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Waking the Spirit

I just finished an inspiring book called Waking the Spirit. The author Andrew Schulman is a musician who nearly died in July, 2009. At age 57, a CT scan revealed what appeared to be pancreatic cancer. After undergoing an operation to remove the cancer,  the surgeon informed Schulman’s wife Wendy that the mass was found to be benign. But soon after receiving this good news, Schulman suddenly went into cardiac arrest. A blood transfusion had caused anaphylactic shock. On the 3rd day, Schulman was in the intensive care unit (ICU), Wendy began to wonder if her husband had lost his will to live. She told the ICU physician “if there’s one thing I know about my husband, it’s that he loves music more than anything else. It’s his passion. . . At this point music is the only thing that could get through to him.” With the physician’s permission, she inserted one earbud into her right ear and the other earbud into Schulman’s left ear. She then played his favorite piece, Johann Sebastian Bach’s St. Matthew Passion. Schulman writes that

Bach’s music began spinning into our ears. Ninety seconds after the flutes and oboes began playing that mesmerizing melody, slowly lifting ever upward, the voices entered, floating heavenward ‘Come, ye daughters, help me lament, Behold? Whom? The Bridegroom. Behold him! How? Like a lamb. Behold! What? Behold his patience. Behold!’ As the chorus sang, my bride was sitting with her face inches from her bridegroom, sharing the music that was bonding us together in the darkest moment of our lives. Bach’s masterpiece, some of the most glorious music ever written, tells a story centered on the most basic of human emotions: love, hate, betrayal, and redemption. . . . The music reached me.

Soon afterward Schulman’s vital signs began to improve. By the next day, the ICU physician felt that he was “out of the woods.” The nurses who cared for him later called it the St. Matthew Miracle.

After recovering, Schulman was inspired to use his musical talents to help other people likewise afflicted by illness. Six months after his own hospitalization, he returned to Beth Israel Medical Center to play the guitar for patients in the ICU. Soon he became a fixture there, integrating his own mode of healing with the rest of the care team.

The rest of Waking the Spirit consists of stories in which Schulman’s music played an important role in patients’ recoveries. Along the way, I learned more about the history of music in medicine and field of music therapy. In the end, Schulman’s service to others generated his own recovery. Due to the brain injury from his cardiac arrest, Schulman discovered that after his hospitalization, he could no longer memorize music. Then one day, he “awoke to a strange sensation in my head. It literally felt as if my brain was tingling.” He suddenly began to be able to play music by memory again. When Schulman presented his case to a neuroscientist, he was told his work in the ICU was the best possible type of rehabilitation for his injured brain. The researcher told him that

I think by committing yourself to playing in the ICU you forced your brain to rewire. The consistent and deliberate exercise every day of what you had to do to become what you call a medical musician, the constant auditory attention, the intense thinking as you watched the patients’ responses and the changes, or lack of changes, in the vital signs monitors over their beds, your constant awareness of all the sounds surrounding you so you could be attuned to other needs should an emergency arise, and, very importantly, making sure all your fine motor functions were at their best to guide you in making soothing and healing music for your patients–all these factors combined to force different parts of your brain to make new connections to each other. . . You did repair your own brain and gave yourself an upgrade at the same time.

Schulman writes that “I’d gone back to the ICU to avoid survivor’s guild and to give thanks for a great gift after having my life saved. I stayed because I found I loved this new experience of helping and healing others through music. I wound up healing myself as well.”

Here is a link to Waking the Spirit if you’d like to buy it or check it out at the library. https://www.kirkusreviews.com/book-reviews/andrew-schulman/waking-the-spirit/

 

 

 
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Posted by on December 6, 2016 in Uncategorized

 

A Solution for Sleepless Nights?

It’s been a while since I’ve added anything to this blog. Teaching, medical practice, and family have left little time to write. But I’m finding that I miss doing so. So my modest goal is to regularly share interesting health stories with brief introductions.

Insomnia continues to be common problem that is challenging to treat. Medications like Ambien are often not very effective. Moreover, people who take them may become dependent upon them and develop side effects. An approach called cognitive behavioral therapy (CBT) is currently the recommended intervention for people suffering from insomnia. CBT trains people to use techniques that address mental factors that are associated with insomnia, such as a racing mind and worry about sleep. It also helps people establish habits, such as a regular night-time ritual, that are conducive to getting sound sleep.

The main limitation of CBT is that it takes time and money to see a therapist to provide it. And that is if you are able to find one of the limited number of therapists trained to apply CBT for people experiencing insomnia. That’s why it was good news that a recent study in the journal JAMA Psychiatry showed that an online program enabled people to resolve their insomnia through CBT without having to see a therapist.

300 participants were randomized for six weeks to either an online CBT program called SHUTi or to online patient education about improving sleep. After 1 year, 57% people who did the SHUTi CBT program no longer experienced insomnia. And more than seven out of 10 SHUTi participants showed improvement in their sleep.

The SHUTi program costs $135 to $156 according to the website here. http://www.myshuti.com

I plan to recommend the program to my patients experiencing insomnia and look forward to their feedback.  The JAMA Psychiatry article and a commentary on it in the same issue are linked below.

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2589161

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2589158

 

 

 

 

 

 

 

 

 

 
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Posted by on December 5, 2016 in Uncategorized

 

Are Heartburn Medicines Safe?

