In the late 1990s, Helm was diagnosed with throat cancer after suffering hoarseness. Advised to undergo a laryngectomy, he instead underwent an arduous regimen of radiation treatments at Memorial Sloan–Kettering Cancer Center in New York City. The tumor was then successfully removed, but Helm's vocal cords were damaged, and his clear, powerful tenor voice was replaced by a quiet rasp. Initially Helm only played drums and relied on guest vocalists at the Rambles, but eventually his singing voice grew stronger. On January 10, 2004, he sang again at his Ramble sessions. In 2007, during production of "Dirt Farmer", Helm estimated that his singing voice was 80 percent recovered.