Texas DO gets in tune with musicians

This is what I do with the College of Music at Michigan State University. Please enjoy. 

The following was originally posted on the website of the DOs (Osteopathic Physicians) on June 3, 2016.

MUSICIAN HEALTH

How I Practice: Texas DO gets in tune with musicians

Sajid Surve, DO, talks about the changing world of music education and why osteopathic physicians are uniquely qualified to treat musicians.

Musicians at the University of North Texas (UNT) College of Music recognize that when it comes to their health, the Texas Center for Performing Arts Health is a helpful instrument.

A musician himself, Sajid Surve, DO, co-director of the Texas Center for Performing Arts Health, a partnership between the UNT College of Music and the Texas College of Osteopathic Medicine in Fort Worth, discovered early on that music and medicine share a common goal: to heal. In this edited interview, he discusses the center’s efforts to help change music education and the reason DOs are uniquely qualified to treat musicians.

What is the Texas Center for Performing Arts Health?

The center, known as the Texas Center for Music & Medicine until two years ago, provides health care to performance artists and studies the performing arts population from a health perspective. It’s a lively research hub with a clinical presence. We have pianos with sensors built into the keys so we can measure the forces that pianists use, and we have sensors for trumpets to look at mouthpiece forces.

Is this research influencing music education?

Yes. Music education is changing right now. The UNT College of Music and the Texas College of Osteopathic Medicine worked together to build a body of evidence to show that musicians have pretty high injury rates. We then joined with other groups to recommend that the National Association of Schools of Music (NASM) create new standards requiring colleges to make students aware of the musculoskeletal, hearing, and vocal risks of making music. Because of our efforts, NASM issued the new standards a few years ago. The Texas Education Agency adopted similar standards for high school and middle school students.

What matters to me is that the musician is now better at playing music because of what I’ve done.

What’s the most common condition you see in musicians?

In general, musicians suffer from repetitive stress injuries. Every instrument has unique demands and as a result, they have these unique injuries. Trombonists, for example, can develop shoulder problems from the weight of the trumpet. Pianists often have hand problems. Clarinetists and oboists develop right thumb problems.

What does treatment look like?

With an osteopathic approach, we have to consider the whole situation. My focus isn’t necessarily on the instrument. For example, posture is how your body rises up to meet the instrument. Any aberration in a musician’s posture can cause neck and back pain. Maybe we give the patient a strengthening program to improve their posture. Or maybe they need to take more breaks. Or we need to treat their shoulder with osteopathic manipulative treatment. I do a ton of OMT in the clinic.

Treating musicians’ injuries can be really tough if you don’t approach treatment with the mindset of considering the whole patient. This is why DOs are uniquely qualified to treat musicians. I’m so thankful to have my osteopathic background.

What is the most rewarding aspect of your job?

I had the fortune of helping a young singer who had been injured and was unable to sing. She came to me with paperwork to withdraw from the university, but over the course of six to seven months she was able to sing again. She invited me to her senior recital, and sitting in that audience watching her deliver stunningly beautiful arias, knowing that I had a part in making that happen, was one of the greatest moments ever.

What matters to me is that the musician is now better at playing music because of what I’ve done. 

VARIATION, SUBTLETY, AND SLOW IN PRACTICE

On the subject of transforming limitations into possibilities, Anat Baniel, well known Feldenkrais practitioner and teacher, describes aspects of her work with children in a teaching video, which depicts her working with children and also talking about the work separately from being with them.  I found my reaction to what I saw changed over the course of three complete viewings over the course of one day.  The first viewing I watched nearly straight through only pausing a couple of times to look again at something or to better hear what she said by repeating a section.  I didn’t take notes.  The second time I used a pause, stop/start, rewind, review, and make notes kind of method.  The third time I watched in order to fill in aspects of my notes, and to watch most sections several times, each time with different intentions about what I was trying to see.  I tried to see it from her point of view, and then from the perspective of the child as well.  There were several parts where the two blended into a coherent whole as they moved together.  As I watched the video, I began to see more and more of what was taking place between she and the child that was part of her non-verbal physical presence:  elements of this included tactile, kinesthetic, and emotional/vital flows that had wave-like properties.  From my notes I made summaries to facilitate my understanding of three of the main points conveyed in her discussion and tie them into my understanding and experience thus far.  Three qualitative elements of the work emphasized were:  VARIATION, SUBTLETY, and SLOWNESS.

