Dear Dr. Jahn,
I may have to undergo some treatments if I want to get pregnant, including regular doses of progesterone and clomide, but I am afraid of the side effects on my voice. In general, what are your thoughts on this?
—Name Withheld
Infertility treatments involve injections that reset the hormonal cycle and can have significant effects on the voice. The vocal folds can become more vascular, and there is a higher incidence of hemorrhage. Most singers find a significant, although ill-defined effect on the voice, and it might be wise to stop singing while the treatments are in effect. Long term effects are less predictable, and, according to patients I have spoken with, there may in fact be no long-term adverse effect. Good luck!
Dear Dr. Jahn,
I am a 48-year-old soprano who happens to be enjoying a flourishing of my performing career. I have uterine fibroids, which my gynecologist has been monitoring for about four years, and which have increased and grown to the point where my uterus is about twenty-week gestation size.
I have fibroids both inside and outside the uterus, many pedunculated. My symptoms are currently primarily limited to the discomfort of the uterus being so large; I have no abnormal bleeding and no premenopausal symptoms. My question to you has to do with evaluating the alternatives currently available to me for eliminating the fibroids in light of how each might effect my vocal apparatus and the systems involved in a singer’s breathing capabilities.
I think I basically have three alternatives:
1) Have an abdominal hysterectomy for removal of the uterus and fibroids.
2) Try to shrink the fibroids with Lupron therapy for a couple of months prior to a laparoscopic assisted vaginal hysterectomy of the uterus and fibroids.
3) Wait for menopause to shrink the fibroids. (I’m not real wild about this idea!)
I realize that you are not a gynecologist, but I thought if you do not feel comfortable in advising me on this issue, perhaps you could refer me to someone who can. I trust my gynecologist, and I am in the process of getting a second opinion from another gynecologist, but these doctors have no experience in advising me how each alternative will effect my singing. Thank you for your help!
First of all, you’re right—I’m not a gynecologist. From the vocal point of view, however, I would be least excited about hormonal shrinking of the fibroids—if you’re going to have a hysterectomy anyhow, what is the point? You may wish to consider a partial hysterectomy to allow the possibility of a future pregnancy.
If not, then the hormone option is even less appropriate, from a vocal point of view.
One other point: If they make an incision on your abdomen, remind the surgeon that you do need those muscles to support the voice. Good luck!
Dear Dr. Jahn,
Can you clear up the coffee issue? What is the final word on its effect on the voice? Many singers who sing beautifully drink it
daily, and yet some teachers swear that it’s detrimental to good vocal health. I’ve even heard that if you drink twice as much water as coffee that they cancel each other out. I have personally not noticed any side effects from my love of coffee, but would love to hear your thoughts.
—Aaron
From the vocal perspective, coffee has two potentially significant effects. First, caffeine is a diuretic. If you get rid of too much water, it can cause a degree of dehydration, not significant in the general sense, but possibly in terms of the vocal apparatus. This is the part that can be “corrected by drinking water.” The second effect is on the stomach and esophagus. Caffeine causes a relaxation of the sphincter between the esophagus and the stomach, and can predispose to acid reflux. Naturally, if you can drink coffee without either of these problems, you don’t need to worry. An unrelated issue, in women, is that caffeine liberates calcium from the bones and can accelerate osteoporosis. Women who drink coffee, especially after menopause, should consider taking calcium supplements.
Dear Dr Jahn,
I’ve been prescribed Accutane for a fairly severe case of adult acne. I have it everywhere, and can no longer do auditions without a heavy application of makeup. It has been going on since the spring and it seriously interfering with my looks and thus the “total package” as a singer. I haven’t started the course yet, but I am aware of all the birth-defects/depression hype and I know that it does dry out the membranes. Are you aware of any other effects on the vocal mechanism? My dermatologist tells me that if I hydrate a lot I will be fine, and that is what I have heard from a fair number of other singers, but I have also heard a lot of negative feedback.
—Name Withheld
The main voice-related effect of Accutane is its drying of mucous membranes and skin. This is certainly reversible, and should disappear after you finish the medication, but you may have a dry larynx while taking the drug. Drink lots of water, and consider taking a mucous thinner type medication. There are various forms available, speak to your dermatologist or local laryngologist about this. Also, if you take vitamins, reduce or eliminate any Vitamin A while on Accutane. The two are similar in some ways.
Good luck!
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
