body":"So yes, what comes first really?"},{"speaker":"Tor","startTime":995.205,"endTime":999.435,"body":"There's with chronic dry cough,"},{"speaker":"Tor","startTime":995.205,"endTime":999.435,"body":"there is rarely anything significant"},{"speaker":"Tor","startTime":999.435,"endTime":1003.035,"body":"to clear, but if we cough enough,"},{"speaker":"Tor","startTime":999.435,"endTime":1003.035,"body":"we will produce a bit of mucus."},{"speaker":"Gillyanne","startTime":1003.785,"endTime":1004.025,"body":"Yeah."},{"speaker":"Gillyanne","startTime":1004.025,"endTime":1007.265,"body":"Because, aren't there mucus"},{"speaker":"Gillyanne","startTime":1004.025,"endTime":1007.265,"body":"glands in the ventricular folds?"},{"speaker":"Gillyanne","startTime":1008.045,"endTime":1011.856,"body":"Obviously, if the the system detects"},{"speaker":"Gillyanne","startTime":1008.045,"endTime":1011.856,"body":"that the vocal folds are getting"},{"speaker":"Gillyanne","startTime":1011.856,"endTime":1014.286,"body":"very dry, what are they going to do?"},{"speaker":"Gillyanne","startTime":1014.556,"endTime":1015.786,"body":"They're going to create mucus."},{"speaker":"Gillyanne","startTime":1015.786,"endTime":1018.786,"body":"So I imagine you get this"},{"speaker":"Gillyanne","startTime":1015.786,"endTime":1018.786,"body":"sort of cycle going on."},{"speaker":"Gillyanne","startTime":1018.85,"endTime":1019.649,"body":"Very interesting."},{"speaker":"Jeremy","startTime":1019.729,"endTime":1020.759,"body":"I'm really curious."},{"speaker":"Jeremy","startTime":1021.149,"endTime":1022.619,"body":"Just thinking about the physiology."},{"speaker":"Jeremy","startTime":1023.714,"endTime":1027.711,"body":"Uh, And we talk about sipping"},{"speaker":"Jeremy","startTime":1023.714,"endTime":1027.711,"body":"water, but the water actually"},{"speaker":"Jeremy","startTime":1027.711,"endTime":1029.211,"body":"doesn't get down to the vocal folds."},{"speaker":"Jeremy","startTime":1029.241,"endTime":1032.991,"body":"It's the action of the vocal folds"},{"speaker":"Jeremy","startTime":1029.241,"endTime":1032.991,"body":"closing fairly gently in a swallow that"},{"speaker":"Jeremy","startTime":1032.991,"endTime":1036.331,"body":"is going to do something, am I right?"},{"speaker":"Tor","startTime":1036.891,"endTime":1040.206,"body":"If we think about the upper airway"},{"speaker":"Tor","startTime":1036.891,"endTime":1040.206,"body":"as a whole, and the fact that yes,"},{"speaker":"Tor","startTime":1040.206,"endTime":1041.916,"body":"the cough is happening in the larynx."},{"speaker":"Tor","startTime":1042.006,"endTime":1046.539,"body":"And a lot of people will feel that"},{"speaker":"Tor","startTime":1042.006,"endTime":1046.539,"body":"trigger in the larynx, but actually,"},{"speaker":"Tor","startTime":1046.539,"endTime":1051.957,"body":"the pharynx above can also be dry"},{"speaker":"Tor","startTime":1046.539,"endTime":1051.957,"body":"and irritable and cause an urge to"},{"speaker":"Tor","startTime":1051.957,"endTime":1053.577,"body":"cough or clear something from it."},{"speaker":"Tor","startTime":1053.587,"endTime":1058.219,"body":"So the water in a sense, washes down the"},{"speaker":"Tor","startTime":1053.587,"endTime":1058.219,"body":"back of the pharynx before it goes down"},{"speaker":"Tor","startTime":1058.219,"endTime":1060.109,"body":"behind the larynx, into the esophagus."},{"speaker":"Tor","startTime":1060.166,"endTime":1064.16,"body":"And, equally the back of the mouth,"},{"speaker":"Tor","startTime":1060.166,"endTime":1064.16,"body":"the palate, if that's all dry that"},{"speaker":"Tor","startTime":1064.16,"endTime":1066.68,"body":"can contribute to an urge to cough."},{"speaker":"Tor","startTime":1066.68,"endTime":1072.013,"body":"So sipping water will help in that sense,"},{"speaker":"Tor","startTime":1066.68,"endTime":1072.013,"body":"but yes, it's it's the swallow part of"},{"speaker":"Tor","startTime":1072.013,"endTime":1076.457,"body":"that process where the cords close and"},{"speaker":"Tor","startTime":1072.013,"endTime":1076.457,"body":"it gives you something different to do."},{"speaker":"Tor","startTime":1076.487,"endTime":1078.827,"body":"Often a swallow, when we use"},{"speaker":"Tor","startTime":1076.487,"endTime":1078.827,"body":"a swallow for cough control,"},{"speaker":"Tor","startTime":1078.857,"endTime":1080.317,"body":"often it's about distraction."},{"speaker":"Tor","startTime":1080.777,"endTime":1084.227,"body":"It's about choosing to do something"},{"speaker":"Tor","startTime":1080.777,"endTime":1084.227,"body":"different for the purpose of"},{"speaker":"Tor","startTime":1084.647,"endTime":1088.347,"body":"moving away from a typical"},{"speaker":"Tor","startTime":1084.647,"endTime":1088.347,"body":"response, which often is a cough."