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A NIGHT AT THE OPERA: MEDICAL CARE FOR PROFESSIONAL SINGERS
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A Night at the Opera, more than a classic mark by this film, it's the second career of our guest today. When illness strikes at the Met, he makes his entrance on stage.
You are listening to ReachMD XM 157, The Channel for Medical Professionals. Welcome to the Clinician's Roundtable. I am Dr. Michael Greenberg, your host, and with us today is Dr. Anthony Jahn, the New York Metropolitan Opera volunteer medical director and also ENT surgeon in New York, and I am going to talk to him today.
DR. MICHAEL GREENBERG:
Welcome, Tony.
DR. ANTHONY JAHN:
Hello there.
DR. MICHAEL GREENBERG:
Tell us about your two careers, you have a private practice, correct?
DR. ANTHONY JAHN:
Yes.
DR. MICHAEL GREENBERG:
And where is your private practice?
DR. ANTHONY JAHN:
My private practice is in New York on West 59 St., which incidentally is 2 blocks from the Met and I have another office in Englewood, New Jersey.
DR. MICHAEL GREENBERG:
Now, how do the practices differ in between that and the practices in your opera practice?
DR. ANTHONY JAHN:
Well, my practice in Manhattan focuses on singers to a large extent; my second interest is otology, so I do a lot of ear surgery, but the voice patients I see typically comes from the two opera companies; I see people from Broadway, I consult a number of music schools and that's what I do there. In New Jersey, off course, I do some general ENT, sinus surgery, ear surgery, as well as the voice.
DR. MICHAEL GREENBERG:
Do your general patients know that you are treating singers and opera stars?
DR. ANTHONY JAHN:
Well, some of them do, you know, I am always surprised how many people check you are online before they come to see you and some of this is are my website, which is www.operadoctor.com, so they do know and in fact a number of young singers come to me because they know that I have an interest in their voice.
DR. MICHAEL GREENBERG:
You have to make appointments all the time so I can just hang out in the waiting room as famous people and it is going to find.
DR. ANTHONY JAHN:
Well, you know, it's not all famous people. You know, for each time you see a famous person you see probably a hundred young singers, who are trying to pay for voice lessons and waitressing part-time, and you know, it's not an easy profession.
DR. MICHAEL GREENBERG:
Do you find that you have to give a lot of them economic breaks because I know I've treated a lot of dancers in Chicago and they most had no insurance and I had to treat them for next to nothing?
DR. ANTHONY JAHN:
Well, I do that, but you know, I think you need to charge something because people somehow equate quality of the treatment with what you're paid. I don't like the idea of overcharging people for whom it's a hardship, but I think you need to charge them something.
DR. MICHAEL GREENBERG:
I agree, you're absolutely right. Now, are there any tricks that you have to get an ailing singer performing. I know that some of the use steroids, but you don't want to use steroids. Like doing radio shows for instance, there is an old trick that we have that if you have a cold, you can use a Neti Pot and saltwater to get 20 to 30 minutes of clear voice in the middle of your cold. Anything special, any tricks that you do for performers?
DR. ANTHONY JAHN:
Well, you know, I am a big fan of that and it's very funny because I think advocating the Neti Pot for probably about 16 years, and of course, since it has finally made its appearance on the opera show 6 months ago, now it's out there, I am a big fan of nasal irrigation because a lot of vocal problems come from postnasal drip, but I would just say to you before we talk about treatment that one very important aspect of treating singers is to make the correct diagnosis. You know the thing that most people want is the magic potion and a magic pill and the magic shot, but you need different treatments for different problems. If you have somebody, who is hoarse just because of nerves, these patients do very well with acupuncture. If people have stage freight, sometimes should give them some Inderal, which calms them down a little bit, although it does take the edge off the performance. Normally, to give somebody a shot of cortisone, you know, an hour before show is really pointless. I do recommend inhalations. I do recommend nebulizing, sometimes just some saline, you know, just to moisten the cords and really I think a big part of this is just to be there, and I have on many occasions gone back stage to the dressing room before the show and just sat there and explain things and physically treated them and I think that makes a big difference.
DR. MICHAEL GREENBERG:
I think it's a pretty holistic practice, that's great. Let me ask you a question, what about GERD, is it a common cause of hoarseness in singers or in all of us?
DR. ANTHONY JAHN:
Well, you know, GERD is the <_____>, if you can go back 10 years, most people didn't know what GERD was. I think that GERD is the disease of our times for many reasons, first of all, people who are often overweight, they don't eat properly, they go to bed too soon, they were under stress. Having said that, it's my experience that most singers, who are hoarse aren't hoarse from GERD and again this is the diagnosis that physicians often make when they are not quite sure what's going on. I know a lot of singers, who sing perfectly well with GERD. I also know many singers who can't sing very well and they do not have GERD. So the two are not necessarily tightly linked, although there is an overlap. My treatment for GERD would be first of all to take a good history and to get some of the features that were predisposed to GERD, although not every GERD, patient is overweight, then I would treat them for the GERD and there are, you know, a variety of treatments. Again, you have some of the holistic things you can use to and treat them for a month and see what happens, but if after a good aggressive GERD treatment say with a proton pump inhibitor plus an antacid over a month doesn't improve the voice, then I'd probably, put that diagnosis on the backburner and try and look for another cause.
