Common chronic illness symptoms, how they affect the voice,
& why it's worth talking about
I'm going to preface this whole post by saying if you don't understand why I would want to be public about my health-skip down and read the last portion of this and then come back to the top.
Below is a comprehensive list of my symptoms. Not everyone with a chronic illness has the same symptoms and if they do they may not experience them in the same way. I do think it's worth noting that I have talked with several people in the chronic illness community that do have the same symptoms and they seem to manifest in a very similar way (that part is not surprising as the symptoms, although vast, are pretty standard) the interesting thing to me is that they all also experience vocal issues chronically. Some of these people have had classical voice training but were never professional, some have never sung formally at all. Some don't use their voice beyond everyday speaking...some speak for a living but have never had training or therapy and some have voice therapy regularly. This is note-worthy because if you're like me you may be wondering if my experience is different compared to those with chronic illness who have not had thorough vocal training. It seems that regardless of training or use of the voice, the vocal issues are still present but to varying degrees. It's hard to say anything scientific here without more information and research but there's no doubt that my voice would be way worse off if I didn't have the background I have. I have lots of theories about vagus nerve stimulation during singing being responsible for maintaining the voice I still have but I digress...
If you're not familiar with my story my diagnoses are: Fibromyalgia, Dysautonomia, Hashimoto's Thyroiditis, undetermined GI autoimmune disease, anxiety, depression, OCD, and a case of long Covid. The mental disorders obviously are exacerbated by the physical ones and vice versa. Having Fibro is basically like being in a constant state of fight or flight which is an extreme challenge as a singer. There is still so much to be learned about Fibro and many specialists still argue whether or not it's autoimmune or not, or whether it's inflammatory or not, but it is widely accepted that it is a neurological disorder that affects the central and peripheral nervous systems. The emotional and psychological impact that all of this has on me as an artist and performer is a whoooooole other story- I will dive into that side of it soon in a project I'm doing with the fabulous organization Our Singing Bodies (@singingbodies).
Okay symptoms. I'm going to sort these symptoms into categories based on how I generally perceive them. There's a lot of overlap here and some symptoms manifest differently based on what part of the system they are affecting and what I'm asking my body to do at the time...but in an effort to keep this post relatively concise I will only list each symptom once.
pain
Joint pain
Stabbing pain
Electric shock pain
Throbbing pain
Body aches
Throat pain
All of the symptoms above truly are so weird and hard to describe to people that haven't experienced it before. The pain comes and goes. Sometimes it lingers. It's rarely triggered by something obvious and it comes in all of the forms listed above. The throat pain is one of the most interesting and mystifying symptoms. Others with Fibro have also described a similar phenomenon. I have gone to an ENT when it feels like I have strep throat and should have laryngitis and my cords are completely fine and there's no redness or inflammation in the pharynx. This feeling comes and goes but it makes it extremely hard to sing when it flares up because I'm afraid of hurting myself if I sing through it. I'm sure it is the same reason I feel pain everywhere else in my body it is just way more striking because it's my voice...I guess if I were a soccer player with the same issue I'd be more tuned into the pain in my feet?? I don't know. It's weird.
General extreme peripheral neuropathy- this is full body pain and/or numbness that lasts for more than a few seconds. This has prompted me to go to the ER several times over the last 10 years as it feels like a combo of a heart attack and a stroke.
Chest Pain- this definitely feels like a heart attack so it is very unsettling and if it happens when I'm singing or teaching it makes it hard to breathe and assume a healthy posture.
muscular
Muscle pain- This occurs all over but it is particularly frustrating when it is in my neck, intercostals, and larynx. It's hard to get a full/open breath, hard to find balance and feel grounded, hard to focus and just takes up so much energy.
Muscle tension- my neck, jaw, tongue, back, and calves, get the brunt of this. It is very hard to stand and sing - especially in heels. It is very difficult to properly articulate at times and I'm constantly working to release between breaths so I don't become more "locked" than I already am. Coordination between muscle groups is easily thrown off and maintaining a tall or "noble" posture can be quite hard.
Muscle spasms- I'm most affected by the ones in my neck and larynx
Muscle weakness- I have a very hard time feeling and using my pelvic floor and lower abs. This has been worse since my hiatal hernia surgery and the birth of my son. This one comes and goes and is heavily dependent on the level of fatigue I'm experiencing. Sometimes weakness is random or affects my whole body- that is more rare though.
Fatigue- It is hard to use my body athletically. It makes establishing a solid technique very difficult because I feel like I have to have a different technique depending on what combo of symptoms I'm experiencing. I know every singer deals with this on some level but this is like singing on your period or sick or...I don't know- hungover? But like... x 100.
TMD- an obvious and more common issue for singers. Perhaps not so obvious is how TMD affects other parts of the body. It can affect vision, the inner ear, cause neck and tongue tension, can cause neuropathy, headache, digestive problems, cause misalignment throughout the whole body - honestly for a while I thought all my issues were because of my jaw. I wish!
Esophageal dysmotility- worsens tongue tension, causes pain and spasms in my esophagus, makes breathing difficult at times, makes it feel like my diaphragm gets stuck during inhalation. This can make it very hard to get a relaxed open breath.
neurological
Blurred vision- this makes it hard to read music and to direct/teach. Anytime I have to look back and forth between a score or script my eyes won't focus fast enough and I get dizzy and disoriented. Typing this, for example, is doable but I know it will take 20x the amount of energy as it otherwise would so I have to pace myself.
