Music as Medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison

Eric 00:11

Welcome to the GeriPal Podcast. This is Eric Widera.

Alex 00:12

This is Alex Smith.

Eric 00:13

And, Alex, who do we have with us today?

Alex 00:15

We have some terrific guests today. We’re delighted to welcome back Theresa Allison, who is a geriatrician, researcher, and professor of medicine at UCSF in the division of geriatrics. And Theresa studies music for people with dementia and their caregivers. Theresa, welcome back to the GeriPal Podcast.

Theresa 00:32

Thank you.

Alex 00:34

And we’re delighted to welcome Jenny Chen, who is a palliative care fellow at Yale. Jenny reached out to us because she plays music regularly for her patients, and she said, you should do a podcast about music. And we said, hey, we’re recording one. Come join us. And so we’re delighted to have you here, Jenny.

Jenny 00:51

Thank you for having me.

Alex 00:53

And we’re delighted to welcome Tyler Jorgensen, who’s a palliative care doc, emergency medicine doc, at the University of Texas, Austin. His podcasts is MyMedical Mixtape, which is only available on Spotify. And I was fortunate to record an episode of my medical mixtape with Tyler at the…which meeting were we at, Tyler?

Tyler 01:12

AHPM. We were in Denver. Yeah. AHPM.

Alex 01:15

AHPM. Yes. So check that episode out. Check all the episodes out. It’s a terrific podcast, Tyler.

Eric 01:21

We’ll have links to that on our show Notes. Welcome, Tyler.

Tyler 01:23

Thank you, Alex and Eric. Psyched to be here.

Eric 01:27

So we’ve got a podcast on music and medicine. And, Tyler, before we jump into that, I think you have a song request for Alex.

Tyler 01:34

I sure do. Alex, can you hit us up with Do You Realize by the Flaming Lips?

Eric 01:41

Tyler, why’d you choose this song?

Tyler 01:43

Okay. When we started doing more music stuff for our patients in the hospital, a lot of people started to think, hmm, what would I want to listen to? And I had a team member say to me, my final vinyl, if I have, like, a final musical request, would be the song Do You Realize by the Flaming Lips. And so this is a shout out to our inpatient palliative team at Dell Medical School.

Eric 02:06

That’s awesome. Maybe at the end of the podcast, we can all all have our final vinyl.

Alex 02:23

(singing)

Eric 03:43

Dang.

Tyler 03:44

Woo.

Theresa 03:45

Oh, that was lovely.

Alex 03:48

Tyler. Thank you.

Tyler 03:49

Thank you, Alex. That was awesome.

Eric 03:53

That was fantastic. So we’ve got a lot to talk about on this podcast. Man, I could spend, like, an hour just on that song itself. But, Jenny, I’m going to start off with you. You emailed me about doing a podcast on music and medicine. I’m wondering, why did you think it was a good idea to do this podcast?

Jenny 04:15

Good question. So I actually was doing a grand rounds as my final presentation here at Yale for my fellowship on the role of music in hostpice and palliative medicine. And I was looking for articles, and I wasn’t seeing as many as I expected. And then naturally, I went to my podcast, which is the GeriPal podcast, and I looked up, like, is there music in medicine?

Eric 04:42

There was even less on GeriPal. Yeah.

Jenny 04:45

Like, the last article was, like, 10 years ago. So I thought, why don’t I email them? I just met you guys at the HPM conference, and I was like, maybe I can say, hey, I met you guys. Remember me? Do you want to do something about music?

Eric 05:00

And I got to ask because in that email, you said you were introduced to palliative care through music. How. How was that the case?

Jenny 05:07

Yeah. So when I was a college student at UC Berkeley, I was pre med. I was figuring out ways to combine my interests in music and medicine. So I actually volunteered at UCSF Music is Good Med program, which was 10, 15 years ago. And I followed one of the amazing chaplains, Peggy. I don’t know if she’s still there, but shout out to Peggy. And I performed for many palliative patients, and that’s when I started to understand. Wow. I feel like there’s something that I could do with music for these patients. And that’s how I learned more about the specialty.

Eric 05:50

Great. Thank you for that.

Alex 05:53

And, Tyler, I think when I was on your podcast, did I tell you the story about my grand rounds when I was a palliative care fellow?

Tyler 06:00

Yes. You did.

