Singing Through Change for Sweet Adelines Region 21 March 2023 1080WebShareName

I just want to introduce my friend Nancy Bos. Now, most of the time we have been in our organization, we use our own educators for these kinds of things, right? Because we have lots of good, wonderful people that we like to have in front of us. And— but this last year during COVID I ended up meeting Nancy by doing an appearance on a webcast with her, and she was so darn smart and so darn good at everything that she did that all I could wait— I could hardly wait to figure out a way to get her into Sweet Adelines. Well, then guess what she did? She moved to Albuquerque. The minute she moved to Albuquerque and we knew we were coming here, guess what? So normally it costs us a boatload of money to get someone like Nancy Bos in front of us, but right now she has decided to gift this to us. You are getting a remarkable speaker about a remarkable subject, okay, and a remarkable woman in every single way. Ladies and gentlemen, Nancy Bos.

Thank you so much. You can't believe how excited I am to be here. I have given the Singing Through presentation change 50 times on Zoom, at least one time in Vienna, and now Albuquerque. Yes, yes, fantastic. And yeah, I did move to this town from Seattle one year ago. And I love it here, I love it here. Thank you for welcoming me so much. The talk today is going to change the life of at least one person in this room. This is powerful information. And it's also going to change the lives of the women that you touch with this knowledge. It's so exciting to finally know, to know we are not alone if we experience voice changes in our late 30s, 40s, 50s, 60s, and 70s. You all knew you weren't alone, right? You knew that. You're the ones who have been taking care of yourselves all along by having this amazing thing that you do that is holistic. It is your whole body. So you know that when something like menopause, perimenopause— how many people in this room have never heard of what— or you're not sure what perimenopause is? Will you raise your hands if you're not sure? Yeah, thank you, Kathy. I did not know what perimenopause was until I started writing this book. And my apologies to any of the men in the room. Menopause, menopause, menopause, vaginas bleeding, hot flashes.

It's—

we're talking about all of it. Yeah, and any of you who are sensitive, but you're Sweet Adelines, so I know you're cool. Nancy Bosman. So, I did not really know what perimenopause was until I started writing this book with my two co-authors, JoAnn Bosman and Kate Fraser-Neely. Now, I've been a voice teacher, a singing voice teacher for 25 years, and then I became a specialist in physiology and acoustics. I've written several books on voice, including "Singing 101" and "The Teen Girl's Singing Guide." But I knew that there was something scary coming up that I had no idea what it was going to do to my voice. So I got together with another person who was passionate about this topic, Kate Fraser Neely, who was 15 years through already and had suffered tremendously with changes to her voice and her whole body during the menopausal change. We knew together that we had an amazing book to write. But she and I are both the extroverted speakers. We needed an introverted researcher. So, we grabbed Joanne Boseman, and she's one of those women that if you say a word she's not familiar with, you won't see her for 20 minutes. She's going to be looking it up. And so, Joanne, Kate, and I together made an awesome author. And so the book "Singing Through Change" is what started this. In order to write the book, we had to do our own research. There's very, very little research on singing voice changes for women. There's very little research on speaking voice changes for women. And the research that's out there says that in general, through your 40s, 50s, and 60s, your voice will drop by a half step. That's nothing, right? And so anybody in here who does not sound like they did when they were, you know, 20, and you're like, "A half step? That's what? What?" So we had to do our own research, and we interviewed 56 women, and we did a qualitative study. We asked them questions about smoking, acid reflux, where they were in their lives physically and emotionally— divorced, single, kids, parents, all the stressors— and then we asked for the stories. And once we had all this information from 56 different singing women, amateur to professional, jazz, rock, classical, India, Croatia, Romania, Canada, South America, United States. Once we had all of their stories, then we started to see patterns. And that's what brought us to what I'm going to talk to you about today. All right, so I'm actually giving you my 20-minute presentation because I knew that in a live room I would do what I just did. And that's like talk way too long about what I'm not here for. And also, I want to give you time later for 5 to 10 minutes to talk in groups of 4. Okay? So be ready to hear and share each other's stories. Can't stand there, we'll stand here. Let's see. I see this time as a river delta that you can travel through any one of an unknown path to get to the other side. And that's one of the most important aspects of the research that we found was that I can't tell you what your journey is going to be like because there can be a snag or a sandbar or something else that nobody else has experienced that you have experienced. This is a story of Hope, a woman named Hope, now age 66. I got to tell a joke that's completely unrelated. It isn't actually a joke, it's a story. I have a friend named Debbie who takes care of rescue greyhounds. And one day, one of her rescue greyhounds got free. Can you imagine chasing a rescue greyhound? Right? And what makes it worse is this dog's name was Hope.

