Sims HS

Special Article - Head and Neck Surgery

Austin J Otolaryngol. 2016; 3(4): 1083.

Health and Wellness for the Gospel Singer: Using the Tools of the Bible to Reach the Performer

Sims HS*

Director, Chicago Institute for Voice Care, University of Illinois Health, Chicago, USA

*Corresponding author: Sims HS, Director, Chicago Institute for Voice Care, University of Illinois Health, Chicago, USA

Received: August 09, 2016; Accepted: November 22, 2016; Published: November 24, 2016

Abstract

Gospel music has emerged as a unique genre and a recognized singing style. Its origins are rooted in the pain of the experiences of people from the African diaspora coupled with musical expression. This is a unique culture and as we strive to improve patient outcomes and physician-patient relationships, an awareness of this culture can be helpful. Following intuitive principles, it seems reasonable to employ Biblical teachings in counseling gospel singers.

Keywords: Vocal care; Morbidity; Voice therapy

Introduction

Jewish tradition teaches that Adam sang as a form of worship and joy when his sins were forgiven. This song is found is Psalm 92 as “A song to be song on the Sabbath Day, but it may well have been the first song sung by someone in the Bible, maybe the world’s first song. The first song recorded in the Old Testament came from Moses. After leading the Israelites in a song of praise to the Lord after he brought them safely out of Egypt (Exodus). These are examples from the Judeo-Christian tradition, but, praise, worship, and song are connected throughout religious texts, however, to be sure.

This history is an important background as we begin to talk about overall wellness and vocal health for the Gospel singer. Adam’s first song came as a celebration of creation. Taking some license, it probably makes sense that Adam celebrated that he was fearfully and wonderfully made for divine purpose. His song was a response to what his God had done. This Biblical understanding of how and why human beings were created can help any worship leader understand motivation. Also, a clear understanding of worship as a response to God, helps keep things in perspective.

Part of our sense of holistic wellness comes from the freeing concept that worship is not a means to score points with God. One does not HAVE to worship, on GETS to worship! From this perspective, one can begin to think about gospel singers differently.

This writing is targeted to Clergy, singers, or even a layperson who believes that being a good steward of their health and wellbeing is a good response to having a vocal gift and is open to the wisdom of ancient texts. Healthy people can be healthy singers, but it does require some work. It is best to seek wisdom first and part of the purpose of this manuscript to employ Biblical teachings that may be familiar to worship leaders to help punctuate information that can be useful.

Some Pearls from the Bible for the Patients Mental Health and Attitude

One can consider that leading worship is still leadership in the church

*1 Timothy 3:1-13 MSG: “If anyone wants to provide leadership in the church, good! But there are preconditions: A leader must be wellthought- of, committed to his wife, cool and collected, accessible, and hospitable. He must know what he’s talking about, not be overly fond of wine, not pushy but gentle, not thin-skinned, not money-hungry. He must handle his own affairs well, attentive to his own children and having their respect. For if someone is unable to handle his own affairs, how can he take care of God’s church? He must not be a new believer, lest the position go to his head and the Devil trip him up. Outsiders must think well of him, or else the Devil will figure out a way to lure him into his trap. The same goes for those who want to be servants in the church: serious, not deceitful, not too free with the bottle, not in it for what they can get out of it. They must be reverent before the mystery of the faith, not using their position to try to run things. Let them prove themselves first. If they show they can do it, take them on.

No exceptions are to be made for women - same qualifications: serious, dependable, not sharp-tongued, not overly fond of wine. Servants in the church are to be committed to their spouses, attentive to their own children, and diligent in looking after their own affairs. Those who do this servant work will come to be highly respected, a real credit to this Jesus-faith.”

No Christian is able to be complete in their faith without the work of the Holy Spirit. So, these guidelines should not be misinterpreted as ways to keep people from serving, but to help everyone stay humble and realize that the more one tries to do in one’s own strength, the more off course one is likely to go.

A worship leader can set an example about punctuality and selfcontrol and discipline. People can also observe them living out their faith by receiving praise with humility and not letting things go to their head. Congregants can also learn from leaders sharing their struggles and humbly asking for help. The basis of community in church exists because of a belief that individuals can function better collectively than alone.

Be sure you are using your gift the way god intended

1 Peter 4:10NLT “God has given each of you a gift from his great variety of spiritual gifts. Use them well to serve one another.”

One of the lessons from this passage is to understand that everything, even your voice part was determined and designed, not by accident. Intelligent design provides enough sopranos, altos, tenors, and basses to make a full choir that can serve one another as well as the church. There is no need for individuals to define or redefine their voice parts to help God out. Moreover, when David tried to walk in Saul’s armor, he stumbled. We cheat ourselves of our best work we try to walk outside of our anointing and divine plans for us.