},{"speaker":"Gillyanne","startTime":1088.387,"endTime":1093.258,"body":"It sort of sounds like cause"},{"speaker":"Gillyanne","startTime":1088.387,"endTime":1093.258,"body":"I know this can happen with pain, can't"},{"speaker":"Gillyanne","startTime":1093.258,"endTime":1098.061,"body":"it that, maybe you break a bone or"},{"speaker":"Gillyanne","startTime":1093.258,"endTime":1098.061,"body":"something and obviously you get pain and"},{"speaker":"Gillyanne","startTime":1098.061,"endTime":1100.026,"body":"you can get pain for quite a long time."},{"speaker":"Gillyanne","startTime":1100.026,"endTime":1103.708,"body":"And I remember being told by my"},{"speaker":"Gillyanne","startTime":1100.026,"endTime":1103.708,"body":"physiotherapist, when I broke my"},{"speaker":"Gillyanne","startTime":1103.738,"endTime":1107.668,"body":"wrist, she said, you must take the"},{"speaker":"Gillyanne","startTime":1103.738,"endTime":1107.668,"body":"pain killers because I'm all right."},{"speaker":"Gillyanne","startTime":1107.668,"endTime":1108.838,"body":"I can manage without!"},{"speaker":"Gillyanne","startTime":1109.288,"endTime":1112.918,"body":"No, she said, take them now because"},{"speaker":"Gillyanne","startTime":1109.288,"endTime":1112.918,"body":"otherwise what can happen is a pain"},{"speaker":"Gillyanne","startTime":1112.918,"endTime":1117.418,"body":"response will be set up and your"},{"speaker":"Gillyanne","startTime":1112.918,"endTime":1117.418,"body":"body will continue that pain response"},{"speaker":"Gillyanne","startTime":1117.658,"endTime":1119.938,"body":"after it's in fact no longer needed."},{"speaker":"Gillyanne","startTime":1120.358,"endTime":1122.728,"body":"And I was shocked actually."},{"speaker":"Gillyanne","startTime":1122.728,"endTime":1127.128,"body":"And in a way you're seeing that"},{"speaker":"Gillyanne","startTime":1122.728,"endTime":1127.128,"body":"this is what happens with coughing."},{"speaker":"Tor","startTime":1128.398,"endTime":1129.27,"body":"Yes, in a way."},{"speaker":"Tor","startTime":1129.3,"endTime":1133.916,"body":"Yeah, coughing becomes chronic because"},{"speaker":"Tor","startTime":1129.3,"endTime":1133.916,"body":"of that that, that idea of that cycle."},{"speaker":"Tor","startTime":1133.916,"endTime":1138.236,"body":"So if you cough, you cause potentially"},{"speaker":"Tor","startTime":1133.916,"endTime":1138.236,"body":"cause irritation or the muscles to"},{"speaker":"Tor","startTime":1138.236,"endTime":1140.366,"body":"tighten up that be tension there."},{"speaker":"Tor","startTime":1140.696,"endTime":1143.276,"body":"And that brings about more"},{"speaker":"Tor","startTime":1140.696,"endTime":1143.276,"body":"urge and feeling to cough."},{"speaker":"Tor","startTime":1143.316,"endTime":1146.096,"body":"So it's about breaking that cycle."},{"speaker":"Tor","startTime":1146.096,"endTime":1149.638,"body":"And like I said, over many years"},{"speaker":"Tor","startTime":1146.096,"endTime":1149.638,"body":"that cycle might've developed, it"},{"speaker":"Tor","startTime":1149.638,"endTime":1153.208,"body":"doesn't necessarily mean that it's"},{"speaker":"Tor","startTime":1149.638,"endTime":1153.208,"body":"harder after 30 years versus one"},{"speaker":"Tor","startTime":1153.208,"endTime":1155.998,"body":"year to work to break that in fact."},{"speaker":"Gillyanne","startTime":1156.328,"endTime":1157.708,"body":"Oh, that's wonderful."},{"speaker":"Gillyanne","startTime":1158.188,"endTime":1159.148,"body":"That's fantastic."},{"speaker":"Gillyanne","startTime":1159.698,"endTime":1163.821,"body":"Tor, I think we should talk about"},{"speaker":"Gillyanne","startTime":1159.698,"endTime":1163.821,"body":"your other love, which is probably"},{"speaker":"Gillyanne","startTime":1163.821,"endTime":1168.021,"body":"your first love as a speech and"},{"speaker":"Gillyanne","startTime":1163.821,"endTime":1168.021,"body":"language therapist, which is voice."},{"speaker":"Gillyanne","startTime":1168.771,"endTime":1172.161,"body":"So as a speech and language therapist,"},{"speaker":"Gillyanne","startTime":1168.771,"endTime":1172.161,"body":"what does voice mean to you?"},{"speaker":"Gillyanne","startTime":1172.261,"endTime":1173.851,"body":"Being a specialist in voice."},{"speaker":"Tor","startTime":1175.861,"endTime":1181.231,"body":"So I quite quickly, when I graduated,"},{"speaker":"Tor","startTime":1175.861,"endTime":1181.231,"body":"I went into a very generalist adult"},{"speaker":"Tor","startTime":1181.231,"endTime":1186.601,"body":"role, but thankfully that did include"},{"speaker":"Tor","startTime":1181.231,"endTime":1186.601,"body":"some voice work in an acute hospital."},{"speaker":"Tor","startTime":1186.601,"endTime":1192.571,"body":"I worked in a voice clinic and got"},{"speaker":"Tor","startTime":1186.601,"endTime":1192.571,"body":"to see patients who have experienced"},{"speaker":"Tor","startTime":1192.601,"endTime":1197.521,"body":"change or problems with the voice"},{"speaker":"Tor","startTime":1192.601,"endTime":1197.521,"body":"plus other throat symptoms as well."