The Visceral Voice Podcast

Joan Lader: Vocal Challenges and Medications

• Christine Schneider • Season 1 • Episode 1

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On this episode, I talk with one of New York's leading voice teachers, Joan Lader. We discuss vocal challenges, yellow and red flags, medications and possible side effects, and her recommendations for lozenges.

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Christine:

Welcome to the visceral voice podcast. I'm your host, Christine Schneider. Every two weeks on this podcast, I talk with voice specialists, manual therapists, health specialists, psychotherapists, movement practitioners and professional voice users about voice science, function, medication, movement, puberty and aging, and everything in between. I am on a quest not only to become a better manual therapist, but also to learn everything I can about the living, breathing body and it's intricate connection to the voice. This podcast documents the continuation of my learning and my experience as a professional singer, a nutritional consultant, and a manual therapist. Join me every two weeks as we strive to provide current, knowledgeable, creative, and compassionate information to help restore, regain, and create happiness and success in your vocal journey. Hello everyone. In this episode I talk with Joan Lader, about medications that you should be mindful of using as a professional voice user. Joan later has her BFA from Penn State University and she is trained as a master's level speech pathologist. She specializes in working with singers and actors and in collaboration with New York's top Otolaryngologists, rehabilitation of injured voices. Joan is a certified master's teacher of the Estill voice training system and has extensive training in the Alexander technique as well as Fitz Morris' voice work, And the work of Arthur Lessac. More than 30 years of providing vocal training and rehabilitation for professional voice users was commemorated in June of 2016 when she was awarded the American theaters highest honor, a Tony Award for excellence in the t heater. Joan Lader is my mentor for my life and my voice. I am so thrilled to have this conversation. Here you are my conversation with Joan Lader. Hi Joan. Thank you for joining me on the podcast.

Joan:

well this is fun, I think.

Christine:

I think we're g oing t o have fun. U m, thank you so much for giving up your break today to talk to me about medications. So I started studying with you in April of 2006

Joan:

wow.

Christine:

Which is almost 13 years ago.

Joan:

Oh wow.

Christine:

I know. Thank you to Steven Lutvak for getting me in. And in that time you became my greatest mentor, not just with my voice, but in my life. So I am so grateful to you and very humbled and grateful that you are on the podcast with me today.

Joan:

I'm going to cry.

Christine:

I might too. So, to my knowledge, you were the first, or at least among the first teachers to integrate speech therapy and the singing voice. Can you tell us a little bit about how that happened for you?

Joan:

Well, thanks for thinking. I was the mother of it. Truthfully, it was considered a specialty at that time. As a matter of fact, there were very few doctors who had more than a laryngeal mirror. And I actually worked with a laryngologist who was a wonderful artist, and he sent me these sketches of his patients pathologies. However, I was lucky enough to be working at Mount Sinai with a wonderful SLP named Arnie Shapiro. And he had a famous singer referred to him following a surgery that didn't go very well. And so he threw up his hands and he said, you're a singer. Give it a try. That's absolutely true.

:

Good luck! And that... And that was it. And then you started getting referred all of these patients?

Joan:

That's correct.

Christine:

Wow. And when you teach at universities and different masterclasses, you talk about vocal challenges. Can you tell us a bit about these vocal challenges?

Joan:

Well first of all there's or, or mine?

:

Both.

Joan:

Both. The goal is obviously to effect some type of positive change and to instill confidence in your clients during a very stressful time. This is here in New York actually, and the list of challenges is quite long. Working with performers who are not miked and shows that are both physically and vocally demanding pubescent boys whose voices are changing or working with ballet dancers who have to sing. And then there were a film and television actors who were not accustomed to speaking above a whisper and they have to perform eight times a week. There really is a difference between talking to a camera and talking to an audience, singers who are not prepared to sing in styles that are out of their comfort zone. And then dealing with emotional ups and downs of artists or especially with students when I'm at universities working with artists who have to perform particularly pop and rock stars who are traveling and they may be performing with problems ranging from reflux. You made accord thickening polypoid edema, travel fatigue and accompanying drying years. And just being aware of the difference between declarative learning, which is giving somebody facts and procedural learning, the actual doing that's, that's really an important thing. I think that the um, love of learning and the love of success is what's gets us going.

Christine:

[inaudible] you mentioned pubescent boys. I mean it might depend on the individual, but do they need to rest during that time or is it okay for them to perform?

