Mark Gould Beta Blocker Discussion

[hup_d_dup]

I was raised to never acknowledge fear or weakness, and as a result I've never really had stage fright. I've always viewed stage fright as cowardice. .

You are a hero!

I will vote for you if you run for president!

We can be great again!

Hup

[ghmerrill]

just a tangential comment health.
Never confuse "public" health with YOUR health.

I'd go a little stronger on this. Never confuse "public health" with health. I'd also go even further and say "don't confuse it with science", but then I'd have to explain exactly what I mean by this, and that would get too lengthy and technical.

Public health is about policy, and statements about, and guidelines for, a broad population (the "public"). Sometimes it's very good, and so is the science that supports it. Sometimes it's not, and neither is the "science" on which it rests. Some years ago, a couple of independently researched and written papers by statisticians were published demonstrating that in approximately 80% of published and peer-reviewed epidemiological studies there were fundamental methodological errors. Unfortunately, many people don't have the training to make their own evaluations in some complex health and treatment situations. More unfortunately, neither do some physicians -- or maybe they're just too busy trying to cram the most 15-minute exams into the day. But it's always worth a try, and always worth learning as much as you can and skeptically evaluating reports, studies, and recommendations being offered to you. If you have open and clear discussions with your doctor(s), and push him/her/them to provide you with answers that seem consistent, complete, and sensible, then you have a better chance of achieving a positive, rather than a negative, result -- and sometimes avoiding a real disaster.

[Rick Denney]

I was probably raised very differently from most of the people on this forum. I was raised to never acknowledge fear or weakness, and as a result I've never really had stage fright. I've always viewed stage fright as cowardice. I mean, what is there to really fear? The audience isn't going to physically rip you to pieces and eat your liver! I might feel slightly apprehensive (like in this one concert where I had to play a ppp G above middle C), but not nervous. If anything I tend to forget about those feelings when I'm playing, especially when playing hard music. Honestly the audience probably won't notice your mistake (particularly if you're a tuba player), and if someone does notice, should you even care?

As far as physiological responses, I believe that physical fitness will help make a player more resilient. I personally enjoy endurance exercises and am currently getting into triathlons. Rock climbing is also really fun. . . I started hunting at a young age, so I learned to not shake when an adrenaline rush hits. Shaking would cause me to miss my shot. My chops only shake when I'm extremely fatigued, just like all my other muscles.

Most of the "mechanical" aspects of playing should be automatic (from practice) so that the player only has to think about their sound and the music. Of course, things don't always work that well in practice. . .

With all due respect...

The conductor will notice, and for professionals, it could be career-ending, or at least lead to additional stress being applied, which will just make things worse. I'm not a pro, but I still care about what the conductor thinks. I also care about what my colleagues on stage think, and about what I think. I care about the musical product, and I don't want to be the person that undermines the best performance that the ensemble can deliver. I'm an amateur and no paycheck rides on it. In fact, when I have played professionally, I never had this problem, because I was younger and usually playing music composed with my abilities in consideration. As an amateur, though, I'm now stretched to my limit with music that challenges me to improve.

I have played when I was physically fit, and I have played when I was less so. I have found no correlation between my physical fitness an my playing, and no correlation between fitness and the effects of adrenalin on my essential tremor. I was extremely fit, by the way, when those symptoms first appeared--I had completed an Ironman triathlon within the previous year. Over the 15 years since then, the symptoms have gotten worse, but I've also gotten older. Despite the essential tremor, however, my playing has improved both technically and musically. Not spending 15 hours a week training is perhaps part of the reason. Life is hard to balance and good health is important. But deep athletic fitness does not make musicians better, except it may help them with hauling the tuba around or avoiding a backache from carrying or holding it.

