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The Story Behind The Song
My recent song, “You Got Me Singing Again,” could be interpreted as a love song for someone whose help has made all the difference in the singer’s life. That’s fine. More likely, it could be viewed as having a gospel origin. That too is fine. But the real inspiration for this song is as a tribute to a medical team who, through skill and care, not only saved my life by removing two different cancers from my neck right next to my vocal chords, but also saved at least some substantial portion of my former abilities as a singer. Perhaps you know care givers who have “given the hourglass of your life another inch of sand,” as the song says. These days it takes an entire team of professionals to supply just that inch of sand. This song is for all of them.
Background
Singing is a surprisingly complex skill, requiring knowledge of music, language, and interpretation. The source of singing (and speaking) lies in the larynx (the voice box or Adam’s apple), located in the front of the neck. The neck itself is chiefly used as a pivoting connector attaching the head to the body, enabling air to travel from the nose to the lungs and food and water to travel from the mouth to the stomach, as well as the conduit for the blood supply going up to the brain and the drainage of the lymphatic system down from the head.
A complicated structure of interlocking muscles called the pharynx (basically the back of the mouth and tongue) detects and automatically directs things to the proper destination. This very complicated mechanism is sustained and lubricated by saliva generated in the mouth, which performs a variety of tasks. It carries things to the stomach, lubricating the pathway and dissolving soluble foods like sugar. It helps prevent bacterial infections in the mouth and it begins to digest some foods like starches right away, which is part of the reason those foods taste good. It also wets the breathing side of the pharynx and keeps the tissues creating and controlling the voice working properly.
Inside the larynx are the V-shaped vocal folds (or chords), which lie on either side of an opening in the larynx about the size of your thumbnail. One primary function of these folds is to close the airway so that foreign objects don’t end up in the lungs. Another is to trap the lungs full of air, making the torso more rigid so the muscles work better. That’s why we grunt when we strain to lift something: the grunt is caused by air escaping past the vocal folds during the exertion. Humans long ago figured out that by forcing air to flow past the vocal folds in a controlled manner and making alterations to the shape of the mouth and throat, sounds would emanate that could carry complex information, which we call speech. The vocal folds themselves can be trained to vibrate at specific frequencies while forming words, which we call singing. What takes just a few words to describe can take a lifetime to learn and few people, least of all me, would ever claim to have mastered it.
Getting Into Singing
I didn’t give much thought to my voice as a kid. We learn how to speak (and sing) indirectly, since we have virtually no conscious control over the structures that create the voice. Instead, we use the somewhat metaphorical technique of forming vowels, which we can only do indirectly and which involves a complex set of nerves and muscles in a specific algorithm to make an “e” sound, for instance. Learning to play piano, by contrast, involves pressing the piano keys with the fingers in a specific pattern, which we learn to do directly, consciously telling our fingers how hard to strike the key and what the sequence is between fingers.
One distinct difference between boys and girls is that as most boys reach their teens, the testosterone in their bodies causes the larynx to grow more prominent and rigid than a girl’s. (That’s why it’s Adam’s apple and not Eve’s.) When this happens, the boy’s voice changes, going through an awkward phase until the final size and shape is achieved. A surprising amount of our self-image is tied to the sound of our own voices and when the voice doesn’t work right, or begins to change, it can both frustrating and disconcerting.
I took my (speaking) voice for granted until just about the time it started to change. In junior high I came down with a throat infection that gave me laryngitis for about a month. My weak voice caused a lot of snickers among my classmates and made it difficult for me to participate in class discussions. I was already relatively shy and this problem didn’t make it better. I didn’t volunteer in class much.
About that same age, I established a couple of benchmarks that I would try to live by, which have proven surprisingly durable. One was that I didn’t want to have children unless I was really sure I could provide such a child a decent home life. (I never had children.) Another was that I felt like it was every person’s right and obligation to decide for one’s self how long life would last and what would constitute intolerable conditions that would justify cutting life unnaturally short. I’ve had some downturns in my life that made me stop and think hard about my options but I’ve managed to make my mid-seventies as of this writing. So things have been mostly tolerable.
Another event that happened at this age for me was that the Beatles invaded from England and I, like many other boys in my age group, began to see the advantage to being able to sing: the singers got the chicks. So I learned to play some rudimentary guitar to accompany myself as a singer, since playing my instrument, drums, didn’t work for an accompaniment. I was a pretty good drummer, though, and eventually landed a gig with a house band in a steak house playing drums with piano and bass, backing a blonde woman who sang a wide repertoire of standards like “Stardust” and “Tie A Yellow Ribbon.” When she was taken ill, I found myself having to cover the vocals for the songs, since neither the pianist nor the bass player sang at all. So, never having sung on stage, I was suddenly thrust into the lead singer role. It wasn’t easy. Drums are noisy and have to be played right on the beat, whereas vocals are fairly quiet and depend on being able to hear the melodic instruments, and are usually sung a bit behind the beat. I didn’t last long.
