When a singer’s physical well being is drastically changed by persistent complications, finding answers can sometimes only lead to more questions. Empowering yourself with knowledge can help, but that’s only one small step in a long process.
This article was originally published in Classical Singer magazine. To subscribe to the print magazine, go to www.csmusic.info/subscribe.
It was a muggy spring day, and I was on my way to a student musical theatre competition. As I pulled into the parking lot, I felt something I almost never experienced—heartburn. Shrugging it off, I went in and got to work. I continued to feel worse throughout the day, so I stopped at CVS on my way home and picked up some Tums. They didn’t help, but I figured it was just some hormonal weirdness that would work itself out as I had just started my cycle. The next day, I felt fine.t all started with heartburn.
But the day after that, it came back—and the next day, and the next. Soon, I was experiencing a cascading spiral of ever-increasing symptoms, culminating in waking up in the middle of the night with acid pooled in my throat. I realized that I was suffering from that malady which all singers dread: acid reflux.
Wanting to protect my voice at all costs, I immediately and radically adjusted my diet, lifestyle, and eating schedule. My symptoms got worse. Over-the-counter acid reducers didn’t help, and my voice began to show signs of wear and tear. Several months, specialists, and proton pump inhibitors later, I was on a highly restrictive low fat/low acid diet, following an inflexible schedule for my meals and daily activities, and experiencing a host of increasingly disruptive GI symptoms.
Despite the specialists and the restrictive diets, I wasn’t seeing improvement, and my response (or lack thereof) to treatment did not make any sense. The state of my voice on any given day felt like a roll of the dice and was a huge source of stress.
Finally, almost one year after that fateful heartburn-filled day, I was diagnosed with small intestinal bacterial overgrowth (SIBO).
I eagerly seized my new diagnosis and aggressively changed course. I took conventional antibiotics, herbal antibiotics, and supplements. I radically changed my diet, again.
Within three weeks, my acid reflux symptoms had decreased by about 75 percent. After a few months following a low FODMAP (fermentable oligo-, di-, and mono- saccharides and polyols) diet, I was able to come off heartburn-related medications entirely. With the reflux in check, I was able to get my voice back to full function.
But the GI symptoms remained—daily, persistent, uncomfortable, and occasionally debilitating. I changed my diet again and again. I saw more specialists. My symptoms improved somewhat, but not enough. I researched SIBO relentlessly with precious few answers.
It’s been two years since my SIBO diagnosis, and three years since my symptoms began. I’m relieved that I, mostly, no longer experience acid reflux, but many of my GI issues remain. The more I research, the more I have had to swallow the bitter pill that this condition may be chronic.
As singers, we are taught from very early on that our body is our instrument and our health is vital. We are obsessed with washing our hands and avoiding germs. We are educated about diet, hydration, exercise—all the things that will keep us functioning to the best of our abilities.
But what do you do when the best of your ability is rarely an option? When some days your body just wants to quit despite your best efforts, preparation, willpower, and hope?
Whether you have an autoimmune disease, migraines, depression, anxiety, diabetes, Lyme disease, or inflammatory bowel disease, chronic or long-term health challenges can affect you in myriad and hidden ways.
I am still very much coming to grips with my condition, but here are a few things I have learned so far.
Adaptability Is Key
Early on, when my reflux was rampant and before I knew that my underlying issue was SIBO, I felt unreliable as a singer. There was a time when I did not know if I would wake up and be able to phonate. Some days my cords felt fried, my high notes felt itchy to produce and sounded thin, and my low range was a crackly mess. Other days everything was fine, and I could perform at 100 percent. It was impossible to know what I’d be waking up to.
As a result, I withdrew from the performing world. I continued to work as a music educator and did a few choice performances, but I did not put myself out there and audition or compete the way I had the year prior. I simply did not feel I could trust my body to pull through. As my symptoms improved to manageable levels with my SIBO diagnosis and subsequent treatment, the reflux dissipated, and I slowly began reentering the performing and auditioning circuit.
My voice is once again strong and clear, but SIBO now impacts my singing in different ways. As with many who suffer from chronic conditions, fatigue and pain are frequent companions. Some days are good, but I’ve had to learn to really listen to my body and accept that how I’m feeling can change on a dime.
Though it’s a rare thing, some days I must decide that I am too tired or in too much pain to work. I still struggle with giving myself permission to make this choice—but on the days when I do make that call, it’s an important means of self-care that protects my body from further stress and symptoms. Learning to be flexible with the uncertainty is difficult work.
People Mean Well and It’s Maddening
When you are ill, everyone wants the best for you. They want you to feel well and get better. This is a great sentiment when you have the flu or a cold or a broken arm. When your condition is chronic, this gets a bit dicier. You learn to live with a new definition of normal, but that normal is often not feeling good.
The nature of my work as a private voice teacher and performer is that I meet with and greet many individuals each day. Each one asks, “How are you?” Many others also ask specifically how I am feeling or if I am feeling better. They mean well. They want me to feel better.
But often, I don’t. And I don’t want to dump my baggage on every person who walks in the door. I don’t want to be negative and I certainly don’t need to disclose everything with everyone. So, I instead opt for the more casual platitudes of “Good” or “Fine” or “Oh, you know, up and down.” But the cognitive dissonance of pretending to be fine or glazing over how I feel on repeat throughout the day feels disingenuous and is emotionally exhausting.
Get Educated and Then Get Out
When you are coming to terms with a chronic condition, arming yourself with knowledge is key. You need to find a good specialist, but the amount of interaction you will have with them is limited and expensive. Facebook support groups are an incredible resource and essential when you are getting your feet under you. There’s no better place to connect with fellow warriors who share your condition and learn about cutting edge or alternative treatment protocols. But these groups can also be a trap.
