The celebrity chef and talk show host seems to have lost none of her trademark vocal vigor despite minor surgery in July to remove a benign cyst growing on one of her vocal cords.
Ray's voice had been weakening to the point where, according to her publicist, Charlie Dougiello, she would end the work week barely able to speak.
Ray was scheduled to have the cyst removed last December but opted to try vocal therapy, hoping the cyst would disappear without surgery.
"Her doctors felt that with some vocal coaching and therapy, they could reduce the size of the cyst and have it eventually disappear," Dougiello said. "She went to vocal therapy and learned techniques on how to use her voice differently."
While it may be possible to manage small cysts with vocal therapy and prolonged rests -- in other words, not speaking -- doctors say the definitive treatment is surgery.
And with Ray's rigorous production schedule --she sometimes taped nine shows per week and appeared on others -- keeping mum for an extended time was not an option.
"When you're at the level where you use your voice all the time, there's a high voice demand that requires a high level of precision," said Dr. Milan Amin, director of the New York University Voice Center. "You can rest your voice and things will get better. But as soon as you go back to what you were doing, within short order, you'll go back to what you were."
Cysts on the vocal cords are relatively common but can be highly disruptive. The causes of these cysts are largely unknown but the vocal cords are in such constant use that they are prone to wear, tear and injury.
Still, a cyst can go unnoticed until it becomes so large that it affects the vocal cord's ability to close fully or vibrate properly. Even then, cysts cannot be diagnosed without inspecting the cords.
Speech or vocal therapy alone can improve vocal function for a time, but Dr. Ramon Franco, medical director of the voice and speech lab at the Massachusetts Eye and Ear Infirmary, said that adjusting to a cyst was like learning how to walk with glass in your foot. It may be possible to get used to speaking differently, but it would not be natural.
Vocal Protection Can Be At Odds With Vocal Performance
While there is little danger of cancer from a benign cyst on the vocal cords, an untreated cyst can mangle and scar the vocal cords so that the sound of one's voice is changed forever.
"Nothing other than surgery is going to make it go away or make it get better," Franco said. "Even if there is a safety net before, once you cross a certain threshold, you can't recover [without surgery]."
Vocal therapy following cyst removal is crucial for preventing strain in the future. Reverting to bad habits -- such as using a breathy voice or overly high or low pitches -- can cause long-term damage.
"Treatment post-surgically must address the specific forms of vocal abuse, misuse and overuse that the patient engages in, in order for vocal rehabilitation to occur," said Daniel Martin, director of the University of Chicago Voice Center. "Examples of bad vocal habits include loud talking, talking over noise, shouting or yelling, excessive talking, improper singing technique."
But speaking optimally can be at odds with the vocal demands of some professions where projecting, speaking loudly, and varying tone and cadence often is important.
Singers, teachers and people who appear regularly on television are a few of the groups often at risk for vocal injury.
The goal of vocal therapy is to learn to use both breath and the vocal cords efficiently.
Like a balloon, the lungs can hold a certain amount of air that can be used to create sound. The more the vocal cords can control the airstream from the lungs, the better the voice sound and quality for the same amount of effort.
Ray's familiar rasp is the sound of excess air escaping, unregulated, from the vocal cords.
But Franco said the biggest difference therapy can make for those with injured vocal cords is the ease with which they can produce voice, with less effort and less fatigue.
"[Ray] still works with a vocal therapist on ways to use her voice better," Dougiello said. "If there's a difference, it's not noticeable to anyone else and she hasn't lost her voice since [her surgery]."