In my late twenties I got a gig as a drummer/part-time guitarist in a Top-40 band called Tight Squeeze. I started as “just the drummer” but we soon found that I could sing pretty good harmonies, doing parts that were either too high or too low for the other singers. Soon I was singing a few leads as well and singing something on most songs.
After dealing with a persistent sore throat for several weeks, I discovered I had developed what’s called a node on one of my vocal chords, a formless lump that sometimes develops on the vocal fold itself and interferes with both speech and singing. An Ear, Nose, and Throat (ENT) specialist diagnosed me and recommended he do a minor surgery to remove the node and biopsy it, since it developed in an unusual location. Happily, the node didn’t contain any cancer and I was singing again within a week.
Nearly Getting Out Of Singing
When Tight Squeeze went the way of all bands, I got a house gig as a drummer with a country band called Colorado Gold. Since I wasn’t traveling at the time, I took vocal lessons from a couple of local vocal coaches but one wanted to train me to be an opera singer and the other taught me what turned out to be not only a bad vocal technique but one that actually made my voice weaker.
By that time, I was trying, like my father before me, to make a living as a musician. (It seems almost quaint these days.) I was fed up with trying to depend on flaky side musicians so I worked up a solo act, just me sitting on a stool playing guitar and singing whatever people wanted to hear. But what they wanted to hear was often rock music that just didn’t work as a solo guitar song. At that time drum machines were new, crappy, and very expensive, but I was already a drummer. So I borrowed a friend’s garage and set up my primitive recording equipment and recorded actual drum parts to the songs. (I still used some of those recordings on my last night performing nearly forty years later.) I bought a cheap bass guitar too and eventually added a harmony vocal and ended up putting out a fair amount of sound for just one guy. With my dad’s help (he was a great keyboard player), I invested in a versatile Yamaha DX-7 synthesizer, which gave me all sorts of keyboard and orchestral sounds. (It figures largely in the recording of this particular song.) Then I bought an 8-track reel-to-reel recorder and suddenly I could really sound like a large orchestra. I could also record good, accurate vocal harmonies, which made singing lead that much easier.
But the solo act put more pressure on my voice, since I had to sing the lead for every song, often singing and playing four hours or more a night in smoky bars five or six nights a week. Sore throats became the bane of my existence. One time on a road trip to California, my voice just quit after a couple of songs. I saw a local ENT specialist, who gave me meds that got me past that incident but he highly recommended I either quit singing or learn how to do it right.
At that time I was living in Renton, Washington, south of Seattle. When I got back home, I called a vocal teacher who agreed to take me on. His name was Paul Ingam and he had been a teacher and researcher in vocal techniques and problems at the University of Washington, now retired. He was a remarkable teacher with an exquisite voice and he soon pointed me in a better direction as a singer, mostly involving breath control. The results were quick and amazing: my tired voice had forced me to take a break every hour but I soon found myself able to sing a full night with just a single break.
But as I said, you can’t teach someone to sing by describing what to do with their larynx. I had locked in bad habits over many years and I spent many frustrating hours trying to understand what Paul was trying to teach me. Indeed, he was a good enough teacher that sometimes even years later I finally figured out how to do what he was trying to teach me. But he steered me right and in the last decade of my career while in my 60s, I often played a full four-hour set without a break because my voice was so strong. (I also learned that singing means breathing about three times more than resting, which dissipates much more water from your lungs, which means your bladder doesn’t fill as fast. In case you were wondering.) My last night of work on stage at nearly age 70, I took just one break to visit with friends and I could have sung another hour after the four.
Retirement
I was booked for a 28th year at that same job, Fairmont Hot Springs, the most popular attraction in Montana, but fate intervened. That winter, Covid-19 became an out-of-control pandemic and the contracts I had for the next year got canceled, which marked the end of my performing career, at least with the solo act I’d been playing for decades. It was a financial and psychological blow but the silver lining was that I didn’t have to depend on my voice to earn a living anymore.
Covid became even worse the next winter but my solitary lifestyle protected me from it. Since an aspect of my life as a traveling musician was that I had to be able to live indefinitely on the road, I decided to head down to Arizona and spend at least part of the winter camping.
Sometime during that winter, I noticed a hard lump under the left side of my jaw that didn’t go away. Nearly a couple of decades before I’d had a routine prostate exam to qualify for health insurance, which found that my PSA was just over the limit, so no insurance company would cover me. (The state of Colorado, using unclaimed funds, set up an insurance program for people like me, but it was mandated to be one and a half times more expensive than average health insurance rates. With my very high deductible, that insurance didn’t pay for anything else and ended up costing me about a third of my gross income until I finally qualified for Medicare at age 65. The Affordable Care Act was designed to help people like me.) Since I caught the cancer early, treatment with radioactive cesium seeds inserted directly into my prostate was successful. The experience made me extra vigilant.