Alex 06:01

Yes.

Tyler 06:02

I think the title of it was get that Harp out of my face. That’s right.

Alex 06:07

If I’m dying, get that harp away from me. That was the title of my final talk when I was doing palliative care fellowship. So we did very similar.

Eric 06:15

That is not your final. Vinyl will not be a harp.

Tyler 06:18

It won’t be a harp. Yeah.

Alex 06:21

And I got. I had some people from the Berkeley School of Music came and performed at that grand rounds, and they did this really haunting melody with, like, a giant music bowl. You know those things that you rub the edge, you rub the edge of, and it just makes this haunting noise. But this was humongous. And we were in the MGH at this big, like, old amphitheater where they discovered anesthesia, and it just rang the whole place like a bell. It was amazing.

Jenny 06:48

That’s actually really funny that you performed or you had someone perform at the end, because I also did that, too. For my grand rounds, I asked my friend who’s a music therapist at Yale, and we performed a song together that we’ve performed for a patient who is at end of life, so.

Theresa 07:05

Oh, I gotta ask.

Jenny 07:06

Which song we played Shooting Star by. Howdy. This was my patient’s favorite song, and I asked her what it was right before the day of performing for her and then surprised her with the song. So she was very surprised.

Eric 07:23

And, Jenny, you sing in front of patients during your fellowship?

Jenny 07:27

Yes, luckily, my program director, Dr. Morrison, lets me do that.

Tyler 07:32

That’s incredible. Oh, my gosh.

Eric 07:34

How do you bring that up? Hey, can I sing for you?

Tyler 07:40

No.

Jenny 07:41

I actually have been doing it where if it’s a patient that I’ve been seeing every single day and I know they’re about to leave, I secretly ask them, what’s your favorite song? And then the next day I say, hey, you know that favorite song you told me about? I learned it within the last 24 hours. It’s not that great, but here you go.

Eric 08:04

You’re like Alex on the JFL podcast.

Tyler 08:06

Yeah, totally.

Jenny 08:09

Yes.

Tyler 08:10

Yes.

Eric 08:12

That’s awesome. Tyler, you do something not. You don’t sing. Right. You actually bring in music to people’s rooms.

Alex 08:19

I read a sang together on your podcast. It’s not true that Tyler doesn’t sing.

Eric 08:23

Oh, really?

Tyler 08:25

Alex, you’re very. You’re very generous. You know, Alex put me to the test right away. He was like, hey, Tyler. Yeah? We’re going to talk about music. Why don’t you sing with me in the middle of this conference in Denver? And he opened up his guitar case like we were hoping people to drop change in there and was just like, come on, we’re singing. Okay, I guess we’re singing. No, Jenny, you are so brave, and that’s so beautiful. I rely on recorded music for my patients mostly, and I think that’s based on my singing. I think that’s more palliative than me.

Alex 09:00

Not true.

Theresa 09:01

Oh, no. My voice is nothing special. I sing with the patients all the time. And we have so much fun because they feel safe joining in. I love that they don’t have a brilliant trained voice. I’m an instrumentalist, so especially you make it.

Tyler 09:16

You make it a safe space for them to sing because you’re not perfect.

Theresa 09:21

Right. And I’m not palliative. I’m doing inpatient geriatrics. So this is typically with patients who have. And I’m using the term patients deliberately as opposed to people living with dementia. They are my patients. I am their doctor. If they have dementia, I’m trying to get them oriented. Assessing delirium. Someone has Parkinson’s, I want to help them produce louder sound. We just kind of weave it into the exam and they sing along and it’s super fun. Try it.

Tyler 09:48

Okay.

Eric 09:49

Theresa, how do you actually weave it in? What do you do?

Theresa 09:53

Okay, so first, I give a big apology to all of my friends in music therapy. I am not a music therapist. My degree is in musicology, technically, music anthropology or ethnomusicology. I am not a board certified. I am not a certified music therapist. A music therapist would use music deliberately to achieve a rehabilitation goal, just like a physical therapist or an occupational therapist. I’m a doctor. I’m just trying to get a better exam. And this gets called, disparagingly, music medicine, where doctors, because they have a license, they just use music like they would use a drug.