Joan:

Hmm, good question. Uh, it depends, you know, they may be able to perform for a certain amount of time. It depends on the show. They may change keys for them. That's certainly happened in Billy Elliot. And then there was a time to say that's enough, you need to rest. So it really depends on the show. And I have someone now, I just, right before I spoke to you, durable, wonderful boy who I knew his voice was changing and he kept saying to me, do you think it's going to happen tomorrow? What do you think? What do you think? And I just got an email that it's, that it's over. He's only been out on the road for about, I think three weeks. And I just had a feeling and at first the director had said to me, you know what? It's kind of real. I don't care if he cracks, I just don't want to change notes. And I did say at that point, I do care if he cracks because I didn't want him to get hurt.

Christine:

Well, and you also talk about yellow and red flag. Can you tell us about both yellow and red flags that performers should be wary of?

Joan:

Sure. Okay. Well, yellow flags or just sort of little, a little things that may not be right and like I have a tickle in my throat or it feels scratchy or I'm not progressing, you know, my range isn't better. I feel some fatigue after singing or I need to cough or I'm developing some mucus after I sing. Those are just yellow flags. Having a little problem with Staccato. The red flags are if you sleep and your voice is still in the same state as it, you know you don't have all of your range, you can't go from one quality to another, then you really have to say what, what's what's going on? If there's a loss of range, if you lose loan outs where if you lose high notes and it's persistent, if you are hoarse, those are the red flags and that's when you need to be seen by a doctor.

Christine:

Okay, and so if someone's experiencing yellow flags, what precautions should they take at that time?

Joan:

Well, first of all, they should be aware of it. If they're in school, they might speak to their teacher, you know, no complaints. They're not going to think there's anything wrong. They might just be doing too much. They might not have enough sleep, they might be stressed. They have to really discuss this with someone and find out and maybe they have to rest. Maybe they have to take some vocal naps during the day where they're really quiet and then they can sort of think, oh my God, that's what happened yesterday. I didn't get enough sleep. I was in a really loud, noisy restaurant. I sang for eight hours yesterday. I ate a lot of spicy food right before I went to bed. They have to be able to figure this, this out and work it out with someone. Or I'm just so stressed because I feel like I have to be on all of the time and I'm afraid I'm going to get kicked out. It may be as simple as a problem with a roommate, someone who doesn't understand you or a teacher that you've, you know you don't get along with or that you don't respect

Christine:

[inaudible][inaudible] and so if someone has one of the red flags, then the top priority is to get to

Joan:

the doctor. Yeah. Yeah. And it should be a laryngologist who is really used to working with singers. We certainly have tons of them in New York. It's a little more difficult when you get out of New York City.

Christine:

So moving onto medications? One of them primary medications that I hear clients or friends have some confusion around is prednisone. So prednisone is an anti inflammatory steroid, but can you explain why prednisone might be prescribed and then talk about precautions that a professional voice user should take when they're on prednisone?

Joan:

Sure. Well, prednisone is prescribed because it decreases inflammation and it's often prescribed in an acute situation just to get an actor through a performance. So when it's prescribed for a performer who has a chronic problem, it's advisable that the performer actually be on vocal rest at the same time. Prednisone is a really serious drug and there are performers who take it too often and many of them take it without being seen by a laryngologist. A friend will say, well, I have someone you know you want some. That's a really dangerous thing. There are doctors and I, I work with many of them who there are two schools of thought about prescribing prednisone. For someone who has hemorrhaged, it can really be harmful if a singer pushes, if they cough or they're not a technically proficient singer because of the blood thinning properties, they may cause further injury or a second hemorrhage. And I've heard doctors say, okay, so they'll hemorrhage again, but you know, we'll get them through this. It's dangerous and prolonged use may actually compromise your immune system. Often it interferes with sleep. It can raise your blood pressure. It's problematic for people with diabetes. It can cause heartburn and it can also cause brittle bones.

Christine:

And so when you say acute, that's someone who's been experiencing something for the first 48 hours.

Joan:

Y up, Y up.

:

And then if it's longer than 48

Joan:

they be sick. You know, they m ight've just t here, they might be sick just coming, coming on, you know, I mean where they've had some kind of u m, excrescence w e'll say, you know, so it could be anything, some kind of inflammation, some kind of thickening, you know, whether it's fully formed or not. It's been going on for a while and they just keep trying to pump them up w ith, with drugs. They need to just stop and rest, be silent and give the prednisone a chance to work w ith. They're not using their voice.

Christine:

So if someone, and both of us work predominantly with singers and the Broadway community, but if it's another professional voice user or say a sports broadcast or a fitness instructor who may not be trained as well, what would you recommend if they have to use prednisone

Joan:

It really depends on what their larynx looks like.[ inaudible] you know, if it's really bad, I would certainly recommend rest. And I have, I've had worked with many broadcasters, you know, where I just actually, u m, said you h ave, you have to stop. And it's amazing because some of them will and they'll find ways of, you know, some of them are third, a TV host and they have a show to do. That's when you know that t hey're really serious if they just listened to y ou and stop[ inaudible] great.