When I got back to Colorado, I asked my doctor about this odd lump under my jaw and he was puzzled too. He referred me to a local ENT to have it checked out. This specialist ordered a needle biopsy and a PET scan and found out that I had cancer that had originated somewhere above that lump, which was a swollen lymph node. But the doctor had had a boating accident that injured one of his fingers and he wasn’t sure he could properly perform the exam (which involves emphatically sticking a finger into a part of the throat where the throat emphatically prefers not to be stuck). He tried as hard as he could (and as long as I could stand) on two occasions to find the primary, the original cancer. No luck.
With an unknown primary on this type of HPV-related cancer, the only way to treat the patient is to use a laser to remove the entire surface of the back of the tongue, since that’s the most common place for those cancers to originate. It’s a brutal treatment, resulting often in a tremendous loss of blood and possible complications in the form of the loss of both speech and ability to swallow (without using something to force the food down the throat). It might save my life but singing would very likely be gone forever, and my quality of life would be drastically diminished.
Decision Time
This is basically where the song begins. I’d written another song (“Enjoy The Ride”) 20 years before that said that “I can’t die young.” By the time I was diagnosed in 2021, I sure wasn’t young anymore and I’d already done much of what I set out to do in life, other than to succeed in any material way. My parents were both long gone, my sisters are well situated, and I don’t have children. At the time I had basic Medicare insurance plus what little savings I’d stashed away for an old age that seemed less likely all the time. If I was going to make good on my commitment in my youth to take control of my own destiny, this seemed like a most appropriate time to at least consider my options.
I did so in the company of my elders. I know a windy ridge in the Colorado Rockies where the bristlecone pines and the rocks depend on each other. (The video that accompanies the song shows an example of it.) The bristlecones live for many, many centuries and the rocks even more. But I was a tree without a rock, without a solid connection to this earth. At that point, I felt like the first line of the song: “Long after midnight, I lost all hope of dawn.” I pretty much made up my mind to decline that drastic treatment and just let the cancer take its course, depending on hospice to make my last days as comfortable as possible. But in the dark hours of that never-ending night, even that option seemed, as Hamlet puts it, “sicklied o’er with the pale cast of thought.” Maybe I didn’t have much of a plan, but I certainly had several methods close at hand to put an end to the matter once and for all.
But I didn’t feel like I really had enough information to make a wise decision about ending things then and there. When I told the ENT about what I was contemplating, he was shocked and assured me my situation was very survivable. Then he did something very wise: he referred me to another ENT who had skills in microsurgery who might be able to find an alternative to his treatment. For that I owe him at least a great debt of gratitude, if not my life.
A New Approach
I am a proud graduate of the University of Colorado in Boulder. When I went in to see this new ENT, Dr. Kimberley Atiyeh, I was pleased and reassured to find that she was part of the large health care system known as UCHealth, as good a place to be sick as one could find. As luck and my good fortune have had it, virtually everyone who has helped in my treatment has been a woman, from my surgeon and radiation oncologist to the lady who emptied the trash in the hospital room. To all of them I’m forever grateful and it’s to them all, which includes a whole lot of lab techs and other vital contributors, that I dedicate this song.
Since most people have ears, noses, throats (and necks), Dr. Atiyeh never lacks for things to do. But she agreed to see me on short notice. Frankly, she made short work of it. Within minutes her fingers, arguably healthier than the other doctor’s, knew right where to look and soon detected the rough spot that she suspected was the primary cancer. She immediately asked to do a biopsy, to which I consented. It involved numbing me with Novacaine and making a deep incision into the base of my cheek inside my mouth, extracting a sample of the suspect tissue.
That night was rough. I wasn’t prepared for how much I would bleed from that incision. I notified friends to check on me if they didn’t hear from me first thing in the morning, since the blood clots would build up and threaten to choke me every few minutes throughout that interminable night. It took weeks to heal during which time my mouth was very sore.
But there was a puzzle. Dr. Atiyeh was confident that she’d found the primary which had shown up, along with some lymph nodes, on the PET scan. But there was another suspicious glow. And it was on the other side. If my cancer had spread from one side of my body to the other, that would mean it was a much more serious situation, since bilateral spreading is rare. So we did another biopsy, this time of a lymph node on my right side, though this time with just a needle instead of an incision.
Part of the genius of systems like UCHealth is the patient portal, where results are online even before you hear from your doctor. The result of the biopsy was that it was cancer on the right side too.
