Singing, lung health & COVID - with Phoene Cave

We're talking about Covid and voice, breathing and singing.
Phoene Cave, music therapist, singer, trainer and developer of the Singing For Lung Health sequences chats to us about her life, singing for people who have chronic lung conditions, and what she thinks is the single most underrated skill for singing leaders.
Why Exercise Induced Laryngeal Obstruction is sometimes misdiagnosed as asthma
What you need as a Singing for Lung Health leader (and why you need to know what your vocal techniques actually do)
Why she's started writing her own songs again after 20 years
And of course, the unpredictable effects of Covid

Phoene's website The Musical Breath http://www.themusicalbreath.com

Singing For Breathing exercises http://www.themusicalbreath.com/singing-for-breathing-exercises/
(50% of profits go to the Royal Brompton and Harefield Hospitals to support the Singing For Breathing project here) https://www.rbht.nhs.uk/about-us/our-charities-and-rbharts/singing-for-breathing

Twitter link @OmPhoenix

Singing With One Voice - article by Phoene Cave https://lahf.wordpress.com/2017/03/22/singing-with-one-voice/

British Lung Foundation https://www.blf.org.uk/support-for-you/singing-for-lung-health/improve-your-wellbeing

This Is A Voice book by Gillyanne and Jeremy https://amzn.to/3qcEXui

Transcript

Okay, so I'm going to be really honest, and careful and honest. So we know that what happened a year ago was that all of us who sing and teach singing lost our livelihoods overnight.

So I think bizarrely with COVID, impacting on people's breathing, a lot of people who lost their livelihoods are now seeing this as a way of making a living again. And that's the bit that makes me really sad. Because it's not - this is where I suddenly lose all the business that I was just getting - it's not about learning to do a thing, to tick a bit of paper, to go out and carry on being a singing teacher, but just with a different clientele. It's so much more complicated than that. 

I've worked with people in hospital beds, who are literally dying, you know, palliative care, really breathless - singing has been so supportive. I mean, I'm remembering a lot of the patients who've just been able to manage and control their breath through using the right song has been, you know, they said things to me, like that was the day hope returned 

This is a voice, a podcast with Dr. Gillyanne Kayes and Jeremy Fisher. 

Hello and welcome to series two. Episode Four of this is a voice I knew I was gonna get that wrong. Okay, series two Episode Four of this is a voice podcast, and we're gonna go straight in with our special guest today Phoene Cave. Now Phoene you are a music therapist, a bodywork teacher, a singer, trainer, you have an MA, you've worked in prisons, teaching women about voice using their voices and finding them properly. You have done so much stuff, and we've known you for ages. So Hello, and welcome to the podcast.

I prefer fod past. Fod past is fabulous for a Phoene

As a person with an unusual name, because I was suddenly thinking the number of people who must call you Phoebe. Yeah,

A lot of people call me Phoebe. A lot of people call me Fo-ebby. Phoney. I like it when people say hello. And how would you like me to pronounce your name? And I'm going to reveal that my birth name was Catherine. Not many people know that.

They do now.

They do now so yes, Phoene P h o e n e.

Yes.

It's so memorable. It's lovely, actually.

So we're gonna try to work out how long it is that we've known you. You thought

I can tell you when I first met Phoene it was in the when you were at Goldsmiths college. 

Wow. 

On the jazz course, with I don't know if it was teaching jazz course. But with Louise Gibbs. That's where I first met you. And that was way back in ye olde Estill days on I came and did a like an introductory chat on it. And then I did a master class. So you must have sung in that master class. It could be 1996.

It was 90? Well, well done. It was 90. Well, it was actually it was 1995. Because I then went on and did my post grad Diploma in music therapy in 1996. My son is 23. He was born in 1997. So there you go. Do the sums, my goodness, a long time. Yeah,

I think it was before your son.

So you have such a wide background. And I love it when people's life history comes together. And they end up being the person that they end up. So all the things that you have done, tell us about a few of them.

And you know, what can I just interrupt and say I was thinking of all the skills that you have in your skill set. And you can look at your career and go oh she's kind of gone all over the place. You know what, you know, what, what is she doing? But no, exactly, you're shaking your head. Because the thing is, it's a series of little flight corrections. So that is a trajectory there. I mean, it's very different from my journey, where I've had two major flight corrections. And I just, I would love you to tell us more about why this skill set is so important in the work that you do.

I will but I'd like to put something in front of that to anybody who's listening who is under the age of to be honest 30 especially under the age of 20. Don't dismiss anything that you do in your life, because every single thing that you do will add to the next and you have no idea what's going to happen in 5, 10, 15, 20 years. Everything I've done has come together So originally, let me just go right back. I worked in the television and record industry. So I worked for the William Morris theatrical agency, when it was, you know, with the kind of big, big names worked in Soho worked in television worked in the record industry in the 90s. What a time to work in the record industry. It was Yeah, it was party time. And then from that I went, I was a professional singer. And I remember somebody saying something Oh, we could do like an F sharp half diminished and I was like what? I need to know about this stuff. Um, do I need to put a swear bleep in because I can be quite swearing when I'm

No, what we would do is say there is explicit language.