Hope!

Where are you?

Hope!

I can't find Hope! Have you found my— Oh gosh. Anyhow. Love that. Is anyone in here named Hope? Oh, thank goodness. Okay. If so, I'm sorry. We have no Hope in this room. So Hope says, "I pursue singing because it brings me joy, allows me to feel beauty, and express myself. I have found out that the voice is hugely affected by menopause, and my current otolaryngologist seems very knowledgeable." Boy, is that a rare statement. Most otolaryngologists Gynecologists, family practice doctors, and menopause specialists have never heard of this. They have no idea. We send our books to doctors all the time. This is me a few years ago when I was a brunette. And, uh, a little bit about me: on the left, I'm Frederick in Pirates of Penzance. Yes, I strapped up in an ace bandage and I was Frederick. That was a lot of fun. In the middle, I'm singing an "O Manio Mysterium" by Morten Lauridsen, maybe some of you have sung that, as a solo in a church in Zagreb, Croatia. That was the pinnacle of my singing career right there. And part of the reason that was the pinnacle was that the room had 3 seconds of reverb. Yeah. Luckily, my song basically had no consonants. "O Manio Mysterium." You know, and I was able to paint with my sound in that room. I could hear what was coming back and shape it. Ooh, what a gift. And I sang lead in a rock cover band. I'd never been able to make up my mind what I wanted to do. So I became a voice teacher. My journey— like I say, I started writing this book and then started noticing symptoms. My menopausal voice change symptoms for me didn't start until 6 months before my last period. I was booked to sing an oratorio for a church with a chamber orchestra. December, Christmas. It was August, I started rehearsing. This is great. I think it was Bach. It was September, my voice sounds really good. I don't even deserve to sound this good. October, wow, phenomenal. We start rehearsals. Some of the pit orchestra is there. I'm singing over the orchestra. Yes! I have waited all my life for this, this sound. November, my volume starts to decrease, my breath capacity starts to decrease, and nothing had changed in my life. And by December 15th, when we did this oratorio, they had to put a microphone about 4 feet in front of me so that I could be heard over the orchestra. That wasn't my fault. That wasn't my fault. That was changes to my musical instrument due to the phase that I was in menopause. Now perimenopause is up to 10 years leading up to menopause, and this is when I was in denial. When I was 42, I thought I was 32, and my sister didn't hit menopause till she was 56. My mom had a hysterectomy, right? Take them out like candy. I mean, who knows? And so I had no idea what my menopause was going to be, but I knew that I was fine till I was 56. Nuh-uh. So these 10 years leading up to menopause is a time of incredible, incredible hormone fluctuation. Ah, I'm gonna, I'm gonna go to the hormone fluctuation chart. So let me just really quick tell you, Shirley Verrett is a very famous opera singer. She's one of the few people who have documented this in her autobiography, that she actually had voice changes where she was going flat and she couldn't tell. Audiation problems are not uncommon. In fact, I would say they're very common in perimenopause, but nobody has officially talked about it before. There's one research study by ear, nose, and throat— or speech-language pathologist group from 20 years ago that shows that when estrogen is fluctuating, people have a hard time finding their pitch center. That's it. That's the only information that's out there. So we started— well, we asked ourselves, and yes, this happened to me. I remember in my 40s thinking, have I become a bad harmonizer? What? What's going on here? I must have never been any good. And yes, that 25-year-old man who's conducting my quartet, he's so much better than I am. And that self-doubt, right? Taking blame for this. I'm happy to say that that audiation problem, that hearing problem, or maybe it's— we don't know what it is. It's a brain issue where you maybe can't hear the tonal center, or you think you're in tune and you're not. That is not researched. It's common, and it's usually temporary. Now some of you in here might say, "Uh-uh, not me, it wasn't temporary." I want to talk to you because we're starting to gather stories. Again, there isn't— we don't have the ability to do neuroscience on this. I don't. But we're starting to gather stories about it. Shirley Barrett wrote about it. And her journey. Where are we at? I'm going to skip through these. There are two more testimonials, but we're going to get to that when you talk to each other. Ah, the menopause cloud. Again, this slide deck I also show to voice teachers, which includes men and choral directors, and they're like, "What?" If you have any women in your life this age group, singers or not, please give them grace, right? When we find someone feeling down about their voice, it is an opportunity to bolster and support them as they seek solutions rather than accept blame. And in this slide I say down about their voice, but sometimes it's rage. Raise your hand if you experience menopausal rage. Oh, I think I have a bunch of deniers in this room.

