Part 3 of 4: Vocal Health with Dr. Paul Kwak
Welcome to FFB’s 4-Part January Series on Vocal Health with Dr. Paul Kwak! Throughout 2017, FFB will regularly host medical professionals, health gurus, fitness pros, & wellness experts on the blog to share their expert advice on the topics we love most!
A Singer’s Guide
to Vocal Health
So we're all on the same page that getting sick is worst-case-scenario-nightmare for singers, right? And it usually takes years and years to understand the remedies and preventive measures that work best for you. And even still, sometimes there's no avoiding the seasonal bug that catches everyone. This week we're getting super informed about the stages of the common cold and how to combat it every step of the way!
Feel free to continue asking question in the comment section below. We're thinking about dedicating next week (the final part 4 to this series with Dr. Paul Kwak) to all of your unanswered questions about vocal health. Any concerns or questions, let us know and we'll make sure we cover it all before the end of January!
Week 3: The Common Cold
Hello, everyone! This week’s topic is one that may be unfortunately timely for many of you, but I hope, ultimately useful for everyone: the common cold. <cue Darth Vader music> While the common cold may be a mere annoyance for the lay person, it can be absolutely debilitating and literally costly for vocal performers. This season, we have been seeing more patients in our clinics with especially severe and prolonged symptoms, and this has taken quite a toll on performers here in Manhattan.
We could write an entire book – or several of them! – on the common cold, so the goal here is not to be totally comprehensive, but to try to give you a few practical tips for understanding what’s going on when you start to develop symptoms, some simple remedies you can try at home, and how to know when you should see a doctor.
What is the common cold?
“The common cold” refers to any one of a number of viruses that infect the upper respiratory tract (from the nose down to the trachea). This infection sets off an inflammatory response in the body that causes a tidal wave of effects, but essentially, the blood vessels that feed your mucous membranes become engorged and leaky, which leads to the development of edema. In a general sense, “edema” is roughly equivalent to “swelling,” but in the setting of a cold, we often use the term to refer to that leaky, watery swelling that can affect every mucous membrane in your head, face, nose, and throat, and can cause any or all of these symptoms:
Nasal congestion
Runny nose
Post-nasal drip
Changes to the voice
Cough
In addition, the infection can cause sore throat and discomfort; when the throat is inflamed, there can also be referred ear pain. Sometimes blocked sinuses and/or nasal congestion can also contribute to headache.
Prevention is the best medicine.
This principle is so widely discussed these days as to make us sometimes immune to its truth – but it is infinitely better to avoid getting the cold in the first place than to have to grapple with its symptoms. This is not easy when we share common spaces with co-workers, friends, family, and strangers. But this certainly bears repeating: hand-washing is the single most effective means of preventing the transmission of disease.
Be aware of communal and public spaces like the subway or bus, the gym, even the workplace. Be mindful of common items that you touch, and about touching your face. Parents! -- I don’t envy the challenge of trying to stay healthy when you have kids in daycare or nurseries. Don’t let germophobia make you a total recluse – but I encourage you to be mindful about prevention and good hand-washing practices!
What can I do if I do get a cold?
It’s important to keep in mind that people respond differently to medications, and symptoms can vary in duration and severity. That said, here are some suggestions for remedies that can be helpful as symptoms develop.
Nasal Treatments
Nasal steroid sprays (such as Flonase, Rhinocort) are now available over-the-counter, or can be prescribed by your physician. They can be very effective in reducing the swelling and drainage from the nose and therefore make it easier to breathe again through the nose, and they can also help reduce cough that develops as a result of post-nasal drip. Sometimes it takes a few days for the nasal steroid to accumulate its effects (though many people do see effects quickly), but these are safe to use over several days and weeks.
Nasal decongestant sprays (like Afrin, phenylephrine) are quick-acting, and often immediately strong in effect, but we advise caution and generally do not recommend use for more than 5-7 days in a row, as they can create a “rebound effect” (we call it “rhinitis medicamentosa”), in which the lining of the nose is essentially addicted to the spray, so that it becomes difficult to breathe without it. That said, however, these kinds of sprays can be very helpful in the short term during a cold.
Saline nasal spray is inexpensive and widely available; it does not have a “medicinal” effect, per se, but it is extremely helpful in keep the nasal lining moist and hydrated.
Nasal saline irrigations (Neti pot, Neil Med) are great at rinsing out the sinuses, which can be essential if you are having a lot of thick and/or crusty drainage from the nose during a cold.
Throat Treatments
Last week’s entry included a more detailed discussion of sore throat, but I will add, this week, that throat pain is a common symptom of the common cold, and it is generally ok to take over-the-counter pain relievers (like ibuprofen or acetaminophen) to alleviate the pain and discomfort. Commonly, singers worry about whether ibuprofen increases the risk of vocal fold hemorrhage; we do not have any strong evidence to support this, so I generally encourage use of pain relievers in the setting of a cold. However, if the sore throat persists or worsens, or is accompanied by a fever, pain or difficulty with swallowing, or certainly difficulty with breathing, you must seek medical attention quickly.
Salt water gargles, just like salt water nasal sprays, can be very soothing to the throat, even if they do not have a direct “medicinal” effect on the tissues of the throat.
I find that most vocal performers own a good steamer and/or humidifier. Warm, moist air is generally most “friendly” to the tissues of the larynx; the warmth encourages good blood flow and is soothing, and the moisture is excellent for lubricating the tissues of the voice box which are inflamed by the cold.
When should I see a doctor?
Honestly, if you had no professional obligations, could stay home and do nothing but rest your voice and be good to yourself – most of these symptoms would resolve on their own, over the period of several days, or in rarer cases, sometimes weeks. I’m guessing, though, that most of you have busy work and life schedules, so you can’t exactly just stop everything when a cold drops itself right in the middle of your life.
Let me start first with some basic, no-brainer reasons that you should see a physician. You should get yourself to a doctor quickly if you have the following
High, persistent fevers
Difficulty breathing
Severe, unremitting throat pain
For vocal performers, in similar spirit to last week’s post, I would also suggest, when you have a cold, that it is wise to see a doctor:
If you are concerned about changes to your singing or speaking voice
If you have an important vocal obligation in the near future
If you have a severe or worsening cough
In many ways, we’ve already talked quite a bit in our first two weeks about the first two points here – why I believe it’s essential to have a squad and to call on us when changes develop to the voice, and when an important performance is on the horizon.
The third point is new this week – and specific to this week’s discussion. The cough that has accompanied this year’s colds has been especially brutal. Patients have described paroxysms of severe, hacking coughs that even keep them up at night. This kind of severe, persistent cough is the vocal performer’s enemy. It slams the cords against one another with each cough; this can cause trauma to the cords, more swelling and irritation, which then precipitates a vicious cycle in which you feel like you have to cough more and more. In addition, when this kind of cough consumes you, it is very hard to get the rest at night that your body needs to heal and recover. So when your cough gets out of control like this, it’s generally time to see a doctor, so we can decide if you would benefit from medicine to help control the cough.
This is a topic that can generate hundreds of good questions, so if you have a question that isn’t answered here, always feel free to get in touch at paul.kwak@nyumc.org. If you are a vocal performer, getting a cold can be extremely stressful and even frightening when there are important vocal engagements coming down the pike. Please know that you are never alone, and I am a single phone call or e-mail away!
Stay tuned for next week’s final blog post! Stay healthy, everyone – wash your hands!
My best gal, Rachel Zatcoff, rockin' “I’m On Vocal Rest” from FITFORBROADWAYAPPAREL.COM