Why does diane rehm talk so slowly

I went from doctor to doctor to doctor, all of whom kept putting tubes down my throat. I think the insertion of those tubes did not help my condition. The last day I was on the air was in February I told my boss that I had to find out what was wrong with my voice. I sat at home for four months, not answering the phones, not speaking to anyone except my husband. Then my wonderful internist referred me to neurologist Dr. Stephen Reich and otolaryngologist Dr.

Paul Flint at Johns Hopkins [Baltimore]. Within one hour they said I had spasmodic dysphonia and gave me a botulinum toxin Botox injection in my vocal chords. Then slowly, slowly they begin to vibrate and I could speak again. What could have been different? The doctor suggested that if John was absolutely determined, he could help himself by stopping food, water, and medication.

So John stopped eating, drinking, and taking his medicines. He said he felt great, and I know why—he felt as though he had taken his life back into his own hands.

Subscribe in a reader. We review what we feel like, and share it with you. Share this: Twitter Facebook. Like this: Like Loading The Pacific Ocean: Part 2 ».

It drives me mad, too. David on April 30, Thanks for your comment. Jason on May 12, David on May 12, Thanks so much for your comment. Drivesmebattytoo on May 16, Sue on June 27, David on July 3, Hi Sue, Thank you for visiting and for leaving a comment.

My opinion stands, your dislike notwithstanding. Jake on July 18, Mark on July 24, Is there a petition we can sign to get her off the air? George in Cincy on August 20, Many speakers don't articulate, they don't move their jaw, they speak through closed teeth so you can't really understand them very well. Nazaneen Grant, you are seeing and treating people who have various kinds of voice disorders.

Give me a range of those problems. Well, there are people -- many people who do strain or misuse the voice, abuse the voice in using it too much or inappropriately and all the lay people would know that just any acute laryngitis or having a cold will give you hoarseness. Other voice problems range from consequences of acid reflux, of developing legions or growths on the vocal folds, such as cysts or polyps or papillomas and then, of course, cancer.

And as you well know, there's also neurologic problems that cause the voice to not be smooth. REHM And explain to me how hard it is to diagnose problems that may not be as serious as cancer or as serious as, you know, a multi-growth on the throat, but something like Spasmodic Dysphonia.

Well, the voice, as Dr. Miller already described, is just very, very complicated and it's -- even in its anatomy, if you think of the voice as an instrument, it's only a few cubic centimeters and yet its range and the beauty that it produces, in my opinion, is much -- is far beyond any human instrument that is created, so.

GRANT But in terms of diagnosing voice problems, first by just listening to the voice with a trained ear, one can pick up on a certain disorder, but the -- also it's necessary is just visualizing the vocal chords, or vocal folds is the more modern term, and that's done through a flexible scope or a camera that goes inside the mouth or the nose and we can visualize the vocal folds and at a higher level, we can use a stroboscopy, which is a strobe light that goes on the vocal folds that we can see the details of their vibrations.

But no, it's definitely not straightforward and the treatment is -- often requires several different approaches. REHM And it's certainly not consistent. I mean, one doctor may take this kind of examination, you're looking at or talking about and see one thing, another doctor may see another. One part of that variability may be the training and then also the equipment that they have to visualize.

But also, as you know from your own example of your story that you illustrated in your book, "Finding My Voice," that the medical professionals' understanding of voice disorders has very much evolved over the last 20 years. And you, unfortunately, were on both ends of that.

You know, both when you weren't able to be properly diagnosed, perhaps, or it wasn't clear. And then later, when it was more clear. REHM How has the understanding of voice problems evolved over these last two decades?

Well, one is just in the way we can study the voice and the acoustic measurements and just in general how technology has expanded for us to examine both the structure of the larynx and then the sound of the voice, but also, even understanding the microstructure of the vocal folds and even surgery has evolved in terms of the importance of preserving the very, very delicate layers of the vocal fold.

It was mentioned, the vocal folds hit each other over times a second and there's no other body part that gets traumatized like that, even when we're walking But for our voice, if you can imagine, there're just these delicate tissues flapping together all day long and we don't even realize it and yet, voice disorders in general are not that common, in general, so that speaks just to the beauty of the human body and just the perfections that we have without knowing about it.

REHM Yeah, that's really interesting because, as you describe it, you'd think there'd be many more indications of voice problems. Miller, I know you wanted to come in on that. Grant utilizes different regimens, such as when a client comes in or a patient comes in, she'll have them sniff-e, sniff-e, sniff-e to make sure the vocal folds are opening and closing adequately and then we'll have them do some speech tasks, such as sustaining an aw sound, watching those vocal chords vibrate if you have stroboscopy.

Then we'll have them say some sentences such as, Peter will keep at the peak with a lot of -- sometimes our vocal folds vibrate Peter will keep at the peak. Sometimes our vocal folds vibrate and sometimes they don't and that's what creates some timing disorders, such as stuttering. But when they don't vibrate, for Adductor Spasmodic Dysphonia, that helps your voice. MILLER Adductor Spasmodic Dysphonia is when those voiced sounds, the buh, duh, guh, a-e-i-o-u, are over adducting and the voice is tight, so your name, had it been Sarah Smith, would've been easier to say than Diane Rehm, 'cause you have all voiced sounds, so that your strained strangle is very tough on your voice.

I mean, it's a hard thing. Whereas someone with Abductor Spasmodic Dysphonia, those vocal folds are flying out, they're abducting. Susan Miller, she's a voice and communications coach, Dr. Claudio Milstein is at the Cleveland Clinic. We'll take your calls shorty, stay with us. REHM We have many callers waiting, but do want to talk a little more with our guests before we open the phones. Grant, talk about when or why somebody ought to seek help for the voice.