Yes.

All right, and one last slide to read before I get to facts. I've had various problems with my voice in the past few years, some normal issues due to menopause, but also additional problems due to chronic illness and the meds I was on. I've been working with an amazing teacher, vocal therapist, who happens to be my co-author, Kate Fraser-Neely, who's helping me work through my vocal issues. "we're starting to discover my current voice, which is pretty different than my younger voice. I love it. It's a bit richer and darker. I still have a lot of work to do before I can really sing anything, but I'm loving where it's going. Embrace the change, everyone." Not everyone's voice gets lower and richer. We have 2 women out of the 56 whose voices got thinner and higher. That might be because they had day jobs where they were talking in their low voice to men all the time. So once they retired, then the vocal folds went to a more relaxed state for them, perhaps. And there'll be time for questions later. I'm going to step up to the slide here and point out a few things. This is a typical menstrual cycle, which very few of us in this room are having. I, I probably don't need to spend much time here, but you know that, that there is a point in the beginning, the first 2 weeks, when we are estrogen dominant. Retain this information for later. And then the last 2 weeks where the estrogen is lower and we're progesterone dominant. And that's why we experience differences in our singing voices through the month before we hit menopause. It might be easier to sing in the first 2 weeks than in the last 2 weeks because of the estrogen. This is much bigger picture. The fertility years, things are relatively stable. Perimenopause— this is not an exaggeration, and this can happen. There's another graphic that I didn't bring with me, but the estrogen levels can change from day to day. There are professional singers who are like, I've got a voice today, I don't know if I'm gonna have it tomorrow. You know, I don't plan on singing that note in that show unless I can do it 20 minutes before the show, then I'll do it. And that's because of the changes in the estrogen and progesterone levels. And then over time, this is where we get into aging voice issues because the hormones have leveled off, and now we can talk about just something simpler where we've got predictable aging voice changes. Back to the fertility years and perimenopause, a woman can enter perimenopause any time after puberty. We have talked to women who were in perimenopause by the time they were in college. We've talked to women who hit menopause at 27, 28, 29. If you have a hysterectomy and the ovaries are taken, that's instant menopause. If you have cancer treatments and your hormones are dampened by that, that's instant menopause. You might come back, or you might not. So when I'm talking about menopause, I'm not talking about the average age of 51. I'm talking about any woman who's experiencing this in her body, no matter what the age. We also had people who were 60 before they hit menopause. They were mad. They were angry. Now this slide is very important. I will be providing it to your region— and it's too small for you to read, so I'm literally going to read these next 3 slides out loud. Estrogen. These are the benefits of estrogen, which I call the devil's hormone. Estrogen causes suppleness of the vocal folds' upper surface. So the vocal folds have layers. The upper surface, the mucosal layer, is more supple because of estrogen. It supports the glands that produce the thin mucus that coats the surface of the vocal folds. So this relates to dry mouth— dry throat. It maintains tone and bulk of skeletal muscles, including the deepest layer of the vocal folds, which produce lower pitches, and the tiny muscles that produce higher pitches. Estrogen blocks the effects of androgens— testosterone— preventing lowering and thickening of the voice. We all have testosterone in our bodies in small amounts, and some of us take hormone therapy that includes testosterone. When that testosterone is at a higher level in your body, you will find— well, I'll get into this more later, but you'll find that your voice gets a little lower and a little thicker because of the testosterone. Estrogen increases oxygenation to the folds by improving permeability of the blood vessels and capillaries. Estrogen is nothing but good for our voices. Progesterone is a mixed bag. It has positive and negative effects on singing. Progesterone balances the effects of estrogen. It encourages the surface of the mucose— mucous membrane of the folds to slough off. Let me talk about this in relationship to your period. In the first 2 weeks of a normal menstrual cycle, estrogen is