Originally published in Performing Songwriter Magazine
Issues #40-41, Sept-Nove 1999
I'm pretty basic about my health nowadays - if it hurts, fix it. If it doesn't hurt, ignore it. Trust in holistic medicine, but don't fool around with infections. When in doubt, see a doctor. Basic stuff.
It took me a long time to recognize that my body speaks very loudly when it's annoyed. I grew up at the dawn of New Age thought, when popular books spoke of "illness as a metaphor", and my friends and I had nothing but contempt for people with allergies or other diseases we regarded as psychosomatic in origin. It took two near-deaths and several hospital stays to convince me that, psychosomatic or not, sick is sick, and a cure is always preferable to the affliction. The youthful arrogance of "I'd never let that happen to me" has given way to a humble adult "What would I do if that happened to me?"
I've done shows with sprained wrist, sprained elbow, sprained ankle. I've managed to sing through colds, bronchitis, strep throat, pneumonia, and asthma attacks. I've even gotten through a night in the midst of food poisoning. I live with a post-nasal drip that would drive anyone else to prednisone; I've learned to sing through it. And no one in the audience has ever suspected a thing. Good early vocal training certainly helps; attention to detail is a must, and listening to my body an absolute necessity.
Still, I'm reasonably cavalier about medicine and remedies. I've learned what works for me, and stick to the tried and true. Some of my friends carry health on the road to what I consider laughable extremes, bringing their own bedding, or donning rubber gloves and cleaning hotel rooms with Lysol before unpacking. They consider me a risk-taker because I eat at Subway and swim in public pools.
Others think me over-cautious - I've learned the hard way what happens when you have to deal with pharmacists who refuse to accept your doctor's phoned-in prescription because you currently have blue hair and sport a leather jacket. When I was younger, I took lots of chances with my health; as I grow older I'm less willing to suffer the consequences of my nonchalance.
As doctor Sally Burbank explains, the hardest thing to maintain on the road is consistency: consistent sleep, consistent exercise, consistent eating habits. The human body likes uniformity, and our profession doesn't allow it.
Then there's the additional problem of explaining to a lay person or an unfamiliar physician that your sore throat is not just a sore throat, but a Sore Throat. That it may, if allowed to flourish into bronchitis or strep, cause cancelled shows and jeopardize your professional standing.
I'm always relieved to be on vacation, because somewhere in the back of my mind I'm thinking "Yay! I can get a cold and not panic!" When I'm on vacation, a sore throat doesn't spell doom; swollen glands won't bring on hysteria.
Day-jobbers do not think this way. For them, a bad throat or the flu are merely symptoms to be treated, while they stay at home and take a well-deserved sick day. Sick day? My partner was stunned when I explained that my profession has no such thing.
"Then who pays you when you're out of work because you're ill?"
Hah! "The show must go on" I replied - first, because that's the show business rule, and second because I'll starve if it doesn't.
So here is an article about helping the show go on. I'm not going to get into chronic problems like tendinitis, vocal nodes, or overuse syndrome. And I am not a doctor! This is not medical advice by a long shot; I'm just going to stick with the basics I've collected over the years. Some of it may sound like paranoia, some just plain old common sense, but remember this - no one thinks clearly when they're sick. It's always good to have a referral source at those times. I know. I've been there.
Picture your immune system as a graph, with a scale of 1 to 100. At 1, you are the healthiest person on the planet; exposed to disease, your system shrugs it off. You can swim in radioactive goop and walk away unscathed. At 100, you are allergic to the very air you breath; any time you come in contact with a microbe, it enters your system and grows unchecked. Most of us hover around 50, bouncing up or down depending on circumstance.
Current immune theorists seem to agree that we all have an "immune threshold". The way this works is best shown by example: say my immune system is set at 50 when I wake up one morning. I'm allergic to cats, but spend the afternoon sitting with one on my lap. By evening my threshold has risen into the 60 range. At that point a big gust of pollen comes along which I might have fought it off in the morning, before my immune system was weakened. Now I don't have the strength anymore, and I begin to sneeze. This exposure pushes my threshold up to 70. I hug a friend with a cold that night, and a week later come down with exactly the same thing. Had I hugged them that morning, there's a good possibility I'd still be well.
That's essentially how they think it works. The immune system is a fickle friend; you may never have been allergic to cats before, but after repeated exposure to them you suddenly get hives on contact. You might have been able to eat eggs as a child, but in your twenties your breathing becomes labored whenever you ingest an omelet.
The good and bad news about the immune system is that it can be strengthened, but it can also be weakened.
Some things that weaken the immune system are: smoking, drinking alcohol in excess, too much sugar (refined or not, from cane or from juice or from corn syrup, it's still sugar), lack of sleep, over-exposure to certain chemicals and pollutants, poor nutrition, and disease. Sounds like your job description, doesn't it? Smoky clubs, air conditioners with dirty filters, irregular sleep and the like all help to lower immune system response.
When you have something as prosaic as a cold, your immune system spends its resources struggling to get well, diverting attention from its normal and healthy fight to avoid getting sick in the first place.