I felt like I was right back where I was before: a cancer so serious that survival would be dicey at best, no matter how you treated it. Once again, it seemed like such a dark night that dawn might never come for me. But, having a curious mind, I started reading through the details of the report. What it found was cancer, but not squamous cell cancer like the other side. Thyroid cancer.
The next day I had an interesting conversation with Dr. Atiyeh, who didn’t downplay the risks I faced, but also held out hope that I could eventually resume a life not that much diminished from presurgery. When she realized I’d figured out that the blip on my right side was thyroid cancer, we both expressed a huge relief. While serious, of course, thyroid cancer is fairly common, especially in my age bracket, and often successfully treated. And we already knew the source: my thyroid. The actual tumor was so small that other doctors, looking at it, would say it wasn’t worth treating, but it turned out to be an aggressive enough tumor that cancer cells had already spread to 18 nearby lymph nodes.
At this point it’s worth saying that if I had consented to that first treatment, involving shaving off my tongue, it wouldn’t have eliminated, or even found, either of the actual cancers I had. Indeed, had I opted for a treatment like that, I probably wouldn’t have been able to go through the treatment that actually got rid of the cancers. Whew.
My Cancers
The original cancer was squamous cell, caused by an infection by the human papilloma virus (HPV) that I had contracted without knowing it decades before. Squamous (pronounced with a long A, like “squay”) cells are unusual in that they form a boundary layer between two different kinds of tissues. They don’t have a blood supply of their own, instead depending on adjacent cells for nutrition and oxygenation. They’re slow growing cells. Until they become cancerous.
In the past, surgery for cancers in this part of the neck often involved breaking the lower jaw to gain access to those inner tissues. Dr. Atiyeh is a specialist in microsurgery using tiny robotic instruments and could access the cancerous tissue through my mouth, removing only enough tissue to pretty well guarantee that it got all the cancer. But especially in that part of the body, there’s no extra stuff. Anything that gets taken out leaves a hole or impedes a function, at least for a while.
The thyroid cancer was more straightforward: just assume that the entire thyroid is suspect and remove it. (The thyroid helps regulate metabolism and the body needs what it creates in order to function.) Sometimes enough thyroid tissue can be spared that it can still function as a thyroid for the patient. That wasn’t the case for me, so I’ll take a replacement medication the rest of my life. The threat to my voice from the surgery was that the tiny nerves that power the vocal folds run right under the thyroid tissue that had to be removed and just a nick from a scalpel can permanently damage the voice.
While obviously fairly major surgery, neither cancer would require much of an incision: a small one between my cheek and gum and another small one over the thyroid on my larynx. But then there’s the lymphatic system.
Lymph is the liquid our cells are suspended in. The circulatory system is contained and pressurized to send oxygenated blood throughout the body in the closed, complex net of arteries and veins. The lymphatic system isn’t like that. The lymph gradually drifts via gravity mainly toward the center of the body in the abdomen. Along the way, channels form to carry a greater quantity of the yellowish, viscous liquid. In those channels, small whirlpools form that are also called nodes (very different from the node on my vocal fold years before), which serve to help keep impurities like broken cell parts and cancerous cells from circulating through the rest of the body as quickly. So any lymph nodes downstream from either of my cancers would be suspect and would have to be surgically removed as well.
That involves something known as a total neck dissection, which is about as bad as it sounds. An incision is made from below one ear, down the neck and crossing over the larynx, and then up to the bottom of the other ear. Both sides of the neck skin are clamped out of the way to give access to the various places that might be affected. The result of that clamping is that many of the nerves that aren’t severed outright by the incision are stretched to their limit and they sometimes either never recover or don’t recover for a long time. (In the movie “Hang ’Em High,” Clint Eastwood’s character is strung up at the beginning of the film but is rescued before he dies. Through the rest of the film the make-up team put a scar on Eastwood’s neck that is almost identical to mine. Fact is, if they had strung him up that way, it would have collapsed his windpipe and he would have died.)
A further complication is that removing one of the lymph node channels suspected of containing cancer requires severing the carotid artery, the main blood supply to the brain, on the left side. This is done above the point where the artery splits in two but the severed section has to be cauterized (permanently sealed) because if the surgeon reconnected the artery but it failed, the patient would die almost immediately. So while I was under total anesthesia, half the blood supply to the left side of my brain would be suddenly and permanently cut off. (The arteries and brain eventually rebalance.)
But wait. There’s more. Neither cancer can be surgically removed without follow-up radiation treatment to assure that any stray cancer cells the surgery missed would also be eliminated. And those are drastically different treatments for those two cancers. The squamous cell would require irradiating the affected area with external beam high energy radiation, five days a week for six weeks. The thyroid cancer would require that I simply take a pill containing radioactive iodine.
