Barbara's Take on Vocal Polyps in 9-1-1 Nashville

Your friendly neighborhood voice and upper airway specialized speech-language pathologist, Barbara has a few things to say about the presentation of Dixie's polyps as portrayed in 9-1-1 Nashville. 

#voicedisorders #voice #commentary #comedy

Transcript

SPEAKER_00 0:00

It's a crossover episode.

SPEAKER_03 0:01

Crossing over what?

SPEAKER_00 0:03

It's a crossover episode between science and technology and media.

SPEAKER_03 0:09

Crossover? This sounds like someone passed away.

SPEAKER_00 0:14

No, no, it's crossing genres. It's crossing the streams. And they say never cross the streams. But sometimes it's a good thing. Okay, great. It's a good thing.

SPEAKER_03 0:26

So we're gonna cross streams.

SPEAKER_00 0:28

Because we know how much you just love 911 Nashville.

SPEAKER_03 0:34

I don't love the TV show 911 Nashville. I like 911 Lone Star and 911.

SPEAKER_00 0:42

911.

SPEAKER_03 0:44

911.

SPEAKER_00 0:45

Yes.

SPEAKER_03 0:47

Especially with Angela Bassett because she is awesome.

SPEAKER_00 0:51

Uh-huh. But she executive produced this.

SPEAKER_03 0:54

And 911 Nashville. It's a departure. It's it's like if you if you go to buy pottery and they give you a plastic bowl.

SPEAKER_00 1:07

No, it's funny. It's kitschy. It's supposed to be funny.

SPEAKER_03 1:12

Bunnies on it.

SPEAKER_00 1:12

It's supposed to be funny. Come on. In one of the first scenes in this show, you have one of the firefighters sitting somewhere with her guitar singing her song. Because of course everybody in Nashville has been a little bit more. Everybody in Nashville, yeah. And you know.

SPEAKER_03 1:34

And the f the firefighters have this firefighter house.

SPEAKER_00 1:38

Oh yeah. That is huge and it is like gorgeous. Just done up.

SPEAKER_03 1:43

And instead of like cleaning the trucks or all the tools, she's sitting there singing her song. Singing her song, and everyone's like, oh, that's great.

SPEAKER_00 1:55

Oh, it's awesome. Yeah, but it, but I mean, and and it's like, of course, perfectly mixed and auto-tuned and all that stuff. So of course that's you know, but yes.

SPEAKER_03 2:07

So she's singing.

SPEAKER_00 2:09

Yeah, and then there's there was there were two tornadoes in the first two episodes. Two massive tornadoes, fabulous, and people like hanging on and their legs like drifting, like, oh no, don't drag me into the tornado. And then some person who was dragging me to the tornado.

SPEAKER_03 2:28

Like in the ending of near the ending of the movie Twister.

SPEAKER_00 2:31

Uh-huh.

SPEAKER_03 2:31

With uh Hollywood. Oh yeah, yeah, yeah.

SPEAKER_00 2:34

They did that.

SPEAKER_03 2:35

Yeah, they just had like had a belt. And the belt saved them. They were holding onto the belt, which was connected to like the water pipe or something.

SPEAKER_00 2:44

And of course the tornadoes are there, and there's like hardly any weather surrounding them. Now I used to live in Minnesota, okay? Like when tornadoes were around, there was weather.

SPEAKER_03 2:57

Oh yeah.

SPEAKER_00 2:58

Like it wasn't just like rain and then tornado. It was like tornado and then hail. The sky was this green-yellow color. I mean, if there's a tornado around, you know there's a tornado. Like there's no like, oh, it's a little windy.

SPEAKER_03 3:18

And at one point the tomato the tornado ended, and and then the music changed, of course, and everyone was like, Phew, all that was interesting. What a great first day for you.

SPEAKER_00 3:27

I know, I know. That was hysterical. And of course, you know, the guy's name. Now, the okay, so we have to start connecting this because this is our science and technology episode.

SPEAKER_03 3:36

Yes, it is. Let's get on to real science as opposed to fake science that is 911 Nashville.

SPEAKER_00 3:44

I'm gonna make you watch Angela Bassett.

SPEAKER_03 3:47

I love you. You are such an amazing I I I totally I respect you. You're great actress, you're gorgeous, you're smart. 911 Nashville? Alright, anyway, so I'm gonna make you watch it. Let's talk about science when it comes to this show.

SPEAKER_00 4:07

Okay. Okay. So we set the stage for a character named Blue. So Blues Mother Dixie. Anyway, the names, they're awesome. Okay, you're gonna watch this show. Because I'm gonna watch this show. Anyway.

