Laryngoscopy

Losing My Voice

by Paul Strikwerda in Articles, Personal 28 Comments

At speech therapy wearing a TENS device

The facts are sobering.

Every forty seconds, someone is struck with a stroke. It is the fifth leading cause of death in the U.S. Most people will never make a full recovery, and more than two-thirds of survivors have some kind of disability associated with the attack.

Those are the statistics.

It’s a good thing I don’t believe in numbers. I believe in proving them wrong. The history of the world is filled with people who were told “It can’t be done,” and yet they persisted and succeeded. Against all odds.

I believe that people don’t equal statistics.

Going by the stats, it seems reasonable to believe that I would never fully recover from the stroke that struck me six months ago. But I chose to be unreasonable.

Last week I wrote about my road to recovery, and I promised you to open up about the one thing that terrified me most. It was something I didn’t want my colleagues or clients to know, because it could ruin my career.

HOW IT STARTED

Let me take you back to March 26th, 2018, the day I woke up on the floor of my voice-over studio wondering what the heck was going on. In hindsight I had the classic signs of a stroke: a sudden and pounding headache, loss of coordination, and blurry vision. One side of my body was paralyzed, my face was drooping, and I had trouble speaking.

That last symptom manifested itself in two ways: I had difficulty speaking sentences that made sense, and my speech was slurred. This usually means that the part of the brain that controls language is not getting the blood supply it needs. It was in fact dying.

As I was being transported to the hospital in a helicopter, my wife got a phone call from the surgeon who was on standby to operate on me. “When Paul comes in, I probably won’t have time to introduce myself,” he said, “so I want to take a moment to speak with you now. I’ll be totally honest. Everything we do will depend on the results of Paul’s CT scan, which will show us what parts of his brain are still intact when he arrives. Timing is crucial.”

He continued: “Be prepared that he might not make it, or that he’ll end up being severely handicapped and dependent on others for the rest of his life. If the scan looks good, we can do a thrombectomy to remove the blood clot from his brain, and take it from there.”

Since you’re reading these words, you already know the outcome. I guess it wasn’t my time to go, and I beat the statistics. Annually, out of the 1600 stroke patients that arrive in the hospital I was admitted to, only 80 are eligible for a thrombectomy.

THE RECOVERY BEGINS

So, my surgery was a success, but this did not mean that all was well between my ears. The scans showed a black area on the right side of my brain where cells had died. Those cells do not grow back. In order to compensate for the loss, the brain has to rewire itself and have other parts take over the function of the cells that are lost. To make that happen I needed at least five things: a positive attitude, a solid support system, plenty of rest, healthy nutrition, and therapy.

Even though I no longer sounded like a drunkard, clear articulation wasn’t my forte in the first few months after my stroke. I suffered from dysarthria. That’s a fancy word for unclear speech caused by brain damage. It’s a weakness or lack of coordination of the muscles of the tongue, lips, palate, jaw, and larynx. On top of that I had word-finding issues, indicative of memory loss.

By far the weirdest symptom of my post-stroke condition was the fact that I didn’t sound like me. My speech had become rather robotic and monotonal. It came in little bursts of language, just like the thoughts in my head. In the weeks to come, I discovered that I had the hardest time infusing my words with emotion.

No matter the subject, I sounded as passionate as a concrete wall. After I came home, I tried my hand at a few voice-over scripts for existing clients. It took countless retakes before I was somewhat satisfied with the result, but clients were noticing that something was off. The feedback I consistently received boiled down to this: “Once more, with feeling, please.”

The problem was that I had no idea how to access those right brain feelings. No matter how hard I tried, I seemed incapable of translating instructions like “confident,” “warm,” or “excited” into sound, whether in my studio, or in ordinary conversations. This was infuriatingly frustrating. I felt like a soccer player unable to handle the ball, or a painter who can’t hold a brush to add color to his canvas.

Would I ever be able to reach these emotions again, or were they part of the right brain that was destroyed by the stroke? What would this mean for my voice-over career?

Twice a week I went to speech therapy to learn how to improve my articulation. With my therapist, I also worked on regaining memory, and on sharpening my information processing skills. Very soon I realized that all of this wasn’t going to be as easy as flipping some internal switch. It needed time, energy, and lots of practice at home.

Speaking of home, on top of her busy schedule my wife became my designated driver, my patient advocate, my caregiver, my personal chef, and my hero. She made sure I got to all my appointments, that I took all my medications, and that my recovery would be pretty much stress-free. Her delicious meals were almost always based on fresh, locally sourced and unprocessed ingredients. You can’t have a healthy mind without a healthy body.

MORE TROUBLE

In the weeks after my hospitalization there was something else about my voice that concerned me. For some reason I was hoarse all the time, and I had no vocal stamina for long conversations and even longer scripts. I was tired, and I sounded like it. Something told me that if I didn’t take care of this, my career as a professional speaker would be over.

In May I went to see an otorhinolaryngologist who specializes in working with actors, singers, and public speakers. She performed a flexible fiberoptic laryngoscopy whereby a small endoscope is inserted through one nostril and guided through the nose to the back of the throat. It’s a funny feeling.

This revealed a slight laryngeal tremor. That’s an involuntary tremor of the vocal folds that causes changes in the voice. My ENT also concluded I had laryngopharyngeal reflux (LPR), a.k.a. “silent reflux.” Why silent? Because it doesn’t necessarily trigger the usual symptoms of acid reflux, such as heartburn. It does lead to hoarseness, coughing, and throat clearing because stomach fluid travels back through the food pipe to reach the back of the throat.

It is likely that the laryngeal tremor was caused by the stroke. Perhaps it will go away over time. Perhaps it won’t. I’m treating my LPR in several ways. I avoid spicy and acidic foods. I limit my intake of chocolate, coffee, alcohol, citrus fruits, mints and tomato-based products. I’ve stopped snacking before bedtime, and I’ve lost about twenty pounds. I’m also taking omeprazole which decreases the amount of acid the stomach makes. A new wedge pillow raises my head in bed, and keeps the acid down where it belongs.

Experts estimate that forty percent of the population may have undiagnosed LPR. If you’re experiencing hoarseness, a need to clear your throat, a sore throat, difficulty swallowing, or a red, swollen, or irritated voice box, please see an ENT to get to the root of the problem.

POSITIVE RESULTS

The good news is that after months of speech therapy my articulation and ability to focus has greatly improved, and the robot voice is gone. Only when I get really tired, it becomes more monotonal. I’m relieved that my speech has become more expressive, allowing me to continue to work as a voice talent. I’m also back to doing four-hour shifts as one of the announcers at the Easton Farmers’ Market.

Twice a week I work on strengthening my vocal folds and building my endurance with my speech therapists. I’m not yet where I want to be, but I’ve started recording longer scripts again.

RECOVERY CONTINUES

It takes a positive attitude, plenty of rest, healthy nutrition, and therapy to recover from a stroke. Add to that a support system; a network of caring people who provide you with practical and emotional support. Reading and responding to your comments on last week’s blog post, I realize how lucky I am to have such a supportive group of friends and colleagues!

Thank you for your kind words, good thoughts, and prayers. Your positive vibes revitalize me, and give me energy to keep on beating the odds. The process of healing goes on, which means that I have to be careful not to do too much, too quickly. So, if you don’t hear from me within 24 hours, and you don’t see me on social media, rest assured that I’m doing everything I can to take care of myself.

I hope you will do the same.

Paul ©nethervoice

Important: the information presented here does not substitute for medical consultation or examination, nor is it intended to provide advice on the medical treatment appropriate to any specific circumstances.

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