VARIATION……fast only gets the brain to do what it already knows.  Sensations barreling into our nervous system without pause prohibit us from being able to listen and learn & prevent our ability to make connections.  Our interactions with the surrounding world and our participation in it with awareness and intention require us to spend time between perception and interpretation.  By doing this, we begin to be present and assume a role in the reality of our experience.  What seems to be out there becomes connected to what seems to be in here, making perception more simply experienced as what is-from a particular perspective.  An apparent duality collapses into unity.  Using meditation and mindfulness practices that allow us to cultivate detachment, we can improve our ability to move between and through perspectives. If that which is aware within us catches the moment between the receipt of a perception and the attribution of meaning to that perception, we can find multiple shades of experience within it.   This is a way to bring variation into each moment and helps us become aware at more levels of understanding, eventually allowing us to watch several aspects of our being simultaneously as we go about doing whatever it is we are doing at the time.

SUBTLETY…..becoming quiet often corresponds to gaining the skill or remembering the ability to listen to one’s own body.  By avoiding excess, pushing too hard, forcing, or trying too hard, we are ushered into the world of fine differentiations.  The amount of force required to accomplish a task is the correct amount of force to use.  Skill, finesse, and the ability to make fine distinctions come from participation with awareness, being present fully as we act.  The ability to perceive subtle differences is the foundation of intelligence. A characteristic of wellness in all living things is the ability to make subtle corrections early on when deviation from equilibrium has occurred.  This allows the organism to remain adaptable to the environment.  This occurs at all levels of organization. Examples include receptors in our feet which send continuous feedback to our brain so that we maintain our balance as we walk, the constant changes in rate and depth of breathing we make to keep up with our level of activity, and the maintenance of a constant concentration of sodium in our blood by little filters in our kidneys that continuously monitor it and decide when to keep or let go of water so that our chemistry remains in balance.  Everything in us is intelligent.  Bringing that to bear on issues of movement means we take the sensations we experience and remember to integrate them smoothly into responses that keep us in balance.

GOING SLOWLY…. Gives the brain a chance to pay attention.  Intention, intensity, precision, and control can be honed by participation in activity with awareness. I am here now, and I am awake.  The experience of being in a boat that slows its speed is a good example of how this works.  As the speed slows, the boat sinks into the water and settles more deeply into where it is at the moment.  If you are in the boat, you notice the change.  More can be felt in the place you inhabit when you slow down.  A depth of experience becomes available that is simply not available when you are speeding past.  Clarity of perception and depth of understanding are gifts we learn from slow.  Not surprisingly, beauty and joy become much more available as well.  To appreciate something in depth requires awareness over time.  Applying slow to all skills in the use of our body facilitates cultivation of our abilities and allows us to grow and evolve at whatever we choose to do with our selves.  The breath is a bridge between our thinking and our feeling aspects, and settling it as we prepare to act is an excellent way to bring all the elements toward coherence as we begin any endeavor, so that the fullness of what we are doing can be appreciated.

dng   

What Cannot be Mended must be Transcended

“What cannot be mended must be transcended.”                
--Ursula LeGuin, in her afterward of the book Tehanu

One of my heroes is Ursula LeGuin.  A living legend, she is not only a writer with countless awards; she is a scholar of the Tao Te Ching. This clearly comes through in her Earthsea books[1].  Recommended by my counselor in Atlanta while Beth was attending seminary, they helped me alter the course of my life.  Her consciousness-expanding allegory shifted my perspective from an entrenched worldview that left me angry, frustrated, and saddened by our world to one that introduced hope and a more rigorous and honest look at myself.  This series of books encourage the reader to bring to light the aspects of self that most of us are reluctant to acknowledge and address.  The shadow as described by Jung is used as a character within the stories.  This shadow, released into the world by an impulsive act done by a powerful but naïve protagonist in his youth serves to be his greatest teacher after he runs to The Farthest Shore trying to avoid it. 