Christine:

What I have read that it's not advisable for his vocal fold ulcers, hemorrhages or acute laryngitis.

Joan:

Well, okay. We already talked with hemorrhages. That's what I, I said, yeah, I know so many doctors who, who handed out a lot of doctors who are not laryngologists, they just speak to you on the phone and they say, okay, I'll call it in. The second thing you said was for ulcers because it's not really used for that anyway. Contact ulcers, you know very often is because of reflux. So they'll put you on reflux medication and the filter thing you asked was acute laryngitis. Well, if it's just an acute episode, you might, you might use it. Okay.

Christine:

Okay. So I am very curious. I was told that a large percentage of acid reflux diagnosis is not actually acid reflex. Do you find that to be true in the u s or do you find that the percentage of patients diagnosed with acid reflux is quite accurate?

Joan:

No, I think we don't know. And we keep hearing that more often, that it's not really acid reflux and we treat them empirically, you know, without really knowing. And now there's all of this information about the dangers of Proton pump inhibitors. And so people are told, you know, maybe, um, change of diet, sleeping on your left side, elevating, not just your head but your whole body built all sorts of things. So I don't really know the answer to this. And I don't, gastroenterologists never seem to agree with otolaryngologists so it depends who makes the, um, diagnosis.

Christine:

So if someone was diagnosed with acid reflux, you know, the first steps for them that they could make is really look at your diet, look at the way you're sleeping, try to make some lifestyle changes.

Joan:

Stress, stress also are showing, you might start with something like just not a proton pumps, you know, just to reduce acid, like Zantac or Pepcid, something like that. And see if you, uh, if they feel better, you know, it depends b ecause some people don't have heartburn, you know, we have silent reflux, which seems to not only t o singers get that all the time, but so t wo runners, you know, athletes, would they need to be mindful on something like Z antac? I don't think so. As, as to how long they can be on it. Well it works right away. That's the difference between those medications. You know, i t'll work right away and so rarely is longterm.

Christine:

Okay. And can you give us just kind of a rundown of common medications that you see and possible adverse reactions for the voice?

Joan:

Yep. So we'll start with, let's just start with nasal inhalers, you know, which are basically anti histamines like Aztlan. The major problem with that is that it can be drying. Not everyone is the same. Then you've got steroidal inhalers for people with allergies, like Flonase, nasal next beckon, A's type Mr and these inhalers reduce inflammation without entering your system, so they're actually pretty safe. Then you've got people on, especially actors, antidepressants, for example, things like effects or Cymbalta Prozac. And they very often dry you out from what I, I don't know for sure, but from what I've heard, the least problematic is Lexapro of those antidepressants. And then you've got psychostimulants like Adderall, Conserta, Ritalin and they may also cause dryness. And then we have asthma inhalers, two types rescue inhalers. When it's just an acute episode like albuterol and these are not problematic. But then the steroidal inhalers like Advair are potentially drawing, not only that, but over a long period of time they can cause muscle atrophy or Canada, especially if someone, if someone is on, and this happened with my husband because he is actually a severe asthmatic and he was on an antibiotic and a steroid at the same time plus his inhaler and used immediately. So we were very lucky that he didn't have to sing. But uh, that's a disaster.

Christine:

So nasal inhalers are quite safe, but steroidal oral inhalers can cause dryness.

Joan:

Absolutely.

Christine:

Okay. That's great. Are there any others?

Joan:

I think those are the big things. I mean we have to be where any kind of blood thinner, you know, we cautioned against aspirin and Ibuprofen because their blood thinners and advise people to take Tylenol and to just read the ingredients. You know, there are so many things out there. Years ago the, the uh, wellness formula had Gingko Balboa, which is also another vasodilator. And so we saw, I saw a lot of hemorrhages and people were on things like that.

Christine:

Does it still have it in it?

Joan:

No. No.

Christine:

They took it out.

Joan:

Yeah.

Christine:

That's good. Cause I know a lot of people that take wellness formula.

Joan:

Yeah, it's good.

Christine:

I would love to talk about heat on the cords. So especially right now there's a big movement for CBD and Thc and people can use it topically. They could use it internally through a tincture or a bong, a joint. Can you talk to us about the possible dangers of something like a joint or a cigarette or a cigar with the heat component on the vocal cords?