But really, it can be as varied as someone who is afraid of the stethoscope, and you get them singing with you, and you slide the stethoscope on their back, and then at the end of the phrase, they go to catch their breath before the next phrase. Or someone with Parkinson’s where you say, have you done your Lee Silverman vocal training? Let’s practice.

Tyler 10:52

Ah.

Theresa 10:53

And they say, come on, Eric, help me out here. Good.

Tyler 10:58

Nooooo (sustained voice)

Eric 11:00

Nooooo (sustained voice)

Theresa 11:01

Yes (sustained voice)

Eric 11:02

Yes (sustained voice)

Theresa 11:03

Do you enjoy this game?

Eric 11:05

No, because I’m terrible. [laughter]

Theresa 11:06

Here you go. That’s how you do it. Join me on rounds. It’s so simple. It’s just another tool.

Eric 11:13

And, Tyler, that’s why I loved your article at J Gym on bringing music and benefits to patients at the bedside. The endearing approach. Because if you’re like me, music isn’t medicine. If I bring it into there, if I’m singing it, it’s probably more like nails and chalkboards.

Alex 11:34

Not true. We’ve heard Eric sing on this podcast. Everybody should take a moment and listen to the podcast with Melissa Way, where the whole room sang Bohemian Rhapsody together. And it was perfect in every way, including pitch oh, that’s awesome.

Tyler 11:52

All right, well, maybe Eric and I are being coy about our singing skills, but.

Eric 11:56

No, not coy at all. And I loved in that article on the JJ article, you start off with a story like Mr. A and Mozart. Can you tell us?

Tyler 12:05

Absolutely. Yeah. You know, actually, Eric, I want to tell you, actually, about a different patient, if you don’t mind, instead of Mr. A. Because this is where the seed of the idea started for all this music for me. I’m originally an ER physician. I’d been doing ER medicine for over a decade when I went back to palliative fellowship. And I found myself, at times, kind of at a. At a standstill in rooms. I’m late in the afternoon with a, you know, somebody, and I just can’t connect with them. And I’m trying to.

Trying to have some kind of rapport and some kind of meaningful relate. And I’m trying stories, I’m trying humor, I’m trying kindness, and nothing’s happening. And I remember one day I was looking at this patient, and I just thought, man, I swear this guy looks just like the old classic rock dude that taught me some guitar lessons when I was in middle school. So I’m just looking at him. I think we’d been staring at each other for a couple minutes, and I just said, hey, can I play you a song on my phone?

It was not very graceful. And he just goes, yeah, I guess. And I was like, I don’t know. I’m going classic rock. He looks like an old rocker. And so I picked that song, the Boys are Back in Town by Thin Lizzy for no reason whatsoever. And I dialed it up and just pushed play. And it was like the lights came on. This guy came alive. It was beautiful. And he totally came out of his shell. He hadn’t been talking to me all week. And we got all into his family stuff and how he’d been suffering with cancer and his goal. It was beautiful. And I walked out of that room just thinking, oh, my gosh, this is a tool. I had no idea. This is unlocking everything for this patient.

And so as I went through fellowship, I just started messing around with it with patients. Like, I wonder if this patient would enjoy hearing a song. If this patient would enjoy hearing a song with Greg Wallingford, my co author on the paper, one of my attendings during fellowship, we got to the place where we were really comfortable. It just felt like a normal part of an encounter to bring up music and listen to a song with a patient. But then we Thought, how do we, how is this a transferable skill? We, we got really comfortable with it.

Eric 14:14

Yeah.

Tyler 14:15

So that’s where the, that acronym, the endearing approach, kind of came out. We, we sort of thought about, what is it that we’re doing? How could we tell somebody else to do this if they’re less comfortable with it? And that’s, that’s kind of how we came up with that strategy.

Eric 14:30

And can you tell our listeners we’ll have a link to the Jim paper, but can you briefly review the. What the endearing approach is?

Tyler 14:39

Absolutely. And I’ll say, just like any communication tool, this is a fallback position. It’s a template, it’s a starter. I don’t go through all these steps every time, but a lot of times, how do we get into this topic? Well, the E in endearing stands for evidence. And so I’ll say something like, we’ve been talking all about your pain and we’re trying all these different medicines, trying to work with your anxiety. Did you know there’s really good evidence that music actually helps your pain or that music can help your anxiety?