From the work I did with my counselor with inspiration from these books, my life entered a new chapter that acknowledged the depth of pain, sorrow, and grief I felt without crippling me. Instead, it strengthened me. It allowed me to move into a more hopeful, creative, and compassionate way of living, starting with compassion for myself.   

There is brokenness in living a life.  It starts early and it just keeps going.  What are we to do with this truth?  LeGuin’s afterward continues with these words:

Maybe the change coming into Earthsea has something to do with no longer identifying freedom with power, with separating being free from being in control.  There is a kind of refusal to serve power that isn’t a revolt or a rebellion, but a revolution in the sense of reversing meanings, of changing how things are understood.  Anyone who has been able to break from the grip of a controlling, crippling belief or bigotry or enforced ignorance knows the sense of coming out into the light and air, of release, being set free to fly, to transcend.                                                                                                                           

This portion of Ursula LeGuin’s comments on her brilliant set of novels resonated with me as a calling to all sentient beings for the work that lies before us. Tehanu was written about ten years after the third book in the series, The Farthest Shore.  It tied together many aspects of the story about characters that were left broken and with many unanswered questions.  She admits it took that long for her to work out how to continue the story, and it was worth the wait.  She writes with astounding wisdom.

Thoughts are things.  We can be addicted to beliefs that may have no basis in reality. Addiction is not limited to mind altering chemicals.  The mind can be altered by thoughts, feelings, and by the misinterpretation of perceptions.  All this is dealt with in the world’s great wisdom writings, like the Tao te Ching and Patanjali’s Sutras, to name two I’ve studied.  I might add the book of Proverbs to that list. 

Energy follows thought.  The force of our life energy is something we have the ability to shape, cultivate, grow, and bring forth into the world.  The Tao te Ching has a central theme.  It is described as wu wei, the way.  I cannot begin to characterize it, for it is equally elusive and obvious.  One has to work to overcome human nature in order to see clearly, but the way is the way is the way.  It becomes clear when the ego is defeated and we can see without self-interest.  That is, to say the least, easier said than done.

What LeGuin says is profound advice for our world today.

Freedom does not mean power.

Being free does not mean being in control.

The refusal to serve power is a revolutionary act.

There are better things to serve.

The discipline it takes to see clearly without ego is formidable.

It is a job that is never finished, but what a worthy goal to put one’s energies toward!

There are many things that cannot be mended; yet there is a way to practice seeing the world that allows you to be free of ignorance and judgment.  You can see others as really doing the best they can, you can forgive yourself and keep trying, and you can enjoy the beauty of the world and appreciate the transcendent light that suffuses it.

[1] A Wizard of Earthsea, The Tombs of Atuan, The Farthest Shore, Tehanu.

Possibilities

I have been listening to Herbie Hancock read his autobiography Possibilities this week in my car. His words about the journey taken over seven decades in music and many other pursuits struck a chord in me about how I am feeling about my career. In case you don’t know who he is, here is a bio.  My first memory of his work is the Jazz Chart Chameleon from his 1973 album Head Hunters.  In high school, I was deeply involved in music 6 or 7 hours a day, and we jammed on that tune whenever we could.  His work really lit a fire in me for jazz music and gave me an outlet for expressing myself during that formative time of my life.

Midway through his career, he talks about how he had to learn how to come to terms with the way people responded to his new ideas and ventures. Incredibly curious and creative, he has often been a leader in exploring new kinds of music and the use of technology in music. Even after 20+ years of success, he remembered the executives of Columbia Records, his friends, and even his manager thinking he was crazy and would lose all his fans when he presented his ground breaking single Rockit from his 1983 album Future Shock. It was the first  jazz hip-hop song and became a worldwide anthem for  breakdancers  and for the hip-hop culture of the 1980s.

He credits his mentor Miles Davis for helping him continue to grow, create new things, and move forward without being afraid to lose fans, fame, or money.  He credits his practice of Zen Buddhism for pushing him to acknowledge and face his own faults and weaknesses so that he could overcome them and keep growing.   And when he won the Academy Award for Original Score of the movie Round Midnight in 1986, he gave a beautiful speech honoring all the jazz artists that have come before to create such an amazing American original Art Form.

