The Injury: From Zenker’s Diverticulum to Pharyngocele

Many of you know that in 2012, a Zenker’s Diverticulum formed in my esophagus. This is a herniation of the muscle that forms a permanent pocket or sac off the back of my esophagus, between it and the front of my cervical spine in my neck. This sac fills with food and liquid when I am eating to the point that it feels like I have a golf ball stuck, sitting behind my voice box.

Thankfully, with manipulation, I could get the contents out and on their way into my stomach. When I was not eating, the sac filled with saliva and other fluids secreted until it aspirated (reflexively sprays) its contents out and into my trachea, which is just across from the opening of the sac, and I choked. In daily activities, when I was not eating and when I was sleeping, this happened about every 45 minutes.

Finding the right doctor who could diagnose it took about six months. It’s a rare condition that only presents in the bodies of those in their mid-to-late 70s, and the doctors were not looking for it.

Once it was found, I canceled all my performances and went into surgery within a few days.

The procedure requires that I lie on the table with my head dropped back so that a tool resembling an extension claw is inserted down my throat. At the end of this tool is a series of alligator-like staples that both cut open and suture the shared wall between the esophagus and the sac. Essentially, they open the esophagus to include the sac, and the sac spills into the esophagus.

The recovery was uncomfortable but fairly simple: two weeks at home with liquids only (water and broth), then two weeks of thick liquids—smoothies—and two weeks of transitioning back to solid foods. It’s a great weight loss program, let me tell you!

I wasn’t allowed to play for 2 months.

What we didn’t know 10 years ago is that this procedure only works in a 70+-year-old body. The body of a 30-year-old grows scar tissue fast. Thus, there is a 30-50% failure rate in the first 5 years and 80% thereafter. In the next eight months, I had to have the procedure another 2 times, as each doctor thought they could improve upon the work of the previous - up to working directly with the surgeon who developed the procedure itself.

Following 3 surgeries, my body needed time to recover from all the chemicals, so I lived with the symptoms and returned to my career as a clarinetist. I knew that I needed a much more extensive procedure that opened the neck to directly remove the affected area of my esophagus. This procedure came with extreme risks to my career, so I was encouraged to put it off for a while and enjoy playing.

I did just that. I put it off for 10 years. I got a tenure track position and achieved tenure in 2020, just in time for COVID to shut down live music performances for almost 2 years.

This past October 2021, I was backstage warming up for my first recital performance post-pandemic when I saw a reflection of my neck while I was playing. I noticed a ballooning bulge in the right side of my neck when I played. Given my experience working with wind musicians over the past 17 years, I knew what this was and that I needed to see a specialist fast.

It took three months, but I was finally able to see an Otolaryngologist and neck surgeon at UW Medicine. He confirmed my suspicions. In addition to my Zenker’s that still needed correcting, I have a pharyngocele. It’s a second herniation of my esophagus that bulges under the internal pressure in my esophagus when I play the clarinet. This is a performance-related injury.

These are rare in the general population but quite common in clarinetists, oboists, and trumpeters. What I didn’t expect in that meeting was to find out that because I have had three failed surgeries, my esophagus has weakened from all the incisions to the point that this may be irreparable.

After three months of testing, my surgeon met with his team and consulted with numerous surgeons nationwide to formulate a treatment plan. I met with him in March (2020) to learn that I needed two surgeries.

1 - The first step is to repair the existing Zenker’s so I can swallow properly and enjoy eating again. This procedure is very similar to what I have had before, only done with a laser. I would be out for 4-6 weeks. I will be on a feeding tube for 2-7 days, liquids only for a few weeks, thick liquids such as smoothies, and puréed soups for another 2 weeks. By 6-8 weeks post-surgery I can transition back to solid foods slowly. I will not be able to return to playing for 3 months.

