Music and medicine are deeply connected. But what kind of music should your surgeon really be listening to?

BY RAHUL PARIKH

iStockphoto/lisagagne/Salon

PopRX is a new weekly column about the intersection of pop culture and medicine.

In 1889 Nietzsche wrote, “Without music life would be a mistake.” As someone who regularly spends a chunk of change on Radiohead and Bright Eyes, I completely agree. I’m not the only doctor who finds nirvana in Nirvana. There’s a reason hospital dramas always feature surgeons listening to — and arguing about — music in the operating room. It’s because music and medicine are deeply connected.

The fascinating links go back as far back as ancient Greece. Apollo, the God of healing, was often depicted with a harplike instrument called a lyre. Some doctors have doubled as musicians. In the 1950s, a group of doctors at the Mayo Clinic started the Notochords (named after the primitive spine in a developing fetus), playing with Duke Ellington and Jack Benny. More recently, NPR ran a story about an orchestra of doctors from Albert Einstein Medical Center in New York.

Surgeons have a particularly profound relationship to music. As Siddhartha Mukherjee noted in his book “The Emperor of All Maladies,” music and medicine “go hand in hand. Both push manual skill to the limit; both mature with practice; both depend on immediacy, precision and opposable thumbs.” A 2008 study, in fact, tested whether musical prowess has any impact on performance during laparoscopic procedures (special scopes that surgeons use to perform minimally invasive procedures). Non-surgeons who had experience playing music performed better at suturing using this equipment than did non-musical participants. There’s perhaps no better example of the facility of the musician-surgeon than Theodor Billroth, a 19th century virtuoso who pioneered surgical techniques to dissect abdominal tumors from the body and whose talent on violin and piano forged a close friendship with Brahms.

But surgeons don’t have to play instruments to enjoy music in the operating room. It’s a regular, enjoyable part of the daily routine and one way a surgeon creates a comfortable atmosphere in a sometimes tense setting. Atul Gawande, contributor to the New Yorker and author of “The Checklist Manifesto,” operates to Modest Mouse, Arcade Fire, the Decemberists and other alternative bands. (He does own a Fender ’62 Stratocaster replica at home, but he says he’s rusty.)

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Salon.com The truth about music in the operating room 3/8/11 11:29 AM

So is operating to music a good idea? Lest you go into a panic the next time you hear Lady Gaga while they’re administering the laughing gas, the answer seems to be yes.

It’s a bit of a tricky thing to prove. It’s far from ethical to take a group of surgeons and measure their performance on and off music while they cut into real patients. But studies have offered some insight into the effects of music on surgical performance. One is from the Journal of the American Medical Association and dates back to the grunge rock era, 1994. In this study, researchers took 50 surgeons and measured blood pressure, heart rate and other physiological markers while they performed a series of subtraction problems. Each volunteer performed this task while listening to self-selected music and, later, music selected by the researchers (“Pachelbel’s Canon in D,” which is supposedly included in a lot of “stress reduction” musical compilations).

It turns out that when surgeons listened to music of their own choosing they had very steady vital signs and performed the subtraction task better than when they listened to Pachelbel. That’s encouraging, though it’s important to note that the surgeons who participated listened to music regularly both in and out of the operating room. So if you’re a surgeon and you think investing in an iPod will make you better with a scalpel and sutures, first ask yourself whether you care for music to begin with.

What about the rest of the operating room team? Anesthesiologists are, of course, indispensable to surgery. Does music help or hurt them? In a study out of the U.K., where 70 percent of anesthesiologists say they’ve been subjected to music in the operating theatre (as the Brits call it), 63 percent of those surveyed said that they enjoyed the sounds of music while they worked. Those in another survey who did not said it was because they felt music reduced their vigilance and impaired communication with other staff members. Not surprisingly, the most distracting tunes were ones they hated the most. On the other hand, another study contradicted any deleterious effect of music on anesthesiologists’ performance: That study measured psychomotor performance, and it didn’t change when subjects were listening to self-chosen music, Pachelbel, white noise or no music at all. Finally, surveys of other O.R. team members (nurses, techs, etc.) indicate that music enhances teamwork and communication among members, though, again, most of those surveyed listened to music regularly on their own time.