Joan:

So the most obvious problem is smoking a joint is the heat component. It's probably more drying than a cigarette. And there was a recent article in the science times by Jane Brody and she discussed the fact that it's the combustion that is most dangerous even in in cigarettes. It's the combustion which causes the heat rather than the nicotine alone. And so I guess that's why people began using bongs. I remember student years ago, he actually brought one in here to show me and I said, I don't think you could do that in this room. He said, no, no, no, no, no, no. They won't smell anything. It'll be fine. It was very interesting and the use of CBD tinctures and oils is an entirely different story because they're used for a variety of medical conditions ranging from pain, managing anxiety, sleep problems. I don't know of any negative data, but there seems to be confusion with regard to proper dosage.

Christine:

Well, I think, well, I'll just admit I'm in in support of, but I think there just hasn't been a lot of research because it's in public domain. Who's going to make money from researching this? The research that's being done. It seems to be that it is effective in a positive.

Joan:

Yeah. Yeah. I agree. When we were talking about other medications, I'm just thought of else the use of glutathione, which a lot of singers do it as an infusion. They are also pills. It's actually quite costly. But basically what Glutothyon is, it's an antioxidant and I've never seen a polyp disappear, but very often instead of going the route of steroids, they feel better and there may be some relief and they're able to um, function

Christine:

if someone takes glutothyon?

Joan:

Yeah.

Christine:

Wow. How great.

Joan:

Yeah. There are also group of drugs that are called Cox two inhibitors, which are also not dangerous. We have a real problem with dancers who have to sing, you know, to get them on the proper medication.

Christine:

So regarding lozenges.

Joan:

Oh good.

Christine:

What are the best and the worst lots.

Joan:

Okay. I love this topic. All right, so I'm going to tell you the worst ingredients first.

Christine:

Okay.

Joan:

Ok, menthol, it numbs the throat masking pain, but it causes dryness. So when pain is numbed, it makes continued voice drain more likely. Yeah. Eucalyptus. Eucalyptus is an irritant to sensitive vocal folds. Sugar, sugar is often found in throat drops, but it's actually food for bacteria and it may worsen the infection and therefore cause more coughing. Zinc when taking in huge quantities may be very drying. And I'll tell you, I remember so many years ago when my husband was still performing and he was, you know, taking zinc. He thought he was getting sick and his skin actually began to peel. Oh Man. It was really something. So the best ingredients, okay, it's hard green apples because Todd green act, Apple's act as a mucus thinner. I remember Luciano Pavarotti in so many concerts, he would have a little tray with his little green apples and a, you know, in the middle of a piece who just walked to the back of the stage, take a bite of an apple and come back.

Christine:

And now that is different from someone drinking apple juice or apple sauce.

Joan:

Absolutely different. Yes. So it's an a ntiinflammatory. It's hydrating and extremely good for your vocal folds. Okay. Natural Glycerin is made from plant oils, also very hydrating. Menuca honey, i f I find this very interesting, all honey is good, but Menuca is derived from the Menuca tree in New Zealand and it is considered the gold standard of healing honey. Supposedly it has a great soothing effect on throat muscles. And then there's Aloe Vera, which is best known for use on b urns, t he skin injuries, but it's also known for soothing and hydrating scratchy t hroats. So I f avorite products, g randmothers, which a re g lycerine based, black currant, r ed c urrent Fontis, which is green apple g lycerin and aloe vera. And I tell you a funny story about Fontis Kaitlin Hopkins w ho i s a student w ho, w ho's an actress and was a student of mine for many years who is now the head of the department at Texas State University. And she always complained or dryness. And she was the first person I ever knew to eat these little green green apples. And when she left the business and she was, you know, um, she must have worked with a biochemist or, or someone in Texas and they developed Fontis and she sent me, she would send me packages of these and say, you know, what do you think of these? Cause I remember the very beginning saying,[inaudible] a singer could choke on this. It's too big. It tastes very nice. Good. But they're now very nice little side. And my other new favorite, favorite cough drop is put out by whole foods and it's made of Menuca honey and lemon, and they're fantastic and they're cheaper than all of these other things.

Christine:

Is there a name to it or just you have newco? Honey cough drop. Yeah, Manuka honey and lemon, I think it's called[inaudible]. Okay, great. So really quick before we move on to my rapid fire questions. Yeah. I just want to tell the listeners that if you want specific information or comprehensive list of medications, you can go to the website in cvs.org that's the National Center for voice and speech type in medications and the search engine, click on the first tab, search for your medication. The effects will come up and you can see how the medication could potentially or may affect the voice.

Joan:

Yeah, and I also think, doesn't he talk about the interaction of some medications?

Christine:

I am not entirely sure. I've looked up a few different medications on it, but I haven't looked up very many. So that would be amazing.

