Friday, May 18, 2007

On beta blockers

Thanks for all the comments on that other post, by the way.

I should be reviewing more biology or sleeping but instead I am up thinking about beta blockers, which I guess are at least marginally related to my studies.

The reason I am taking beta-blockers is for a heart condition I developed 4 years ago. I wasn't playing oboe yet and had already quit the sax. I began to notice that everything I did felt like I over-exertion. I frequently felt the "fight or flight" feeling. It began to interfere with my ability to handle everyday tasks. They ruled out things like adrenal gland or pituitary tumors and eventually we realized that for some reason my heart had started beating too quickly all of the time. It was downright scary. As I lay in bed every night with my heart pounding in my chest, I would wonder if I would wake up to see morning. The cardiologists couldn't figure out the WHY, but since the symptoms were severe (and confirmed on various tests, i.e. it was not in my head) they decided to treat the symptoms with the beta blockers. Eventually we got the dosage right and my heart rate is now in the normal range.

I brought up breathing in my post because I have always been a shallow breather. My Dad would yell to me about it as a kid. Sometimes I wonder if the shallow breathing was part of what caused my heart to go haywire in the first place. Maybe all the shallow breathing forced my heart to work harder (or to think it needed to work harder) to get oxygen to all my cells? Hmm. Just my own little theory. Because even with the beta blockers I still tend to hyperventilate when I exert myself. So there may be some respiratory aspect to my condition that is still untreated. And maybe that same thing is causing me all my headaches at my lessons. Or maybe I am just looking for excuses.

When initially prescribed them, I knew nothing about musicians taking beta blockers for anxiety or stress since I was very much in the fringes of the musical world back then (and I guess I still am). So it came as a pleasant surprise to me when a few months into the regimen I realized that I was getting bolder about my harmonies at church. I had been singing in our "choir" for a decade and had NEVER sang solo and was always loathe to get picked up by the microphones. The few times they tried to get me to sing on my own, I got so nervous that my teeth chattered and I broke into cold sweat. I realize now that it was nearly a panic attack. My voice would either come out tiny and quivery or would completely disappear. All of a sudden the person with the good ear became tone deaf and arrythmic. I simply broke down artistically due to the nerves and so always preferred to be in an ensemble where I didn't stand out. I was delighted to finally be able to do the things I wanted to do without the panic. Within a year I was able to finally sing solo at my church. Now I do it all the time. I wish I could say that I grew up and that I overcame my irrational fears. But no, I know NOW that it's just the beta blockers.

So it sounds like on top of the heart thing, and the possible (but improbable) lung thing, I definitely have some anxiety issues. Otherwise the beta blockers wouldn't have "cured" me of my stage fright, right?

All of my oboe playing has been "under the influence" so I know no other way. It's been great to be pretty fearless about my playing. Fearless for me, that is . . . which might not be saying much. Less than a year into playing I got together with respected friends of mine to try to form a woodwind quartet. I can only imagine what I sounded like back then, yet I wasn't really nervous about them hearing me play. If anything, I was excited about it. Then again I think that at that point my passion for the oboe was still so novel that I was just happy to share my love of it with others. I really need to get back to that point. At this point I've overcomplicated things with emotional issues. Playing is not about my love of the instrument so much anymore. I've gotten all worked up about not being "good enough" yet or am too busy whining about not having people to play with. All these feelings play out at my lessons these days I think. But I digress . . .

I wonder, with some degree of fear, what would hapen to my playing if i stopped the medication. If I am a nervous wreck at lessons now, what would happen then? This past Sunday I played the intro to a Mother's Day song at my church. While I warmed up when the church was empty I produced a very nice sound, but when the time came to actually perform I did get nervous and my sound and pitch were both iffy. If I had to go off the beta blockers will I be able to even get through a lesson? As it is I am fighting back tears at most of them. Would I be able to play at all? Or would I completely break down like before, unable to play anything closely resembling music? Scary thought.

Or perhaps, as was suggested, maybe the beta blockers are holding me back in a way. Maybe letting some of the nervous energy back in would help my musicality. Well, we won't know for now because my use of the medication is not really elective so I can't just stop cold turkey. But my doctor did recommend to stop if I conceive (no, I am not trying just yet).