Then there's stress, and "bad stress", as opposed to "good stress". Good stress is things we like doing that cause stress - the adrenaline rush before going on stage, the excitement of making a record, a birthday party we've been looking forward to. Bad stress is a bomb threat before you go on, a record company interfering with your album, a birthday party filled with people you loathe. It's healthier to avoid bad stress, or at the least to learn ways to cope with it.
Some things that seem to strengthen the immune system are:
If you're going away for a weekend it's one thing; if you're leaving for a month or two it's another, particularly if you're going overseas. No one wants to get sick while they're away from home, touring artists least of all. Our livings depend on our health! My tours usually run 12-16 weeks, so I try to make sure I've covered these things in the preceding 12 months:
Most people don't know any musicians, though this is hard for those of us living in the music business ghetto to believe. All they know about us is what they read in the papers, which is usually something like "Drug-crazed performer arrested in barroom brawl", or "Singer overdoses in restaurant". Is it any wonder that a strange doctor, called to your hotel room at midnight, doesn't want to prescribe Valium for your back? Players know that back problems are common in our profession; we also know they need to be dealt with immediately, or they'll affect performance. But if you show up at a strange physician's with a two-day beard and a shirt that says "Life sucks", you will be unlikely to get any medication. Worse yet, if you're really ill precious time may be wasted while you try to convince them you're not drunk or over-dosing. My best recommendation to avoid these scenarios is to find a good personal doctor and use them sparingly but efficiently. That way, when you're on the road your own doctor can speak with the local doctor and reassure him/her that you are, in fact, in need.
Why is it that verbal people like songwriters, used to the push and pull of our business and able to stand up for themselves in every other situation, will sit quietly in a doctor's office and take in the most absurd amounts of bullshit without balking?
Your doctor should be someone you trust implicitly - to be truthful with you, to explain things until you understand them, to be aware of your profession and the difficulties you face while trying to maintain your health on the road. If your doctor doesn't know about these things already, he/she should be willing to let you educate. And above all, your doctor should be available. It's no use having a doctor who will not discuss current symptoms with you on the phone when you're stuck in Korea. I don't mean you should call the doctor at 3 am because you're worried about a wart on your toe, but if you're really sick on the road, you should be able to call and speak with your doctor - if only to see whether the doctor can recommend an associate in the area. You may also need your doctor to explain to a colleague that you are not a weirdo!
I was in Amsterdam once and came down with a staph infection on my cheek. I'd had one before, and my doctor warned me that it might come back, telling me to take penicillin if it did. I asked the hotel clerk to recommend a local physician who might give me a prescription, made an appointment, and soon found myself in a waiting room filled with extremely well-dressed young women. "Must specialize in obstetrics", I thought. It wasn't until I sat down with the doctor who, without looking up from his desk, asked what kind of venereal disease I needed the penicillin for, that I realized who his regular clientele were.
It's not easy being a performer's doctor. As Sally Burbank notes, "I think people who are on the road need to find a doctor who's willing to work with them. It's different from local people who just don't want to take the hour off from work and come in - they're wanting phone management, when it's not really the best care. But people on the road don't usually have time to spend six or seven hours in the local emergency room for treatment of recurring sinusitis, so I use my best judgement. A performer can't afford a doctor whose staff use the standard line 'You've got to come in' when the performer's in Hawaii.
"Having a good relationship with the doctor's nurse is helpful," Dr. Burbank continues. "Letting us know when you're going to be on the road is helpful, because we can plan ahead and fill your meds beforehand. Particularly if you have back problems or sleep problems, a strange doctor isn't going to prescribe narcotics for you. Remember that from a doctor's point of view, we're legally responsible from DEA audits for who we give narcotics to, so we really have to be careful with a patient."
Ask around, query other performers, set up a physical and get yourself into the system, so there's a file on you somewhere. Be scrupulously honest; your doctor and lawyer are the two people you should never lie to! If you don't want something a matter of public record, say so, and ask them not to write it down. And don't expect your doctor to make allowances when you're the one who's been lax; if you know you're going on tour for six months, don't wait until two days before to try and get a physical!
I used to know a singer who traveled with a traditional doctor's bag. It was filled to the brim with every medication he could get (antibiotics, antihistamines, pain killers, muscle relaxers), as well as sterile bandages, condoms, and the like. I thought he was a little nuts, but who knows? The last thing you want is to be stranded somewhere at 3 am without an open pharmacy available, or stuck in a strange country when you're allergic to aspirin and the local equivalent of Tylenol just doesn't do what Tylenol does. The list that follows is everything I can think of that I've longed for at one time or another on the road, plus a few things friends suggested. Make a list for yourself and keep it with your stage stuff, noting what has to be replaced at the end of each tour.
It may sound like a lot of stuff, but once you personalize it, it's not too bad. And just like anything else, if you don't take something, sure as shooting you'll end up needing that one thing!
