JOIN MY COMMUNITY

Episode Transcription

Dr Marisa Lee Naismith  00:00

Hi it’s Marisa Lee here, and I’m so excited to be sharing today’s interview round episode with you. In these episodes, our brilliant lineup of guests will include health care practitioners, voice educators, and other professionals who will share their stories, knowledge and experiences within their specialized fields to empower you to live your best life. Whether you’re a member of the voice, community, or beyond your voice is your unique gift. It’s time now to share your gift with others develop a positive mindset and become the best and most authentic version of yourself to create greater impact. Ultimately, you can take charge, it’s time for you to live your best life. It’s time now for a voice and beyond. So without further ado, let’s go to today’s episode. 

Dr Marisa Lee Naismith  01:15

This week’s guest is Lori Sonnenberg, a Chicago-based licensed speech language pathologist, clinical voice specialist, and singing voice specialist whose clients include professional performers, educators and speakers. In her voice clinic, Lori works exclusively with voice and breathing disorders and specializes in muscle tension dysphonia related disorders, recovery from voice injuries, professional voice care and support, post-operative voice recovery and problematic technical voice issues for singers. In this episode, Lori explains what is involved in the initial consultation with the patient including the diagnostic process and gives us an insight into the treatments she uses to assist her patients recover from voice disorders and pathologies. Prevention is better than cure, and Lori explains how we as voice teachers can detect when there is a potential problem occurring within our own instrument as well as that of our students and when to proactively seek the help of a voice specialist before it’s too late. Lori also discusses the impact of COVID 19 on the singing voice, misconceptions concerning the incidence of voice disorders across genres, how we as a voice community can listen better, and the importance of supporting and not shaming singers through voice problems. This interview with Lori is a must to listen. So without further ado, let’s go to today’s episode.

Dr Marisa Lee Naismith  03:18

Welcome to the show Lori Sonnenberg. It’s such a pleasure having you, how are you?

Lori Sonnenberg  03:25

Hi, Marisa. I’m doing great. Thank you. How about you today?

Dr Marisa Lee Naismith  03:28

I’m doing well, except my cat is meowing, Charlie! He needs to know his place. But no, it’s such a pleasure having you and there is so much information that I want to extract from you. I’m totally going to be geeking out. 

Lori Sonnenberg  03:47

Oh yeah, I’m excited. I can’t wait to geek out with you.

Dr Marisa Lee Naismith  03:50

Yes. So, you’re the first speech pathologist that I’ve interviewed and I truly have a million questions. So let’s start unpacking you. Let’s start getting to know you, Lori, you are a licensed speech language pathologist, a clinical voice specialist, and singing voice specialist and you’re based in Chicago, one of my very favorite cities in the US and you’re also a soprano. You have a Bachelor of Music degree and a Masters of Music. There is so much to learn about you. So let’s start with and I love doing this with all my guests is finding out-okay, so as a child, did you sing? and when did you actually figure out that okay, I’m not such a bad singer.

Lori Sonnenberg  04:43

Yes, I’m pretty sure I I have memories. I don’t really, really have a lot of life memories that don’t involve thinking I have memories from such a young age thing. My whole family was musical both both sides of my family were musical. Oh, and my mom really wanted me to play piano and expose me to a lot of music growing up. And so I started studying piano very young as well about age five. But I got memories of doing solos and little music clubs and things. Even at that early age. I think my very first public Solo was preschool graduation. Somewhere Over the Rainbow. 

Dr Marisa Lee Naismith  05:26

Oh, of course. What else? 

Lori Sonnenberg  05:28

Yes. And my parents still have like a cassette tape of me singing it.

Dr Marisa Lee Naismith  05:34

Oh, I would love to hear that. You’ll have to put it up on social sometime.

Lori Sonnenberg  05:39

I know. That would be great, wouldn’t it? So I did. I did a lot early on. Just singing for a–wait, I grew up in a really small town in Northwest Louisiana. But surprisingly, we had a really robust music community, the music teacher, the national music teachers association, how to club there. And so I had my very best friend’s grandmother used to host these old timey salon gatherings in her front parlor with her grand piano. And I would go and sing for all these, these old ladies at the music club meetings, and so that those are my earliest earliest memories of doing that, but then I really feel like church was where I started kind of being shaped as a singer and a musician. It was a great outlet for me to play and, and to sing. I started participating in choirs and so forth. And I had a choir director who took an interest in me, I was about 11 years old. And he went to my parents and said, There’s something here, like, you know, there’s something going on here, and we need to foster it. And so those were that was kind of how it all began, I started taking voice lessons and never looked back.

Dr Marisa Lee Naismith  07:00

Well, thank goodness for that. So you went on to study voice and vocal pedagogy formally, what happened first? I know that you’ve done some teaching, you’ve had a performance, little performance career, you’ve done some teaching, and then you transitioned into speech pathology. What was that journey like? What order did all that happen in?

Lori Sonnenberg  07:23

You know, I started out like a lot of young singers who were gifted in in the classical realm. So I, my voice was really well suited to classical singing. And I was a high soprano. I was also really strong musician, so I could learn and sing very difficult music. And so I was really focused and motivated about just pursuing a big performance career in opera, right. I mean, that was what I thought I wanted to do. I would envision myself the Met and in Europe and galavanting about and singing and doing all and knowing and learning all the languages and, and that was really my focus for most of college, I was still pretty focused on that. But during college, I took my first pedagogy course, which is kind of unusual for undergraduates at that time, that was in the 90s. And it was an old book, but it had these hand drawings of the lyrics and the anatomy and physiology. And we started learning about injury ran, I never had injury and not I was fortunate as a singer to never have really struggled. But I had a lot of friends who were music education majors, who were struggling and getting diagnosed with nodules and different things. And so I was sort of observing all of this as a very young singer and want to be teacher. So I tried teaching very young, I started teaching lessons when I was like 19, which I would never want someone to do that now. But I look back and it was just a good fit. I, I was good at teaching music to young people. And so I use my piano skills, and just my budding skills as a voice teacher to you know, start playing around in a private studio setting with other voices and realize, hey, I’m pretty good at making changes and the sound, yes, you know, I can listen to them. And I can sort of internalize that and diagnose it by introspection, what do they need to change about what they’re doing to make it sound better or different? And so I think I started doing that sets at such a young age and, and then when I went to my master’s degree, I was recruited for that degree by a professor named Norman spy v. And it was a new program at that time, and they they there weren’t that many of them. Masters and pedagogy were just unheard of. And they recruited me for that gave me a teaching assistantship, and I just loved teaching. I was just I felt like I am born. Learn to teach boys that I’ve had a good instrument too. And so I was really torn. You know, I had it, I felt like maybe I have the chops for the performance thing, but I wasn’t sure. And I just couldn’t get the vocal injury rehabilitation piece out of my head. Sure. And I lived really close to Philadelphia at that time when I was doing that degree. And so I started observing and spending time in a Laryngology Clinic.

