The healing power of music
Roger Dobson

The sound of piano music coming from the operating theatre was the first clue that something unusual was afoot. As the theatre doors swung open and the trolley was wheeled in, the patient was greeted by a smiling surgeon sitting at a piano playing "The More I See You".

As the surgeon played on, with random extracts from other piano works, the patient was sedated and prepared for surgery. With the patient and theatre team ready, the music finally stopped, and the surgeon stood up and began his day job.

The experiment in Hawaii, a world first, was testing whether music has an effect on health, pain and vital signs, such as blood pressure and heart and breathing rates, as well as levels of hormones and antibodies.

Meanwhile, a second team of researchers has found that music has a powerful effect on the immune system, boosting compounds that defend the body against infections.

Evidence is growing that music can have a beneficial effect for patients. Researchers have been looking for effects in conditions as varied as stroke, autism, heart problems, mental health, depression, pain, fractured limbs, Alzheimer's and lung disease. Piped music has been used to ease anxiety before operations, and harp music to reduce pain after surgery, with some research suggesting it can be as effective as the sedative Valium.

Listening to music has been found to aid recovery after a stroke and heart attack. A study of 60 men and women at Helsinki University found that patients who listened to music soon after having a stroke recovered better. Three months after the stroke, memory had improved by 60 per cent in those provided with music, compared to 29 per cent in a control group. Concentration, mood and attention to detail also improved in the music group by 17 per cent, compared to no change in the other.

Music has been found to ease chronic and acute pain, too. Research at Dongsan University in Korea on 40 patients with fractured legs showed that 30 to 60 minutes of music a day lowered levels of pain and of blood pressure, and also improved respiration rates.

Some research suggests that not all music is effective. Tune and tempo have been found to be more important than melody, rhythm, harmony or timbre. Quick, pulsating rhythms and vigorous music have been shown to have a counter effect, triggering negative emotions.

So how exactly does the body derive health benefits from music? At one level, it may work simply as a distraction, taking the mind off the pain. When healthy people are exposed to experimental pain, as they were in research at Glasgow Caledonian University, they had greater tolerance to it when they were listening to their favourite music.

But distraction is not the only way in which symptoms are eased. One Finnish stroke-recovery study found that music is processed and handled in different parts of the brain, and one suggestion is that by holding the patient's attention, it stimulates nerve cells which go on to bypass the region damaged by the stroke.

One theory is that it works through the emotion circuitry of the brain, which has an effect on the production of key hormones, which in turn impact on body functions, from the repair of nerves to pain relief.

The latest research, by the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig and the University of Sussex, had provided new evidence about how music boosts the immune system.

The researchers carried out two studies looking at the effects of music on stress hormones. After exposing around 300 people to happy dance music, the researchers measured levels of immunoglobulin A or IgA and hormones including cortisol and adrenocorticotropic hormone.

Results show that cortisol levels dropped significantly, while IgA levels went up considerably in those exposed to music for around 50 minutes. Effects on compounds involved in inflammation and behaviour were also seen, and mood improved noticeably in those exposed to music.

These findings provide clues to the understanding the role of music in health. Cortisol is a hormone produced in response to stress and it increases blood pressure and blood sugar levels, and weakens the immune system. The drop in levels of the hormone in response to music may explain the reduction in blood pressure and risk of infections found by other researchers.

The rise in IgA is also an important finding because it is an antibody that plays an essential role in protecting the body against infections and allergens.

— The Independent

Exercise provides relief in spondylitis
Dr Ravinder Chadha

All back pains may not necessarily be related to disc problems or muscle injuries. Back pain experienced while sleeping or getting up in the morning with stiffness in the upper back could be due to a more disabling condition — ankylosing spondylitis. This is, in fact, a systemic disorder which is characterised by the inflammation of the spine and large peripheral joints.

In chronic cases, the ligaments joining the vertebrae become calcified leading to fusing of these bones. This results in severe stiffness and diminished flexibility of the spine and the joints, especially between the spine and the hip bone (i.e. sacroiliac joint). The exact aetiology of the disease is not well known, but genetics does play a role. The disease affects young people between 20 and 40 years, and men are generally more afflicted than women.

The usual symptom is mild-to-moderate episodes of pain and discomfort alternating with symptom-free periods.

Symptoms:

Severe back pain while sleeping or during rest.

Early morning stiffness.

Stooped posture (bending forwards) as this relieves back pain.

Spine straightens due to limited motion in the back.

Difficulty in breathing deeply due to the limited expansion of the chest.

Loss of appetite, weight loss, fever and fatigue.

Eye inflammation.

Diagnosis is based on history, physical examination and laboratory investigation like ESR, HLA-B 27 and radiological evidence.

Treatment: Conservative treatment such as drugs to alleviate joint discomfort.

Short-term corticosteroid therapy to reduce inflammation. Long-term use is not advocated as it is fraught with serious adverse effects vis-à-vis osteoporosis of the spine.

Firm mattress without a pillow provides comfort.

Deep breathing exercises like pranayam help maintain/ increase chest expansion. Repeating deep breathing at frequent intervals during the day helps too.