Almost everyday in the clinic patients ask for my take on recent studies raising concerns about Proton Pump Inhibitors (PPIs) such as Prilosec, Prevacid, and Nexium. I wrote a short article on the topic you can access through the link here

Heartburn article

 

 
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Posted by on June 4, 2016 in Uncategorized

 

Fasting Labs

Is it necessary to be fasting when you have labs drawn? The dogmatic answer has long been yes, creating an uncomfortable, inconvenient situation for patients.  They either have to return to the clinic a second time for labs or else uncomfortably fast until their doctor’s appointment. But a recent study published in JAMA Internal Medicine suggests that fasting likely isn’t necessary after all.

The study’s author looked at 3 meta-analyses (or collection of studies) and found the following:

-There wasn’t a significant difference in the cholesterol levels whether people fasted or not.

-Fasting and non-fasting lipid levels had the same predictive power for whether people would have an adverse cardiac event such as a heart attack.

For these reasons, clinical practice guidelines have changed to endorse non-fasting labs in most circumstances. The main situation when a person needs to do a fasting test is when the level of triglycerides (a type of bad cholesterol) is above 400. In this unusual circumstance, the lab should be repeated on a fasting basis.

This study’s conclusion, that people don’t need to usually fast for their labs, fits my practice. It’s news many patients will be glad to hear.

The study’s conclusions are linked here:

Article

 

 
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Posted by on May 17, 2016 in Uncategorized

 

The History and Future of Hypertension

In an interesting essay, Dr. Marvin Moser writes that “as late as the 1950s, elevated blood pressure was considered by many experts to be necessary for adequate perfusion of vital organs.”[1] The eminent American cardiologist Paul Dudley White suggested in 1937 that “hypertension may be an important compensatory mechanism that we should not tamper with even if we were certain we could control it.”

 

In 1937, 54 year old Franklin Roosevelt’s blood pressure was 162/98. But in accordance with medical opinion of the time, his personal physician did not prescribe medication to lower it. By 1941, a reading of 188/105 was recorded and finally a barbiturate and massages were prescribed. In 1944, a cardiologist examined Roosevelt and was appalled at what he found. Many of the now well-understood results of untreated high blood pressure were present. A chest x-ray showed fluid in his lungs and an enlarged heart from congestive heart failure. His urine showed protein due to kidney damage. The cardiologist recommended digitalis (a medication to treat heart failure) and a low salt diet. By the time Roosevelt attended the Yalta conference his blood pressure was recorded at 260/150. Seeing Roosevelt at the conference, Winston Churchill’s physician Lord Moran noted that “Roosevelt looked straight ahead with his mouth open as if he were not taking things in.” In 1945, while sitting for a portrait, Roosevelt complained of a headache and suddenly lost consciousness. His blood pressure was measured at over 300/190 and he was later found to have a cerebral hemorrhage.

 

In the late 1950s, thiazide diuretics were identified as the first well tolerated and effective medication for treating high blood pressure (hypertension). In the 1960s and 1970s, new blood pressure medications became available and a consensus on the importance of treating hypertension solidified.

 

It is now clear that treating hypertension early can prevent heart attacks and strokes, as well as heart and kidney failure. But until recently, there has been debate about how low we should aim to get the pressure. In November of this year, a landmark study called SPRINT (Systolic Pressure Intervention Trial) offered tremendous insight into this issue. The study took people 50 years and older with hypertension and randomized them to aim for a systolic blood pressure of either a) less than 140 or b) less than 120. The study was stopped earlier after 3.3 years when it became clear that the people with tighter blood pressure control were experiencing clear benefits. There were significantly less bad outcomes such as heart attacks, congestive heart failure, strokes, and death in the group with the lower blood pressure.

 

My takeaway from this study is to aim for a systolic blood pressure closer to 120 in patients I treat for hypertension. The trial provides firm evidence that doing so lowers the risk of having a heart attack, stroke, and congestive heart failure. Nonetheless, a person’s individual situation must be taken into account. As people age, the ability to compensate when standing up can be compromised, making them prone to fall if blood pressure is lowered too aggressively. In addition, decreasing blood pressure below a certain level in some people can cause fatigue and a poor quality of life. It takes more medications to achieve a lower blood pressure and these can sometimes have side effects. So patients and their doctors should work together to find a combination of medications and behaviors (such as exercise and diet) that fits their unique situations.

[1] Historical Perspectives on the Management of Hypertension

 
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Posted by on December 9, 2015 in Uncategorized

 

Boxing and Parkinson’s Disease

Although I’m not a neurologist, I’ve seen firsthand how devastating Parkinson’s Disease can be.  Parkinson’s does not just consist in tremors. It is a progressive neurological disorder than can ultimately take away essential capacities such as walking, writing, and swallowing.  Research into Parkinson’s has yielded impressive therapeutic interventions such as deep brain stimulation.  Nonetheless, the human brain is the most complicated structure in the known universe, so that our current understanding and treatment of Parkinson’s is limited.

I am moved by the courage people with Parkinson’s, as well as their loved ones, display in living with this disease.  CBS Sunday Morning recently had a segment that was particularly inspiring.  CBS correspond Leslie Stahl reports on how her husband and other people with Parkinson’s have found some hope and healing in an exercise program that uses boxing techniques.  In the segment, a researcher says a  study of the program showed it offers people with Parkinson’s genuine clinical benefit.  I highly recommend watching the segment  linked below (it starts with an advertisement that quickly passes).  Whatever challenges you face might seem less daunting after witnessing such bravery.

 
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Posted by on November 25, 2015 in Uncategorized

 

The Nuclear Option

Here’s an article I wrote on a reproductive method that uses DNA from three different people to prevent mitochondrial diseases. The technique raises challenging ethical questions.

http://www.worldmag.com/2015/10/the_nuclear_option

 
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Posted by on October 27, 2015 in Uncategorized

 
 
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