So maybe in the not so far future we'll be able to use me as an experiment. I don't think there are that many other musicians in my situation where they were on beta blockers BEFORE they began to play an instrument. It was a coincidence that I was placed on beta blockers and then years later had to deal with anxiety issues in music. Now I am curious to see what will happen without them. Given my penchant for anxiety, however, I have a feeling that things will just get harder. *sigh*

Now in the meantime if I could just recapture the joy of playing just for the sake of it, then maybe everything will be ok in the end.

7 comments:

Valerie said...

Thanks for sharing so honestly about your experiences. My feeling personally is that a lot of what you describe sounds like anxiety, which manifests physically as well as in other ways. Have you considered any sort of coaching or counseling? I've found it extremely useful myself.
Wishing you well...

oceanskies79 said...

Hi Hilda, it has been a while since I have last came here.

Thank you for your honest sharing.
May I ask if our body secretes components similar to beta-blockers naturally?

Perhaps it is when you face the anxiety that it would be your friend, not enemy?

T. said...

Hi, Hilda-Just wanted to wish you good luck on the MCAT. I'll be praying for you (with a special nod to all the doctor saints!). As an adult beginner on the oboe I have gotten so much from reading your blog - thank you! It helped inspire me to start one so I could vent about my love of oboe too. When you take a study break come visit: http://anesthesioboist.blogspot.com.

Anonymous said...

I don't want to sit on the psychiatrist's couch here but I hear where you come from with beta blockers. My case was a little different. When I first took up the clarinet I loved performing and nerves really did make me play better.
Out of the blue, one performance, i was tired and, admittedly, a little hungover. As a student at the time, it wasn't unusual, what was, was that I "lost it". I felt like i was having epilepsy on stage with no back up.
I went on to study music at uni and asked my teachers what i could do to overcome it, only to have helpful comments like "i know people that drink a bottle of wine before they go on stage" and "I know people that take beta blockers and as long as it's infrequent it's fine". Great advice from the pros you look up to.
I've yet to know someone with a remedy. It made me take my search wider. It's everywhere. But no one seems to know how to help. Hypnosis is touted but would help one but wouldn't help another; breathing techniques would help one not another; alexander technique would work for one and not another, and so it goes on. Even googling articles about BBs describes how it's underground but not how to help.
For me, I'm playing again and the more confident I've got the more I've tried to cut down and, to some extent, it has worked. But the one attempt at cold turkey set the shakes off - and not just because it was psychological. I was in a comfortable environment with friends.
I've learnt some triggers - tiredness, tension or, weirdly, even eating habits. Yes, anxiety does have its place of course but even when you don't feel fright or flight the doctor pointed out adrenelin points in your body (back of the neck etc) just function that way. Think about times when you've had to speak at a meeting or go on a first date.
Don't want to paint a bleak picture here but there is such a stigma surrounding BBs I would love to know if you or anyone else can -and actually has - gone back successfully, and how.
The health consequences are a worry. But when you love playing as much as I do, I would like to be able to get to the point where I feel "clean". But to do it without scarificing how good you know you can play without them? I'm open to suggestions.

Anonymous said...

PS - sorry, like i haven't posted enough! What BBs don't do is take away you - hence still the nervousness, cold sweats etc. They just make sure that when the time comes you can get through it.
The musical ability is always in you - they're not performance enhancers. They block the adrenelin from your heart not the thoughts from your brain or your musicality. So on the positive, the confidence you experience is you!

Anonymous said...

sounds tomelike mitral valve prolapse and or tachycardia. BB's have saved me from what you all speak of. I always thought I had anxiety.and for no apparent reason. Finally, IK went to a very thourough doctor who sent me in for an echocardiagram. Sure enough, Mitral Valve prolapse, which causes anxiety, and the "panix" feeling. Good luck to all!

Anonymous said...

I am an amateur oboist and find that solo phrases in orchestral pieces are generally not as good as they should be due to I imagine stress. Recently whilst playing Tchaikovsky 5th I messed up 3 notes in a very important solo in the second movement. It happened after counting about 30 (very slow) bars rest (just counting very accurately stressful), then is the reed going to respond after perhaps drying out (stressful). The outcome was my mind actually blacked out for I guess 1/2 second at the crucial moment. I thought I knew how to manage stress but it got the better of me. Do you think I am one of these people that should consider beta blockers for a performance ?