Sensitivity to sound- Sometimes random sounds bug me and I get irritated or tense but the big issue as a singer is with loud noises. The last concert I sang was the first time I noticed being super sensitive to the piano. I began to rehearse with the pianist and I was literally thrown back by how loud the piano was. Granted she started at a forte but to me it was like a bomb had gone off. This instantly sent my whole body into a heightened state as if I were in serious danger. I instantly backed up and had to rehearse the first song literally standing 20 ft away until I got used to the sound. A sound I should be very very comfortable with right? Now that I know this is an issue I can prep myself in this kind of situation and function.
Sensitivity to smell- it is hard to explain how severe this sensitivity is. If someone is wearing perfume- especially certain kinds- I might as well be inhaling bleach mixed with carbon monoxide. I can't breathe, I get nauseated, I can't think, I feel like I'm going to pass out, my airway becomes irritated, my eyes water, and I get a horrible headache. This will last for at least an hour after I encounter the smell.
Dizziness- hard to feel grounded and breathe. Focus is thrown off as well. If I'm on stage or having to look back and forth at music it can be really disorienting. This also throws off coordination.
Pins and needles/numbness and tingling- this is more annoying than anything but it will definitely take me out of the moment when I'm singing or working. It can also be an indicator of an imminent flare up.
Sensitivity to heat and cold- being in a rehearsal or performance space that is too hot is almost impossible and my breathing becomes very shallow and cognitive function goes out the window. My hands and feet are easily ice cold (even with shoes) and that can lead to tension in arms and feet/legs and lack of centeredness when standing.
Migraine- my migraines are "complex migraines" so they are less headache and more resemble symptoms of a stroke.
Vertigo- this happens regularly but can get bad enough that I pass out or can't drive or walk.
Fine motor skills impaired- this will happen during a flare up. I will have problems putting my contacts in or opening a water bottle. These are days where I notice issues with arytenoid function, for example, and will have more vocal "glitching."
Other/combo
Gastro issues- can cause pain, unpredictable bathroom habits, and lots of bloating which makes it uncomfortable to breathe deeply.
Congestion- post nasal drip and closed/ inflamed airways. I'm constantly fighting the urge to clear my throat.
Non-restorative sleep- adds to fatigue and also prevents muscles from healing and relaxing. Worsens brain fog and anxiety and overall tension.
Skin sensitivity- My cheeks and face get very red very easily. This happens with sun, blue light, fluorescent light and heat. This is one of the only visible signs of my illness and is always worse on stage. My whole body is sensitive as well so sometimes costumes can be very irritating or painful.
Shortness of breath- This one is really tricky and is triggered by bending over or standing suddenly or sometimes by running. Stage movement can be extremely difficult and during a flare up it can be triggered by even more basic motion or standing for long periods of time.
Nausea- this will impact my breathing because it feels very uncomfortable to allow my diaphragm to fully descend. It will also prevent me from eating when I should which obviously exacerbates the fatigue.
Swollen Thyroid- this guy gets in the way of my larynx a little bit- preventing full range of motion (tilt) and also presses on the laryngeal nerve which we think is partially to blame for the voice cutting in and out at times. It is also painful and makes my whole throat feel closed off- which is not ideal for singing.
Rash/possibly psoriasis- Can occur in different places on my body. Occasionally this has made me feel self conscious but the bigger issue is it is painful and when it occurs on my feet/ankles it is hard to wear shoes and hard to stand/walk for long periods.
Mucosal membrane dryness- this one is pretty obvious. Everything gets dried out!
Performance anxiety- this anxiety comes from not knowing how my symptoms will impact my voice on a daily basis. This is separate from my anxiety disorder and did not exist until the last couple years when my illnesses became more pronounced. I hate it because I love an audience. I'm one of those singers that prefers thousands of seats- the more the better. Super frustrating.
Brain fog- this sometimes makes learning music and memorizing very difficult. Sometimes it will take me a very long time to process a basic rhythmic pattern or to translate a phrase. Other times, I will have no issues at all and can plow through an entire act in no time and with no problems.
why am I sharing all of this?
If you are reading this and asking yourself, "How can she function with all that?" or "How can she sing at all with all that going?" This is one of my main points. I am very high functioning regardless of all the hurdles listed above. Two of the videos I have on my website (the ones where I'm wearing a black dress) were recorded at the end of a two week "bootcamp" for singers and I 100% had a flare up during that recording. That means I had every symptom listed above with the exception of a migraine (thank God). The recordings where I'm in a blue dress I did have a migraine. During both recordings I was unaware of the current issue with my thyroid and maybe would have done things differently going into the recording...maybe not. Anyway, my point is singers can be going through a LOT and still produce art. They can still tell a story, they can still produce an accecptable tone. Was I limited by the symptoms. Yes. Are there issues in the recordings....oh yea. But even at my worst my voice is still worthy of being heard.
For any other artist out there that needs to hear this: YOUR VOICE IS WORTH BEING HEARD- always. Not just at your best.
It's imperative that we normalize disability and illness and anything that our bodies may have to go through that may make us imperfect singers. We must fight against the stigma in our industry that really only prevents us from being better artists. Artists that feel free and vulnerable and empowered to take risks. Not artists that have to hide and pretend just to fit some predetermined image of what a successful singer looks like. I have heard from and of many successful singers that were brave enough to be open about their health and have since not been hired. I have heard from and of far more singers that refuse to be public about their chronic illness out of fear that they will not get work. Both situations are unnecessary and neither do anything to serve the singer or the art form as a whole.
I'm also sharing this for all the voice teachers out there. You would be amazed how many of your students experience some of these symptoms. Please keep in mind your student doesn't need to have a chronic illness to experience these symptoms. Many of the neurological symptoms in particular can manifest from performance anxiety alone.
We have to be investigative teachers.
We have to be comfortable talking about these things with our singers.
We have to listen to our singers.
Our industry and our art will be better for it.
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