March 2003

Comments, Suggestions?

The show must go on: Center targets health needs of performing artists

By Ruth SoRelle, MPH

Richard Stasney, MD

When the song is silenced;
When en pointe is impossible;
When the brassy ring of horns becomes a whisper and the sinuous whine of the oboe slides off into nothing, what are performing artists to do?

A unique group of physicians with special expertise in treating performing artists have stepped forward to offer specialized care to individuals whose skills give delight and solace in a difficult world.

In Houston, those physicians have formed the Methodist Center for Performing Arts Medicine. Staffed mostly by physicians affiliated with Baylor College of Medicine, the Performing Arts Medicine Program provides treatment and surgery in dentistry, gastroenterology, general and internal medicine, neurology, nutrition, occupational therapy, orthopedics, otolaryngology, psychiatry, physical therapy and rheumatology.

The prime mover in developing this clinic is Richard Stasney, MD, a member of Baylor’s voluntary faculty and an otolaryngologist who combines his performing arts medicine with a love of music and opera.

In the beginning, Stasney thought he could model this program on others in the nation.

“I’ve had this dream for 20 years,” he said. “I thought something like it already existed elsewhere. I thought everyone did this, that there was a model you could follow.”

However, when he checked with leaders in the field who had treated performing artists, he found that there were individual physicians who “case-managed” care of performing artists, referring them to appropriate specialists.

“At all those other places, it was just the people themselves,” he said. They had a list of people who could deal with specific problems, but there was no established center backed by a major institution such as The Methodist Hospital or a medical school like Baylor.

“It is much better to have an institutionally sanctioned clinic that represents the best people who are interested in the arts,” he said. “For example, there is talent you wouldn’t believe on the Baylor faculty.”

F. Charles Brunicardi, MD, chief of surgical services at The Methodist Hospital and chairman of surgery at Baylor, is a songwriter and plays the guitar. Doug Koch, MD, “one of the best ophthalmologic surgeons in the field of refractive surgery” and a professor of ophthalmology at Baylor, is a fine trumpet player.

Specialists in this unique clinic understand the problems of performing, Stasney said.

“A performing artist cannot go on stage wearing glasses unless the character also wears glasses,” said Stasney. “The artist either wears contact lenses or has refractive surgery (to correct vision abnormalities by reshaping the eye). If a ballerina wears contacts and gets something in one of them, she can’t dance. The same is true of someone on the opera stage.”

David Rosenfield, MD, a Baylor neurologist with expertise in treating nerve problems of the larynx, “used to be the physician for the Boston symphony,” Stasney said.

Richard Harper, MD, an assistant professor of neurosurgery at Baylor, is a great fan of the ballet and “incredibly knowledgeable” about the art, said Stasney. ”The orthopedic surgeons who back us take care of the Rockets and the Astros and other athletes,” he said. “Why would you have people like these sitting on the bench for the Astros or Texans and not have the same sort of care for the extraordinary people in the performing arts? It’s an athletic endeavor whether the performer is playing a violin, singing or running with a football.”

Stasney has sought to have at least two of every kind of specialist available to the artists who seek care in his clinic. Along with that, he has had to look for other practitioners who are necessary to the proper care of performing artists. Some of the fields might be surprising.

“You have to have physical therapy and physiatrists,” he said. He has recruited Susan J. Garrison, MD, an associate professor in the Baylor department of physical medicine and rehabilitation, and Robin Sekarek, MD, who have a lot of experience caring for performing artists. He has also recruited dentists, oral surgeons, plastic surgeons, general surgeons and psychiatrists. Gastroenterologists, dermatologists and urologists are also among specialists in the clinic as are neurologists, neurosurgeons and internists.

“Specialists in obstetrics and gynecology are indispensable. For example, one of the problems of vocalists is something called laryngopathia premenstrualis. Shortly before women menstruate, they retain fluid, which can cause slight swelling of the vocal cords. The Queen of the Night in the opera The Magic Flute can lose a couple of high notes because of this.”

In Europe, said Stasney, some opera houses actually excuse a singer from performance during this time because of the problem. “People need to know how to treat it,” he said. “You don’t give them diuretics because it dries up the mucous that is important to proper vocal cord functioning.”

Those are the kinds of issues that performing artists face, he said. He’d like to be able to spread some of the knowledge he and his colleagues have gained in treating artists more widely. More research is needed in the proper way to care for performing artists.

“For example, I’d like to bring them all in for a 20,000 mile checkup, just as they do for Olympic athletes,” he said.

Some facts might surprise the average arts lover, he said. “Rock singers have much better hearing protection than classical singers. They (the rockers) know how dangerous loud music is to the ears. Three-quarters of the rock singers you could name go through Chicago and pick up musicians’ earplugs. They have their hearing tests yearly.

“That doesn’t happen in the classical setting,” he said. “About one-third of a symphony is wearing earplugs.” It’s particularly important for violinists who are exposed to sounds as high as 110 decibels for hours at a time. That would violate standards of the Occupational Safety and Health Administration.

“It’s a matter of educating them that they are hurting themselves,” he said. “It’s not the trombones behind you. It’s you.”

At $1,000 each, the specially fitted earplugs are not cheap and may be the reason that many musicians do not wear them. In addition, many performing artists lack health insurance. Stasney would like to have enough money in his center to pay for the care of uninsured students at Houston institutions such as the Shepherd School of Music at Rice University, Houston Baptist University, the University of Houston and the University of St. Thomas.

“Then it sure would be nice to have an HMO that will take care of performing artists and at least pay what Medicare would to the doctor,” he said. “If his or her practice is half performing artists, he or she would at least be able to pay the bills.”

A last component of the program is the ability of these medical professionals to come to the rescue so that the curtain can go up. Performers receive a card that they can present at the Methodist emergency room and staff will follow procedures designed especially for the artists.

Those who want to schedule an appointment with a physician in the program can call 713-394-6088. As Stasney promises, the show will go on.

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