high, our bodies are the most cooperative. In the second 2 weeks, progesterone is high, and that's when we get ready to slough off the blood. That's the menstrual period. Same thing's going on in here without the blood. Um, it causes decreased and thickening secretions of the outer layer of the vocal folds, so thicker vocal folds. Skin, resulting in drier vocal folds. It decreases the permeability of the fold capillaries, leading to swollen vocal folds. And it may be involved in neuromuscular activity— this is a good— supporting the quick responsiveness of the muscles. And the last hormone to discuss is testosterone. It causes— testosterone is an androgen. It causes the vocal folds to thicken, which lowers the pitch, and it increases the dryness of the vocal folds due to changes in the glands that secrete fluids near the vocal folds. Now, I experienced vocal— this, this menopausal dryness 3 times during that 6 months. I know some of you have experienced it all the time for years, and I'm so sorry, because it's like trying to sing through the Sahara Desert. It is just incredible. It doesn't matter if you drank 120 ounces of water that day. The dryness is there. Mine was stopped once I went on hormone therapy, which I did pretty quickly after my voice started not doing what I wanted it to. The, uh, the vocal fold dryness is because the glands— mucus and saliva come from glands— and the testosterone and the progesterone cause those to not work so well anymore, and that's what the dryness comes from. So you would have to treat the glands or the hormones that affect the glands in order to get rid of that vocal fold dryness. So if you have a non-understanding teacher who says, "You're clearly not drinking enough water," no, it's not your fault and you're not alone. All right, where are we at? Oh yeah, back to this, uh, slide. Now that you've got some context, the fertility years, perimenopause where hormones are in crazy fluctuations, perhaps even day-to-day. Menopause, where everything's just gradually decreasing, and then post-menopause, where we're talking about aging voice issues. And I'm happy to talk about those too. They are more covered— aging voice issues are more covered in literature and articles than the menopause is. And so that's why I'm spending so much time there. But later, when I get to questions and answers, if you have aging voice questions, I'm happy to answer those too. All right. I would now like to take a 10-minute break because I want you in groups of 4 people, you'll each get 2.5 minutes to share if this is a surprise to you, any story that you have, if you knew this, if you're wondering something. And I will call you back in 10 minutes. Go for it. Powering through vocal issues can mean less risk Powering through vocal issues. You know, I've got a cold, I've been hoarse for about 3 weeks, but I'm really sick of not singing, so I'm going to rehearsal tonight. That's powering through vocal issues. It can mean risking vocal injury that can impact the singing for the rest of your life because it can lead to something that might cause scar tissue or damage. So that's why this slide says, have— this is probably impractical— have all vocal issues checked by a fellowship-trained laryngologist. A laryngologist is an ENT doctor who specializes in this. Not this, not this, this. Yep. And so ideally, y'all live in New York City where there's 15 of them. And you can go find one. But at any rate, any doctor who can even use a mirror to look at your vocal folds and say, "You're fine. They look pearly white and pristine. Go for it." The impact of hormones on the voice, that's a pipe dream, but we're working on it. Accept change, don't stop trying. Not everyone is going to have voice problems. There are some of you in this room, maybe even 40% of you, who skate right through without any issues, and congratulations to you. And that's why we need grace for those people who are struggling, because our journey is different than everyone else's. One thing I haven't gotten into in this presentation is the stress, the stress hormones that impact everything, including our sleep. Singers need a lot of sleep, otherwise these core muscles don't work like they're supposed to. So if you're not sleeping well, which is also caused by fluctuations in estrogen and progesterone, If you're a sandwich generation, if your kids are giving you trouble, if your choir is driving you crazy and you're not sleeping well, it's going to impact your voice. Give yourself grace. Give yourself grace. Some of the issues for the vocal tract might be continued or increased vocal fold dryness. I had two groups ask me about this, so I know a lot of you were talking about this. What's with the gloopy clumpy mucus in my throat.

