It started the night before. I'm never sure if it is a sore throat, an ear ache/infection starting, or the arthritis.
Rheumatoid arthritis affects the cricoarytenoid joint. When I first learned this I was absolutely devastated. I had just completed a concert and was overjoyed that I was actually able to make it through the rehearsals and the show. The show was a success and it was to be the mark of a major vocal comeback for me after being away for almost thirteen years. But the very next day I thought I had a sore throat or an ear infection or that I had perhaps just a really tired set of vocal bands from the concert. I was careful to sing correctly and take care of my voice (I'm a classically trained singer so I have the right tools and I know how to use them). But no training at all could have prepared me for the diagnosis. The cricoarytenoid joint is the joint between the cricoid and arytenoid cartilages in the back wall of the larynx. The Cjs are rotated by the vibration of the vocal cords, thus changing the tone of the voice 1 This can cause hoarseness, a sense of pharyngeal fullness in the throat when speaking and swallowing, pain in the ears and dyspnoea (difficulty in catching your breath). Today I'm battling these symptoms but stubbornly treating it like an ear infection. I'm taking in more fluids and zinc supplements and warm tea and putting myself on vocal rest. I had to cancel future engagements and let down some ticket holders. I cancelled anything that required singing or talking and sadly said "not now" to a chance to sing at a church of a college friend. I had to say no to an opportunity to preach recently as well. You just never know how much you depend on things like your voice until that is taken from you. I could teach a course on this now.
However, what I need to do is come to grips with this and seek the advice of a specialist and touch base with either my current vocal coach or my undergraduate vocal professor who, to me, is the guru of all things vocal. This disease has so far stolen my enjoyment of walking, dancing, organ playing, and now seems to want to take any hopes of a revitalized singing career away as well. Now, many of my friends and family will say things like, "it'll get better" or "stay strong it'll all work out" but the truth of the matter is, there is NO CURE for this damned disease. We have medications that we're trying that will mask it and take away a few annoying side effects but remember that when you get rid of a side effect you typically trade one for another (you've heard those annoying Rx ads on tv that go on for ten minutes discussing the side effects).
Today I was to start my cimzia injections but now I need to wait another week. It must be taken on Saturday as it is timed with my mid-week injectable methotrexate. I'm waiting because I'm not 100% sure if what I'm experiencing is a sore throat, ear infection or swollen Cjs. I can't start this medication if I have any type of infection going on. All I know today is that I'm angry - very angry - at the thought of loosing yet another love in my life - singing. But also focused on not giving up and praying for a miracle.
1 (Stringer SP, Schaeffer SD. Disorders of laryngeal dysfunction. In: Paperalle MM, Shumrick DA, Gluckman Jl, Meryhoff WL eds. Octolarygology, edn 3. Philadelphia: W.B. Saunders, 1991:2257-72)
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