To All Who Use Their Voice for Work – Teachers, Lawyers, Ministers and so on


FACE A-FIRE: RESTORING A VOICE

“They’re fantastic people who can answer any question I have”

Seven seconds. Not much can happen in seven seconds. Or so we think. But to Wesley Daniel, in just seven seconds life can flash – literally – before your eyes. That’s because Daniel’s face was on fire. Daniel, at 24 and a recent graduate of Chicago’s Roosevelt University, caught on fire during a dress rehearsal of the Lyric Opera’s production of Richard Wagner’s “Die Meistersinger von Nurnberg”. A trained actor and theater/circus performer, Daniel’s role was as a fire-spitter on stilts as part of a festival scene in the famous opera. While he’d performed the unique skill several times in rehearsals without incident, and had worked with fire before, was Daniel’s unlucky day. The liquid used to ignite the flame, essentially the fluid used in cigarette lighters, singed his face, setting it aflame. Imagine yourself on fire, the flames literally in your eyes. Then imagine yourself several feet off the ground, on stilts, and contemplate the feeling of terror you might experience.

Imagine yourself on fire, the flames literally in your eyes. Then imagine yourself several feet off the ground, on stilts, and contemplate the feeling of terror you might experience. “When my face caught on fire, initially a lot of bad words went through my mind,” Daniel joked. “When I realized what had happened, I saw my chin was red, so I tried to put the fire out with my right hand.” That didn’t work. But the well-trained, nimble Daniel knew what to do next. He had the presence of mind to fall forward, onto his knees, to minimize damage to his hands and wrists, in a “controlled fall.” “Thank God I remembered the proper way to fall on stilts. I’ve been on stilts at least four years, but hadn’t fallen from them before,” he remembered. As he fell, he noticed stagehands rushing onto the stage. The moment he hit the ground, they placed his face directly into a fire extinguisher, then pulled him offstage and immediately applied towels to his face to control the burn and minimize damage to his skin.

“The crew was absolutely fantastic,” he said. Had this happened at a smaller theatre with little or no crew – or without people trained in first aid – the results could have been far worse. That treatment not only helped minimize immediate damage, but contributed to the lack of long-term scarring he can expect. Still packed in towels, Daniel was rushed to a hospital for treatment of his second-degree burns and some upper respiratory conditions that quickly passed. Thankfully, he suffered no lung or airway damage. He was discharged after a couple of days. After the incident, Lyric dropped the fire-spitting element from the festival scene. But there was damage to his vocal folds, most likely from his inhalation of the lighter fluid and/or the chemical in the fire extinguisher. Daniel’s voice, typically what he calls a “high tenor,” became a soft rasp. For a professional actor and performer who’s appeared at some of Chicago’s most prestigious venues – including Chicago Shakespeare Theater – that injury was a threat to his livelihood and passion. Daniel uses his voice quite a bit. He, like many others in his profession, came to Chicago to train and become a working actor in theatre, the city’s growing film production industry, and corporate communication and video work. With his voice essentially out of commission – at least temporarily – the injury has potentially significant career ramifications.

That’s where H. Steven Sims, M.D., a UI laryngologist and director of the Chicago Institute for Voice Care, and Jan Potter Reed, MS, CCC-SLP, a UI at the Institute, entered the scene. A colleague of Daniel’s recommended he see Dr. Sims, who works regularly with performers at Lyric Opera and other venues across the city. His casual, less invasive approach was a welcome relief to Daniel. Surgery is not a primary option. While injections of collagen or hyaluronic acid and/or steroids to boost the cords’ natural healing are still possible, they were put off until speech pathologist Reed works extensively with Daniel. “Dr. Sims is great and knew exactly what to do,” Daniel said. It’s also a relaxed environment – that’s the best part of my treatment. They’re giving me tools I can use at home. Most of the time, Jan has me talking and doing exercises. They’re fantastic people who can answer any question I have.” “Having worked with so many patients like Wes who rely on their voice as an instrument, I know how stressful such an injury can be, both to their self-confidence and their work,” Dr. Sims said. “They have enough worries to deal with. Our job is to give them the medical attention they need along with the personal comfort and security that eases the pain and promotes real healing.” Jan Reed believes that being informed on the science of speech pathology is critical to recovering fully and to do so with the least invasive treatments possible. For example, some speech pathologists adhere to a now-dated notion that injured vocal cords need to be rested to promote healing. That’s not what today’s science recommends, she noted.

In fact, resting the cords slows recovery. “You need to make the cells in the epithelium and vocal cords move through exercises,” she noted. “You want to stretch those cells, get them moving as much as you can, because exercising those cells helps to get them vibrating on their own.” At their sessions, Reed uses increasingly challenging exercises with Daniel. “I don’t want the healing to happen so that the scar tissue become hard as it heals,” she said. “The object is to get more pliable tissue to promote recovery. In Wes’ case, we need to promote healing so the cords work as well as they did before. If that doesn’t happen quickly enough, we can inject some material to fill it out.”Though she’s worked with many burn victims before, this case is highly unusual to Reed, because most burn cases involve bronchial injury and treatment, so a different kind of wound healing and therapy is required. “The type of therapy we’re offering Wes has been shown to produce anti-inflammatory chemicals on the vocal cords. The combination of treatments we’re providing is highly unique and generally limited to the top-end voice centers,” she added.

