Dr. Brian Hands has had a long association with COC as a specialist frequently used when singers need assistance. “In my practice I see all professional voice types, primarily singers – professional, students, classical, pop and rock. I also see those who use their voice to earn a living in other ways – actors, CEO’s, lawyers, teachers, clergy, and TV and radio broadcasters.”
Dr. Hands is also the force behind VOX CURA (launched in 1995) – the only free-standing voice center of its kind in Canada. By using a technique called videostroboscopy, the shape, the movement, vibration and timing of the vocal cords can be closely viewed and recorded. Dr. Hands explains, “A strobe light illuminates and slows down the vibration of the vocal cords so one can study them. This helps me determine why a singer is missing one or two notes in their range – why their ‘low’ is not good, why their mid-range break does not float the way it used to. By being able to see more precisely, I can make a very accurate assessment as to the cause of the problem.
“99% or professional singers have never seen their vocal cords,” says Dr. Hands. “When they actually see this instrument – where it is located, positioned, what it does, and what its relationship to the various parts of the voice production mechanism is – they are astounded.
“We try and put it in proper perspective and show the four parts of this vocal production mechanism. The generator – the diaphragm – is the source of power blowing out air over the vocal cords, which are set into motion by virtue of that exhaled air. When people realize that the size of the larynx is the size of a thumbnail and the white of the nail is the size of each vocal cord they’re overwhelmed. So we have a generator, a vibrator (the larynx), and the articulator (which is the jaw, tongue and palate). Singers have to relax, open up and let the sound come through the fourth component – the resonator (the head, mouth and nose).”
Dr. Hands’ mantra is “the breath.” “It’s the hardest thing to learn because you have an innate sense that singing usually comes from the throat. No one focuses on the diaphragm which is “the center of the universe” for the voice.
“The majority of singers come in to make sure their ‘pipes’ are clear. Some may come with colds: others come if they have to sing that evening and they want to make sure they’re not in any danger. Often the company wants to know if the singer is well enough to perform. I make the determination if they’re safe to sing with no risk of damaging the vocal cords. A haemorrhage on the vocal cords is perhaps the sole, absolute indication when I would advise a singer not to perform. It’s my judgment in conjunction with the singer because singers know their body better than I do. I can say, ‘Your cords look healthy and you’re safe to sing.’ However, if they feel they can’t go on stage and give a performance that makes them happy, then it’s their decision whether to cancel or not. I always respect the singer’s wishes.
“Most professionals really do very little damage to their cords. Usually it’s just that they are singing when they shouldn’t be and need rest. Some are singing eight shows a week so they start compensating and end up with difficulties.
“Performers are usually extroverted and they can become social animals after a show. That’s when the most damage is done. They go to a restaurant or bar, the music is loud, usually someone is smoking and there is a din that they have to speak above. It creates problems worse than singing two to three hours on stage. When they go to bed, there is a risk that the alcohol will reflux back up from their stomach causing a burn to the vocal cords.”
Dr. Hands’ best advice? “Don’t eat or drink three hours prior to bedtime. Reduce the amount of coffee, chocolate and tea (very dehydrating). Always warm up before vocalizing. Use steam inhalation. NEVER whisper. It hurts the vocal cords the most because it forces the cords into complete apposition. The rubbing will abrade the surface of the cords and may lead to nodules. You can yell, but never whisper.”
Dr. Hands first became involved with singers when he joined the ENT (Ear, Nose and Throat) Department at Central Hospital in 1975. “The Chief of Staff, Dr. Paul Rekai sat on the Board of the COC with Herman Geiger-Torel back in the 60’s and 70’s. Dr. Rekai came to me and said ‘I want you to take care of the opera singers. You will be the doctor for the opera.’ One’s training in the professional voice is quite limited as a resident, so I started reading and attending courses. That’s when all the touring musicals were starting to come to Toronto – Cats, Phantom of the Opera – and those companies would contact the COC to see what doctor they used. In the 1970’s singers occupied 5% to 10% of my practice. Now it’s 65%.”
Singers are often accused of being overly sensitive about their voice. “So many things affect the voice,” Dr. Hands says. “I tell my singing students that voice production involves the entire body. Anything that goes wrong with the body affects the voice.”