A lot of it

Jolly good. So I went and worked as a singer and then I went to Goldsmith's to do my music degree. But I didn't actually have A level music because I was the person one of the people with Nikki Yeoh the pianist was also in my year and lots of other well known people in the 90s. We went into Goldsmith's and we did We've gone in as kind of high level performers. And yet, you know, we still managed to get our degrees. And that's when Louise Gibbs did a lot of work at Goldsmiths around changing that in that time. So I worked as a professional singer. I did my music degree, I then did my post grad training and music therapy. But then, my, you know, there's major things in life, death, divorce, childbirth, all of those things happened, bang, bang, bang, one after the other. And so, I raised my son and I then went into education as a singing teacher. So I worked for a music Trust has headed the vocal team, Richmond music trust in West London. And I set up a team of about eight teachers there, primary, secondary, and whole class individual work. Then I answered an ad for a job to go and work as the first Singing for Breathing leader at the Royal Brompton Hospital in London. And then after that, after setting up that programme with inpatients, outpatients we'll talk more about that later.

Coming back to that Phoene definitely

Absolutely. I then went into to become head of music services for London at Nordoff Robbins, which is a really big music therapy charity that a lot of your listeners will have heard. And Sony, by the way, has just donated 10,000 pounds bursary for people to train as a music therapist at Nordoff Robbins.

Excellent.

Oh that's a really good piece of information. 

We'll put it in the shownotes

Deadline's past for this year, but hopefully that won't happen again. And after Nordoff Robbins, the brain goes a bit blank, I went back into freelance work. But basically long story short, I've worked in nursery schools, further/higher education, and communities two years working as a music therapist at high security female prison doing a lot of voice work. Free-composing, songwriting, also in Yarls Wood Detention Centre, refugee hostels, children and young people and hospital settings, as well as kind of leading choirs at the Albert Hall and the Royal Festival Hall. I mean, that's enough, but loads and loads of different things. And I trained.. some time, I can't remember, I think my son was 10. Because I remember practising anatomy and physiology and sticking postit notes on the poor boy. I was trying to learn the different parts. And I was training to be a Shiatsu practitioner. Because I was working as a singing teacher, and I was thinking what is going on with people's bodies here that is impacting so massively on the voice and what is happening that people are unable to be in their bodies in terms of a kinesthetic awareness. And that then moved me to training as a body worker, which didn't suit my personality long-term. But it was a really, really important part of my work.

Well, I was gonna ask you about this because I knew you trained in Shiatsu and I had a feeling you might also have been a yoga teacher,

no, I've just done yoga for 30 years is my go to kind of dance.

You and me. 

But before you go on, I want to come back. And I actually wrote this down because I was looking at everything that you've done. And I wrote this down before we started, which is we as as human beings are essentially the product, the result of our souls, and our experiences. And I think that's really interesting that the you look at the experiences that you have over the years, and you look back to where you are now you look backwards, and you go, Oh, is that how I got here? That's really interesting.

Can I add something to that Jeremy Sorry, it's, it's it actually goes further back to that. I have body memory of not being able to breathe as a baby. So I was a premature baby, I was blue lighted across London in an ambulance, put in an incubator for a long time. And, and then I was raised in a household with what are now known known as adverse childhood experiences, you know, it was kind of a bumpy start and a bumpy ride. But all of that stuff has informed me, you know, to raising my son in a bedsit on benefit to then be working in a prison and people saying, I've never met anyone like you before. But like, you're really cool. And it's kind of like, you know, don't judge the exterior. Because actually, you never know what's going on in a person's life.

And I thought, I think what's really interesting about that you talking about, you know, the body memory is that I think somewhere along the line where I was reading maybe the notes that we bounced between us about what we were going to talk about. Sometimes people are diagnosed with conditions such as asthma, whereas in fact, what's happening is that there's a body pattern or breathing pattern that really can be undone by breath work and fitness. Work and possibly with the work on the psyche as well. So it's not necessarily an illness. Am I offbeam here?

Yeah, I think we need to be careful here. But oh, no, no, no, no, you're absolutely bang on. It's just we need to be careful, because we're not dismissing an asthma diagnosis, but we need to be aware of two things. She says holding up 3 fingers - 54321. And one is this, there's a condition called Exercise Induced Laryngeal Obstruction that you will have heard of, that is often diagnosed misdiagnosed as asthma. The wheeze for EILO is on the inhale, not on the exhale, one of the markers, that's something that's really worth people knowing about, it's where literally the vocal folds close, and it's often misdiagnosed. So that's one thing. The other thing, you're talking about something called a dysfunctional breathing pattern or breathing pattern disorder. And I have worked with a number of people with asthma, who have been taking more and more of the blue reliever inhaler, and have thought their asthma is getting worse. But actually what they're struggling with is their dysfunctional breathing pattern. Which I also have, as a result of what I mentioned about my premature birth and my adverse childhood experiences. So I hyperventilate, as you can see when I'm a bit nervous. But you will get you will get people who have a chronic lung condition, such as asthma, and a breathing pattern disorder, as well. And you might get somebody just with a diagnosis. But generally, they weren't when I say diagnosis, I mean of a pathology. But generally, it's very hard to separate a lung condition from a breathing pattern disorder, because the latter is the great mimic. And it behaves as if it were a pathology. Sorry that's a long answer.