The next logical question to ask is: What kind of music should your surgeon be listening to while he or she closes your grapefruit of a hernia or bypasses your clogged coronaries? A study from 1976 suggested that rock (sorry, disco), with its varying rhythm and intensity was best. Other surveys have shown that the preferred genre in the operating room is classical, followed by folk, rock, jazz and blues. But, like the JAMA study I mentioned above, most studies hint that music’s positive effects have more do with the personal preference of the surgeon or the O.R. team than any particular genre of it.

A couple of last points: First, there is a body of evidence that music also helps patients going to surgery, including reducing anxiety before and after an operation; it may help patients cope better with pain, leading to their requiring less pain medicine. Finally, here’s an interesting B-side to this story: Take a listen to a 2001 album called “A Chance to Cut Is a Chance to Cure” by a San Francisco music group named Matmos. The two members of the group, Drew Daniel and Martin Schmidt, took their recording equipment to the hospital and sampled the sounds of surgery, creating electronica out of them. Highlights include “California Rhinoplasty” and “Lasik.” Let the sounds of cauterized flesh and dripping anesthetic be music to your ears.

– Rahul Parikh

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 More and more people are hearing about our Surgical Serenity Headphones and choosing to use them.  People remember reading about them and know  that they will use them if they are told that they need surgery.  That’s exactly what happened with a customer today and she  will be “practicing” with them over the next few weeks so that she automatically relaxes and calms down when she hears this particular music.

For people who don’t happen to live in Louisville, KY, they are readily available online!  Surgical Serenity Headphones are also being test and several key hospitals around the country and just this week I talked with two more hospitals about research and testing.  There are so many interesting studies that people people are devising for me; studies that look not only at the headphones ability to decrease the amount of pain medication, but also comparing our headphones to acupuncture, and another looking at whether people wearing our headphones and listening to our proprietary music perhaps leave the hospital sooner, thus getting back to their homes and lives sooner as well as allowing the hospital to see more patients.  Lots of good information to be gathered.

As a matter of fact, I’ve sold so many lately that my inventory is getting low so I’ll be ordering another 100 or so soon.  The price on the new ones may have to go up so if you want some, now would be an excellent time!  Surgical Serenity Headphones.

We’ve known for a long time that listening to calm, comforting, soothing music before surgery could do the same thing as the drugs that are now given…and without the risk of adverse reactions or overly and unnecessarily sedating the patient.  Today another study appeared also documenting this! 

Biol Res Nurs. 2011 Jan 28. [Epub ahead of print]

Evidence That Music Listening Reduces Preoperative Patients’ Anxiety.
Lee KC, Chao YH, Yiin JJ, Hsieh HY, Dai WJ, Chao YF.

Abstract
Background: Patients often exhibit preoperative fear and anxiety that may influence the process of induction and recovery from anesthesia. Music is thought to be an alternative to medication for relief of fear and anxiety. Objectives: The purpose of the present study was to explore the feasibility of using heart rate (HR) variability (HRV) for evaluating the efficacy of music listening to relieve the patients’ anxiety during their stay in the operation room waiting area and to compare the HRV measures with subjective Visual Analogue Scale (VAS) scores. Methods: In total, 140 patients were randomly assigned to the experimental (n = 64) or control group (n = 76). The intervention consisted of a 10-min period of exposure to relaxing music delivered through headphones. Anxiety levels were measured by VAS (a 10-point scale) and 5 min of HRV monitoring before and after the music intervention. Results: The music group demonstrated significant reductions in VAS scores, mean HR, low-frequency HRV, and low- to high-frequency ratio and an increase in high-frequency HRV, while patients in the control group showed no changes. The subjective results of patients’ VAS anxiety scores were consistent with the objective results of HRV parameters. Conclusions: Listening to music can significantly lower the anxiety levels of patients before surgery. The frequency-domain parameters of HRV can be indicators for monitoring the change in anxiety level of preoperative patients.

So you’ve just found out that you need to have surgery? It’s always a shock to find that you need surgery and people are filled with apprehension, if not fear. The biggest fear of course is always: what if I don’t wake up? Statistics tell us that the vast majority of people do wake up after surgery but the risk is there. One of the biggest unknown factors is anesthesia and how a patient will react and respond. There’s been a lot in the news recently about “anesthesia awareness” and people who say they felt every part of the surgery and heard all the conversations, but were simply paralyzed by the anesthesia and could not let anyone know.

