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Empowering musicians: Teaching, performing, living: when your body is your instrument--advocating for yourself and your life as a singer.

After decades as a professional singer, I was faced with a devastating health issue in December 2013. Diagnosed with stage 3 cancer, my life and function as a singer was irrevocably changed. I remember being rolled into the surgical suite, cold and protected only by the flimsy cotton of a hospital gown and a paper head covering. All my training, degrees and performances seemed useless, and my future lay beyond a medically induced sleep. I felt the anesthesiologist put the needle in my arm to begin the sedation. Terrified, I began to sing a Christmas carol. The nurses and doctor slowed their movements to listen and the beeps of the machines faded as I weakly sang. Instantly they understood that while my health was a focus, the very essence of whom I was lay in my ability to sing and be a musician. We were joined in our combined goals of removing the cancer and helping me to return to my role as a singer. The critical ability to advocate for your health requires one to navigate and communicate with multiple professionals and institutions, and to insist that the process maintains focus on creating a wellness plan that includes your singing occupation/identity.

Creating A Plan

1. Language is key: The vast majority of research on singers focuses on the physical vocal production mechanism. Studies on breath, posture and laryngeal function have been of particular interest to the health community. Professional organizations such as the Performing Arts Medical Association, the Voice Institute and the National Association of Teachers of Singing have active forums and research on the physical wellness of the voice. As singers navigate their own wellness, knowledge of their own physical demands/requirements is at the core of their ultimate success. Health professionals may have baseline anatomical knowledge of the voice, but your ability to clearly explain issues in physiological terms is paramount to ensuring quality care.

2. Establish a home base: There is a nomadic quality to the life of a professional singer as well as educators that perform frequently. Travel can have direct health implications. Travel can also be a deterrent to advocating for wellness and the continuity/consistency of your care. My advice is to establish a home base of care. This home base usually will be the location of your primary care doctor, but you must be confident that, if necessary, the doctor will be attentive to your situation and needs well beyond normal primary care. They will need to act as your prime representative and must be the trusted health care professional that will communicate to other physicians and specialists on your behalf. In addition to establishing a home or base line physician, many health care programs now offer access to online medical resources to help establish a digital home base. For example the Cleveland Clinic system offers online virtual chart access/forums for their patients. 1 If needed, a virtual home base can be created by the individual. Below is a list of the information important in creating a digital medical home base:

* Contact information of all doctors (e-mail access and phone numbers).

* A list of all medication and allergies with dosing and renewal information

* Family medical history

* Emergency contact information and advance directives

* Digital copies of all tests, records and hospitalizations

* Health information (policy, contact numbers and deductible information)

* Calendar for appointments

* Wellness diary. This is a running log of questions/concerns you may have and would like to ask your physician when you see them. Include duration and time for the onset of symptoms/events.

Logistically establishing both a digital and physical home base insures consistency of information regardless of your travel, and eliminates the possibility for redundancy in testing and treatment options.

Clarity Of Priorities

Jane Oakland described the voice as a "biologically embedded identity." (2) For a singer, this means their voice is a part of who they are rather than simply an occupational identity. A singer with a health issue or a circumstance where their voice is vulnerable to injury or dysfunction can experience implications that could have significant impact on the overall mental and emotional wellness of the individual. When addressing the psychological components of identity, it is ideal to include behavioral, cognitive and affective areas of their identity. (3) The person's perception of the significance of his/her identity as a singer is a predictor of behavior in dealing with emotional damage if that identity is challenged in a physical sense because of pathologies or injuries. (4)

1. Be clear in what you do: Often missing in our health care is the link between psychological and occupational stresses that impact wellness and recovery. Clarity in expressing your priorities as a singer is essential to building a complete wellness plan. In the communication you have with your health care providers you must clearly outline the importance of your ability to sing and to continue singing. I don't suggest that you have to sing as you walk into every appointment or surgery as I did. However, it would be helpful to provide examples of the impact your health issues have on your voice and occupation. Bring a CD or video of your performances. List specific physical demands required in your performances (dancing, staging necessities, costume constraints). Have a list of the performances you have coming up to give them an idea of the time line by which you would like to resume normal activity.

2. Bring a friend: There is strength and support in numbers. I found that my own health issues were overwhelming. In negotiating all the elements, tests and information I was unable to hold on to my priorities and/or remember important information. Most major health care issues require that patients be accompanied. My experience is that whenever possible having a companion with you is helpful.

The Future Can Be Bright

1. Have a recovery plan: Ideally the goal of advocating for your own health is to create a wellness future. In my own care I found that my focus had been on treatment, but little thought and planning had been on recovery. In light of this my recommendation is to consult and determine prior to treatment what services you may need to ensure comprehensive recovery. Establish and make contact with therapists (voice, physical and/or psychological) that will be essential to your recovery, and engage them in your full treatment and total wellness process.

2. Save for a rainy day: A 2012 study by the National Health Survey found that more than one in four families experienced financial burdens from medical care. (5) These figures are a rough estimation of the financial impact an individual and their family may have as they navigate their health care. There is a direct relationship between financial security and advocacy. (6) In an ideal world our choices regarding care would not be impacted by financial requirements. Part of advocacy requires knowledge but it also requires the ability to make choices based on the health implications not financial ramifications. To better allow for the individual to achieve this, performers should make health care requirements an active element in their financial planning. A rainy day fund allows you to have the financial support/freedom to focus on wellness. Financial freedom/support may even allow for the improved choices between facilities, tests, medications and recovery plans that otherwise could have been limited.

Conclusion

A singer's awareness that his/her health is a coordination of their physical and mental self is key to creating a successful wellness/health plan. Establishing clear communication, common language, consistency and future planning enables the singer to create a plan that encompasses the health, psychological, financial and recovery aspects in a complete wellness agenda. Creating a digital and physical medical home base, accessing accurate language on the voice and its anatomy and setting up a future recovery and financial plan all allow for the singer to effectively advocate and promote their own health and wellness.

Notes

(1.) Cleveland Clinic. 2016. "Online Services." Accessed 4 December 2016. http://my.clevelandclinic.org/online-services.

(2.) Oakland, J., MacDonald, R., & Flowers, P. (2013). Identity in crisis: the role of work in the formation and renegotiation of a musical identity. British Journal of Music Education, 30(2), 261-276.

(3.) Ajzen, I. (2005). Attitudes, personality, and behavior. Maidenhead, Berkshire, England: Open. University Press.

(4.) Reed II, A. (2004). Activating the self-importance of consumer selves: Exploring identity salience effects on judgments. Journal of Consumer Research, 31(2), 286-295.

(5.) Cohen, R. A., Kirzinger, W. K, & National Center for Health Statistics (U.S.), (2014). Financial burden of medical care: A family perspective.

(6.) Hanratty, B., Holland, P., Jacoby, A., & Whitehead, M. (2007). Financial stress and strain associated with terminal cancer--a review of the evidence. Palliative Medicine, 21(7), 595-607.

By Katherine Rohrer

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Katherine Rohrer, BME, MM, is currently on the voice faculty at the Ohio State University. In addition to her extensive performance career, her research focus is on the role of identity formation and the empowerment of musician health and wellness.
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Title Annotation:Professional Resources
Author:Rohrer, Katherine
Publication:American Music Teacher
Geographic Code:1USA
Date:Jun 1, 2017
Words:1510
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