Suspect restaurants: My kid brother is a chef, trained at the Culinary Institute of America. He's not the overly fussy type; when I mentioned that I'd seen a cat in a local restaurant he laughed and said "Every smart restaurant in New York has a cat - they keep the rats at bay." Yet for years the only restaurant he'd take his family to was McDonald's. He knew what went on in the back rooms of most eateries, and he didn't like it, whereas he'd studied the McDonald's training program and knew how high their quality control was at that time.
If you walk past the kitchen and it's filthy, if people are handling food with their bare hands and going from item to item without washing, if the cutting boards or counters look "wrong", don't stand on ceremony. Eat something safe, or leave. "When in doubt, get out!" is the rule here.
On that same note, try to eat things in season. We're so used to the availability of everything that we forget nature has her own timing. Shellfish out of season will be mushy and taste lousy, and it will also have been in storage for a lot longer than in season. And eating questionable sushi in the summer is just silly. Much as I love it, I've seen too many parasite problems among my friends to risk eating it when the temperatures are that high.
Food poisoning: You can get food poisoning from just about anything you ingest. I got it from a pickle once; I was backstage before a show, the food hadn't shown up, I pulled a pickle out of the fridge and ate it - even though it smelled and tasted metallic. How stupid can you be? Two days in bed worth of stupid, in this case.
You can get food poisoning from ice cream, pickles, and a host of other foods you wouldn't think could carry it. Any food that's been broken down and "re-created", like meat loaf, should be suspect - it's been handled a lot, and you don't know where those hands have been. Ditto foods like potato salad, with mayonnaise or eggs in them; both are notorious for spoiling quickly. I have a friend who never gets food poisoning on the road because she only eats what she calls "clean foods"; if she wants beef, she has a steak at Outback or some other familiar chain. All her food is as plain as possible, without sauces. I don't know if that's why she doesn't get sick, but it's logical that the plainer the food, the shorter the prep time, and the less chance of something going wrong.
Backstage food: There was a period in the '60's when some of us wouldn't eat anything at a gig that wasn't sealed in a can or bottle, because so many people thought it was really fun to dose backstage food with everything from hashish to LSD. I have nothing against someone else doing drugs, but I don't do them any more, and I sure as hell don't want to go onstage stoned. My rider specifies "simple foods", and I look them over with a jaundiced eye. I beg people to go easy on my system, foregoing fancy sauces and experimental dishes in favor of plain broiled chicken and fresh salads and fruits. Carry emergency food with you - pop-top cans of tuna, jerky, Power Bars, raisins are all items that can live in your stage kit without much damage.
A funky hotel room: Is there mold in the tub? on the shower curtain? You can get everything from athlete's foot to Legionnaire's Disease that way. Dirty sheets? My drummer got scabies at the Kerrville Folk Festival from some questionable sheets in a doubtful motel. When in doubt, ask for another room, or clean it yourself before you relax. Some people carry flip-flops to wear in the shower, probably a good idea if you're prone to fungus infections. And while we're at it, check the air conditioning filter if you can - most places will change it if you complain that you have allergies and it's making you sick (they don't want the liability, even if they're a cheap motel). At worst, you can pull the filter out of the floor unit kind; it won't hurt you to leave it that way for a day or two, and it will avoid your breathing back in all the gunk that's collected when you use the air conditioner or heating unit.
Air conditioning: It really wreaks havoc with the vocal chords. It's terribly frustrating that so many of the "nicer" hotels have windows that don't open. They say it's because people were jumping out of the windows to commit suicide, but really, how far can you drop when it's a ground floor room? I opt for less expensive places that can't afford those high-tech hermetically sealed rooms, and carry a Swiss Army Knife so I can open the windows myself when necessary; I also call hotel/motel desks and raise a stink, warning them that I'll get sick and be unable to perform (again, the veiled threat and their reluctance to risk any legal liability works in my favor here). I vastly prefer to sleep with my windows open, even if I have to have the heat or A/C running at the same time. Throats hate dryness; it's a singer's worst enemy.
Fatigue: Face it, on the road you're pulled in a dozen different directions all the time. That can be exciting, and it can be dangerous. Writer Orson Scott Card makes this case: "Be absolutely selfish about your schedule; think of the people you'll be performing for the next day and the day after, and don't allow the generous desire to do 'extras' with this or that group of eager fans or friends keep you from getting adequate rest - including unwinding time... otherwise you end up more exhausted than you needed to be, and thus more susceptible to disease." Don't be afraid to say No, even if it irritates people. If you're playing one-nighters and your friends in that town get annoyed because you can't party after or before the show, you need a set of more understanding friends. Use your natural performer's selfishness to help you get adequate quiet time and sleep.