When I thought I had reflux, I made my way through various reflux and reflux diet support pages. When I received my SIBO diagnosis and had a positive upper GI response to treatment, I left the reflux groups and migrated to a host of SIBO support groups and groups for its related dietary treatment options. I researched relentlessly.
At first, it was necessary to get my bearings. But after a few months, my Facebook feed was overrun with posts about antibiotics, diet, and a demoralizing catalogue of symptoms. All my free time was being spent researching, reading, or responding.
Everyone on the forums was desperate for answers and suffering a lot. Scrolling through my newsfeed became a completely overwhelming and toxic habit. Finally, I had to put my foot down. I unfollowed and turned off notifications for all the SIBO-related groups. I kept my memberships open, however, so I can still periodically check in or ask a question when I need to.
The research is important, but don’t let it take over. Your condition is not the totality of your life.
You Need a Support Team
This goes for all areas of life, but it’s important to find your tribe. Through a few transparent social media posts I chose to make about my SIBO, to my surprise I was able to connect with three colleagues who also have SIBO.
One has been on the journey for several years and was able to offer an immense amount of experience and advice as I was sifting through treatment options. Another has had it for a middling amount of time and was able to connect me with an excellent specialist who has been a big help. The third lives across the country and has been sick about as long as me. We have a monthly facetime “coffee date” to share what new things we’re trying and what’s currently working for us, commiserate about symptoms, and just be friends.
Your Feelings Are OK
When you are diagnosed with a chronic health condition, there are going to be a lot of emotions you may not be prepared to face: grief, anger, anxiety, depression. These reactions are normal, and your feelings are valid. Coming to accept these feelings can be challenging, and recognizing that you can allow yourself to feel disappointed or sad is an important part of the process. But there’s also a line past which such feelings are no longer normative, and it can be tricky to recognize the signs when you’re in the thick of it.
I’ve always been a person who struggles with anxiety, and over the years I have developed a good support system of self-help tools, therapists, and occasional medication to manage it. But a year and a half into my health journey, things started spinning out of control. My emotions were all over the map. None of my coping mechanisms worked. I felt emotionally out of control.
It was right around this time that I started seeing a new therapist. Twenty minutes into our first session she asked if I’d ever considered an antidepressant. I laughed and told her that was ridiculous. I didn’t feel sad or lethargic—I was a person who had anxiety and my GI disorder was exacerbating everything.
But as I stepped back and looked at the broken pieces of my life at that moment, I realized she had a point. I decided to give it a try and started on a low dose antidepressant.
This was not an easy decision. I felt embarrassed even considering it initially. I thought that if I just had better control over my emotions or if I was stricter with my diet protocol, maybe I wouldn’t be feeling the way I was. This was, of course, all a false narrative. The antidepressant was one of the best decisions I’ve ever made.
Within weeks I was back to baseline. I really do feel like it gave me my life back. I am so grateful that I had someone in my life who recognized the signs and was able to point me in the right direction.
Give Yourself Time to Grieve
When you are encountered with a chronic health challenge, it is life-altering and there will be loss. Loss of the lifestyle you used to have, the ease with which you could do your favorite activities, the simplicity of attending social events with no extra considerations. Loss of not having to micromanage or optimize your schedule to protect your health. And, in my case, loss of the foods I used to enjoy and the ability to find “safe” foods outside of my home.
It is a major change in quality of life, and you will absolutely mourn the loss of what once was. In my desire to beat this thing, however, I never took the time to process my grief, and this contributed to a lot of the anxiety I was experiencing. Be gentle with yourself and give yourself the time and space to process the loss.
Make Time for Things that Bring You Joy
When you don’t feel regularly well, you are likely to feel like you don’t have the time or energy to do the bare minimum that is required of you, much less carve out space for extra things. And on some days or in some seasons, that will be a valid feeling that needs to be respected. But, for the most part, it is essential to carve out space for things that bring you joy. This can be something active like biking or long walks or skydiving—or something more contemplative like reading a book, knitting, painting, or having a good chat with a friend. It needs to be something that takes you out of your head and something that allows you to immerse yourself fully in the task at hand without thinking about anything else.
For me, this meant completely rearranging my work schedule this year so that I could attend a partner acrobatics class that I love. It wasn’t convenient, and some weeks I really am too tired or my symptoms are too severe and I need to stay home. But 95 percent of the time, I’m there, and it brings me joy. Particularly since chronic health conditions are so likely to lead to mental health challenges, being intentional about doing something for yourself that brings joy helps to create healthy mental pathways that will make you better able to cope with your illness.
Listen to Your Body
Whether conscious or not, most of us rely on a fair amount of outside input that shapes what we think, do, and feel daily. This can come from online sources such as our Facebook feed, a favorite blog, or Instagram, or through professional connections like trusted voice teachers, coaches, and mentors. Particularly in the performing arts, we’re often conditioned to care deeply about the opinions of others. When it comes to what you experience within your own body, however, the only person who can feel what is going on is you.
You need to develop your own metric for what is an acceptable level of discomfort and trust your own intuition on when it’s time to scale back. No one can determine when it’s time to take a break but you. Keep in mind that what feels right in April might be different in May. It’s important to learn to trust yourself without guilt and stick to your guns.
As I continue my health journey, many days are still a struggle. Each morning when I wake up, however, I hope to live with a little more grace, acceptance, and ease. I wish you well on your journey and hope that you surround yourself with people, places, and things that offer you support and love.