A Vanderbilt University Medical Center Alumni Publication

Vanderbilt Medicine

facebook rss digg
FEATURES :: WINTER 2014
PRINT

‘Off the Pain’ and Back to Singing

Vocal surgery puts country rocker Gary Allan on the road again


By Craig Boerner
July 2011

Featured Image

Country rocker Gary Allan still belts out his hit song “Get Off On The Pain” when performing in music venues, big and small – just not as the opener.


Allan spent a good part of last year starting his shows with the powerful screamer, but eventually lost his high-end falsetto due to a polyp on his vocal cord, prompting cancellation of his remaining tour shows and a visit to Vanderbilt’s renowned Voice Center.

“We opened our show with that song, and I think it was my consistently going out there every night, without warming up much, that led to the polyp,” he said.

He had been on The Last Rodeo tour with Brooks & Dunn, which was cancelled and postponed due to Ronnie Dunn’s physician-ordered vocal rest. Allan and his manager, John Lytle, took it as a sign for him to seek treatment for his vocal issues as well.

“He knew something was limiting his vocal range, but he didn’t know what it was,” Lytle said.

Knowing he’d need three months to rest his voice after the procedure, Lytle canceled a New Year’s Eve gig in Las Vegas, and Allan made an appointment at the Vanderbilt Voice Center in November 2010.

Wall of Fame
The Voice Center staff has treated preachers, radio personalities, auctioneers, businessmen and a long list of celebrities including Johnny Cash, Minnie Pearl, Kathy Mattea, Patty Loveless, Emmylou Harris, Jack White, Trisha Yearwood, Martina McBride, Ronnie Dunn, Pam Tillis, Wynonna Judd and Gretchen Wilson.

Allan had been there for vocal checkups and to accompany his father, Harley Herzberg, when he was battling cancer.

“I think every musician who lives in town knows about the Voice Center,” Allan said. “It is a perfect marriage for Music City to have a Voice Clinic. People fly in from all over the world and I think a lot of it is because of the recognition they get in Nashville; it is a fantastic marriage.”

Gold and platinum records line the familiar hallways of the Voice Center – a sign of appreciation from Music City’s singers for their successful treatment. As Allan entered the waiting room, a Johnny Cash record was on the wall across the room.

“I think that makes musicians feel like they are in the right place,” Allan said. “It’s comforting to me to look around and see people I know on the walls. To me, it says that they really know what they are doing because this is all they do.”

Founded in 1987 and consistently ranked among the best by U.S. News and World Report, Vanderbilt’s Department of Otolaryngology, which houses the Voice Center, is placed among the top 10 in NIH funding, with more than $10 million in grants. The department’s “founding four” physicians, executive director Robert Ossoff, M.D., James Duncavage, M.D., James Netterville, M.D., and David Zealear, M.D., are still active full-time faculty members.

Larry Gatlin’s 1991 vocal operation provided a spark to the Vanderbilt Voice Center when Gatlin served as the Master of Ceremonies for the grand opening in March 1992 and credited Ossoff and the Voice Center with saving his career.

Gatlin went on to establish the ‘Gatlin Fund,’ named in honor of the Gatlin Brothers, to assist musicians who require treatment but are uninsured or unable to pay for medical care.

Rising through the Ranks
Ossoff’s 1994-95 trainee, Gaelyn Garrett, M.D., is now medical director of the Center and has begun building her own legacy.

Willie Nelson wrote the song “Superman” about the time Garrett took him off a tour to rest his voice:

Well I blew my throat and I blew my tour
I wound up sippin on soup d’jour
I wasn’t Superman I wasn’t Superman
Try to do more than I can
I wasn’t Superman

Well the doctor said son it’s a cryin shame
But you ain’t Clark Kent and I ain’t Lois Lane

Garrett sees just about everything under the sun from Nashville’s singing population, which encompasses not only Music Row but also Vanderbilt University’s Blair School of Music, the Belmont University School of Music and the Fisk Jubilee Singers, an African-American a cappella ensemble consisting of students at Fisk University.

Gaelyn Garrett, M.D., medical director of the Vanderbilt Voice Center, encourages artists and managers to view a voice disorder as an injury that needs treatment. Photo by John Russell.

Gaelyn Garrett, M.D., medical director of the Vanderbilt Voice Center, encourages artists and managers to view a voice disorder as an injury that needs treatment. Photo by John Russell.

“Singers have everything from a little swelling of the vibrating edge to nodules to polyps to cysts,” she said.

Allan had a vascular polyp, which is a lesion on the vocal cord or vocal fold.

“It is not a tumor,” Garrett said. “It is basically something that arises due to trauma to the surface of the vocal cord or vocal fold. What we think happens with the vascular polyps, which is what Gary had, is you get these little recurrent bleeds in the vocal cord and as it starts healing, it forms a polyp.”

As part of their treatment, patients see a speaking or singing therapist at the Voice Center in order to change the behaviors that caused the problem.

“We either do that in an attempt to avoid surgery or we do it in an attempt to get them in the mindset for the rehabilitation after surgery. So, for him, we knew that he was probably going to need to go ahead and have the surgery and that most of his therapy would be post-op. So we look at that more of a rehabilitation,” Garrett said.

