When Your SwimmerContinues to Literally Choke:

More ideas on how to manage symptoms of VocalCord Dysfunction (VCD)

BY TONYA RA.SOR

In October 2007 and again in August2008, ASCA published my original arti-cle on Vocal Cord Dysfunction, "Whenyour swimmer literally chokes: Howto recognize and manage symptoms ofVocal Cord Dysfunction (VCD)." Thisarticle was discovered by a resourcefulswim mom, Tracey Lafferty, seekinghelp for her 16-year-old daughter,Kelsey, who suffers from Vocal CordDysfunction. Over several months inconversation with Tracey, I remem-bered additional ways to manage thesymptoms that were not mentionedin the original article. These are listedlater in this article.

First, Vocal Cord Dysfunction, simplyand quickly, is a breathing disorderwhere the vocal cords close off partial-ly when they should be open, and sothey restrict air on the inhale, inhibit-ing a full inhale and often producinga high whistle as air squeezes throughthe tight space to get to the lungs.

Kelsey fits the typical profile; she'san over-achiever (in other words, onewho strives to do the best she can ineverything and usually excels), she'sfemale, and she tries to use her will todeal with her disorder. Keep in mindthough, that these are the character-istics of those who suffer, and also ofmany other elite athletes who do not.The correlation does not mean Kelsey'ssuffering is psychosomatic.

Iknow what it is like. Ihave beenthere. I fit that profile, too, and I swamin practice and races struggling forair, making loud whistling noises thatpierced across the long course poolclear to the other side, and worriedmany people I wished would just

22 ASCA Newsletter Volume 2009-07

ignore it. I simply wanted to work hardand swim fast - and not worry about ifI was going to have enough air to fin-ish the race.

My worst memory of it was taking outmy 200 meter freestyle in a champion-ship final exactly where I wanted to, at1:01 for the 1st 100, and then instead ofmy typical 2-3 second split differencebetween the 100's, I ran out of air goinginto the second 100 and fell off my paceto a 1:11. Anyone watching might havethought I gave up or choked underpressure, but those who knew me sawmy purple shoulders and blue lips.

Running out of air at a championshipmeet is the worst time because thefinals of the championships are wherean overachiever performs, where allthat hard work pays off. So this mem-ory hurts worse emotionally tha~ thetimes I had to be pulled out of practice,had to swim sets slower than I wantedto, passed out while swimming, andgenerally gasped for air every stroke ofthe way. I

Tracey told me similar stories regard-ing Kelsey. Each race, Tracey saidshe watches anxiously, looking forthe signs her daughter is strugglingbecause when Kelsey gasps for air dur-ing her race she usually does not evenhave enough energy left at the end topull herself out of the pool withouthelp.

There is no telling when episodes aregoing to hit, though they are frequentlyworse around the time of a woman'smenstrual cycle, I say this with con-fidence, though I have never seen re-search to substantiate it, because I kepta journal every day of my swimmingcareer and recorded such information.The data lends evidence to the theory,and the Tracey said she definitely no-ticed the same pattern.

She said that as irregular as her daugh-ter's menstrual cycle is as a younglady, her difficulty breathing canpredict its onset. I hypothesized thatthe reason for this is the tightening ofmuscles during this period (especiallyin thin, fit, young athletes) also tight-ens the vocal cords. Tracey shared mytheory with a voice doctor in her area,and he gave credence to the idea witha different hypothesized underlyingreason; he said it makes sense to himsince the larynx (vocal cords) holdsmore fluid during a woman's men-strual cycle. If I had the participants, Iwould be interested in researching this.Perhaps he will.

The cause and treatment of VCD isstill unknown. The dysfunction itselfis relatively recently recognized (1983)

continued on paqe 24

shown when an anchor is used at thebeginning of the process, people donot sufficiently adjust from that initialanchor value to a more accurate one.A study of real estate appraisers andthe effects of anchoring showed that bychanging only one piece of information(the listing price) in a ten-page pack-age of materials, the researchers wereable to shift the real estate appraisal bymore than $10,000.

Most commonly, anchors take theform of last year's strategic plan orthis year's budget numbers. By usingthe assumptions that went into lastyear's plan, strategy becomes fatallyflawed. Strategic thinking demands allassumptions, beliefs and informationare looked at from a fresh perspectiveon a continual basis. Simply tweakinglast year's plan is a major disservice toone's business because it suffocates anychance of discovering new insights thatmay dramatically alter the strategicdirection.