“Singers have great creativity and emotional attachment to what they do. You couldn’t get the musical expression if there wasn’t that soul, that spirit, that sensitivity that allows them to express themselves. So it’s not just the fact that the cords don’t look right or they’re red or they’re inflamed – it’s the whole body. When the instrument is not working they worry that it either means the end of that performance or the end of their career. There’s a reassurance needed. The singer has to feel that you understand them, respect them and have their best interests at heart.
“The greatest high I get is seeing a patient that I have treated, perform on stage and know that I played some small role in allowing them to sing that night. That gives me great pleasure. I have met some truly wonderful people.”
Did Dr. Hands ever want to sing? “In grade 5 the major even for boys and girls was the formation of the glee club. If you didn’t make it in you were ostracized. Twenty-nine of us arrived for the audition, and the singing teacher recognized that rejection would affect our lives forever! So not wanting to ruin our social careers he let us all join. The opening song was ‘My Grandfather’s Clock’ and I had a particular role – my job was to make tick-tock noises with my tongue – that was all I was allowed to do! I still see that singing teacher – he’s a patient of mine and we laugh about it now. He tells me, ‘I knew you would be successful in your career, but I never thought it would be anything related to music.”
“NEW VOICE CARE FOR CANADIAN PERFORMERS”
It’s past midnight. After a full day of seeing patients, Dr. Brian Hands, a Toronto ear, nose and throat specialist, has just returned from Skydome. He was called in to examine a well-known rock star in the middle of a world-wide tour.
“It’s not unusual to get a frantic call from a tour manager asking if I can come by to see a rock, opera or stage performer moments before the curtain goes up,” comments Dr. Hands, “or from a movie producer on a major film production asking if I can come to the set to take a look at one of the actors. There’s not only a lot of money at stake, but, for these performers, their voice is their livelihood. Over the last twenty-five years of practicing medicine, I have developed a real understanding, admiration and fondness for these people.” This understanding has lead Dr. Hands to create VOX CURA: VOICE CARE SPECIALISTS, the first and only centre of its kind in Canada specializing in services for the professional voice.
“Traditionally, singers, actors, broadcasters, CEOs, public speakers, lawyers and teachers have had only two choices when vocal problems arise: they could either see a physician using the conventional mirror examination, or they could see a professional voice coach. In my opinion, these choices were not necessarily the most efficient forms of treatment.”
Located in mid-town Toronto, VOX CURA’s offices have nothing of the sanitized appearance of a typical doctor’s office. The waiting room is filled with posters and autographed photographs from the various film, opera, music and stage productions with which Dr. Hands has been involved. In fact, as Dr. Hands is voice consultant for Livent Inc., Mirvish Productions and the Canadian Opera Company, he has, in one way or another, been associated with nearly all the major live theatrical productions being performed in Toronto. Beyond the waiting room is a large piece of sophisticated equipment called the video strobe. Dr. Hands explains that there are currently only a handful of these units in Canada and they are used primarily for teaching or for hospital-based cases. At VOX CURA however, videostroboscopy is available for voice professionals daily.
“The video strobe is a state-of-the-art technology that allows us to pinpoint and asses exact vocal difficulties — from the more obvious haemorrhage, polyp or nodule, to being able to differentiate very, very subtle abnormalities. Its small video camera and strobe light illuminate the vocal cords’ vibratory pattern that is otherwise impossible to see with the human eye.” The video strobe provides an immediate image and, more importantly, a personal, portable record on videotape for diagnostic comparison. An opera singer, for example, is able to show the tape to his/her coaches or doctors whether performing in town or around the world.
Dr. Hands explains, “Besides the invaluable use of the video strobe, what really makes the centre unique is its multi- disciplinary approach.” Following the initial evaluation, Dr. Hands and his team of a speech-language pathologist and a voice coach then determine the most appropriate rehabilitation and enhancement program. “Apart from the convenience of having everything all under one roof, there is no other place that offers the variety of services and the manner in which our team works together in order to provide the best possible treatment.”
“VOX CURA LAYS HEALING HANDS ON CANADIAN VOICES”
Even though vocal cords have been seen as professional instruments since the ancient Greeks introduced theatre, the arrival of recording technology has really kicked the idea into high-gear for the modern world. This is an age, after all, where there is an unprecedented number of professional voice users, among them actors, singers, broadcasters, public speakers, who are exercising — and bastardizing — their vocal cords.