Well, if someone has had hoarseness or a change in their voice that lasts longer than two weeks, that would be a reason to see a physician who can inspect the larynx. Especially in a smoker, as we know, early detection of laryngeal growths that can turn into cancer is key. Also, if someone is experiencing voice fatigue or their voice quickly deteriorates, any breaks in the voice, if they have noisy breathing or difficulty swallowing, those are other reasons people should seek the attention of a otolaryngologist.

Milstein, what about in your case? Why do people come to see you? MILSTEIN Well, people come with all kind of voice problems, anything that changes the sound of their voice or if they have an associated illness that is also affecting their voices.

There's also a newer area in the study and treatment of the larynx which has to do with breathing problems that are caused by a malfunctioning or misbehavior of the vocal cords and this is an area that is gathering more interest around the country and we're seeing more and more patients that have shortness of breath caused by problems in the larynx. MILSTEIN Well, this is a condition that is called paradoxical vocal cord motion or it -- there's another -- there are probably 50 terms that you can find in the literature that refer to this condition, but basically, it's a closure or an inappropriate movement of the vocal cords where they come towards the midline and they create an airway obstruction, so patients have periods where they have severe shortness of breath.

And they -- this usually doesn't respond well to asthma treatment and that's where they get referred to ear, nose and throat doctors and then we can realize that this condition is not caused by problems in the lower airways or the respiratory system, but in this malfunction of the larynx and vocal cords.

Miller, when I first met you, we didn't talk about Spasmodic Dysphonia. It seems to have become a more widely known and understood phenomenon, as Dr. Grant has said. But just how common is it? I'm not really sure what the incidence of Spasmodic Dysphonia is. In fact, there's some people who have come to me and said that, I think I have what Diane Rehm has. And I said, that's why I'm here laugh. GRANT So you actually have helped significantly in people, you know, approaching medical help just because they know -- if you don't know that their problem is something that's treatable, then we haven't diagnosed them and we just don't know.

Explain that, Dr. Well, Spasmodic Dysphonia has been explained as a problem where there's an overuse of the voice -- vocal folds, which are essentially muscles with a delicate tissue over them.

So when we go to make a voice, the muscles inappropriately squeeze together, producing a voice that can be sometimes strained or choppy. Botox or botulinum toxin as we know more from the cosmetic world, is -- it's a -- it temporarily paralyzes muscle, so it -- when we inject it into the vocal folds, it creates a condition where you're still having the problem, you're still flexing the muscles 'cause that signal's coming from the brain, however, they're unable to squeeze too much and so that smoothes the voice out.

And it wears off after three or four months on average. And so people who get that treatment often need repeated doses of it in a few months. Miller, even after treatment with something like botulinum toxin or Botox, people still need voice coaching, don't they? Especially because when that voice is smoothed out, there's a lot of breath coming through, so people won't be able to speak with as many words in one breath.

They'll have to take replenishing breaths much more often and it's important that they don't try to force their voice out because then they start getting strain and that can lead to pain in the larynx, also.

Milstein, where does stuttering fall into this whole block of voice disorders? When we were talking about the understanding of voice disorders and now we're focusing on Spasmodic Dysphonia, if we look at the history of Spasmodic Dysphonia, in the past, it was thought to be a psychogenic disorder, so patients that presented with this kind of choppy voice, they were basically referred to psychiatrists. And so one of the great advances in the understanding of voice disorders is to recognize, particularly in the area of neural laryngology, where we started realizing that this is not in the patient's head, but there is actually a central nervous system or a peripheral nervous system problem and that really advanced our understanding and we were able to start treating patients much better.

REHM On the other hand, we still do not understand the cause. The cause of Spasmodic Dysphonia itself is definitely unclear. And although many people get it after some sort of a trauma or after a cold, many people just get it out of the blue. And it can run in families, but not always. It's thought, though, to -- the problem is thought to originate in the brain -- in a small area of the brain that controls movement.

Miller, people think I'm years old because of the way I sound and yet I have to say that for years, from until last year, I was having botulinum toxin injections every four months and now I am having vocal coaching via Skype from Gary Catona, who is out in Los Angeles. Gary, are you there? And I want to hear about your approach to not only people like myself with Spasmodic Dysphonia, but to others who, for example, I know you treat lots of opera singers.

Current : And I want to make it clear that I am not intending this — at least on my part anyway — as an implicit criticism of Tom Ashbrook, whom I love. Do you listen to his show? I am struck by how matter-of-factly you write in the book about your dust-up with NPR last year. You write:. I told them I was saddened by their belief that I should cut short my active participation in these dinners but would reluctantly accede to their wishes.

Rehm : I do believe in my own case. I attended these dinners without urging anyone to do anything. Rehm : Absolutely, I was the draw because my husband had died, because he had desired help in dying, he had not been given it, and I was his widow. Therefore I had the experience of watching someone I loved with my whole heart die before my eyes without being able to help him. And what I believe — and stated that I believed — was that I and he should have the right to choose.

But I did not advocate for any organization or call for any action. Current : So you have no comments about conventional journalism ethics writ large that you would derive from this experience?

Rehm : I have no compunction about what I did because I continued thereafter to have discussions on the air about the right to die, always having all sides represented. And the agreement with NPR was that I would state up front that I felt very strongly, out of my own experience, that he should have had the right to die.

But I feel absolutely no compunction whatsoever about having attended those dinners. Did you feel that you were treated well? Rehm : Absolutely. I feel I was treated with courtesy, I felt they heard me out, I felt they understood and sympathized with what I had been through.

But they believe — which I happen to disagree with — they believe that, as a journalist speaking on these topics, I should not in any way be involved with any organization that had a very definite opinion on how to move forward.

Current : I am intrigued by the manner in which your stepping away from the show was made public.