Tag Archives: Dr. Jerry Saliman

Music As Therapy

by on June 9, 2015

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My Patient
Irene (not her real name) was my patient for many years, and during a routine visit she showed me a lump on her abdomen which turned out to be metastatic pancreatic cancer. I went to visit her one afternoon in hopes of offering her some comfort. The day I visited her was sunny and cloudless, but when I entered the mobile home, I was ushered in by her daughter into a low-lit room with all the shades drawn. Irene was lying in bed surrounded by photos of her children and grandchildren. I inquired about her family, and she shared what life was like growing up as a child in Ireland. I played a few songs for her on my viola, but she had one musical request – “Humoresque” by Dvorak. I felt bad that I did not know this piece from memory or have the music with me, and I apologized for not playing it for her. She died within a few days of my visit, and her daughter telephoned me asking me to play Humoresque at her Rosary Service. Of course, I agreed.

It was a rainy night, but the church sanctuary was packed with over 200 people. I removed my viola from its case at the back of the church sanctuary hoping to play and then make a hasty escape. However, Irene’s son intercepted me, and invited me to play in the front of the sanctuary. The delightfulness of the music triggered smiling expressions on the congregants as it somehow reminded everyone what a vivacious and friendly person Irene had been. Irene’s son did not want me to leave after I played. He welcomed me to sit next to him for the rosary service and asked me to play some additional music for the conclusion. I chose a reflective piece called Meditation on a Theme by Thais by Massenet. After the final note of the music resounded in the church, it was followed by an unearthly silence. The music, together with the rosary service, evidently managed to touch many souls. I felt a sense of comfort because I was able to express a second good bye to Irene.

Medical Benefits of Music
Music has profound effects on our mind and behavior, and medical professionals have begun to harness the neurological effects of music to promote health and well-being of their patients. One of the first ideas of how music affects the brain was published in 1995. It was called “The Mozart Effect.” It claimed that listening to Mozart could improve IQ. Subsequent studies found the effect was minimal. However, children who learn to play music develop neurological benefits which persist until adulthood. Music listening in older adults has been associated with improved cognitive function. Music therapy has been useful to help stroke victims recover speech, and music has been used in patients with Parkinson’s disease to help gait and balance. Patients who listen to music while undergoing cataract surgery are found to have lower blood pressure and heart rate. In patients with post-operative pain, listening to music has been associated with reduced requirement for opiate drugs which suggests that music stimulates the release of pain relieving substances in the brain.

Plato believed, “Music gives a soul to the universe, wings to the mind, flight to the imagination and life to everything.”  When people are suffering with terminal cancer, depression, or chronic pain, music therapy has been found to improve quality of life and mood. Whenever I have gone to visit patients at end of life, I have brought along my viola and played a few pieces. I like to think my viola playing provides a few minutes of distraction from the burden of illness. I think as we age and maybe recognize our own mortality, senses are heightened, which enhances the appreciation of music. We can listen in ways we did not before. For friends and family members of Irene, her favorite piece of music helped them to remember her as a vibrant person, and provided a sense of closure. In the congregation of 200 friends and family, music united everyone.

Conclusion
It should not be a surprise that the ancient Greeks assigned the roles of healing and music to one god, Apollo. Before there were medicines, music might have been the best therapy to offer to any ill person. Playing music for patients has become one of my favorite interventions.

For additional information about Music As Medicine, please see the excellent review article by Dr. Harvey Simon in American Journal of Medicine, February 2015.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff. He plays viola in the Peninsula Symphony, and he accompanies Hashirim choir with his violin.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.

Related PJCC Program
Join us on July 13, 2015 at 2:00 pm for a showing of Alive Inside, a moving documentary about social worker Dan Cohen as he uses music to unlock memory in nursing-home patients with Alzheimer’s disease.  Register here…

 

Beware Of Ants In Your Toilet!

by on May 5, 2015

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A patient left a message for me which caught my attention. He wanted a blood sugar test for diabetes because there were ants in his toilet. When I spoke to him, he denied having some of the more typical signs of diabetes. His only concern was that there were ants in his toilet. I decided to order the test.

According to the CDC, 29 million people in the U.S. have diabetes, and at least one-quarter of them don’t know it. An additional 86 million people (1 in 3 adults) have pre-diabetes. Without change in lifestyle, 15-30% of pre-diabetics will develop type 2 diabetes in five years.

Diabetes Basics
There are three main types of diabetes. Type 1 diabetes is when your body does not produce enough insulin. Type 2 diabetes is the most common type (90-95% of diabetics), and this is when your body does not use insulin properly. Gestational diabetes occurs in 4% of pregnancies, and these women are at increased risk of developing type 2 diabetes after pregnancy.