Stupid self-diagnosis: Take me as a case in point. Around 1986 I got two bladder infections in a row. When I began cramping on a tour of Florida that summer, it felt very similar, so I took some Tylenol and ignored it. The cramping continued and I decided I had an infection, so I tried to get my road manager to give me some of the penicillin he was carrying for emergencies. He refused, and I refused to go to the hospital in a strange town on my one day off. I told him I would deal with the pain for a couple of days until I could get home. Fortunately for me, he invited me out for lobster that night, and when I said I wasn't hungry for my favorite food, he took me to the emergency room - where a quick blood test showed my white count was triple and rising. I would have died if he hadn't gotten me medical attention; I had a burst intestine that was leaking into my bloodstream, poisoning my system. Another 36 hours would have been too late. So as much as this article will talk about emergency procedures and things to bring with you on the road, when in doubt seek professional medical attention.
Know your own warning signs: My partner can have a sore throat that goes into her lungs, take some over the counter medicine, and be well in two days. I have had several bouts with pneumonia and know that the minute I have that "dirty laundry" feeling in my lungs, I need to go to the doctor and take antibiotics. If you have a pre-existing condition, or a weak spot, baby it.
Strange doctors: If you distrust the person you're dealing with, or their diagnosis, get another opinion as soon as possible. Even if you trust them, sometimes it's a good idea. Case in point: my Florida experience. The first doctor who saw me assumed I was a drug user having a bad reaction, merely because I was a performer. He failed to perform critical tests, then decided he'd "better just go in there and check things out". I waited eight hours for him to come back and arrange surgery, my white count rising every minute, my fever starting to rage out of control. Luckily, that same road manager took a hands-on approach, called some relatives who knew a relative who knew someone at another hospital, and he had me moved to a better facility in time
Generic drugs are not the same as non-generics, no matter what your pharmacist tells you, and sometimes it's not worth the money you save. Generics only have to come within 20-30% of the dosage obtained by the non-generic version.
Foreign drugs: If you take certain medications regularly, take enough overseas to see you through plus one extra week. Drugs are not the same from country to country, and one country may call your blood pressure drug another name entirely. Worse yet, the name of your blood pressure drug might be a liver cancer drug there. If this is a problem with your insurance company, try calling them for a one-time exemption. If that fails, arrange with someone to Fedex you your supply as needed. It's expensive, but it's cheaper than a stay in the hospital.
Get immediate medical attention if you have sudden severe pain, difficulty in breathing, shortness of breath, persistent vomiting or diarrhea, persistent abdominal pain, or significant bleeding. Gaffer's tape works wonders, but it doesn't stop infection, blood poisoning, or any of the other horrors we only discover when we experience them!
Don't get trapped into thinking medications are the answer to everything. You pay the price for taking them, and certain drugs should be a last resort only. For instance, cortisone (Prednisone) was hailed as a miracle drug when it was first tested in the late 1940's; patients with severely crippling rheumatoid arthritis noted a 50% decrease in their pain with its usage, and could suddenly get out of bed after years of confinement. No one knew that side effects included euphoria, abnormally large appetite, "moon face", adrenal dependence (because eventually, since the cortisone is replacing your adrenal usage, your adrenal glands atrophy), and a host of other dangerous side effects. Yes, cortisone is fantastic; if you've got a bad cold or infection with swollen eardrums, it will bring down the swelling enough to allow you to make your flight and do your show. It will also make you feel really, reallygood. And eventually, you'll crash, or you'll become dependent on it. Don't use cortisone for anything but a serious emergency; take voice lessons instead.
Ditto anything pharmaceutical that you begin thinking is a necessity for you to do a good show. Unless you have a chronic condition like asthma, pharmaceuticals have no place on stage. How many stories have you heard about performers who ended up addicts? It's just as bad to overuse or become addicted to cough syrup, or Prednisone, or alcohol, as it is to anything else. Remember - the only thing you need to turn in a great show is your talent.
Keep a list with you: Illness does not aid coherence. Especially for those of us whose livelihood and reputation depend on something as ephemeral as the quality of a voice for a few hours each night, a sore throat anyone else would shrug off can provoke fear, if not downright panic. Being away from home and all that's familiar only intensifies those feelings. Try to put a lid on your panic; if necessary, make a list of things that you know will help you when certain situations arise.
For instance, I have Chronic Fatigue Syndrome. Not only is this difficult because it's a bizarre and hard to diagnose disease, but it's made doubly hard because people look at me and say "You're tired? Just push through!" I can't really make clear that there's tired and there's tired, or that if I ignore it, the next stage is like having mono plus the flu twenty-four hours a day.
Additionally, when the CFS hits hard I have a lot of neurological involvement - can't remember my phone number, forget the names of people close to me and the like. The last thing I'm capable of doing at that point is remembering what will help me get through it! So I carry a list, made up with my partner during one bad bout, of Things To Do When CFS Hits. And because I know I'll be "stupid" at that point, my road manager carries the same list.
Likewise, if you are prone to any sort of illness on the road - if your colds always turn into bronchitis, or your headaches to migraines, carry a list of what helps you feel better at those times. You might add comfort foods to it, as a reminder of some things that will make you feel nurtured when you've got the chills on a sunny day. It's easy to forget how to feel good, when you're feeling that bad.
If you need a doctor, check with the promoter or club owner/manager - after all, it's in their best interests to get you well. Sometimes local radio station personnel can be helpful. Your own physician should be available 24 hours a day in an emergency, or their partner (who can then look at your records) should be able to take your call.