Enter one Dr. Brian Hands, whose multi-disciplinary balm for vocal-related problems has made him one of the most in demand voice care specialists around and a regular consultant for Livent, Mirvish Productions and the Canadian Opera Company. Hands’ multi-disciplanary approach to training and maintaining a problem-free voice purports breakthrough medical, diagnostic, therapeutic and coaching resources despite tongue-twisting terms like “videostroboscopy.” In fact, videostroboscopy is the major breakthrough of the technique. Initially developed back in the 1950’s by German engineers, videostroboscopy allows for examination of the larynx via an audio and a visual recording done through a strobe light, which allows the vocal cords to be slowed down and enable doctors to see their individual wave motions.
“Prior to this, we would have to take someone to the hospital and put them to sleep and look at the vocal cords,” explains Hands. “But now, with videostroboscopy, we can visualize the vocal cords in actual motion and have them reduced in speed in their cyclical vibratory motion.”
Hands says that vocal cords vibrate in individuals anywhere from 80 cycles per second to 1000 cycles per second, speeds which far exceed observation by the human eye.
“But with use of the video strobe, we are able to see the very subtle changes in the voice production such that if a singer comes in and says, ‘listen, I’m having trouble in my middle range or my high C is gone or my falsetto is not quite there,’ we can actually identify the problem.” he says. “And we can do that in conjunction with our singing teacher and our speech language pathologist. We have come to a point now where we can put together the performer and all the people that should be assisting this person in one room. After one examination, we are able to have the patient focus on the problem and the people who are going to provide treatment focus on the problem. We’re reducing the therapy that’s necessary to a minimum.”
Not surprisingly, the idea has seen huge interest from the entertainment industry, especially artists and broadcasters. That interest is one of the reasons that Hands will be part of a panel discussion at this week’s Canadian Country Music Week (‘Basics for Building & Maintaining A Sound Voice’ with Katherine Ardo, Joan Kennedy and Jamie Warren on Sunday, September 7).
“What we are planning to do essentially,” says Hands, “is to talk about the do’s and don’ts of voice care; the basic techniques, the effect of various environmental factors, drugs, alcohol – this type of thing – on the voice. We are also going to try and express to the audience the nature of what the vocal tract consists of, how to work it and how to make it more efficient and describe the very sophisticated way in which we can now intervene and improve the status of vocal quality.”
‘PAGE 1 NEWSMAKER’:
“DOCTOR CARES FOR THE VOICES OF THE STARS”
Dr. Brian Hands is very concerned about seven sinewy bits of flesh and muscle that dangle in your throat, just behind your Adam’s apple.
So concerned that he opened a centre that specializes in the care of your vocal cords, making VOX CURA the only centre of its kind in Toronto.
Hands, an ear, nose and throat surgeon, initially did consulting for the Canadian Opera Company. “More and more people were calling the opera and asking, ‘Who takes care of your singer because if he takes care of yours he must be good,'” he says. “We’ve done something that’s never been done before. We put together a centre that cares for the professional voice.”
And he soon became known as the Doctor to the Stars. In fact, he’s had his fingers and his much-prized videostroboscopy probe in the mouths of many of today’s biggest music, film and television stars – throw out a name and you’re likely to find their autographed picture on his office walls.
The probe is what vaulted voice analysis into the twentieth century, Hands said.
“Videostroboscopy came into being in 1950,” he said. “Until then, we used a dental mirror and a head mirror to look at the larynx. But the video strobe system was so costly and large that any use besides laboratory was impossible.”
The device uses a strobe light and camera to film the movement of your vocal cords, which vibrate at 80-1,000 cycles per second. From the images, the doctor can make an exact diagnosis of the problem.
Dr. Hands first came across the new technology at a conference in the States and was overwhelmed by the possibilities it opened.
“I thought, ‘How am I practicing? I’m still in the Dark Ages,” he recalled. “I felt that for someone who is caring for voices that are heard throughout the world, it was not fair to my patients. So I went about finding out how I could purchase one.”