Dr Marisa Lee Naismith  07:34

Well, so that opportunity came up for you.

Lori Sonnenberg  09:19

Very early, very early. And there weren’t very many, I really wanted to be a singing voice specialist. I didn’t want to do the speech pathology piece, I just wanted to do the singing voice specialty. But here in the States, you know, there are the stronger lines, the somewhat between the practice of those things. And I realized after talking to people that I probably would not get to really be all that involved in the medical side of things. If I didn’t do the speech pathology degree. Sure, sure. And so I was still I was in my mid to late 20s. And I said, you know, if I’m going to do this, this is the time and I actually gone on started my doctoral work, really. So you started. Well, I had started my document musical arts. Yes. And and I just couldn’t get that I was envisioning this role where fingers could have very specialized support or recovering from injury.

Dr Marisa Lee Naismith  11:37

Yes. And isn’t it strange in life, sometimes you have that calling, and you can’t move away from it. That’s it. That’s all you want to do, and nothing else and you can try other things. But when your heart’s in something, you just have to go for it, don’t you?

Lori Sonnenberg  11:55

That’s exactly right. And I think that that’s a great way to say that because that looking back, I do think there was just this deep sense of calling and, but I was scared, I was scared. I devoted my entire life to cultivating the craft of theming for my, for my own instrument. And I actually remember the day that I came home and officially said, Okay, I’m doing this, I’m leaving performance behind and making this this change here. And it was those tough, I was depressed for a while it was the big thing to give up.

Dr Marisa Lee Naismith  12:34

But that would have taken a lot of courage. So Good on you to make that call. Because look at you now. It’s all been worth it. Work, you’re doing such amazing work. Okay. Now, I want to ask here, and this may be a really ignorant question. What is the difference between a voice therapist and a voice pathologist? And is there a difference? into use of the same thing?

Lori Sonnenberg  13:04

I think we interchange them a lot. He especially here in the States, I think everyone kind of calls themselves something just a little bit different. I use voice pathologist sometimes because I am involved a lot in the diagnostic process. And that that pathology diagnosis of and I don’t know it it for me, it really feels like it gives me some credibility on the science side of things. Absolutely. Yeah, but I think a lot of speech pathologists just use that new interchange them voice therapists. To me, it’s a little more like colloquial, the pathologist sounds a little more credible sometimes, I guess.

Dr Marisa Lee Naismith  13:48

So, it sounds a little bit more qualified, more formal, more important. And we’ve made it and yeah, we want to be all those things.

Lori Sonnenberg  13:58

Right. Right. And my favorite title to use is clinical voice specialist. I feel like that is probably the best representation of what I do in my day is.

Dr Marisa Lee Naismith  14:12

Yes, so in your work as a clinical voice specialist, what are the most common voice pathologies? Or do you call them disorders pathologies versus disorders? Or is that a interchange of-

Lori Sonnenberg  14:27

I don’t use the word pathology to me refers very specifically to a lesion on the local hold.

Dr Marisa Lee Naismith  14:36

All right, okay.

Lori Sonnenberg  14:38

Right. So, I probably say disorders or injury more often, but I like disorders because I feel like disorders is a little more a correct sort of categorical description, right to types of things, because so much of my practice is devoted to what we call functional voice disorders, because muscle tension dysphonia falls in that functional realm. And so, so muscle tension dysphonia with or with our pathology is, is the number one diagnosis in my clinic.

Dr Marisa Lee Naismith  15:18

Really? Well, we I was going to ask you about that a little later. So, but I’m happy to go with you here. So muscle tension dysphonia that is really common, and it’s more common than what people realize. And it’s actually something that I’ve suffered from myself in the past. And it came at a time when I was completing my PhD. I was working five days a week, as well as doing completing my PhD on a full time basis. So I had no life. I was absolutely just running on adrenaline the whole time. And I was tight as in every part of my body, and I was diagnosed with muscle tension dysphonia. Now, do you want to explain what that is?

Lori Sonnenberg  16:12

For sure. Well, muscle tension dysphonia I, I mean, one of the things I want to make sure I say first is that it is a bit of a it’s a bit of a wastebasket term. Oh, time in it and no, no, no. And just being like, a lot of things go in the bin. And here and here’s what I mean by that. Because when we it means that it’s a big umbrella term, rather, when a doctor doesn’t see anything wrong from an organic or physical standpoint with a larynx, which is what we want, right? We don’t want to see anything, yes. Even if they don’t really see muscle tension. So it’s kind of hard to see that. They’ll that’s what we diagnosed the person with, when the voice is a little, you know, something’s not working correctly or well, about the function. Yeah. And so it encompasses so many things. It can be primary or secondary. That basically, the way I like to describe it to my patients and my students is that there are very particular muscles intrinsically and the larynx that are responsible for vocal fold vibration, and closure, abduction and that process, and we don’t really want the extrinsic muscles and operators involved. All right, I understand. And so what happens in muscle tension dysphonia usually is that there are muscles that are not supposed to be involved in that process become involved, we start recruiting help from them. With compensatory strategies. Yes. And then, you know, the body learns what it learns.

Dr Marisa Lee Naismith  17:53

And it becomes habitual?

Lori Sonnenberg  17:55

That’s right, the brain learns it. And we’re looking and especially singers like we’re looking at work. From the moment something doesn’t sound right or feel right, we start looking for a way around it.

Dr Marisa Lee Naismith  18:06

Yes, yes. I call that manipulating, we start to manipulate. And that’s why often, like when it comes to my singing students, I can tell more so in this speaking voice, if there’s a disorder, rather than their singing voice, because in their singing, we all when we see we can learn to mask it and as you said, work around it. But it’s very hard to disguise in the speaking voice.

Lori Sonnenberg  18:33

Yeah, you’re right. Well, because we’re not as aware of technique. Usually, you know, one of my mentor talks about like, how, as singers, we were really good at dressing up our voices. Like we put all the layers on we put our most beautiful gowns on and our and our coats and our hats and our scarves and we dress it up. And and we’re good at that. Yes, we’re really good at that. It is. So it can be it can develop all by itself as the primary issue but a lot of times muscle tension dysphonia is a secondary diagnosis to another diagnosis.