It's a great answer, because it's so clear. It's for me, this sounds very much like the sort of vocal diagnosis that we do, where we go, yes, you're doing x, y, and Zz And they're all three together. But we need to know what the underlying thing is. And you just you look at the threads that you've the possible threads that you can pull, and you go, if I pull this one, will it undo the other two? And maybe not? So let's go with the one that we think will undo everything else? I'm sorry, that's a that's quite a vague answer as well. B

No, no, I know, I know what you mean. And it's being able to hold those things simultaneously, Jeremy. So one of the things about working with a group of people with chronic lung conditions is that your eyes are open and your mouth is moving, and you're delivering, be it online or in person, but all the time you're watching and you're listening, and you're watching and you're listening. And I think that is the hardest part for singing leaders who are used to being performative, and they used to being teachers, and it links Gilly with the music therapy part of my training, you have to be able to do both.

Mm hmm.

Which you to know because you do it all the time.

That's very interesting. Um, how about you tell us about that first experience at at the Royal Brompton,

I've never been so scared in my life. And I think that it says something very interesting about the correlation between those two words fear and breath, particularly with what's going on in the world at the moment. Even to the point and you may hear it but you'll definitely see it. When I start talking about breath, it starts to impact on me when I go back to a memory of being in a place where people were in bed in thin nighties and pyjamas with attached to oxygen tanks, cannulas and masks, some of them, wheezing, steam, breath, I didn't know what was going on, you know, drawing breath high in the body through the mouth with the SCM muscles moving fast and a lot of fear, and sort of eyes on stalks. I'm really... Bless Victoria Hume. She's now the director of the Culture Health and Wellbeing Alliance, but she was the arts manager at rb&hArts who first employed me. And she really supported me well but but trusted me enough, and again at Harefield in 2016 when I went back, to just go around and talk to people and meet people and patients and try things out. And it would change the mood of the entire place. Soundscape... I'm pausing, because I could talk about soundscape a lot. The minute you start singing in a hospital setting, you're changing the entire environment for everybody who works there. For every member of staff and It confuses patients. So I'm a bit of a disrupter 

No!

No!

because people don't understand it's like an anarchy with a small a, they don't understand who I am. I'm clearly not a consultant, I'm not a physio I'm not an OT. I've got a very professional air, but a very warm air. And they're kind of like, Who are you? We don't understand. So I've immediately taken people out of that habitual way of responding in a healthcare setting. That sounds arrogant. I don't mean to be

Having been a patient myself much more than I would have expected over the last year or so. I, I think you're right, it's extremely difficult for patients to take power, to be their own advocates, particularly if you have something wrong with your breathing, because breath is life. And you can become very passive and very afraid. That's certainly my experience. And sometimes you have to learn to take yourself out of that mindset, and have the conversations that put you on a level in terms of patient experience, you know, those are two words I have had to say very, very loudly. When I've been in a&e. This is my experience. Listen to me

You are the expert. Absolutely. And there needs to be much more PPI patient and public involvement in, well, everything in research and delivery and commissioning. Sorry Jeremy, you just reminded me Gilly of you being in hospital and not in A&E but in if you have had to go in for longer. The sessions we used to run in the inpatient area with literally people dancing around. You know, you get those IV...

The IV stands

Dancing around those to Abba, you know, with, with, with, with consultants kind of shimmying in the corridor as they go past. I mean, just fabulous. That's what I mean about, you know, as a disrupter, it's a wonderful disruptive.

I mean, I'm gonna say you have two things there. And I know that you know, this, but you have dismissed one of them gently. Because, yes, you've got the disrupter element. But you also the first thing you do is listen. 

Yeah

And listening is such an important skill. And it's also a skill that's underrated. Because you can go in as somebody who is expert in the field, you can go in and you can you can spout, and you can lecture and you can pass on your information and your knowledge, but it's not necessarily what that person wants in front of you. And there's no way you can find it other than listening and asking,

The biggest amount of my work is around helping people to land back in their bodies, in order to listen, and it makes, it can make people vulnerable. And if you are working as a vocal coach, you may have been a performer and there's quite a lot of ego and performance there. Hello, I've been there. And so being able to be within your vulnerability and to open up heartfully to A N other, not knowing what is going to happen. That's the most important thing, the not knowing and the fear around I know we'll come to this around existing singing for lung health leaders and new people who are thinking of doing the work around COVID is off the page because it's unknown. But the whole joy of it is, is that as a music therapist, we are used to walking into a space... When I worked in the prison, I used to go down into the separation and care unit known informally as SEC, where serious, you know, life lifers were, and it was very, very unpredictable. But in a way, that's what allowed magic to happen. Sometimes with less magical than others, but it's been able to, to know enough to have enough knowledge in your toolkit. And you will have seen this with singing teachers as well have enough in your toolkit to know how to respond. But allow for that pause, to listen and to to see what's appropriate.