Of course this is terrifying but it happens so very rarely that it doesn’t justify cancelling the surgery or even losing sleep. The thing is, more anesthesia is definitely not the solution. What you want is actually the least amount of anesthesia that will sedate you and keep you comfortable during the procedure. This might be a regional anesthesia and it might be a local anesthesia. It doesn’t have to be a general anesthesia.
One of the things that can help lessen the amount of anesthesia that you need is the addition of music to the procedure. There is ample research now showing that listening to calm, soothing music before, during and after the procedure can decrease the amount of anesthesia needed, in addition to decreasing pain meds requirements afterwards and anxiety meds before. So how do you make that happen?

• One of the first things you want to do is start thinking about the kind of music that relaxes, calms and soothes you.
• If you have a playlist of this music that you’ve created you can put it on your iPod or an Ipod shuffle.
• The next thing is to tell your surgeon that you’d like to take some soothing, relaxing music into the procedure with you.
• If the doctor says you’ll be asleep and won’t hear it, you can assure him that you just want to have it playing subconsciously and you also want to make sure you don’t hear any of the surgical sounds or conversations.  (Certain procedures require sawing, drilling, hammering, etc.)
• If necessary you can purcahse a new MP3 player to avoid introducing any germs into the operating room.
• OR, you can use the Surgical Serenity Headphones which are pre-programmed with the ideal slow, steady, soothing music for surgery.  These are being used at hospitals across the U.S. and have not been to any patient by a surgeon or anesthesiologist.
• If you take your own iPod, you might want to have 3 separate tracks for pre-surgery, surgery and recovery.  Ideally, the music for surgery is the slowest tempo and is purely instrumental.  The music for the recovery room should be a little more up-tempo and can have words or lyrics that are very positive.  The headphones are already programmed with music for all three phases of the procedure.

If you have any questions at all about the procedures and how to best start them for youself, feel free to contact me through this blog and I will get back to you!

Introduction
Colorectal cancer is cancer of the colon or rectum. It is equally common in men and women. An estimated 146,970 people will be diagnosed in 2009, and an estimated 49,920 people will die from the disease. With recommended screening, this cancer can be prevented (by removing polyps before they become cancerous) or detected early, when it can be more easily and successfully treated.

At Risk

•Men and women age 50 and older
•People who use tobacco, are obese or are sedentary
•People with a personal or family history of colorectal cancer or benign (not cancerous) colorectal polyps
•People with a personal or family history of inflammatory bowel disease, such as long standing ulcerative colitis or Crohn’s disease
•People with a family history of inherited colorectal cancer
Risk Reduction

•Be physically active and exercise regularly.
•Maintain a healthy weight.
•Eat a high-fiber diet rich in fruits, vegetables, nuts, beans and whole grains.
•Consume calcium-rich foods like low-fat or skim milk.
•Limit red meat consumption and avoid processed meats.
•Don’t smoke.
•Don’t drink alcohol excessively.
Early Detection
If you are at average risk for colorectal cancer, start having regular screening at age 50. If you are at greater risk, you may need to begin regular screening at an earlier age. The best time to get screened is before any symptoms appear. Use this guide to help you discuss screening options with your health care professional. Consider one of the following:

Screening intervals for tests that find pre-cancer and cancer:

•Colonoscopy: Every 10 years
•Virtual colonoscopy: Every 5 years
•Flexible sigmoidoscopy: Every 5 years
•Double-contrast barium enema: Every 5 years
Screening intervals for tests that mainly find cancer:

•Fecal occult blood test (FOBT): Every year
•Fecal immunochemical test (FIT): Every year
•Stool DNA test (sDNA): Ask your health care professional
Any abnormal result of a virtual colonoscopy or double-contrast barium enema, as well as a positive FOBT, FIT or sDNA test, should be followed up with a colonoscopy.

Symptoms
Early stages of colorectal cancer do not usually have symptoms. Advanced disease may cause:

•Rectal bleeding or blood in or on the stool
•Change in bowel habits or stools that are narrower than usual
•Stomach discomfort (bloating, fullness or cramps)
•Diarrhea, constipation or feeling that the bowel does not empty completely
•Weight loss for no apparent reason
•Constant fatigue
•Vomiting
Treatment
Surgery is the most common treatment. When the cancer has spread, chemotherapy or radiation therapy is given before or after surgery.