And patients are often like, huh, that’s interesting. And you say, yeah, actually, you know, music that you like has been showed to really help. It can lower your pain score. And so they’re okay, cool. And then we normalize it, you know, we’re like, yeah. And actually, you know, so it doesn’t feel totally weird for them, like, yeah, we try to share music with all our patients and like, oh, that’s interesting. So I love that Jenny has been brave enough to ask patients their favorite song because the letter D in Endearing for me is, is a reflection of. I ran into roadblocks when I would ask patients their favorite song because it was such an intimidating question, like, what’s your favorite movie?

What’s your favorite book? And they would freeze. So instead I would just say something like, hey, what’d be a cool song to hear today? And so it’s just, it kind of lowers the stakes and it’s like the song of the day. That’s what the letter D stands for. And then the EA is just, that stands for experience alternatives, which basically means you kind of don’t know what’s going to happen when you push play. So just kind of sit back and be ready for it. And I think that generally you experience whatever the patient needs.

And sometimes it’s a dance party in the icu, sometimes it’s a sing along, sometimes it’s reverent prayer and holding hands and Sometimes it’s just kind of an opening up and sometimes it’s just quiet. So it, it really goes any direction. And then just the last letter in it for of endear is repeat. Just encourage patients and families to bring music into their healthcare experience. And it has a great impact. So that’s been, it’s been a fun, really fun thing to do with our patients.

Eric 16:42

So does it, do patients like it? Like, does it go over well every time? Does it.

Tyler 16:46

Oh, it’s. It’s unbelievable. It is, I would say. Here’s the thing, it goes over well almost universally because you’re letting them guide it. Yeah, you’re easing it, you’re introducing it. I’m not. Hey, you need to listen to Van Morrison, Madame George today. Now. You know, it’s. It’s them steering it.

Eric 17:04

Do you have like a boom box that you’re bringing in there? Like.

Tyler 17:08

Yeah, it’s like we say anything. Yeah, I just stand like this, you know, and play Peter Gabriel. No, no, I just, I just put it on, on the phone and kind of hold it up near them. And a speaker would be nice. That’s. That would be a nice, a nice touch. But no, it really goes over well. And if you can tell that it’s not, you can just kind of turn down the volume and start talking over it and just walk out, you know.

Eric 17:32

Well, I did see a Dell news report on something that else you’re doing is you’re actually wheeling a record player into people’s rooms too, and.

Tyler 17:40

Yes, yes, yes, yes.

Eric 17:41

Is that different? That. That’s not what you’re doing in pal of car rounds. That’s.

Tyler 17:45

That’s right. No, you’re right. That one’s different. So the record player. So our inpatient hospitals are kind of under resourced for music therapy. So we’re sort of like thinking of what are some creative ways we can bring music to our patients. And we got this idea to have a record player on wheels, on a cart, and have a library of 50 records. And the idea with the record player is that it is a. You can’t. It’s in your face. It’s a distraction. It’s something that has no place in a hospital in most people’s thinking.

So she’s like, well, this is odd. It just kind of takes you out of the sterile medical numbers and beeps and stuff environment. But what we do with it is we leave it in the room. We introduce it to families and patients and explain how it works and show them. And then we say, hey, you know what? This is yours. You drive. You flip through this, you find records that are meaningful to y’ all, and y’ all spin them, and we’ll. We’ll come get this from you in a couple hours and just let us know how it went. And that’s been a really fun kind of very. It’s. It also is music, just like Jenny and Theresa, but. But it’s what they’re doing and what the smartphones are doing, but it’s just a different. A different medium. It’s, you know, it’s tactile and it’s old school, and people really seem to enjoy that.

Eric 19:04

Do you clean the vinyls after? Like, how do you. Like, it’s like a hospital. We have to worry.

Tyler 19:09

I know.

Eric 19:10

Decontamination and.

Tyler 19:11

Absolutely, we do have to worry. Cleaning it is. And we obviously don’t bring it into contact precaution rooms or, you know, other rooms, but that. Yeah. And so we have. And we’re. We’re sort of. We have. Our volunteers are starting to take over ownership of this program, so we’re kind of like building a team to help kind of maintain it, manage it, and make sure that everything’s on the up and up with it.

Theresa 19:34

So you’ve hit on something really interesting there with the vinyl. Not to, like, advertise my age, but just as one of the. The younger of the analog and the age of digital.