Avoid emergency rooms if you can; they are overcrowded, understaffed, and won't appreciate dealing with your problem if it's not a true medical emergency. They're also great places to get sicker. A sore throat and sniffles are not emergencies. However, if there's any chance that it is an emergency (like the "get immediate medical attention" list earlier in this article), go without fail, right away.
If you are in a foreign country, come home. That's the safest thing to do. However, it's rarely possible, so be wary. Americans make the mistake of assuming the rest of the world's medical systems operate the way ours does. No way. When I blew out a tendon in Japan, I went to a famous sports clinic, where I thought they'd have some experience in that sort of injury. I forgot that being female counted against me. So did being American. So did not being a sports figure with a traditional sports injury. After waiting five hours for a doctor, I tried to explain that a cortisone shot would be bad because I over-react to steroids, and that this didn't feel like tendinitis anyway. The doctor merely said "Patients do not advise doctors in Japan", and gave me a shot of cortisone before I knew what was happening. The poor treatment I received from doctors unfamiliar with musicians' injuries over the next six weeks resulted in two year's of physical therapy and rehabilitation when I got home, and I'll never have better than 80-90% of my former usage again.
I had a friend who was hospitalized overseas for food poisoning, where he discovered that showers were only available every other day and soiled bed linens changed once a week. When a family member was hospitalized in Russia, she quickly learned that the only way to get anything from aspirin to a pillow and water was to bribe the attendants.
On the other hand, I lost half a tooth in Kyoto and was taken to a local dentist by the promoter's representative; I received the most painless care imaginable, and my dentist at home was very pleased with the work. Most doctors overseas do care as much as our own physicians, but even with all the flaws in the American medical system, we do tend to have better health care than many other countries. Try to get really sick at home.
Failing that, check with the local promoter for a recommendation. In a pinch, if there is a local US military installation (air force base or the like), call them and explain the problem - they may be able to help. Remember that all your local embassy can do if you call for help is provide you with the names of English-speaking doctors; they have no idea whether these people are qualified to do anything other than speak to you in a common tongue!
Bring your medications and keep them with you. Don't leave them in your luggage; have a three day minimum supply on your person at all times, and preferably a week. You don't need to couple the fatigue, fear, and loneliness of being sick in a strange country with a lack of the things that are familiar to you. Be forewarned that drug amounts vary from country to country - Tylenol #3 (with codeine) in the US is completely different from the Tylenol + Codeine you can buy over the counter in Canada. Even antibiotics come in different strengths. The same name, same drug company, same look may be only part of the dosage you are accustomed to. It's always better, if you take something regularly, to take it with you when you go.
Be careful with your water. We take safe water for granted in this country, but it's not true everywhere. If you are going to a country known to have problems with water safety, don't drink the water. I thought I was being very clever the first time I went to Spain because I drank only bottled Coca Cola, until I got dysentery and discovered the Coke was bottled locally. Drink factory bottled water, and check to see where it was bottled.
And beware of ice! Many people get dysentery because they forget that ice is made of water. Most fruit juices are diluted with water as well, so avoid those. Bottled beer, wine, carbonated sodas without ice are usually okay. If you're going somewhere really questionable, iodine tablets or crystals will kill most of the dangerous critters lurking in that innocuous-looking clear liquid, but large amounts of iodine are not great for your system either.
Carry a doctor's letter listing any medications you're carrying, whether they're prescription or over-the-counter. It doesn't hurt if it also lists any conditions you're being treated for. Make sure it's on your doctor's letterhead stationary or a prescription pad! I had a road manager arrested at customs overseas because he was carrying a bottle of cold remedy pills, available at any quick-stop back home. Unfortunately, they weren't available without a prescription in that country. If he'd had a doctor's letter explaining his sinus condition, they might still have confiscated the medicine, but they probably wouldn't have booked him.
Get your shots. Some countries are laxer with their public health than we are. Some countries have malaria problems. Some countries have a higher rate of infections. It pays to be prepared. Your doctor can recommend vaccines for youm depending on where you're going; the Center for Disease Control also has a hotline and a regularly updated Internet site which will advise you of any potential problems on a country-by-country basis. The basic shots I'm aware of are as follows - note that a number of them must be given over a period of several months, so prepare early.
Realistically, the easiest way to remain healthy on the road is to go out healthy in the first place. There are some basic things you can learn to help maintain that health while travelling.
Wash Your Hands! Wash them obsessively, wash them compulsively, wash them as often as you can. I can't emphasize this enough. Bugs are transferred through hand contact - colds, viruses, dozens of things too disgusting to mention. Washing with soap and water is the first thing any doctor will tell you to do in order to help prevent getting sick. It kills or neutralizes most critters before they have a chance to burrow through your defenses. In our profession, where body contact is de rigeur, it's doubly important. I asked Dr. Ernest Esakof 30 years ago why I seemed to catch every cold out there, and he noted that I was exposed to several thousand people a night, all breathing toward me in an enclosed space. Every germ in the room finds its way to my stage. Also, I shake upwards of 200 hands a night, which means even more direct exposure. As soon as I started washing my hands a lot (that means before eating, after eating, before and after show, before and after greeting... a lot), I stopped getting sick.