And that's that's about holding the space, isn't it your you need? And I think this is the terrifying thing for someone who's maybe working in the situations of dealing with illness and singing is the ability to hold that space. And also we're going to be asking you about you know, what's the knowledge set? What's the skill set that is required in order to hold that space so changes can be made? I think that's a key thing.

Would you like me to go there now?

Shall we? Yeah. Why not? We're not working in a linear fashion.

Gosh, ask me the question again. Because there's almost two answers. There's one that I would talk about from my experience. I mean, I have touched on it a bit, haven't I, because I've talked about vulnerability. I've talked about openness to not knowing, I've talked about educating yourself, so that your toolkit is sufficiently full that you know you can dip in and respond. And so yes, clarify a little bit more about what you'd like to extract from me

I actually want to pick up on something you just said, because I think it's really important. And we can, we can sort of go on from there. Your toolkit is full enough. There is a real difficulty because this is also when ego comes in. If your toolkit isn't that big, you know that this thing works. And it works with everybody. And you go in and you hand that technique to somebody and you know, it works, because you don't have that much to choose from.

That's really interesting, because I actually say to people, the opposite, which is know what you are doing, and why you're doing it. And if you don't know what you're doing, don't do it. So I would rather have a Singing for Lung Health leader do the same thing, again, and again, really, really well and know exactly what they're doing and why. Than to desperately try and learn techniques too fast and make a mess of it or do it because they've seen... one of the classics, is back in the day, when a lot of people used to run community choirs there was this exercise. I don't know how you're going to translate this for for sound, not vision, and people would go and they do a sort of shimmy shake. 

It's like the big bear shake. Yeah,

yeah, we have seen it. We've seen it.

And I'd say, what what are you doing that for? And why? 

Yeah.

And people would say, "well, it was this leader who did it at this workshop and it was great." What does it do?

For me, Phoene, what you're saying is not the opposite. It's actually the same 

Okay

Which is, however many techniques that you have in your box, you've got to know what they do. Yeah. And this is actually this is really interesting, because personally, I think you have to work out yourself what they do, despite what other people tell you what they do. This is a really weird thing to say. Because any anybody who teaches you a technique will tell you what it does, and you go Okay, yeah, you know, I accept that. And the next thing you have to do is question because if you don't question you are taking someone else's word for it. And you just go blindly and blithely to hand it over to somebody else and just pass that information on. It may not be the right information in the first place.

You've got to dig into it. But also I know that you know, when you became involved, sort of more formally with the Singing for Lung Health programme, you pushed really didn't you to get an appraisal going of the programme itself. So you were looking at outcomes. You were also co-working with Adam?

A multidisciplinary team.

Yes, thank you.

Can I drop that in? 

Please do

So I work at The Musical Breath with Adam Lewis, who's a research respiratory physiotherapist who's now a lecturer at Brunel. He has just been given £250,000 from the National Institute of Health Research, to look to see whether it is feasible for people with chronic lung conditions to do singing after they'd done pulmonary rehabilitation. Fabulous. So work with Adam, I work with Juliet Russell, who a lot of you will know 

Yes

A fabulous vocal coach and human being. I've worked with Elizabeth Swain who is another fabulous human being and vocal coach. And I work with Charlotte Wells, who is a phenomenal respiratory physiotherapist. And I've just got another respiratory physio on board from Belfast called Elaine Martin. So what I was going to say about what you were saying is that we communicate all the time - the team - formally and informally on WhatsApp and phone calls. We're constantly checking and double checking. And I also want to name check Rachel Goldenberg and Jessica DeMars. Jessica DeMars has done a podcast, which is called the long COVID podcast works with Rachel Goldenberg in Canada. And also there's a dancer called Emily Jenkins and all of us are coming together to connect, talk, to share expertise to offer masterclasses to to really figure out is what we're saying a load of rubbish Do you know? Actually road test it. Sorry, went slightly down a cul-de-sac on that

I think this is so important

No because we're on the same track, which is you you self examine, you examine your own practice to find out whether actually what you're doing is really what you're doing

Reflective practice

We do that all the time.

Yeah. And it's my lovely new store because

you have one of Oren Boder's straws

I do 

Rayvox's straw

Rayvox.

Because one of the big things around singing for lung health is dysphonia is massively high for people. 58% in an Egyptian study, and Juliet Russell came up with a fantastic toolkit that includes a lot of SOVTs. And I just thought, Well, actually, how does this work? And how would it work if you had an obstructive condition in your airways? And how would it impact if you had a restrictive condition, scarring of your tissues and what is going on? You know, so it's, it's really trying to give it the same welly and weight and reflective practice that I gave all of those exercises on the singing for breathing CD,

which was terrific

Which took months to get the tempo and the pace. And I've got to share because I'm excited. And you'll you'll you'll get this. Yesterday, I started to record some material for the new training on repertoire, just a simple little song, I think it was Black is the Colour I think that was the song. And you know, the time I stopped and started and stopped and started to get key right? To get tempo right? To get pitch and pulse right? And even like a semitone and a millisecond of speeding up or slowing down. I thought, Oh, that's gonna really impact for somebody who's got a restrictive condition. And it's painstaking work. And you're going to say, but how do you know? How do you know how can you measure that stuff? I don't know.