},{"speaker":"Tor","startTime":1197.521,"endTime":1201.391,"body":"Of course, we can't really isolate"},{"speaker":"Tor","startTime":1197.521,"endTime":1201.391,"body":"a voice change without thinking"},{"speaker":"Tor","startTime":1201.391,"endTime":1205.171,"body":"about the upper airway and"},{"speaker":"Tor","startTime":1201.391,"endTime":1205.171,"body":"other symptoms at the same time."},{"speaker":"Tor","startTime":1205.651,"endTime":1209.701,"body":"But I have always loved"},{"speaker":"Tor","startTime":1205.651,"endTime":1209.701,"body":"the medical side of voice."},{"speaker":"Tor","startTime":1209.731,"endTime":1214.714,"body":"But also the fact that you can"},{"speaker":"Tor","startTime":1209.731,"endTime":1214.714,"body":"weave that in with, the art and"},{"speaker":"Tor","startTime":1215.344,"endTime":1220.024,"body":"performance voice, and all the amazing"},{"speaker":"Tor","startTime":1215.344,"endTime":1220.024,"body":"things that go along with that."},{"speaker":"Tor","startTime":1220.054,"endTime":1225.664,"body":"And the how fascinating the larynx"},{"speaker":"Tor","startTime":1220.054,"endTime":1225.664,"body":"is that it helps us with these hugely"},{"speaker":"Tor","startTime":1225.664,"endTime":1231.184,"body":"important life altering functions like"},{"speaker":"Tor","startTime":1225.664,"endTime":1231.184,"body":"communications, swallow, breathing."},{"speaker":"Tor","startTime":1231.214,"endTime":1232.384,"body":"It's also interlinked."},{"speaker":"Tor","startTime":1232.414,"endTime":1234.676,"body":"So I've always been"},{"speaker":"Tor","startTime":1232.414,"endTime":1234.676,"body":"fascinated by the larynx."},{"speaker":"Tor","startTime":1234.679,"endTime":1241.63,"body":"And as a voice therapist, I'll see people"},{"speaker":"Tor","startTime":1234.679,"endTime":1241.63,"body":"with a huge range of different voice"},{"speaker":"Tor","startTime":1241.63,"endTime":1245.857,"body":"problems or voice disorders, problems"},{"speaker":"Tor","startTime":1241.63,"endTime":1245.857,"body":"linked directly with the larynx, but also"},{"speaker":"Tor","startTime":1245.857,"endTime":1250.659,"body":"sometimes problems linked with breathing"},{"speaker":"Tor","startTime":1245.857,"endTime":1250.659,"body":"patterns, for example or problems in the"},{"speaker":"Tor","startTime":1250.659,"endTime":1252.879,"body":"nose or elsewhere in the upper airway."},{"speaker":"Tor","startTime":1253.029,"endTime":1258.291,"body":"But yeah, so there's, huge range of voice"},{"speaker":"Tor","startTime":1253.029,"endTime":1258.291,"body":"disorders from structural disorders to"},{"speaker":"Tor","startTime":1258.291,"endTime":1263.751,"body":"an inflammatory disorders, neuromuscular"},{"speaker":"Tor","startTime":1258.291,"endTime":1263.751,"body":"disorders, but there is a big group"},{"speaker":"Tor","startTime":1263.751,"endTime":1268.317,"body":"of patients who have muscular tension"},{"speaker":"Tor","startTime":1263.751,"endTime":1268.317,"body":"imbalance in the larynx, which can cause"},{"speaker":"Tor","startTime":1268.317,"endTime":1273.987,"body":"voice change and all those four areas of"},{"speaker":"Tor","startTime":1268.317,"endTime":1273.987,"body":"the conditions or interlinked as well."},{"speaker":"Tor","startTime":1273.987,"endTime":1275.538,"body":"So, Yes,"},{"speaker":"Jeremy","startTime":1275.666,"endTime":1280.121,"body":"I mean, We love diagnosis when"},{"speaker":"Jeremy","startTime":1275.666,"endTime":1280.121,"body":"we're dealing with performing issues and"},{"speaker":"Jeremy","startTime":1280.121,"endTime":1284.531,"body":"it's a real, this is the sort of skillset"},{"speaker":"Jeremy","startTime":1280.121,"endTime":1284.531,"body":"that speech and language therapists"},{"speaker":"Jeremy","startTime":1284.531,"endTime":1288.851,"body":"have, which is that ability to take in"},{"speaker":"Jeremy","startTime":1284.531,"endTime":1288.851,"body":"all of that information and diagnose."},{"speaker":"Jeremy","startTime":1289.421,"endTime":1293.514,"body":"And there's a lot of information"},{"speaker":"Jeremy","startTime":1289.421,"endTime":1293.514,"body":"that you need to take in order to be"},{"speaker":"Jeremy","startTime":1293.514,"endTime":1295.779,"body":"able to do a reasonable diagnosis."},{"speaker":"Gillyanne","startTime":1295.779,"endTime":1297.429,"body":"It's like a"},{"speaker":"Gillyanne","startTime":1295.779,"endTime":1297.429,"body":"clustering, isn't it?"},{"speaker":"Gillyanne","startTime":1297.429,"endTime":1299.619,"body":"You can't just be looking at one thing."