Now, after my first Botulinum shots, its clear that I'm going to have to learn to change the pitch I talk in by habit - to get a fully "normal" voice.

I don't quite understand why you need, post-botox, to intentionally change the pitch of your voice? Often after a botox injection, one's voice may be higher pitched for several days to a couple of weeks (due to the over-weakening of the cords) but that will resolve with time.

I have never intentionally changed the pitch of my voice with or without botox and don't feel the need to. It's not natural and I wouldn't recommend doing it (although some others use it as a compensatory strategy to hide SD symptoms -- especially those who do *not* use botox. I personally think this sounds very unnatural and is probably not a very good habit to get into).

For me, after a botox injection (after any initial breathiness wears off), my voice sounds normal with no changes in pitch whatsoever.

I am not certain that I do need to do such, but my Neurologist, ENT and Speech Pathologist at Dartmouth told me I may need to explore other pitch ranges - post Botulinum injection.

Some people claim they have cured their SD or that they themselves can cure SD in others by teaching oneself/another to speak in a different pitch. That, to me, is just plain misleading. The underlying SD will still be there when an SD affected person speaks in their NATURAL pitch.

I am not, in the least, impressed with this compensatory strategy. Others may disagree so to each his/her own.

Overall, I think that any extra effort to purposely mask one's SD symptoms is often counterproductive.

Todd, I'm going to guess (but it's not any more authoritative than that!) that you'll find whatever is working right now isn't what will work as a few more weeks pass, because of the physical changes at the injection site. Whatever feels like a strain is, to me, no help at all.

Not meaning to get into a debate about this as whatever works for you is fine by me... But I'm certainly not trying to make any sort of "statement" by not trying to distort my voice to cover up spasms. SD is not, for me, political in any way! I know some people who won't have treatment as after having SD for 10, 20 years (before botox, etc.) they feel it would diminish the significance of how they survived for so long without it. Now that is what I would call a "statement!" I can't personally comprehend that rational but they're entitled to that approach. But it is not at all my approach. I'm all for having a completely normal sounding (and FEELING) voice if something like botox can provide it!

When my botox shot is working (AFTER the initial breathiness wears off) there is no need for any pitch changes, alterations, etc., as I sound normal. When it starts to wear off, I go back. End of story.

I suppose I would tend to think it's bad for one's vocal apparatus as it's using muscles in an unnatural way (i.e., "...that it can actually physically cause more problems.").

I can understand the volume issues after botox, but all I would say about that (from what I've learned at conferences, etc.) is that one should not try to force one's voice any louder than it wants to be.

I would tend to think that any sort of compensating (forcing volume, pitch changes, etc.) would tend to make botox wear of quicker! One's goal with treatment, in my opinion, is to regain (as close as possible) the ability to speak freely in one's natural voice.

The pitch issue is an interesting one. I know that some doctors advocate pitch changes but I've also heard from many well-known SD experts that this is not a great idea. The few people I know who do it sound very unnatural. I don't think it's a matter of "[needing] to let them know" as doctors are entitled to different approaches to treatment.

Honestly though, whatever works for anyone else is fine. I'm not trying to push what I've learned on others. It's just my "take" on the issue.

I read all posts on this thread but just responding to the first one.

Seems like you are trying to gather alot of information all at once since you just had your first Botox treatment and I hope you are also researching the BB as these types of issues have been discussed at length over the years and some of that information from previous contributors might be helpful to you. Just a suggestion. Sounds like you are in *panic mode* which is understandable at the beginning but which might block current learning opportunities.

Every patient is different and whatever works for a particular patient is the right thing for him/her. I wish you success in your first Botox experience also; but, as folks on this BB might say (and have over time)...it may take a few cycles to get it working best for you so I hope you don't burn out.

I'm not familiar with the doctors at Dartmouth (thus no comment on them as I don't know them but I'm sure they are fine medical professionals); but, over time, it seems patients who have been to alot of doctors and done alot of research and attended SD-symposiums (meeting more expert-doctors in person) and have worked with support groups can grow a larger *body-of-knowledge* on our numerous cases than even doctors can. Not to say one is right and one is wrong. But, research and meeting lots of SD'ers in person seems to be a good approach in getting the scope of our disorder.

"Scope" is a key word. If a doctor has 5-10 SD patients (but he/she is an MD), how does that relate/compare with a knowledgable patient who has met between 100-200 other patients in person? My personal opinion is that both should be acknowedged and learned from. All patients are different and I personally wouldn't believe any doc who told me SD was *just so* because I've learned different. As many of us do, you may be educating your doctors in the near future. I do, and she appreciates it. A good medical professional will welcome your new knowledge.

The pitch-issues you described can be problematic. Many of us have had numerous years of speech therapy and, as a severe surgical AD-case, I know that when I speak very high (pitch), my voice is smoother. But, it is not my voice. I can do it, as I have trained myself, but I'm having to stress and strain to do so. It hurts my laryngeal muscles.

