Voice update from Scott Adams, creator of the Dilbert Blog

January 15, 2007—Voice Update

No jokes today on “serious Sunday.”

Many of you asked about my voice. As I’ve explained in this blog, about two years ago I suddenly acquired a bizarre and exotic voice problem called spasmodic dysphonia. I couldn’t speak for about 18 months unless I was on stage doing my public speaking, or alone, or singing. The rest of the time my vocal cords would clench and I could barely get out a word.

Other people with this condition report the same bizarre symptoms. We can also often speak perfectly in funny British accents but not in our own voices. We can speak after we have laughed or yawned. Sometimes it helps to pinch our noses or cover our ears. I found I can talk okay if I stretch my head back and look at the ceiling or close my eyes. And we can all sing and hum just fine.

It looks like a wacky mental problem, except that it comes on suddenly and everyone has a similar set of symptoms regardless of their psychological situation at the time. (It’s not as if we all have postpartum depression or just got back from war.)

The only widely-recognized treatment involves regular Botox shots through the front of the neck and directly into the vocal cords. But because the Botox takes some time to reach full impact, then immediately starts to wear off, you only have your best voice about half of that time. And the shots themselves are no picnic. I was hoping for a better solution, especially since I couldn’t do my public speaking after Botox injections because it weakened my voice too much to project on stage.

One day, long after the last Botox shot had worn off, I was repeating a nursery rhyme at home. I found that I could speak a poem fairly well even though I couldn’t speak a normal sentence. Suddenly something “clicked” in my brain and I could speak perfectly. Just like that. It was amazing.

[Note: I doubt the choice of poem had anything to do with it, but it was Jack Be Nimble.]

Many of you asked if it lasted. It did last, for several days. Then I got a cold, my throat got funky, I had to speak different because of the cold, and lost it. After the cold wore off, it took a few weeks to get back to my current “okay” voice.

At the moment I can speak okay most of the time in quiet conversation. In other words, if there is no background noise, I can talk almost as if I never had the problem. That’s a HUGE improvement over the past.

But I still can’t speak in noisy environments. That’s common with this condition, and it has nothing to do with the need to speak loudly to talk over the noise. It has something to do with the outside sound coming into my brain and somehow disabling my speech function. If I cover my ears, I can speak almost normally.

Unfortunately for me, the world is a noisy place. So outside of conversations with my family at home, I still can’t have a normal conversation.

Today I am flying to Los Angeles to spend a week with Dr. Morton Cooper. He claims to be able to cure this problem completely – in many if not most cases – using his own brand of intensive voice exercises and feedback. I’ve communicated directly with several people who say that he did indeed fix their voices. The medical community’s reaction to his decades of curing this problem is that they say each of his cures is really just a case of a person who was misdiagnosed in the first place, since spasmodic dysphonia is incurable BY DEFINITION. But many of his cures have involved patients referred by the top specialists in the field of spasmodic dysphonia. So if they are all misdiagnosed, that would be a story in itself. Maybe I’m lucky enough to be misdiagnosed too.

I’m not sure how much blogging I will be able to do this week. I’ll let you know at the end of the week just how it went. It’s not a sudden cure, and would involve continued voice exercises to speak in the "correct" way, but I am told to expect significant progress after a week.

Wish me luck.

January 16, 2007—Apparently I’m Spoiled

I like to stay at whatever hotel is nearest the place I need to be. Sometimes that’s a 4-star luxury hotel. Sometimes – such as today – it’s more of a “what’s a star?” situation. My first clue that this isn’t the Bellagio presented itself when I called ahead to make sure they would hold my room if I checked in after 11 pm.

“That’s no problem. Our office closes at eleven, but I’ll just leave your room unlocked and the key on the bed.”

And they did. That method worked surprisingly well, although there’s always that tense first moment when you open the door and wonder how many hobos have already used the bed before you got there.

The room itself is about the size of the bed plus a generous allowance of leg room for people who do not have thick legs. I decided to go light on the continental breakfast available in the lobby across the courtyard because I’m only a few ounces of leg weight from being trapped between the bed and the wall.

The room’s decorating scheme is best described as “grandma’s jail cell.” The furniture makes a statement. And that statement is “I’ve fallen, and I can’t get up.”

Somehow the decorators have managed to capture the feeling of claustrophobia, old age, and correctional facility all in one.

As I brushed my teeth, I couldn’t help staring at the tile behind the sink that has separated from the wall and is waiting for the next large truck to drive by outside before it completes its journey to the top of my foot.

