Ah yes, the shot. For singers, the injection has acquired almost magical significance. Every week I see at least one singer who, having just returned from performing in Europe, was saved by a shot given shortly before an important performance. When I ask what was in that injection, I get a look of incomprehension and a shrug of the shoulders.
As a singer, you need to know what was in that injection, for many reasons. The effect may in part have been psychological, but the medication you received could also be a powerful steroid or other pharmacologically active substance. As the ultimate gatekeeper of your healthcare, it is important that you know what is currently in your body.
Let’s look at some of the substances doctors may commonly inject.
First, various forms of cortisone. Cortisone is a powerful anti-inflammatory steroid, but it can have many side effects, depending on your underlying medical history as well as the amount and formulation of the injected substance. In general, I am not an advocate of cortisone for singers, unless there is a specific reason to give it. Acceptable reasons include severe allergy, or evidence of non-infectious inflammation or swelling of the vocal folds in a singer who has an imminent, important engagement that can’t be postponed or cancelled.
I am talking about career-making performances and career-breaking cancellations. I am talking about single appearances or a short run of performances followed by a week or two of down time.
Unacceptable reasons include the desire for a quick fix, singer panic, or physician ignorance or intellectual laziness. Unfortunately, the repertoire of many “performing arts doctors,” is essentially cortisone. I specifically warn against the use of cortisone for singers who are in a long running engagement, such as musical tours.
The formulation of a cortisone injection is also important. You must weigh how quickly and for how long you need its effect. If you need to get through a weekend of two or three engagements, you do not need Depo-Medrol, for instance, which stays in your body for a month. You might do better with a couple of pills instead.
If you do take a cortisone shot, find out what it is, and how much you were given. This is important information not just for you, but also for the next doctor you consult, on the next leg of your trip. I am always in a quandary when a singer with several injections “on board” is asking me for medication.
Before leaving the topic of steroids, be aware that cortisone makes a number of medical conditions worse, including glaucoma, diabetes, and osteoporosis. An injection has many advantages, but it has one main disadvantage: it stays in your body until it is fully metabolized—you cannot “change your mind” and discontinue it.
Other injected substances include various vitamins and herbal substances. Most of these are harmless and some are quite beneficial.A couple of warnings here also: You can overdose on vitamins that are fat soluble rather than water soluble. Too much vitamin A, D, or E can be harmful, since they are stored in the liver, and continue to act for a long time. Water-soluble vitamins (B and C) on the other hand are generally not harmful—in the worst case, you will simply produce some expensive urine. Another consideration should be whether you might have allergies to anything in the injection. For this reason, always ask what is in that syringe.
Finally we need to consider the psychological effect of injections. I do not disparage the importance of treatment that requires only one injection and works quickly. Whether some of this is a placebo effect is not important. The important thing is that it makes the patient feel better. Effective treatment, like an effective performance, always has a psychological component, and any treatment, especially treatment of a performer, does not need to fit the paradigm of a rigorous scientific experiment—it simply has to work. You, however, as the recipient of such treatment, still need to know what you are being given, what to expect, and what to look out for while the medication is in your body.
DISCLAIMER: The suggestions Dr. Jahn provides in these columns are for general information only and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