Anchors Away: To avoidthe danger of anchors instrategic thinking, consider thefollowing:

1. Create an open mind by activelyconsidering the range of startingpoints available, not just the an-chor point (i.e., budget numbers).

2. Identify anchors as soon as theyappear and call them out mentallyand physically (on paper/flip-chart) so everyone is aware of theirpresence.

2. Group ThinkAs strategic thinking and strategicplanning are often done in a group set-ting, it' 5 important to recognize the in-fluence of "group think." Group thinkoccurs when there is a homogeneousgroup of people with little influencefrom outside sources and a high levelof pressure to conformity. Group think

. tends to directly and indirectly reducethe level of objective thinking, remove"devil's advocate" thinking and pun-ish those who attempt to do either.Irving Janis describes eight symptomsof group think. As you participate inyour group's next strategic thinking or

planning session, try to observe if anyof these symptoms are present

1. Illusion of invulnerability thatleads to over-optimism and exces-sive risk-taking.

2. Efforts to rationalize or discountwarning signs.

3. No challenges to collective think-ing.

4. Stereotyped views of competitorsas inconsequential.

5. Pressure on group members thatdisagree with the majority.

6. Shared illusion of unanimity.

7. Self-correction when thinking ofdiverting from group consensus.

8. Seek information that supportsgroup consensus and unwill-ingness to look for or considerinformation that is contrarian (alsoknown as the" confirming evi-dence bias").

Group (Think) Therapy: Toavoid the danger of group thinkin strategic thinking, considerthe following:

1. Utilize an external resource tofacilitate the strategy session toensure objectivity and divergentopinions.

2. Bring in people from other func-tional areas (marketing, R&D, IT,HR) to offer different perspectives.

3. Status QuoPopular adages such as "If it ain'tbroke, don't fix it," "Don't rock theboat," and "Let sleeping dogs lie"all feed into the natural tendency toprefer the status quo. Time and again,research has proven when individualshave the option of doing somethingnew or staying with the status quo,they overwhelmingly stay with thestatus quo.

Feeding into the danger of alwaysleaning toward the status quo is the

fact that human beings are generallyrisk-averse. Research in the field ofdecision-making by Amos Tverskyand Daniel Kahneman has shown thethreat of a loss has a greater effect ona decision than the possibility of anequivalent gain. The response to lossis more extreme than the response togain. Consequently, many strategydecisions place too much weight on thepotential negative outcomes or threats.This principle of human nature has astrong effect on strategy decisions andmust be taken into account to avoidalways acting in a risk-averse mannerwhen the probability of success is actu-ally greater.

Turning the Status Quo intoDough: To avoid the dangerof the status quo in strategicthinking, consider thefollowing:

1. Focus on the outcome desiredand use that as a measurementbetween the status quo and otheralternatives.

2. Examine the actual changes thatwould need to be made to aban-don the status quo, as the reality isoften less painful then imagined.

When developing strategy, it's im-portant to avoid the strategic thinkingtraps. Built into these traps is the factthat 90% of managers have never hadany education on strategic thinking.If you're pulling a team together todevelop strategy and the majority ofteam members aren't strategic, do youreally believe you'll end up with greatstrategy? It's more likely you'll windup with an outbreak of 'but disease.'Ointment anyone?

Rich Horwath helps organizationsachieve competitive advantage throughstrategic thinking. He is the presidentof the Strategic Thinking Institute,a professor of strategy at the gradu-ate level and a former Chief StrategyOfficer. Rich is the author of the newbook, Deep Dive: Mastering the ThreeDisciplines of Strategic Thinking forCompetitive Advantage and creator ofthe Strategy Vault, the premier onlinestrategy resource center. -

www.swimmingcoach.org 21

continued from page 22 When Your Swimmer Continues to Literally Choke

and sti1llargely misunderstood. Many 5. The coach needs to spend time 10. Sets may need to be modified.times it is misdiagnosed as asthma. As analyzing and looking at the Fins (with a snorkel) can be help-indicated earlier, although my original breathing, body alignment, muscle ful in giving the swimmer a feelarticle gives many good ideas for man- use (neck, chest, shoulders, jaw, for speed. Broken distances areagement, I have expanded on the ideas traps) while the swimmer is swim- probably the most effective wayand added a few more: mingo Swimmers need to learn to to train (i.e., 200' s broken at the 50