Tyler 19:46

Yeah.

Theresa 19:46

A lot is lost in that transfer from analog to digital recording. And some of that was deliberate. We were excited when CDs came out and there was less hiss and there was better signal to noise ratio. Right, right. And we were surprised when young folks started putting hiss back in and white noise became part of the music. But we know that music is a potent trigger of autobiographical memories and of nostalgia. We know that nostalgia reduces terror. We have good reason to link together a set of basic science studies along with what we know about life review to really believe that there is a potent, important role for music at the end of life, to bring people together to transmit legacy, all of these things.

And if this is an older person who is used to hearing it on the record, their acoustic experience will be different on our smartphones. And I’ve had patients say, I don’t like it when the music comes from your phone. And I’ve had a research participant buy a turntable just to get that experience back. So I think you’ve hit on something really important from an acoustic standpoint, and then bring into that the whole experience of lifting the record out of the sleeve, setting it on the turntable, putting the needle down, and you have this entire embodied experience that just, like, breaks down the whole hospital patient role. That’s beautifully put out.

Jenny 21:24

I love it.

Alex 21:24

We should say, Theresa, that was awesome.

Tyler 21:27

Thank you.

Alex 21:27

I should have put it in the intro. Theresa, in addition to being a geriatrician researcher, is an ethnomusicologist, like a Ph.D. ethnomusicologist. So thank you for that insight, Theresa, into the history.

Theresa 21:39

Yeah, sorry. I’ve been obsessing over this for decades. And now one of our new research participants, like I said, is a former radio show host, and he was going off on it. And the whole issue that we’re now seeing where people have playlists, right? You just go into Sonos or Spotify and say, cool jazz, 60s, and you get what you get, and you. You can skip it, Right? But you can’t listen to a whole album in the same way as you can with a vinyl or even cd.

Eric 22:10

Yeah.

Alex 22:11

Jenny, you had a question? Jump in here, Jenny.

Jenny 22:14

I was curious if Theresa or Tyler or anyone here has heard of the Alive Inside documentary.

Theresa 22:22

I’m such a nerd. I wrote the review for the Journalist Apology with Jenny Coon.

Eric 22:28

What is this? What is this?

Theresa 22:31

Tell us about Alive Inside and we’ll talk about the ipod project. Alex has written on it.

Jenny 22:37

It’s so amazing. So I got introduced to it when I was rotating through Connecticut Hospice here, and they were implementing that new program where you have patients who are agreeable with having ipods and listening to their favorite music. So I feel like this really goes hand in hand with what Tyler is bringing in. He’s bringing in, like, a physical record player, but now also in hospice units as well, they’re bringing out music players with headphones. But my concern with dementia patients was always, it’s. It’s hard and can feel a little bit suffocating to have headphones on your head. So I love the idea of having, like, a record player being wheeled in and having the music surround the entire room.

Eric 23:24

What’s Alive Inside?

Jenny 23:26

Oh, it’s literally a documentary of people following specific patients in nursing homes who benefit from music and seeing the impact of music. But Theresa has done a review, so I’m sure you could talk more about that.

Theresa 23:42

Well, we really should have Dan Cohen on the podcast. He’s a social worker with an MBA who decided that he wanted to improve quality of life in nursing homes and everyone deserved music and went on this mission to bring then iPods, now MP3 players, to people in nursing homes across the country. Alive Inside is a documentary that was made of the process, and a YouTube clip of this man named Henry waking up in response to a song became just, like, viral on the Internet. So it’s a whole organization. You can find it@musicandmemory.org we’ll have a.

Eric 24:24

Link to it on our show notes.

Theresa 24:25

You’ll have a link to it on your show notes. It’s lovely. And singing live at the bedside, like Jenny is doing, is lovely. And bringing in the record player, I mean, music engagement is not one thing. It’s all of these things, and we all should be supporting one another’s work. So.

Tyler 24:46

Yeah, Theresa, I totally agree. As I’ve done, you know, as I’ve read the research, as I’ve talked to more people, I’ve become a. You know, while I’m. I love the record player. I love this and that. It’s. I’m almost like a music universalist. I think all of us are. Like, just get music in there however you can. You know, it’s like, if you got a record player, use that. If you’ve got a cello and know how to play it, do that.

Eric 25:10

Not a harp for Alex. Don’t.

