Audition season is in full swing, which means that cold and flu season is also at its height. Singers spend months preparing for major auditions, and a serious upper respiratory infection means the loss of opportunities and potential jobs. And the added stress doesn’t do anything to help the immune system. Many singers who find themselves in the throes of illness turn to antibiotics to recover quickly and power through work, travel, and auditions, feeling that they have no other choice in order to be able to move forward in their profession.
Overuse of antibiotics is a persistent problem, however—and not just in singers, but the general population as well. General surgeon Dr. Shelly Reynolds notes that “the overuse problem isn’t necessarily just a problem with the individual, but rather with the population as a whole. As bacteria continually adapt and become resistant, current technology cannot adapt our current antibiotics quickly enough to keep up. We are all responsible as physicians to be judicious with our antibiotics and their use.”
Registered nurse and amateur singer Susan Young mentions the severe digestive problems that can occur with antibiotic use, as the drugs kill the beneficial bacteria in the intestines as well. One of the most prominent problems is “C. Diff” or Clostridium difficile, a gut bacterium that causes diarrhea and, in severe cases, inflammation of the colon. Dr. Tim Young, Susan Young’s husband and a specialist in internal medicine at St. John Memorial Hospital in Tulsa, agrees: “C diff is a growing problem. Our rates [in the hospital] are up 15 percent, and the experts think it’s entirely due to antibiotic overuse outside the hospital.”
According to the Centers for Disease Control and Prevention (CDC) report Antibiotic Resistance Threats in the United States, 2013, “at least 2 million people become infected with bacteria that are resistant to infections and at least 23,000 people die each year as a direct result of these infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection.” The CDC also notes C. Diff as a threat level of “Urgent” among a slew of other problematic bacteria.
In addition to the unpleasant experience of severe diarrhea and the possibility of fatal infections, other serious problems can accompany antibiotic overuse. Antibiotic resistance is well known, but developing allergies to antibiotics when they are overused can have disastrous results. “When I was ill with diverticulitis a few years ago, I had an anaphylactic reaction to Augmentin,” says Susan. “Even though I was taking it appropriately for a potentially life-threatening bacterial infection, the results were not good—and now I can’t take penicillin at all, for anything, which is a problem. I don’t think most people realize that this can happen.”
“Virtually all upper respiratory infections, including bronchitis and sinusitis, are viral, and antibiotics won’t help by definition,” says Tim. “There isn’t a specific amount that one should or shouldn’t take, but the less exposure the better, as Susan’s example points out. She actually needed them, but now she can’t take penicillin because of the exposure, so when/if she needs antibiotics again, that’s an option she won’t have.”
“We are taught in medical school that 99 percent of all upper respiratory infections are caused by common ‘cold’ viruses which are not treated with antibiotics and have to be allowed to ‘run their course,’” agrees Reynolds. “Luckily, those courses are generally short lived, and symptoms resolve within a week.”
Rather than insisting on antibiotics, many illnesses are actually better treated with remedies we learned from our mothers. “Get plenty of rest, eat a balanced diet with plenty of fresh fruits and vegetables, exercise regularly, get a flu shot every year, avoid crowded indoor events as much as possible during flu and cold season, wash your hands regularly with soap and warm water, and drink plenty of water,” recommends Susan. “Treating allergies is important, as they can cause so much irritation to the throat and vocal cords. Also, chronic throat irritation can be due to GI reflux, so it’s worth investigating that rather than assuming that everything is due to infection.” Giving up coffee and other reflux irritants may be disappointing, but persistent illness and losing the ability to sing is a much greater consequence.
It is difficult to avoid crowded indoor events during audition season, as anyone who has been to the most-rented audition studios in New York City can attest. Nevertheless, hand washing (which should seem like common sense) is an oft-broken rule. I recently watched one singer leave a bathroom stall, fix her hair and makeup, and leave the restroom without washing her hands. While this may have been an isolated incident, it’s probably safer to assume that elevator buttons, door handles, and public bathroom faucets are teeming with disease-causing bacteria and viruses. Constant vigilance—for example, frequent hand washing and use of hand sanitizer, and avoiding touching one’s face while in public—can make all the difference in whether you catch something or not.
Getting rest is especially important for performers. “Sleep is more important than food,” purported a 2011 Harvard Business Review article. The article went on to say that the average person needs seven hours of sleep, but that “great performers are an exception. Typically, they sleep significantly more than the rest of us. In Dr. K. Anders Ericsson’s famous study of violinists, the top performers slept an average of eight and a half hours out of every 24, including a 20- to 30-minute midafternoon nap—some two hours a day more than the average American. The top violinists also reported that except for practice itself, sleep was the second most important factor in improving as violinists.”
Balancing work, travel, and auditions is stressful, and planning naps and early bedtimes can help maintain good health—and, consequently, good voice! For singers traveling to New York City from out of town for auditions, this can mean cutting back on fun and visits with friends, but choosing the more healthful option can make or break an important audition.
No one likes to be sick but, occasionally, it still happens. At what point should you get an antibiotic? Reynolds advises waiting to see if symptoms last for more than a week “and are accompanied by symptoms such as fevers, a productive cough, or persistent pharyngitis.”
Tim says that for the doctor, a good history and physical exam are the best ways to tell. “There are characteristic physical signs and symptoms of bacterial infections that can be seen on exams and on blood tests like white cell counts, which are higher in the presence of bacterial infections, but normal or slightly lowered in viral infections.” And Tim warns against getting a prescription over the phone. He believes that antibiotics should be given only after an exam, with very few exceptions. Be wary of a physician who does otherwise, as they may prefer to placate patients who nag them, rather than insist that their patients make good choices for long-term health.
Being sick is never fun, and it’s even more stressful when your livelihood depends upon your good health. “It’s hard, if you want to do something to get better, to not badger your doctor to give you antibiotics,” Tim says. “However, taking them when you don’t need them is bad not only for you but for everyone else in the world, as it breeds resistant germs that spread to others.”
Some singers are still very persistent with their doctors, insisting that they “know their body” and that an antibiotic is absolutely necessary. I should know; I used to be one. But at the time of writing this article, I have deliberately not taken an antibiotic in just over a year. I have chosen instead to ride out upper respiratory infections and take several days of complete, real rest instead. My infections lasted the same amount of time as they did when I relied on antibiotics, and I was spared the digestive discomfort that often comes with antibiotic use. I actually enjoyed my time of mandatory rest. I took much needed naps, hot baths, and caught up on episodes of television shows I hadn’t had time to watch. I generally took care of myself the way my mother insisted when I was sick as a child. And like my illnesses in childhood, I bounced back quickly.
Accepting that I was sick was critical. I know many singers who pretend they’re well, and then act surprised when their obvious symptoms develop to a full-blown infection. These same singers are unaware that by not recognizing they were under the weather they then exposed more people to their infection.
This audition season, be especially careful with your health—short term and long term—by avoiding antibiotic overuse and abuse.