2 - the second surgery is to repair the new pharyngocele. This procedure is trickier. They have to go in through an incision in my neck, remove parts of my voice box so they can get to the spot, and I have to be awake to pressurize my throat so they can see where it is and remove it. The risks are considerable and worsened since my esophagus is already weakened. I risk paralysis of the right side of my voice, my esophagus, and may have to be on a feeding tube for the remainder of my life. The primary concern is the integrity of the esophagus. Likely, they will not be able to seal it so that food and liquid won’t leak into my body, much less hold up to the internal pressure of playing the clarinet.

It was his recommendation, and every other surgeon consulted, that I do NOT have this procedure. Currently, the symptoms are connected only with my clarinet playing. This will change in time, and I will eventually suffer the symptoms of this condition. Surgery is inevitable, but it may be possible to put this off for 30 years. The catch is that to put it off for that long, I must stop playing. This condition is caused by performing on the clarinet. Continuing to perform and play will only exacerbate the situation and significantly shorten the period to approximately 5-10 years.

So, in August 2022 I had the first procedure to significantly improve my quality of life. It took the whole Fall semester to recover. In January 2023, I was able to return to light playing, experimenting with an external compression sleeve of my own making, with the hopes that it could hold the new phrayngocele in place while I played.

Following the Spring semester, I met again with the ENT in May for re-testing and learned that the situation had worsened. I was allowed to play for one year, given time to wrap up any open projects before I would then need to completely retire from performing.

I started the 2023-24 academic year with hopes of finishing a CD, playing a few concerts, and wrapping up my teaching career in academia. I had by this point, opened mBODYed which was intended to bridge me into a second career. Due to many circumstances, most of the Fall concerts were cancelled, thus practicing and performing for me did not really become intense until January 2024.

After 3 months of concerts, my symptoms progressed significantly enough to be worrisome. My doctor decided for me that March 4, 2024 would be my final performance. It was fitting and meaningful that I was able to play PULSE as my final piece.

I went on medical leave for three months until I was able to take a medical resignation and leave my academic teaching position.

It was an unbelievable journey through my identity to prioritize the health of my body ahead of my performing career. That sounds so crazy to say. I’ve been a performing musician since probably before I could read. The pandemic was the longest period of my life that I haven’t performed. It has always felt like my primary mode of communication. I had a lot of plans, and even plans within plans.

For most of the journey I was angry, no….enraged! I felt betrayed by my body. I was disappointed that I wouldn’t have the life and career that I had dreamt of since my freshman year of college. I spent too many hours thinking about all the recitals that I had planned, all the pieces that I wouldn’t get to play again, and all the people with who I would never perform.

I am also excited. Weird right? I have been given the opportunity to reinvent myself as I come into midlife. I’ve spent many hours dreaming of what I may become. I’m excited about that opportunity to grow, or at the very least, I’ve convinced myself that I am excited. Who really knows?

I’ve had to do the work of separating my identity from my work. I have some idea of who I am without the clarinet and the profession and identity of a musician. I retain all of myself and can direct that all in any direction. I’m not giving up; I’m not pivoting! I’m growing; I’m becoming.

Anyhow, if you’ve made it this far…. thanks for reading my story.

You are a friend.

I write this here to share my story.

My professional career has been based on helping musicians recover from and prevent performance-related injuries. I have been an advocate for public discourse around the injuries that musicians suffer. They are a source of shame and fear for many musicians. Not sharing all that happened has felt like I was not living authentically.

So, this is my story. I’m sharing it here to reach the most people possible, hoping it helps someone step in and live their truth. Injuries are not things we need to hide in secret. They are our battle scars and reminders that we are fighters and survivors.

In the coming months (October 2024) I will learn to what extent the last year of playing has damaged my throat beyond repair. We will decide by year's end if I can live with the symptoms as they are now or if they constitute the need for surgery, given the risks involved. If they have to open my neck, I will likely never eat solid food again and could lose the ability to talk as well. So we shall see. In the meantime - onward we go!