SPEAKER_03 4:27

How many seasons are there?

SPEAKER_00 4:28

No, it's just starting. This was literally.

SPEAKER_03 4:31

So you want to continue watching this? Absolutely. We have so many other things in life that we want to do. Do we really need to be watching 911 Nashville?

SPEAKER_00 4:41

Funny!

SPEAKER_03 4:43

Alright, so anyway, yes.

SPEAKER_00 4:45

Blues mother Dixie.

SPEAKER_03 4:47

Okay, wow, blue Dixie.

SPEAKER_00 4:50

A backup singer. She's a session singer in Nashville.

SPEAKER_01 4:55

Yes.

SPEAKER_00 4:56

Now that is a very like intense job. You have to be ready to go at any time. And you've got to get in there, nail it, and then be done. Like that's very, very intense.

SPEAKER_03 5:12

Yeah, for recording artists.

SPEAKER_00 5:13

Yeah, like so, like the set the the recording artist will bring you in to be the session singer, sing harmonies, sing backups, all that kind of stuff. You've got to go and you've got to nail it. Huh? And then like, because if you don't, they'll just like find the next person who can. Wow. So it's just like it's yeah. So you so Dixie's got a problem. We've been told, well, Dixie has many problems.

SPEAKER_03 5:39

Many problems. Dixie has many problems, but including naming her child Blue.

SPEAKER_00 5:46

Yes. And the fact that she is now going to be trying to get Blue to insinuate himself into the captain's life, who is Blue's father, and all this. Anyway, no spoilers.

SPEAKER_01 5:59

Okay.

SPEAKER_00 6:00

But Dixie has a problem with her health.

SPEAKER_03 6:04

Okay.

SPEAKER_00 6:06

She has what they're calling vocal polyps.

SPEAKER_03 6:10

Okay.

SPEAKER_00 6:11

So of course my antenna go up as the speech pathologist, voice therapist, yes.

SPEAKER_03 6:17

My antennas don't make that sound.

SPEAKER_00 6:19

You don't make sound with your antenna?

SPEAKER_03 6:21

No.

SPEAKER_00 6:22

Aww.

SPEAKER_03 6:22

No, I got the yeah, I got the package there.

SPEAKER_00 6:27

So my antenna go up, the noise, the sound, dee dee dee, dee. Okay, and because Blue has this line where he's saying, You've only got polyps because of all the smoking and drinking.

SPEAKER_01 6:38

Mmm.

SPEAKER_00 6:40

Okay. So now my voice specialized speech pathologist sort of antennae also come up with the same.

SPEAKER_03 6:49

Does it make the same sound?

SPEAKER_00 6:50

Two sets of antennae.

SPEAKER_03 6:52

Does it make the same sound?

SPEAKER_00 6:54

Dee-dee dee dee dee deep. Womp womp. Womp womp. Okay. Yeah. All right. So I got antennae all this place.

SPEAKER_03 7:01

This is it's getting noisy in the house.

SPEAKER_00 7:04

It is. It is. So what this brings to mind is that probably she doesn't have like a run-of-the-mill like isolated polyp.

SPEAKER_01 7:18

Okay.

SPEAKER_00 7:19

Probably not. What she has, probably, is what they call smokers' polyps, usually, because they're most common with smoking. Okay. And most common in women who smoke, even though it's still not, it's still not super common, but they're they don't know actually. They're not exactly sure why women get more uh Ranky's edema than than others. So they it's called like smokers' polyps, Ranches edema, um, or polypoid degeneration. This is different than an isolated polyp.

SPEAKER_03 7:56

Do do do these women who get smokers edema sound like this?

SPEAKER_01 8:03

Well, yeah, I mean like they suddenly sound like they're from New York.

SPEAKER_00 8:06

Not suddenly. And they don't get an accent, no. But like Marge Simpson.

SPEAKER_01 8:13

Yeah, call for a taxi. Where's the taxi?

SPEAKER_00 8:16

Yes, Marge Simpson's sisters, for example, had voices that might have been typical for someone who has Rankes edema. The voice gets rough, the voice gets low in pitch. So I have questions.

SPEAKER_03 8:35

As a medical specialist.

SPEAKER_00 8:36

As a medical person about Dixie.

SPEAKER_03 8:38

Alright. Do you have a third set of antenna that go up when you have these particular questions?

SPEAKER_00 8:43

No, I'll stick with the two. I'll stick with the the two antenna. Alright. Because that's scary if you had more than two. Yeah, that that that just starts to get then then it's just over the top. It's you know, that's just too much.

SPEAKER_03 8:56

The other two? Yeah, those are fine. Understandable.