},{"speaker":"Gillyanne","startTime":1299.859,"endTime":1304.269,"body":"You've talked all the way through about"},{"speaker":"Gillyanne","startTime":1299.859,"endTime":1304.269,"body":"the importance of looking at the whole"},{"speaker":"Gillyanne","startTime":1304.269,"endTime":1310.509,"body":"lifestyle, the pattern of how that person"},{"speaker":"Gillyanne","startTime":1304.269,"endTime":1310.509,"body":"runs their life, including how many"},{"speaker":"Gillyanne","startTime":1310.509,"endTime":1312.729,"body":"hours they work, et cetera, et cetera."},{"speaker":"Gillyanne","startTime":1312.759,"endTime":1314.679,"body":"It's very holistic in that sense."},{"speaker":"Tor","startTime":1316.314,"endTime":1316.614,"body":"Yeah."},{"speaker":"Tor","startTime":1316.617,"endTime":1321.824,"body":"So I mean, a speech and voice therapy"},{"speaker":"Tor","startTime":1316.617,"endTime":1321.824,"body":"case history will take at least an hour"},{"speaker":"Tor","startTime":1321.854,"endTime":1329.084,"body":"of time in that initial session to talk"},{"speaker":"Tor","startTime":1321.854,"endTime":1329.084,"body":"to people about everything from obviously"},{"speaker":"Tor","startTime":1329.114,"endTime":1333.865,"body":"the presenting condition and symptoms"},{"speaker":"Tor","startTime":1329.114,"endTime":1333.865,"body":"and the patterns of that how it started,"},{"speaker":"Tor","startTime":1333.865,"endTime":1338.725,"body":"how it's developed, but then medical"},{"speaker":"Tor","startTime":1333.865,"endTime":1338.725,"body":"history, medications, social history,"},{"speaker":"Tor","startTime":1338.725,"endTime":1345.325,"body":"lifestyle, work, voice use, vocal demands,"},{"speaker":"Tor","startTime":1338.725,"endTime":1345.325,"body":"the patterns of which people use their"},{"speaker":"Tor","startTime":1345.325,"endTime":1350.005,"body":"voices, stress and psychological history."},{"speaker":"Tor","startTime":1350.017,"endTime":1352.828,"body":"And then obviously all the"},{"speaker":"Tor","startTime":1350.017,"endTime":1352.828,"body":"observation that goes into it as well."},{"speaker":"Tor","startTime":1352.828,"endTime":1354.358,"body":"So, you know, You really"},{"speaker":"Tor","startTime":1352.828,"endTime":1354.358,"body":"have to get to know."},{"speaker":"Tor","startTime":1355.063,"endTime":1355.543,"body":"People."},{"speaker":"Tor","startTime":1355.614,"endTime":1357.474,"body":"And I do, that's what I love about it."},{"speaker":"Tor","startTime":1357.54,"endTime":1360.84,"body":"You never know who's walking through"},{"speaker":"Tor","startTime":1357.54,"endTime":1360.84,"body":"the door and what their symptoms"},{"speaker":"Tor","startTime":1360.84,"endTime":1362.49,"body":"are going to be before they do."},{"speaker":"Tor","startTime":1362.506,"endTime":1367.613,"body":"And yeah, of course the amount that can"},{"speaker":"Tor","startTime":1362.506,"endTime":1367.613,"body":"go into a voice disorder, the amount of"},{"speaker":"Tor","startTime":1367.613,"endTime":1372.279,"body":"different factors and influencing factors,"},{"speaker":"Tor","startTime":1367.613,"endTime":1372.279,"body":"precipitating factors is enormous really."},{"speaker":"Gillyanne","startTime":1373.089,"endTime":1376.389,"body":"When you're listening to a"},{"speaker":"Gillyanne","startTime":1373.089,"endTime":1376.389,"body":"voice and I'm just going to throw this"},{"speaker":"Gillyanne","startTime":1376.389,"endTime":1381.599,"body":"at you and, if you don't want to go there"},{"speaker":"Gillyanne","startTime":1376.389,"endTime":1381.599,"body":"say cause sometimes in, in our side of"},{"speaker":"Gillyanne","startTime":1381.599,"endTime":1386.129,"body":"the profession, people will go for a"},{"speaker":"Gillyanne","startTime":1381.599,"endTime":1386.129,"body":"lesson or they'll go to a master class."},{"speaker":"Gillyanne","startTime":1386.129,"endTime":1389.699,"body":"And they work with someone who"},{"speaker":"Gillyanne","startTime":1386.129,"endTime":1389.699,"body":"says you've got a voice problem."},{"speaker":"Gillyanne","startTime":1389.733,"endTime":1394.743,"body":"And we always say, actually, you can't"},{"speaker":"Gillyanne","startTime":1389.733,"endTime":1394.743,"body":"tell without looking, but let's assume"},{"speaker":"Gillyanne","startTime":1394.743,"endTime":1398.943,"body":"someone's come to you who's maybe"},{"speaker":"Gillyanne","startTime":1394.743,"endTime":1398.943,"body":"had some kind of a diagnosis or was"},{"speaker":"Gillyanne","startTime":1398.943,"endTime":1401.553,"body":"coming to you specifically as an SLT."},{"speaker":"Gillyanne","startTime":1404.123,"endTime":1406.733,"body":"What do you listen out for when"},{"speaker":"Gillyanne","startTime":1404.123,"endTime":1406.733,"body":"you're listening to a voice?"