The television is made by a company called Daewoo. I’m guessing that’s a Korean company. Possibly North Korea. It looks hungry yet oddly belligerent.

The heating and cooling unit is inexplicably located on the wall just below the ceiling line. It’s operated by a remote. I didn’t understand this arrangement until I tried to use the remote and it didn’t work. Or at least I couldn’t figure it out.

Allow me to digress for a moment. Is there any real reason that your thermostat needs to have a setting for both “heat” and “cool” and ALSO a place to set your preferred temperature? Why the @$!& can’t I just put it on the temperature I want and let the frickin’ thermostat decide on its own whether it needs to make me warmer or colder to achieve that goal? Is that so hard?

Sorry. I had to get that out.

Anyway, after putting on my winter coat inside my hotel room, on the coldest day of the year (It’s about 30 degrees in California) and fussing endlessly with the remote control to no avail, it all became clear. They put the heating and cooling unit up by the ceiling so you won’t beat it to pieces with grandma’s furniture.

The blanket on my bed has the most fascinating huge stain in the center. It does not have irregular edges like you would expect from a spill or a spooge. It has perfectly straight edges, as if someone left the iron on the bed. Normally I wouldn’t think anyone was dumb enough to leave a hot iron on a bed, but if this place has “regulars” then it’s safe to say that they might.

I have to go get my voice fixed now.

January 17, 2007

I’m off to another day of voice rehabilitation. So far, I can hum really well.

January 22, 2007—Voice Update

As regular readers know, about two years ago I lost my ability to speak. The problem is called spasmodic dysphonia (SD). This update is primarily for the benefit of the other people with SD. Many of you asked about my experience and for any advice. The rest of you will find this post too detailed. Feel free to skip it.

First, some background.

There are two types of spasmodic dysphonia.

Adductor: The vocal cords clench when you try to speak, causing a strangled sound. (That is my type.)

Abductor: The vocal cords open when you try to speak, causing a breathy whisper.

You can get more complete information, including hearing voice clips, at the National Spasomodic Dysphonia Association (NSDA) web site: http://www.dysphonia.org/

The NSDA site describes the two medical procedures that are recommended by medical doctors:

  1. Botox injections to the vocal cords, several times per year for the rest of your life.
  2. Surgery on the vocal cords – a process that only works sometimes and has the risks of surgery.

What you won’t find at that site is information about Dr. Morton Cooper’s method of treating spasmodic dysphonia, using what he calls Direct Voice Rehabilitation. I just spent a week with Dr. Cooper. Dr. Cooper has been reporting “cures” of this condition for 35 years. He’s a PH.d, not MD, and possibly the most famous voice doctor in the world.

According to Dr. Cooper, the NSDA receives funding from Allergan, the company that sells Botox. Dr. Cooper alleges, in his new self-published book, CURING HOPELESS VOICES, that Allergan’s deep pockets control the information about spasmodic dysphonia, ensuring that it is seen as a neurological condition with only one reliable treatment: Botox. I have no opinion on that. I’m just telling you what Dr. Cooper says.

Botox shots are expensive. Your health insurance would cover it, but I heard estimates that averaged around $2,500 per shot. I believe it depends on the dose, and the dose varies for each individual. Each person receiving Botox for spasmodic dysphonia would need anywhere from 4 to 12 shots per year. Worldwide, Dr. Cooper estimates that millions of people have this condition. It’s big money. (The “official” estimates of people with SD are much lower. Dr. Cooper believes those estimates are way off.)

I have no first-hand knowledge of Allergan’s motives or activities. I can tell you that Botox worked for me. But it only gave me a “good” voice about half of the time. Individual results vary widely. Even individual treatments vary widely. I think I had about 5 treatments. Two were great. Two were marginal. One didn’t seem to help much. And the shots themselves are highly unpleasant for some people (but not very painful).

I’ve heard stories of people who feel entirely happy with Botox. For them, it’s a godsend. And I’ve heard stories of people who had okay results, like mine. Dr. Cooper says that people with the abductor type of dysphonia can be made worse by Botox. I know one person with the abductor type who lost his voice completely after Botox, but temporarily. Botox wears off on its own. It’s fairly safe in that sense.

I can tell you that Dr. Cooper’s method worked for me, far better than Botox. (More on that later.) And you can see for yourself that the NSDA web site doesn’t mention Dr. Cooper’s methods as an option. It doesn’t even mention his methods as something that you should avoid. It’s conspicuous in its absence.