From there Dr. Hands’ practice flourished. He doubled his office space and added a voice coach and a speech-language pathologist to his team. And he made changes to the overall operations of his office, so he could cater specifically to individuals who use their voice to put bread on the table.
“We wanted to create an environment where a singer could come in and not have to worry about, say, catching a cold from other patients. We tried to raise the sense of awareness about the voice – to be a group of people who know and understand the problems.”
Now, Dr. Hands said, his clients look to the probe as a way to enhance and prolong their careers.
“An untrained rock singer’s voice has a short life span. When they realize it is their dream to have a sustainable career as a professional singer, they come to see me,” he said. “They won’t last on the techniques they are currently using.”
“VOICE DOC HITS HIGH NOTE WITH THE STARS”
Vocal cord expert Dr Brian Hands mends celeb patients’ pipes
By Judah Issa
It was an Italian opera – a Verdi or a Puccini, he doesn’t remember which — and the prima donna was in trouble. Otolaryngologist Dr Brian Hands got an urgent call to go to Toronto’s Hummingbird Centre in the middle of the second act. “She said, ‘I can’t sing,'” Dr Hands recalls. One look at her throat and the doctor told her she’d be risking permanent damage to her vocal cords if she continued the performance. But the show must go on.
“A young Montreal soprano who was singing in the chorus had to take over,” the doctor reminisces. “She stood up backstage in her jean skirt and sang beautifully, while the lead singer lip-synched for the rest of the performance.” That young Montreal chorus girl went on to become a world class diva – but the doc won’t divulge her identity.
Dr Hands has been the vocal doc of the rich and famous for years — Mick Jagger, Celine Dion, Nicole Kidman, Lionel Richie, Sigourney Weaver and Gordon Lightfoot are all rumoured to have flocked to Toronto to see him, though he refuses to confirm or deny. Their photos, signed with gratitude, line the walls of his office. “People come to the office and see who’s on the wall, but I can’t discuss my patients,” he says with a chuckle.
He’s been servicing these illustrious vocal cords for over 30 years and enjoyed every minute of it. “Dealing with music and professional voices is the most exciting part of my practice,” he says.
A STAR DOC IS BORN
It all started in 1975, when the young doctor was just about done with his residency. “The chief of staff at my hospital, a cultured Hungarian who sat on the board of the Canadian Opera Company (COC), came to me and said ‘You’re going to be the doctor for the opera,'” says Dr Hands, imitating a Hungarian accent.
Here he was, a fresh graduate, thrust into the position of treating performers whose livelihood depends on their voices. It was a little unnerving, he admits. But he rolled up his sleeves, took extra courses and went for special training in New York and Philadelphia, then returned to Toronto in time to witness its theatrical golden age.
“Suddenly there were big productions being previewed in Toronto, and somehow opening nights always involved the male or female lead getting sick,” he says. From the COC to Mirvish productions, his practice evolved. So did his technique.
“In the old days, we used to freeze the throat, then use dental mirrors and a headlight. It’s a far cry from what we do now,” says Dr Hands. These days the doctor relies on sophisticated equipment, like his trusty videostroboscope. The tiny camera inserted in the throat painlessly records digital images of the vocal cords in action and allows the doc to diagnose the problem instantly.
“Many times, the performers will come back to get another picture of their vocal cords when they’re healed,” he says. “This way, when they’re in trouble in Paris or Milan, they have a recorded image of what their cords look like when they’re healthy, to show to the doctor.”
THE FIFTH CHAKRA
But almost 85% of the time when singers come to see him, the problem is not with their pipes at all, says Dr Hands. “Sometimes it’s the baggage from work or family that affects their ability to perform. The stress or anxiety changes their normal breathing support patterns for singing.”
That’s when Dr Hands pulls out his secret weapon to heal the wounded songbirds: Buddhist chakras. “I’m a firm believer in energy,” he explains. “The seven chakras [energy centres] in the body are all interconnected, and they all relate to voice production.”
The fifth chakra is where the voice is located, the throat. “When this area becomes overly tense, it means performers are holding a lot of underlying angst,” he says. Dr Hands’ holistic approach allows them to explore the source of their anxiety and deal with it to regain their full vocal form. “I get quite overwhelmed when I see the person I’ve treated singing on stage and recognize the very minimal role I had in getting them there.