},{"speaker":"Tor","startTime":1408.273,"endTime":1412.053,"body":"So it will lots"},{"speaker":"Tor","startTime":1408.273,"endTime":1412.053,"body":"of influencing factors."},{"speaker":"Tor","startTime":1412.053,"endTime":1416.493,"body":"We're biased by quite a few things when"},{"speaker":"Tor","startTime":1412.053,"endTime":1416.493,"body":"it comes to listening to a voice and what"},{"speaker":"Tor","startTime":1416.493,"endTime":1418.683,"body":"we might expect is actually the problem."},{"speaker":"Tor","startTime":1419.043,"endTime":1422.493,"body":"So it depends where your, where"},{"speaker":"Tor","startTime":1419.043,"endTime":1422.493,"body":"at what stage you'll see the"},{"speaker":"Tor","startTime":1422.493,"endTime":1424.233,"body":"patient or that, that does for me."},{"speaker":"Tor","startTime":1424.233,"endTime":1429.033,"body":"So for example, I may, in the context"},{"speaker":"Tor","startTime":1424.233,"endTime":1429.033,"body":"of a speech therapy appointment,"},{"speaker":"Tor","startTime":1429.093,"endTime":1432.123,"body":"they would have gone through"},{"speaker":"Tor","startTime":1429.093,"endTime":1432.123,"body":"ENT and I'll know the diagnosis."},{"speaker":"Tor","startTime":1432.693,"endTime":1436.636,"body":"So I thought when I listened to a"},{"speaker":"Tor","startTime":1432.693,"endTime":1436.636,"body":"voice, I'll be listening and watching"},{"speaker":"Tor","startTime":1436.636,"endTime":1440.287,"body":"what they're doing and listening"},{"speaker":"Tor","startTime":1436.636,"endTime":1440.287,"body":"for various different parameters"},{"speaker":"Tor","startTime":1440.287,"endTime":1442.567,"body":"of abnormality within that voice."},{"speaker":"Tor","startTime":1443.047,"endTime":1447.652,"body":"And in my head, I'm thinking if that's"},{"speaker":"Tor","startTime":1443.047,"endTime":1447.652,"body":"the diagnosis and what I'd expect, for"},{"speaker":"Tor","startTime":1447.652,"endTime":1452.512,"body":"example, with vocal cord paralysis,"},{"speaker":"Tor","startTime":1447.652,"endTime":1452.512,"body":"where one vocal cord isn't moving or"},{"speaker":"Tor","startTime":1452.512,"endTime":1456.892,"body":"isn't working properly because the"},{"speaker":"Tor","startTime":1452.512,"endTime":1456.892,"body":"vocal chords won't adduct or close"},{"speaker":"Tor","startTime":1456.892,"endTime":1460.792,"body":"fully, you would expect a voice"},{"speaker":"Tor","startTime":1456.892,"endTime":1460.792,"body":"that's quite breathy, quite weak."},{"speaker":"Tor","startTime":1460.792,"endTime":1463.882,"body":"It wouldn't necessarily be rough,"},{"speaker":"Tor","startTime":1460.792,"endTime":1463.882,"body":"but that might be a bit of roughness."},{"speaker":"Tor","startTime":1463.974,"endTime":1467.064,"body":"And if that's not, if I'm not"},{"speaker":"Tor","startTime":1463.974,"endTime":1467.064,"body":"hearing what I'm expecting, then I'm"},{"speaker":"Tor","startTime":1467.064,"endTime":1468.856,"body":"questioning what's going on here."},{"speaker":"Tor","startTime":1468.916,"endTime":1471.605,"body":"Not everyone is the same,"},{"speaker":"Tor","startTime":1468.916,"endTime":1471.605,"body":"but you're with experience."},{"speaker":"Tor","startTime":1471.605,"endTime":1474.815,"body":"You're get to know what you expect"},{"speaker":"Tor","startTime":1471.605,"endTime":1474.815,"body":"to hear based on the diagnosis."},{"speaker":"Tor","startTime":1475.205,"endTime":1479.885,"body":"But more recently I've worked in a speech"},{"speaker":"Tor","startTime":1475.205,"endTime":1479.885,"body":"therapy-led two week wait clinic, where"},{"speaker":"Tor","startTime":1479.885,"endTime":1484.475,"body":"I've been the first contact for a patient"},{"speaker":"Tor","startTime":1479.885,"endTime":1484.475,"body":"coming from a GP with a voice disorder."},{"speaker":"Tor","startTime":1484.955,"endTime":1488.525,"body":"And that really changed my thinking"},{"speaker":"Tor","startTime":1484.955,"endTime":1488.525,"body":"quite a lot because none of these people"},{"speaker":"Tor","startTime":1488.525,"endTime":1493.415,"body":"had been scoped or examined yet they've"},{"speaker":"Tor","startTime":1488.525,"endTime":1493.415,"body":"come in, fresh set of eyes on this"},{"speaker":"Tor","startTime":1493.415,"endTime":1495.938,"body":"disorder and you're going the other way."},{"speaker":"Tor","startTime":1495.938,"endTime":1498.309,"body":"You're thinking oh I"},{"speaker":"Tor","startTime":1495.938,"endTime":1498.309,"body":"can hear breathlessness."},{"speaker":"Tor","startTime":1498.309,"endTime":1501.879,"body":"I can hear roughness, it's intermittent,"},{"speaker":"Tor","startTime":1498.309,"endTime":1501.879,"body":"ooh, what am I going to see?"},{"speaker":"Tor","startTime":1501.879,"endTime":1504.797,"body":"And I'm starting to think"},{"speaker":"Tor","startTime":1501.879,"endTime":1504.797,"body":"and imagine what I might see."