Being a professional singer all those years had made me a vastly better singer but it hadn’t made me a lot of money. At that time I had just basic Medicare insurance, which covers 100% of hospital procedures but only 80% of out-patient treatments, which would include both types of radiation treatment I would need. The cost of the treatment was so high that just my 20% would eat up almost all of my life savings and leave me in a much weakened state and with very few resources.
This treatment option, though, seemed to offer at least a fair chance of living a relatively normal life once (if) I recovered from both the surgery and radiation. But I would likely end up broke. And there was still significant risk of damage to my voice and to my quality of life, like an inability to swallow and other complications. Both singing and having something worth singing about seemed a long way away.
So I went back up and spent time with my elders again, the ancient bristlecones being excellent listeners. I’d found a sturdy length of nylon rope at a previous campsite. Long and strong enough. Bristlecones are quirky trees so finding a good spot would be a bit tricky. Going back to town and having the surgery would be even trickier, since even Dr. Atiyeh had told me that post-surgery I would have to find “a new normal.” My body seemed to lobby for the first option: something I ate, added to my extreme stress, disagreed with me and I spent the important pre-surgery hours becoming quite malnourished and miserable.
The fact that you’re reading this is a dead giveaway about what decision I made that night, which was to an extent a matter of faith in Dr. Atiyeh’s words of reassurance. But there have been a number of times since when I’ve had my doubts it was the right decision. And facing those sorts of decisions takes a heavy toll.
Post-Surgery
It turns out, the surgery took seven hours, for all of which I was totally anesthetized. Dr. Atiyeh was able to get all of the squamous cell cancer from my pharynx with clear margins as well as all the gloppy thyroid tissue. She removed a total of 88 lymph nodes, some from behind my ears. A friend called the hospital room as I was waking up and I spoke for a while before it hit me that my voice still worked. That was a major hurtle.
Not the last. It turns out that removing all those lymph node channels leaves the lymph with nowhere to go. After I left the hospital, I still had three drains attached to my upper chest which had to be emptied regularly. In addition, I soon developed a seroma in my neck above the scar, a swelling where fluid builds up between layers of skin, that had to be drained several times. (I did much of my recovery at the home of my good friends, the Mitguards, an excellent folk duo from Manitou Springs. I don’t know how I would have survived without their help.)
More disconcerting, and perhaps more problematic to my voice, was that after the surgery I was completely numb from my jaw down past my collarbones and as far out as my upper arms, both on the surface and inside my neck. At first I was afraid to touch my neck because I couldn’t feel it from the inside, only from the outside, and from the outside it was like touching some old guy’s neck. For over a year after the surgery, I had the distinct sensation that someone’s hand was gripping my neck, preventing me from moving it correctly and from making the sounds I intended at times. Only recently have I been able to really stretch because of the complicated, often painful situation in my neck and shoulders.
Another unanticipated result of the surgery was that it created what’s called a soft palette insufficiency, which means that the soft palette, part of the pharynx that seals the esophagus, no longer fits properly. Gulping a liquid would send the liquid down my windpipe as well as my throat. Eating ice cream would make me cough because the viscous sweet would trickle past the palette. At the dentist, I couldn’t use the suction thing where they stick a straw in your mouth because it would just suck air through my nose.
I don’t have any recordings of my voice during that part of my recovery but my recollection is that as the swelling in my neck increased, my voice deteriorated and took on a rough quality that I came to assume was an unsurprising if unfortunate outcome of the surgery. At the beginning of my treatment, I told everyone I was a singer; after awhile, I realized that my singing days were behind me and I was grateful that my voice still worked at all.
Another unexpected result of the surgery (and my malnourished state) was that I developed thrush, a mouth and throat condition that results from an imbalance in the body. It made the incision in my mouth very sore and made my entire mouth extremely sensitive, to the point that brushing my teeth became ten seconds of brushing followed by three minutes of excruciating pain. I tried a number of treatments but nothing seemed to make a lot of difference.
Meanwhile, the good ladies of UCHealth had worked against their own financial interests and set me up with the good ladies working with the Medicaid office. That turned out to be one of the rare lucky breaks I’ve had in my life. Since at that point Covid-19 was running rampant (while I was recovering from surgery, an entire wing of the hospital was exclusively Covid patients, most of whom had come from other parts of the hospital), the Biden administration made the wise decision to at least temporarily expand Medicaid coverage to anyone un- or underinsured, just so people wouldn’t survive a hospital stay with Covid only to have to declare bankruptcy and end up living on the street, which is sort of where I was starting out. They found a way to get me covered, which paid for the entire radiation treatment bills, for which I am also forever grateful, not only for their hard work but also for the generosity of the taxpayers of Colorado and the United States to foot the bill.