Also, it's quite easy to suggest that people who suffer from these issues just don't practice enough. Well, hell, none of us practice enough, do we? I'm a hobbyist on the tuba, but I still take it seriously. That seriousness does not, however, mean I can set aside the many other responsibilities of life to pursue it. (That's the main reason I don't post much on Tubenet any more--I work much harder now than ever, and have many more responsibilities in other aspects of life than I used to.) So, I do my best, just as we all do. But my essential tremor problem does not get better with practice. More practice would make be a better musician, perhaps; a better technician, certainly. But it is extremely frustrating to have all that practice invalidated by a physiological condition that does not afflict me during practice. If that has never happened to you, then blessings upon your house. Perhaps you should consider what you might do if it did. Once all those techniques that have worked for you in the past no longer worked, would you 1.) consider a beta blocker, or 2.) stop playing tuba? I do not believe this is a false choice.

To Mr. John: I detect quite a bit of defensiveness in your responses. I don't mean to disparage the tools in your toolbox (recognizing that as a clinical psychologist, those are the only tools you have). But I have tried many of them. Essential tremor is a physiological problem that is exacerbated by adrenalin. I might learn to control adrenalin release, up to a point, by the methods you espouse, but at what cost? Is that cost greater or lesser than the negligible risk (your word) of taking 10mg of Propanolol once in a while?? How many therapy sessions would I need, that my insurance company would have to pay for, with someone such as yourself, to get the same result? Is that a better deal for me (and my time is precious) or my insurance company than that tiny dose of Propanalol?

But if you think my language dismisses the methods you are suggesting, perhaps your words are equally dismissive. Please consider that. I suspect that before I'm ready to give up playing the tuba, I will be doing it all, because the alternative is to be forced to stop playing.

Rick "not taking the easy way out" Denney

[hup_d_dup]

Honestly the audience probably won't notice your mistake (particularly if you're a tuba player), and if someone does notice, should you even care?

With all due respect...

The conductor will notice, and for professionals, it could be career-ending, or at least lead to additional stress being applied, which will just make things worse.

In fact, the audience also will notice. Listeners, even unsophisticated ones, are quite good at evaluating performance quality and (in my experience) can unerringly recognize the difference in performance quality between two orchestras or bands, even if one is only slightly better than another. They may not be able to pinpoint exactly what the problems or deficiencies are within a group, but whatever those deficiencies are, they are cumulative and ultimately are perceived. If I make a mistake and no one knows it's me I suppose I could say I don't care, but since that mistake goes towards making the the group's performance just a little worse I care a lot.

Hup

[royjohn]

Hi Rick,

Thanks for your reply. As to your comments to me,

<<To Mr. John: I detect quite a bit of defensiveness in your responses. I don't mean to disparage the tools in your toolbox (recognizing that as a clinical psychologist, those are the only tools you have). But I have tried many of them. Essential tremor is a physiological problem that is exacerbated by adrenalin. I might learn to control adrenalin release, up to a point, by the methods you espouse, but at what cost? Is that cost greater or lesser than the negligible risk (your word) of taking 10mg of Propanolol once in a while?? How many therapy sessions would I need, that my insurance company would have to pay for, with someone such as yourself, to get the same result? Is that a better deal for me (and my time is precious) or my insurance company than that tiny dose of Propanalol?

But if you think my language dismisses the methods you are suggesting, perhaps your words are equally dismissive. Please consider that. I suspect that before I'm ready to give up playing the tuba, I will be doing it all, because the alternative is to be forced to stop playing.>>

It's been a long thread and I think there's plenty of defensiveness to go around. I do get defensive of my position when people trivialize approaches that are supposedly not "medical" when they are more powerful than many medicines. The NYT article someone referenced in this thread indicated that beta blockers are not the treatment of choice for essential tremor and that CBT is one of the best treatments:

NYT: "Beta blockers are far from the primary treatment for panic attacks. There are a variety of medications, doctors said, and there are multiple treatments that do not involve drugs. Among the most effective treatments has been cognitive behavioral therapy."

As far as how much you would spend on therapy, I think that would depend on whether you saw someone within our fee-for-service system or not. Those paid by the hour tend to keep people coming. It would not be a matter of a lot of sessions, but a lot of practice. Since meditation is so helpful in so many ways, the practice could well be worth it. There would also be practice on one's own self-talk. Which is also helpful in lots of ways.