But you have experience. Yeah, you have experience in the field. And that's the point. It's not theoretical.

Insight, insight, experience. Yeah.

But it's the doing. My point is, it's the doing of it. And I spent probably a couple of well, maybe an hour, just getting the tempo and the key, right, knowing that working differentially across different people with different needs. It could be adapted.

Yeah, fascinating. makes sense to me. So I want to ask you, if you're, you're running your own programme now, aren't you called, as part of, The Musical Breath? Which is your company? What are you looking for in a Singing for Lung Health leader

Already need to have some basic skills and competencies. So we don't have time it's a 20 hour training, we don't have time to teach the basics of song leading. So they have to have the basics of how to lead community singing, or group singing teaching, either online or in person, they have to have a basic understanding, not your level of understanding but a really basic understanding of vocal anatomy and physiology. I have had some extremely strange things written on application forms, which I won't quote, because it would be disrespectful if anybody listening went, Oh, my god, that was what I wrote. But there's some real misunderstandings from people who have been teaching for decades around what is a muscle? What is a nerve, particularly how the diaphragm is moved? And you know, so they need to have that basic knowledge there. What else do we require? Oh, really importantly, some kind of... when I say bodywork practice, some kind of conscious body relaxation practice. So I'm always nervous saying that, because it can get a bit wafty and wussy. But I mean, you know

You can go Whoo, anything Whoo is fine. 

But just something that helps them to notice their own breathing patterns, notice their own movement patterns, and not just be kind of moving blindly through space. So really some kind of practice that means they have some kind of connection with breath being movement and movement being breath, breath being voice, voice being breath, you know, that sort of relational thing.

It's that experience of an awareness mode.

Ooh, experience of an awareness mode, tell me more.

And awareness mode can be any formal or informal thing. It could be yoga, or it could be Feldenkreis It could be whatever But it's, it's some things that it requires you to bring your attention to something.

Yes, and I'm loath to use that word mindful, but actually mindful in the original sense of the word rather than mindfulness. Because I think one of the things is back to what we were saying earlier, what you don't want to do with somebody with a chronic lung condition is to try and fix, you want to look, and Jeremy, this is what you were saying earlier, you want to look and say, What are you doing? And how is that serving you? Because if you go ploughing in there and try and pull away everybody's defences, you're asking for trouble. So what are you doing? How is that serving? And can I invite some options for you? 

Yes. 

And if you can't do that for yourself, you know, I know, all of my stuff around my lordosis. And my breathing pattern, and the way that I, you know, push a bit hard at vocal fold level, it doesn't mean I stopped doing it, but I'm aware of it. 

You know, you're doing it. Yeah. I mean, I think the two really interesting things that have come out of this one is that you've said, you need a basic level of singing leadership experience. Being able to sing, being a good singer is not enough. 

Absolutely not. And I think there's a really good reason why, Phoene, because I'm just writing an article on it. What is the difference between a singer and a singing teacher? One primary difference?

But even a singing teacher isn't a singing leader? 

No, no, no, bear with me on this, because this is what I'm writing about. The difference between a singer and a singing teacher is the singer uses their own voice. It's the only voice they use. And a singing teacher it's the one thing that a singing teacher doesn't do is use their own voice. They are working with everybody else's voice. They're not working with their own.

Yeah, well, that brings you know, it's lucky. It's not a therapy session, isn't it? Because that's that's the thing that's been very interesting in my journey about how it's other people's voices. And what's beginning to happen, she says wagging her finger, is I started to write my own songs again, for me for the first time in 20 years. 

Excellent. 

Because I'd spent and I'm feeling emotional. I spent 20, 30 years doing exactly what you just said. Almost channelling, it's that other person's voice. Yes. Yeah. Yeah. Yeah, totally.

And that that's also to do with the awareness that you're aware of somebody else, and what they're going through and what's happening for them. Now you can reflect it in yourself, you can go, how would I feel if that was happening? And what would I do, but that's not necessarily the fix or the thing to do with them. You know, that's where you're listening and awareness comes in

No. But you know, the other slightly freaky thing. And I bet you're finding this on zoom now, as well is, you know, when we all started working on zoom a year ago, and it's like, this isn't the same as being in the room, I can't tell what's going on, I can't feel it. And something happens in one of my trainings, and somebody made a comment about accompaniment, ukulele or guitar cop member, which, and I found myself saying to the zoom, accompaniment, and I said, Oh, the whole room is just gone a bit nervous. And then I said, How the hell did I know that happened?

Yeah,

And we are beginning now and as a supervisor, so I supervise music therapists. And there's, you know, transference and countertransference. It's beginning to happen through the screen. 

Yes. 

Yes. 

What's that all about?