Use wipes Those silly little packages of anti-bacterial wipes made for traveller's might just become your best friend on the road. Medical studies done on doctors as they made their daily rounds showed that, used correctly, the wipes actually worked better than washing frequently. You have to make sure you've wiped up to above the wrists, inbetween the fingers, etc., and you have to let your hands air-dry - no towelling the wet off. But these can be carried and used anywhere; in the car, in your guitar case, at the merch table. And after shaking 50+ hands, you should use one.
Don't mess around with anything you can avoid that may jeopardize your overall health. In other words, be a good steward of your body. Get a physical every year, and when your doctor recommends it, bite the bullet and get mammograms, pap smears, be tested for prostate cancer or whatever else the doctor advises. Don't have high-risk sex; wear a condom or insist your partner wear one. If you have an infection, don't treat it by putting yogurt on the area and hoping for the best.
Learn to listen It amazes me how Western culture is complete body-conscious whe it wants to prohibit something like nudity, and abysmally unconscious of the connections our bodies try to make with us.
Your body tells you things all the time, from "I'm tired, I want to sleep now" or "I'm hungry, feed me" to "This food tastes funny" or "My back hurts a little, better not lift that box". The trick is learning to listen before things get out of hand. Sometimes this is hard; incest survivors in particular seem to have trouble connecting with body signals, probably because they learned to ignore them in order to survive. But body consciousness can be learned, and can help you prevent many problems in days to come.
A good tool for learning is to lay in a quiet room, on your back, and clear your mind. Starting with your toes, try to feel each piece of your body - toe, sole, heel, foot, ankle etc. Work your way all the way up to the top of your head. This will sound silly, but talk to your body (though you should probably not speak out loud if you're doing this on a tour bus). Ask how it feels; tell it everything's all right. Not only does this exercise bring you more in touch with your physical self, it's very relaxing.
Take yourself seriously Sometime during the mid-'70's, at the height of my single "At Seventeen", I began having trouble breathing. I don't mean my nose was stuffed - I mean it felt like I couldn't take in enough oxygen. I went to my family doctor, who suggested I was over-stressed and hyper-ventilating. "Try breathing into a paper bag, that will straighten it out." All it did was make me nauseous. I went to another doctor, who diagnosed anxiety attacks and told me to go into therapy. It made no sense; here I was in the middle of a huge hit record, doing exactly what I'd been working toward for years, yet these people were telling me my breathing problem was the result of bad stress.
Finally I went to Dr. Nicholas Macris, an allergist, for a completely different complaint. I remember the visit well; an intern was in the room with us during our initial discussion, and when I mentioned my difficulty breathing the allergist turned to him and said "Always listen extra-hard when a singer tells you something about their throat, nose, or lungs. They're hyper-sensitive to those areas, and often notice things well before a standard test can diagnose them." Then he checked my nose and throat and said "It's a wonder you can breathe at all with that post-nasal drip!" He gave me antihistamines, I gave away my cat, and the breathing problem cleared up in a week.
When I began polling friends who traveled a lot for their suggestions, I got many interesting responses. Mary Faith Rhoads of John Pearse Strings says Royal Jelly in glass vials from a Chinese grocery (cheaper than the health food store) and Ginseng will get you through extreme physical fatigue like nothing else. Tret Fure and Cris Williamson carry garlic capsules or make garlic tea (steeping chopped garlic & cayenne in hot water) to drink before they fall asleep; they also eat Umiboshi plums when flying in the hopes of counteracting excessive radiation from all the air travel. Gaynor Thomas suggests finding the nearest Indian Restaurant when you feel a cold coming on; I feel the same way about Thai food - theoretically the hot food increases circulation and warms the innards. Some people feel milk products are harmful to singers, while others swear a milkshake at showtime does the trick. I've never found lemon helpful, or honey, but I know people who do. So I would say, find what works for you and stick to it. Below are some things I've gleaned over the years.
Food Poisoning I keep coming back to this because it's so common. Salmonella is the bane of a road rat's existence. I'm not talking about a little upset stomach or diarrhea; I'm talking about the debilitating real thing. It ranges from mild discomfort (stomach ache, diarrhea, gas etc, usually curable with a handful of Rolaids) to middling (me stupidly eating a pickle backstage that tasted wrong on first bite but I was starving so who cared? Nobody but me for the next 36 hours of vomiting) to life-threatening (a friend of mine got something called giardia from a piece of bad fish; it has a 48-hour incubation period, after which liquid poured from every orifice and her fever shot up to 104º. It took five days in the hospital to get it under control.)