Dr Marisa Lee Naismith  19:12

Really? Okay, there’s so many questions here. One, what causes muscle tension dysphonia? So what are those primary and secondary problems that are going on?

Lori Sonnenberg  19:25

So, the most common example is, well, there are two I can think of one is is like nodules or polyps, but especially nodules, very common for singers to develop the muscle tension patterns while continuing to sing and speak with injury present.

Dr Marisa Lee Naismith  19:44

Okay, so that’s pretty serious.

Lori Sonnenberg  19:46

Right, and then there’s a lot of Muddy Waters sometimes in treatment, because I have to sort of suss out what’s the main issue here? Is this are we dealing with an issue because of Oh, or use is this person truly overusing their instrument. And that’s why they can’t get better, or is muscle tension, the primary issue. And I were paired with a group of laryngologist here in the Chicago area who are super super savvy at diagnosing muscle tension dysphonia in the singing voice. And that’s why so much of my practice involves that, usually what we see on an exam, just to be really clear here, we usually see a gap of some sort between the vocal folds where they do not come all the way together from front to back.

Dr Marisa Lee Naismith  20:35

Really? And that was, what I was going to ask you is when just say I’m a brand new patient, or client, and I come to you, I’ve never been to before, what is the diagnostic process that one goes through? 

Lori Sonnenberg  20:51

Typically, when I evaluate a patient, the majority of them have already seen a laryngologist. And a diagnosis has been confirmed? Right? So I begin, there are really three major components to my my time with them in that initial visit one is a very detailed dive into their history. We’re going to talk first, yes, I’m gonna learn everything I can learn about that person. And their their personal life, their professional life, the role that voice plays in their lives, what’s going well, what’s not going well, what is your voice not do that you need it and want it to do? Right for You? Yeah, no. And so the history is first and that sometimes that’s not a big deal. And sometimes that’s a really long, deep, deep dive into a lot of medical things. The second piece is the actual vocal assessment or assessment of what I call vocal capabilities that I’m trying to find out what is this voice capable of? And then what are its limitations?

Dr Marisa Lee Naismith  21:56

Right. So how do you do that? Is that through like a spectrograph or scone?

Lori Sonnenberg  22:03

Not right now, when I was me, I’m primarily still virtual and teletherapy. Right now, though, the majority I started did away with a lot of my more formal assessment things online. I’ve also been doing this a really long time, and I’m, I’m pretty good at just assessing things with my ears and the keyboard. So I do we do speaking samples, I try to find out like what what can this voice do all the things that it should be able to do? Yes, in in the speaking way, mean? Meaning louds and softs and highs and lows and authoritative and then we do a lot of sustained sound making so long sounds holding things out. I try to assess the way the breath is working. Are there limitations in the breath? I’m listening to tone and coming up with how do I describe this tone? Is this a clear tone? Is it is it horse? Is it husky? Is it breathy? Is it Are they straining? Are they working too hard? And then singers? If it’s a singer, which it is, yes, we go into more more subtle nuances to Kotti. I want to know what can what can they do with staccato legato lines and transitioning between vowels and and what is the range? Like is this? Is this a balanced vocal range from a registration head standpoint? Or is there a lot of imbalance?

Dr Marisa Lee Naismith  23:30

That’s amazing. And what causes muscle tension dysphonia usually, well what is the most common cause that that you see in your practice?

Lori Sonnenberg  23:43

Usually, the voice either there’s there’s an overuse component, or that is either one time or repetitive wear, they’re never quite recovering to their baseline and then they fall into those compensatory strategies show, I call it just kind of getting off track. There’s also lack of use. So you know, the disuse or too much, too much vocal rest. That happens a lot. People are scared, they rest too much for too long. And then they try to come back to singing and then it’s not working like it’s supposed to you another circumstances getting sick, getting ill.

Dr Marisa Lee Naismith  24:31

And people, well perhaps returning to work a little too soon. And not fully recovering.

Lori Sonnenberg  24:37

Right or the body the physical body comes back to normal, but the voice never quite comes all the way back. There’s just something a little and the thing is though singers like I said, we’re really good at making things work. So I think a lot of singers that just Band Aid things for a little while. Yeah, and in the muscle tension and grows. The other thing I just want to make sure I mention because this you had asked about the primary versus secondary. Another very common sometimes under diagnosed issue that we’re muscle tension can be secondary to it is vocal hold per recess. Oh, okay, which is a weakness in the nerve. Right? Okay, then the nerves and so that there’s weakness there’s sometimes the vocal folds get kind of foggy or one’s not vibrating and moving the way it’s supposed to. And that’s very common in the singing voice too.

Dr Marisa Lee Naismith  25:36

Okay, so how do you treat muscle tension dysphonia, I know when I was diagnosed, I was given like, accent breath work to do, I was given stronger foundation, puffy cheeks, that kind of thing. But working on breath, and I know at the time, because I was so highly strong that I was holding my breath a lot. 

Lori Sonnenberg  26:01

Yes, yes. Breath holding is very common with muscle tension dysphonia.

Dr Marisa Lee Naismith  26:05

Yes. And that came from tension. And also the back of my neck was really locked. So I was given a lot of exercises to loosen the back of my neck.

Lori Sonnenberg  26:17

Yes, yes. You know, every person’s priority list is a little bit different.

Dr Marisa Lee Naismith  26:22

Of course.

Lori Sonnenberg  26:23

I am a little out of the box, as a speech pathologist in the way that I that I treat voice, I don’t follow like the typical methods, I sort of create little blends of my own things based on what I think is gonna work. And I really rely on my skills and the singing teacher. And therapy, I rely on those skills so much. Yes. And, and so usually there’s, I refer to it as kind of an unloading process. Yeah. So we begin with, let’s make sure the breath is a mop, we’re going to move, we’re going to work with flow, we call it flow phone, we be flow the breath, yes. Usually, there’s a component of like laryngeal massage, and I do something called trigger point therapy, where we’re sort of isolating specific areas and applying pressure. And in trying to figure out, what does that do? Does that change what’s happening? So then we begin with unloading, but I’m really particular in my process, because even while we’re unloading, I mean, very sneaky. About getting other things going without the person knowing. Yeah, that’s what I’m doing. Yeah. So. So while we’re unloading, I’m already choosing downs for their therapy exercises, where I can tell that they’re getting really clean, clear, adduction, and better vocal hold positioning and really efficient voice thing. So really, I just use my ears in a trial and error sort of way to determine what results in really, really efficient voicing for this person.