Yes.

You probably don't have more mucus than you used to, but the mucus is now thick and it gets stuck. And what's the magic bullet? There is nothing. Yeah. Unless you're interested in going on hormone therapy, it's It's just the way it is now. Hydration doesn't hurt. Drink all that water. That's definitely going to be the best thing that you can do. There are some people who talk about some products that you might spray or whatever. Those products hopefully aren't touching your vocal folds. Because if they are, they're going to go in your lungs and you're going to be coughing. So, yeah, I'm sorry. That's bad news. Oh, somebody else brought up increased allergies. Which is common in midlife, that your allergies increase. Again, yeah, go to the allergist. Reduced or altered singing range— some of your voices go higher and thinner, some of them get lower, and some of them don't change at all. Be willing to change sections in your choir. Is that a hot topic? My choir director called that "trans-sectional singers." Who knew you would laugh this much at a menopause talk? And then changes to the structures of the vocal folds includes thickening of the skin, which isn't something you have to know, but it's, it's interesting to nerds like me. Betty, age 74, said, there's a real lack of vocal dependability even when I'm rested, hydrated well, and singing every day. There is a researcher in England, Rebecca Mosley Morgan— I'm sorry, Rebecca— who did a study on what does it take to keep your voice toned. And she learned that 20 minutes a day of simple exercises, 5 days a week, is fine. Everyone she worked with who did a 20-minute regime of, ah, 20 minutes of that type of exercise, 5 days a week, their voice improved in her 2-year study. And finally, the book. I brought— I'm gonna go to questions and answers next. Let me tell you, I brought 48 copies of the book and ways that you could buy them digitally from me on Amazon. It's $20 right now. I would love for you to buy them on Amazon. If you do, please leave a review. We've got 4.8 stars, which is really cool. Yeah! Woo! So don't leave me a 3-star review. We'll talk. But I did bring 48 copies, and I'm happy to stay. This room apparently is not being used after this, so I can stay and sign those if any of you would like those books today. What else? I think it's time— oh, there's a singingthroughchange.com website where we've got videos of us 3 authors talking about this and articles we've written, more facts. We've got a Facebook group with over 4,000 people in it. You're welcome to join the Singing Through Change Facebook group. And my contact information is there. It's small, but it says nancy@studiobos.com, and you can always reach out to me, especially if there's something that I haven't talked about today, or if I've said, "We don't know why," I would love to hear your story. All right. I have the first hand for a question. I just want to ask about the third member of your team. Oh, Joanne. So Kate Fraser-Neely is the one that I originally partnered with. And Joanne. Kate Fraser-Neely is in Washington, D.C. area, and I told you that she had lots of struggles physically. She had something like 7 surgeries, and so her entire core was kind of shredded. Joanne Bozeman lives in Wisconsin. Door County, and heard of it? And Joanne is also a voice teacher. She was at Lawrence University for decades, and she specializes also in reproductive hormones, and she was actually a birth person, sorry. Midwife? Not quite a midwife, but close.

Doula.