Symptoms
The typical symptoms of diabetes include feeling thirsty, frequent urination, fatigue, blurry vision, cuts or bruises that heal slowly, and tingling or numbness in the hands and feet. Many people with diabetes have no symptoms or mild ones that go unnoticed. The American Diabetes Association (ADA) does not list ants in the toilet as a warning sign.

Complications of Diabetes
The biggest risks of having diabetes are strokes and heart attacks, which with proper medication can be prevented. Uncontrolled diabetes leads to damage of many organs in the body, particularly the eyes, nerves, and kidneys. Last year I saw a young man for a check-up because his dentist noticed a severe gum problem which was going to require extraction of most of his teeth. I ordered a blood test which revealed he had diabetes. He had not realized that diabetes was the root cause of his dental woes.

Diabetes is associated with an increased risk of certain cancers, specifically cancer of liver, pancreas, endometrium, colon, breast, and bladder. The explanation for this is unclear. It could be due to shared risk factors such as obesity, diet, and inactivity, or because of something intrinsic about diabetes such as elevated insulin or blood sugar levels.

Diabetes and pre-diabetes are risk factors for Alzheimer’s dementia and other types of dementia.

The Numbers
The normal fasting glucose is less than 100 mg/dL. Pre-diabetes is defined by fasting sugar between 100-125 mg/dL. Diabetes is defined by fasting sugars of 126 mg/dL measured on two different days. Another way of diagnosing diabetes is the A1C test which measures the average glucose in your body over the past 2-3 months. A1C of 6.5% or higher indicates diabetes. Normal A1C is usually less than 5.7%, and 5.7 – 6.4 is considered pre-diabetes depending on the lab reference range.

Treatment
The mainstays of most type 2 diabetics are diet and exercise, but because it is so hard to change one’s habits, pharmaceutical companies are reaping enormous profits from a multitude of diabetic drugs. There are medicines which work on the pancreas, liver, gut hormones, and kidneys to lower sugar, and there is even inhaled insulin now. It takes more effort for people to make personal changes, but an Asian diabetic patient of mine was especially determined to rid herself of diabetes. Her blood sugar was so high when she was diagnosed that she needed to take insulin at least twice a day to keep her diabetes controlled. She decided to give up her routine of eating rice at every meal, the main staple of her diet. She went from minimal exercise to exercising three hours a day. When I saw her back in clinic two months later, she had been successfully able to discontinue her insulin entirely. (Warning: don’t attempt to stop your diabetic meds on your own without doctor’s supervision.) Most people cannot make these dramatic life style changes, but she serves as an example of what healthy lifestyle change can achieve.

Screening for Diabetes
The ADA recommends adults get screened for diabetes every three years. You should get tested more often if you are overweight and have other risks such as family history of diabetes, sedentary lifestyle, history of gestational diabetes, polycystic ovary syndrome, or a racial background of African-American, Hispanic-American, Native-American, Asian-American, or Pacific Islander ancestry.

Conclusion
My patient who I mentioned in the beginning did not have any particular risk factor for diabetes, but I tested him anyway because normally there should not be any urinary sugar in the toilet to attract ants. The bad news was that his blood test did reveal he had diabetes. The good news was that he did not have to hire an exterminator since once his diabetes was controlled the ants had to find a different location to host their picnic. Hopefully early detection will prevent him from having any future complications or further ant invasions.

For further information about diabetes, visit the American Diabetes Association.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.

Improving Your Memory

by on March 23, 2015

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“Memory is the mother of all wisdom.”
― AESCHYLUS

With advancing age, many adults worry not only about their health, but also about their memory. First, let us examine why we value our memory, and then look at some of the latest research in how to improve memory.

With the externalization of memory by cell phones, computers, digital photographs, books, and pencil and paper, one can wonder why we need our brains to remember anything at all. However, thousands of years ago the major way we passed along information was orally, which required focused attention and memory. Dating back 2500 years, the Iliad and the sequel, the Odyssey, were transmitted orally by the rhythm of the words. It is said that the Torah, or Five Continue reading

Optimism & Your Health

by on February 5, 2015

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During medical training at UCLA, I had the good fortune to learn from Norman Cousins, a Jewish writer, editor, and adjunct professor of medical humanities. Despite being misdiagnosed with tuberculosis at age 11, he set out as a boy to “discover exuberance.” He believed that positive emotions were the key to fighting illness, which he exemplified in the telling of his own battle with a severe form of arthritis. In the book Anatomy of An Illness, he describes his victory over a potentially life-threatening condition by taking mega doses of vitamin C, and watching Marx Brothers movies and TV sitcoms. He relates, “Laughter is a form of internal jogging. It moves your internal organs around. It enhances respiration. It is an ignitor of great expectations.” His Continue reading