SPEAKER_00 8:59

Yeah. So I have questions. So first of all, like they didn't refer to her having had any other treatment, like voice therapy or something. So if we're going to presume that she has Ranchizedema, the first thing we have to presume is that it's actually not that advanced because listening to the actress's voice, and it's very hard to like, you can't, it's very hard to like pretend to have Ranky's edema with your own.

SPEAKER_03 9:26

You're very difficult to require an actress to acquire.

SPEAKER_00 9:30

Right, Ranky's edema, to require, yeah.

SPEAKER_03 9:33

Yeah. So like if you put that on your resume.

SPEAKER_00 9:37

But they they could have tried to hire an actress who who maybe had Ranki's. I mean, there are people out there.

SPEAKER_03 9:44

That's true. That's true.

SPEAKER_00 9:45

You know, so they could have cast some. You could also talk like this. Well, why the s why the New York?

SPEAKER_03 9:51

I don't know.

SPEAKER_00 9:52

Why? I don't know. It's nothing to do with that.

SPEAKER_03 9:54

You got trintena, I got my fake New York accent with smoker's edema.

SPEAKER_00 9:59

Okay, cool. Ranky's edema so.

SPEAKER_03 10:01

It's on my it's up now, it's on my resume. I'll just up a date it at the end.

SPEAKER_00 10:05

Okay, cool, cool, cool. But you'd you'd usually try conservative measures first. All right. Especially if it's not that bad. Because the surgery is not a slam dunk for Ranches edema.

SPEAKER_05 10:18

No.

SPEAKER_00 10:18

Right? Like Ranches edema, they call it polypoid degeneration because kind of the whole structure of the vocal fold is breaking down.

SPEAKER_03 10:26

Oh, so the the edema is just a small part of a larger.

SPEAKER_00 10:32

So you cut the vocal fold, right? And if you have a polyp that's like a little round polyp on the vocal fold, it it's like it's got a beginning and an end, right? And so if they go in and they go to remove a vocal fold polyp, that's like a typical polyp, like there it's it's a little more circumscribed. Ranchizedema usually involves the whole vocal fold, the whole structure of the vibrating surface, the the superficial lamina propria. And that it's like an alien.

SPEAKER_03 11:06

Say that again just the way you said it. The superfici the superficial lamina propria.

SPEAKER_00 11:11

The superficial lamina propria. Yes. And it it's breaking down. Oh it becomes boggy, it sort of loses its structure, um, it becomes heavier, and and especially when it's not that bad, they want to try conservative measures first because like if you yes, you can do surgery, and they do will do surgery sometimes, but it's just a little dicey of whether or not the surgery is also going to cause some scarring for somebody in that condition. And and as a singer, you need and a Nashville session singer, you need such fine control over your vocal folds that if like you have like Ranky's edema and then the surgery, and you've got then some scarring on your vocal folds, like it's not gonna be a good situation. Like, she might not be in a better situation than she is right now.

SPEAKER_03 12:09

Is vocal fold sorry, is vocal therapy, voice therapy, is it cheaper than surgery?

SPEAKER_00 12:20

It depends on how much the insurance company has negotiated and how many sessions, right? You know, I mean, well, it's all negotiations, right?

SPEAKER_01 12:29

Uh-huh.

SPEAKER_00 12:30

So, but what we would, but it's definitely less invasive. So, what we would typically do for someone is advise that they go to voice therapy, and we would help them optimize. Well, she needs to Dixie needs to stop smoking if she's still smoking.

SPEAKER_03 12:48

Well, we didn't I don't think we saw her smoke.

SPEAKER_00 12:50

Okay, but they haven't said one way or the other, so we don't know. And if you get surgery for Ranchizedema and then smoke afterwards, yeah. Don't bother having don't don't even bother having the surgery. Just don't, don't like wait, wait until you can be successful. What about like stopping smoking? Like I mean, it's all like it's it's all the it's all the the particulate matter. Well, so some people, right, like you can get particulate matter in the air.

unknown 13:21

Right?

SPEAKER_03 13:22

So having a fireplace can be harmful to your health.

SPEAKER_00 13:25

Well, I mean, it depends on how your flu is working. Like if like if it's backing up into the house. Well, you there are chimney fires, which then the firehouse would get caught to take care of.

SPEAKER_03 13:39

Blue would end up Yes.

SPEAKER_00 13:44

See? It all comes around. It comes around a big circle. Right.

SPEAKER_04 13:48

So now we've got this.

SPEAKER_00 13:50

Right, okay, but but let me finish.

SPEAKER_04 13:52

So okay, yeah, go for it, go for it.

