Long COVID part 2 - with Highly Specialist SLT Carrie Garrett

So much to share we needed a part 2!
Carrie shares the top symptoms to look out for (according to the RCSLT Voice CEN Survey)
Accessibility decisions for singers experiencing Long COVID
Why "train train train" on a straw isn't the target
Startling advice on singing lessons and dizziness (we agree!)
How using the One Minute Voice Warmup app can support singers in recovery
What to aim for first if you have Long COVID
and a multitude of resources on Long COVID, breathing and voice


Resources mentioned in the show:
Michael Rosen's BBC Radio 4 Word of Mouth episode with Fiona Gillies
https://www.bbc.co.uk/sounds/play/m000vp3y

The One Minute Voice Warmup App (Apple and Android) from Vocal Process

SOVT Singing Straw https://rayvox.co.uk with the code VOCALPROCESS for 15% off your straw

My Singer Has A Voice Problem (course) in the Vocal Process Learning Lounge https://bit.ly/VocalProcessLearningLounge

Listen to our This Is A Voice episode with Phoene Cave on Singing, Lung Health and COVID
https://www.buzzsprout.com/1180343/8039135

Ask us anything - submit your questions on https://speakpipe.com/Vocalprocess

Why We Sleep - Matthew Walker https://amzn.to/33Eutye

British Medical Journal https://blogs.bmj.com/bmj/2021/02/19/we-need-to-do-more-to-understand-chronic-vocal-symptoms-of-covid-19/

Allied Health Professionals webinar - Long Covid Speech and Language Therapists
https://www.youtube.com/watch?v=olKyibwGiXc

NHS England National guidance for post-COVID syndrome assessment clinics https://www.england.nhs.uk/coronavirus/publication/national-guidance-for-post-covid-syndrome-assessment-clinics/

NHS Supporting your recovery after Covid19 www.yourcovidrecovery.nhs.uk

British Lung Foundation www.blf.org.uk

NHS Voice problems after Covid19 with Paul John McKenna https://youtu.be/Y9QqYuHhSkI

Transcript

Carrie: 0:00

You know, we've got to think what are people singing for? Is your choir, is your singing lesson there to help improve someone's life? Or is it sort of what are called Hardcore is it for the music only and only the music? So maybe you can change the size of the music print, the lyrics, the size of the lyrics print, let people have their music with them in performances, God forbid for some people but but you know, that can really help. Allow people to sit for performances, allow them to have breaks even if you want them to stand for some of it. Let there be you know, more frequent pauses and rests and breaks, shorter sessions you know, all these different things. So less rehearsals of, as I said, an altered expectations of people's stamina and performance, ability.

Jeremy : 0:52

Love all of that.

Gillyanne Kayes: 0:53

I think that is brilliant. And you know, can I just say, All Hail every choir leader who has got out there over the last, I mean, you know, we're coming up to two years, and has been prepared to go online and work with singers online and every singing teacher who has adapted to teaching online.

Announcer: 1:26

This is a voice, a podcast with Dr. Gillyanne Kayes and Jeremy Fisher.

Jeremy : 1:36

Hello, and welcome to This Is A Voice Series 3 Episode 7. And we're continuing the conversation on Long COVID with highly specialist speech and language therapist, Carrie Garrett who is also a singer and a singing teacher. So she knows so much about this whole thing.

Gillyanne Kayes: 1:50

Thank you so much for being with us today. Carrie, we had so much to talk about, we just had to go on,

Jeremy : 1:56

I think we should go to SOVT tell us about SOVT Carrie, semi occluded vocal tract

Gillyanne Kayes: 2:03

Why does it help?

Carrie: 2:04

How does it help? Well, what are the things which is really fantastic. I mean, considering the key sort of symptoms that we're finding are being reported when people are suffering from Long COVID or breathlessness, fatigue, and also obviously problems with memories, memory and concentration as well. The wonderful thing about SOVT is you don't have to think about words and language when you're doing the exercises, which is a really big plus point. So it's not too taxing on memory and things. So I will just get that in as well. But also, I did want to actually just briefly before we I mean it's linked with SOVT, one of the things that we're finding in terms of laryngeal implications of SOVT, of sorry, of long COVID Is that actually sometimes people are experiencing, they're running out of air when they're speaking. And they're finding that they're getting more short of breath following activity. And actually, SOVT can be really great in helping with this, because it can help with the improved closure of the vocal folds. Some people who are experiencing shortness of breath as following Long COVID may be suffering from post viral vagal neuropathy, it's called, so reduced vocal folds movement. And actually, the SOVT, is really good at trying to rebalance the whole system encouraging that great drive the appropriate breath drive, and the appropriate pressure at the level of the vocal folds so that it's easier on the vocal folds, you provide therapeutic on the vocal folds. And it's balancing the system as well

Gillyanne Kayes: 3:48

That's so interesting. So our neuropathy means that something isn't quite functioning as well as it should with the nerve. And the vagus nerve wraps around the heart, doesn't it the recurrent laryngeal nerve wraps around the heart. And the vagus nerve also feeds almost all of the muscles of the larynx one way or another via various branches. Have I remembered that right?