One of the tools in my toolbox has always been "why don't you go see your doctor and get some meds." A lot of people are much happier with that than any other intervention I might propose and that is fine with me, as I said several times in this thread. There is only so much you can do to change a person and there are many folks who are quite happy with using a little (or a lot) of meds and with viewing a problem as "physical" rather than "mental" although that is a false dichotomy.

I once had a patient who had an anxiety disorder secondary to coming off of cocaine. He got very anxious in a car driving to see his girlfriend, who lived about 100 miles away. Because taking Xanax jeopardized his sobriety, we got him to a point where he could hold the Xanax in his hand at the ready and reduce his anxiety that way, without taking the pill. Unfortunately, that isn't a possible method with musical performance. But it isn't really known how much of the anxiety reduction comes from some physiological effect of the meds and how much from the security of knowing the problem is taken care of. This would require one of those cool controlled double blind trials and IDK that one of them has been done yet.

As far as dismissive, I'd prefer the term critical. And, yes, I am critical and I think I have a right to be when folks propound all kinds of medical advice and opinion without looking in the slightest at what the literature says. If you went to your doc and he used, "well, this has worked great for my brother-in-law" as his rationale, I think you'd be "dismissive," too.

I do wish you and all who struggle with performance anxiety and essential tremor the best in coping with something so frustrating and debilitating. I've had some anxiety attacks that came out of nowhere and thankfully returned there without treatment and it's quite possible that, if they'd continued, I'd have run, not walked, to my primary care doc and his prescription pad.

[Rick Denney]

Roy, the common belief isn't that non-pharmacological methods don't work, but that using drugs under the care of a doctor are somehow cheating. At one time, musicians would never disclose their own use of a beta blocker, because they thought it would damage them professionally. Thus, the open and sensible use of a beta blocker for debilitating conditions has been the underdog, which is rather opposite of your concern that folks are running to the drug without due consideration.

By the way, Harvey Phillips, one of the foremost performers of all time, stopped playing altogether the first moment he noticed unintended vibrato. This affected him when he was, I suspect, ready to retire from performing anyway, but perhaps not. I wonder if he rejected beta blockers as "the audition drug"--a sign of weakness.

We've both made our different points, but I think we would agree that professional help is better than trying to just "be tough".

Rick "seeking a balanced approach" Denney

[royjohn]

bloke wrote:

<<I don't believe that the power of suggestion or the "think method" will cure my relative.>>

CBT or meditation or any lifestyle change is far from the simple "power of suggestion" or the "think method,"
if you are using those phrases pejoratively. When you say such, you are indicating that you don't know what
these things entail. If that's the case, I'd use the power of suggestion to indicate that maybe it would be better
not to post than to reveal your ignorance. As to what would work for a specific person, that person would have
to try things. If you don't believe it will work, it certainly won't. If you use the extent and severity of the tremor
to indicate what type of treatment would work, that would seem to make intuitive sense, but lots of intuitive
sense is wrong. But I have no experience with this, so maybe it's correct.

OTOH, I looked a little further into treatments for essential tremor and on the Johns Hopkins website there is
some very interesting info on surgery for essential tremor, including implantation of electrodes and electro-
stimulation via programmed remote controllers. Obviously there are a number of treatments ranging from
non-drug through various drug treatments and on to brain surgery.

Ya pays ya money and ya takes ya choice, as Popeye would say. I believe in his later years Popeye
could not get the spinach down for the tremors and he took beta-blockers previous to the spinach when the "power
of suggestion" and the "think method" did not work any longer.

OTOH, the "power of suggestion" that you were wrong worked real good to get several of you to post numerous times in this thread...I'm on my third glass of wine tonight and my tremor is a lot better, contrary to all medical advice. It's my "think method." I think so, so it must be true.

I also note that tremor appear to be worse with a 6/4 tuba than a 4/4 and that they are virtually non-existent with a kazoo, so
I would suggest also trying switching to a BBb kazoo...

[windshieldbug]

[sousaphone68]

Saw this today

[windshieldbug]

Saw this today

[Donn]

I would like to hear more about Zen Buddhism and its application to tuba performance.

[windshieldbug]