},{"speaker":"Tor","startTime":1504.935,"endTime":1505.775,"body":"Not always right."},{"speaker":"Tor","startTime":1505.775,"endTime":1508.385,"body":"Sometimes that you see"},{"speaker":"Tor","startTime":1505.775,"endTime":1508.385,"body":"very unexpected things."},{"speaker":"Jeremy","startTime":1508.465,"endTime":1511.795,"body":"I love this because you're talking"},{"speaker":"Jeremy","startTime":1508.465,"endTime":1511.795,"body":"about filters and I talk about this"},{"speaker":"Jeremy","startTime":1511.795,"endTime":1517.527,"body":"all the time, which is when you already"},{"speaker":"Jeremy","startTime":1511.795,"endTime":1517.527,"body":"have a diagnosis from the department,"},{"speaker":"Jeremy","startTime":1517.917,"endTime":1521.625,"body":"then you put a filter on that says,"},{"speaker":"Jeremy","startTime":1517.917,"endTime":1521.625,"body":"this is the diagnosis I've been given."},{"speaker":"Jeremy","startTime":1521.625,"endTime":1524.295,"body":"And this is what I would"},{"speaker":"Jeremy","startTime":1521.625,"endTime":1524.295,"body":"expect to see and here."},{"speaker":"Jeremy","startTime":1524.955,"endTime":1528.915,"body":"And your, this is going to sound"},{"speaker":"Jeremy","startTime":1524.955,"endTime":1528.915,"body":"really callous, but it's not."},{"speaker":"Jeremy","startTime":1529.125,"endTime":1530.475,"body":"It's like you have a ticklist."},{"speaker":"Jeremy","startTime":1531.165,"endTime":1531.765,"body":"And you go, okay."},{"speaker":"Jeremy","startTime":1531.765,"endTime":1532.185,"body":"That's that?"},{"speaker":"Jeremy","startTime":1532.185,"endTime":1533.613,"body":"That's that's actually that isn't there."},{"speaker":"Jeremy","startTime":1533.613,"endTime":1534.543,"body":"That's quite interesting."},{"speaker":"Jeremy","startTime":1534.903,"endTime":1536.163,"body":"And you've got that filter on."},{"speaker":"Jeremy","startTime":1536.163,"endTime":1539.853,"body":"So you're processing the information"},{"speaker":"Jeremy","startTime":1536.163,"endTime":1539.853,"body":"with that filter in place."},{"speaker":"Jeremy","startTime":1540.063,"endTime":1544.383,"body":"Whereas when you're in the two week"},{"speaker":"Jeremy","startTime":1540.063,"endTime":1544.383,"body":"clinic, you don't have that filter."},{"speaker":"Jeremy","startTime":1544.383,"endTime":1547.238,"body":"You are, it's I have"},{"speaker":"Jeremy","startTime":1544.383,"endTime":1547.238,"body":"no idea of what it is."},{"speaker":"Jeremy","startTime":1547.478,"endTime":1550.418,"body":"You're presenting me with you."},{"speaker":"Jeremy","startTime":1550.568,"endTime":1551.858,"body":"So I'm listening."},{"speaker":"Jeremy","startTime":1552.158,"endTime":1557.378,"body":"And then my tick list is almost much"},{"speaker":"Jeremy","startTime":1552.158,"endTime":1557.378,"body":"bigger because I go, all I'm doing now"},{"speaker":"Jeremy","startTime":1557.378,"endTime":1560.228,"body":"is I'm noticing what you're telling me."},{"speaker":"Jeremy","startTime":1560.228,"endTime":1565.538,"body":"I'm noticing what you're giving me"},{"speaker":"Jeremy","startTime":1560.228,"endTime":1565.538,"body":"and I'm building my ticklist, if you"},{"speaker":"Jeremy","startTime":1565.538,"endTime":1567.128,"body":"like, rather than having it there."},{"speaker":"Jeremy","startTime":1568.148,"endTime":1570.168,"body":"I love this whole thing"},{"speaker":"Jeremy","startTime":1568.148,"endTime":1570.168,"body":"about filters and diagnosis."},{"speaker":"Gillyanne","startTime":1570.188,"endTime":1570.938,"body":"Yes."},{"speaker":"Gillyanne","startTime":1570.998,"endTime":1574.705,"body":"And the other thing I was thinking"},{"speaker":"Gillyanne","startTime":1570.998,"endTime":1574.705,"body":"is that, the GP has referred."},{"speaker":"Gillyanne","startTime":1574.762,"endTime":1579.712,"body":"What's the benchmark for the GP,"},{"speaker":"Gillyanne","startTime":1574.762,"endTime":1579.712,"body":"referring someone with having"},{"speaker":"Gillyanne","startTime":1579.712,"endTime":1580.972,"body":"a potential voice disorder."},{"speaker":"Gillyanne","startTime":1582.012,"endTime":1584.977,"body":"This might be really useful for"},{"speaker":"Gillyanne","startTime":1582.012,"endTime":1584.977,"body":"members of the public to know."},{"speaker":"Tor","startTime":1585.847,"endTime":1587.71,"body":"So it varies."},{"speaker":"Tor","startTime":1587.71,"endTime":1592.87,"body":"So ENT UK do have some clear guidance on"},{"speaker":"Tor","startTime":1587.71,"endTime":1592.87,"body":"their website, which might be interesting"},{"speaker":"Tor","startTime":1592.87,"endTime":1599.13,"body":"for people to look at, but a GP will"},{"speaker":"Tor","startTime":1592.87,"endTime":1599.13,"body":"make two types of referral into ENT."