Carrie: 4:13

Yep. Yeah, absolutely. Yep. Got various branches. Yeah,

Jeremy : 4:16

I think it's interesting, because if

Gillyanne Kayes: 4:18

it's fascinating

Jeremy : 4:19

If people are suffering from their vocal folds aren't getting together as well as they used to. For whatever reason, one of the things that SOVT does is you are co opting backpressure to enable them to come together and they're being brought together from above. It's one of the best things that you can do for SOVT. And I'm assuming then that we're talking straw in water?

Gillyanne Kayes: 4:43

Well, I was gonna ask that straw and water or straw out, which is more likely to be better.

Carrie: 4:50

Off the top of my head, I wouldn't like to say I don't know I don't have those details. I think the way because the way that I work is the SOVT And many speech therapists work is. SOVT is, it's variable according to the individual doing it and what the task is and what they want. So for example, we can do everything from LaxVox, which is where you've got a much wider straw, and you're trying to retrain the diaphragmatic side of the breathing, and the loose, loose voicing for that lovely coordination. And then obviously, you've got the more sort of high level, I might call it, straw in straw out storing water straw out of water. SOVT as well, you've also got all the ones that you can use without straws, which... lip bubbles, that everything that Michael Rosen talks about when his work with Fiona Gillies, you know, in the hand, you've got different sounds you can make with your lips with you know, you don't need necessarily extra sort of props and resources. But what we do find is that using the straw is really beneficial because of this, taking it away from having to think. So using the straw. And I know that there's a, there's that particular product out there, Oren Boder's SOVT straw, and I know that it's sort of a straw that is very variable, and you can change the pressure that the individual can can use, I mean, maybe you can share a little bit more information about that straw.

Jeremy : 6:21

The one that's out currently has 12 different settings. So you can raise or lower the pressure by changing the length of the straw and also changing the diameter of the straw. And I know that he's bringing an extra attachment out that will take it up to 40 different levels, which is amazing. So it means that you've got something that you can vary depending on the task, which is so important. It's like what is the task that you're actually using the straws for?

Gillyanne Kayes: 6:49

I mean, what nice about this, and Carrie, I know you might want to say more is that it encapsulates exactly what you've just said. And what we say over and over again, is singing teachers. One size doesn't fit all. Yes, yeah,

Carrie: 7:02

absolutely. Yeah.

Gillyanne Kayes: 7:03

Do you want to say a bit more about that?

Carrie: 7:05

Well, I mean, it's, it's partly what we've been speaking about already today, in terms of absolutely doesn't fit all and we It doesn't fit everybody on the same day, everybody changes day to day, week to week, you know, we we may have. I mean, I'm just putting it into context, as a singer, myself. When I was gigging and performing, I know that on some days, I would have a little bit of reflux because I would have eaten late at night, you know, so it would have caused a bit of inflammation in my larynx, and I take longer to warm up and I might have needed a different straw setting on the mornings on those mornings. When I had children, I found that my you know, after having C sections, my sort of diaphragmatic control and the muscular activity that I had to support breathing and respiratory drive as well. It all changes as we go through life, things change hormones affect us. You know, stress and anxiety, house moves, relationship changes, pressure of performance, that's a huge one as well. All sorts of things. I mean, do you mind if I bring back as well, it is still SOVT related, but some of the we had a Royal College of speech language therapists voice is called a clinical excellence network. We had a survey of people of speech language therapists who were working with people experiencing Long COVID. And actually, what we found from laryngeal findings, so the laryngoscopy findings that most frequently observed was phonatory gap and and muscle tension dysphonia in patients with Long COVID. For whatever reason, you can't just say, Oh, it's always because of this, it's always going to be multifactorial. Sometimes it may be stress and anxiety and psychological causes. Sometimes it's changed habits, you know, but essentially, it's muscle tension dysphonia. And SOVT is perfectly placed for that for various reasons. And like I said, day to day, if people are changing, it may be if you're suffering from Long COVID, that actually in the relapsing stage, that it's really difficult and you need a completely different setting, which allows for much easier vocalisation than when you are feeling better your respiratory drive is better, and you've got more energy, you probably will be want to use it the more challenging settings that you that provide more pressure back pressure, so that actually you you're sort of getting your gain from that. One thing I will say though, is you must always monitor how you're feeling. Never overdo it with Long COVID. Please never overdo it. Let's talk about that later.

Gillyanne Kayes: 9:52

I think I know one thing that came up in our last SOVT course with Oren was that some people were saying that, you know, they thought that what you're meant to do with a straw is Train, train and train a bit like you do in the gym and keep on and on pushing yourself. And we went No and we talk so much about what's your comfortable effort level. The idea is to feel more and more comfortable not to work harder. And I think that's really important. Jeremy, you have a point to make

Jeremy : 10:27

we're going to just take a little moment because we are sponsored for this and we're going to play a little advert from our sponsor. Oh Gillyanne, what are you doing?