Doula, thank you. When I was doing that, it was just nurses. You know, it was— at any rate, Joanne is also— she's very scientifically minded. She does a great job of talking science to voice science people better than I do. I like talking stories to people who sing. So that's where we all work out together. All right. Raise your hand if you've got a question. Can I give you the mic? Sure. Thank you. Hold it close. In terms of an extra added or if there's anything about breast cancer and chemotherapy and then having like tamoxifen or some other thing that really takes away any estrogen that your body can make. Thank you. I'm the wrong person to ask. She asked about cancer treatments. The, the medicines and how it impacts estrogen. For some people, chemotherapy and other cancer treatments stop the ovaries from working. There are other sources of estrogen in our bodies. We don't know exactly how those are impacted by the cancer treatments. Some women who are younger and have cancer treatments do go into menopause, but they get their periods back sometime after. Some never get them back. And so then that's the only variable that I can really address is that impact on the estrogen, which is all those symptoms when the estrogen starts to go away. Things get drier, thicker, things like that. Thank you. Yeah, let's see, as long as the mic doesn't squeal, I'm walking carefully. Vibrato! Yes! All right. Thank you. This is a complicated topic. The Pan American Vocology Association and the National Association of Teachers of Singing is having a session on this just this week, where everybody, 10,000 voice teachers and scientists, are trying to figure out about this vibrato. But not specifically about what we're talking about. Vibrato— I'm sure you have vibrato experts in the room, so my apologies if I'm stepping on anybody's toes. Vibrato can be created through diaphragmatic movement. It can be created through a weakness in the core muscles. It can be created through an imbalance of breath pressure in the throat. It can be created by tongue tension, and the position of the tongue in the mouth impacts the speed of vibrato and the width. So it is such a complicated holistic thing, vibrato is. And if you can imagine the old-fashioned French sound that was almost a bleeding vibrato compared to, say, a bel canto romantic sound where it's going to be this, or somebody whose vocal folds and larynx just are not set up for vibrato and just has a straight tone. Part of my solution for people who have vibrato problems is how physically fit are you? Are you working out 30 minutes a day like we all know we should? If not, that's the first thing. Start looking at your core strength. The next thing to look at is do you have a vocal tremor? Do you have a muscle issue in your throat that's causing erratic vibrato? Pretty common. And that is a visit to an ear, nose, and throat doctor to find that out. But the most interesting thing, the reason why I got excited that you asked this, for me, is this new research about the tongue. When I was— I'm 55 now. 4 years ago, my vibrato was as big as a truck. It was just, "Whoa, like, what is this vibrato?" And what I realized was that I was subconsciously altering my sound to sound like I always had, by using muscle tension in my tongue. So I learned again, studied again how to use my tongue, which I was now using without any thought. It was completely on automatic. And now I took a look at, okay, if I loft my tongue a little bit in the middle, I get a warmer, richer sound with a more controlled vibrato. How cool is that? So that is best done with a voice teacher. Who can really help you sort out that stuff. Yeah, complicated question, complicated answer. Love your hair.

I think our issue is just different on vibrato. As Sweet Adelines, we try not to have any vibrato so that we all sound like one sound.