Dr Marisa Lee Naismith  28:07

Yes.

Lori Sonnenberg  28:08

And then that’s all we do for a little while.

Dr Marisa Lee Naismith  28:11

Okay, so it’s just repetitive work to begin with?

Lori Sonnenberg  28:14

Very repetitive, we start with very short, frequent practice, and, and we get results, usually, I mean, very quickly, usually, the person is feeling better when we finished the first session, and they go away, and they do it. And as the voice becomes more efficient, and we’re unloading and peeling back the layers of tension, and so forth, and we get in there, and we start building. And we’re going to build and we’re going to start to work on resonance and aural shaping and vocal tract shaping. And then we move into vowels and tongue positioning. And I mean, it’s just a lot of different things.

Dr Marisa Lee Naismith  28:55

It’s like a massive can of worms. It’s a lot, isn’t it? That’s incredible. I just want to move on to now there was when we had a meeting some weeks ago, you talked about vocal folds swelling as well, that is something that is very, very common, and many voice users who, like professional voice users don’t realize that they have it. So do you want to talk a little bit about what that’s all about?

Lori Sonnenberg  29:26

Yeah. One of my favorite things to talk about. Well, I have learned that this kind of comes from my knowledge about swelling and how it comes and goes in the life of a singer or a professional voice user comes from taking people through that process of resolving swelling and injury and helping them learn the day to day week to week balance of how much voice and how much silent, right balance and be so vocal folds swelling. I mean, really swelling is our body’s way of trying to protect us. So we, you know, vocal vocal whole vibration is a biological thing. It is not infinite there. And so there is a limit. Yes, there is we all have a limit, your limit and my limit are different. And, and so the thing about falling and vocal fold vibration, you know, did you know that there is no other tissue in the human body that gets subjected to the kind of trauma that vocal folds do on a daily basis.

Dr Marisa Lee Naismith  30:35

I’m not surprised because we’re constantly using the vocal folds not only to find aid, but they have other little jobs that they do as well. So, yes, yes.

Lori Sonnenberg  30:46

So we vibrate so much. And if we go past the limit, the vocal folds are going to there are going to be these little cushions that kind of pop up, you know, on the vibrating edge of the fold to protect us. But when that little cushion pops up, something’s going to change about the voice. And we have to know what the in our body or our voices are going to give us a warning signal that that spelling is present. Now, if you’re not a singer, you might not ever know.

Dr Marisa Lee Naismith  31:17

Yeah, so what are the warnings? And I didn’t ask what the warning signs are of muscle tension dysphonia either. So how can we tell that we have something sinister going on? Or potentially sinister?

Lori Sonnenberg  31:32

There are some really key common signals, warning signals, I like to call them for singers especially and I, you know, I ever I do work with non singers, but just for the purpose of our conversation, I’m gonna use that. So, and remember, the outer edge of the vocal hold is the mucosa. So we are referring to mucosal swelling in this. So the number one thing is loss of the high soft singing?

Dr Marisa Lee Naismith  32:04

Ahhhh. That’s interesting. Because even in, I mean, how many students come to me and they say, I can’t sing high softly. The only way I can sing high is if I sing loudly.

Lori Sonnenberg  32:17

Yeah. So you know, we don’t know. We never know unless we look right. So but it’s, it’s one thing for someone who have never been able to do those notes that way. But it’s another thing for someone to say, I can’t sing above G5 today. Like I’ve lost everything above that, what what’s going on? So but loss of high soft singing, because even the smallest of vocal folds swelling might not interfere until soft head voice or soft falsetto. And you have to get quiet to notice that. So the loss of high soft singing, day to day variability.

Dr Marisa Lee Naismith  32:57

Aha, so the voice behaving itself one way on a one day, and the next day, the voice behaves differently. So the voice is inconsistent from day to day. And you don’t know how it’s going to behave. It’s just random, right?

Lori Sonnenberg  33:15

But there’s almost always a pattern in there. And that’s one of the fun things is helping people find those patterns. So the other really common things are onset delays, error escape in the tone, yes. And increased effort. Right. Okay. So those are probably the top five warning signals that come out. Another thing that kind of stands out just for like our listening audience, so colds and viruses and upper respiratory type things, even allergies, and reflux and all these things that that can really cause havoc, and they’re, they do cause they cause what we refer to as more global swelling in the environment. So the whole area is going to be inflamed and-

Dr Marisa Lee Naismith  34:00

All right, not just the folds.

Lori Sonnenberg  34:03

Right. Vocal folds swelling is vocal. So, if someone happens to have a little baseline swelling, that other swelling on top of it is going to really just make that voice very impaired. 

Dr Marisa Lee Naismith  34:20

Okay, so it’s going to wreak havoc.

Lori Sonnenberg  34:23

Right, right. So now vocal folds swelling. Well, I get very excited about this topic. People get stressed out about it, because it’s a scary thing sometimes but the reality is when we are a busy voc- when we are a busy vocalist, we have very high expectations of our voices on a daily basis. Absolutely. Yes. And we don’t listen to the warning signals a lot of times and and we say, well, I got to teach that lesson and I’ve got to sing that rehearsal and, and so when you go when you ignore the signal, even if it’s the smallest little signal, but then that’s it. signal keeps showing up, then you’re moving towards something a little more chronic. So regular monitoring, knowing how to monitor mucosal swelling is important. Now, one of the things that’s confusing is the difference between, okay, I didn’t say vocal fatigue, and I should have said vocal fatigue, because that should be in the list of common complaints. Yes, vocal fatigue could mean so many different things. How do we know what it means? And so I talk a lot with my singers about the difference between is what I’m experiencing mucosal welling issue from overuse for board. Is it really a muscular thing?

Dr Marisa Lee Naismith  35:45

Wow. Okay.

Lori Sonnenberg  35:47

How do we know the difference? 

Dr Marisa Lee Naismith  35:49

Well, that’s something you can diagnose, obviously.

Lori Sonnenberg  35:53

Well, we have to suss it out, you know, we talk about okay, tell me exactly, you know, we talk about the exact thing. So, what I have learned. Now, this is all anecdotal. You know, there’s no paper out there. But this is based on close to 18 years of clinical experience here. And what I have learned is that it takes a characteristic of vocal swelling is that it usually takes a little while for that to show up in the voice, right? Like, you’re not going to notice swelling, like immediately, it’s going to be like a few hours later, or sometimes the next morning, is when swelling shows up.