Gillyanne Kayes: 10:42

That feels so much better. I'm a little bit tired today. My voice feels a bit croaky and I have got my SOVT straw in water.

Jeremy : 10:50

Okay, let's talk about the SOVT Singing Straw, precision engineered, food grade metal. And it's changeable. So you can change the width you can change the length and that means that you can change the resistance.

Gillyanne Kayes: 11:01

You know what I think so important about that, Jeremy is that singers are all talking about straws. Teachers are talking about straws. Researchers are talking about straws, and there's a lot of different information about which size to use. What's so great about the SOVT Singing straw is we have a number of different settings and like you said, number of different resistances It's fabulous.

Jeremy : 11:24

So haven't got yours yet. What are you waiting for? You're waiting for a code? Okay, we'll give you one. If you go to Rayvox.co.uk and use the code VOCALPROCESS you get 15% off your SOVT Singing Straw

Gillyanne Kayes: 11:36

Let's have a competition okay. [Applause] Now where should we go next? We have a few more questions

Jeremy : 12:03

And this is there's a theme that started to come up which is some of the symptoms. So a couple of people Foggy Nick has talked about tingling colleague has low level low oxygen levels and feels tingling and extremities since COVID. And somebody else mentioned tingling,

Gillyanne Kayes: 12:20

Franka mentioned it

Jeremy : 12:21

Franka mentions it in another question. She also mentions dizziness. I wasn't quite sure what caused the dizziness and watch what I should do in the lesson about it with her student apart from stopping what we were doing and making her comfortable. Breathe is interesting until it is nice was gone. And someone else has made mentioned symptoms like that as well. And also, this is from Jo Fabro in Australia. Ongoing sinus pain, memory loss, shallow breathing. There's a lot of things going on in there. So just as singing teachers in singing lessons when people give you those those symptoms or that feedback, what do you do? Well, I think

Carrie: 13:08

was it Franka, you said who talked about the dizziness? Yeah. So dizziness. I mean, I think exactly as she did, sitting comfortably on a chair, you know, asking her to breathe normally, until the dizziness subsides is absolutely right responded in the appropriate way. I think it's really important to manage the what's happening in the moment, but also be mindful of providing advice as well. So dizziness, and and that can be a sign that somebody is about to faint, but it can be other things as well. likely due to blood pressure changes, heart rate changes. But also there are other causes for dizziness and tingling. I mean, anxiety, as we mentioned being too hot, not eating or drinking enough. I think the practical advice I would say is do not try to move that person from the spot they're in, sit them down with a head between their knees, or ask them to lie on the floor and raise their legs. Have a sip of water, maybe eat something, take some deep breaths. So you're you know what to do. You're managing that instance of dizziness. I obviously can't provide an answer as to what exactly is causing those symptoms that that Jo's sort of described as well. But I would say that there's a lot of research being done, but we just got to be present with our students to ease the symptoms. And then possibly, and I know people won't like this but it is for the best of the individual possibly suggest ceasing further singing lessons until the dizziness if it's really bad and very frequent, ceasing, singing until the dizziness eases and becomes less frequent. And by that I mean stop the singing lessons until that individual is able to do some physical They call it exercises. You know all sorts of have that physical engagement where and it not causing dizziness. It's distressing for them. It's distressing for you. And actually, if the dizziness is still impacting on their life in quite a big way, after that 12 weeks, it's possible it's post COVID syndrome. And they probably do need to have further assessment. It could be dizziness might be neurological it might be vestibular, so balance related as well. But of course, it could be the oxygen levels, as we've said, all stress and anxiety as well.

Gillyanne Kayes: 15:38

I think that's really important. And I'm glad you've said it, which is that is a marker for singing teachers to refer on. Because you need to find out more information. And as you've pointed out, there can be many causes of dizziness.

Jeremy : 15:57

I think there's a by the way, there's an implicit thing in there, which is that you should be standing up when you sing. And I'm going nope, not necessarily.

Gillyanne Kayes: 16:04

It's a call on the body, though, isn't it, you know, was standing up, you know, calling more on the heart, calling me on the lungs, the blood flow is having to move around. I don't know, if anybody's looked at changes in blood pressure and singing, which would be a very interesting study.