A note of warning to those of you gifted with a large vocal range: Serving the choir, the church, and another does not necessarily mean singing soprano when needed, alto when needed, and tenor when needed. The natural, comfortable vocal range is predetermined and it is best to stay in your lane, though helping out from time to time will not likely ruin your voice.

Stay focused on god and your given ministry

Hebrews 12:6 - Avoid the distractions

Acts 20:26 - Keep going and share the gospel, share it with joy!

1 Samuel 17:37-39 - Walk in your own anointing or you won’t get far

1 Corinthians 12:11 - We don’t get to pick which gift we should have

It is very easy to be caught up in our work and ministries. Sometimes, however, we focus more on the ministry than the actual mission. Taking time to step back and look at what we are doing and why we are doing it is always helpful. One thing to always consider: When you say “yes,” to something, what are you also saying “no” to? You cannot be everywhere. You cannot be everything to everybody all the time. Many of us are exhausted to the point of becoming ineffective because we are listening to voices in our own heads, the voices of people around us, and aren’t seeking to hear the voice of the One who called us to minister to others in the first place.

Remember what praise is really about

Psalm 68:25-26 - To bless, give thanks, and gratefully praise God

Psalm 97:8-9 - Give the Lord the glory due Him, worship is an offering

I Chronicles 16:7-9 - David calling the “first” worship team to give thanks, praise Him, and make His works known

Romans 12:1 - Give your all as living, holy sacrifices

Again, we remember Adam and a song to be sung on the Sabbath. It is probably helpful to even think about what the Sabbath is and why it is observed. After creation, God rested on the Sabbath. However, we have to think a little deeper. God surely was not tired—and if he was, a day of rest wouldn’t fix it—so it is reasonable to believe that there is a deeper meaning to observing the Sabbath. We are called to work, scripture is clear. However, we are also called to rest in God’s goodness and realize that we don’t need to work, because God is enough. Sunday was not supposed to be a day of exchange the choir loft for your workspace. Worship can be the simple acknowledgement that God is enough and praise flows from that.

Don’t overcomplicate things

II Kings 5:13 - Sometimes God’s instructions seem simple

James 4:2 - You don’t have because you don’t ask

I know we’ve all been in a worship service or a concert and heard someone perform some of the most amazing vocal acrobatics we’ve ever heard. Yet, we feel slightly betrayed because we can’t quite figure out if we heard the simple melody at least one time. Most voice care professionals and musicians agree that it is a good practice to let your audience hear the simple tune before adding embellishments. Stylistically, this also helps create interest and gives the song somewhere to go as you invite the listener to go on a journey with you through the song. Even if you can do a run that makes people believe Dr. Mattie Moss Clark herself trained you, that is almost never a good place to start a song.

You do have to work

II Samuel 24:24 - David said he wouldn’t offer God anything that costs nothing

Exodus 13:18 - Sometimes God’s path for us seems to be the long way around

Luke 17:10 - Coming to nearly every rehearsal isn’t really beyond your obligation

Titus 3:1 - Be willing to do upright and honorable work

I often compare singers to athletes and consider singers vocal athletes (hence my reference to vocal acrobatics). Athletes train. They condition their bodies to be able to achieve peak performance on the court/track/field/arena. I do not think I have ever heard a professional athlete or someone who aspires to that level say to me, “I don’t warm up or train. I want my stuff to be natural.”

I do not know if it is the influence of American Idol or another reality show, but the idea that vocal training is innately harmful to singers really needs to be challenged. I think finding a good voice teacher/speech pathologist is like dating. Someone may be a fine person, but not really right for you. So, finding the right fit is important and a bad fit can produce less than satisfactory results. That said, nearly every singer at every level can and at every age can benefit from working with a professional to make the most of the natural gift.

You don’t have to wear yourself out

Exodus 18:17-18 - You can’t do it all yourself

Romans 12:13-15 - Work with one another, share burdens and praises

Luke 10:41-42 - Jesus’ advice to Martha is like Jethro to Moses

Often in the context of church organization, people talk about the 80/20 rule and it is frequently true that a minority of members do a majority of the work. However, it is difficult to find a scriptural basis for a small group of people doing a large share of the work. Solomon shared his wisdom that there is a time for everything. There are seasons for all of us as well. Sometimes the voice in our heads that tells us we personally need to do everything it just our own ego. Whenever you say yes to anything, you automatically say no to something else. It is important to count the costs of all of our activities and remember Sabbath rest.