Tyler 25:12

No harp.

Alex 25:13

Alex.

Tyler 25:13

No harp for Alex.

Theresa 25:14

Prayer bowl for Alex.

Tyler 25:16

Yes. Yes.

Eric 25:17

I got to ask. The question, though, is that you said there’s really good research, Tyler, that it improves anxiety. I think, well, being pain. Like, do we have, like, big randomized controlled trials showing that music improves pain? Well, being anxiety? Like, what do we mean by really good research?

Tyler 25:38

Well, that’s a. That is a great question, Eric. I think that it’s probably not research on the level of statins or aspirin for MI or, you know, these sorts of things. There was a very. You kind of have to. You kind of have to find it. There was a really nice Systematic Review about three years ago in JPSM about various music interventions and pain scores in ICU patients. It was out of McGill University, and they found that 20 to 30 minutes. This is based on reviewing a number of studies. 20 to 30 minutes of patient preferred music could lower pain scores by two points.

Eric 26:21

That’s actually better than most.

Tyler 26:23

I know, Exactly. So you then have to extrapolate from that, that, oh, this record player has. You know, there’s no. I don’t. I’ve never found a record player study or a smartphone. We did, you know, so it’s. It’s kind of a combination of. There are enough small studies, signs out there that this stuff helps and doesn’t hurt, and then common sense and humanity kind of Put it all together. I would. I bet. Theresa.

Eric 26:50

Theresa, you’re actually doing research on this, aren’t you?

Tyler 26:53

Exactly, yes.

Theresa 26:56

And before we do that, let’s remember, for all of you who do palliative. I haven’t done palliative care in years. I let my boards lapse a few years ago. But for those of you who do it, we always talk about risk and benefit. And even if the evidence for the benefit is small, there’s zero risk of constipation. Right. There’s zero risk of pruritus, there’s a small risk of windup. And we would be wise to listen to our music therapy colleagues about, like, increasing agitate.

Eric 27:24

What do you mean by wind up?

Theresa 27:26

Oh, when you. When you give to an opioid and someone gets more pain instead of work less and you give more and it gets worse and you have to rotate the opioid.

Eric 27:37

So if I’m playing tool for somebody, maybe that. That may wind them up. Well, Metallica.

Theresa 27:43

Eric.

Tyler 27:43

I have some.

Theresa 27:44

Or if the song has associations with their trauma history.

Eric 27:48

Yeah.

Theresa 27:49

And this is where I think you’re hearing from both Tyler and Jenny, what a lot of docs do intuitively, which is we ask, right? We ask, would you like to listen to music? What kind of music? What would you like? And I gotta say, In I guess, 20 years. Has it been 20 years since you and I were fellows?

Eric 28:10

Eric, it’s been 20 years. 20 years.

Theresa 28:12

In 20 years, I have once seen somebody deliberately choose a song that was so traumatic, I had to actually put in my very first adverse event report. And I asked, why did you choose this? And was told, because it’s important and it’s related to my current cognitive issues. But back to the point. Generally speaking, the risks of opioids are far greater than the risks of singing to a song. Singing a song you like. And tears can be therapeutic, too. So even though this person was very upset, it was also, in their mind, helpful.

Eric 28:56

Yeah. And Tyler, you’re going to say something. Go ahead.

Tyler 28:59

Oh, I was. I was going to. I was going to say there’s one of my favorite resources on this. There’s a small book called Music and Creativity in Healthcare Settings written by Hilary Moss. She’s a music therapist out of Ireland.

Theresa 29:11

Oh, she’s amazing.

Tyler 29:13

Isn’t she amazing?

Theresa 29:14

Oh, my gosh. She has a new book coming out, but keep going.

Tyler 29:16

Oh, good, good, good. But it’s a really nice. It’s about six or seven chapters and there it’s kind of like a nice little summary about, you know, her Experiences, but also her understanding of research. She quotes a lot of. A lot of studies. So it’s a good kind of starter for what’s out there on this. But she does have a chapter called When Music Causes Harm. And essentially it is kind of insisting on music when a patient doesn’t want it, or playing triggering music for a. So it’s sort of like. It’s kind of like if we insist on music in a certain way, that’s when it can be harmful. If we’re involving the family and the patient in the choices. Like Theresa saying the risk and benefit, you know, it seems very low risk.