Carrie: 16:20

It would it would, I do have something I wanted to chat about as well, which I it's sort of enabling singing teachers and voice professionals working with singers to recognise and this is my big speech and language therapy hat as well. Because accessibility for people who are experiencing these symptoms is really important. So obviously, as I've just mentioned, if somebody is experiencing dizziness, but they feel it's manageable, then that's up to them to choose to continue to sing because singing is such a quality of life. Joy, isn't it as well. It's not just for, like I said, we've said before technique and things. But there were a few things which I would like all singing teachers and all choir leaders and everything to consider which is going to improve accessibility for people with these longer term conditions. And by accessibility, I mean just levelling the playing field to allow people to engage in music and singing. So things like providing sessions online, may be completely beneficial to somebody who struggles with fatigue, because the journey to a lesson or the journey to acquire rehearsal is going to take all of the energy that they do have, and they won't have left to engage in the singing. So sometimes even though you want to see them in person, be mindful that if they're having a bad day, maybe a shorter less than online is actually what they need. And that's improving their accessibility to your session. I mean in person sessions are obviously great to consider is individual individual sessions going to be more beneficial for some people are group sessions more beneficial. Other things as well, if people are sub struggling with memory issues and brain fog, so memory and concentration is being mindful that in the past, we possibly sometimes come to performances. I mean, it's Christmas time at the moment, we're thinking lots of people having choir thing outs, and they're doing concerts and various things which involve a lot of performance. And if people have concentration issues and memory issues, they're going to be anxious about remembering the words remembering the music and what comes next. And that's going to have a real physiological impact on their ability to sing and participate. And, you know, we've got to think what are people singing for? Is your choir? Is your singing lesson there to help improve someone's life? Or is it sort of what I call Hardcore is it for the music only and only the music? So maybe you can change the size of the music print, the lyrics, the size of the lyrics print, let people have their music with them in performances, God forbid for some people but but you know, that can really help allow people to sit for performances, allow them to have breaks even if you want them to stand for some of it. Let there be you know more frequent pauses and rests and breaks shorter sessions you know, all these different things. So let's record rehearsals as I said an altered expectations of people stamina and performance, ability.

Jeremy : 19:44

Love all of that

Gillyanne Kayes: 19:45

I think that is brilliant. And you know, can I just say All hail every choir leader has got out there over the last I mean, you know, we're coming up to two years and has been prepared to go online and work With the singers online and every singing teacher who has adapted to teaching online? Absolutely, because big, big change, isn't it? massive changes I'm sure you found, you know, in the SLT community,

Carrie: 20:15

One of the things we found as well is that it, we still in the NHS have to wear masks in person, we do have the option of clear masks, but they haven't really been sort of recommended as the safest option. So we wear our masks on our faces when we're in session. And sometimes that's not ideal. You want people to see your face, you want to demonstrate and model because you've got mirror neurons, and you've got things that help with learning. And so sometimes a blended approach is really, really important to consider as well. So some sessions online, some sessions in person,

Gillyanne Kayes: 20:52

I think that's enormously helpful

Jeremy : 20:54

Me too. I want to go to what you've just been saying about performance and performance expectations. Because if you like if you have a singing lesson, or a singing set of singing lessons, which is just to improve your own voice for your own sake, that's one thing, if you have a set of singing lessons that are performance geared, or performance led, that you're leading up to singing in public singing in public is a whole different ballgame. And some of the expectations that that people are actually singing teachers have of their students are wild, you know, we expect you to sing like Pavarotti. Well, no, you know, we expect you to perform like an international opera singer. Well, no, actually. Because that's not the point. That's not not the purpose of me being here.

Gillyanne Kayes: 21:37

That's not why the students gone for lessons. Yeah.

Jeremy : 21:39

Or we expect you to do a three hour gig. Well, no, because again, that's not why I'm here. So for me, that's part of a really eclectic job that the singing teacher has, which is I have to work out what my client actually wants this week, this month this year.

Carrie: 21:56

Yeah, absolutely. I mean, as I've said, a lot during today's chat, you perfectly placed to support their rehabilitation through encouraging self management skills. So looking at their scheduling, to reduce them, the risk of them burning themselves out, you know, and anything else that may be impacting on their voice, you know, giving them rehearsal space, so that they can practice frequently in short bursts and things. So yes, self management skills and helping them to look at what it is they're doing across their week, the whole of their vocal context, is sometimes really important, if they are a performer, and if they are having to come up to a performance, it's about helping support them as well, sometimes, if that's within your skill set, to pace themselves, not to do massive long rehearsals, dress rehearsals that last a day, before the actual performance, you know, click week.

Gillyanne Kayes: 22:57

That's important for colleges as well, because colleges are coming up to assessments, you know, particularly performing arts colleges, and they're, maybe they're expecting the same thing from their students, you know, that's down in their curriculum, and some of them won't be able to manage it.

Jeremy : 23:12

I think it's important that some people have tremendous stamina, and will do whatever is required of them. And some people have very good stamina and will do whatever is required of them as long as they are feeling healthy. But the moment you start feeling unhealthy, your general energy levels go down, and also your stamina levels go down. And I think we need to acknowledge that some people who have been phenomenal, up to now get a diagnosis like this, and they go, I can't do it anymore, not because my voice may or may not work, but because I simply don't have the energy levels to be able to sustain what I used to do.