The fact that I got even this far in the process is due largely to my radiation oncologist, Dr. Mackensie Daly (who signed her first email to me “Mac”), also with UCHealth. Between the difficulty of the procedure and the fact that even my portion of the cost would leave me broke, I first discussed post-op radiation treatment with her skeptical that I would still have a life worth living after all this. She convinced me that it would be difficult but that I had a better chance of not only survival but of leading a more or less normal life afterward than I was assuming. She also assured me that we could work out the financial portion of the treatment but that having both radiation treatments in a timely fashion would greatly increase my chances of living a cancer-free life. She was right on both scores (I no longer have any detectable trace of either cancer) and for that I owe her my heartfelt thanks.
Dr. Daly had to hustle to create a treatment plan for me but she got it done. The external beam radiation is boring and painless, at least at first. The result is damage to the skin and underlying muscles but also fatal damage to any remaining cancerous squamous cells.
The radioactive iodine treatment for the thyroid cancer, which involved taking just one dose of one of the most dangerous radioactive substances in the world, was more complicated than I anticipated. For one thing, it required me to remove iodine from my diet for three weeks before treatment, meaning no iodized salt or dairy products, which turns out to be a surprisingly difficult diet to follow. (Virtually all prepared foods and all restaurant foods contain iodized salt.) It also required me to go off my thyroid medication for three weeks before the treatment, by the end of which I felt like my very bones were beginning to collapse in on themselves. No one ever skips that medication just for laughs.
Just that one dose made me actually radioactive. The second night in I suddenly got the overwhelming feeling that something was very wrong with my entire body all at once and for days afterward I felt low and weak and a bit nauseated, which was better than what many patients suffer. For a couple more weeks I had to keep to myself and was cautioned against sitting close to a child or a pregnant woman. I had to scrub down the room and kitchen where I stayed by myself so no one else would be contaminated. For three months after the treatment, I was required to bring an explanatory letter with me if I boarded an airplane, since even after all that time I might be radioactive enough to set off the alarm at the screening area.
Another unanticipated side effect, and one that definitely threatened the health of my voice, is that the radioactive iodine kills not only the thyroid cells but also the similar cells that make up our six main salivary glands. So in addition to losing my smell and taste for months due to the radiation, my salivary glands died a slow and painful death, after which I developed a terrible case of dry mouth. There’s a Canadian company called Biotene that specializes in dry mouth products and I’ve used several of them to good effect. But a wide variety of unpleasant side effects from the loss of saliva glands set in and seemed to become permanent, including cracks in my tongue and lower lip, swelling of my hard palette, and extreme sensitivity of my mouth to toothpaste, peppers, ginger, acid fruits and other favorite foods. Alcohol became intolerable. Not just my mouth was dry, everything below, including my vocal folds, became dry and often didn’t work correctly.
Unrelated to my cancer but related to my singing was the fact that I got a middle ear infection that ended up perforating one ear drum. For a couple of months my hearing was in a variety of levels of impairment. Without hearing, singing isn’t possible. Once again, the fine folks at UCHealth got it straightened out and my hearing is not only back to a standard level for an old pro but my ears haven’t been this healthy maybe ever.
Considering the alteration of the blood supply to my brain and the seven hours of total anesthesia, it’s not surprising that I ended up with a condition called brain fog. Actually, it was surprising to me, because I had brain fog. For about a month after my surgery, I spent many hours a day just staring out the window, often crying as well. Eventually, I got myself more or less functional again, but for the long months of radiation and recovery, I went through life in the fog of brain dysfunction, feeling, as I expressed it at the time, as though of every five moments, I only caught two or three, the rest streaming by unappreciated. Computer tasks involving multiple steps became impossible without going back to the beginning several times and reviewing what I was trying to do. Minor frustration could blow up into an emotional meltdown and require a few days of recovery by concentrating on simple tasks.
One aspect of serious medical treatment is that patients to an extent become dependent on their health care providers to help them make life-changing decisions, so there’s some loss of identity built in. But I found myself feeling detached from myself. I couldn’t make simple decisions like where to eat or what to wear. In the summer of 2023, I had tremendous bout of depression that left me wondering whether any of what I’d been going through was worth it. I sought help through UCHealth but for a change couldn’t get timely relief.
An Unexpected Find
During the summer of 2023, nearly two years after surgery, my mouth became so sensitive that I was beginning to despair of living a normal life or eating a normal diet again. Thrush once again ran rampant in my mouth and throat and none of the treatment or dietary approaches I tried seemed to make any difference. My throat was so damaged that my voice became even more unreliable and rough than before.
I had a routine visit with Dr. Atiyeh’s team, in this rare case (for UCHealth) a fine fellow and bearer like me of a Y chromosome named Matt Hicks. He performed an exam of my throat using a camera inserted through the nose and down into the pharynx and larynx. He noticed something that was to alter the course of my recovery: I had a node on my vocal chord.