Phoene, we've noticed the same thing, whatever it is that you bring to the screen. As a trainer, oh, my God, it will be amplified. So if you bring negativity to the screen, that gets amplified across the airwaves, if you bring openness, positivity, and joy that will be transmitted across the airwaves, 

I think there's something else as well, which is because it was one of the reasons why we cut our workload down a lot. Because we've been doing zoom sessions for 10 years, just you know, teaching all over the world. But when it started to be the only way that you're going to teach and we started cutting it down, because there is a way that you can reach out through the screens down the internet and actually communicate with that person on the other end of the camera, which I've known for years. And it's one of the reasons why I think people are getting so tired is because when you have that intention to do that, and to communicate and meet with that person, even though they're only on a screen or in a computer, you're working harder to make that connection through the screen. Yeah, I think it's why people get so tired,

it costs

Completely and do not find you know, already I mean, I'm a big front front body Anyway, you know, chin to the screen. But often I'll do work around, okay, where's my spine, what's happening behind me what's happening behind me behind me behind me. And it makes it much less tiring.

I have a wobble cushion that I get out in the middle of a training, zoom training, and I knead the wobble cushion. I stand on it. And that that helps me. Um, I got another question I want to ask you. And it's a bit of a rookie question, which is, you know, if human in the street is thinking about someone with breathing difficulties, you might think, Okay, well, I'm working with him on the breathing difficulties so they're kind of just need to be still so that they can conserve the breath and work with the breath and not waste energy. And what I learned from appraising the programme a few years ago was, that's actually not what you're doing, that movement is involved, physical activity is involved. And I'd love you to say a bit about that.

It's really important and it's, you know, breathing and heart conditions. So we get out of breath, and then we get frightens, so then we don't move, I'm actually going to move myself, I'm going to stand up while I'm talking to you. Yeah, so it's called a cycle of inactivity. And as I say, what happens is we we stop moving, because we're frightened of being out of breath. The word breathless is a normal response to exertion. There is nothing dangerous about being breathless. What might be dangerous is an underlying pathology. And what is confusing is that the same word is used. So I mentioned I've got a dysfunctional breathing pattern, I hyperventilate, and I don't like the feeling of being out of breath, probably because as a baby, I couldn't breathe. In a brief period when I started running, haha, I live with a marathon runner who does kind of ultra marathons and things. It took me six months to do counts to five K.

Respect.

But anyway, I was running with Adam Lewis in Wolverhampton, we've gone up to look at a Singing for Lung Health Group up there. And he had to... look, I'm hyperventilating talking about it. He ran around the park with me, reassuring me that what was happening was really normal. And that I was just working harder. And it was making me breathless, but it was not dangerous. But my body memory was saying this is dangerous. I don't like this feeling. So if you multiply that by 1000 times for somebody who's been diagnosed with COPD, that's the problem. I have to put a really important caveat in here. Long COVID is something different. Post exercise malaise. And when you start looking, and we don't know yet, we don't know yet. But when we start looking at an ME type chronic fatigue, it's not the same. And having been there myself in 2016, that I remember lying there thinking I was so tired, that breathing was tiring me out, there was nothing wrong with my my lungs, just the very act of breathing, I just wanted it to stop because it was tiring. So yet, as a general rule, if you've got chronic obstructive pulmonary disease, you need to keep moving. And breathless, not speechless. So if you can say, I can hardly believe that singing is helping me breathe, you're okay. If you're going, I can har..dly..be..lieve if you've ever done it. And that's a big part of the training.

Really interesting. Thank you for that. I mean, we could talk about how Phoene had to pivot as all of us. But I also really want you to talk about COVID. Because obviously, we know that people are having, first of all suffering from long COVID. And people are also having really quite long term effects from COVID. And I'd love you to talk about that

They're related actually, two things are related. So March 2020. Is anybody else finding it difficult about knowing quite what year it is? Yes. What day? Oh, and also do you have that thing where you're not quite sure, like, you know which parts of the country you're in geographically, but sometimes do you walk around your house and go, I'm not quite sure where I am. Or is it just me.

I think that's just you. It's because you're not good, but it's because you're not going out anywhere so that your map is getting smaller and smaller.

Good point.

It's very, very strange. Anyway, March 2020. I lost all my income. It went down to 50 quid a week because I was working as a music therapist with children and young people. face to face. So that work stopped. And I thought, oh my god, what am I going to do? And we had a chat Gilly around that time. Remember?

I do. 

And I spent two months after we spoke, repurposing the three day a week in person course, two bodies, and now a 20 hour training over eight weeks. So it's two and a half hours a week, with a 15 minute break over eight weeks. And I just was in despair, I just thought this is never gonna work. This is just ridiculous. You can't do this online. 

I knew you could. 

But the thing that was really surprising to me was, there were a couple of people who done both courses, they came back for a refresher. And they said, We prefer doing this online, weekly, with time to reflect in between with home study resources to look at in between, with being able to connect with other group members on whatever comms platform we were using. And that to me was extraordinary. And then, of course, people started to realise that well, originally people thought COVID was a respiratory condition. So what has happened is that as more and more people are being impacted by COVID, I'm getting more and more inquiries for people who want to do the work, yeah, basically.

That doesn't surprise me at all. I want to pick up on what you said is your experience from having pivoted to an online training? I mean, you've been on a couple of our three day courses

In person 

In person, and you know, how intense they are. And it's wonderful, because you have everyone in the room. Yeah, we didn't know what was gonna happen when we first put it all online.

