Modern audiences bring to the theater influences from the cinema, television and other pop culture. The tendency of artistic directors to hire for physical traits, as well as for vocal and musical abilities, is now common practice.
Training organizations stress physical as well as vocal development (many offer Alexander Technique, yoga, etc. as part of the curriculum). The deluge of advertisements for weight loss products and programs saturate our society.
One particular procedure getting enormous press lately is the Rouxeny gastric bypass surgery, popularized by the success stories of weatherman Al Roker or singer Carnie Wilson. I know first-hand that thousands of people have experienced life-changing results after having the surgery. This is a wonderful thing, but I am also concerned with the number of people rushing into this procedure before having tried all other means—and without understanding the impact it can have on both the body and voice.
Developing early in my “tweens,” during the “skinny ‘70s,” I did not develop a good body image. In my 20s, this image problem took the form of a “matronly figure,” and finally manifested into morbid obesity in my 30s. I have experienced first-hand the bias of the singing profession. Moving into stage directing later on, I still experienced a fair amount of bias from others in the business because of my size. I physically didn’t look like what my voice-type dictated.
I tried many diets, including Weight Watchers (with which many of my friends have had excellent success) and earlier on, The Diet Center. I also tried the prescription medication Xenical, which absorbs fat. Even at my heaviest, I still went to the gym regularly, but was not able to control my eating habits.
As Opera Director and Chair of Music Performance at a large, primarily undergraduate, music education school, my schedule was out of control. For several years, often I was at work for meetings by 9 a.m., teaching classes and private lessons the rest of the day, then in rehearsal from 6-8 p.m., followed by recital/performance attendance two-three times a week. Often I didn’t eat dinner until after 9 p.m. I had nothing that resembled a “life.”
The intense teaching and directing load really began to interfere with my singing. I was an active singer when I first began teaching college (I received an MM & GD in vocal performance from the New England Conservatory of Music, where I was a member of the opera theatre program under the direction of John Moriarty and participated in the Phyllis Curtin Seminar for Singers at the Tanglewood Music Center).
But something had to give. I was just not able to do so many things well. I felt I had to choose. Directing was something I was genuinely interested in, so I began giving more of my attention to it. To learn the ropes of directing, I worked as an Assistant Stage Director for Central City Opera for four summers and at Tanglewood (for the 50th Anniversary production of Peter Grimes). The combination of a full-time teaching position, plus the 8- to 10-week summer gigs gave me no downtime. Things were nonstop for me and honestly, I felt like I was running on anxiety more than real energy.
During a routine doctor’s visit, I asked her what she knew about gastric bypass surgery. She could not put the name and number of a surgeon in my hand fast enough.
“I was wondering when you’d ask about it,” Dr. Evelyn Weissman replied. “You’re the perfect candidate: you’ve tried other options and you’ll have no problems meeting the criteria for morbid obesity.”
“Morbid obesity.” That took awhile to (pardon the pun) swallow. I couldn’t possibly be heavy enough to qualify for morbid obesity. Sadly for me, I was not just morbidly obese, I was “extremely morbidly obese,” based on my BMI (body mass index). I obviously was in denial, and this was quite a wakeup call.
I made an appointment with Dr. Edward Hixson at the Adirondack Medical Center in Saranac Lake, N.Y. (about an hour from my home). He is part of a team of three surgeons at the hospital who specialize in bariatric surgery. The appointment was in early January 2002. From that date up until my surgery on June 18 of the same year, I underwent numerous tests and evaluations—including psychological, stress, a complete blood workup and a sleep apnea test, in addition to several office visits with the surgeon. After going through a good deal of education on the subject, nurse practitioner Karen Hixson gave me a “quiz” to determine if I understood everything I was getting myself into. (I passed.) I was also urged to read Barbara Thompson’s book, Weight Loss Surgery, and to visit her website.