Allan’s diseased tissue was removed through a technique known as microflap, which uses a microscope to look at the actual vocal cord and the polyp.

“His polyp was probably 2 mm - 3 mm and we were trying to take out the diseased tissue, most of which was underneath the surface, and leave enough of the surface tissue intact so that they close on top of each other,” Garrett said.

“It is like taking a pea out of a pod except you open it up and then close it back. It is gentle dissection.”

Garrett said she delivers the same amount of care to every patient, whether it is a singer or a teacher or a call center employee, but singers in some cases may have had a pre-existing lesion that actually helped create what is known as their ‘signature sound,’ so it is even more important to have a baseline examination to view the vocal cords before there is a problem.

“When the labels sign a new artist, they will often send them to us before they have problems. They will get an initial voice evaluation to make sure they are not doing anything damaging to their voice,” Garrett said.

“It also creates a baseline exam so we know what their vocal cords look like and if they do end up developing a problem down the road we will be able to say what is new and what is not. In an ideal world it would be great if every new singer came to us and got this first evaluation so that we knew where we were starting.”

Garrett said one important uphill battle for a laryngologist is to change the mindset of employers, in particular, who don’t view having a voice disorder as being ‘sick.’

“I wish that, generally, people recognized the handicap you have when you have a voice disorder, whether it is acute or chronic,” Garrett said. “If you were a football player, and you had an ACL tear to your knee, you are going to be limping and obviously can’t practice.”

Garrett says that new singers are singing more than ever with a hefty booking of radio shows and meet-and-greets in addition to their tour shows.

“Their speaking voice use has gone way up and their managers are frequently more focused on doing shows and radio interviews, and they are not paying attention to the fact that they are killing their voices because of all their speaking responsibilities,” she said.

“To be fair to the managers, I have seen a nice transition through the years where the management actually is taking a more proactive role in the musicians’ voice health, whereas before it was up to us to tell them they shouldn’t be singing a two-and-a-half hour set without a break. A lot of these young artists want to go, go, go. They think, ‘This is my chance.
I can’t not go out.’ They have so many people depending on them.”

On the Road Again
Garrett is wearing her usual light blue scrubs and white doctor’s coat on this typical clinic day. She has seen Gary Allan a couple of times since his surgery in late November, and he seems to be doing well, back on tour and playing shows.

Allan said the surgical procedure was relatively painless and the last thing he remembers was an anesthesiologist putting a tube in his mouth.

“I think the last thing I said as I was passing out, I laughed and said ‘Just don’t break my teeth,’ because I saw the great big pipe they were going to shove down my throat,” he said.

“It was painless, it was as good of an experience as it could have been. I remember after the surgery Dr. Garrett said, ‘Just don’t hurt yourself thinking that you are healed.’”

Garrett prescribed one week of vocal rest that had Allan communicating with his three daughters via a dry erase board.

“It is hard to do with kids,” he said. “I think they got to the point that if it really wasn’t worth talking about they wouldn’t say anything, because they knew I was going to have to try to write it out.”

The first show back after the surgery was Valentine’s Day at the San Antonio Stock Show and Rodeo, setting off a successful 15-city run of shows that ended in mid-April. Allan will typically play about 100 shows in any calendar year.

“There was all of the ‘what ifs’ in my head, because it makes you wonder,” Allan said. “But I think I had known so many people who had vocal surgery that it is almost par for the course. If you do what I do, you eventually have to have something done to your throat.

“My voice is my instrument; it’s like being a guitar player and somebody taking all of the guitars in the world away from you. I think hearing is the last thing I would want to lose, second to last is my voice because hearing is how I interact with singing, so I think my life would be very different without those things.”

In time, he was healed.

“I’ve got it all back, basically,” Allan said. “I carved out three months of my schedule and just took it off, and tried to make sure my first show back wasn’t an hour and a half, it was an hour.”

Country rocker Gary Allan had a polyp removed after losing his high-end falsetto. Thomas Cleveland, Ph.D., checks on his progress following surgery. Photo by Joe Howell.

Country rocker Gary Allan had a polyp removed after losing his high-end falsetto. Thomas Cleveland, Ph.D., checks on his progress following surgery. Photo by Joe Howell.

Vocal therapist Tom Cleveland, Ph.D., recently did a stroboscopy on Allan. He grasped Allan’s tongue with a gauze pad and placed the scope in his mouth. Allan’s vocal cords showed up on the monitor as he made the “E” sound. After a minute or so Cleveland had seen what he wanted to see.

A couple of minutes passed and Garrett reviewed the video of Allan’s vocal cords.

“Everything looks great,” she said, obviously pleased with what is on the monitor. “They are moving very well.”

Allan is now good to go for his summer shows and he can still sing “Get Off On The Pain.”

The trick, he says, is to place it a little farther down in the set list.
 



RELATED STORIES



MULTI-MEDIA HIGHLIGHTS


Play Video

Voice Concerns

A rare treatment is offered to those who use their voice for a living. Barb Cramer has more on this out of the box treatment for vocal strain.

Submit a classnote here!
©2009 Vanderbilt Medical Center
Editorial tool created by Vanderbilt Medical Center Web Development
Vanderbilt University is committed to principles of equal opportunity and affirmative action.