Miguel Arellano - Recovered from SD with Variety of Techniques

I want to share with everyone about my recovery from SD. I'm a 35 year old male who was diagnosed with SD back in December 2001. After a long journey, I'm happy to say that my voice has been fully functional for over seven months. I'm now back working full-time as a Business Systems Analyst where I often have to use my voice but I'm no longer concerned with it.

I want to share my personal story in hopes of helping other individuals living with SD. I share my personal account as it happened without suggesting any specific approach to recovering from SD.

Brief background history:

I was initially diagnosed with severe SD-AD in late 2001 by very well known doctors at the UCLA Head and Neck Medical group. My onset of SD started in late 2000 with an upper respiratory infection, which was one day followed by a sudden hearing impairment in the left ear (Early in 2006, I had been diagnosed and treated for Toxoplasmosis which is thought to be the culprit behind the initial upper respiratory infection and hearing impairment). During my initial onset of SD I noticed a gradual tightening/tension in the voice as a result of constantly compensating around the congestion, weakening of the throat muscles and decrease in hearing in one ear. Not that my health problems weren't enough, there were sudden stressful events in my life such as losing my job, my grandmother's passing away, the 9/11 events, all within months apart. I feel these events worsened my SD to a certain degree. By the end of 2001, I had fallen victim of the vicious cycle of SD.

1. Temporary use of Botox

I started using very small dosages of botox to help me temporarily break the cycle of SD while reconditioning my voice using the voice exercises listed in section 2. As I began to slowly rely more on proper voice usage I noticed that overtime I was able to expand the window period between botox injections. I then made a choice to ensure that I took smaller dosages of botox (every 6 months or when I felt I was losing control of my voice) for each future injection. In other words, it was imperative for me to use botox only as a temporary crutch while I worked on perfecting the voice exercises and educating myself with the alternatives that I was researching.

•  Consistent Voice Exercise Practice:

At the beginning, the amount of voice therapy I was doing did not seem effective or consistent enough. Everyday life seemed to somehow always interfere with the amount of conditioning I needed to do, causing me to have limited results. Eventually, I felt that in order to make some noticeable progress, I'd have to devote more time to practicing voice therapy exercises. My first step was seeing a wonderful speech pathologist, twice a week for two months, to help me stay consistent and motivated with what I needed to do. Even though my speech therapist had no prior experience with SD patients, he was very knowledgeable, persistent and instrumental in helping me. Nevertheless, my speech therapist proved to me that my greatest challenge was no longer the ability to functionally use my voice but rather to be able to cognitively carryover the voice in everyday life. At this stage, I felt I had overcome most of the dysfunctional aspects of SD but still needed to overcome the psychological and emotional factors that were stimulating and perpetuating my SD. For example, anticipating my failure to speak, or being uncomfortable using the phone, or feeling phony about using a different voice (sometimes referred to as a voice image), all hindered my ability to make any consistent progress. I became my worse enemy for it was mentally difficult to consciously control my vocal muscles when my mind was so preoccupied with all the anticipations, perpetuating thoughts and anxiety of not being understood by others (Section 4 explains how I dealt with this challenge).

After I completed my voice therapy sessions, I then embarked on an additional four months of self-initiated voice therapy exercises so that I could continue to make improvements from where I left off. I used a variety of resources and literature that may be familiar to people with SD. For many of the voice exercises, I had used the exercises available from Connie Pike's book, Jessica Harwick's online reference reading and Roger Love's singing CD. I also read about the Valsalsa Hypothesis (method for treating stuttering), which I found to be insightful and played an important part in helping recover from SD.

The following are some of the steps I took to reconditioning my vocal cords. Particularly helpful was doing some of these exercises with a speech therapy software called SpeechPrism which my speech therapist introduced me to (please refer to the end of this document for further information).

Voice Exercises - 2 Hour Daily:

•  Warmed-up with Roger Love's singing exercises while controlling my diaphragm breathing. I recorded many of the exercises from Roger Love's CD to my computer so that I can play his exercises in the SpeechPrism software to use it as pitch and frequency feedback while I was doing the exercises.

•  Read Jessica Harwick's online reference. This was the bulk of my daily practice. I would practice each section very slowly while concentrating and sometimes exaggerating a nasal quality. I read aloud and recorded the sessions as well.

•  Practiced the exercises from Connie Pike's SD book. I started incorporating her techniques with Harwick's exercises. Especially helpful was using Connie's confidential voice technique while reading aloud.

•  I also videotaped myself while reading aloud and doing spontaneous voice carryover exercises. Videotaping helped me to desensitize myself from some of the anxiety/stress I would experience when having to speak in public or answering the phone. In addition, it allowed me to identify and address certain physical behaviors, such as raising my shoulders or not breathing properly, which otherwise I would not have been able to have noticed.

•  Valsalva Hypothesis.