When I’d had a vocal node decades before, it was in an odd place and back then minor surgery was a common treatment. In the intervening years, it was discovered that vocal chord nodes can often be successfully treated simply by treating the cause of the node, which is often due to stomach acid leaking into the mouth, which then trickles down into the larynx. (Matt also diagnosed me with the soft palette insufficiency, which caused things to leak down my throat. I suspect it was allowing stomach acid to leak up into my mouth as well. In any case, that particular problem seemed to heal up in Fall, 2023, and hasn’t returned.) Matt prescribed me an acid-blocking medication which I’d never tried.
The result was quick—a couple of days—and surprising. My voice cleared up! The node went away and suddenly, for the first time in a couple of years, my voice sounded more or less like me again. It was a remarkable experience, like recovering the use of a limb almost. A person’s identity is very much associated with one’s voice. And considering I’d been treating two cancers right next to my larynx, I never expected to recover my singing voice and was thankful just be able to make myself understood.
The medication worked great but the longer I was on it, the more I noticed unpleasant, and eventually intolerable, side effects. It upset my stomach quite a bit but even more troubling was that I was beginning to feel anxious all the time, the feeling you get when you’re very nervous about something and have butterflies in your stomach. I finally had to go off the medication. The side effects went away but so did the acid reflux protection, so my voice rapidly deteriorated again. I happened to have a different, over-the-counter acid reflux medication on hand but it had the same result: it worked for a while but when the side effects became too strong and I had to quit, the side effects cleared up but the reflux returned and my mouth and voice quickly grew rough and hoarse again.
Another unpleasant result of the surgery had been a severe skin reaction, which required a round of prednisone, an anti-inflammatory, to treat. Since I was now bound to Drs. Atiyeh and Daly with UCHealth, I decided to find a primary care physician through the system and found, as usual, another woman who quickly solved the problem and who has been my front line of care ever since, Maria Smith.
Still struggling with my voice and mouth but not willing to tolerate the side effects of the medications, I asked Maria in an email if she could recommend some other approach I could try. She mentioned the same over-the-counter med that I’d already tried, and just simply Tums, an antacid.
For some reason that suggestion brought to mind a conversation I’d had years before. I’m a tea drinker and I’d asked the helpful person at a tea shop why some teas left me with a dry mouth. She said it was because of the tannic acid in the tea, with some teas being more acidic than others.
It occurred to me that not only my dry mouth but a whole lot of other symptoms I was suffering were due to acid in my mouth, not from tea but from acid reflux. While I was still singing, I used to take a different antacid (brand name Gaviscon) that seemed to help prevent vocal issues. I had always routinely chewed up and swallowed the chalky tablets. But most of the damage the stomach acid was causing was in my mouth. What if I tried using the antacid as a topical treatment in my mouth instead? I started swirling one of those tablets around my mouth until it dissolved a few times a day and especially before I went to sleep. It was an unlikely solution. But I soon found that the dry, chalky tablets actually got my mouth to water enough to dissolve them. Dr. Atiyeh told me that there are thousands of tiny salivary glands in my mouth which might not have been wiped out by the radiation. The best I can figure is that the acid shuts them down and the antacid enables them to work again.
In any case, the results have been nothing short of amazing. Many of the symptoms in my mouth—cracked lips and tongue, swollen palette, sensitive salivary glands, thrush—have largely disappeared. I can eat (mild) Mexican food again. The last time Dr. Daly scoped my nose, it was far less painful. And best of all, she no longer saw a node on my vocal chord!
During a recent visit to Dr. Atiyeh, I mentioned that I’d sung a few songs on stage recently. She thanked me for letting her know.
But in light of the dramatic improvement I’ve seen in my voice recently, I felt like it was too pale a thanks to all the efforts these fine women (and Matt) have put into this to merely tell them my voice was working again well enough to sing. It seemed incumbent upon me to actually prove it. So I did my best to tell the story in a song and then to actually sing it for them (in a recording, since it would be mighty hard to get all those people together at the same time). So I wrote the song “You Got Me Singing Again” and recorded it.
I should add here that an unexpected result of doing the recording was that it required me to use parts of my brain that had lain dormant for at least three years. In the course of writing and playing the instruments in the arrangement, using the complex recording gear, and creating the video and audio recording, my brain seemed to get itself realigned and most of the brain fog has lifted. I feel like myself again in a way I wasn’t sure I could anymore. Doing the recording turned out to be the best therapy I could find. The next two sections deal with some of the technical details of what went into the song.
The Recording
The first challenge was to condense the whole experience into a couple of verses I could set to music and then a chorus stating the obvious: “You got me singing again.” Since it was a celebratory, thankful song, I wanted something upbeat and cheerful for the chorus, a contrast to the rather somber subject of the opening.