Eric 30:03

And Theresa, what do we know about music and dementia? So you’ve done some studies on this.

Theresa 30:09

Without going on for 14 minutes and tanking your podcast?

Eric 30:12

Yeah.

Theresa 30:14

Music is relatively preserved in many kinds of dementia, particularly Alzheimer’s. The ability to sing can remain after one has lost the ability to form sensible speech or has forgotten how to remember what they had for breakfast. Or even when people have, like, adl, total care, ADL needs, they will still occasionally sing. And in vascular dementia and Parkinson’s, cognitive hits that affect your vocal production also, singing can be relatively spared. So we have all the beautiful things we’ve just talked about in terms of palliative care and the fact that some. Someone who can’t self represent with words can still engage in music. So it can be very normalizing. One person told me it creates moments of great joy. You know, you hear advertisements on the radio about how I got my mom back that day. And then that’s interesting, right, that people have what Andrea Gilmore Bolkovsky refers to as moments of lucidity.

Alex 31:22

Oh, we’re doing. We’re recording a podcast. That’s a terrific advertisement. Probably the next podcast that we release is on terminal lucidity. Recording that.

Theresa 31:32

But this isn’t just terminal lucidity and dementia. You have lucid moments throughout the process.

Alex 31:37

Yeah, lucidity.

Theresa 31:38

It’s fascinating.

Eric 31:40

What do you think the mechanism is that in Alzheimer’s, Theresa, what do you think that mechanism is that?

Theresa 31:45

Oh, yeah. If I knew that, she wouldn’t be doing all this research.

Eric 31:48

Oh, yeah. So we’re still learning. But you’ve also done research on. You’ve done research on caregivers, too, and the engagement of music and caregivers.

Theresa 31:56

Yeah, my studies are dyadic, so I’m really focused on caregiving. Relationships are usually more complicated. There are lots of people involved. Ideally, it’s very hard to study those whole networks. So to begin with, I’m focusing on dyads of a person living with dementia and the care partner. In the earlier studies that I did with Alex, we were focused on people with moderate to end stage dementia requiring 24. 7 care at home. We made house calls. Alex has played the guitar for one of our participants.

Alex 32:32

Two.

Theresa 32:33

Two, correct. I forgot about. Yes. Oh, I miss them. Anyways, the current study is looking at the impact of music on well being after a new dementia diagnosis. And this has been really interesting because people are like, they just got their diagnosis. They’re getting their PET CT and MRI scans so they can start lecanemab. I mean, it’s like it’s so mild that one IADL impairment. So it’s totally different from what we were talking about before, where someone can’t remember to speak, but they can remember to sing or respond to music.

Jenny 33:11

I think when I’m taking care of my palliative care patients, I always check in on my patient’s family. And nowadays with singing for my patients, I’m realizing the huge impact and maybe even more so on the caregivers. So I love, love that you’re doing that, Theresa. I remember when I was performing a patient’s favorite song. It’s a Christian song. And giving prayer for them as well from our lovely palliative care chaplain, Leah. We were singing and noticing the vital signs of the patient actually improving. And right before this, the caregiver kept interrupting her dad and saying, wake up, wake up.

Tyler 33:56

Your.

Jenny 33:56

Your saturations are low, your blood pressures are low. And every 10, 15 seconds, she kept looking at the vital monitor. And then once we started singing, his vitals improved and she started closing her eyes and just sat with the music and stopped waking up. Her dad, who had such unrest. And I’ve gotten really close to that family. He passed away recently, but she was asking for me and the chaplain during his last moments. Can they come in and sing?

Tyler 34:29

Gosh.

Jenny 34:30

And they do the same thing for us that they did for us last time. And because of that, I’ve actually been trying to do more research and caregiver support with music, too. So we’d love to read more about what you do, Theresa.

Tyler 34:44

Jenny, you’re giving me chills over here. That was beautiful. Thank you. Oh, my gosh.

Eric 34:49

And Jenny, how are you planning to involve music once you’re done with fellowship in your clinical work?

Jenny 34:56

That’s a great question. I’ve been trying to think about that. Well, I think I’ll continue. I’m going to be doing inpatient palliative medicine mainly, so I’ll continue Doing what I’m doing now. But I am planning on performing music outside of the hospital as well. You might see me on America’s Got Talent. You might hear it first.