Norovirus – The Winter Bug

by on January 16, 2015

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Thanksgiving weekend 2014 was a time to forget for our family. My wife and I planned for the arrival of our children, their spouses, and four grandchildren for months. One of my granddaughters would Facetime daily to see what toys she would play with when she would eventually visit. The night before Thanksgiving, one son-in-law became acutely ill with a GI bug, and he wasn’t able to go to Thanksgiving dinner. The day after Thanksgiving, two of my daughters became acutely ill. By Thanksgiving weekend, the illness had ravaged through our entire family except for my wife and one granddaughter who was protected through the magic Continue reading

Depression — The Lowdown

by on December 2, 2014

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News of Robin Williams’ suicide was a shock. How could a man devoted to making others laugh take his own life? His death brought the disorder of clinical depression to the forefront.

Depression is a common mental illness that is manifested by prolonged sense of sadness, and other symptoms such as loss of desire to do pleasurable activities, irritability, insomnia or oversleeping, change in appetite, loss of energy, fatigue, difficulty concentrating, and sometimes thoughts of death or suicide. Depression affects 1 in 11 adults, and nearly twice as many women as men. Sadness and depression are different. Many people feel sad after losing a loved one, or losing a job, or ending a relationship. People who are depressed, however, can usually differentiate normal grief from the disabling continued weight of clinical depression. Although there is excellent treatment for depression, many people do not seek help because they mistakenly construe it as a personal weakness rather than a legitimate illness. Many celebrities have publically acknowledged their own battles with depression in hopes that others Continue reading

In Search Of Sleep

by on November 4, 2014

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But I have promises to keep, and miles to go before I sleep, and miles to go before I sleep.”  Robert Frost

A relative of mine, Stewart, (not his real name) was driving home from LA, and fell asleep at the wheel. Stewart was 18 years old at the time, and on winter break from college. He drove to LA in the morning, and then, after spending the day there, drove home that night. Although he knew he was drowsy, he made the decision to drive home. The last thing he remembered was listening to a 49er Monday night football game before he dozed off without warning. His new 1996 Toyota Corolla was totaled when the car crashed into a barrier on the side of the highway Continue reading

Hepatitis C – A Stealth Killer

by on October 14, 2014

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I recall my Great Uncle Sidney.  He loved to devour a delicious steak for dinner.   Eventually he had to undergo coronary bypass surgery for cholesterol-clogged arteries of his heart.   Within a decade he died!  His heart did not kill him.  He died of cirrhosis of the liver because of a blood transfusion contaminated with hepatitis C virus which he received during his bypass surgery.

Hepatitis C (HCV) is one of those conditions one hardly hears about because most people who have it don’t know they do.  Of the 3.2 million Americans who have hepatitis C, only 5-6% of them have been successfully treated.   It is 3 times more common than HIV in this country, and it is the leading cause of liver transplantation and liver cancer.  The mortality from HCV has Continue reading

The Meaning of Life – As Seen through The Eyes Of My Patients

by on September 3, 2014

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As we approach the High Holidays of Rosh Hashanah and Yom Kippur this month, I find myself becoming more reflective, particularly about what’s important in my life. Twenty years ago I was asked to complete a biographical survey for a physician newsletter about my personal interests, which included questions such as the latest book I read, my favorite movie, etc. There was one question that stood out, “What is the meaning of life?” My response, “God knows.” It occurred to me a few years later that I could delve into a better understanding of this existential question by probing my patients for their stories about what has been meaningful in their lives. You may wonder how during a 15-20 minute visit with patients I could have time for such a discussion. One cannot come out and say, “Tell me the meaning of your life,” but I felt I could approach the Continue reading

High Blood Pressure – The Hidden Killer

by on August 5, 2014

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On April 12, 1945, President Franklin D. Roosevelt was sitting in his living room having his portrait painted by artist Elizabeth Shoumatoff, who later became most renowned for “Unfinished Portrait” of FDR. Also present was Lucy Mercer, Eleanor’s social secretary, but most notorious because of her affair with the president. His dog, Fala, and two cousins were in the room as well according to biographer Doris Kearns Goodwin. At 1:00 pm, FDR complained of “traffic pain at the back of my head,” and collapsed, unconscious. His cardiologist quickly arrived and recognized the signs of a cerebral hemorrhage, a type of stroke. One could argue that one of FDR’s visitors that day triggered his stroke, but it is much more likely that years of untreated high blood pressure led to FDR’s demise at the age of 63.

High blood pressure or hypertension still remains a hidden killer at large. It is estimated that high blood pressure kills approximately 1000 Americans each day due to its effects on Continue reading