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!

But there’s no question, when the concert is re-created next year as part of the Kennedy Center’s tribute to the 50th anniversary of Kennedy’s inauguration, about who will represent Casals. When there’s a commemorative event that calls for classical music, Yo-Yo Ma is almost sure to be the person playing it.

In every generation, a few musicians reach a level of fame that takes them into an orbit beyond their art. They become iconic, like Pavarotti; they become spokesmen, like Bono; they come, at the very least, to represent their field to a wider public.

Ma, 54, has certainly reached this level. He’s one of the most recognizable classical musicians on the planet. Extroverted and smart, he’s a natural spokesman for the arts. It’s almost a matter of course that he represents classical music on the President’s Committee on the Arts and the Humanities and is a U.N. peace ambassador.

Ara Guzelimian, dean of the Juilliard School and former artistic adviser for Carnegie Hall, has known Ma since the 1970s. “I think in Yo-Yo’s case,” he says, “all of the things he does and his public role have helped keep reinventing him as a musician. That’s not only kept him alive, but fresh.”

“I just finished playing a bunch of recitals with him,” said pianist Emanuel Ax, one of Ma’s earliest and most frequent collaborators, speaking by phone last week from Europe. “I think he’s playing better than he’s ever played.”

If Ma weren’t a cellist, he could be a world-class politician. His gift for connecting with people is stunning. Some stars have a presence that commands attention; Ma, by contrast, makes you feel like his best friend, whether you’re an orchestra musician, one of the backstage crew or the owner of the restaurant Henrietta’s Table in Cambridge, a town where he and his wife, Jill Hornor, a German professor whom he met as a teenager at the Marlboro music school in Vermont, have lived for decades.

By Anne Midgette
Washington Post Staff Writer
Sunday, March 14, 2010 (excerpted)

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

This morning I had the distinct pleasure of spending a morning in a wonderful workshop at the U of L School of Music, listening to and learning from Dr. Clive Robbins, who has spent his life working with handicapped children and using music therapy to transform their lives. If you’re interested in learning more about him and his work with Paul Nordoff, go to http://www.nordoff-robbins.org.uk/

Surgical Headphones FAQ

–A. Wrubel, R. Gilbert

“Do-wah diddy-diddy dum diddy-do …”

–The Moffats

“Super-cali-fragilistic-expialidocious …”

–The Sherman Brothers

“What an odd thing it is to see an entire species–billions of people–playing with, listening to, meaningless tonal patterns, occupied and preoccupied for much of their time by what they call ‘music.”‘

–Oliver Sacks, Musicophilia

“Music is playing inside my head, I Over and over and over again, My friend, there’s no end to the music …”

–Carole King

Throughout human history and in all known cultures, people have been immersed in music. Humans passionately create, listen to and dance to it. We Americans, most of whom have no particular musical talent, spend hours daily listening to music on car radios and MP3 players, and as background in offices, homes, TV shows and movies.

The fact that music is such an integral part of being human raises intriguing questions, some of which are relevant to MS. Does the brain have specific regions that respond to music? Could people who have conditions that affect the brain, such as MS, obtain therapeutic effects from music?

The neuroanatomy of music

Music is experienced through the simultaneous activation of a remarkable number of brain regions. Listening to music involves two major processes–perception and emotional response. Through perception we recognize music’s physical characteristics–the rhythm, harmony and tone. Our emotional response evokes feelings–sadness, happiness, relaxation and more. The two processes, perceiving and feeling, activate multiple brain regions that are interconnected through complex and vast networks. They range from the front of the brain (frontal lobes) to the back (cerebellum), from top (motor cortex) to the bottom (amygdala), and from outer surface (auditory cortex) to the inner core (nucleus accumbens and hippocampus). Creating or dancing to music activates an even greater number of brain regions.

Importantly, perceiving and feeling music are two distinct processes. For example, there are people who are gifted at perceiving music, such as those with absolute pitch, but who are indifferent to its emotional effects. The reverse is true as well (and is more common)–there are many people who have little or no musical talent, including those who are tone-deaf, who are passionate about music. In other words, you don’t need to be musical to be strongly affected by music and potentially to benefit from its therapeutic effects.

Why do we like music?

“I know it’s only rock ‘n’ roll but I like it, like it, yes I do …”–The Rolling Stones

The widespread activity in the brain that music arouses suggests that music serves a critical role in human existence. Some have proposed that music actually preceded language in human evolution, thus making it a core characteristic or instinct. There is considerable evidence that music is involved in sexual attraction, especially for men trying to attract women. (However, playing the clarinet in my high school band didn’t seem to make me a chick magnet.) Music may, in a more general sense, promote social bonding and may also be important for cognitive development.

Music as medicine: studies in MS and other conditions

“‘Cause music’s been my therapy, Taking the pain from all my anatomy …”–Marvin Gaye

“Music is the medicine of the mind.”–John Logan

It is thought that music may act as a sort of tonic or jump-starter to activate or improve neurological function. MS may be particularly well-suited to respond to music therapy. Each person with MS has a unique collection of brain lesions that produces a unique collection of symptoms.

Music may be capable of accessing diverse brain regions in an individualized way.

Researchers have studied music therapy in MS and other neurological conditions, but most of the studies done so far have had limitations, such as small numbers of participants. Even so, it appears that music might alleviate a remarkably wide range of MS-related symptoms:

* Stress (music may be combined with other relaxation strategies-see Summer 2009 Momentum)

* Emotional problems such as anxiety and sadness, and difficulties with self-esteem, self-acceptance and coping

* Cognitive issues, including problems with memory, speech, or communication

* Weakness, poor coordination and walking difficulties

* Pain

To determine whether music therapy has definite therapeutic effects in MS, larger and more rigorous studies are needed.

What can you do now?

Music therapy is generally safe. The only precaution is that excessive noise (greater than 90 decibels) may increase blood pressure and impair hearing. Although studies of music in MS are limited at this time, music is readily available, and for those who are interested, it is certainly a reasonable approach to try. Music may be pursued on one’s own or by consulting a professional music therapist.

Examples of approaches to try on your own include:

Listening

* Although many people listen casually, it may be helpful to be more thoughtful about the types of music one chooses and to be more attentive to them.

Creating music

* Play an instrument.

* Make simple movements, such as tapping a drumstick, along with music.

* Join a chorus or choir.

* Even if you’re not musical, have a jam session with friends.

Moving or dancing

* Take dancing lessons.

* Just dance or move parts of the body to music.

Additional Information

Two outstanding lay books on music and the brain have been published recently:

* Musicophilia, by Dr. Oliver Sacks (New York: Alfred A. Knopf, 2007).

* This Is Your Brain on Music, by Dr. Daniel J. Levitin (New York: Penguin, 2006).

by Allen C. Bowling, MD, PhD

Suzanne Darley, MA, REACE, reviewed and provided valuable input to this article.

Dr. Allen C. Bowling is the medical director of the Multiple Sclerosis Service and director of the Complementary and Alternative Medicine Service at the Colorado Neurological Institute. He is also clinical associate professor of Neurology at the University of Colorado-Denver Health Sciences Center and author of Complementary and Alternative Medicine and Multiple Sclerosis (2nd edition, Demos Medical Publishing). For more on CAM, visit his Web site, NeurologyCare.net.