Carrie: 23:46

Yeah, I mean, we're in a real pickle across the country, because we've not got the accessibility to the sort of scoping that we would normally have. So the endoscopic evaluation of the larynx. So we're not able to see very often, whether there's, I mean, there's obviously a hospitalist group, as we've talked about, but I'm not specifically talking about that group. Today, I'm talking about people, as we've said before, in the community who have self managed their COVID symptoms, but there still is a very real possibility that they have what we call vocal folds, ima airway inflammation, that ongoing cough, that inflammatory response to infection. So they may be going through cycles where there's inflammation in the airways, in the larynx, reflux maybe be triggered more frequently. And whereas if a person never experienced or for they had COVID Then it's really tricky to get your head round. Why, why? If I am following to the letter, all this vocal hygiene advice that people have given me, why am I still not able to get a clear smooth tone? It you know, what am I doing? wrong, what am I doing wrong? And it leads into this cycle of sort of beating yourself up, doesn't it? You know, like we said before, there's the psychological side to consider that very fact that people are beating themselves up. And I've got that level of anxiety and sort of frustration can cause that secondary muscle tension dysphonia. And we know about the vocal, the fatigue, the vocal stamina has possibly become less the endurance of athletes in every sense of these athletic singers may have been reduced. And, you know, it may well be even be that it's because of the diet, we know that people with COVID have lost their sense of taste and smell as well. And sometimes people have a lower appetite, so they're not getting the calories they need. They need to look at nutrition to get the right balance. You need to look at sleep, your breathing, everything is going to help support these people who are experiencing these long COVID symptoms. The Sleep is something I really wanted. I have been blown away by one of my colleagues spoken recently about a book called Why why we sleep Matthew Walker, I don't know if you've come across this. Do you mind if I read just a little little paragraph from it? It's really interesting. And it's also got something about caffeine, which I was like, Oh my word, I just want to speak to people who are voicey about this. So okay, this is an amazing breakthrough. That's in Matthew Walker, why we sleep. So he has at the start of chapter six, scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It Ward's off colds and the flu, it lowers your risk of heart attacks and stroke, not to mention diabetes, you'll feel even happier, less depressed and less anxious. Are you interested?

Jeremy : 27:00

Sign me up

Carrie: 27:00

What's it all about? Its sleep? Just think, you know, I think really we all know about vocal hygiene. But I'm starting to think that sleep hygiene is actually a really big area we need to be mindful of Yeah,

Gillyanne Kayes: 27:15

you are preaching to the converted here. I am very, very interested in sleep. I've been listening to podcasts on sleep, and finding out about sleep. I had quite a lot of difficulty sleeping as a child because something was going on in the household. My mom was in hospital. And I think ever since then I've had intermittent periods of not sleeping very well. And in fact, I've had to teach myself to sleep. I had to teach myself that if I wake up, I have certain kind of breathing exercises and kind of little bits of self talk, that take me back to sleep because a good night's sleep really does make a world of difference. And we live in a society at the moment. With lots of electric light, we've got electronic light around us, we've got these, you know, things that we hold in front of our eyes, which give all the blue light. And people don't realise the impact that this is having, which I imagine the book talks about. At length. Yeah. Well do with me child shouldn't be doing for yourself.

Carrie: 28:21

Yes, yeah. I mean, we all know the, the impacts that having small children has, you know, and and also gigging late at night, you're having concerts lately. It's disruptive. And actually, this book is fascinating. It really is, in terms of whether people are morning locks night owls, what your circadian rhythm is up to. And one of the things I did want to say, because I do think this is really interesting was about caffeine. Now I know in vocal hygiene, we all so voice care advice that we provide to our singers, we always talk about caffeine and how it's a diuretic. And we just have to be mindful of, of sort of what you take, possibly because it possibly has a dehydrating effect. And the jury's out there as to what that you know, what is the case surrounding that, but in turn, I want I want to talk about caffeine in terms of sleep. I just it really sort of struck a chord. So the way that he describes it that Matthew describes it is that we've got receptors, newer receptors in our brain. And through the day, we have a buildup of sleep pressure, and it's adenosine. I think that's right, adenosine and it's a it's a sort of chemical buildup that attaches to those receptors. And so by a certain point in the day that your circadian rhythm and their sleep pressure reaches an optimal sort of comes together and you want to fall asleep, you're tired and you have a lovely sleep and it's restorative. And actually what we're doing with caffeine is caffeine bonds to these neuro receptors and prevents the adenoma seen from attaching to it. So we're not getting Getting that overriding sleep pressure building up so you can understand because it's a psychostimulant is it psychoactive stimulant caffeine is. So when we when we have. So for myself, I'm a morning lark. And when I used to have late night gigs, I would drink coffee, I would take chocolate, I'd have things that had caffeine in them. And obviously what was happening was they were dampening my responsiveness to this adenosine sleep pressure. And then what you find is you have this almighty crash, because the caffeine is eventually processed through the body by the liver. And when it's gone out of the system, suddenly the adenosine doesn't go away, it's still building up, even though the caffyns got hold of all the receptors. So this overriding amount of adenosine makes us have this crash, this absolute crash, which is which is where, you know, we feel incredibly tired and feel very ill very unwell and need to sleep. And obviously, if if we're in a situation where we had been following our natural rhythms during lockdown, and now we're back on the road, we're performing, we're working, you're teaching, we're not listening to our bodies as well as we had been, we're not taking care of ourselves, in the same way that we possibly had opportunity to, during all these lockdowns. Everybody felt so well, what I'm not saying everybody, sorry, that's an awful thing to say. But generally, people who were going through a lockdown and weren't getting poorly from COVID were reporting, you know, they had time for their free time, their rest, their meditation, their activities, their hobbies. And so they were feeling generally better. And this is partly because of they're able to sleep possibly follow their natural bodily rhythms, and then the restorative function that those have.