Yes, thank you. Yeah, because you're trying to mold an entire choir to be a flawless painting. Absolutely. The straight tone can, for some people, that comes quite naturally. And for straight tone, for other people, it means an actual clenching of muscles in order to create a straight tone. In all things, moderation, right? So if you're a person who naturally has a big vibrato and you spend 3 hours a week singing in straight tone, maybe you could spend 3 hours a week singing in vibrato as well. And that way the muscles get a break. But each of you is different and each of you has a different story, so that's not blanket advice, that's just advice to inquire. Yeah. It's probably a totally complete other discussion, but as you mentioned, we've talked about perimenopausal and menopausal, now postmenopausal. Let's do it. Which probably many of us are in. —right now, how are those— I mean, it looked like there were not as many changes, but it feels like there are more changes. Thank you. Okay. Yeah. So she asked— I'm just going to call it aging voice. And if there's anybody in here who's over 60, that's who I'm talking about. Yeah. So— I may not feel over 60. That's right. You may not feel like— I got to see how much time I have left for this one. Woo, good. We're good. We're good. I would say one of the most interesting aging voice issues to me that was a surprise to learn about is, as we know, our cartilage hardens as we age. And you know how your cartilage— well, you can hug a 5-year-old and it's like they just, you know, and you hug an 85-year-old and it's not quite as flexible. That's the cartilage. Our rib cage is held together with cartilage, and our vocal folds are held together with cartilage. On top of that— No, I'm going to go with that one first. Okay, about the rib cage. If this is cartilage here and cartilage here that's holding our ribs together, when we were 20 and we learned how to breathe for singing, we could expand our rib cage much more easily than we can as we age. And the science that's been done on researching how people breathe not surprisingly, was traditionally done by overweight older white men. Yeah, of course. Yeah. Oh my gosh. So these overweight older white men would have been more interested in abdominal breathing because it's a lot of work to lift a heavy loaded rib cage when it doesn't have flexible cartilage. So I would say to that research, and this is actually what my Singing 101 book covers this in great detail, is sure, maybe. Now learn how your body works and how it works now, and guaranteed your body works differently now than it did when you were in college or in your early 20s when you first started to develop these habits. Next thing to know about aging voice is that arthritis can happen in your throat. Wow. Oh, I feel like I just dropped a nuclear bomb in the room. Yeah. So there are very few nerve endings in our singing, in this part.. And so we're not going to feel pain, but we might feel a stiffness that wasn't there before. One aging issue that's pretty common is acid reflux, or GERD, right? And so then if a drop of stomach acid or the fumes get on your vocal folds, you're going to have swollen vocal folds. One way to self-diagnose that maybe I've got this problem is if you have morning voice. If you wake up and you can't really talk for an hour or so in the morning, then this might be an acid reflux issue from being horizontal at night. So research that a little bit on the keeper of all wisdom, Google. And there are good things about aging voice. And my favorite thing is what you all are so good in, and that is you have the stories to tell now. You've got the richness of your spirit behind you, and most of you— excuse my language— are "I don't give a fuck" anymore. Right? Yeah. Yeah. Those are the big gifts of aging voice, I think, is around our mental attitude. Also, as you pointed out, the hormones are stabilizing. So I talked with some women in their 50s in the back of the room that are like, "Wow, I don't know what I'm going to do today." That starts to go away. Yeah, it calms him. Thank you for asking that. How are we doing? Oh, that was 3, 4 minutes? Not bad. Yes, can you pass this down? This is kind of an aside, but was Hope the Greyhound found? I'll think about whether I'm going to tell you that or not. Yes, hope was found. Questions back here? All right. I'm so glad I can walk around with this mic. Hi, I'm wondering about the physiological changes for women that have had a hysterectomy. Mm-hmm, thank you. There are hysterectomies that are partial and full. A partial hysterectomy is where just the uterus is taken, A full hysterectomy is where the ovaries are taken as well. And since the ovaries are the main hormone producers of estrogen in our bodies, if the ovaries are taken, the doctor will put you on hormone therapy if at all possible. If the ovaries are not taken, you probably don't need hormone therapy, or maybe a much smaller dose. Say a woman is 35 and has a hysterectomy. Fibroids or something have just made that the only good option. If the ovaries are left in there, that woman can have a controlled and natural journey through menopause. If the ovaries are taken out, it's instant menopause. And then if the woman does not go on hormone therapy at that time, it's a train wreck of menopausal symptoms all happening, which I'm sure many of you experienced. Many of you were in menopausal years when the 2001 hormone study, nurses' study, came out. Somebody here just gave a snort. Yeah, that piece of— This study was huge and it should have been very important, but what happened was that they gave hormones for the first time ever to women who were in their mid-60s, and there was an increased death rate among women who had never taken— they had been 15 years without estrogen in their body, and now they had estrogen. And that's what the media reported on, and the study had to shut down because