9:53
So a few years ago, I did a master’s in performing arts medicine which very nicely married up my medical background and my performing arts background. And of course, my questionnaire has extended. And I look at not just sort of general health things, but I also look at, has someone had an accident or injury of the spine or neck? At any point, do they have any spinal issues such as scoliosis, or they hypermobile? Do they have any kind of chronic illnesses or conditions that might be impeding their skeleton in some way, because what I realised is that, once you have a problem in one part of your skeleton, very likely, at some point, it will end up creeping up as each of the other parts start to compensate. And eventually, you will end up with problems around the shoulders and the neck. And then the larynx is going to be off kilter, out of alignment and that may be contributing to vocal fatigue, and difficulty with accessing range. So as I said earlier, I have a background in medical and health things and so it is a lot easier for me to dig in and ask these questions. But even as a singing teacher, there is no reason why you can’t be asking some of these questions that feel intrusive, but actually, if delivered in a, a particular way, may not seem so intrusive, and may actually give you more respect from the student, because you’re actually thinking about them sort of in a 360 way, more holistic way. So I certainly feel that it’s part of your accountability as a singing teacher, to become comfortable asking these questions so that you can fully understand the implications of someone’s vocal health and workload. We want to know, are there any medical conditions, any prescribed or over the counter medications that they’re taking? Have they had any injuries that may have an impact on their voice? And then also, obviously, all the other things that we’re asking them about how they use their voice on a day to day basis, and when they’re singing, but we’re going to focus in this moment on just the health side. Now, you may not know exactly what some of these medical conditions are all these medications, but there’s no reason why you can’t write them down, ask them to be spelled out, and then say to the student, I’m going to go and do some further research to see if this has any impact on the voice. If there’s any thing that we should know so that we can optimise what’s going on with with you and as you sing, you’re not going to be diagnosing or treating or making any recommendations in from a medical health point of view. But it might be that understanding that somebody has asthma, and they’re taking a steroidal puffer on a constant basis. It’s, you know, just common vocal health knowledge that it is better when you do that, that you rinse your mouth afterwards, or that you use a spacer. And then I also will ask about ‘what time do you take it?’ ‘Can we maybe shift the singing lesson so that it’s not immediately after you’ve taken your puffer?’ Because steroids can weaken the epithelium, especially when you’re on long term, it is just, I’m not saying it’s what happens, it’s just consideration. So I tend to time things around, the singer, being a little bit further away from taking their medications when they’re taking medications that dry their mouth, or dry their respiratory system out. So it’s not that you’re treating them or changing anything, you’re just accommodating what they’re already doing, so that it’s going to reduce the strain on the voice. They may then also want to consider you know that if they need to take their puffer at particular times of the day, how’s that being impacted in terms of when they’re performing? Then you can recommend that they go back to their doctor and make an inquiry and just say, ‘Is it important for me to take that dose just before I go up and perform? Or could I wait till afterwards?’ So you don’t have to necessarily know the answer. But you can then say, ‘you know what, this may be a problem. You should go and have a discussion with your GP to see what the alternatives are.’ Another one for females in particular, not only do we have all these hormonal things going on, but if you’ve got a female who is on oral contraceptive, then progesterone can have an impact on the vocal folds. And so there are plenty of different options for contraceptives. And you might say to the singer, ‘If you’ve noticed a change in your voice, and she started to taking this oral contraceptive, then maybe it’s worth going to your GP and asking if they would consider another type that isn’t so high in progesterone.’ And there is plenty of research out there that supports this. Sometimes I’ll actually give the student a recommendation of reading for the GP, if they’re not sure, because the reality is GPS don’t know the voice probably as much as you do and so they won’t be aware that progesterone has an impact on the vocal folds.  