Dr Marisa Lee Naismith  36:30

So one thing you mentioned to me, when we were chatting some weeks ago, was that with vocal folds swelling, usually people when they wake up in the morning, that it takes their voices some time to warm up. Was that correct? 

Lori Sonnenberg  36:47

Well, it depends. It depends. If you don’t have any swelling, we should be, you know, ready to go pretty quickly. What I may what I’m you may be referring to is that, okay, so if you want to try to find out, am I swollen today? How do I know? You can just test your high soft voice.

Dr Marisa Lee Naismith  37:16

There’s a little break in there. But that’s–

Lori Sonnenberg  37:19

So but I know in my voice, you know, and you you go into falsetto, or your very high head voice, you get really soft. Like you just want to be able to beat Yeah, that’s how you do a spelling test. So if I were still one, this is what I’m gonna sound like.

Dr Marisa Lee Naismith  37:47

Ahhh. You know, there are times I do sound like that. 

Lori Sonnenberg  37:50

We all do. 

Dr Marisa Lee Naismith  37:51

Yeah, bit, especially after a really long teaching day. You know, some days, I may teach for 12 hours without a break. I mean, the next morning, I may be a bit tired, or if I’ve been out and being in a noisy restaurant, yes. And having to have big conversations with a group of people. That is another time it happens in the morning. That’s probably my worst is being out in a noisy environment.

Lori Sonnenberg  38:22

Yes, but see, we all do that. And then we the next day, we might we’ll be warming up and be like, like, those notes are sometimes kind of weird up there. And you know, they’re not working as well as they usually do. And, but we just let them you know, whatever. It’s fine. I’m probably just a little tired. But yeah. Are you really tired? Or are you swollen? Yes. And so now the muscular. So just to kind of finish that thought. So, swelling usually takes a little while to show up. But it also takes a little longer to go away. All right, so So now we want you to recover overnight. That’s what we want. No more than one to two days, muscular issues. So if you start to feel fatigued and or even getting a little hoarse, muscular, almost shows up immediately like that. I just happen like, right away.

Dr Marisa Lee Naismith  39:11

Right. I had something that was going on with my voice many, many years ago was the only time I had some sort of disorder going on. And I was touring in a rock band. And you know, I’d had a big career already, my voice at all always behaved itself never had any vocal issues. And with this rock band, I blamed the lifestyle because there were a lot of things going on a lot of heavy lifting, lugging gear, very late nights, not sleeping properly, lifestyle, eating bad food, the position of the monitors on stage where I couldn’t hear myself and trying to sing loudly to be able to get some sort of a feed like oral feedback and all Also the demands from management that we’d have media on the days off, and all those sorts of things. And it started off that very slowly. That one day, you know, my voice started to become a little shady. And to the point where I after not even finishing one song, my voice just cut out. Yeah. And that’s when I knew I was in deep trouble. But I knew there was something going on earlier, and I was doing my best to try and keep going. Because in the industry, it’s all about the show must go on. But how many people come to you, when it’s too late? Like, they don’t listen to the warning signs. They know something is up, but because if we don’t work, we don’t get paid. We keep pushing through. Do you see that a lot?

Lori Sonnenberg  40:54

Yes, absolutely. And, you know, I don’t ever feel like it’s too late. I really don’t. I don’t, I’ve had too many successful experiences with singers, bringing them through the injury experience and journey and recovery, whether that involves a surgery or not. Sometimes it does, sometimes surgery is exactly what that person needs to get them back to original equipment or as close as we can get them to original equipment. Yeah, and if you’ve got a great surgeon, there are rarely issues with that. And so, and I love that I love helping singers recovering from surgery. It’s a really fun process. But a lot of people a lot of the people that that I see with official vocal injury now not just not the technical aspects or functional aspects of muscle tension dysphonia, I talk about those a little separately. You know, I don’t call muscle tension dysphonia and injury, right. And, and but most of them have like pushed, you know, push the voice past that limit. So many times not really understanding what was really happening in there.

Dr Marisa Lee Naismith  42:09

Yes. What are the worst injuries one can have as a singer? What would be your worst nightmare? 

Lori Sonnenberg  42:16

Oh, gosh, 

Dr Marisa Lee Naismith  42:18

Would you say? What would you not want to have?

Lori Sonnenberg  42:22

I wouldn’t want to have an injury that was under the surface of the vocal fold. So usually vocal folds cyst, form under the surface. And so but I’m going to take that one step further. If so, if you say if you continue to work on an injury, that’s very obvious. And if it were a cyst under the surface, it can burst. And there and long term damage can cause a little something that we refer to as a sulcus. So that means there’s like a little divot in the mucosa. There’s like an actual little furrow-

Dr Marisa Lee Naismith  43:02

Yes. Wow. Okay.

Lori Sonnenberg  43:06

And it, it turned, you know, it’s scar, like, it’s got scar tissue, and it can be dealt with surgically. But it’s a really, really difficult thing to get improvement in. And, and most other at but I have, I’ve helped one of my favorite postdoc cases are preoperative and post operative in my memory, was a young singer, a college student, who had two cysts, one on each side. And so when we’re dealing with something like that, because you can’t operate on both sides at once, you have to do them separately. So you have to do the first surgery, and then it’s like months of recovery. And then we do the second one, and then it’s another stretch of recovery. And it took a good year to get that singer back on stage. But it was such a rewarding, joyful thing when it was all over.

Dr Marisa Lee Naismith  43:58

Yes. So would that be the worst case that you’ve seen?

Lori Sonnenberg  44:01

I don’t know. I don’t really read them like worse than–

Dr Marisa Lee Naismith  44:07

Well, have someone come to you and you’ve just gone well, this singer has some serious problems going on. Houston, we have a problem!

Lori Sonnenberg  44:17

We have a problem. I think I think the most the worst situations like that are when the vocal hold tissues are just so beat up from a lifetime of of asking more than they should have. And it’s important, it is possible to continue to sing pretty well. I mean, there are some pretty high profile singers with vocal cord injury that probably have very little vibrating, viable tissue left. And they’re, they’re singing they’re still making money and doing a good job so.

Dr Marisa Lee Naismith  44:53

Do you listen to those singers and go oh my gosh, I just can’t listen to that? Knowing that they’re injured?

Lori Sonnenberg  45:00

I don’t really I’m very versatile in my listening. I’m appreciative and enjoy a lot of different singing styles. I grew up listening to pretty intense, heavy metal and rock rock. And I don’t react that way. I mean, I, I’m appreciative of even those really aggressive sounds that that we can make vocally because I always say, you know, our voices were designed to do this stuff for us.

