Speak up! The Colorado Voice Clinic thinks every person has the right to be heard
He knew something was gravely wrong when he tasted the blood in the back of his throat. He'd been forcing out sounds for nearly an hour, his voice becoming more and more hoarse, each individual word feeling like it was wrapped in barbed wire and dipped in rubbing alcohol. Finally, the audible tones devolved into an amorphous hiss of air. That's when he tasted the blood.
A practicing attorney for the better part of three decades, Jim Evans needs to be able to talk to make a living — both in court and in the classroom. He'd been having problems with his voice for nearly twenty years, but this last episode, in front of an office full of students and explained away as a slight case of laryngitis, was markedly different. "I had this severe, stinging pain," he recalls. "It was like a muscle cramp in my throat. I'd be talking, and all of a sudden nothing would come out. Air would come out, but nothing else. I felt absolutely panicked and desperate."
Almost twenty years earlier, when he first began experiencing persistent, nagging laryngeal problems, Evans had undergone surgery to have a granuloma — essentially an ulcer — removed from his vocal folds. "Within weeks, it had grown back," Evans remembers. "The procedure then, with another ENT I followed up with, was simply to try to go into voice therapy when the granuloma came back." But despite seeing a succession of speech therapists and other ear, nose and throat specialists over the years, nothing seemed to help.
Colorado Voice Clinic
Alarmed by the blood-tasting incident, he tried yet another doctor, one who specialized in treating cancer patients — and who seemed very concerned over the condition of Evans's granuloma. "Without saying the C word, I knew exactly what he was talking about," Evans says. "'I'm not the one who probably should do this,' he said. 'You need to go see this Dr. Opperman. He's very specialized in this area, and he'll take a look at it.' I'd never quite gotten that reaction from other doctors. And I'd been under the care of a doctor since my initial problem in '91."
So Evans wasted no time looking up Dr. David Opperman. He found him at the Colorado Voice Clinic, which Opperman had started with colleague William "Buzz" Reifman, a nurse practitioner/physician's assistant with more than thirty years' experience, in late 2007. It was the culmination of a longtime dream for the two friends — and the unlikely result of their shared love for working behind-the-scenes at concerts.
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David Opperman was just a teenager in 1989, in the midst of a special-effects apprenticeship, when he first met Buzz Reifman. By then, Reifman had been working for years under Dr. Paul Dragul and had a well-established reputation as the go-to guy who'd make house calls in green rooms across Denver. Area promoters had him on speed-dial, and called whenever a singer's voice gave out or a bandmember seemed to be suffering the effects of the Mile High altitude. And Reifman didn't just treat renowned entertainers; he also helped countless Country Dinner Playhouse actors, techs, waiters, waitresses and just about anybody else who required his care.
Just about everybody on the local entertainment scene knew "Buzz," as he's better known.
Everybody but Opperman. "I was backstage at Metallica," Opperman recalls, "looking like I do now, mixed in with a roomful of black leather and chains, and this guy walks in wearing a suit. Both of us didn't fit in the room, so he came up to me and said, 'What are you doing here?' And so I told him who I was and said, 'Well, what are you doing here?' And he said, 'That doesn't matter.' He wouldn't tell me who he was. But we talked for like an hour and a half, and then he left. It turns out he ran out and talked to Peter Cappadocia, the pyro guy I was working under, and found out who I was. And while he was going to check on me, I went to production to check on him."
Opperman's background was easy to check out. He'd landed the special-effects gig through his association with Guy Cooper, a local paintball manufacturer. Cooper had tapped the teenager, an avid paintball enthusiast, to help build guns and play with them — sort of like a one-man focus group. From there, the teen had become a member of a team that traveled the country playing paintball tournaments. At one point, Opperman was asked to set up a private game, something low-key where the players could just hang out and have fun. Little did he know that the players were all touring with AC/DC.
Through the game, Opperman became friendly with Cappadocia, the band's pyrotechnician, who took a liking to the precocious kid. And before Opperman had even enrolled for his freshman year at Columbine High School, Cappadocia had gotten permission from his father to train him in concert pyrotechnics. That experience helped Opperman land a contract with Elitch Gardens one summer, when he asked another friend he'd met at a pyrotechnics convention, Francis "Pinky" Pilkerton, to lend a hand with the wiring and the music cues.
"You never had to tell him how to do something more than once," Pilkerton recalls. "And Dave always, in school, if he didn't get a 100, he was upset; I heard stories from his mom and his sister how he could get so upset if he came home with a 99. He strove to get straight As. Anything he's ever set out to do, I've always known him to do the absolute best that could be done at it."
Opperman did so well at pyrotechnics that he launched his own outfit, Flash Point Entertainment (he still runs the company), and co-authored a book on proximate pyrotechnics safety with Pilkerton.
