Never do card tricks for your poker group.

David Epstein, MD, Wilmington, Del., Chapter discusses care of the voice when you are ill.

Last issue, I wrote about things to do every day to keep your voice healthy. Now I want to suggest some ways to protect your voice if you become ill.

• If you catch a cold or other upper respiratory infection, turn on a humidifier or vaporiser, especially during the winter. A stuffy nose will cause you to mouth-breathe, which dries the throat and larynx. Either the steam-type or cool-mist type will do. Don't put Vicks or anything else in the water; plain H20 is most effective.
• Drink lots of fluids. It sounds a bit gross to say it, but the best indicator is the colour of your urine. If it is dark yellow, you need more fluids. You're doing fine if your urine looks like water. (Check with your doctor on this if you have a heart or kidney condition.)
• Avoid aspirin. It makes bleeding injuries in your vocal cords more likely. Tylenol (acetaminophen) or Advil (ibuprofen) are better choices for fever or pain in singers.
• Avoid antihistamines and decongestants if possible. Most non-prescription cold remedies contain them, but they are too drying for singers. Mucolytic agents that break up mucus, such as Organidin (by prescription) or plain Robitussin (over the counter), help liquefy secretions without drying your mucus membranes if you have a cold.
• Avoid Vitamin C in excessive doses. It has no proven benefit in fighting colds, but it is a mild diuretic and will tend to dry out your body.
• Pay attention to your general health. Constipation or diarrhoea will make your stomach uncomfortable and ruin your support. Chronic allergies cause swelling in the mucous membranes of the larynx; the nasal stuffiness also leads to mouth breathing, causing excessive dryness in the larynx. These and other minor conditions, if untreated, will affect your singing.

If you have hoarseness or cough lasting more than a couple of weeks, see a doctor right away. If he or she can't diagnose the problem, ask for a referral to an Ear-Nose-and-Throat surgeon who specialises in voice problems (not all do). Ask the doctor if you have "chronic reflux," a much under-diagnosed condition in which stomach contents flow up your oesophagus while you're asleep and irritate your larynx. You may have reflux if you wake up hoarse or with a sore throat each morning, or cough a lot at night. (Other conditions can also do these things.) The treatment usually consists of elevating the head of your bed, antacids, never eating immediately before sleep, and avoiding caffeine, alcohol, and spicy food. I hope you don't have "reflux"-life becomes very dull!

If you have diabetes, take good care of it. The fluid shifts caused by changing blood-sugar levels may give you fluctuating swelling in your vocal cords.

The hints from Dr. Sataloff that I have passed on in these three articles will, I hope, help keep your voice healthy. The four basic principles are:

• Avoid irritants such as alcohol and cigarettes.
• Avoid speaking or singing over noise.
• Use good posture and support while singing and speaking.
• Take care of your health.