Watch out for pride

GOOD

II Cor. 10:17-18 - Boast about knowing God

Jeremiah 9:24 - Understand and know God

James 4:10 - Let God be the one to talk about how good you are

Amos 3:2 - God will let you know where He wants your ministry to go

Daniel 10:12 - God responds when we’re humble and purposed to serve Him

BAD

James 4:6 - Be careful about having too much pride in your gift and forgetting to honor the giver

3 John 1:9 - Diotrephes’ example of putting himself first

Proverbs 19:21 - Trust God’s plan for you more than your plan for Him

Keep your eyes on the prize

1 Chronicles 16:9 - Sing to Him, meditate on Him, talk about His works

1 John 2:16-17 - Only what you do for Christ will last!

Genesis 22:11-14 - Our sacrifices for God are always rewarded and God will provide!

Psalm 73:17 - There will be times it seems that worshipping Him is pointless, but remember God and His heaven.

Acts 4:12 - One name for salvation only!

Matthew 28:19-20 - “Go then and make disciples of all the nations, baptizing them into the name of the Father and of the Son and of the Holy Spirit. Teaching them to observe everything that I have commanded you, and behold, I am with you all the days (perpetually, uniformly, and on every occasion), to the [very] close and consummation of the age.” Amplified Bible.

Advice for Physical Well Being Some Medical Diagnoses that Church Singers should know about

Viral Upper Respiratory Tract Infection (URI)

The common cold: As the lay terminology tells us, this is a shared experience. A stuffy nose that also seems to be runny at the same time is often part of the journey through illness. A sore, scratchy throat and some hoarseness are not uncommon. Coughing and sneezing seem to add to the overall body pain as these symptoms often make the stomach hurt too. You may also have fever, chills, body aches and headaches. All in all, you just don’t feel well. The good news, however, is that the viruses that cause colds are usually not that sturdy and burn themselves out fairly quickly. So, within two-to-three weeks, things are usually close to normal.

One of the best ways to avoid catching a cold is washing your hands with good, old fashioned soap and water. While hand sanitizers seem to be all the rage now, and they are effective, soap and water still works quite well to keep people from spreading viruses.

I also recommend building up the immune system, especially during cold season. Wellness formula, Echinacea, goldenseal, vitamin C, vitamin B, Vitamin E, and zinc are all helpful ways to build the immune system and strengthen the body to help fight colds. Eating an orange is better than drinking processed orange juice. Wheat germ is a good source of vitamin E. Try to look for the most natural sources with the least amount of processing to get the maximum benefit from any nutrient.

Obesity: I know that weight can be a very personal and a very touchy subject. The fact is, most of us have embraced a culture of leisure prevalent in the Western world. For the most part, we are grateful for the deliverance that allowed our word to be inside and in comfort as opposed to laboring in the fields. In many cases, however, our diet has not been altered to fit our more sedentary lifestyles and most of us could stand to lose a pound or two, so we can all lay egos aside to have a reality check. We have to be honest about the fact that our traditional diets coincided with a much greater degree of physical activity. The problems created from a mismatch of caloric intake with physical activity to burn calories are well documented [1].

Obesity remains one of the leading causes of morbidity (complications and sickness) and mortality (death) in the African- American, Native American and Hispanic communities. While it is absolutely true to many of the standards used to create ideal bodymass index used Caucasian body-types as the model, we can no longer suggest that obesity is the normal condition for ethnic folk simply because the idealized body type happens to be fair skinned, blue-eyed, and blond haired. There is no place for body shaming and we must love ourselves as we were made, but we must also honor the gifts of our bodies and be stewards and protectors of that gift.

The wisdom literature Solomon wrote in proverbs is actually pretty clear. He warns his people not to carouse with drunkard or feast with gluttons. (Proverbs 23:20). The scriptures are clear that God intends to supply our needs, but it is also clear that we are to develop discipline and only consume what we actually need, not everything that is laid before us. This includes the abundance of food and snacks that so often accompany church meetings and social events. In Proverbs 25, honey is both metaphor and literal. In verse 16, we are warned that too much honey can make us sick. This is true for anything that is designed to be good for us. Too much of it can make us sick. In verse 27, honey is used to suggest that we also not crave sweet praise or seek to bring too much honor to ourselves. Once again, something good can be bad for us if we consume too much of it [2].