But as much as he liked blowing things up, Opperman was even more interested in medicine — which is why he was so excited to meet Reifman and hear about his work with musicians. Opperman had noticed that many performers and crew members were experiencing problems that seemed to be directly associated with their exposure to pyrotechnics, and he was perplexed that no one was studying the long-term effects. Meeting Reifman was fortuitous.
Reifman's support and encouragement ultimately convinced the pyrotechnics kid to go to medical school.
"I called him like two weeks later," Opperman remembers, "and said, 'I have this interest, and I really need to talk to you.' So he grasped on to me and got me doing research in voice and pushed me all the way through until I got into medical school and started working with, basically, the fathers of voice in the country."
First, Reifman steered him toward the Wilbur James Gould Research Center, then a division of the Denver Center for the Performing Arts. Gould, who passed away in 1994, was a pioneer of vocal research; a revered otolaryngologist, he'd treated many of the world's top entertainers and dignitaries, including President Lyndon B. Johnson. With the experience he gained from Gould, Opperman had no problem getting into Tufts University, where he completed his undergrad schooling. "He had more training than anybody in the whole business," Reifman declares. "He was already there at 21."
Gould had been a mentor of Dr. Bob Sataloff, who returned the favor and mentored Opperman when he enrolled at Jefferson Medical College in Philadelphia. And even before Opperman finished med school, Sataloff asked him to pen a chapter for a new textbook, Professional Voice: The Science and Art of Clinical Care. After receiving numerous inquiries from performers he'd been treating (Sataloff himself was an accomplished opera singer), the doctor realized he needed a section on the medical implications of pyrotechnics — and he knew that Opperman could write that section from firsthand experience.
After earning his medical degree from Jefferson, Opperman moved on to the University of Minnesota, where he studied under George Goding, another respected physician in the voice-medicine field, and completed his residency. He also became board-certified in Minnesota and obtained his masters in otolaryngology. From there, Opperman went to the University of California, Los Angeles, on a fellowship, where he studied with Gerald Berke — the same Gerald Berke who'd played guitar in the Looking Glass.
Through the grueling schedule of his advanced education, friends like Reifman and Pilkerton continued to offer Opperman encouragement.
"I was doing the pyrotechnics stuff simultaneously, so I was trying to do everything," Opperman remembers. "And that was my initial love. The pyro world is what really drew me into everything. So I had to give up doing that for a while. It was hard to be a pyrotechnician and a doctor simultaneously. So they encouraged me not to give up and to keep fighting to get through the process."
"When Dave was doing his residency, he called me one night, and he's like, 'I can't take it anymore. These long hours are driving me crazy; I'm ready to quit,'" recalls Pilkerton, who'd become good friends with Opperman's parents before his father passed away. "I said, 'I'm going to tell you one thing. You've got two choices: You can either tough it out and finish school, or you can find a good surgeon.' He said, 'What do I need a surgeon for?' I said, 'If I have to come out there and put my foot in your rear, you're going to finish this out, because I promised your dad.'"
And that wasn't the only promise that would be kept. Years earlier, Opperman had talked with Reifman about opening their own practice in Denver, one geared specifically toward treating entertainers. Now, as his fellowship with Berke was coming to a close, Opperman was getting serious about that idea.
"I got this call three years ago," Reifman remembers. "I'm 61 now, and I thought back then, to start a new project now.... But I said we would do this fifteen years ago. So I said, 'Let's go along for the ride.'"
Bolstered by Reifman's endorsement of the plan, Opperman took advantage of the fact that he was still living in Los Angeles, the heart of the entertainment world, and presented his clinic concept to physicians and promoters alike. "I said, 'How about Denver for a satellite clinic designed around your industry?'" he recalls. "Everyone said, 'We'd love it, but nobody can do it. Nobody has the contacts in the special-effects or the music world to link it to a medical practice.'"
Nobody but Opperman and Reifman.
And Reifman wasn't just bringing thirty years of music and medical experience to the partnership. He also has valuable ties with all of the concert promoters, including Chuck Morris.
Morris and Reifman first met in the late '70s, when Morris was a patient of Dr. Dragul and Reifman was assisting the doctor. Morris was working for Fey Concerts at the time, and when one of the company's acts had some voice problems, Morris contacted Reifman, who made a special trip to treat the vocalist. After that, Morris frequently called on Reifman.
"There's been more than once where Buzz has literally saved our concert from an artist that was in trouble medically," Morris says.
But Reifman has also had to pull the plug on a concert or two over the years. When the dreaded announcement comes across a local PA that an artist has received medical advice to cancel a performance, Reifman is usually the one who's given the advice. For example, Buzz recommended canceling the Killers' show at Red Rocks in May 2007 (an announcement captured on a YouTube clip). Such situations don't come up often, but when they do, Morris — who keeps the details confididential — trusts Reifman's judgment implicitly.