Dr. Cooper claims that spasmodic dysphonia is not a neurological problem as is claimed by the medical community. He claims that it is caused by using the voice improperly until you essentially lose the ability to speak correctly. Most people (including me) get spasmodic dysphonia after a bout with some sort of routine throat problem such as allergies or bronchitis. The routine problem causes you to strain your voice. By the time the routine problem is cleared up, you’ve solidified your bad speaking habits and can’t find your way back. Dr. Cooper’s methods seek to teach you how to speak properly without any drugs or surgery.

Some people get spasmodic dysphonia without any obvious trigger. In those cases, the cause might be misuse of the voice over a long period of time, or something yet undiscovered.

Botox Versus Dr. Cooper

Botox worked for me. It was almost impossible for me to have a conversation, or speak on the phone, until I got my first Botox shot.

But I had some complaints with the Botox-for-life method:

  1. Botox made my voice functional, but not good. There was an unnatural breathiness to it, especially for the week or two after the shot. And the Botox wore off after several weeks, so there was always a period of poor voice until the next shot.
  2. It looked as if I would need up to ten shots per year. That’s ten half days from my life each year, because of travel time. And the dread of the shot itself was always with me.
  3. The shots aren’t physically painful in any meaningful way. But you do spend about a minute with a needle through the front of your throat, poking around for the right (two) place in the back of your throat. Your urges to cough and swallow are sometimes overwhelming, and that’s not something you want to do with a needle in your throat. (Other people – maybe most people – handle the shots without much problem.)
  4. I couldn’t do public speaking with my “Botox voice.” It was too weak to project on stage. People with spasmodic dysphonia can often sing and act and do public speaking without symptoms. That was my situation. Public speaking is a big part of my income.

I used Botox to get through the “I do” part of my wedding in July of 2006. Then I took a break from it to see if I could make any gains without it. My voice worsened predictably as the last Botox shot wore off. But it stopped getting worse at a “sometimes okay, often bad” level that was still much better than the pre-Botox days.

I could speak almost perfectly when alone. I could speak well enough on stage. I could sing. About half of the time I could speak okay on the phone. In quiet conversations I was okay most of the time. But I could barely speak at all if there was any background noise.

Do you know how often you need to talk in the presence of background noise? It’s often. And it wasn’t just a case of trying to speak over the noise. There’s something mysterious about spasmodic dysphonia that shuts off your ability to speak if there is background noise.

As I wrote in a previous post, one day I was practicing my speaking with a nursery rhyme at home. Something happened. My normal voice returned. It happened suddenly, and it stuck. The media picked up the story from my blog and suddenly it was national news.

My voice stayed great until I caught a cold a few weeks later. The cold changed my speaking pattern, and I regressed. With practice, I brought it back to the point where I could have quiet conversations. But I was still bedeviled by background noise and sometimes the phone. Despite my lingering problems, it was still amazing that anyone with spasmodic dysphonia would have that much of a spontaneous recovery. I’ve yet to hear of another case. But it wasn’t good enough.

After the media flurry, I got a message from Dr. Cooper. He listened to me on the phone, having an especially bad phone day, and he said he could help. I listened to his spiel, about how it’s not really a neurological problem, that he’s been curing it for years, and that the medical community is in the pocket of Allergan.

Dr. Cooper is what can be described as a “character.” He’s 75, has a deep, wonderful voice, and gives every impression of being a crackpot conspiracy theorist. His price was $5K per week, and he reckoned from my phone voice that I needed at least a week of working with him, with a small group of other spasmodic dysphonia patients. Two weeks of work would be better. (The hardcore cases take a month.) I would have to fly to LA and live in a nearby hotel for a week. So it’s an expensive proposition unless you can get your insurance to pay for it. (Sometimes they do if you have a referral from a neurologist.)

Needless to say, I was skeptical. Dr. Cooper sent me his DVD that shows patients before and after. I still wasn’t convinced. I asked for references. I spoke with a well-known celebrity who said Dr. Cooper helped him. I heard by e-mail from some other people who said Dr. Cooper helped them.

You can see video of before and after patients on his web site at: http://www.voice-doctor.com/

I figured, What the hell? I could afford it. I could find a week. If it didn’t work after a few days, I could go home.

With Dr. Cooper’s permission, I will describe his theory and his treatment process as best I can.