},{"speaker":"Tor","startTime":1599.53,"endTime":1603.521,"body":"One of those will be a two week"},{"speaker":"Tor","startTime":1599.53,"endTime":1603.521,"body":"wait, which is under the suspected"},{"speaker":"Tor","startTime":1603.521,"endTime":1605.141,"body":"head and neck cancer pathway."},{"speaker":"Tor","startTime":1605.171,"endTime":1608.171,"body":"Now that can be obviously quite"},{"speaker":"Tor","startTime":1605.171,"endTime":1608.171,"body":"terrifying for people who went to"},{"speaker":"Tor","startTime":1608.171,"endTime":1612.216,"body":"the doctor to talk about a voice"},{"speaker":"Tor","startTime":1608.171,"endTime":1612.216,"body":"change, not not thinking, you know,"},{"speaker":"Tor","startTime":1612.366,"endTime":1614.421,"body":"any point that it might be cancer."},{"speaker":"Tor","startTime":1614.822,"endTime":1619.737,"body":"Um, Uh, Generally isn't, you know,"},{"speaker":"Tor","startTime":1614.822,"endTime":1619.737,"body":"much more people are referred through"},{"speaker":"Tor","startTime":1619.737,"endTime":1623.497,"body":"a two week wait then, not a very small"},{"speaker":"Tor","startTime":1619.737,"endTime":1623.497,"body":"percentage of those are going to have"},{"speaker":"Tor","startTime":1623.497,"endTime":1627.847,"body":"cancer, but it's the way the National"},{"speaker":"Tor","startTime":1623.497,"endTime":1627.847,"body":"Health Service works through the process"},{"speaker":"Tor","startTime":1627.847,"endTime":1630.817,"body":"of getting those people through quickly,"},{"speaker":"Tor","startTime":1627.847,"endTime":1630.817,"body":"because we don't know what's going on"},{"speaker":"Tor","startTime":1631.372,"endTime":1633.052,"body":"in the larynx until we have a look."},{"speaker":"Tor","startTime":1633.412,"endTime":1637.102,"body":"So GPs will make the decision about"},{"speaker":"Tor","startTime":1633.412,"endTime":1637.102,"body":"a two week wait, based on various"},{"speaker":"Tor","startTime":1637.132,"endTime":1641.524,"body":"risk factors, um, both in someone's"},{"speaker":"Tor","startTime":1637.132,"endTime":1641.524,"body":"history, for example, whether they're"},{"speaker":"Tor","startTime":1641.524,"endTime":1646.884,"body":"a smoker, certain age or the symptoms"},{"speaker":"Tor","startTime":1641.524,"endTime":1646.884,"body":"that the GP is observing or hearing"},{"speaker":"Tor","startTime":1646.884,"endTime":1648.474,"body":"when they're in the appointment."},{"speaker":"Tor","startTime":1648.834,"endTime":1652.194,"body":"So those two week wait patients,"},{"speaker":"Tor","startTime":1648.834,"endTime":1652.194,"body":"I was saying where people were"},{"speaker":"Tor","startTime":1652.194,"endTime":1653.944,"body":"suspected head and neck cancer."},{"speaker":"Tor","startTime":1654.464,"endTime":1659.892,"body":"Um, Now there's a new and developing"},{"speaker":"Tor","startTime":1654.464,"endTime":1659.892,"body":"pathway through using the speech"},{"speaker":"Tor","startTime":1659.922,"endTime":1664.152,"body":"therapy profession to see these"},{"speaker":"Tor","startTime":1659.922,"endTime":1664.152,"body":"patients, because we know only a tiny"},{"speaker":"Tor","startTime":1664.152,"endTime":1668.703,"body":"percentage of them do actually have"},{"speaker":"Tor","startTime":1664.152,"endTime":1668.703,"body":"malignant pathology in the larynx."},{"speaker":"Tor","startTime":1668.709,"endTime":1673.293,"body":"And speech therapy runs that clinic"},{"speaker":"Tor","startTime":1668.709,"endTime":1673.293,"body":"well, because we can see them through"},{"speaker":"Tor","startTime":1673.533,"endTime":1678.343,"body":"the history, the diagnostic and immediate"},{"speaker":"Tor","startTime":1673.533,"endTime":1678.343,"body":"advice and information that helps and"},{"speaker":"Tor","startTime":1678.371,"endTime":1683.241,"body":"send them on their way often with er, with"},{"speaker":"Tor","startTime":1678.371,"endTime":1683.241,"body":"enough, for to reassure, tell them what's"},{"speaker":"Tor","startTime":1683.241,"endTime":1687.351,"body":"going on, and then people can opt in to"},{"speaker":"Tor","startTime":1683.241,"endTime":1687.351,"body":"speech therapy if they need it later,"},{"speaker":"Gillyanne","startTime":1687.351,"endTime":1690.591,"body":"It's a really"},{"speaker":"Gillyanne","startTime":1687.351,"endTime":1690.591,"body":"important role actually, isn't it."},{"speaker":"Gillyanne","startTime":1690.653,"endTime":1695.213,"body":"And obviously it's essential"},{"speaker":"Gillyanne","startTime":1690.653,"endTime":1695.213,"body":"that we do rule out head and"},{"speaker":"Gillyanne","startTime":1695.213,"endTime":1696.89,"body":"neck cancer, straight away."},{"speaker":"Gillyanne","startTime":1699.5,"endTime":1702.89,"body":"That's going to be very interesting"},{"speaker":"Gillyanne","startTime":1699.5,"endTime":1702.89,"body":"and we'll look up that ENT UK."