Food poisoning can be gotten from anything you ingest. The symptoms are chills, fever, vomiting, diarrhea, cramps, nausea, and muscle pains. If you have it, you know it. For basic food poisoning, by which I mean it eases up after around 12 hours and is pretty much gone in 36, the biggest danger to you is dehydration. Try to sip a soda, preferably flat Ginger Ale, but any carbonated beverage that's gone a little bit flat is easier to hold down than water at first. Sweetened weak tea or broth are also good; stay away from acidic drinks like orange juice. Don't take anything else in the first twelve hours you can get anything to stay down. Then go for bland, non-fatty foods - rice, Jell-O, pudding.
For more serious food poisoning, go to the emergency room. Don't mess around; the more dehydrated you get, the more fuzzy your thinking gets, so it's important to keep an eye on the clock and go immediately if you start running a high fever or the diarrhea and vomiting don't subside. You can die from food poisoning.
Making friends with your nose & throat Moisture, and the lack thereof, is the most difficult problem singers face on the road. Your voice is produced by two little things called "vocal cords", which rub against one another to produce the sound. They're coated with mucus, which in an ideal world is soft and pliable and wet. When it gets gloppy, sticky, or hard, you're in real trouble. When you keep singing through it, you wind up with raw skin rubbing on raw skin, and it behaves exactly the same way a sore on your hand would behave if you kept rubbing it. Airplanes, air conditioners, heaters, dry climates, lack of sleep - all of those things conspire to create your parched throat. Fortunately there are a number of things you can do to counteract this; try them and find what works for you.
Heat stress is a real problem during the summer for those of us who work outdoor gigs a lot. The one time I had it, I remember thinking "I'm not thinking straight", which is one of the first signs of serious dehydration. A person with heat stress may not even be aware that they're dehydrated, and may refuse to drink or lay down. If you think someone is having heat stress or heat stroke, lay them down with their feet slightly elevated in a cool shady place (or air conditioned car or room if you have access to one). Try and get them to sip cold water (not ice water); apply a cool cloth to the back of their neck. If you can, get them to drink some Gatorade or something else with electrolytes in it. Don't use beer or ale; for some silly reason people think these replace electrolytes, but in fact alcohol is very dehydrating.
Try to avoid heat problems yourself by drinking copious amounts of water; even if you're not sweating, you're still losing a lot of moisture each time you breath in that kind of hot weather. And wear a hat, even if you think it makes you look goofy.
Jet lag I hate arriving in a foreign country with a six or sixteen-hour time difference, and spending the next three days alternating between manic walks and total stupefaction. Jet lag is one of those things no one believes in - until it hits. It's the oddest feeling; your eyes roll back in your head, your speech slurs, and you can't think of anything but going to sleep. Next thing you know it's three am and you're wide awake until ten or eleven in the morning, when you can't stay awake for the life of you.
My least favorite memory of jet-lag was during a trip to Holland, where I'd arrived and gone straight to work taping a three-day TV show. On the second night my record company took me out to dinner - lobster, as it happened. I vaguely remember ordering my food, trying to keep track of the conversation. The next thing I remember, someone was laughing and shaking my shoulder to wake me, as they lifted my head out of the plate of lobster where it had fallen. I was sound asleep.
You can help yourself by eating high protein, low carbohydrate meals for a few days before the flight, during the flight itself, and for a few days after. Avoid fatty foods and alcohol. There's a lot of evidence that natural light (or even incandescent lighting) plays a big role in readjusting our circadian rhythms, so I sleep with the shades in my room wide open. They say even if you sleep through a few hours of daylight, your body is still adjusting, and you'll get over the jet lag sooner.
Melatonin seems to help re-adjust the sleep cycle; sometimes I carry it with me overseas. Not the time-release capsules, since I seem to wake and fall asleep five or six times each sleep cycle if I take those, but the regular ones. The trick, I've found, is to take it before getting into bed and then the instant you feel sleepy, turn off the light and go to sleep. If I take it more than three days running I start getting a little logy in the morning, so I watch my intake, but it's a lifesaver those first few days. There's also some great holistic stuff called No-Jet-Lag, buyable at health food stores and on line; I've used it a few years now to good effect.
Try to stay up and go on local time and mealtimes as quickly as possible, even if it means eating dinner when you feel like breakfast. I usually get to England around 6 am and drink a few strong cups of coffee, then go for a long walk. I eat a light lunch and normally take a nap around 4 o'clock, when the lag hits hardest. Be careful of napping too long - more than half an hour or so and you'll sleep right through, waking at midnight raring to go. Set your alarm, then try to stay up until a "normal" bedtime.
Eye infections Do not self-treat an eye problem, even if you just suspect it'll go away - it's not worth losing an eye over. See an opthamologist. In the meantime, if your eyes are blurring, burning, itching, take your lenses out and flush with cool water until you can get to the doctor.
Makeup Mascara rots faster than anything else in your kit, so change it frequently, and don't lend it! Likewise, don't lend combs or brushes, not to mention toothbrushes. You can get all sorts of nasty bacteria from someone else that way. If you use makeup, be scrupulous about washing and replacing your brushes - wash with soap and cool water, rinse thoroughly, then air-dry. If you use applicators, replace them after every show. You can get pre-cut foam applicators at any large drugstore for around $1.79 per 50; they're not worth re-using. Powder puffs should be washed at least weekly, and replaced often. And take your makeup off completely every night! It harbors bacteria, clogs the pores, and leaving it on is about the worst thing you can do for your skin. Could you breath with a film of waterproof stuff over your mouth and nose? Neither can your pores.