Although I did not come across this literature and it's techniques until towards the end of my recovery, I feel that it greatly benefited my recovery. This is an extremely insightful hypothesis and although this theory is based on understanding stuttering, I found and related to almost every aspect that the theory proposed. Basically, the Valsalva hypothesis suggests that stuttering may be the result from a neurological confusion between the voice and the Valsalva mechanism (mainly the abdominal and rectal muscles). I don't know if stuttering or SD are neurological or not, however, I felt that the author's proposed hypothesis can be of great benefit in overcoming these speech/voice problems. In a nutshell, the author suggests that people who stutter should learn techniques to tone down any one part of the Valsalva mechanism to help disengage the stuttering cycle. When I started applying these exercises to relax the Valsalva mechanism (mainly relaxing the rectal muscles), I dramatically noticed a much stronger and more fluent voice production…Quite honestly, I was amazed at the results. I think having learned proper voice usage prior to trying this new technique was still very much an essential step. Overall, the voice therapy and the Valsalva approach, both complimented each other in helping me overcome SD from a functional approach. Ironically, I found it interesting that the author suggested that the Valsalva control should probably not apply to vocal problems such as SD. I didn't let this deter me from trying his approach anyway.

•  Dealing with the mental blocks/stressors of SD.

As I mentioned in section 2, my most challenging aspect of overcoming SD was to be able to effectively carryover the proper voice usage I had learned in the previous months. I was truly my worse enemy when it came to doing voice carryover. I could not help but feel the negative anticipation and voice image I had developed from SD. For example, I recall many times where I could literally be in one room with the voice sounding fully fluent when speaking to myself and then going to another room to speak to my wife and at that moment struggling with my voice all over again. It was a reaction that seemed deeply wired in my brain. For some reason I could not help feel uncomfortable using anything else then what the voice muscles voluntarily wanted to do. This was evident when my mind was so preoccupied with all the negative anticipation. It seemed I had developed a voice-image, as the term is often used. Naturally, I also felt very uncomfortable when having to be in loud places or speaking on the phone.

I knew I wasn't going to easily overcome this mental block but I was determined to do something about it. I tried a few things from meditating to videotaping myself, to practicing conversation with family and friends. All these approaches helped me to overcome some of the mental/emotional feelings, however, I wasn't satisfied. The break through happened when I came across an article on the internet of an individual who overcame stuttering with the use of a combination of Beta blocking (managing adrenalin) and anxiety medications (interesting that I bring up stuttering again). The following is an excerpt I had saved from his online article (unfortunately, the website link no longer exists):

“ I was prescribed Propranolol but a month prior to learning about it I was told to take Paxil an anti-depressant and Busparone an anxiety reducer to see if this helped my stuttering…The Buspar really helped relieve the anxiety which in great part I feel is a result of being a stutterer. With these drugs I noticed that I slept better than I had in 15 years and that my breathing was effortless. With better sleep I felt better all around and noticed that my stuttering was disappearing a little each day. As my stuttering lessened each day I felt more and more confident which enhanced my fluency even further and gave me greater self esteem and a better mood. The way the two drugs work are as follows. The propranolol which is a beta blocker blocks the receptors in your body that are affected by adrenaline which in turn lowers your heart rate. The buspar further reduces your anxiety which together allows you to relax and breath easier which ultimately helps you relax your vocal cords for effortless speech. At first I took 10mg twice a day then cut back to once a day.”

I had heard about a small percentage of individuals using beta blockers to help with SD but my understanding was that it was ineffective and sometimes risky to some. Before deciding to give it a chance, I educated myself on the benefits, different side effects and risks associated with the drugs. In the research I read, I found that the combination of drugs were something that I'd be able to use in managing the mental blocks/stressors I was experiencing from SD. I presented the information to my neurologist who was willing to write out a prescription. He reassured me that Propranolol was fairly safe as it had a long history of usage for controlling blood pressure and other conditions such as performance anxiety. As for the Busparone , he explained that it was generally a non-addictive anxiety drug. I felt more comfortable trying out the combination of medications as described in the excerpt above. I slowly built up to the dosage required so that I would not experience too much of the side effects which was mainly feeling of dizziness (20 mg Propranolol: 0.5 to 1 tablet 3x/day, 5 mg Buspirone HCL: 0.5 to 1 table 2x/day). I was also informed that it would take a few weeks to 3 months before noticing any benefits if any.

Within three weeks I noticed that I started feeling more comfortable using the proper voice usage and not letting the mental blocks hinder me. It was a gradual climb to the top but I ultimately overcame all the negative reactions. After a few months, I felt that I was ready to stop the medications and gradually did so. I'm now completely free of any use of botox (since Dec 2005) or medication drugs as I have recovered my voice 100%.

As I mentioned at the beginning, I wanted to share this story of my personal account of overcoming SD. I am aware that there is no single method, medication, or therapy that can help treat SD. I am not endorsing any particular medications, voice therapists, books or methods for which I have mentioned. This is just my personal account of what I have experienced in overcoming SD. If you would like to contact me, I can be reached at Mareltech@gmail.com

Wish you all the best,

Miguel

References:

SpeechPrism Software:

http://www.bungalowsoftware.com/speechprism.htm

http://www.bungalowsoftware.com/download.htm (free 30 day trial download or reinstall every 30 days)

Jessica Harwick's online reference:

http://hometown.aol.com/jharwick/page6.html

Valsalva Hypothesis:

http://www.valsalva.org/index.htm

http://members.aol.com/wdparry/valsalva.htm (Good overview and book info)