Exercises form an integral part of the treatment along with a good posture. Exercises help maintain a good posture and flexibility thereby decreasing pain. Performing exercises during mid-day or evening is more helpful as stiffness decreases during this time of the day in such patients.

Lying flat on hard surface for 20 minutes every morning/ evening.

Loosening up: cat/camel stretch.

Head flexion/extension.

Sitting — bend your right ear towards right shoulder and similarly on the left side.

Facing wall — raising your leg by 4 to 6 inches for a period of 5-10 seconds.

Lifting the head and shoulder in a prone position.

Boucher’s exercise: Back towards wall/ press with the thumb in a vertical, horizontal plane.

Wall push up

Rowing exercise and shoulder shrugs with the help of stretch bands. Four kneeling position — flatten the follow of your back by breathing in and then raise one leg. Repeat with the other leg.

The writer runs a pain management clinic in Chandigarh. Email: chadha_r2003@ yahoo.co.in

Biting one’s own lip 
Dr H.S. Chawla

If an ulcer in the mouth does not heal in seven days, it is a matter of concern, and you must consult a dentist

Everyone experiences it at one time or another. The cheek bite is the commonest out of these. A portion of the soft tissue of cheek, lip or tongue suddenly gets bitten while eating, followed by intense pain. The pain is extreme when it happens on the tongue. The other is chronic/passive biting, i.e., there is passive biting/pressure from the teeth on the lips, tongue or on the sides of the cheeks. It leads to thickening of the local areas.

Cheek bite: In the cheek bite, the bite marks are evident as a thickened line on the inside of the cheek adjoining the point where upper and lower teeth meet. Nipping on your cheek can also be a nervous habit. This creates a white line on the inside of your cheek. It is important to stop the habit by reminding yourself again and again and it is possible.

Cheek bite occurs more frequently with advancing age, due to the loosening of the cheek muscles. The cure likewise is to increase the tonus of the cheek muscles. This can be achieved by inflating the oral cavity with air and then pushing the air backwards to the affected area by pressing the cheeks with one’s fingers, while preventing its leakage from the lips. This is repeated 20 times at one time, three times a day. Similar exercises can be performed with water in the mouth.

Tongue bite: The tongue bite does not happen so often, but once it happens it is likely to be repeated. It can happen if you’re talking and eating at the same time. To prevent this one has to be vigilant not to bite the tongue while eating, by the simple process of concentrating on the chewing motion.

The following tongue exercises help prevent tongue bite: (i) place the tip of the tongue on the anterior part of the palate and push it forward; (ii) place the tip of the tongue on the side of the palate and push it laterally first to the right and then to the left side of the palate; (iii) strengthen the tongue muscles by playing with the tongue as one used to do during childhood. That is, rolling the tongue, making sounds with the tongue by striking it on the palate. These exercises may be performed for a few days.

Lip bite and lip licking: Many people lick or bite their lips when they are nervous or concentrating on something. Usually, it’s more common for people to lick and bite their lower lip. Lip biting is a common habit and is hard to break.

Lip licking leads to the loss of moisture in the lip leading to chapping, peeling of the mucosa (skin). Sometimes deep bleeding wounds may result on the lip and are painful.

When you lick the lips, the bacteria present in saliva is left on the lips. In case you have a small raw area, it will get infected further. The vicious cycle sets in. Lip biting also leaves you more susceptible to cold sores and infections.

Here’s a tip to heal the raw area on lips:

Do not lick, as licking makes them dry and causes the skin to peel, which in turn causes you to bite.

Stop licking your lips, and the habit of biting them should end as well. Some people can stop this habit once they are made aware of it.

Stopping the habit is the only way to heal it, and that is all the treatment needed.

People with severe self-inflicted lip injuries may have psychiatric problems and can injure their lips without even realising it — for example, when they are stressed or worried. They may not immediately connect their symptoms with the habit. In severe cases, they need to visit a psychiatrist and take medication to address an underlying psychological condition to help stop the habit.

Prevention: Firstly, it is important to concentrate on eating when one is chewing the food. The misguided bite often happens when one is chewing food but mentally is somewhere else. Secondly, perform tongue and cheek exercises. Thirdly, if there are any sharp margins/edges of teeth, please do get them ground

Emergency management: When you bite your cheek, lip or tongue, you create a small wound. It may or may not bleed, depending on the bite’s severity. The amount of blood doesn’t indicate the severity of the bite. Fortunately, most such bites aren’t severe. Unless you fall or are hit hard enough to bite yourself deeply, cheek and tongue bites are usually harmless little nips that sting for a little while.

When to see a dentist for cheek, lip or tongue bite?

The following guidelines are very important:

l When you “frequently” bite your cheek, lip or tongue while chewing or speaking;

l Blood flow from a cheek, lip or tongue bite and doesn’t stop within 5 - 10 minutes or so;

l If it has caused an ulcer and the ulcer does not heal in four-seven days.

The writer, Head of the Dental Department, The Apollo Clinic, is a former HOD, Oral Health Sciences Centre, PGI, Chandigarh. Email: chawlahs@ gmail.com