Poisoning Anything can be poison to the wrong person; some folks can't eat chili peppers, for instance, and some people get violently sick from shellfish. Real poisoning is a terrible thing. If you suspect someone's been poisoned, look in the inside front cover of a phone book for the number of the nearest poison control center and call them immediately. If you can't find that, call 911. If calling the paramedics is quicker than searching for a local hospital, call them, but call someone who knows how to handle it. Do not induce vomiting! And if the person seems weak, lethargic, or "stupid", don't listen when they tell you they're fine - just get help immediately. Do not take chances with this, it's not something you can handle by yourself.
Skin infections and acne Well, this is a tough one. I had a drummer who used to literally sit there and push his pimples back into the skin. When we made fun of him, he smiled and said "Do you see any pimples on my face?" We had to admit that we didn't.
Cosmetologists hate to hear this, but I've found that cleaning my face with alcohol swabs a couple of times a day does more for keeping my skin clear than all the medicine in the world. Everyone I've told this to swears by it. If alcohol dries you out too much, try witch hazel pads, which are less intrusive.
Remember, though, that for television it's often easier to disguise a blemish than it is to disguise dry skin.
Sunburn We've all done it; finally, a day off! Me for the pool/tanning booth/beach! "No, don't worry, I know my limits", you say? Well, limits change with age and geography. If you're somewhere like Australia, or even the West Coast as opposed to your normal East Coast holiday spot, you'll have no idea what that sun can do to you. Really, the best thing to do about sunburn is not get it. Evidence is that it promotes skin cancers, ages your skin much faster, and affects your skin forever. Wear serious amounts of sunblock, cover up with clothing that's sun-repellant, and remember that overcast days sometimes give you a worse burn than bright clear skies will. Don't think sitting in the shade will protect you, because it won't.
If you do get a bad sunburn, take a cool (not cold) bath or shower. Hydrocortisone cream or spray, available at the drugstore, will make it feel better. Don't peel or pick at your peeling skin, no matter how tempting that might be - it's a good way to get a serious infection. If you blister and the blisters break on their own, apply an antibiotic ointment like Neosporin and cover lightly with clean gauze. Keep it clean. If it's bad enough you may need a cortisone shot, so see a doctor.
Too much dope In my misspent youth, the common cure when you got too high on marijuana or hashish was to eat two big pieces of bread and drink a glass of Coke or Pepsi - something about the bread soaking stuff up, and the carbonation plus caffeine moving it through you quickly. This also works if you've had too much coffee, though you should replace the caffeinated soda with something like Ginger Ale. By the way, salmonella can live in contaminated marijuana...just how stupid are you?
Yeast infections (Candida albicans) are a serious drag. If you're a female on antibiotics, yogurt may not have enough live lactobacillus to prevent an infection, so take lactobacillus tablets with each antibiotic dose. Forget douching with yogurt and the other old wives' remedies to clear up the infection - there's a one-day non-prescription tablet that does the trick, and you should use it. A yeast infection is not only uncomfortable, it quickly turns into a constant low-grade infection that causes fatigue, irritability, and general malaise, even if you have no vaginal symptoms left.
If you have cramps, there's a spot on the side of your ankle, just behind the bone, that will hurt when you press down on it. No kidding - it doesn't hurt the rest of the time, but during that four or five day cycle it will be very painful when pressed. Rub it as hard as you can, and it relieves the cramping pain a lot. Of course, some people say that the pain of rubbing that spot is so great that it makes you forget the cramps, but I've found it helpful. Hot compresses or a hot water bottle on the abdomen can also help.
If you've been in hot tubs a lot, or have been with a lot of sexual partners, it doesn't hurt to get tested for chlamydia; it's epidemic these days, and in its early years, doesn't show symptoms; the only way to find it is by going to the doctor. Chlamydia, untreated, appears to lead to cervical cancer, so best to be safe.
Basically the best way to stay healthy on the road is to stay home. That isn't a viable option for most of us, so follow the common-sense rules. Do what your doctor advises (unless they're a total jerk, in which event you should get a new doctor). Pay attention to your body. Remember that old wives tales are often true - sayings like "An apple a day keeps the doctor away" exist because of a basis in experience.
And enjoy your time in this body, it's the only one you've got right now, so it pays to be a good caretaker.
Mayo Clinic Family Health Book, David Larson MD ed.; The New Our Bodies Ourselves Boston Women's Health Book Collective; Let's Stay Healthy by Adele Davis, Ann Gilroy ed.; Understanding Your Immune System Eve Potts & Marion Morra; Mayo Clinic Guide to Self-Care, Philip T. Hagen ed.; interviews with various health professionals.
return to The Performing Songwriter Articles