Because we've done one to ones for years, a decade or more. But we've never small, tiny, tiny sort of discussion groups. But we've never actually taught a group training online completely. And we didn't know how that was gonna work.

And we found the two hours a day with Facebook group for discussion and that, you know, that collegial support. People learned more,

we have the same thing. 

People preferred it.

Amazing isn't it. 

you know, you do two hours in the morning, if you're in the UK, you do two hours in the morning. And then you've got the rest of the day. And people have students that you know, they're doing on zoom. And so they're immediately trying out the stuff that they've done that day. And they come back to day two, and they're gone, tried it out, it was really great. Or, you know, they give us feedback. And it's that thing about you do a certain amount of time, and then you have time to put it into practice. And you learn it on a much deeper level.

How How has it changed your training now that it's gone international and global in terms of being in a room, because this is happening on musical breath training as well? Being in a room, you know, with people who are struggling to get out of bed and you've got people and it's freezing cold? And you've got people in Australia? Yeah, just had dinner and it's boiling hot?

And they've got a glass of wine. Yeah,

yeah. Because I think it adds something really marvellous

I think it's amazing for the participants to get that because people from different, you know, cultural backgrounds bring something different with them, they bring a different energy. And I think it's really beneficial. I also think that it changed the way that we teach. I think we have a better focus

we cut half the content.

Oh, yes. Half the content, and less was more.

Wow. 

And what was so fascinating is that people learnt it faster, they got more out of it, they were by the end of the course they were further on, than when we were doing the full content in over three days at home. And it's just been really fascinating. And we've actually completely rewritten course because of it,

they learned at a deeper level,

The biggest gift, you've given me many over the years, the two of you, but Gilly was when you said to me when you first looked at those videos of me when I was first trying all this out six years ago, and you said you need to know what you have to leave out. You put it better than that. But you know, basically, it's not about impressing everybody with every single thing that you know, it's it's really knowing what to leave out. And that has been so important.

And it's also a gradient because the one this is part of the thing about knowing what to leave out because you know that there is a longer journey. And so we've we have a three weeks online singing teacher training out. And in week one, we'd love to give you absolutely everything we have. But first of all, we know it wouldn't work. And secondly, it would take too long

and you're gonna be overwhelmed.

Yeah. So we know that we have certain targets by the end of week one that's not the targets for week two. And people go oh, you know, well, we call this fine, but you know, we're not sure about week two, can you come on it and at the end of week two, they go oh, we see what you mean. Oh, okay. And you know, On week two, you can only do week two, if you've done week one, you cannot jump in, no matter how skilled you are, you can't jump in on week. Yeah, because there's so much gradient and preparation that brings you up. And then by the time we get to week three, we're really dealing deep with people. And it, there's no way that you could jump into week three, without the preparation that we've done. So this is all about having a much longer view of what you want people to know,

when you said you've changed your training content. Again, I think this is really useful for people who are also kind of moving training online. For me, one of the biggest learnings, I'm one of those people, when I get an evaluation that is like 99% gold stars, and one that's not very good. It's the one that's not very good that I will welcome in and not sleep, right. But I think what I've learned, having now done three blocks, I can't remember I think I've done three, and I'm doing good four and five coming up this year, maybe even six. You cannot please all of the people all the time. And actually everybody's learning styles are so different. That being able to really work to make sure you are hitting everybody's learning styles as much as you possibly can without compromising your teaching style. 

Yeah. 

So yeah, that's that's the balance. And I mean, the wonderful thing and I'm sure I know, it'll be the same with the two of you is that every course is tweaked. And every course is all I'm learning something from to them. Yeah, to the next but that there is something about the balance of people. So I have classical singing teachers have suddenly come out of the woodwork. They were never anything to do with singing for lung health. It was all natural voice community, choir leaders. Now there's classical singing teachers, music therapists, community choir leaders. But the really exciting one for me is health care professionals.

I wondered

that's where I'm the most interested. And I said for years, it's easier to teach a singing teacher about respiratory conditions than it is to teach a respiratory physiotherapist how to be musical. Actually, on a mixed course with lots of different people. I'm looking at that again.

Is there anything else you want to tell us about the the COVID on how your work can help people post COVID? I mean, I guess you're still looking into this aren't you? Is she beating her breast?