Gillyanne Kayes: 31:52

That's fascinating. I'm definitely going to get that book. And you can actually go online and do a test on your morningness versus eveningness. And I'm sort of a moderately morning this person, apparently. So I definitely get a dip. Always get a dip around three or four o'clock in the afternoon.

Carrie: 32:11

Yeah. Oh, do you? Do you drink caffeine? That's the thing. Do you drink caffeine at that point to keep you going? Or do you? No, no,

Gillyanne Kayes: 32:18

no, no. I might drink a coffee but it'll be a well decaffeinated coffee, steam cleaned. I don't use the other time. Maybe once a day, never more, and not even every day. So but that works for me for all kinds of reasons.

Jeremy : 32:36

When I was a college, we they instigated concert series at 5pm. And it was horrible. Because I have horrible dips at 5pm. And then back again at six. And I was playing in so many of them going I have to stay awake in this.

Carrie: 32:51

Oh, yeah. Well read the book is fascinating. It will tell you exactly what was happening with your body at that time of day. Absolutely fascinating.

Jeremy : 33:00

We'll link to it in the show notes.

Gillyanne Kayes: 33:02

I think we should talk about why there might be a loss of range sort of pitch range function. Oh, somebody asked Post COVID. We've got a couple of those Lisa's question

Jeremy : 33:14

Becky Owen first of all said, loss of range in the higher register, we're now talking about the high register, because this links quite nicely. Louise le Boutillier sent a question in so let me just play hers.

Louise: 33:28

I've been teaching quite a lot of teenage girls who have had COVID this term. And I've particularly noticed with the girls, that they are experiencing a lot more breathiness of tone in mechanism 2 since they've had COVID. I'm wondering why this is affecting their M2 more than their M1 and what I can do to help them recover from this quickly.

Gillyanne Kayes: 33:53

So Carrie, Why might it be that these female voices are having difficulty with their mechanism 2 rather than the mechanism 1, any thoughts?

Carrie: 34:02

So thank you, Louise. Great, great question. So the way that I sort of make sense of this, in my mind, and from my days working in voice clinics, is that when people have inflammatory response, in or out in and around their vocal tracts, or whether it's vocal folds, or the tissues surrounding what we tend to see with the vocal folds themselves, is that the information causes sort of a heavier, slower vibratory pattern. So there's, I always think of it as them being fluid filled, whether that's totally correct, I'm not really sure. But they they they're not able to vibrate as fast in the in the normal vibratory cycle as they would normally. So when we sing higher notes, we obviously need to get the vibration to be vibrating faster, so more vibrations per second. And when people have inflammatory response, that it's more difficult, so we might find that there's some compensatory tension and creeping in where there wasn't previously, so actually, people who would have previously been able to easily achieve those higher notes in that mechanism to using mechanism to that they're being impaired in that function because of possibly, the vocal folds oedema, the fact that they've got cough quite frequently, they might have reflux, again, it's that that discomfort that functional dysphonia muscle tension, whether it's secondary compensatory muscle tension, or whether it's a muscle tension, that's there for another reason. Again, respiratory drive might be less than actually. And I don't mean less as in you need more. For those higher notes, what I mean is that they're out of balance, they, whereas previously, their bodies instinctively knew what was needed for that task, that vocal task. When somebody has inflammation in the larynx and the vocal folds, things change and, and you know, the respiratory drive has changed, the energy overall in a person has changed. This is where the SOVT exercises will really, really help. Because they will help somebody to approach these higher notes with more ease, so less effort, less pressure and pushing, which is the instinctive reaction of so many people to try and get that that better quality voice. So yeah, so in terms of singing, teaching, I would say the direct things you can do are SOVT tension release exercises, you know, all the things you would normally do. And I don't know if it's sort of part of the singing teachers role. But I would always say that, well, more frequently than they're not I would, when I'm working with people who are singers and young people who come in with voice problems, we tend to work on their speaking voices as well, because our voices are voice that goes across everything. And it's about developing some awareness sometimes about because people are more fatigued, because people are not using the same respiratory effort or the right respiratory effort or breath pressure that they need for speech and singing. They tend to be speaking in everyday life with this sort of dip in pitch at the end of sentences or going into the pitch ditches, we say. And they might have squeeze and creak being audible in their in their voice, because they're just not supporting they're not using the breath to ease them through that sound towards the end of sentences. You mean sometimes people similarly for not using the right respiratory pressure for speaking the onset, the starts of sounds maybe a little bit more squeezed than they need to be. So yeah, so improving their speech quality is really important as well. And if you feel that somebody does have symptoms, which is not just in their M2, but also in their speaking voice, and you find that they've got maybe a slightly breathy a tone, or more squeeze and creak. That's audible, then maybe consider if they need to see an EMT and get referred for some speech therapy to to help them through.