When he reached the age I am now (55), he had this to say:

By the mid 1990s, I came to a conclusion.  I wanted to make every new record absolutely different from any I’d done before,  and different from any record anybody had done before. I was 55 now, and I had been playing music seriously since the age of seven. It’s rare for a person to find the thing he wants to do for life at such an early age, but ever since my parents bought me that first piano, I’ve considered myself a musician.

When I graduated from elementary school, we had to write little captions for our yearbook photos of what we wanted to be when we grew up.  I wrote--concert pianist.  25 years after becoming a Buddhist, I thought of myself being a human being first, which includes being a musician, father, and husband.  Ever since making that change, I’d been thinking less about just writing tunes, and more about my purpose in creating a musical project.  What could I create as a musician that would have deeper purpose and meaning?

How could I serve humanity in some way?  One way I knew was to translate that idea into musical expression.  My perspective had been changing over time and I finally came to the inevitable conclusion that I should never do the same thing twice. If music and Buddhism had taught me anything, it was that the world is full of infinite possibilities, and that there are an infinite number of ways to look at things.  This is what jazz improvisation is all about, and it is what Miles Davis demonstrated to us every time he played.  Miles looked at every single sound as an opportunity rather than an obstacle. I tried to do the same thing, incorporating new sounds and rolling with the punches whenever anything surprising popped up.

Once, when I was playing at a jazz festival in New York, I sat down at the piano to discover that one of the keys didn’t work.  Instead of emitting the correct note, all you could hear was a dull thud because the string was broken.  I could have raised a fuss, but I decided…I liked the sound of that broken string. It gave me an unexpected slap of percussion at the touch of a finger! So I incorporated the sound into the songs we were playing just to see how it came out, opening up a whole new avenue of possibilities that I didn’t usually have on an acoustic piano. When you never stop exploring, you stay active and vital, no matter what you may be doing. People stop exploring in their lives for various reasons---fear of criticism, of failure, of disappointment… but even if you decide you don’t love the direction in which you are moving, you can always change directions.

Making every record of mine completely different from any other record would be the ultimate expression of exploring every facet of myself.

His book inspires me. I look back in wonder to see all that I have done; I look forward and wonder what new thing is ready to be born in me as I continue to grow and create?  A well lived life has themes and motifs that give it form; it also has variations that enhance its beauty and depth.

I wrote this in an essay in 1981, the year before I started Osteopathic Medical School at Michigan State:

“Oh Dave, you’ll make a great doctor.  But what’s Osteopathic Medicine?”  So I am destined to explain my course to others who seldom seem to understand where I am going.  But that’s OK.  I like where I’m going and who I’m going with.  Because Medicine upsets me and makes me happy, just like people upset me and are the source of my joy.  They go together.  Environment and Medicine go hand in hand.  Incorporate the unquantified variables.  Sense, infer, listen, and counsel.  Knowledge is a great process; a synthesis.  I will keep looking for another thread to tie in.  There are no certain answers.  So we test in reality, form ideas, and test again.  That is science;  that is life.

That is my theme.  I practice Osteopathic Medicine. Yet we are complicated beings, are we not? The practice of Yoga tempers me, makes me look at myself squarely, leaves no room to squirm away.  I see how I’ve been creative and industrious, given myself experiences and learned a great deal in each of those settings. Family Practice, Public Health, Emergency Medicine, Physical Medicine and Rehabilitation, Osteopathic Manipulative Medicine, Functional Medicine, Lifestyle Medicine, Private Practice, Academic Medicine, Teaching, Research, Yoga Teacher Training, now teaching and working with musicians and working for a non-profit organization.

But how does that inform what I do now?  How do all these threads tie in? What will help make all these experiences useful in creating a new, greater, integrated initiative? Did I really learn something or am I just good at moving on to something else when I come up against resistance or have an excuse to divert myself to another adventure?

I feel the need to thank those that have come before, shaping my education-- and to honor them and the profession with my work.  I want to be true to this tradition but open to a new direction that I may be uniquely suited to follow.  I listen to the young doctors with whom I work through the non profit Third Circle, the residents who see patients with me in my office, the medical students who I meet with through the Leadership Academy of Compassionate Care at MSU-COM, the young people applying to Osteopathic School who spend time with me in the office, and the hopeful candidates for admission interviewing at the College, and what do I hear?