focus on relaxing the throat and for 5 seconds or at the 75, 75, and1. Swimmers are trained to automati- jaw especially during back and fly, 50 for 5 or 10 seconds). Sprints or

cally hold their breath or blowout and the shoulders and neck during fast swimming might require moreunderwater. When having trouble, free (jaw as well, but not as much recovery time to regain breathit can help to do a 50 or so (it as in back and fly). control (symptom recovery) beforesometimes takes a 400) of under/ the next sprint. Sets with variedovers using the lane line and 6. When in an episode, a swimmer strokes can help. Fast swimmingconcentrating on exhaling fully can relax by exiting the pool, lying mixed with kicking might help.underwater and relaxing the neck down, and lifting the rib cage to Just have the swimmer kick onand shoulders. Going underwater open the lungs. Maybe roll up a her back rather than with a board.facilitates blowing out by counter- towel and lie with the roll width- Kicking with a board puts the neckacting the tendency to hyperven- wise just under the shoulder in a crooked position that makes ittilate when out of air (which, in blades. harder to breathe.this case, only tightens the openingmore). 7. If running or otherwise out of the 11. Don't panic! Panicking excites the

water, the athlete may want to sympathetic nervous system - the2. Exhale fully! When swimming, all stand up during recovery to open "fight or flight" response. That

the time, exhale immediately after the lungs. However, if she is dizzy, means it speeds up the heart ratetaking a breath. This is probably it may be better to hunch over. I and increases respiration due to anot the way a swimmer usually recommend lying down or, if in need for more oxygen. Those withbreathes during the cycle. The the water, doing under/ overs and VCD are already short of breathusual method is inhale-hold-ex- bobs for recovery. and short on oxygen. Panic com-hale-inhale-hold-exhale, but it will pounds the issue. As scary as it ishelp to get all the air out and relax 8. The coach may need to watch for when the throat closes and therethe cords for a better inhale. Swim- when to pull the swimmer out. is not enough air, those with VCDrners, cut out holding your breath! The reason for this is that the typi- must learn to remain calm andTry for a full, deep, quick inhale cal stricken swimmer is one who have confidence that the cords willand a longer, forceful, continuous will keep going no matter what, open again.exhale. Speech pathologists teach one who is determined to fightto exhale through pursed lips in through the pain. Stopping will 12. Try not to cry. This is an emo-order to speed up the exhale. A feel like giving up. Swimmers with tional, hard thing to deal with, butrounded mouth position likely VCD are not often the weak ones crying makes it harder to breathe.comes naturally to a swimmer try- who stop at any excuse. So givinging to exhale quickly. her encouragement, but making As long as there is no known treat-

her stop when it is bad may be ment, the best we can do is to learn3. Use a front-mounted snorkel to necessary. how to manage the symptoms. To fig-

promote smooth inhale and exhale ure out what is best for your swimmerwithout holding your breath. This 9. Upon cessation of the exercise, the (and as recommended in the originalcan help a swimmer keep practic- symptoms will clear up on their article), keep a journal. Record whening during a mild episode. Have own. It is important to stay calm the symptoms are worse and better,her use the snorkel even if all the and try to relax. The duration of different management techniques,other swimmers are not using one. the symptoms varies. Unfortu- thinking and emotions, and menstrua-

nately, once the symptoms start in tion. Look for patterns. If you wish4. Mentioned in the original article an exercise session, they rarely go to participate in my research on VCD,

is the importance of keeping the away, so when the swimmer tries contact me at JRasor2000@yahoo.com.neck in line with the spine (top of to resume exercising, the symp-the head forward, not eyes). The toms will likely return. Strug- Lastly, as a coach or parent, alwayssnorkel is meant to help learn this gling for air during exercise also remember to offer encouragement andposition. fatigues the muscles quickly; even support. Kelsey, and other swimmers

when the symptoms subside after who suffer, need that.asome rest, the swimmer may beexhausted.

24 ASCA Newsletter Volume 2009-07