Singing with Chronic Health Challenges
BSR welcomes guest author and soprano Kim Lamoureux to share her experiences battling a chronic health condition as a singer.
It all started with heartburn.
It was a muggy spring day, and I was on my way to a dance competition in my role as vocal coach for the musical theater team. 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.
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. It felt like I was dying. I realized that I was suffering from that malady which all singers dread: acid reflux.
I immediately and radically adjusted my diet, lifestyle, and eating schedule. My symptoms got worse. I took over-the-counter acid reducers. They didn’t help. Several months, specialists, and PPIs later, I was on a highly restrictive low fat/low acid diet, operating within the framework of a strictly timed schedule for my meals and daily activities, and experiencing a host of increasingly disruptive GI symptoms. Despite the specialists and the restrictive diets, my symptoms kept getting worse and nothing made sense. Finally, almost one year after that fateful heartburn-filled day, I was diagnosed with Small Intestine Bacterial Overgrowth (SIBO).
I eagerly seized my new diagnosis and went at it full tilt. I took conventional antibiotics (the standard first course of treatment), herbal antibiotics, and supplements. I radically changed my diet, again. The acid reflux symptoms decreased by about 75%. Finally, progress! I was able to come off of 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. And again. I saw more specialists. My symptoms improved somewhat, but not enough. I researched SIBO relentlessly. I had more and more questions and precious few answers.
It’s been one year since my SIBO diagnosis, and two years since my symptoms started. I’m relieved that I (mostly) no longer experience acid reflux, but the GI issues remain. The more I research, the more I have had to swallow the bitter pill that this condition is most likely chronic.
As singers, we are taught from very early on that our body is our instrument. 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, best preparation, best willpower, best hope?
Whether you have an autoimmune disease, chronic migraines, depression, anxiety, diabetes, chronic lyme, or IBD, chronic or long term health challenges affect us in myriad and hidden ways.
I am still very much coming to grips with my condition, and am quite new along the journey, but here are a few things I have learned so far.
LESSON #1 Things Change
Early on, when my reflux was rampant and before I knew that my underlying issue was SIBO, I felt unreliable as a singer. I literally did not know if I would wake up and be able to phonate the next day. As a result, I entered what I know view as my “hidden time.” I withdrew from the performing world. I continued to work as a voice teacher and 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, I slowly began reentering the performing and auditioning circuit. I’ve had to learn to really listen to my body, and accept that how I’m feeling (and thus able to function) can change on a dime. Sometimes I am able to ramp things up, and other times I need to scale back. Unfortunately, I can’t plan for or control that. Accepting this is important and difficult work.
LESSON #2 People Mean Well, And It’s Maddening
When you are ill, everyone wants the best for you. They want you to feel well, to 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 more dicey. 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?”, the standard American greeting. 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. 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 (nor is it appropriate to do so). So I instead opt with 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 is emotionally exhausting and feels disingenuous.
LESSON #3 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 have with them is limited and expensive. In this day and age, 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 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 jumped ship on 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 symptoms. All of my free time was being spent researching, reading, responding. Everyone on the forums was desperate for answers and suffering a lot. Scrolling through my news feed became a completely overwhelming and toxic habit. Finally, I had to put my foot down. I unfollowed and turned off notifications for all of the SIBO-related groups, though I still remain a member so I can periodically check in or ask a question if I need to.
The research is important, but don’t let it take over. Your condition is not the totality of your life.
LESSON #4 You Need A Support Team
This goes for all areas of life, but it’s important to find your tribe. As mentioned in Lesson #3, Facebook groups can be immensely helpful, but can also lead to toxic navel-gazing and despair. 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. One 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 in another state and has been sick about as long as me. We have a monthly Facetime coffee date to share what new things we’re trying, what’s currently working for us, commiserate about symptoms, and just be friends.
Each person has played an invaluable role on my health journey, and I don’t know where I would be without them.
LESSON #5 Your Feelings Are OK, And You May Need Medication (and that’s OK too)
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. It’s OK to feel depressed and discouraged, anxious, angry, uncertain, disappointed. 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, and I didn’t recognize myself.
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 somewhat 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 this way. 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 who recognized the signs and was able to point me in the right direction.
An estimated one third of individuals with chronic health conditions also suffer from depression, and anxiety doesn’t far fall behind. (Cleveland Clinic, Web MD). If you are feeling unlike yourself or struggling to cope, don’t be afraid to reach out for help.
LESSON #6 Give Yourself Time To Grieve
This is one that I am only just now beginning to unpack and process.
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. However, in my desire to BEAT THIS THING, to push through, to fight, to conquer, 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 let yourself process the loss.
LESSON #7 Make Time For Things That Bring You Joy
When you don’t feel well on the regular, 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 actually be a valid feeling that needs to be respected (see Lesson #8). 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. Netflix doesn’t count.
For me, this meant completely rearranging my work schedule this year so that I could attend a partner acrobatics class that I love. It definitely wasn’t convenient, and some weeks, I really am too tired or my symptoms are too severe and I need to stay home (see #8). But ninety-five percent of the time, I’m there, and it brings me joy every. single. time. Particularly since chronic health conditions are so likely to lead to mental health challenges (see #5), 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. It might feel inconvenient, but it’s essential.
LESSON #8 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, both in our personal and professional lives. However, the only person who can feel and understand what is going on inside your body is you. You need to develop your own metric for what are acceptable levels of discomfort, and trust your own intuition on when it’s time to scale back. At the end of the day, no one can determine when it’s time to take a break but you, and what feels right in April might be different in May (see lesson #1). It’s important to learn to trust yourself without guilt, and stick to your guns.
As I continue on my health journey, most days are still a struggle. However, each morning that I wake up I hope to live with a little more grace, a little more acceptance, a little more love, and a little more 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.
Kim Lamoureux, soprano is a North Shore based educator and performer. Praised for her “clarion upper range and delicate tone,” she has performed with many companies across New England, including Odyssey Opera, Cape Symphony, Juventas New Music Ensemble, Opera51, and The Savoyard Light Opera Company. Kim currently teaches voice privately and at Brookwood School, and is a former Board member of the Boston Chapter of NATS. Kim is also the co-founder and Artistic Director of Rising Stars Productions, a performing arts company offering musical theater youth summer camps. Read more about Kim at https://www.kimlamoureux.com/.