SPEAKER_00 13:54

Okay, so vocal vote therapy. Because what we would have to do is we'd have to see if using her voice more efficiently would help.

SPEAKER_03 14:03

Okay.

SPEAKER_00 14:04

But then also she needs to make sure she's not smoking, make sure that her air is clean in general. Like so, as we mentioned, there are many things that can put particles in the air. She's gotta stay well hydrated.

SPEAKER_03 14:17

Uh-huh. Drink, drink lots of alcohol.

SPEAKER_00 14:19

She's gotta make no you don't want reflux. You just say water.

SPEAKER_03 14:26

Got it. Okay.

SPEAKER_00 14:27

Water is specific. Alcohol will dehydrate you.

SPEAKER_03 14:31

Beer is mostly water.

SPEAKER_00 14:32

Well, according to the nephrologist, beer does not have as much of a dehydrating effect, however. As hard alcohol or wine.

SPEAKER_03 14:42

Oh, okay.

SPEAKER_00 14:43

But but with the alcohol, it still makes you more prone to reflux. And reflux is another situation that's gonna make things in your throat bad.

SPEAKER_03 14:54

Can it can it exacerbate uh smoker's edema?

SPEAKER_00 14:59

Well, it makes the everything worse, right? So if you have a little bit of Ranki's edema and you stop smoking and you control reflux and you stay well hydrated and you control allergies, like you can make some progress and you have some voice therapy, you can make some some really good progress often in without needing surgery, especially if it's mild, right? And it must be because she's still singing a little bit, she's still singing, and she had this one scene where she's like, huh, you know, I'm like, yeah, that's not the kind of result of she's an actress, we don't want to give her Ranky's edema for the role. No, no, why would you even succeed? We would like do that conservative work before, and then if they were considering surgery, they'd have to have a real talk with her about like what does this look like for a singer? Because when you're operating on Ranchizedema, you're not operating on this little tiny polyp, you're operating along like the entire length of the vocal fold.

SPEAKER_03 16:09

But she she's also she needs money to Right.

SPEAKER_00 16:15

Well, that's the whole that's why they brought it up. She's trying to somehow get Blue to insinuate himself into the captain's life to see if they can somehow extort money for the surgery out of the rich wife.

SPEAKER_03 16:28

But she really just should have first been getting voice therapy.

SPEAKER_00 16:33

It's Nashville, yeah, they've got Vanderbilt Voice Center right there.

SPEAKER_03 16:39

And at part of the like Vanderbilt Hospital?

SPEAKER_00 16:42

Yeah, yeah. And they've got the Vanderbilt Voice Center there, fabulous voice center, right?

SPEAKER_03 16:47

Have you been there?

SPEAKER_00 16:48

I have not visited, but I've talked to some of their folks at conferences and stuff and seen them present. They're fabulous. And and like if she's not making a lot of money, which they're they're setting her out to be to not have any money, right? That's what they're saying. Okay, so why is she not on Medicaid, first of all? And if she's making a little bit too much to be on Medicaid, then she would uh qualify for one of the Affordable Care Act plans. And a medical center this size of Vanderbolt accepts all those plans.

SPEAKER_01 17:26

Okay.

SPEAKER_00 17:27

So it's not like she has to go to some special private laryngologist with a private operating room and pay privately.

SPEAKER_03 17:36

Like it's well, that's what the writers probably were assuming. Either that or let's just make drama for drama's sake.

SPEAKER_00 17:44

So, like, I don't I don't understand why she has no access.

SPEAKER_03 17:49

I think you are dissecting it more than you need to, is what I'm saying.

SPEAKER_00 17:54

So you're accusing me of overthinking something.

SPEAKER_03 17:57

No, I'm not accusing you of it. I'm accepting it.

unknown 18:01

Yeah.

SPEAKER_03 18:02

Yeah. But we all do that. I do the same thing, I I dissect it from a filmmaking standpoint.

SPEAKER_00 18:09

I would never over- so this is a I would never.

SPEAKER_03 18:12

This is a model of the larynx.

SPEAKER_00 18:15

Well, it's got more. It's got a lot of the mouth on it.

SPEAKER_03 18:18

The mouth, it's got the bottom of the mouth, the jaw, the tongue. Yes.

SPEAKER_00 18:22

A lot of people don't realize how far the tongue goes down into the throat.

SPEAKER_03 18:26

This is right, exactly. So this goes right here.

SPEAKER_00 18:30

Mm-hmm. Right there.

SPEAKER_03 18:32

And then the back of it inside looks like that.

SPEAKER_00 18:38

The back of it has the the esophagus here. Which is why.