The good-spirited Daniel became a bit of a local, national, even global celebrity from the incident. That’s because it occurred during an “invited dress rehearsal,” one that typically includes press and photographers who prepare write-ups or previews of shows. His father and girlfriend witness the tragedy at the Lyric Opera, and understandably were concerned. “If my face had been on fire any other day, no one would have reported it,” he noted. Months later his voice was limited – he called his rasp his “Batman voice” – Daniel is back on stage, though not on stilts breathing fire. At press time, he was preparing for a minor role in Lyric’s production of “A Streetcar Named Desire.” And he notes given his condition, “It’s a good time to be working at the Lyric –and it’s a non-speaking role!”


CALLOUT BOX COPY: “He’s fantastic… the best thing to ever happen to me.”

Thomasina Torres is a longtime educator, who, like many in her field, has periodically struggled with her voice. A South Suburban Chicago teacher, Torres used to have constant sinus problems that had her regularly clearing her throat and sucking lozenges. On top of that, “people always thought I was yelling,” Torres, 54, who lives in the south suburbs of Chicago, said. “I didn’t know that, and couldn’t tell the difference, because that was my voice.” Torres is an all-too-typical case: an educator with a voice problem, said UI laryngologist H. Steven Sims, M.D. “Teachers are far more likely than those in many other professions to lose their voice or encounter voice problems that affect their performance, even shorten their careers,” he said. Of the roughly 600,000 teachers in the United States, as many as 20 percent miss at least one day of work a year due to voice problems (two to three times greater than the population as a whole), and a comparable number complain of hoarseness on a typical school day, Dr. Sims said. Of those with voice problems, studies show that as many as 40 percent of teachers cut back their teaching activities, leading to shortened careers in many cases.

“Especially with larger classes, there are greater demands on teachers’ voices – raising their voice so students can hear, or projecting it for discipline, for example,” he said. Environmental factors, especially in older school buildings, often make voice issues more challenging. All of these factors were present in Torres’ teaching career. Having originally come to UI for allergy care, she was referred to Dr. Sims nearly 15 years ago, when he first joined the Department, to look at her vocal cords. “I always thought I had a sore throat, but I was putting more stress on my vocal cords as a result,” she said. “The first time I saw Dr. Sims, he checked my throat and informed me that it wasn’t just my sinus, it was my vocal cords,” she recalled. “There was an initial shock. I was very afraid.”

Dr. Sims found polyps on Torres’ vocal cords, a common diagnosis among teachers and others who rely on their voice for their jobs, said Dr. Sims, also director of the Chicago Institute for Voice Care. Polyps, he said, can form from a ruptured blood vessel or blood seeping into the vocal cord tissues. In Torres’ case, her polyps were connected to menstrual issues. “Polyps are mostly inflammatory,” he said. “Heavy voice use and the related friction can contribute to that. Often people like teachers who really care about their voice quality are more likely to come in for treatment, and Thomasina clearly was one of those patients.” Dr. Sims’ approach was not only on-target clinically, but reassuring to Torres. “He would always take a picture with the scope and show me what was going on in my cords,” she said. “That would indicate how the polyps were rubbing up against the cords. He was very reassuring,” she added.

Dr. Sims at first gave her steroids, which worked for a while, but eventually, the polyps needed to come out. The surgery took place in summer, when she was off work. Dr. Sims took care of one set of polyps on one side of her cords, then the other. And when she returned to school the next fall, everyone noticed the difference. “It was like night and day, a miracle,” she said. “When I had the cords treated the first time, my voice changed. I had a totally new voice. I was so used to my raspy voice all my life, everybody told me about how good the new one sounded. “The kids and my coworkers said they could tell the difference in my voice,” she said. Her husband echoed that. Speech therapy that accompanied her treatment helped her learn to how control her voice and breathe to keep her voice at its best and the vocal cords healthy while she presented and talked in class. “I was so pleased with the outcome,” she added. “I love his bedside manner. He works with a lot of teachers as well as actors and singers, and that made me confident that if I didn’t take care of this, it wouldn’t get better.”

“When I find myself getting loud, or my pitch is going up, I know how to control it now.” There were other benefits of the treatment: fewer headaches and sore throats, less snoring, less need for a humidifier in winter, among others. Torres’ breathing is better overall as well, she added. While not life-threatening, Dr. Sims said, untreated polyps at minimum interfere with our vocal cords, making the voice raspy and hoarse. Involuntarily, those with polyps often squeeze their vocal muscles more to produce the same kind of sound they’re used to. But because those muscles are small, they often feel pain. “More often than not, people’s voices just deteriorate without proper care, though if untreated over time, polyps can block the airway and complicate breathing,” he said. For educators especially, he added, it’s important to learn voice exercises to help preserve the voice for classroom use. “People’s careers are threatened and shortened by polyps and other voice issues,” he said.

“It’s a real disability for many teachers, even if it’s not technically treated that way, though some school systems have accommodated some teachers’ needs with amplification devices.” Torres did not need any amplification devices to do her work, though has had normally recurring polyps, which Dr. Sims has treated, including surgically, over the year. She maintains her regular appointment with Dr. Sims every April, toward the close of the school year. “He’s fantastic… the best thing to ever happen to me,” she said. “He’s a blessing who makes you feel so comfortable.” “I’m very afraid of doctors, but he’s always there for me. He’s always promised me that when I have surgery, he’ll be there when I wake up. And he always is.”