“The purpose of the surgery is two-fold,” explains Hixson. “One, to restrict the amount of food consumed, and two, to reduce the absorption of carbohydrates and fats the body consumes.”
“The Rouxeny surgery involves two processes. The stomach is divided (either by cutting and sewing, or stapling) to decrease the size of the pouch, usually down to 1-3 ounces [in volume]. We then go down into the small intestine and bypass it up into the new pouch.
“The new stomach pouch and the remaining stomach section, via a connecting small intestine tract, are then reconnected lower, so that bile and pancreatic juices can mix with the food and pass on down through the remaining digestive tract.”
What everyone needs to understand is that this is major abdominal surgery! You will be intubated (see the Classical Singer March 2003 issue for an article on Intubation). Whether you have the open version of the surgery or the laparoscopic version will determine the length of your recovery. In addition to recovering from the surgery, you must deal with a new lifestyle and all the psychological effects that accompany it. The first several months can be difficult, as you learn how to deal with reprogramming your life.
In monthly support group meetings, I learned that everyone’s experience is different. Many go through a mourning period over the loss of their best friend (food) and a small percentage say they wish they had never had the surgery. It is not uncommon for some people to develop an intolerance to lactose, and almost everyone has to deal with “dumping syndrome” (caused when a person eats something with a high concentration of carbohydrates or fat, which move through the new digestive system like a freight train, causing diarrhea, vomiting, nausea, dizziness, cramping, extreme fatigue, or all of the above).
Even before I began thinking about the surgery, I was seeing a psychologist. After the surgery, when I was recovering at home, I had sessions via telephone. I had come to understand that I was eating for so many reasons other than nutrition. I feel this sort of emotional/psychological support is critical to longterm success.
Though many patients begin feeling great soon after they recover from the surgical procedure, I had problems with stamina for about the first six months. I would “hit a wall” and have to sit or lie down—even if I was in the middle of a rehearsal. Thankfully, I programmed a relatively “easy” scenes program for that semester, so when I had to stop, it didn’t hinder the overall production process. I honestly don’t think I could have handled a full production that semester.
I also lost my voice for about 10 days (I think due to a combination of the intubation and the number of visitors and phone calls). In about the fourth month, I started to lose my hair, but that only lasted for about 4 months. I was warned about this, but it was hard for me to deal with at the time.
I didn’t initially lose weight as quickly as others in my support group, but for the first 10 months, I steadily lost about 12 pounds a month, which since has tapered to about four pounds a month. I noticed that I would lose weight more towards the beginning of my menstrual cycle and then plateau for the rest of the month. The rapid weight loss at the beginning of each cycle was physically draining at times, but it also taught me a valuable lesson—I had to learn how to take time for, and care of, myself.
Getting back to singing
About nine months after my surgery I had found new energy. Prior to the surgery, I had lost interest in many things, including singing, and I was excited to get back into it again (though I did not have aspirations for igniting a professional singing career).
Losing more than 100 pounds makes a big difference in your lung capacity and how you support your physical structure. I was not prepared for how the changes in my body affected my singing.
At first, I tended to overblow, to force support and compensate with added tension in the neck and shoulder area. I also had difficulty coordinating the breath with articulation. I couldn’t believe how frustrating it was.
I worked with a close friend, Barbara Clark-Paver, an excellent voice teacher and colleague, who was positive, patient and very persistent about helping me correct the issues I faced. It is an extremely slow process, but I am working steadily towards getting back what I allowed to slip away over the last few years.
Looking back, I now wish I had not given up singing in lieu of other things, but it was a choice I made at the time in order to keep my sanity. My ambitions now are to enjoy singing and to make good music at a high level.
Is gastric by-pass surgery the answer to our obesity problems?
No. My fear is that too many people will opt for this solution before trying other means to lose weight. Gastric bypass surgery should be a last-ditch resort after all else fails. It is a drastic procedure that changes the structure of your digestive system for life.