"As a promoter, I want them to do the show," Morris admits. "But it's not fair, and it's also bad business to force an artist to perform if it may create permanent damage. That karma you don't want. And I've been doing this long enough to know that I'll still be in business, and I want that musician to still be in business. So I'm not the kind who would try to convince an artist to sing when a doctor or expert tells me that there could be some serious damage as a result. You've got to think long-term. Maybe that's why I've survived long-term, because I do think that way."
Morris was thinking long-term a couple of years ago when he ran into Reifman at a show, and Reifman said that he and Opperman were looking for a space for a voice clinic. Morris had just left his job overseeing Live Nation's local operations for a gig heading AEG Live's Rocky Mountain Division, and he was setting up shop in a building he was buying on Seventh Avenue off Santa Fe Drive. He enthusiastically supported the idea of a dedicated voice clinic in Denver, and he had just the place for it — the space next to his own new office.
"For a doctor of that caliber to move to Denver is great," Morris says of Opperman's decision to return to Denver. "I know just from my artist friends that there's three or four doctors in L.A. who are real good. There's one in Philly, and the guy in Nashville's real famous because he treats all the country stars. There's a handful, but there's nobody in the Midwest. So it's a great thing for us. I am thrilled, and Denver should be thrilled to have a guy that good being available to the public, to anybody who has vocal problems.
"He has an impeccable reputation," Morris continues. "There's very few people trained in what he does for vocal surgery. And he trained under this guy who I know at UCLA, who's considered the dean of the whole field.... I mean, there's only like five or six or seven doctors in the country who can actually work on artists and really know what they're doing and have enough advanced degrees, and he's trained under the best."
Opperman flew in to tour Morris's space. He and Reifman agreed that it was perfect for their clinic, with the proximity to one of the city's major promoters an added bonus.
"I talked to some performers that I knew and I asked them, 'What do you guys want in medical care?'" Opperman remembers. "The problem they all have is that they're on the road every single day. And they're in a town for no more than 24 to 36 hours. Very rarely do they ever stay longer than that. So it's impossible for them to get continuity in terms of medical care, like you or I have with a family doctor or specialists. In their world, that can't happen, because they're constantly traveling."
The performers had very strong opinions. "The first thing I heard back was that he hates doctors," Opperman says of one person he polled. "'I don't understand their world,' he said, 'and I hate the way the clinics are so sterile.' And I thought, Hmmm...okay. And the second thing he said was, 'I can never get a doctor who will put up with the fact that I travel and still take me on and care for me, where I can call him from another city and say, 'Hey, this is what's going on. Can you help me?' Even if it's just to get a referral in that town."
Because of all the places he'd studied around the country, Opperman knew that linking patients up with other doctors wouldn't be difficult. And for his part, Reifman was a member of a Texas organization called Backstage Medical, which gave him access to a slew of health providers across the country. That took care of one concern. But the new partners still needed to establish a home base where musicians would feel comfortable.
"My sister's an artist," explains Opperman, "and as we were putting things together, we stumbled upon some research that talked about the use of art in medicine and the healing and relaxing properties of subtle images. I said to my sister, 'Well, you have all the art, why not create a hybrid office in the art district? We can literally create an art gallery inside of a backstage world, in a medical office, and completely take away the feeling that you're in a sterile medical office.' You could blindfold me and walk me into a dentist's office and I'd tell you where I was the minute I smelled the chemicals. I didn't want that in this environment. I wanted it to be a clean, sterile, top-notch medical office with state-of-the-art equipment, but I wanted it to feel relaxing and inviting."
But they didn't stop at state-of-the-art equipment and art. They thought about where their clients would feel most at home, and they decided to add a recording studio to the mix.
The result is a sleek, ultra-modern facility. Bright with track lighting that runs the perimeter, the clinic is framed by rounded walls that lead from the entryway to the examining rooms, which are all linked via Apple TV; patients can watch shows customized to their interests. Neo-deco furniture sits atop hardwood floors; Cheryl Opperman's paintings and photographs hang on walls painted eggshell white. The clinic looks more like the sort of place where you'd expect to see Ari Gold negotiating deals than a stuffy doctor's office.
"We could've moved into some other part of town, into some fancy buildings or some fancy hospital," Reifman offers. "But the feel was just very nice here."
And they're adding features all the time. The clinic recently acquired a revolutionary post-KTP laser, the only one on this side of the Mississippi, that was recently featured on an ABC News segment with Dr. Steven Zeitels. The "radical new approach," as the reporter described it, uses "a special laser to target a tumor's blood supply, thereby killing the cancer cells."
Other amenities are less high-tech and more high-touch. As an added enticement for entertainment types, a sealed-off area in the back of the clinic has a private entrance, allowing high-profile artists to be treated discreetly. This space is outfitted with comfy chairs and tables, not unlike a well-furnished green room, and in the recording studio just on the other side of the doors, Opperman and Reifman can analyze and assess the vocals of patients before, during and after treatment.