While basic hospitality calls for some form of beverage and refreshing, cakes, pies, and cobblers and not commanded by scripture. Culturally, gatherings of people of the African diaspora have included food as entertainment and this is deeply woven into the fabric of our churches. However, the Daniel diet leads away from an overabundance of meat. The current American diet relies too much on meat and processed foods. All of us would be better eating more fresh—not canned—fruits and vegetables or at least trying to find the frozen kind if fresh is not an option. The canned versions typically contain all kinds of preservatives that we cannot pronounce and that do not occur in natural food sources [3]. This is an area in which we can make very practical changes to still enjoy fellowship that includes nourishment, but still support a culture of health and wellness in our community [3-5]. The good news is that research shows that the nurturing, supportive environment of a community of faith actually improves adherence to health and wellness programs and is a source of strength and improved compliance and reduced recidivism [4-7].

We have also chosen to accept the mythical icon of the “big” singer. The dual problem of this line of thinking is that it robs the thin singer or their due and confers talent that may not actually exist on a person of large size. Good singers come in all shapes and sizes. This is also true for not so good singers. It is better let the ears guide and not the eyes.

Reflux (GERD and LPR): What is reflux? It is pretty simple, actually. Your stomach is designed to digest food. In order to do that, it makes and holds acid and digestive enzymes. As you might think, acid and digestive enzymes, while necessary to break down food into nutrients for the body, are actually harmful if they are not properly contained in the stomach and the digestive tract. When you have reflux, acid and digestive enzymes that should stay in the stomach or below travel up, either back into the swallowing tube (esophagus) or sometimes all the way up until the back of throat or even higher into the back of the sinuses. Because of this, the symptoms of reflux can range from heartburn, to throat clearing, to feeling like there is a lump in throat, to a burning or bitter taste in the mouth, to a runny nose and lots of mucus all the time [8].

The stomach is designed to hold the acid, so that tissue is protected. However, when acid and digestive enzymes leave the stomach, only a little bit is required to do some damage. This is why people can have acid related voice problems and not have heartburn.

In some instances, problems with reflux relate to problems with obesity. We are clear that people with higher Body Mass Indices (BMI)—the polite terminology for people who are overweight—are more likely to experience reflux symptoms and weight loss is a pretty powerful way to reduce or eliminate these very symptoms. Studies have shown as association between BMI and reflux symptoms as well as the complication of esophagitis and even cancer of the esophagus.

The bottom line is that reflux is treatable and manageable and even curable, but often weight loss, changing the diet and breaking the habit of eating and then lying flat are all required to make laryngitis from reflux improve [9].

Hypertension: Hypertension is high blood pressure. Most people are familiar with the 120/80 normal values. Both numbers reflect how hard the heart has to work to move blood around the body. The top number is when the heart is actively squeezing, and the bottom number is at rest. It is important to remember that 120/80 is an average. So, young, healthy, petite women can be 90/60 and be pretty normal. Likewise, a young male who is 6’4” and 210 pounds, might be 130/70 and still be perfectly fine. Pretty much everyone agrees that if the top number is above 140 in 2 or 3 separate readings and/or the bottom number is creeping up to 90 or above, something should be done. Sometimes the something to be done is taking medication, but sometimes is it pushing back from the table, getting up and getting active. It is almost never a bad idea to try to eat a little less and walk a little more.

In a 2011 study, Dr. Baruth found that 62% of the 1119 African Methodist Episcopal church members she surveyed were obese and 64% had hypertension [1]. The association between elevated blood pressure and risk of stroke, heart disease and even a heart attack is pretty well understood [10,11]. Fortunately, we have recent literature that shows us, again, that faith based communities are ideal settings for accountability and support to improve compliance and improve outcomes of attempts to reduce disease risk [7,12,13].

Historically, some research studies have shown that African- Americans, in particular, obtain better control of blood pressure with diuretics (water pills). However, water pills often make people dry because they are designed to help the body dump water. For the singer, these are not always ideal medications. So, it is a good idea to ask questions and ask your doctor to explain all your options to you and for you to make sure you are involved in choosing a medication or a medication regimen that works for you and your lifestyle. As always, increasing fat burning, physical activity and reducing the amount of food you consume helps with health and most often lowers your blood pressure.

Diabetes: There is a clear connection between dietary intake, exercise, weight and some disease processes. Obesity and Reflux are related. Obesity and high blood pressure are related. The last of the big three is diabetes. In the African-American community, this is sometimes called “sugar”. In many ways, this makes good sense because consuming too much refined sugar will elevate the level of “sugar” in the blood. God made natural sugar that our bodies can process. Manmade, refined sugar, however, often causes some problems.

For the most part, blood sugar less than 150-180 is the goal. There are different regimens and some different ideas about how tightly the numbers should be regulated, but everyone agrees that not checking your blood sugar and just going by how you feel is a pretty bad idea. Also, pills you take by mouth and insulin injections are meant to compliment the changes you make in your diet. The idea behind the medicines is NOT for you to eat poorly and then take the medication to make up for it.

