Vocal Health: what i wish i could have told my younger self when i was diagnosed with nodules…

I was in my second year at ArtsEd when I was diagnosed with ‘soft nodules.’ Finally. A name for the huskiness, inconsistency and loss of range.  I was given a clear treatment plan by an expensive and highly regarded doctor with many letters after his name.  After a scope down my throat, he offered his diagnosis with brusque dismissal and impersonal certainty.

The relief of this diagnosis and a treatment plan was second only to the relief I felt, a decade later, when I gave up singing professionally because these treatments hadn’t worked. It was only after I started coaching, that I understood why it would have been impossible for me to overcome the vocal issues that remained with me. 

I remember everything about that time. The bearded doctor treated me more like a pair of vocal cords than a human being, but that was okay; my vocal cords were the most important thing to me, too. They were the love of my life and I was ready to do anything I could to protect them.

He told me that soft nodules would become hard nodules if I didn’t follow his advice. 

‘Complete vocal rest for a week,’ he said, ‘Write, don’t talk.’ I walked around college wearing a notebook with pride. Any frustration was menial compared to the avenue of hope that had opened up. These nodules explained everything but soon they would be gone and I would sing with ease again! Friday night, in the student bar, I drank water, imagining my high notes gratefully glugging the hydration. He sent me for three sessions with a speech therapist who made me hiss like a snake. She had awards all over her walls. I could feel my vocal cords healing.

Then there was the prescription for Gaviscon.

‘It’s like leaving your violin in acid overnight,’ he’d commented on the effects of the reflux he’d diagnosed, ‘Think about how that would affect it…’

I did. I thought about it all night long, imagining the erosive acid on my fragile, nodule-d vocal cords and couldn’t sleep for fear – fear of losing my future and fear for the performances the following day.

But, this cardboard rectangle with capsules that would make everything okay. The pills were sunlit stepping stones across the uphill swamp to the future: a future in which I could sing again with the freedom I used to feel.

If I’d have known then, that the swamp would last for the next decade, that my prescription would be upped gradually over the next five years until they tied my stomach in a knot, and that I would be chasing stepping stones – or treatments – like an addict, would I have stopped then? 

I know the answer with certainty. No. Even after what happened next, singing has still been one of the greatest loves of my life and continues to be so: from the time ‘before nodules’ when vocalisation ‘just happened,’ to now, as a coach. It’s the closest I have got to believing in something bigger, to flying, to being fully alive, and I feel privileged to have spent my life exploring it. 

So what would I say to myself now, if the young me, from half a life time away, booked in a session, or came for some advice? Would I still use anything from that initial treatment plan or try something else?

Over the next decade you’re going to see many experts: vocal coaches, doctors, nutritionists, hypnotherapist, and get advice from colleagues and friends…

I would start with saying this,

‘Over the next decade you’re going to see many experts: vocal coaches, doctors, nutritionists, hypnotherapist, and get advice from colleagues and friends. You’re going to read many conflicting articles and spend a lot of money and take a lot of prescription drugs and natural medicines. Although much of this advice is great advice, you will feel lost. They will give you what they can in the hour you see them, but they cannot fix this. This is not their fault. They have their own journeys and this is yours. 

I would say that none of the advice or exercises will work, unless you first understand the relationship between the mind and the body and the physical manifestations of stress and anxiety. That the body and mind are, in fact, inseparable. Start inside and build out.  

I would explore how that fear would have put my body in a state of high stress, a sense of being under attack, sending my sympathetic nervous system under attack, into a state of fight, flight, or freeze. I’d try to explain how those brain signals inform our physiology. To start exploring the difference between para-sympathetic and sympathetic states and how, in this massively impacts digestion – even with all the Gaviscon in the world, I didn’t stand a chance at managing the reflux. 

This would start a spiral: reflux caused voice loss, fear of voice loss caused reflux.

I would try and explain how the state of my nervous system – or my sense of ‘safety’ also affected vocalisation. I’d talk about the wonders of the Vagus nerve and how to stimulate it, to activate a state of calm so our vocal system can respond to the signals in the music and storytelling, so our digestion is optimised and our mental and physical health improves. 

I’d explore the assumptions or misunderstanding around the direction I’d been given to ‘save my voice,’ or ‘not to push,’ and how those words can counteract good singing technique. 

In fearing ‘pushing,’ was I fearing the muscularity of adduction (cord closure)? Was I holding my breath? Were my cords unable to function without the subglottic pressure needed? I remember the days choosing songs that  used a light breathy tone that I perceived as a save ‘head voice’ but that that perpetuated poor support, a high larynx, lack of cord closure and a tense jaw 

In caution was I ‘holding’ my jaw. In restraining, was I creating tongue tension? 

I’d got through graduation. I was hit and miss in auditions. I’d arrive hours early, sitting in coffee shops across the road from the audition venues in a state of terrified limbo. I’d enter the room on a tide of hopes, prayers and wishes, pleading with anything out there for the notes to come out. I got recalls on good days and was politely steered out the doors on bad days. It was like tightrope walking with crocodiles below.  

