Speaking of voice problems...

Traveling abroad with type 1 diabetes.

A woman shouts (illustrative) (photo credit: INGIMAGE)
A woman shouts (illustrative)
(photo credit: INGIMAGE)
I am 52 years old and voluntarily lead prayers in my Jerusalem synagogue on many Shabbat mornings. While I enjoy chanting the prayers and am generally healthy, sometimes my voice suddenly “goes” on me and I can’t sing for a few hours. The congregation has suddenly to find somebody else. Is there anything I can do to prevent this condition?
Z.N., Jerusalem
At 86 I’m still too young to quit leading prayers at our synagogue, but during the early morning hours I have a pesky frog in my throat. When I paid a visit to my ear, nose and throat doctor, at his earliest appointment, he couldn’t find anything wrong. By that time of day, things clear up some. What can your experts suggest I do to correct my problem?
S.S., Hadera
Dr. Michal Icht, a clinical communications specialist and lecturer in the Health Sciences Faculty of Ariel University, replies: Voice problems are very common in the general population, and it is communications specialists or otolaryngologists who treat them. The problems can involve voices with low quality, weak voices or the inability to vary the tones as needed. The voice should not ordinarily be a burden or cause pain.
The problems can affect any age, from children aged three or four to the elderly aged 70 or 80. Most of them complain of a rough voice, vocal effort and difficulty talking or voice fatigue. There are cases where there is really no sound, and sometimes discomfort and even real pain in the throat area.
These conditions can be permanent or variable in severity, new or prolonged and chronic. They can appear after a disease, such as influenza, or for no apparent reason.
Usually, the vocal symptoms begin as a mild problem such as temporary hoarseness, sore throat or vocal tiredness after a long period of using the voice, a broken voice or the need to clear one’s throat frequently.
The more the person is dependent on his voice for work or other purposes, the more disruptive the problems are, even though they are rarely life-threatening.
Nevertheless, they cause discomfort and can disrupt one’s professional, economic and social life.
When the voice changes through the day or when one becomes hoarse or has swallowing problems, one should go to an ear, nose and throat doctor for an examination. If more help is needed in resolving the issue, he will refer you to a communications specialist.
In general, to prevent or alleviate voice problems, you should drink a lot of water to hydrate the throat. Drinking herbal teas is also helpful, as is inhalation for a few minutes from a pot of boiling water at least twice a day.
Many people have voice problems because they constantly shout (often they have hearing problems); they should try to speak softly without a feeling of effort.
While you should not shout, whispering for a long period is also an effort and can cause problems. If you do have to whisper for some time, make sure to take a drink of water periodically.
It is not recommended to drink beverages that are especially hot or cold, or that have caffeine (coffee, regular tea or cola) or alcohol.
Try to avoid clearing your throat. If you feel irritation in the throat, it’s better to cough or drink a bit.
When you have to speak or sing a lot, avoid eating spicy or salty foods, as these dry out the throat. If you suffer from a lot of mucus in the throat, don’t consume a lot of dairy products.
Of course, you should never smoke – which causes great harm to the throat and health in general – or be exposed to other toxic chemicals that irritate the mucosal tissue of the throat.
My seven-year-old son suffers from type 1 diabetes and has to regularly monitor his blood sugar and inject himself with insulin. We are going abroad soon for the first time with him, and are wondering how to cope with the problems of handling his diabetes abroad while traveling.
P.S., Arad
Experts at the endocrinology and diabetes institute at the Schneider Children’s Medical Center in Petah Tikva comment:
Parents of children with type 1 diabetes should ask their doctors for a letter in English detailing the treatment, dosage and type of insulin and injection program before they leave for abroad. We recommend that you make copies, including one kept close to the passport and another in the bag with injection equipment. Also, photograph it with your smartphone.
Make sure you have health insurance for travel abroad with an emergency number to call. Store the equipment in a bag that you take with you onto the plane, and not in a suitcase stored in the plane, as temperatures there get to be very cold. A bottle of insulin can freeze, break or get spoiled, and sometimes suitcases don’t reach their destination.
Injections may also be needed while at the airport and during the flight.
Take with you suitable drinks and sweets, in the event of hypoglycemia.
Sometimes, there are delays before the flight, or meals are delayed. Low-cost flights may be without any food at all, so plan ahead.
If you are traveling in a group, it’s a good idea to tell someone else about the diabetes and say what should be done if the child (or an adult) develops hypoglycemia.
If the child is using an insulin pump, change the time and date to suit that of the place where you have gone. Take shortand long-term supplies of regular injectable insulin, in case the pump stops functioning, or if the child has to disconnect from it.
Take extra hypodermic needles and batteries with you.
If the family goes on a hike or other physically demanding activities, make sure enough blood-sugar tests are carried out, and bring along sugar gel or tablets. Consider reducing the amount of insulin the pump provides.
During your travels, it is best to keep the insulin supplies in the refrigerator, not the freezer, or in a special temperature-controlled pack. Do not leave insulin in the trunk of a car, because of the risk of the car being stolen.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.
Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or email it to [email protected], giving your initials, age and place of residence.