15:34
So when you’re asking about medical history, if you wanted to do it verbally, one way you could say, obviously explain why you’re asking and then ask, ‘Are there any medical conditions or medications prescribed or over the counter that you’re on that you think I should know about?’ So when they tell you some of these things, you want to maybe delve a little bit deeper and ask the what, when, how, who, where, why, kind of questions. So for instance, ‘What are the symptoms?’ ‘When does it occur?’ ‘Does it start around a particular thing?’ ‘Or in particular time of the day?’ ‘How long have you had this for?’ ‘What kind of treatment have you had?’ ‘How did that go?’ ‘Was there any underlying root issue/reason why you had it?’ ‘What changes did you make?’ ‘What treatment did you get?’ ‘How long does it last?’ ‘Are there any triggers?’ ‘What helps medically and non-medically?’ Also ask ‘Who did you see?’ ‘Was the a medical person or somebody who was maybe non-medical?’ ‘How did it impact your voice?’ ‘How does it impact your physicality?’ So you can ask all of these questions around these particular themes to get a better framework. So when I’m asking about someone’s medical history, I will also ask, ‘Is that something they’ve diagnosed themselves or have they been actually diagnosed by a doctor?’ If somebody tells you about a medication you’ve never heard of, the next question really is, ‘Have you noticed any changes in your voice since you’ve taken that medication?’ ‘Have you noticed any changes in your energy level or your physicality, since you’ve taken the medication, how has it impacted your performance and your singing?’  

17:36
The most common side effects that we have from medication will be dryness, coughing, maybe increasing mucus, those are mostly the common things in terms of voice and airway. Occasionally, it might actually directly impact the vocal folds causing some kind of swelling, or change in the size and so the singer may find that their range and their vocal tone is impacted. So they might have hoarseness or breathiness that they didn’t have before, they might find their singing is more effortful, or they might find that they have a break where they never used to have one. They might find that their voice gets fatigued more easily. They might even lose parts of their range, or maybe not have as much control over their pitch, they might find that their speaking pitches also affected, maybe it’s dropped if the vocal folds are thicker. These kind of side effects will happen with a whole range of medications. Sometimes they’re hormonal, sometimes they’re treating things like depression, sometimes they’re for respiratory disorders or for other conditions. There’s a whole range of different kinds of side effects that we can have from medication. And I’ve, I think we’re sort of more going to be focused on the ones that might impact the voice, or the person’s energy level and their ability to perform comfortably. Oh another side effect that sometimes happens with certain medications is feeling nauseous, vomiting, reflux, and of course, that’s going to have a huge impact on the voice. In terms of, if any acid gets onto the vocal folds. Changes in hormones, even under natural conditions such as pregnancy, PMS, puberty and menopause will also have an impact on the voice. I can often tell with female singers that I’ve worked with for a long time, where they are in their cycle, because their voice gets heavier and more difficult to get through the range or maybe their range changes or the tone changes or there’s a shift in where their transition occurs. So understanding how hormones will impact the vocal folds will be really important thing for a singing teacher to understand, because you don’t want to be pushing the voice say when a female’s premenstrual because their voices quite vulnerable at that time. So sometimes I will ask a female singer if they’ve noticed changes around their period so that we can plan workload and also what we’re doing in terms of exercises where we’re focusing. I might not do as much in the way of, heavy sort of belting kind of technique during that time, and then wait until the voice has calmed down. And we have to also balance this in if you’re working with a working singer with what they have to do when they’re actually performing. In the sports world, female athletes keep a journal with that’s related to their cycle. And they put everything in like, you know, is that more difficult? Are they more bendy, less bendy? You know, how’s it impacting their energy level? How’s that impacting their results, you know, like speed? So with singers, there’s no reason why you couldn’t suggest that with a female singer who was noticing inconsistency in their voice during the month. And this means that they can plan around their period. And in terms of workload, and when they accept work, and when they don’t. 