Eric 35:20

Really?

Tyler 35:21

Yeah.

Jenny 35:21

And they, the producers reached out and they loved the story of having like a palliative care doctor performing for their patients. So I’m, I’m, I might be. You might see me on the TV screens next year.

Eric 35:35

This is the. We knew her when.

Tyler 35:38

That’s right.

Eric 35:40

Before you have like the stay in the sphere in Las Vegas, performing every night. Theresa, I gotta ask, what’s next for you as far as this from a research perspective?

Theresa 35:55

Well, so this is the beginning of a large longitudinal mixed method study. So we’ve recruited 25 dyads, like I said, really close to their diagnosis. The comment we’ve gotten from almost everybody with a new diagnosis at the end of spending an hour or two in their home was, well, this was fun. Seriously. Except for the person who said this was exciting and the person who cried who said this was important. You’re coming back. So we’ll see them again at three months. We’ll see them again at six months. We’re recruiting to 100 dyads, so 200 people. We’re looking at community based organizations and we’re just going to keep synthesizing this to try and construct a picture of music in everyday life.

Eric 36:39

Oh, that’s wonderful.

Tyler 36:40

Incredible.

Eric 36:41

And Tyler, what’s next for you with music and medicine?

Tyler 36:45

Well, Eric, I’m excited. We’re. We’re kind of organizing a volunteer corps and it’s a lot of pre med students to work with our record player program at the hospital. Pre meds love anything that combines their humanity and medicine. Right. Like, I want to be a doctor, but I don’t want to give up on music or art or internship.

Eric 37:07

Takes the humanity straight out of us.

Tyler 37:09

It takes it right out. Exactly, exactly.

Jenny 37:11

Or they’re exposed to the specialty of palliative and become a palliative physician like me and like all of us.

Tyler 37:17

Yeah. And then America’s Got Talent star, Jenny Chen. Exactly. Yeah. So working on that.

Eric 37:23

And is that going to be. Are they just dropping the record player off at someone’s room or are they actually sitting with them with the record player?

Tyler 37:30

We, you know, I think it, it depends on the case and it depends on the situation. You know, there needs to be a sensitivity around it. Of course, I think it’ll be exciting for them to get some exposure to like, patients and families in that situation. But also we want to make sure that you know, we’re approaching these really delicate situations with sensitivity. So TBD a little bit on that. I’ll report back. Eric.

Eric 37:55

Great. Well, I promise at the end of the day, we’re going to do the final vinyl, what your final vinyl is. But then I realized after listening to Tyler, the endearing approach, which we’ll have a link to in our show notes. Maybe that’s not the best thing. That puts everybody on the spot. What’s the song of the day? Jenny, what would your song of the day be today?

Jenny 38:16

I would say Dream by Priscilla on.

Eric 38:20

Is there a reason why you picked that one?

Tyler 38:23

Yes.

Jenny 38:25

It walks you through your life as a child, as a young aged adult, and then when you’re close to the end of life. And it’s one of the first songs I ever learned to perform for my patients. And I still do, like 15 years later. So, yeah.

Eric 38:44

Great. Theresa, what’s yours?

Theresa 38:48

Oh, I’ve had David Wilcox, Rusty Old American Dream running through my head all day. So funny. We have the dream connection going.

Eric 38:56

And Tyler, what would yours be?

Tyler 38:58

Mine would be where the Streets have no Name, first song off of U2’s Joshua Tree, so.

Eric 39:05

Well, mine is actually going to be Thin Lizzy. The Boys are Back.

Eric 39:13

That wasn’t the song of the day. Alex, what is your song of the day that you’re going to end us with?

Alex 39:18

We’re going to do a little more Flaming Lips here.

Alex 39:32

(singing)

Eric 40:50

Theresa, Jenny, Tyler, thank you for joining us on this GeriPal podcast.

Theresa 40:55

Thank you so much.

Jenny 40:56

Thank you.

Tyler 40:57

Thank you, Alex and Eric, what a pleasure.

Eric 40:59

And to all of our listeners, thank you very much for your continued support and joining us on this podcast.

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Disclosures:
Moderators Drs. Widera and Smith have no relationships to disclose.  Guests Jenny Chen, Tyler Jorgensen, & Theresa Allison have no relationships to disclose.

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