What does a day in the life look like for a voice SLP in both a hospital and private practice (during COVID)?
Wake up 6 am. Get ready for my hospital job.
Leave to walk to work:
Think about upcoming social media content, about upcoming private patients that evening, or listen to a podcast during the walk
Submit my COVID symptom questionnaire on my phone to be cleared for work that day
7:40 am: Prep for clinic day- grab my PPE (fresh mask when entering hospital ✔️, N95 ✔️, goggles ✔️)
Check email and do chart review of morning clinic patients. Prep any patient charts that I can with eval template, relevant medical history information gathered from chart review and intake form.
8 am-12 pm:
Morning joint voice/airway clinic
8 am: Grab first clinic patient after the MA confirms her vital are done. She had a Thyroidectomy 3 months ago, with significant immediate voice change post surgery. Even though I had a strong suspicion of what was going on, I asked some medical and case history probing questions as well as asking her. Conduct CAPE-V and objective measures.
Due to the severity of the breathiness I knew that I will likely not have a role here in voice therapy just yet if at all. I give a case summary to my team physician (laryngologist). I discuss that I suspect high likelihood of unilateral vocal fold paralysis based on history, symptom onset, and perceptual symptoms that both I hear and the patient describes.
We then do the joint evaluation with stroboscopy (both the laryngologist and I go into the clinic room together for further discussion, evaluation, and stroboscopy). We confirm we are indeed correct in our suspicions- unilateral vocal fold paralysis! The physician describes the procedural options for augmentation for after the 6 month time period post-onset as I run to start with the next patient.
Patient with chronic cough symptoms for past 1.5 years. She experiences coughing fits, triggered by strong odors, cold air, and talking.
I probe into other potential LPR or allergy symptoms, any prior treatments trialed and success level and if voice is an issue (I suspect this based on what I hear and how she notes talking triggers a cough). She notes some vocal fatigue and moderate roughness, similar to what I hear.
I get a thorough case history, educate a bit on how voice can trigger a cough and conduct stimulability for voice and respiratory retraining techniques.
I discuss the case with the physician and how she was stimulable to stop a cough with my techniques.
...continue with morning clinic patients...
11:00: The patient says their voice feels hard to get out, feels effortful, has been a gradual change. Gets better with singing or speaking softly. Sometimes they sound nervous when they’re not. I hear them and my neuro bells go off- now I differentiate between SD and tremor. Have them do sustained /a/ and I hear consistent rhythmic oscillations in pitch. Tremor? Likely. Then I do specific ADSD sentences to try to elicit any potential breaks. I have her sing, speak in high pitch and whisper - definite change in symptoms when she does those and I hear voice breaks so I’m suspect of SD too). We see tremor in multiple locations on strobe and a few voice breaks when I probe her on strobe exam. She has severe compensatory tension so we discuss benefit of Botox injections with therapy. We set up an initial botox counseling and voice therapy session. I’ll be in close communication with the physician to let him know if she had any change with voice therapy in releasing tension and if she’s open to therapy. We will then discuss dosage with patient if moving forward to botox.
11:30: The patient is a physician who reports gradual worsening of voice over the past few months. Roughness with increased speaking especially during zoom meetings and patient calls and during rounds with an N95.
I listen to his voice and do a CAPE-V. I collect some objective measures (no full acoustic/aerodynamic measure collection permitted due to high risk during COVID so I do MPT, DDK, and s/z)** note: typically, in non-COVID times, I would do a full voice lab on him**. I also do stimulability and his voice is amenable to quick change with resonant voice techniques that I guide him through. I gauge that he’s highly motivated to do therapy.
I brief the physician on what I found and that it sounds like atrophy based on perceptual assessment and history and we do strobe to confirm. We both look at closure pattern, how much air he’s losing during phonation and the severity of the atrophy. I try some of the same techniques I did with him earlier, now on strobe, and he achieves a more efficient pattern of vibration and better sound. We confirm that voice therapy is the starting place for him.
12:00: Lunch- quickly grab a bite from the caf and get to note writing to prevent note build up after my day. Respond to a few emails I didn’t get to check during the morning.
Afternoon is all therapy from 1-4!
I see a patient with atrophy, one with chronic cough, and one with phonotraumaric lesion with secondary MTD. I supervise my extern for parts she conducts.
Once patients are done it’s onto note writing to catch up on any notes for the day. I’ll catch up with my extern I’m supervising if needed to recap the day, provide feedback and to plan for the next day.
Uber home, quick shower after hospital work during COVID and quickly get ready for my two virtual private patients (one gender affirming voice, one SD). Quickly document their sessions after.
Quick yoga session, dinner, and catch up on business emails while watching some Below Deck 😊
Finally to bed! 🥱😴
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