Analyze and assess, but never discuss. One of the secrets to the success of the clinic is that Reifman and Opperman know when to keep quiet about their high-profile patients, although Opperman will surely be on call this weekend during the Mile High Music Festival (see page 47).
"I would recommend them to anybody," says Sully Erna from Godsmack. "Anybody! I don't care what level of entertainer they are. I think they're top-notch people. I haven't seen any other doctors take the time and give a patient the attention they do. They're very attentive, and they're very good at what they do. If they don't have the answers, they will research until they get the answers, and they'll triple-check them to make sure they're the right answers."
Over the past decade, Erna has learned to take care of himself while touring. Nonetheless, he rests easy knowing that he has the clinic on speed-dial. "Now that I have someone like Dr. Opperman on board, I have him to lean on," he says. "So if something's going on, I can say, 'Hey, these are the symptoms. What do you think, and what should I do?' I obviously just want to have the best show that I can have, and it's very comforting to have them on my team, more so than anybody else."
Jim Evans finally landed at the Colorado Voice Clinic last summer. Although the clinic has seen more than its share of famous patients, the facility is designed to help everybody who needs to keep their voices healthy, and clients range from students to housewives to lawyers to politicians to local musicians.
Opperman, too, was concerned by the size of the attorney's granuloma, though he didn't believe the growth was malignant. Just to be sure, he did a biopsy in the clinic — no need to send Evans to the hospital — and it came back negative. Still, given how long Evans had been suffering from vocal problems, Opperman knew he needed to find a long-term solution.
To that end, he recommended a new technique he'd been studying, one that involved injecting botox directly into the vocal folds. This would essentially paralyze the folds, preventing them from coming into contact with one another. That contact was what was causing the irritation, and the irritation was causing the granuloma; neutralizing the contact would give the folds a chance to heal.
While that sounded great to Evans in theory, he was still apprehensive about undergoing the treatment. "Having made my living speaking most of the time, I was a little concerned about what this was going to do to my practice when he said the words 'injection into the vocal cords' and 'botox' and 'paralyze,'" Evans remembers. "I was obviously very concerned with what was going to be happening with the procedure."
To quiet his concerns, Opperman offered to put Evans in touch with other patients who'd undergone the procedure. But then Evans caught an NBC News segment featuring Dr. Sataloff, Opperman's mentor, speaking about laser technology, botox injections and vocal cord dysfunction; the report made him comfortable enough to schedule the procedure, which took less than twenty minutes.
At his first appointment, Opperman had also determined that Evans suffered from severe acid reflux — even though one of Evans's previous doctors had told him just the opposite. That physician had been looking for signs of reflux in the esophagus, Opperman explained, whereas he was surveying the larynx, which is very sensitive to any kind of acid. The reflux had been weakening the vocal cords, making them more susceptible to irritation and aggravating the granuloma.
To alleviate the effects of the reflux, Opperman recommended that Evans follow a very strict regimen, which included elevating the head of his bed by six inches, refraining from eating within three hours of going to bed, and getting on anti-reflux medicine immediately. "He kind of got me on the wagon, so to speak, to try to control the reflux," notes Evans. "The combination of the acid reflux control and the botox injections — at least in my case — was a career-saving kind of thing. The chronic problems I was beginning to have in terms of pain in the throat and discomfort was impeding my ability to talk."
His treatment didn't end there, though. Opperman recommended a speech pathologist who essentially helped Evans learn how to speak all over again, breaking all the bad habits he'd acquired over the course of his life doing something most people think comes naturally: talking. "There's a way of speaking in which you literally slam your vocal cords together, which causes irritation and more wear than you need to," Evans explains. "And it's something that you're totally unconscious or aware of, but it's how you pronounce your syllables, your consonants, how you attack your words, that really makes the difference.
"Almost from the very first speech-therapy session, I began to see an immediate improvement with respect to learning a different way to talk," Evans says. "And, of course, I was completely amazed because the vocal cords are technically paralyzed; they're not able to function as they normally would, and I was able to begin to regain my voice. The amazing thing in all this is that with the combination of the injections with the therapy, exactly six weeks after the injections, I went back for a follow-up appointment with Dr. Opperman, and there was no granuloma. The granuloma had completely disappeared...I was just totally amazed. He was not at all surprised; he was very pleased and happy. I was shocked."
A year later, Evans has recovered completely and credits Opperman and the Colorado Voice Clinic with saving his voice. "He was the only one in the Denver area that I could've gone to," Evans notes. "Everyone else would've recommended a surgical procedure to try to remove the granuloma, which is always a mistake to do a surgery on that, because they just grow back — even when you tie that with therapy. Without question, this probably was not only the best thing to do, this was probably the only thing to do."
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