Hopefully your recent Botox treatment will be successful; but, if not this time?...keep on going back because eventually a capable doctor-team and receptive patient will find what works. Also, based on my experience (not just me but friends' experiences), changing pitch could cause some serious problems so don't do anything too soon (except for collecting info from other patients). Wait until your shot(s) kick in; and, usually if the injector has hit the right spot, you will be very happy with your vocal results and won't feel a need to change pitch.

Good luck, Todd. Also, keep in mind that "changing pitch" is something which may work well for vocal abuse cases but not generally for SD, which is a neurological disorder. It's not normally workable for us.

OK, I'll weigh in, too.

I once read the book by that doctor in LA who claims voice therapy is the solution to SD. (I can't remember his name, but he is well-known--or should I say infamous?--on this BB!) While I do not subscribe to his analysis or treatment of SD, I do think he does make a valid point when it comes to switching your pitch. His point is that many people have voice problems (not necessarily SD) because they are trying to talk in a range that is not natural for them. In some cases, they might be trying to speak higher, to sound cute or sexy or lower (to be taken more seriously). He claims this is part of the reason why Bill Clinton had that perpetual frog in his throat.

Anyway, his point is that by speaking outside of your natural range for any length of time, you are actually putting more strain on your vocal cords. (Think about how long you could really continue to talk in that sing-songy voice we all use when addressing little kids: it would tire you out after a while...even without SD!)

I agree with this and think that you should always try to speak at your natural range.

He suggests that to find your natural pitch, that you say Uh-hmm (Kind of that hum of yes). That tone that it comes out in is your natural pitch.

As for botox, I have found that the best way from preventing the voice from getting to Minnie Mouse-ish during the first few weeks is to avoid trying to project or shout. The harder I try, the worse it gets. If I just try to speak at a normal to slightly below normal volume, it sounds a little better. Eventually, it wears off and you sound like yourself again.

One final word of caution, which I hope your doctors have already given you: When I went for my first shot, my doctor warned me that this is not an exact science. Because it could be a variety of muscle combinations, it might take a few shots to get the dosage and the muscles just right. In my case, after just over a year and about 5 shots, I think he has finally gotten the dosage right! YAY! I found I didn't lose my voice as bad this time, and the spasms stopped immediately. So my advice is Patience and Education.

Keep reading through the material on this BB and reading up on SD.

Good luck!

Those were excellent posts. I'm not really in a panic mode about it so much as just really looking for info. I'm an information freak by nature, so don't take my desperate thirst for info as panic. When I want to find out the physics behind why the sky is blue, or the history behind the evolution of the mountain Marmot - just for the hell of it, I reek just as badly of deperation for knowledge! :) I'm one of those geeks who was reading dictionarys and encyclopdedias as a kid for pleasure, and still do. And this BB is an excellent resource.

Thanks for the thanks. I truly believe in high-quality speech therapy (unfortunately, my several years in speech therapy could not be termed that because those folks couldn't even figure out what I had, let alone what to do with it) and, like you, I try to gain as much knowledge as I can.

You're in the right place. Lots of knowledge here, as well as the *gifts* of the Internet. So many of us with long-term cases of SD would have been diagnosed and treated much sooner, had we had the Internet years ago.

So...deep breath...slow down...and keep reading/researching and meeting other SD'ers on the phone or in person. SD is an *auditory thing* so it's impossible to figure out your own case (ie: severity, variety, as in mixed AD/AB/MTD, other anomalies, etc.) completely on the BB or online. Until you bounce yourself off others, voice-wise, you won't be satisfied. Local support groups and symposiums really help.

You are younger than me (I noticed...LOL) but I think of this one often, when dealing with my own case. In the old days, there was a TV show with the voice-over by-line: "There are 8 million stories in the Naked City....and this is one of them." That's how I view SD. For how many cases we have/are, that's how many unique stories we patients have. With all your research, I hope you find what works for you. The positive thing, these days, is that there is a name for what we have and there is are treatments. Didn't used to be that way.

Glad you're not panic'ed and I hope you can relax. It might help to learn the terminology (breathy, falsetto, hoarse, gravelly, weak, Minnie Mouse, squeaking, etc.) that your voice goes through and get one of those Botox Injection Cycle charts from the NSDA or just document your vocal reactions, in order to compare notes with your docs over various shot cycles. That way, you can track your own progress (with a baseline and daily charting of how you are doing) and it will help in communicating re doseage and whatever you want to do re speech therapy in the future.

I'd drop the "pitch change" thing for now though. Just my personal opinion. You have other things to pay attention to which are more important right now. In trying to establish a baseline, an effort to change your pitch now (mid-treatment), might screw things up.

Best of luck.