},{"speaker":"Gillyanne","startTime":1704.54,"endTime":1708.56,"body":"Gosh, how did you learn"},{"speaker":"Gillyanne","startTime":1704.54,"endTime":1708.56,"body":"to specialise in voice?"},{"speaker":"Tor","startTime":1710.17,"endTime":1713.585,"body":"So I was very lucky"},{"speaker":"Tor","startTime":1710.17,"endTime":1713.585,"body":"where I started my first job."},{"speaker":"Tor","startTime":1713.639,"endTime":1719.789,"body":"I, that my manager was the voice"},{"speaker":"Tor","startTime":1713.639,"endTime":1719.789,"body":"lead and we worked together very"},{"speaker":"Tor","startTime":1719.789,"endTime":1724.413,"body":"well it was a small voice caseload"},{"speaker":"Tor","startTime":1719.789,"endTime":1724.413,"body":"and I quickly made it known that was"},{"speaker":"Tor","startTime":1724.413,"endTime":1726.383,"body":"an area I was really interested in."},{"speaker":"Tor","startTime":1727.233,"endTime":1733.218,"body":"You have to develop and come up with your"},{"speaker":"Tor","startTime":1727.233,"endTime":1733.218,"body":"own ways for developing your, your, your"},{"speaker":"Tor","startTime":1733.218,"endTime":1735.558,"body":"voice skills and your voice competencies."},{"speaker":"Tor","startTime":1735.918,"endTime":1739.728,"body":"When you're studying as a speech"},{"speaker":"Tor","startTime":1735.918,"endTime":1739.728,"body":"therapist, you do, you have ENT"},{"speaker":"Tor","startTime":1739.878,"endTime":1742.878,"body":"lectures, you have voice disorder"},{"speaker":"Tor","startTime":1739.878,"endTime":1742.878,"body":"lectures, you learn the basics."},{"speaker":"Tor","startTime":1743.238,"endTime":1746.658,"body":"And I was lucky enough to have a clinical"},{"speaker":"Tor","startTime":1743.238,"endTime":1746.658,"body":"placement in the voice department,"},{"speaker":"Tor","startTime":1746.688,"endTime":1749.358,"body":"ENT department, but not everyone does."},{"speaker":"Tor","startTime":1749.358,"endTime":1753.288,"body":"And there's a lot of post-graduate"},{"speaker":"Tor","startTime":1749.358,"endTime":1753.288,"body":"learning that goes on, going to"},{"speaker":"Tor","startTime":1753.288,"endTime":1757.152,"body":"courses, doing learning on the"},{"speaker":"Tor","startTime":1753.288,"endTime":1757.152,"body":"job, alongside a clinical caseload"},{"speaker":"Tor","startTime":1757.152,"endTime":1759.532,"body":"and having supervision is vital."},{"speaker":"Tor","startTime":1759.547,"endTime":1762.757,"body":"But everyone's process through"},{"speaker":"Tor","startTime":1759.547,"endTime":1762.757,"body":"that is slightly different."},{"speaker":"Gillyanne","startTime":1763.218,"endTime":1764.238,"body":"It's interesting, isn't it?"},{"speaker":"Gillyanne","startTime":1764.238,"endTime":1769.268,"body":"Because Joe Public doesn't realize"},{"speaker":"Gillyanne","startTime":1764.238,"endTime":1769.268,"body":"that there isn't a clear pathway"},{"speaker":"Gillyanne","startTime":1769.658,"endTime":1773.798,"body":"for a speech and language therapist"},{"speaker":"Gillyanne","startTime":1769.658,"endTime":1773.798,"body":"to start specializing in voice."},{"speaker":"Gillyanne","startTime":1773.798,"endTime":1775.364,"body":"It's it's a bit like"},{"speaker":"Gillyanne","startTime":1773.798,"endTime":1775.364,"body":"being a singing teacher"},{"speaker":"Jeremy","startTime":1775.624,"endTime":1778.054,"body":"very much like being a"},{"speaker":"Jeremy","startTime":1775.624,"endTime":1778.054,"body":"singing teacher where there is no"},{"speaker":"Jeremy","startTime":1778.054,"endTime":1779.584,"body":"clear pathway and you make your own."},{"speaker":"Gillyanne","startTime":1781.185,"endTime":1781.845,"body":"Wow."},{"speaker":"Gillyanne","startTime":1781.875,"endTime":1783.315,"body":"So much to talk about."},{"speaker":"Gillyanne","startTime":1783.315,"endTime":1785.175,"body":"This has been great so far."},{"speaker":"Jeremy","startTime":1785.235,"endTime":1785.835,"body":"Oh yeah."},{"speaker":"Jeremy","startTime":1785.865,"endTime":1788.085,"body":"We're definitely having"},{"speaker":"Jeremy","startTime":1785.865,"endTime":1788.085,"body":"to two episodes for those."},{"speaker":"Jeremy","startTime":1788.095,"endTime":1791.706,"body":"So we're going to stop there and we're"},{"speaker":"Jeremy","startTime":1788.095,"endTime":1791.706,"body":"going to bring Tor back next week."},{"speaker":"Jeremy","startTime":1792.116,"endTime":1793.396,"body":"Tor, we'll see you then."},{"speaker":"Tor","startTime":1793.616,"endTime":1794.236,"body":"See you then!"},{"speaker":"Jeremy","startTime":1806.686,"endTime":1809.644,"body":"This is a voice podcast with Dr."},{"speaker":"Jeremy","startTime":1809.644,"endTime":1811.804,"body":"Gillyanne Kayes and Jeremy Fisher."}]}