I got my first West End job, then another one. I loved it. I was covering a lead and thank goodness I had warning when she pre-booked a night off for dental surgery. I had time to go on complete vocal rest, to stop drinking for a week.  By now I was learning that I could manage my voice if I stopped everything else: eating, drinking, speaking, socialising…

That was the only way I got through the following years. I was lucky enough to keep getting work, but all other life stopped which only added to the pressure I was putting on myself. Despite seeking out singing teachers and going to the speech therapists my voice was profoundly inconsistent which I think was down to a perception of these people as infallible.  

I was so eager to conquer this, that I took everything I was told and didn’t ask why: why are you making me sob or hiss? Why is it easier on a certain vowel? Why the chopstick between my teeth? 

If I could go back, I could explain that in was probably the tongue position of the EE vowel, the larynx freedom or ’tilt,’ and openness on the sob and the jaw release with the chopstick. We could look at how to transfer these techniques into song, via awareness and repetition. 

In 2005, during a run of Joseph at the New London theatre, my reflux medication was ten times what was recommended. The doctors kept upping it and I just kept popping. The side effects made me so anxious, I was unable to sit still – god knows what it was doing to my nervous system and the subsequent connections with digestion. The other drugs caused a deep fatigue that pulled me under the covers in the middle of the day whilst the anxiety wouldn’t let my body stay still.

I did what the doctors said and kept taking the medication. I paid hundreds of pounds to see a nutritionist but, but then, I was on so many acid suppressants that if I stopped I’d wake choking on my own stomach acid, unable to breathe.




She told me to avoid tomatoes and chilli, then asked for more money.

At this point, my voice had started to mysteriously disappear mid show, from all to nothing. There was a new terror. I’d stand in the wings, hearing the sound of a full auditorium and leave my body. There was a high chance at this stage that I was about to implode into a stratospheric failure. This is when I first learn that I was the ‘freeze’ in fight, flight or freeze. A new default started to occur where I slept walked my way through performing, hovering somewhere above, trying my hardest to flee.

How I wish now, that someone had handed me a straw, some SOVT exercises and taught me some mental strategies to calm the hell down.

Instead, the doctors instructed a Nissen Fundoplication, tying my oesophagus in a knot. I was twenty three and nodded along. They were the grown ups, they were the ones with letters after their name. 

I tried giving up the job and going travelling but on the day I booked my flights, I got my first lead role and left for a year on tour. It was a dream come true. A cast of performers I idolised and a director and creative team that made you feel you could be the best version of yourself. Each second in the rehearsal room felt deeply precious. Time moved in slow motion as I tried to absorb each second.

Yet, the cloud of fear hovered. Six weeks in, I hadn’t lost my voice yet, but we were moving into theatres now, friends and agents were coming to watch, Andrew Lloyd Webber was in, the director was watching! The memories of humiliation haunted and the fear of losing my voice again started to take over everything.

I used a vocal steamer twice a day for twenty minutes, probably burning my vocal cords on the just boiled water. I was extensively warming up, using endless warm ups from all the expensive vocal coaches I’d seen. I’d warm up with the cast, then alone in my own dressing room, then again before the next act and evening show.

I had started to understand the benefits of using meditation, playing music as loud as it would go through headphones until the fear was drowned out but my warm ups were so acrobatic, and without awareness or sense. I was introduced briefly to Alexander Technique by a fellow cast member and experience a complete vocal regeneration in fifteen minutes of body scanning yet explained it away as, ‘luck’ because it seemed too easy and I was so used to thinking that success were the result of ‘effort.’ 

Writing helped. That was my only saviour as it offered some of the stabilising meditative qualities yet it brought me too much into my head and out of my body, out of balance, and breath and awareness. I was looking for certainty.   

That is probably why it felt such relief when, at the end of that job, I told my agent I didn’t want to sing any more.

I had to be perfect, something I could never have been, so would always fail.

I wanted to spend my life singing and exploring singing, but not necessarily performing, and there is a big difference. Ironically, after stopping performing, I’ve have spent the next decade enjoying singing for a job and never loosing my voice again.

I wanted to share this before this evening’s class – and what I’ve shared is only the surface of it. It’s influenced all my teaching since, and my urge to help other singers. In class we’ll be looking at the general vocal health rather than rehabilitation and the effects of hormones, fatigue, muscle tension, over work, bad technique, habitual patterns, diet, mental health and some things you can do to on a daily basis to keep in top vocal condition. Book the class here

I’ll sign off with this:

Close your eyes, take a deep breath. Your voice is you. It is not a pet to tell what to do, It is not engineering to ask someone else to repair. It is your breath, it is what you use to communicate with the world. It responds to your nervous system, the motions of your limbs, it’s intertwined with your memories.

​Aim for awareness. Feel how everything feels. You know your voice better than anyone else. Any command, any piece of advice, is one colour in your picture. Stop going to people for answers and instead go to people to learn from them. There is a difference.

It is not your land to conquer and dominate, but to explore and play with. For like our world there are parts we will never fully understand.



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