Dr Marisa Lee Naismith  45:27

Yes, yes.

Lori Sonnenberg  45:28

I mean, really, they were made to, but it for me, it’s when people just continue to push past without that awareness. And that makes me think of how hard it is for singers to go for help to ask for help. You know, it’s a mystery to me. Yeah, it’s such a mystery. It’s why why would you not go get answers?

Dr Marisa Lee Naismith  45:52

That is all about the shaming. There is no shame around having injuries and disorders. I mean, look at poor Adele, when she had her last lot of vocal injuries. I was totally embarrassed to be a voice teacher, I was ashamed as a voice teacher to read some of the commentary on social media forums, from our professional voice teaching community. I mean, I can see why they don’t go and have help ask for help. If it was shameful, it was shameful what I was reading. And people seem to have all the answers and they don’t know.

Lori Sonnenberg  46:37

Yes, voice teachers, we do. We feel very knowledgeable.

Dr Marisa Lee Naismith  46:42

And very opinionated, and can I tell you, unless you’ve walked the walk and you talk the talk, you don’t know what’s going on in a person’s life. Now, for example, I had vocal injuries as are a disorder, whatever it was at the time, but that lifestyle was not helping. And you don’t know now Adele had done something like 100 shows. It was her last show. She’d been on a flight every second day. Come on people, you know and-

Lori Sonnenberg  47:17

It is a brutal, brutal lifestyle and what I want and I always chime in when I feel when I get my feathers, you know, a little ruffled. Why am I here I come? Yes. And I say my my pushback is okay, people this is not, she didn’t do anything wrong. You know, she’s singing. Do you know how many shows she’s singing every week? That the voice was not it was designed to do amazing things. But remember, I said it isn’t infinite.

Dr Marisa Lee Naismith  47:50

Yes. And also to what I mean, it was a lot of the classical voice community that was chiming in on all of those forums. And they only have to sing a few songs. And then they go home. I mean, when I was singing professionally, there was a time when I was a single parent, and I had to put food on the table for my daughter. And I was taking every job possible. And there was a stage that I was working 11 gigs a week, the minimum didn’t the minimum I was doing was a three hour call. And then, so I was working from seven to 10. And then going to a nightclub that was seven nights a week doing that. And then four nights a week, I would go into a nightclub and sing from 1030 till three. Now, that’s not getting up and just standing there. Sorry, classical singers, but we have to move. We have to have banter with the crowd, we have to speak to people in between, we add voices don’t get a break from the time we arrive to the time we finish. So it’s completely different.

Lori Sonnenberg  49:10

And you know, the thing that I dream, I dream of a world, of a voice world where we all understood those nuances of swelling and and I dream of a world in academia and in private studios and in theater in the theatrical world and in the commercial singing world, where everyone gets education in that. What is it? How do I know if I’ve done too much? And what does that really mean when I feel like that? Yes, yes. If everybody knew that, and knew how to test for it, we could we could cut some of these things off at the past, you know, and and I and that’s how I work with my patients. I don’t let them I say No, we’re gonna monitor this and we’re gonna test it every single day. And you’re gonna write down what that is. Mm hmm. And you know what? It empowers them to make really good choices.

Dr Marisa Lee Naismith  50:13

That’s fantastic. Okay, I’m going to ask a very controversial question here. And Lori, I would really appreciate an honest answer. So we’re not going to we’re not going to faff. That’s what an Australian term, we’re not going to faff, for a particular community that exists within our voice teaching community. So, when it comes to injuries and disorders, are CCM singers, more likely? Or do you see a higher incidence of problems within that group of singers than classical voice singers?

Lori Sonnenberg  50:58

That is a great question. And not one that I think about a whole lot. 

Dr Marisa Lee Naismith  51:02

Oh, that’s good. So you don’t have biases?

Lori Sonnenberg  51:05

You know, I really don’t think I do.

Dr Marisa Lee Naismith  51:08

Yay. First soprano from the classical world, I’m very proud of you.

Lori Sonnenberg  51:14

Yes. No, I don’t. I see all genres equally, and my practice and styles and environments, and the only thing I would say is that this is from the muscle tension dysphonia side of things, because when I mentioned that issue with a gap between the vocal folds, yes, and usually the gap is towards the back of the so if you’re looking at vocal folds on a screen, and then there’s going to be more of a gap in the back here. I do tend to see that shape of the gap in Belters that take chess voice a little too high. That’s the only thing I can think of, but that’s not necessarily like an injury type thing. It’s more of a technical thing that okay, that gets imbalanced and so we just have to teach them how to rebalance that. But But no, as far as injuries concerned, I mean, everybody walks through the door, they’re coming from all different. I mean, I’ve i i see impersonators. You know that from from Elvis impersonators to the the upper echelon, elite, classical soprano at, you know, the Opera House. I mean, and everything in between.

Dr Marisa Lee Naismith  52:29

Yes. So what you were talking about, sorry about that belter. That’s, that’s obviously a training issue, they haven’t been trained correctly, to belt that high. And I love that you’ve said that people come to from all walks of life, they sing across a variety of genres. No one is more problematic than others. And because to me, this would be my assumption. And it’s not based on anything other than the sheer workload that the singers have to, you know, that their workload not only in terms of singing, but they have to speak as well, is musical theater singers, I worry about them, because of all the different styles that they have to be able to sing across. It’s basically non stop for a lot of them for two hours on stage, everything else the positions that they have to sing in, I would assume that they would, could possibly end up in trouble, more so than singers that other singers

Lori Sonnenberg  53:33

from, from my perspective, part of the problem with that a big part of the problem is they get confusing messages in terms of vocal health, like the the value of their vocal health and the priority of, you know, their vocal health in the rehearsal situations and the way programs are put together. course curriculum, the training, the way that the build, because we don’t, we want you to be careful, and we don’t want you to injure yourself. And we support you, and we care about that. But we’re gonna run the show twice today. Yes. Okay, so where’s the logic in that? I mean, there’s no way there’s no way, especially young singers, there’s no way that they can handle that kind of load. And see that’s confusing to them, because then they feel like this is being presented as I’m supposed to be able to do this. Yes. And do they then when they can, they feel shameful? 