Specifically for singers, not controlling blood sugar and treating diabetes can leave you dehydrated. The vocal cords don’t work well when we are dehydrated and vocal range and clarity are likely to suffer if the diabetes is not under control. Also, one of the long term effects of poorly treated diabetes in nerve damage. This can affect the nerves that tell the vocal cords to move and decrease vocal power and endurance.

HIV/AIDS: The Human Immunodeficiency Virus (HIV) emerged in a cloud of secrecy, shame, fear, and misunderstanding. Fortunately, the ability of modern medicine to manage HIV infection has grown rapidly to face this epidemic. However, the African- American community still bears a disproportionate burden. For this reason, if for none other, we must acknowledge HIV as an infectious process. Totally separate from how it is transmitted and who gets it is the reality of how the virus works and why it is important to know some symptoms and problems that can occur from infection [14].

Specifically, the virus is what we call neurotropic. This means it is prone to affect nerves. The nerves that tell the vocal folds to move—the recurrent laryngeal nerves—can be directly affected by HIV infection [15,16]. Obviously, there is a lot of information out there about HIV, but not everyone knows that it can directly affect the voice and make the vocal folds weaker. As a word of caution, a weak voice does NOT mean you might have HIV. First, there are number of viruses that can attack nerves, even the viruses that cause the common cold can do this. Also, weakness in muscles can come from many things, so it is better to go see your doctor and ask some questions that to worry about HIV based one symptom and something you read in a book chapter.

Infections in the lungs (pneumonitis and pneumonia) can reduce lung capacity and make it more difficult to support singing. The medications to treat HIV also can have some side effects that can show up in one’s voice and ability to sing and speak for longs periods of time.

Head and neck cancer: This diagnosis is usually the one most feared and, sadly, the one that creates so much fear that people will avoid seeing the doctor rather than risk being told they have cancer. So that we are all on the same page, cancer is uncontrolled cell growth. What does this mean? The cells of the human body are intelligently designed. So, they realize they can only take up so much space. When they grow to their full size and take up the allotted space, they stop growing. When the system is working properly, each cell grows as much as it needs to then, stops growing.

What makes cancer a problem is that cancer cells do not stop growing. They will grow into the space of the cells around them and take over. This concept is why small tumors usually have a lower stage AND a higher rate of disease free survival, when we talk about solid tumors. This is not meant to confuse anyone, but the type of cancer relates to the type of cell is comes from. So, cancers of the blood stream (lymphoma, leukemia, multiple myeloma) are a little different in that we can think of them as flowing in the blood rather than being in a solid organ like the lungs, kidney, liver, stomach, or the head and neck [17].

The reality about cancer is almost the exact opposite of what happens when people are driven by fear. Cancers that are caught early when they are small can usually be cut out completely

What healthcare providers should consider when seeing gospel singers

Four Fears the patient’s may have

1. Fear of not being able to afford care. Even with the Affordable Care Act, many patients are reluctant to seek care because of fear of enormous medical bills. Being sensitive to this, we try to make the first visit as efficient as possible and lay out management plans. We engage the patient in decision making and remain sensitive to financial concerns.

2. Fear of losing one’s natural voice or gospel style and being turned into a classical singer. The voice care community continues to evolve, but much of the research has been geared towards bell canto singing. Cultural competence requires that the genre of gospel singing be recognized. It is best to make it clear to the patient that the goal is to enhance, not reconstruct one’s singing voice.

3. Fear of losing the voice completely.

Most performers develop an intimate relationship with their own voice. When the voice because unpredictable or less reliable than it has always been, this phenomenon can create great angst for the performer. It is very important for clinicians to recognize and validate this emotional response. This helps build trust and empathy.

4. Fear of a terminal disease.

To the lay public, benign vocal fold lesions are often not well known. Many patients are familiar with the term “vocal nodes,” but may not possess an in depth understanding of how they are formed, whether they have malignant potential, and how they can be successfully treated.

There is an opportunity here for the clinician to address the fear first, then educate the patient about benign vocal fold lesions. A discussion about vocal fold lesions can also serve as an entryway into a discussion about speech pathology and the importance of voice therapy/voice training.

Conclusions

The physician-patient relationship can be unique. A clinician can establish rapport and familiarity by speaking in a language common to the patient. It is reasonable to use Biblical scripture to make points about singing and vocal health with gospel singers. Of course, there is an assumption to gospel singers are familiar with Biblical scriptures and this assumption should be explored before a clinician proceeds. However, if the clinician is comfortable with this approach, it can be a useful tool and may improve patient outcomes.