21:12
If you’re working with a singer who’s got some sort of neurological problems, such as Parkinson’s or MS, then this will have an impact on their voice eventually. Having said that, singing is actually a great way to help stave off that impact, and keep the voice as strong as possible for a lot longer. So I highly encourage people who are experiencing Parkinson’s or MS to do singing just as a way of keeping their voice as strong as possible for as long as possible. If you’ve got a student who’s actually been to an ENT, or speech therapist for any reason in the past, I always ask ‘What was the diagnosis?’ ‘What was the treatment?’ ‘Did they have any specific discharge instructions?’ And in particular, ‘Is it okay to go back to singing now? Given I’m talking in the era of COVID-19, it’s very relevant to find out if anyone’s suffered from COVID and what happened to their voice. ‘How they are now?’ ‘Do they think they might have long COVID?’ ‘Have they had any ongoing issues? Because quite a lot of, there’s quite a lot of coughing during COVID, and then afterwards, a quite a lot of deficit in the respiratory area. So we want to know, what are we working with here? And what’s helping what’s hindering? It may mean that you just take things a little bit slower and you also help encourage the singer to be a bit more patient with themselves. Of course, it’s also important to think about mental health. Is there anything in that person’s history that may be problematic? So for instance, if someone’s got OCD, does that mean they’re over doing practice, for instance, or maybe they’re on medications for depression or anxiety, so that might impact their mood and their behaviour, it might also have an impact on their voice. Some of the especially the antidepressants can cause dry cough, it’s quite easy now to go on to Google and find out what the side effects of various medications are. And so if you’re not sure, then just hop onto Google, put in the medication name and the side effects and see if there’s anything that might be causing any change in the voice and the vocal health. Now, you’re not going to ask that person to then stop taking that medication, but you’re going to make them aware of it. And then give them some strategies to help them mitigate whatever those side effects are. That might be steaming or nebulizer, drinking more fluids. Like I said, with the steroid puffers, making sure that they’re rinsing their mouth or using the spacer to take the medication. So we’re just trying to mitigate the side effects and optimise vocal health as much as possible.  

24:03
So my top tips for asking those awkward health questions. First of all, create a form. Give them the form to fill in before they come for the lesson. That way, you don’t have to ask the question in person. Also, you don’t have to necessarily get spellings of everything. You can look it all up before they actually have their lesson. And then just focus on the things that you think you feel comfortable with. You might also find some resources to help somebody understand how their various conditions and medications might impact their voice. And then at least you’re covering those issues in your students. If you’re wanting to know what to ask in the list, you don’t have to be as deep and in depth as say a medical person might but you can get some advice through ‘Singing Voice Rehabilitation: A Guide for the Voice Teacher and Speech-Language Pathologist’ by Karen Wicklund. I’ll make sure these are listed in the notes that accompany the podcast. Also, Robert T. Sataloff’s, ‘Vocal Health and Pedagogy: Advanced Assessment and Treatment’ has in the appendix, a few examples of history forms, for taking history for voice. And you might also find ‘Laryngeal Endoscopy and Voice Therapy: A Clinical Guide’ by Sue M. Jones useful as well in figuring out what the kind of medical and health issues are that you want to know about that might impact the singer and their voice. 

So my second tip, if you don’t have a form is just ask a generic question. Explain first, why it’s important for you to know their medical history in terms of how it might impact their voice, and then just say, ‘Are there any medical conditions, medications prescribed or over the counter that you feel I should know about?’  

26:17
And three, understand that the student actually will appreciate the fact that you’re thinking about them from a holistic point of view, making connections that maybe they hadn’t, and helping them to understand how they can support their vocal health, in terms of what they’re eating, drinking, how they’re behaving outside of singing. So the more education you have, the more education they have, the easier it is for you to ensure that they’re singing in a healthy manner, and that they’re able to go out and just enjoy singing. So I hope what I’ve spoken about will encourage you to feel more confident to step up and ask these more awkward health questions without worrying too much about the fact that you’re going to be prying. I think it’s really part of your responsibility as a singing teacher, if I’m honest. But if you’re wanting to have more support, then check out what Vocal Health Education are doing and get more educated, or go and hang out at a voice clinic or go to the British Voice Association, workshops and seminars or if you live in another country, then look around to see what kind of education workshops are available to non-medical people to help them understand the implication of health and wellbeing and the voice.  

So if you have anything you think you’d like to hear more of on the Singing Teachers Talk podcast, don’t hesitate to drop us a message, either through social media or our website, or drop us an email, info@basttraining.com and let us know. If you have any specific questions to me, then drop me an email, or get in contact through social media and I will make sure that I create a podcast that answers your questions. In the meantime, if you haven’t already joined the Facebook group, because there’s lots of wonderful singing teachers in there who just love to support and help each other. And they’re from all over the world. Some of them have done the BAST course, some haven’t. But it’s a wonderful community that there’s always going to be someone in there that can help answer your questions. So in the meantime, I hope to see you somewhere in the community, and all the best with your singing teaching.