Theory

People with spasmodic dysphonia (SD) can’t hear their own voices properly. Their hearing is fine in general. The only exception is their own voices. In particular, SD people think they are shouting when they speak in a normal voice. I confirmed that to be true with me. I needed three other patients, Dr. Cooper, a recording of me in conversation, and my mother on the telephone to tell me that I wasn’t shouting when I speak normally. It has something to do with the fact that I hear my own voice through the bones in my head. In a crowded restaurant, if I speak in a voice to be heard across the table, I am positive it can be heard across the entire restaurant. Most SD patients have this illusion.

People with SD speak too low in the throat, because society gives us the impression that a deep voice sounds better. Our deep voice becomes so much a part of our self image and identity that we resist speaking in the higher pitch that would allow us to speak perfectly. Moreover, DS people have a hugely difficult time maintaining speech at a high pitch because they can’t hear the difference between the higher and lower pitch. Again, this is not a general hearing problem, just a problem with hearing your own voice. I confirmed that to be true with me. When I think I am speaking like a little girl, it sounds normal when played back on a recording.

(People with abductor SD are sometimes the opposite. They speak at too high a pitch and need to speak lower. That doesn’t seem to be a societal identity thing as much as a bad habit.)

Since SD people can’t “hear” themselves properly, they can’t speak properly. It’s similar to the problem that deaf people have, but a different flavor. As a substitute for hearing yourself, Dr. Cooper’s voice rehabilitation therapy involves intensive practice until you can “feel” the right vibration in your face. You learn to recognize your correct voice by feel instead of sound.

People with SD breathe “backwards” when they talk. Instead of exhaling normally while talking, our stomachs stiffen up and we stop breathing. That provides no “gas for the car” as Dr. Cooper is fond of saying. You can’t talk unless air is coming out of your lungs. I confirmed this to be true for all four patients in my group. Each of us essentially stopped breathing when we tried to talk.

The breathing issue explains to me why people with SD can often sing, or in my case speak on stage. You naturally breathe differently in those situations.

Dr. Cooper's Method

He calls it Direct Voice Rehabilitation. I thought it was a fancy marketing way of saying “speech therapy,” but over time I came to agree that it’s different enough to deserve its own name.

Regular speech therapy—which I had already tried to some degree—uses some methods that Dr. Cooper regards as useless or even harmful. For example, a typical speech therapy exercise is to do the “glottal fry” in your throat, essentially a deep motorboat type of sound. Dr. Cooper teaches you to unlearn using that part of the throat for ANYTHING because that’s where the problem is.

Regular speech therapy also teaches you to practice the sounds that give you trouble. Dr. Cooper’s method involves changing the pitch and breathing, and that automatically fixes your ability to say all sounds.

To put it another way, regular speech therapy for SD involves practice speaking with the “wrong” part of your throat, according to Dr. Cooper. If true, this would explain why regular speech therapy is completely ineffective in treating SD.

Dr. Cooper’s method involves these elements:

  1. Learning to breathe correctly while speaking
  2. Learning to speak at the right pitch
  3. Learning to work around your illusion of your own voice.
  4. Intense practice all day.

While each of these things is individually easy, it’s surprisingly hard to learn how to breathe, hit the right pitch, and think at the same time. That’s why it takes anywhere from a week to a month of intense practice to get it.

Compare it to learning tennis, where you have to keep your eye on the ball, use the right stroke, and have the right footwork. Individually, those processes are easy to learn. But it takes a long time to do them all correctly at the same time.

Nuts and Bolts

I spent Monday through Friday, from 9 am to 2 pm at Dr. Cooper’s office. Lunchtime was also used for practicing as a group in a noisy restaurant environment. This level of intensity seemed important to me. For a solid week, I focused on speaking correctly all of the time. I doubt it would be as effective to spend the same amount of time in one hour increments, because you would slip into bad habits too quickly in between sessions.

Dr. Cooper started by showing us how we were breathing incorrectly. I don’t think any of us believed it until we literally put hands on each others’ stomachs and observed. Sure enough, our stomachs didn’t collapse as we spoke. So we all learned to breathe right, first silently, then while humming, and allowing our stomachs to relax on the exhale.

The first two days we spent a few hours in our own rooms humming into devices that showed our pitch. It’s easier to hum the right pitch than to speak it, for some reason. The point of the humming was to learn to “feel” the right pitch in the vibrations of our face. To find the right pitch, you hum the first bar of the “Happy Birthday” song. You can also find it by saying “mm-hmm” in the way you would say if agreeing with someone in a happy and upbeat way.

The patients who had SD the longest literally couldn’t hum at first. But with lots of work, they started to get it.

Dr. Cooper would pop in on each of us during practice and remind us of the basics. We’d try to talk, and he’d point out that our stomachs weren’t moving, or that our pitch was too low.