Gillyanne Kayes: 38:18

I think that's a great idea. So it sounds like you're saying, you know, because of the effects of COVID. There's less responsiveness in the vocal folds. And it could be that that's happening more in the I'm talking about how a singer...

Carrie: 38:35

how yeah, that's, that's another option. So in terms of respect, there is the possibility of that neuropathy. So that that sort of sluggish vocal folds movement, there is the possibility of that, but I wouldn't jump to it being that I would more often than not presume. I mean, again, from the endoscopy findings of my speech and language therapy colleagues, it's oedema. You know, slight reduction in movement. That's, that's more typically encountered when we look at what's going on in the larynx. So

Gillyanne Kayes: 39:09

it's interesting that responsiveness for you is more about a neurological thing. Yes. From your perspective. So I'm really happy that you clarified that. So if the vocal folds are a little bit sort of swollen because of the impact of COVID? Well, first of all, the wiggle factor on the mucosa is not going to be as as strong as it normally is. And when we're in mechanism 2, we need more of that going on. And maybe the swelling also impacts on the ability of the vocal folds to find some stretching us, which they might need for height, no stretch, plenary meeting. Yeah, yeah, I think that makes sense to me. So, Louise, and Becky. I hope that that's helpful. And what you're saying is, maybe listen to the speaking voice and work on the speaking voice as well. And then SOVT could be your friend.

Carrie: 40:02

Yeah, absolutely voice care, make sure that they are completely looking at, you know, hydrating enough, make sure they are managing their reflux, all those things. Oh, yes. Jeremy is showing us

Jeremy : 40:14

the app, I just want to remind you, of the One Minute Voice Warmup App, that we may because it is for speaking voice. And there are 15 exercises in there that you can build into as lengthy a warm up as you want to. But it's absolutely specifically for speaking voice. And we get singers to use it. Because the speaking voice for us is such a basis for for nating in any way singing or speaking.

Carrie: 40:36

Absolutely. Yeah, that sounds brilliant. Yeah, so that app would be perfect for people to use, you know, anything that they can carry around. Because it comes what we call compliance in therapy and motivation to engage in these activities. What we do in our sessions is great, but really, we're trying to give individuals whether it's in singing or in therapy, we're trying to give people skills and the ability and the knowledge to take it outside of our sessions, to continue to do these things independently and self manage what's going on for them be it habilitated Their voice and developing their vocal technique, or actually rehabilitating their voice so that that One Minute Warmup Voice App is perfect, because it's in your pocket. You can use it wherever you want to in the toilet on the tube, or wherever you feel confident using it.

Gillyanne Kayes: 41:32

Michael Rosen referred to practising is to go to the loo. Yes, yep. And what you're talking about here, I think the word that you use in speech and language therapy is generalising the skill. So you're not just doing it in the session, you're taking it out into everyday life, the more that we use our speaking voice healthily in everyday life, the more likely we are going to be able to use our voice healthily in the small specialist skill of singing.

Carrie: 42:02

Absolutely, yeah. Because we can't, we can't separate the two voices, our instrument is with us every single day. And we can stand in a singing lesson and go, right, we're going to work on breath, body work, and all these kinds of things. But if they're not speaking correctly, when they're hanging out with their friends, and they're reinforcing, you know, this, this competence, you know, secondary muscle tension and, and, you know, this creaking and everything, a certain amount would probably cause people no concerns whatsoever. But when you've got in vocal folds, which are inflamed as a result of a viral infection, or whatever, you've got to be mindful of this. I mean, we other things you can do in your session, Louise and things like the breath and broad body work retraining, the breathing mechanisms. And again, talking about things that might reduce anxiety within the context of singing, you know, it, like we've spoken about before, if it's using your your words and music, rather than having to remember things, but more importantly, listening to their own body of fatigue is an issue and maybe altering expectations and to making different choices, alternative song choices, alternative musical choices,

Gillyanne Kayes: 43:12

to transpose button news, the Press the transpose button

Jeremy : 43:14

Use the transpose button on your keyboard, it is your friend.

