WVD Message from Adam D. Rubin, MD

Unable to Say Hello From The Other Side

Adam D. Rubin, M.D.

Dr. Rubin, left, singing in a Quartett

April 16th is World Voice Day. As a laryngologist (otolaryngologist specializing in care of the voice), it is my responsibility to celebrate this day with the community.   The day was created to raise awareness of laryngeal cancer. If you do not ignore hoarseness and are appropriately evaluated in a timely fashion, you will identify problems early and be appropriately treated. Early recognition of vocal fold cancer can yield a better prognosis for cure and voice preservation. But, early recognition of any voice problem yields the best chance for voice recovery. So the day’s meaning has expanded, and the main message is to not take your voice for granted. One should never accept prolonged hoarseness as normal and should seek evaluation if hoarseness persists for more than a couple of weeks. Furthermore, you may not realize how important your voice is to you, until it is gone.

Every year that I have been in practice, I have hosted a concert in honor of World Voice Day. As a former professional actor and singer, I have to admit I enjoy being on stage again. However, I get much more satisfaction watching my patients who have lost and regained their voices volunteer their time to share their stories and celebrate their voice recovery by gracing an appreciative audience with beautiful performances. And these are not all Adeles or Steven Tylers, but rather voices of people who love their instruments and have recognized through vocal loss, followed by recovery, how important they are to them.

Some of the most inspiring performances came from a lovely young pharmaceutical representative (former professional singer) who presented to me after losing her voice following surgery for an aggressive thyroid cancer. The cancer invaded the nerve that opens and closes the vocal fold, so that the vocal fold could not move after the dissection.  Unfortunately, the nerve to the other vocal fold, which was uninvolved with cancer, was cut during the surgery. The vocal folds have to close to produce sound. Neither of hers could move and were stuck wide open. Her voice was barely a whisper. She went through multiple surgeries and radiation therapy to battle the cancer. During this trying time, she often seemed most distressed about her voice. Without it, she lost part of herself. Fortunately, she beat the disease, and the nerve invaded by cancer regained function as the cancer regressed. Through her hard work with our voice team, she regained a beautiful singing voice. She performed at many of our concerts through the different stages of her battle – at times with one vocal fold paralyzed, at others with both immobile. Her performances were awe-inspiring and often moved audience members to tears.

“But, I would argue that the voice each of us should cherish most is his or her own.”

Other memorable performances include testimonial of a prosecuting attorney who had to postpone trial for a horrendous murder case after injuring his voice. He never recognized how important his voice was until the moment he realized he was powerless in the courtroom without it. In his World Voice Day speech, he also explained how he was most devastated by not being able to read to his children at night. Fortunately, we were able to help him regain his vocal power, so he could put away the perpetrator for life and entertain his children. And there was the young band teacher who developed meningitis and sepsis years ago and suffered severe injuries to the vocal folds from a prolonged intubation. He suffered significant scarring of the vocal folds, impairing their ability to vibrate and close. He continues to wow people and do what he loves best with his instrument. His passion is infectious.   Last, but certainly not least, there was the reverend who could not preach to his congregants due to a vocal injury. After recovery, he blessed us all with a moving rendition of Martin Luther King’s “I have been to the mountaintop”.

There are many who have participated: high-school singers, clergy, college voice majors, professional singers, and singers who love to sing when they are not doing their day job (like being a laryngologist). We even have had a couple of American Idolists heading to Hollywood. However, the point of the night is not to suggest that only singers’ voices matter. Many of the audience members are also patients who have struggled with their voices – some with lumps and bumps, some with paralysis, and some who have been cured of cancer of the vocal folds. They have all learned to appreciate and care for their voices. They bring friends and family to celebrate with them, and to share the message of not taking their voices for granted whether they are a singer, teacher, lawyer, salesperson, assembly line worker, stay-at-home parent, or anyone else dependent on his or her voice for livelihood or pleasure.

This year, I am celebrating World Voice Day in a somewhat different fashion. I suffered my own vocal injury. After coughing for 2 weeks straight, I developed a hemorrhagic polyp. I struggled in my clinic. It was difficult to talk to patients, let alone demonstrate vocal tasks that I routinely ask them to perform during examination. I had lost my upper range, in particular, my falsetto. My speaking voice became raspier as I used it each day. It became clear to me that my polyp was not going to resolve without surgical management. I had just transformed from physician to patient. This is a difficult transition for any type of physician, as we are often too busy taking care of others, that we forget to take care of ourselves.

After voice surgery, a certain amount of voice rest is required for proper healing. How much is controversial, however, most would agree that overuse or improper use too soon will put the patient at significant risk for poor healing and a suboptimal result. I took a week off of work after surgery and drove to the east coast with my wife and 2 kids. I was on complete voice rest. Imagine spending a week with your family without speaking. To top it off, we were visiting Grandma! I improved my texting, writing, and self-made sign language skills. I might have even improved my listening skills. There were moments of comedy, and many moments of frustration. I subsequently have returned to work, but am doing everything I can to not overdo it with my voice. I am writing a lot to my patients, and using my support staff to explain things I normally would. I have been so impressed with the support I have received, as well as the understanding and compassion from my patients. Being a physician is a vocally demanding job. I wonder how many physicians recognize this. How would you do your day-to-day activities without a voice. We all can benefit from the message of World Voice Day.

When Adele, Sam Smith, or John Mayer have to cancel a concert or tour, the whole world hears about it and mourns. This is because these are incredible voices that we all cherish. But, I would argue that the voice each of us should cherish most is his or her own. This is the message of World Voice Day.

I celebrate World Voice Day this year by experiencing what many of my patients must go through. There is no better way to develop more empathy and understanding as a physician. I was unable to put on a concert this year to promote vocal health awareness. Hopefully, I will be ready to rock next April 16. For now, this testimonial will have to do.   Happy World Voice Day.

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