Eventually I graduated to humming words at the right pitch. I didn’t say the words, just hummed them. Then I graduated to hum-talking. I would hum briefly and then pronounce a word at the same pitch, as in:

mmm-cow
mmm-horse
mmm-chair

We had frequent group meetings where Dr. Cooper used a 1960s vintage recorder to interview us and make us talk. This was an opportunity for us all to see each other’s progress and for him to reinforce the lessons and correct mistakes. And it was a confidence booster because any good sentences were met with group compliments. The confidence factor can’t be discounted. There is something about knowing you can do something that makes it easier to do. And the positive feedback made a huge difference. Likewise, seeing someone else’s progress made you realize that you could do the same.

When SD people talk, they often drop words, like a bad cell phone connection. So if an SD patient tries to say, “The baby has a ball,” it might sound like “The b---y –as a –all.” Dr. Cooper had two tricks for fixing that, in addition to the breathing and higher pitch, which takes care of most of it.

One trick is to up-talk the problem words, meaning to raise your pitch on the syllables you would normally drop your pitch on. In your head, it sounds wrong, but to others, it sounds about right. For example, with the word “baby” I would normally drop down in pitch from the first b to the second, and that would cause my problem. But if I speak it as though the entire word goes up in pitch, it comes out okay, as long as I also breathe correctly.

Another trick is humming into the problem words as if you are thinking. So when I have trouble ordering a Diet Coke (Diet is hard to say), instead I can say, “I’ll have a mmm-Diet Coke.” It looks like I’m just pausing to think.

Dr. Cooper invented what he calls the “C Spot” method for finding the right vocal pitch. You put two fingers on your stomach, just below the breastbone, and talk while pressing it quickly and repeatedly, like a fast Morse code operator. It sort of tickles, sort of relaxes you, sort of changes your breathing, and makes you sound like you are sitting on a washing machine, e.g. uh-uh-uh-uh. But it helps you find your right pitch.

Dr. Cooper repeats himself a lot. (If any of his patients are reading this, they are laughing at my understatement.) At first it seems nutty. Eventually you realize that he’s using a Rasputin-like approach to drill these simple concepts into you via repetition. I can’t begin to tell you how many times he repeated the advice to speak higher and breathe right, each time as if it was the first.

Eventually we patients were telling each other to keep our pitches up, or down. The peer influence and the continuous feedback were essential, as were the forays into the noisy real world to practice. Normal speech therapy won’t give you that.

Toward the end of the week we were encouraged to make phone calls and practice on the phone. For people with SD, talking on the phone is virtually impossible. I could speak flawlessly on the phone by the end of the week.

Results

During my week, there were three other patients with SD in the group. Three of us had the adductor type and one had abductor. One patient had SD for 30 years, another for 18, one for 3 years, and I had it for 2. The patients who had it the longest were recommended for a one month stay, but only one could afford the time to do it.

The patient with SD for 3 years had the abductor type and spoke in a high, garbled voice. His goal was to speak at a lower pitch, and by the end of the week he could do it, albeit with some concentration. It was a huge improvement.

The patient with SD for 30 years learned to speak perfectly whenever she kept her pitch high. But after only one week of training, she couldn’t summon that pitch and keep it all the time. I would say she had a 25% improvement in a week. That tracked with Dr. Cooper’s expectations from the start.

The patient with SD for 18 years could barely speak above a hoarse whisper at the beginning of the week. By the end of the week she could often produce normal words. I’d say she was at least 25% better. She could have benefited from another three weeks.

I went from being unable to speak in noisy environments to being able to communicate fairly well as long as I keep my pitch high. And when I slip, I can identify exactly what I did wrong. I don’t know how to put a percentage improvement on my case, but the difference is life changing. I expect continued improvement with practice, now that I have the method down. I still have trouble judging my own volume and pitch from the sound, but I know what it “feels” like to do it right.

Dr. Cooper claims decades of “cures” for allegedly incurable SD, and offers plenty of documentation to support the claim, including video of before-and-afters, and peer reviewed papers. I am not qualified to judge what is a cure and what is an improvement or a workaround. But from my experience, it produces results.

If SD is a neurological problem, it’s hard to explain why people can recover just by talking differently. It’s also hard to understand how bronchitis causes that neurological problem in the first place. So while I am not qualified to judge Dr. Cooper’s theories, they do pass the sniff test with flying colors.

And remember that nursery rhyme that seemed to help me the first time? Guess what pitch I repeated it in. It was higher than normal.

I hope this information helps.