I hear hope, compassion, intelligence, fatigue, worry, uncertainty.  They talk about the financial burden,  the disconnect between the way medicine is practiced and the way they want to practice it, the time pressures, the discouragement when day after day they do less for their patients than they would like to do.

They face a far more complex world than I did 35 years ago.  Medicine was not addressing the real needs people had for health care then and it hasn’t really changed much in that regard. However, molecular genetics, immunology, biochemistry, microbiology, physiology—to name the dominant chords of medicine—have evolved exponentially in knowledge and understanding of the interdependence and complex interactive nature of how our bodies work.   How are they supposed to fit the far more complex and integrated model of health and disease into the current business model of health care?  They are brilliant young people with good hearts and amazing energy, and we are sending them into a machine that is going to treat them and their patients like numbers on a spread sheet.  It is going to break their spirits, and I do not want that to happen.

There is not enough time in a typical doctor visit to address the patients’ needs.  The cost of that time keeps going up, but we are operating under the definition of insanity.  If we can’t address their needs, we are not going to be able to help them become healthy.  They then become more ill, and we still don’t spend enough time, but we see them more often without addressing the root of the problem. More money spent with no change for the better.  Insanity.  Do you see what I mean?

Here is what I have to say:  POSSIBILITIES.  Let’s work together to change the way we experience health care.  The students and residents who spend time with me see more possibilities in the way I practice with more opportunity to actually help people become healthy. I took radical deviations from the normal “physician lifestyle” to get myself to a place where I can afford to see fewer patients per day.  Can we afford to wait 35 years for them to be able to do that?  And will they still be standing and wanting to practice medicine by then?

Let’s all advocate for a change.  This system is broken.  I see and hear the effects of it on my friends, family, and patients every day.  What can we do to fundamentally change the way it works?  I am going to be working on this, and I invite you to join me.  Call, write, contact me any way you want.  Let’s work on this together.

Many thanks to my son Ben who gave me Herbie’s book as a gift and often seems to understand me better than I understand myself.  You inspire me, and I love you.

The Invisible Universe Of The Human Microbiome

This is a great animation about how important bacteria in our bodies are, and why they are essential to our health.

Phoenix Dancer

And now, here is the ninth and last piece in this little series introducing you to our office!

The picture you see is called Phoenix Dancer, a dry point etching made in the 1920s by an English artist named Elyse Lord.  I found it in May as we were nearing the end of the wait to get into the new office.  To cope with the stress we were feeling, Beth and I took a study break and spent the first weekend of May in a vacation rental by owner invitingly named “writers cabin.” I wasn’t looking for a piece of art necessarily to bring to our new space, but I was open to the idea I might find something that struck me as just right for my experience of this new venture. 

We were walking around the Petter Art Gallery on the Blue Star Hwy in Saugatuck/Douglas, MI,  (http://petterwinegallery.com/) at the end of the weekend, reluctant to get in the car and drive home.  When I came to this picture I stopped in my tracks. I was transfixed by it.  First I really liked the colors.  They are rich and beautiful, warm and elegant. The jewels on the dancer suggest to me abundance and fluidity.  I love their color the most. I thought the palate and the well-chosen frame would match the accent color in my office, and that is where you see it in this picture. The deep red in the phoenix’s tail and the burnt sienna of the wall give a lot of life force energy to the scene.  Burnt sienna was the first color I chose when my Grandmother Grimshaw took me to the art store at age 12 in order to help me buy oil paints, canvases, brushes, and accessories.  She was an artist, and it was she who taught me to paint over the next few years. 

Next, I immediately identified with the Phoenix symbolism.  Moving up and away from a Phoenix, a figure is dancing.  Her clothing and positioning of her hands reminded me of a traditional Indian dance form I have seen performed at the Ashram where I study Yoga in Quebec.  My focus was drawn to the energy of the dancer’s spiral shaped spin; it has a powerful sense of direction and purpose. I see her as one person at the moment she both acknowledges the Phoenix (rebirth, renewal, grace?) and spins away to engage fully in her newly realized sense of purpose.

I could see myself in her.  It’s really wonderful for me when a work of art or a piece of music brings all of these things to my awareness in what seems like almost no time at all—just a blink of an eye, a beautiful little explosion of connected ideas coming forward already organized for me to experience.  This gave me a rocket shot like infusion of inspiration and energy.