During this very important month for screening and awareness, Peter Yarrow of the 60′s-70′s group “Peter, Paul and Mary,” wrote this humorous song about getting a colonoscopy. Hum it to yourself this month and then ask yourself if it’s time for YOU to get a colonoscopy!

For as long as humans have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting their spirits and — as new research shows — calming their nerves. Literally. According to a study at Cleveland Clinic, music can slow the neuronal firings deep within the brain during surgery designed to treat Parkinson’s patients.

The seeds of this study were planted about two years ago, when a patient named Damir Janigro was being prepped for spinal surgery. Janigro, who is also a neuroscientist at the clinic, lay captive to the nerve-racking din of the operating room and in his frazzled state thought about how dentists often give their patients earphones to help ease anxiety. (See the top 10 medical breakthroughs of 2008.)

If people getting root canals merited a musical intervention, he thought, why not people undergoing brain surgery? Patients with conditions such as epilepsy, brain tumors, severe depression, and obsessive-compulsive and motor disorders like Parkinson’s have to be awake for surgical procedures that often take several hours. Janigro and his team decided to use that wakeful period to determine whether music made the subjects’ experience in the operating room less stressful.

He will present his findings on Oct. 30 as part of a symposium in New York City on music and the brain. The son of a world-renowned cellist, Janigro specializes in studying epilepsy and is associated with Cleveland Clinic’s Arts and Medicine Institute, which is working to advance our understanding of how music can do such things as help decrease pain and blood pressure and improve movement in Parkinson’s patients.

The medical community has long been interested in how the brain is affected by music. Historically, however, most research was linked to the cortex, the brain’s outer layer, which is associated with functions like memory, consciousness and abstract thought.

In those studies, neurosurgical patients, wide awake with their cortex exposed, listened to certain sounds and music. While their neural activity was being recorded, they told researchers how those selections made them feel.

Janigro wanted to perform similar studies on motor centers deep within the brain. Because music is often associated with movement — like tapping one’s feet — he theorized that music could be used to modify the activity of thalamic and subthalamic neurons, which are located in the same area where a neuronal pacemaker is implanted during deep-brain stimulation.

In Janigro’s study, more than a dozen neurosurgical patients, predominantly with Parkinson’s, listened to three musical selections — rhythmic music with no discernible melody (by Gyorgi Ligeti, of Stanley Kubrick–movie fame), melodic music with undefined rhythm (by Aaron Jay Kernis, a Pulitzer Prize winner) and something in between (Ludwig van Beethoven). In the later stages of the research, to prevent familiarity from swaying the subjects’ responses, music was specifically composed for the study by students from the Cleveland Institute of Music.

In the end, patients almost unanimously said the purely melodic offerings were the most soothing. But the recordings of their brain activity were eye-opening. (Read “The Year in Medicine 2008: From A to Z.”)

Listening to melodic music decreased the activity of individual neurons in the deep brain, says Janigro, adding that the physical responses to the calming music ranged from patients’ closing their eyes to falling asleep. Some patients even settled into a nice round of snoring. And when lead neurosurgeon Ali Rezai needed patients to perform an action, such as lifting a limb, during the procedures, he simply removed their earphones and relayed instructions. Once the music resumed, patients returned to their snoozing.

These are very desirable results, says Janigro. With the right music, he says, patients can be more relaxed in the operating room. And that relaxation may mean not only that procedures involve less medication — to control blood pressure, which increases with stress — but perhaps that patients have quicker recovery times and shorter hospital stays.

Janigro anticipates that following institutional approval, music will be used during certain neurosurgical procedures at the clinic as early as 2010. He hopes other hospitals will soon follow Cleveland’s lead. “This type of surgery can be a traumatizing experience, and using music can decrease anxiety,” he notes.

And you can’t beat the cost.

With health-care expenditures through the roof, this patient benefit is practically free, says Janigro, who used his own iPod and that of a colleague’s to pump in the music for the study. “The clinic doesn’t have a budget for iPods yet, but soon I think we will. It’s a no-brainer,” he says. “There’s nothing more calming than sleep.”
By Coeli Carr