Dr Marisa Lee Naismith  54:38

Exactly. And do they have a support team in the US for musical theater singers? So just say if you’re in a production of hairspray, that production show has different therapists that that like physiotherapist they have-

Lori Sonnenberg  54:59

That’s a great question. I think we’re there’s definitely more of that happening. Being like on Broadway, that’s probably one of the few, you know, locations where more of that is happening. But at that regional theaters local theater, I mean, even I don’t know, with touring companies? That’s a great question. It’d be a good question for someone who’s familiar with that? Yes. But at the regional level, local level in the school, you know, people get hired to be vocal directors. And they half the time, a lot of times the vocal director isn’t very familiar with injury and how to protect the students from that. And so then they’re putting forth these expectations. And then they all wonder why when you get to tech week end or two days before the show, nobody has a voice.

Dr Marisa Lee Naismith  55:40

Hmm, yes. A lot of the time, people in those leadership roles because I know this, my daughter works on cruise ships. And I know that the rain sample, the vocal captain is not necessarily someone who has the most training, it’s someone who sings, according to the production team, who is the best singer, who might be the most experienced or may have had the greatest career leading up to that contract, but has no knowledge of how the voice works.

Lori Sonnenberg  56:13

Right? Well and see another another thing that’s kind of tricky about vocal folds swelling and injury is that it responds really, really well to warm up. So if you you can cover that up pretty quickly with your warm up. And the voice responds to that and it gives in and so that’s why we want to teach fingers to monitor before they warm up so that they have some sense of what that naked voice, is like,

Dr Marisa Lee Naismith  56:46

Yes. So what is your favorite warm up? Or what would your preferred warm up regime be? What would it involve?

Lori Sonnenberg  56:54

Hmm, I like to start with something that gets the airflow moving. So either lip trills, temp trills, raspberries, usually when of, or straw phonation in the water.

Dr Marisa Lee Naismith  57:07

Oh, you prefer in water? 

Lori Sonnenberg  57:09

Yes, yes. Well, to start out with usually. So lots of gliding, just lots and lots and lots of a lot of up and down to begin with. So I usually want people starting with airflow of some kind moving at, then I just like sustaining tones on something that feels really good vibe. voiced consonants are really valuable like these and am my favorite warmup for muscle tension dysphonia is the L consonant

Dr Marisa Lee Naismith  57:43

Really?

Dr Marisa Lee Naismith  57:48

Okay. 

Lori Sonnenberg  57:49

Yeah, yeah, I’ve worked with L a lot in therapy.

Dr Marisa Lee Naismith  57:52

So what does that do? Why do you like the L so much? 

Lori Sonnenberg  57:55

Well, the tongue is I mean, we, you notice the tongue is a, it’s a muscular hydrostat. So it’s, you change the shape in one place, and it just distorts and another. So so when we make that L position with the tongue, it’s sort of in this, you know, it’s in this sort of diagonal position hole, but the root of the tongue goes to such a position back there, that it aids in vocal fold. adduction. And, and closure, usually, and it’s really great for mixed voice. Okay. Like, yeah, and so I love El, my favorite of all time, if you said to me, Lori, forevermore with all of your students, patient injury, healthy singer, injured singer, or whatever you want to call it, if you could only pick one exercise to carry forward forever and ever and ever, and is the only one you could use. Yes, it would be the word. Knoll. K-N-O-L-L.

Dr Marisa Lee Naismith  59:01

Knoll? Really?

Lori Sonnenberg  59:06

So, let me demonstrate. 

Lori Sonnenberg  59:15

It’s just this perfect little combination of the n, the oh, and not necessarily saying the L but sort of thinking the L.

Dr Marisa Lee Naismith  59:25

So one question on that. When you say the so is it a dipthong that you’re using? So, is it just No or is it No like an OE? Is it an O?

Lori Sonnenberg  59:42

It’s more O. The way I teach it, it’s more O.

Dr Marisa Lee Naismith  59:46

Okay. Okay, so it’s still that Italian vowel like more you sitting on the open open part of the first vowel and you stop it there?

Lori Sonnenberg  59:55

Yes. Now okay, now and with it, it works really well across genres, and I mean, I just have so much success with it. It sort of comes from a very beloved exercise routine therapy exercise routine that was created in the 90s by someone named Joe Stemple. He was a speech pathologist. He just retired in recent years, but no was sort of came from one of the exercises in this regimen that he called vocal function exercises. And he didn’t really say it was normal, but when you watched and listened to him demonstrate it, that’s what you heard. And so that’s kind of where it came from. And so I’ve been working with that sound in my choirs and solo stuff. I have a lot of success with it. Now, the challenge is that for the CCM singers, it’s not the best vocal shape. I’m sorry, it’s not the best vocal tract shaping a yes. For what they need. And so I use, I use it more therapeutically with them. And then when we need to cross over into more training aspects, we have to abandon that usually and find something a little more appropriate.

Dr Marisa Lee Naismith  1:01:05

Okay, because it’s lowering the vocal tract. 

Lori Sonnenberg  1:01:08

Yeah, it’s just too, it’s too long. And yeah,

Dr Marisa Lee Naismith  1:01:13

Okay. So, what is your favorite cooldown? Because singers generally forget to cool down or they don’t realize the importance of a cooldown what would you suggest? 

Lori Sonnenberg  1:01:24

My favorite cooldown, they’re all there to either straw phonation. Or lip trills. And I, I like downward like descending lines. I teach my singers to do a lot of downward movement with the voice for cooldown.

Dr Marisa Lee Naismith  1:01:46

Okay, because one of the most popular call downs here in Australia is just doing like some vocal fry.

Lori Sonnenberg  1:01:55

I like vocal fry. I-Yes, I love it. I teach a have a whole barrage of therapy exercises and singing exercises that come out of what I call creaky voice. Yes. Noises Yeah. And yeah, and no, I love vocal fry. I don’t, I only recommend it for cooldown or relaxation purposes. When I have my muscle tension dysphonia singers, that means something to sort of pull them out of that, that kind of intense place. But I that’s interesting. That’s very interesting to me. 

Dr Marisa Lee Naismith  1:02:32

Yes, well it’s supposed to bring everything back to neutral and back into, especially for high belters, where the larynx has been floating from that neutral to high position, it just brings everything more into a neutral position again.

Lori Sonnenberg  1:02:49

I love that and I’ll I’ll buy that.

Dr Marisa Lee Naismith  1:02:52

Okay, well I taught Lori something, I’m so proud. Now, we’re down to the last final questions. You’ve been amazing, and I’m just going to ask you, this is for my students, because I’ve had a number of students who have recently had COVID. And they’ve come in with some vocal issues, they’re saying their voices are not behaving that is actually the words that they’re using. Okay, they’re having some little funky pitch issues going on. So every now and again, the voice cuts in and out. But they can’t rely on their voices to do what the voice was doing prior to COVID. So there’s a little bit of lack of control over the voice for want of a better word, because we don’t like to use the word control. But the voice is not responding perhaps the way that it used to prior to COVID. Is this something that you’ve seen with any of your patients?