I really do, No I'm pausing. Because it is this is a such an important question. And it's really challenging. And it makes me feel sad, perhaps for reasons that I hadn't realised. Okay, so I'm going to be really honest, and careful and honest. So we know that what happened a year ago was that all of us who sing and teach singing lost our livelihoods overnight. So I think bizarrely with COVID, impacting on people's breathing, a lot of people who lost their livelihoods are now seeing this as a way of making a living again. And that's the bit that makes me really sad. Because it's not - this is where I suddenly lose all the business that I was just getting - it's not about learning to do a thing to take a bit of paper to go out and carry on being a singing teacher, but just with a different clientele. It's so much more complicated than that. And in terms of me, teaching people with COVID, I would want for example, online classes for people with COPD. Some classes are maybe 12, 16 people if I was working with a group of people with COVID, I wouldn't want more than four, maybe six, as an absolute maximum. And I would be working so slowly and carefully. I think the best way of summing it up is Rachel and Jessica in Canada. I mentioned before who are changing their programme to respond to COVID, their original programme was called Breathe, Sing, Move, the new programme is going to be called Breathe, Sing, Rest. So it's, I've worked with people in hospital beds, who are literally dying, you know, palliative care, really breathless - singing has been so supportive. I mean, I'm remembering a lot of the patients who've just been able to manage and control their breath through using the right song has been, you know, they said things to me, like that was the day hope returned, really moving, moving stuff, you know, gave them... change locus of control, it gave them tools to self manage, but that has to be done so delicately. And so responsively to the individual, what we don't want is a system of one size fits all singing at - silent hypoxia, where you know, happy hypoxia where your blood oxygen levels suddenly go through the floor. That's not something you can see even in the room, let alone through a screen. And, and also, that thing of simply choosing a song that is a little bit too fast, or the phrase lengths are just too long. That can that could actually, it could distress people. And I know this is why people want to come and train and it's wonderful. And of course, we'll make sure that we say all this in the training. But this is not a way to suddenly... it's really hard because it costs it's impacting my income and livelihood. But we need to balance that with with just being careful, being responsive, and continuing to read as much as we can, as the literature and the research comes in about the long term effects on COVID. I really wasn't expecting to say any of that. But I think it's really important 

well it is because essentially it's not a bolt-on to your singing teaching career.

It's, I mean, I'll say the thing that you are being too sensitive and nice to say, which is this is not the next bandwagon. No, it's it's more than that. Where there could be a value for mainstream singing teachers is in helping clients who have had some singing training, who have who are performers who are used to singing, maybe helping them to get back on the horse, which I think I presume simply because of the the memory of having done it might be slightly different from using singing to help people to recover who weren't singers. I mean, is that a false distinction? 

Different things, I mean, certainly people who've been ventilated, without going into the gory details of having a plastic tube shoved down, you know, between your cords that there will be and there are quite serious impact. And we know a lot of speech and language therapists are doing that work, so that there absolutely singing teachers can support people who've been really unwell and ventilated. I think it's... what do I think? I just think we've got to go slowly, carefully, respectfully, and we need to know the difference. I've always said this, there's nothing wrong with a singalong. Love a bit of a singalong, but we need to not mix it up. And I think one of my jobs, particularly with the new job around arts therapies is to help people understand the difference between a sort of trained, responsive embodied singing teacher with a toolkit and Mr. So and So who comes along with his ukulele and does some performing? I mean, it was ever thus It used to be like this in in care homes with people with dementia, where the staff didn't know the difference between a trained music therapist with a Masters and a performance person. And I don't say that disrespectfully. But I think there's some educating that needs to happen

it's also know your own boundaries. Know the boundaries that you have another boundaries that other people have.

Can I say something, add something to that? What we don't want to do is instil so much fear. So I've trained about 220 singing leaders now, they need to know that what they have is enough, and if they return to their musicality, and their responsiveness and they really trust the repertoire, they will do a good enough and more than a good enough job. But what happens is people want information. When we first started working with people with idiopathic pulmonary from fall, idiopathic. I liked put this into a warm up "idiopathic pulmonary fibrosis". 

There was a lot of fear around that it's a restrictive condition, not a constructive, obstructive condition. It affects the airways. Sorry it affects the tissues, not the airways. Just responding to a human being. It's obviously a bit more complex than that, but it's like don't get hung up by the pathology, just respond musically to the person.

For our listeners, can you unpick idiopathic?

Just means we don't know why. Okay. So fibrosis is scarring and idiopathic is an IPF, Katie Price's mum has got it, and it sadly killed Keith Chegwin, people don't know why people get it very, you know, healthy people can get scarring. And this is what's complex about COVID is that COVID can cause scarring, at alveolar level, but some of the manifestations of it is a bit more like an obstructive airways condition. So we don't know yet. We don't know yet.

Scary, scary. Is there anything you're doing in the near future that you would like to point people towards?

Well, just come and have a look at the website. There's lots of reading and lots of resources at WWW.themusicalbreath.com. March/April training is sold out. Next training is May, and then there'll be another in September. And there's a quite a long waiting list. And the Yeah, the CD, please, please use the CD. The money goes to the Royal Brompton. So if you can, you know, download it rather than stream it, the Royal Brompton would be really pleased.

Yes. Is it available for sale then? I didn't know this.

Absolutely, yes, it is called Singing for Breathing CD is on the website. You can download it from all the usual places. And to let you both know, This Is A Voice is still the prerequisite. They have to have This Is A Voice and they have to have the Singing for Breathing CD for every single person who's done the training. So that's 220 copies I've managed to flog for you!

You have indeed. Thank you.

We'll put a link to the CD in the show notes so that everyone can find it. It's been a joy. We better not leave it quite as long next time.

No, quite, no

It's lovely. Thank you. Thank

Thank you so much Phoene. Hanging around for the jingle.

I will

And we will see you soon. Okay. 

Thank you!

Bye bye.

This is a voice a podcast with Dr. Gillyanne Kayes and Jeremy Fisher