SPEAKER_03 18:41

Right, that's the esophagus, and you can see down the room.

SPEAKER_00 18:44

No, you can it's not the esophagus, isn't part of the model. I'm just saying that it's there. It's its neighbors. Oh, right. It's right behind there.

SPEAKER_03 18:52

Right. And then don't break it, don't break it.

SPEAKER_00 18:59

So one vocal fold on each side. Let me hold that up to the uh so you can see that it's got this little slanty thing, and the air comes up through the through the trachea, and it and it vibrates the vocal folds.

SPEAKER_03 19:16

Mmm. Right. So when you're speaking or singing, you can feel vibration, and that is Well, you don't want to feel it here.

SPEAKER_00 19:27

That's a whole other episode.

SPEAKER_03 19:29

I mean, but you can feel something when you're speaking.

SPEAKER_00 19:32

I mean, if you tune in there, you can, but the more you feel in your throat, then the more likely less efficient your voice is. And then we're just gonna head into a whole like I have been here for an hour or more.

SPEAKER_03 19:44

Well, I don't I don't think we want to speak for an hour on vocal fold uh anatomy and function.

SPEAKER_00 19:52

Why not?

SPEAKER_03 19:54

Uh because that's not the show.

SPEAKER_00 19:56

Oh, right, because the show is saying, okay, if you have, if you're a singer and you have Ranky's edema, it is not at You okay there? I'm it is I'm fine. It's not just as simple as I'm gonna go out and have surgery. Like you need to find a good laryngologist.

SPEAKER_03 20:18

Please do.

SPEAKER_00 20:19

If you are in Nashville, there's Vanderbilt right there. Just don't pass go, don't collect$200, just go.

SPEAKER_03 20:27

Um and you can use that$200 to get Yeah, for your copay.

SPEAKER_00 20:34

Yeah, you know, yeah.

SPEAKER_03 20:35

You know, might as well.

SPEAKER_00 20:36

Right. But you need to do all of the other things first.

SPEAKER_03 20:41

Like stop smoking.

SPEAKER_00 20:42

You ha I mean you have to take care of the uh every singer needs to take care of the air around them. They even have uh I was gonna say hydrate too, but yeah, yeah. And hydrate, right? Take care of the air around you, and that goes into your body. Hydrate.

SPEAKER_03 20:58

Where wear a HIPAA filter.

SPEAKER_00 21:01

Huh!

SPEAKER_03 21:02

Just like wrap your face in the body. And a HIPAA filter.

SPEAKER_00 21:06

Yeah, that okay. That would do something.

SPEAKER_03 21:09

I yeah, actually, you know, make it like like as you open your mouth, it just kind of expands. Like uh the the whale. Whales have the what do you call it, the thing in the back, that that the thing that strains the water and then the fish and the the baline? Is that what it's called? The baline?

SPEAKER_00 21:32

Baleen.

SPEAKER_03 21:32

Alright.

SPEAKER_00 21:33

Yeah. Yeah.

SPEAKER_03 21:34

Basically, it's a HEPA filter just for water and fish.

SPEAKER_00 21:38

Wait, where did we see somebody get eaten by a whale and get spit out?

SPEAKER_03 21:43

That was some other T. Oh, was it this one? Was it 911?

SPEAKER_00 21:46

It might have been this one.

SPEAKER_03 21:48

No, it was Which one was it?

SPEAKER_00 21:50

It was one of the first responder shows.

SPEAKER_03 21:52

No, it was 911.

SPEAKER_00 21:54

It was 911!

SPEAKER_03 21:54

Yeah, because Chim was interim captain and he decided that the best way to save this person is to make whale sounds.

SPEAKER_00 22:06

Right. Yeah, because Oh no, no, no, no. They didn't make whale sounds. Oh, that's a whole other thing. I'm sorry, we're going on a tangent here. They put the they put the fire siren underneath to make the whale come on.

SPEAKER_02 22:18

Oh, that's right. Okay. Yeah, that's right, that's right.

SPEAKER_00 22:21

Yeah. So, anyway. Yeah. Singers.

SPEAKER_03 22:27

Yes.

SPEAKER_00 22:28

Take care of the air around you.

SPEAKER_03 22:30

Take care of the air around you.

SPEAKER_00 22:31

Hydrate.

SPEAKER_03 22:32

Hydrate a lot.

SPEAKER_00 22:34

Do whatever you need to do to control and not have reflux.

SPEAKER_03 22:37

Control yourself.

SPEAKER_00 22:40

Control your allergies.

SPEAKER_03 22:42

Have a good attitude. And if you if you happen to have antenna that pop up and go, then you're my kind of person.