After the surgery, you still have to commit to a healthful lifestyle. When you get off-track (and everyone does), you will pay for it via dumping, or vomiting, or both. The surgery is only a tool to help you achieve and maintain a healthy lifestyle; it is possible to regain the weight.
Aside from the initial recovery period, the loss of stamina, the incision healing (part of mine didn’t close at first and took eight weeks to heal), the hair loss and occasional vomiting from eating too fast or not chewing thoroughly, I can finally say now that I feel wonderful and have the energy to do all the things I want to do. I sleep better, have the stamina to get through each day, plus have time for myself (a new and wonderful concept). I also took significant steps to improve my teaching schedule (tenure helps). I look forward to doing lots of new things and feel more like “myself” than ever before. And my singing continues to improve!
Gastric by-pass surgery is a very personal decision that no one should be pressured into making. Do not accept advice from anyone (aside from your primary healthcare professional) that you should have the surgery. Even within the medical community, there is much debate over the issue, and some general practitioners still do not endorse the procedure. The most important thing: do your research before making this or any kind of major medical decision.
I now am 15 months post-op and have lost 136 pounds (my BMI went from a 52 to a 28.5), something that just over a year ago I would never have believed possible. I’m proud of my accomplishment and feel comfortable in my own skin, but I struggle with the issue of how I allowed myself to get to a place where I was so physically uncomfortable and not able to function the way I wanted to.
People of all sizes grace our profession and I hope that what will continue to matter in the end is the quality and integrity of the music created, rather than the perceived glamour or sensation of the business.
If you are considering gastric by-pass surgery, you need to:
• Be at least 100 pounds overweight (or have other serious medical conditions, such as diabetes, a frequent companion to obesity).
• Have honestly tried other forms of healthful weight loss under a doctor’s supervision.
• Seek pre-approval from your medical insurance carrier (you may have to deal with appeals) or pay anywhere from $18,000-$30,000.
• Have a support group of friends and family who will help and support you during the process, as well as an official support group to attend (usually once per month).
• Be completely ready to make lifelong changes in your daily routine.
Once you have the surgery, you must commit to:
• Drinking at least 48 oz. of liquid (half of which needs to be water) everyday.
• Attempt to consume 60 grams of protein everyday (though nutritionists will argue with this—they can endorse anywhere from 30-80 grams/day, depending on your physical activity.
• Taking a regimen of vitamins (multi-vitamin, iron, B-12 and calcium) everyday for life.
• Eating very slowly and chewing each bite thoroughly (not always easy when eating out or with a group of friends).
• Exercise regularly.
Problems that can occur from having the procedure include:
• Staple popping, making the new pouch larger.
• Bypass incision leaking.
• Dumping syndrome.
• Vitamin/nutrient deficiencies.
• Excessive skin sagging (apron area, breasts, underarms, neck). Many find it necessary to have the excess skin removed surgically a few years after their weight stabilizes.
• Difficulty in adjusting socially to others’ eating habits (as well as others having difficulty adjusting to the “new you.”
• The change in the absorption rate can result in developing gallstones (many, like me, opt to have their gall bladder removed during the bypass surgery, to avoid another surgery later on.)
• Hair loss, from the trauma of surgery combined with the large decrease in calories consumed (usually starts to happen anywhere from four to eight months post-op. It will grow back!)
• Financial burden of replacing your entire wardrobe, more than once over the course of an 18-month period (I bought a few cheap staples that could easily be altered, then would buy it again later in smaller sizes).
Resource Information
http://www.wlscenter.com (you can order Barbara Thompson’s book, Weightloss Surgery, here).
http://abcnews.healthology.com/focus_article.asp?f=beyond_dieting&c=obesitysurgery2#Introduction Excellent article on the procedure by Dr. Elliot Goodman.
http://www.niddk.nih.gov/health/nutrit/pubs/gastric/gastricsurgery. html
Information on calculating your body mass index can be found in numerous places on-line. One choice is http://www.integrarx.com/bmi