I wrote the chord progression on piano, using a very simple drum pattern on a drum machine to establish tempo. Then I came up with a tentative melody using the piano to find notes and I tried recording it for the first time, which resulted in probably the worst vocal track I’ve ever done. (An unanticipated brain fog issue was that sustained notes at first seemed to me to be drifting sharp, a figment that the lifting of the brain fog seems to have alleviated. It sure complicated singing.)
Then I began laying down tentative tracks on bass guitar, keyboards, and background vocals. Then each track is rerecorded to reflect the changes to the arrangement and to make the performance work on a final version. I sold my red sparkle Ludwig drums a few years ago but I still have my Zildjian cymbals (some of which are older than I am), my Ludwig chrome snare, and the stands I need. So now I record drums in separate parts, doing each part individually. (The bass drum is the machine.) Since I played drums for many years, I know how to integrate the different parts into a single drum track.
My Yamaha DX-7 keyboard is over forty years old now but it still works and covers sounds like organ, electric piano, and horns. I often run it through my Line 6 Pod guitar preamp for special effects, like the Leslie speaker sound on the organ. My Fender Stratocaster is what the Pod was designed for and the combination offers me more different sounds than I could ever use. The Strat is one of just two stringed instruments on the intro; instead of a guitar pick, I used a toothpick to strum it. The Pod even makes my Yamaha bass sound like it’s run through a Bassman amp.
The harmonica parts are real. I used an old Golden Harmony I didn’t know I had for the intro and then both a G and an A Hohner for the chorus (for the full step up, which you can’t do on a standard harp). For the other stringed instrument on the intro and the pizzicato notes at the end of the verses, I used my mandolin, which I played on stage for the last few years of my career. I used a good instrument mike for the left track and ran the electronic pickup on the mandolin through the Pod to the right, enhanced with chorus, filling out the stereo spectrum in an unusual way.
Singing The Song
First, it will probably be obvious that I didn’t use an auto-tune device on the vocals, which aren’t as accurate as they used to be. Not a surprise, considering my age and the fact that it’s been five years since I sang a full night on stage. (For a comparison to my voice before the surgery, see www.tombishop.biz/music.) Some element of that has to do with the fact that I’ve barely even warmed up my voice and in the past year have sung less than I have since I was a teen.
Since I took lessons from Paul Ingam, I’d been in the habit, particularly when performing, of going through his recording of vocal exercises, often twice a day when I was working. That seemed like the place to start in rehabilitating my voice. The first couple of times I had to quit halfway through because the muscles in my neck became so sore. But I kept at it and within a few days I was doing the full exercises, perhaps not as well as I used to but across my full range.
Doing the exercises brought back the good habits I’d formed and once I got the muscles to cooperate, I found my voice doing much of what it used to do. I wrote a melody that didn’t push my range too far but I ended up singing background vocals that used even my falsetto voice. I use an inexpensive but quality condenser studio microphone and enhance the result with the usual effects like reverb and limiting, but no tuning software. At first I couldn’t sing standing up, which is what I did my whole career, which was disconcerting. But once I got loosened up, I did the final take standing up. There is a close harmony on the song’s chorus above the lead vocal and two answering tracks, with a third harmony on the ooos in the choruses.
Conclusion
One could argue that the premise of the song, getting me singing again, wasn’t necessarily important even to me since I’d retired, and one could also most reasonably argue, hearing the song, that the loss of my voice wouldn’t deprive the world of an irreplaceable treasure. But listening to the recording, there’s no disputing that I’m singing again.
It’s an unlikely outcome. Both my cancers were adjacent to my vocal mechanism and some loss of function would certainly not have been a surprise. The vocal mechanism itself depends largely on a thin edge on the vocal folds that can be injured by a caraway seed. All of it depends on the balance of a number of different systems, most of which were adversely affected by my treatment. Indeed, the fact that I can speak and sing at all is the surprise.
In a way the real turning point in the recovery of my voice was when I decided to try the antacid as a topical treatment in my mouth, my own idea. But the medical team got me to the goal line and I just kicked a field goal. Healing, at least from the sort of life-threatening condition I had, is a team sport and the patient is the most important member of the team. Without sensing when something’s wrong, seeking help, and following through with the treatments, patients can’t realize the full benefits of even the most sophisticated treatments, and caregivers can’t accomplish much without the patient’s cooperation.
My story is not particularly unusual and many people endure far worse every day. Cancer treatments like mine aren’t miracles and surviving cancer is more the norm than the exception. These treatments are the product of years of training by dedicated professionals, creating complex, highly accurate systems for treating the sheer volume of patients, and creating treatment plans that optimize success based on years of similar procedures. Chances are, if you’re over fifty, you probably wouldn’t have made it that far without the intervention of fine folks like the team that helped me. So if this song I wrote expresses something you’d like to say to a care-giver in your life, please feel free to share the video and this story.with them.