Gillyanne Kayes: 43:19

Now, I'm wondering, because I think we've actually answered all the questions that came in so far. Carrie, are there any other points that you would like to make that you think our listeners would like? Wouldn't you know, would like to know about?

Carrie: 43:35

Well, I think just just as sort of list of things that you might expect, voice symptoms, voice and laryngeal symptoms, you might hear of our things. I know we've talked about some of these quite extensively today, but going in List of prep order of prevalence in the research so far, we are finding that vocal fatigue and lack of vocal stamina is number one in the in these shoes that are presenting to so the the evidence for this is in several research papers actually, but also in our Royal College of speech language therapist voice CEN survey. And when we were talking about symptom clusters and trends of non hospitalised sufferers of non COVID But it's also in a an article by Lechien I think it is Lechien features of mild to moderate COVID-19 patients with dysphonia and also Davis et al from 2021, characterising Long COVID in an international cohort, seven months of Long COVID and speech and language therapy and their symptoms and their impact. So, this is where this information comes from. So, vocal fatigue number one lack of vocal stamina and that is actually higher than how often dysphonia so, so problems with voice itself was seen in post COVID patients. So It's not necessarily that you're expecting to hear the breathiness, the roughness, you know, and the strain and things. Dis... throat discomfort and soreness is number two changes in voice is number three, reduced respiratory drive is number four, so that the overall lung capacity the the coordination of breathing is something that suffers quite frequently in patients with Long COVID. People with Long COVID, which is where these breathing programmes are really supportive and risk can be helpful and restorative of diaphragmatic function things. Shortness of Breath is next, lump in the throat. So what we call Globus Pharyngeus, which also might be attributable to anxiety and things, persistent cough. And then we've got things like sticky throat mucus, I know some people have mentioned, and swallowing difficulties, because we again, we can't... Voicing is the third function of our larynx, you know, outside of airway protection and swallowing, voicing is the third important thing. So swallowing difficulties are also impacted. And I would suggest, if you do have anybody who comes to you and says, Oh, I'm really struggling to swallow. Again, if it goes on for longer than sort of 12 weeks and things definitely suggest to them, possibly they may want to get get that looked at just to see if they can get some advice from the professionals.

Gillyanne Kayes: 46:26

That's brilliant. Thank you. And isn't that interesting? That vocal fatigue and lack of stamina is really the most prevalent? Yeah, of symptoms.

Jeremy : 46:37

And we should mention at this point, Phoene Cave, who's doing the musical breath and singing for breathing courses, and she was on a previous podcast with us. So we will link to that in show notes as well.

Carrie: 46:49

Perfect, perfect. I think I'm just looking through whether there was anything else. Oh, I know that the British Lung Foundation has some fantastic resources. For example, if they've got resources that are videos on if somebody needs, so it's not necessarily for your singing lessons, but just for interest for people who are interested in breathing, I need to clear my lungs, and there's some deep breathing and diaphragmatic breathing as well. I'm breathless videos. So helping people to try breathing in different positions. Because essentially, when you're rehabbing breathing, you're trying to slowly rehab somebody to function across all contexts is not just for singing and speaking, it's about moving and participating in all their different ways, things they have to do. So again, a respiratory team is possibly the best, we'll definitely the best place to start for advice, and proper assessment. If you feel somebody has something that's without outside of your boundaries of knowledge,

Gillyanne Kayes: 47:50

excellent. To know what's occurred to me. I think, though, none of us could have ever expected this and none of us would ever wished it to happen. I think we've learned a lot.

Carrie: 48:03

From Absolutely, yeah. I mean, it's different for everyone. I mean, the last things I've sort of got on my list of things I wanted to make sure I said was it is different for everyone. There is no way that anybody can predict recovery trajectory. That is not everybody's searching for how long will this last? How will I know I'm better and things like that. I think don't expect too much from yourself as you recover, enable your body to return to everyday life before trying to improve your fitness. So everyday life just normal functioning, good sleep and rest is important. And once your energy levels have stabilised which may be four to 12 weeks, or it may be moving into that post COVID syndrome era and beyond. So once your energy levels have stabilised and fatigue has improved, then start setting achievable targets so that you can see progress each week. So it's motivating you to to develop again. And just remember that doing too much can set your recovery back. So listen to your body and in our professional capacity. Listen to the people you're working with and follow be led by them because they are the experts on themselves.

Jeremy : 49:16

That's perfect Carrie

Gillyanne Kayes: 49:17

Fabulous.

Jeremy : 49:18

Thank you so much for being a guest on the podcast.

Carrie: 49:21

You are so welcome.

Jeremy : 49:23

And we'll see you soon

Gillyanne Kayes: 49:24

Jingle time?

Announcer: 49:37

This is a voice, a podcast with Dr. Gillyanne Kayes and Jeremy Fisher.