Lori Sonnenberg  1:03:51

Yes, sometimes a lot of it’s interesting. I have a lot of people that don’t disclose that they’ve had COVID Not not on purpose, they just forget to mention Oh, and by the way, I had COVID, six months ago, you know, and, and I have to kind of dig into it. But yes, I think that I I would call I like what you’re saying like lack of control. I am I am seeing some of that. I think of it as sort of, I also think of stability. Like a grounding in the voice like a grounded stable instrument. And I think a lot of it is like coordination related. And and so identifying. So what I’ve been doing is just kind of like my normal process identifying. Okay, what I always say with singers, we’re going to come down to the smallest denominator, we’re going to find the smallest number of things to think about when we make the sound to get better and, and so finding a sound that really coordinates the breath with vocal phone closure and adduction and Then the resonance, they have to go together.

Dr Marisa Lee Naismith  1:05:03

Yes. And and I think the key this this would be my theory would be that because COVID really does impact on breathing, the lungs, the breath, that a lot of those issues may be coming from air pressure.

Lori Sonnenberg  1:05:20

I agree with you, I absolutely agree with you.

Dr Marisa Lee Naismith  1:05:23

That was the thing that I noticed when I had COVID was that it felt like someone was sitting on my chest and my breath was laboring, and I’m thinking that the singers there maybe because they are seen as they would notice it, whereas probably the average person wouldn’t so much. 

Lori Sonnenberg  1:05:42

Yeah, I’ve had a lot of I do a lot of manual therapy and hands on or with, especially with muscle tension, but with breath work as well. And, and a lot of my fingers recovering from COVID, we’ve had some success doing some like hands on work where the identify like areas in the chest or the ribcage or the abdominal area, where they might be able to identify holding of tension. So even sometimes just pulling, you know, like putting the hands on the chest and kind of pulling away, you know, anything to sort of open those. Yes. Is that Yeah, yes. And that that’s kind of I’ve had some success with that. As simple as it is. It’s amazing how they start to feel some control over the breath with that, and then the voice is going to come out smoother and more coordinated.

Dr Marisa Lee Naismith  1:06:35

Yes. Well, thank you for answering that on behalf of all my students. Okay, so final question. And then by the way, we’re going to share all your links with our listeners. So, if people want to learn more about you, we will have all those in the show notes. And if they want to visit your website or make friends with you on social, we will share all that info with them.

Lori Sonnenberg  1:07:02

 I love it. I’m new on Instagram of late. 

Dr Marisa Lee Naismith  1:07:05

Oh, yes. Well, I’m not a fan of social media, to be honest. And I shouldn’t be saying this, because there’s a lot of promotion that goes on around in this podcast on social, but I have someone that takes care of that for me.

Lori Sonnenberg  1:07:22

It is as. I say it is a labor of what I love.

Dr Marisa Lee Naismith  1:07:28

Yes, so what can we piece of advice for our singing voice community? What can we as teachers do better to take care of our students in terms of vocal health?

Lori Sonnenberg  1:07:41

Talk about it with them. I think we need to be having a lot more conversations in all of the spaces that we exist with our singers in the studio, and classes in the theater in Backstage at the concerts. I mean, we need to be talking about asking, how’s your voice doing? Do you ever notice changes in your voice, you know that that’s that monitoring piece, but but if we talk about it with them openly share our own experiences of limitations or problems that we’ve had it it opens the door for them to they recognize I think this is a person that I can talk to about this. And I don’t have to be fearful of bringing this up in conversation.

Dr Marisa Lee Naismith  1:08:34

That’s great advice. And that really goes along with what I try and advocate through the show. And that is holding safe spaces for our students to be heard. It’s not about us, we need to leave our biases at the door. But listen to what our students are telling us.

Lori Sonnenberg  1:08:55

That’s right. That’s right and not wipe it away with a word like well, your voice is just tired today.

Dr Marisa Lee Naismith  1:09:05

That doesn’t have it.

Lori Sonnenberg  1:09:06

No, no, it really doesn’t. And, and also not swipe it away with Well, if you just do this differently, I bet it’ll come out okay.

Dr Marisa Lee Naismith  1:09:15

Yes, that’s where we must learn to have conversations with our students and find out what’s really going on. Don’t wait-

Lori Sonnenberg  1:09:22

That’s exactly right. Because they I can tell you from my side of things, being the professional that’s supporting them in that recovery journey that they need and want that so desperately. They’re so afraid to tell you what’s going on.

Dr Marisa Lee Naismith  1:09:40

They are. Unless you build that trust within the studio. And we have a responsibility as voice teachers to take care of our students and to make sure that they’re vocally safe, and we do the only way that we can do that is to allow them to communicate with us what they actually need and To listen to three. Yeah, well, Lori, it’s been amazing. I’ve loved listening to everything that you’ve had to share with us. You’ve been really generous with your time with. It’s been a long interview, but I just wanted to keep knowing more. And the listeners are going to learn so much from you. Thank you for your time. And good luck, and I’m sure we’re going to catch up sometime soon. I must come back to Chicago.

Lori Sonnenberg  1:10:28

Oh, I hope you will. I would love to host you here. I like a good time.

Dr Marisa Lee Naismith  1:10:35

I know we will. Okay, thank you so much. Take care.

Lori Sonnenberg  1:10:41

Thank you, Marisa. Bye bye. 

Dr Marisa Lee Naismith  1:10:42

Bye.

Dr Marisa Lee Naismith  1:10:47

Thank you so much for listening to this episode of a voice and beyond. I hope you enjoyed it as now is an important time for you to invest in your own self care, personal growth and education. Use every day as an opportunity to learn and to grow so you can show up feeling empowered and ready to live your best life. If you know someone who will also be inspired by this episode, please be sure to copy and paste the link and share it with them. Or share it on social media and use the hashtag a voice and beyond. I promise you I am committed to bringing you more inspiration and conversations just like this one every week. And if you would like to help me please rate and review this podcast and cheer me on by clicking the subscribe button on Apple podcast right now. I would also love to know what it is that you most enjoyed about this episode and what was your biggest takeaway? Please take care and I look forward to your company next time on the next episode of A Voice and Beyond