Coming from being injured and having to accept a major loss (my hip) and face my own sense of the wear and tear of these now 27 years of practicing medicine, I have worried about how much I have left in me.  I have also felt (with urgency) that there is so much more I want to do and learn and experience--- Wondering whether I have the strength and energy to be able to accomplish these hopes and aspirations has given me many nights of angst.

I brought the beautiful and graceful Phoenix dancer to my new office to remind me of the endless flow of inspiration, strength, and beauty that is available to me each day.  Every day is new.  We are given the opportunity to dance with the cosmos and co-create with others and the earth opportunities for healing and renewal and reconciliation—for ourselves and each other.  She reminds me of this each day, and here I am—again-- starting something new. 

I’m glad Life has given me this many chapters.  I am ready to dance into this one with renewed energy and engagement and wonder at the ability each of us has to cultivate an ever-expanding awareness about who we are and what we are doing.

Our Building

We are truly thrilled and thankful to be in our new location, and we hope that you are happy with it as well. To look around our suite, and any other part of the building, you’ll see the extraordinary amount of work and vision it took to build this structure back up from the brink of collapse. What is just as extraordinary is that in the process those visionaries were able to preserve pieces of its former glory, such as the beautiful terrazzo floors throughout the stairwells and waiting rooms.

If you’ve been in the main waiting room outside our office and have noticed the photos adorning most of the walls, you know this building has considerable history as the Cedar Street School. Photos and blueprints from the early 1900s are interspersed with collages of class photos all through the century, up to its closing in 1977 due to structural problems. The building remained closed for almost 30 years until Dr. Carla Guggenheim and Gail Shafer-Crane of ARM Physical Therapy had the initial vision to give it new life.

The building was understandably in rough shape at that point. Among other major repairs that had to take place before it could be habitable again a new roof was needed, and more insidious small issues like mold, lead paint and asbestos wrapped pipes needed to be addressed. This was no small feat by any stretch of the imagination!

Not only was the entire building restructured to accommodate the types of practitioners it would soon house, but they chose to go even further and install green elements into the space, and became LEED (Leadership in Energy and Environmental Design) certified in the process. To name a few of the eco-friendly modifications, this building is equipped with: geothermal hvac system, rainwater collection and recycling for non-potable water, recycled content for carpet, and environmentally friendly paints and insulation materials.

Blending old and new can sometimes be a challenge, but Dr. Guggenheim, Gail, and each and every worker that lent their time and expertise to the project were able to achieve this balance and breathe new life into a beautiful old relic, further preserving it for future generations to enjoy. Where others could have seen the aging and dilapidated structure as an eyesore and may have simply torn it down to make room for something new, Dr. Guggenheim et. al took the challenging route in restoring it, and we sure are happy that they did!

The Conference Room

Over looking Cedar Street is our Conference room.  It serves double duty as the room I use for counseling.  There is a small nook in the corner of the room with the “therapist” couch and “crying chair”.  This room also holds a large table that can seat 8-10 people and more of the beautiful bookcases floor to ceiling.  We have tucked a TV in the shelves so we might hold educational forums and community gatherings in this room.  This room opens up into the kitchen which is decorated with travel posters.  What better way to travel the world than through the endless varieties of foods and flavors.
 

We have many hopes and dreams for what will go on in this room of our office suite. 

Some of the ways we hope to use this room are:

• Food Becomes You Gatherings- a chance to come together and realize that food really is our most powerful medicine and learn new ways to eat and be sustained.
• D3 evenings Dinner and Documentary Discussions-a time to share a meal and watch a documentary on various health and wellness topics.
• Daring Greatly groups—weekly and intensive retreats to meet, study and process the work of Brene Brown about our common needs for connection, community and compassion.
• Group Patient Visits- Gathering patients together with similar diagnosis and concerns to learn and support one another while seeking health.
• Mixed Media Art Mantra Classes- come and unlock your inner artist and create a mantra to inspire your living.

We are thrilled to have a place where we can come together and share and learn.  We are sojourners on this adventure of life.  In this place we can gather, share and shore each other up to lead us all to a holy, wholly place of health.