Joan:

So important otherwise too, to find out. Even with some of these homeopathic medications of you're on other other medications they are, there can be a really negative reaction.

Christine:

Yeah. So making sure that if you're put on a medication, make sure that your doctors know what other medications you might be on and you can also do your own research as to any kind of reaction that they need to have. So my rapid fire question, what is some advice that you would want to give to an aspiring young performer

Joan:

if you don't absolutely have to do it. Don't. There is no performer who doesn't fail at some point, but the ones who pushed through it are often the ones who have careers. And I loved it the other night during the grammys, lady Gaga said it's really about how many times you stand up for yourself and keep going. And Vladimir Nabokov said, in art, as in science, there is no delight without the detail. And that means that there's a lot to learn. You can't expect to excel without practice. And that's a really important thing for young performers to know. You've got to keep doing it and you have to find teachers who not just know the anatomy and physiology and, and are very well informed, but they have to have motivational skills. That's what you're looking for because you have to be motivated.

Christine:

Yes. Well I certainly was.

Joan:

I'm from, you know, so yes Lynn Hilding see just speech pathologist who was a dancer first than she was a singer. People always ask me this question about masterclasses cause I'm sort of hesitant. I do a lot of them, but I just don't think they're great. And it's not that they're not worth anything, but the truth is that somebody could do something for me and I'll, and I'll say, okay, look at that. And they'll just go, wow, brilliant. Thank you so much. I was genius and I know that within 48 hours it will have no effect that they'll lose it. But she's even said if that student after the masterclass ran through a practice room and practiced it, that's a form of motor learning and you have a better chance of, you know, of a number and you're keeping it in the file. Making it part of your skillset. So I think that's a really important thing.

Christine:

Well, and I love, I tell Lillian my three and a half year old, every time she falls down, I tell her, it's not about how you fall down. It's about how you choose to give up.

Joan:

That is, but that is great advice. Really. Yeah. And it's better than you just giving instruction after instruction, but if that's how they discover it's got discovery.

Christine:

Yeah. What has been your greatest professional achievement?

Joan:

Well, watching my students blossom on stage night after night, and I guess being recognized for the work I had, the Broadway League and the American theater wing.

Christine:

Yes. Yes. And the many people who feel like, I mean you in particular, the amount of students that feel like they're never going to sing again or speak again or whatever their actual performance might be that you get back up, you get us back up, you get us going again and, and give us a career, give us, you know, our voice back and give us the life that we wanted. Thank you. Yeah. Thank you. What has been your greatest professional setbacks?

Joan:

Hmm, well, let me say, my greatest setback may have been my greatest success.[inaudible] I was a professional singer and an actress for many years until my final audition. So I'll tell you about that. I was auditioning for a revival of Annie and Martin Charnin was holding the audition and those days we used to have auditions, you know, right on Broadway stage. And I sang a very obscure song called where did the elephants go? Was from a show called 70 girls 70 and he was so not amused and he said, but, um, I, you know, I think you could sing and I'm going to call you back, but you've got to sing. I've got rhythm. And I knew that he just wanted to know if I could belt. And I couldn't, I didn't know any of us. And so I practice that. I practiced and I thought the only way I'm going to do this, if, if I lower it so much, I won't have to build, you know, I think I started on like g three or f three, something like that in the basement. I was, he looked at me, I was so embarrassed. I thought, I just can't do this anymore. Oh, turned out all right though.

Christine:

Yes. Because we have you changing our lives. What do you wish that you would have learned sooner? Wow. Learning is a constant pash and you can't rush it. I wish I knew that. And I guess what do I think I should've learned, sir? I guess I would have to say what I know today. Yeah. And unfortunately that is not the way we learned because it's a lifetime process. But that's something that I love about you and that I'm very similar or am similar, is that you love learning. You're learning all the time. And even when I was, I was, I was learning things about the body. Every time I come in and you'd say, what did you learn today? You know? And I love that. That you're never done learning. Thank you so much for joining me for doing this. And I learned so much. I hopefully all of the listeners learn so much. And again, thank you for giving up your break. I hope you get something.

Joan:

Yeah. So the next minute. Okay. Yeah, no, it was great talking to you, Christine. Thank you. We'll talk soon.

Christine:

Yeah. If you enjoyed this podcast, please like us. Tell your colleagues, your students, and your friends. Please subscribe, write a review, and find us on Facebook at lifelight massage. You can also check out my website at lifelight[inaudible] dot com join me in two weeks for a talk with a Bel Canto can Beltone voice teacher extraordinaire Mary Saunders. Bart, thanks for listening. Everyone.