people seemed to be dying because of the study. So since then, all of the other amazing things that were learned by the study have been reassessed been assessed, more studies have been done like it, and now really, well, there are still OB-GYNs and general practice doctors who really don't want to put you on hormone therapy. And there is, I think, a very rightful contingent of our female population that says, "I'm going through the natural journey the way that my body was built to go through it." And then there's people like me who want to be young forever. So I do take the Fountain of Youth. And I'm going to take it until somebody says that I have to stop taking it, the hormones. Yeah. All right, I'm gonna head to the back for another question. All the way to the back. Anybody else want to sing Jingle Bells today with this beautiful snow outside? So my question is basically, do you have advice for those of us who are in that latter category where you have already been with a Got it. Thank you. She asked what we should do if we are well past menopause and are not interested in doing hormone therapy, but I'm assuming are struggling vocally. Not too much. Yeah. I still have a long ways to go, so I'm trying not to struggle any more than I have to. Thank you. That's great. So the great advice for this is the voice is holistic. You cannot sing without using— you guys can't sing without using your toes, right? Because you're dancing, right? Yeah, your little toe is involved in your singing. Even people who are just stand and sing people are using every part of their body. And so the better that your body works, the better that your singing is. If you need a hip replacement and you've been putting it off, you're going to sing better once you get that hip replacement. Oh yeah, has anybody experienced that? Yeah, exactly. You got a question? Okay, so fantastic that you're fit and lean, taking the medications that you're gonna— that you that optimize your health for you. If you would like to increase the estrogen in your diet, you can do that. Avoid things that we now know cause estrogen issues, like plastic Tupperware. Um, oh, Google it. And I think I'll leave that one there. Just live your best life, and your voice will show it. Yeah, yes. Thank you. Kind of related to what you just said, I'm wondering if plant-based estrogen supplements are healthier for you than— thank you— chemical estrogens. All right, so are plant-based estrogens more healthy for you than chemical estrogens? Boy, this is pretty subjective. I'm not going to give a yes or a no, but I'm going to tell you that there are 3 basic different kinds. Of estrogen that you could take. One is the traditional, which is made out of horse urine, not really used much anymore. Another is the bioidentical, which is made in a laboratory and is meant to be identical to a woman's natural hormones rather than a horse's natural hormones. And then there's the plant-based. There is evidence that cultures that eat a lot of soy have a more gentle passage through menopause. I developed a severe reaction to soy a year and a half ago, so not, not an option for me. It's in my gut. So, uh, it's a— it's, it's interesting. Um, some people talk about yams. Yams contain a lot of plant-based estrogen. They might put yam lotion in their abdomen area to increase the suppleness and flexibility of their nighttime activities. Yeah, you could spot treat. Turns out you can spot treat for that, but you can't spot treat for this. And so I— each person has to experiment on themselves. No, no down effects No bad side that I've heard of for plant-based. There's that lumpy mucus in my throat. No plant-based bad signs. All right, I've got time for one more question. The clearing of the throat. The clearing of the throat. Ear, nose, and throat doctors, specifically Al Maradi, Dr. Al Maradi in Seattle, uses an analogy of you've got 20 coins for the day for your voice. If you are a professional voice user, if you are a person who is a school teacher or a nurse who talks all day, you're using those 20 coins by 5 PM. You better not go to choir that night or figure out how to get more coins. Vocal exercises, straw phonation, things like that. If you're a person who is quiet all day, you are going to start to decrease your coins unless you're doing vocal exercises and singing. Okay, your 20 coins will turn into 18 and then 15 and then 12. Then that happened to a lot of us during the pandemic, and you can build that number of coins back up again. If you have swelling in your vocal folds from a cough or a cold, you might be down to 5 coins. If you go to your grandson's football game, you might be down to 1 coin. Yeah. If you clear your throat, how many coins does that cost you? I don't know, half a coin? Quarter of a coin? If you do that 4 times in a row, does it cost you 1 coin? If you do that 40 times a day, is that your entire supply of coins? Yeah. So that mucus in the throat and clearing it out, sure, there's good reason to— Ah! How many people does that work for? So it's better to treat the situation with the mucus, find out what it's about. By the way, mucus is a bandage for our vocal folds. It puts a nice greasy layer over our vocal folds. So if you've got— if you've had a cold and now you have extra mucus, that's protecting your vocal folds. And so that— until you get to our age when it's actually just a problem. Yeah. All right. Oh, I can't end on that note. Let me end on this. Yes, can you yell it out? So if you have to use an inhaler periodically, does that really affect your vocal cords? An asthma inhaler? Yeah. I'm sorry to say that I don't know the answer to that. I do know that some inhalers are steroids, yeah, and that's going to impact the actual layers of the vocal folds over time. So I'm sorry, that's out of my scope. So you guys are awesome. You're inspiring. I am so, so glad to be here. Thank you. Tom. Thank you.