DR. MICHAEL GREENBERG:
All right.
If you've just joined us, you’re listening to ReachMD XM 157, The Channel for Medical Professionals. I am Dr. Michael Greenberg and I am speaking with Dr. Anthony Jahn, an ENT surgeon in New York, who has been medical director of the Metropolitan Opera. Tony, let's talk about your second career here and you got involved because you've a background in music, I understand.
DR. ANTHONY JAHN:
Yes, I do. I started off my life as pianist in Toronto. My parents were both professional musicians from Hungary and they were actually quite well known in Budapest as professional performers and my dad was also a composer and a conductor and then in Toronto they ran a big music school. So, I grew up with music, I had music lessons all my life. I was a student at the Royal Conservatory of Toronto and that was really a potential clear choice for me in high school and I stuck with that to a certain degree. I married my wonderful wife, who is a professional <_____>, so we have worked our way through. Most of the piano channel would refer to her by now after 37 years of marriage and my kids are also playing instruments and that's really been the big avocation in my life, is music.
DR. MICHAEL GREENBERG:
Did you folks wanted you to be a musician rather than a doctor?
DR. ANTHONY JAHN:
Actually my folks wanted me to be anything but a musician. My dad and I had a conversation when I was in grade XI when I was a scholarship student at the Conservatory in Toronto and he said to me, look I am not going to tell you what you should do with your life, but I will tell you what you cannot do. You cannot go into music, and he said, but since I don't want you think that I am telling you what to do, I will give you three options, which are law, medicine, and architecture and I was a good biology student, I just went into medicine, which turned up to be a perfect synthesis for me of the music and the science of medicine.
DR. MICHAEL GREENBERG:
About your children, what do they do, are any of them is doctors?
DR. ANTHONY JAHN:
Yeah, my daughter just finished medical school this year and she is a very fine violist. She was the principal violist at the New York Youth Orchestra and she also was principal violist at Colombia when she was a student there and she will hopefully follow me into ENT.
DR. MICHAEL GREENBERG:
That's great. Let's talk about in these two careers, that's interesting because of Medicare keeps cutting our fees and might get more money as a violist and a doctor eventually, but there are so many of our listeners, who are medical professionals with a second talent or passion like you have. Can you tell us how you got started, I know it was probably through your connection, but can you give us some tips as to how our listeners should pursue or incorporate their second talent into their medical lives and is worth it?
DR. ANTHONY JAHN:
Well, I think it is really more that worth it, it gives you, you know it's salvation because it not only gives you something to retreat to after your finish with your office, but it also enriches your practice. You know, I'll spend a lot of extra time with patients discussing music, you know, specially of course opera and it just really livens your life on a daily basis, but I think that if you have a true artistic avocation, you should definitely try and bring it into your career. I have known, you know, plastic surgeons, who have sculpted, and I've known ENT doctors, who sing and it's just a wonderful thing to do and the other part of it is that you get to meet people outside of your normal professional circle. I don't play golf and this is my cultural circle, are musician and performers, and finally when time comes to slow down, it gives you something to spent more time at which you've loved all of your life, it's not something new that you've just picked up to structure your talents, so I would strongly advocate all of your listeners to look very carefully at what their second professional choice would've been and if it was something artistic try and put time into that and to let that enrich their life.
DR. MICHAEL GREENBERG:
And even if they are volunteering, yours is just a volunteer job is that correct?
DR. ANTHONY JAHN:
Yes, absolutely.
DR. MICHAEL GREENBERG:
But you get free seats for the opera, is that right?
DR. ANTHONY JAHN:
Yes.
DR. MICHAEL GREENBERG:
Besides getting free seats and meeting all your artistic heros and heroines, I guess the benefits your get are more emotional and spiritual, correct?
DR. ANTHONY JAHN:
Absolutely right.
DR. MICHAEL GREENBERG:
I am going to ask you an off-the-wall question now, this is kind of funny. When you're in the theater in the opera have you ever had to content, I was just thinking about this, with doctors and non-doctors in the audience having taken charge of an another audience members become ill, for instance you know, somebody collapsed with an MI and your find yourself surrounded by a bunch of other people. How do you break through, just say hi I am the theater doctor here, let me in?
DR. ANTHONY JAHN:
Yes, basically I do, but we will look if somebody has had a serious incident and we've had patients with, you know, cardiac events and things. If there is another physician there, who is clearly taking charge, I don't push him out of the way, I'd like to be there because that's my job to be there, but you know the bottom line is to get the patients well and get them to the hospital or to their primary doctor.
DR. MICHAEL GREENBERG:
Now, I understand that a lot of performers are very interested and you are also in nontraditional medicine. Can you talk about that for our listeners?
DR. ANTHONY JAHN:
Performers are artists and they are very in-tune with their body and they are in-tune with their perceptions and then the physical sensations and, as we had said before they are very open also to a sex, some placebo and some not, which are not really quantifiable, but nonetheless they work and you know I sometimes think about treating singers at the ultimate, you know, outcomes measure. I mean the bottom line is can that person perform? If they can't perform, it doesn't make a difference, what tests you've ordered, what medications you've given. So you have to do whatever you can, safely of course, to get that patient, that singer to be performing and to feel good. They do like alternative medicine. I have a big personal interest in acupuncture, I trained in acupuncture here in New York and also in China and I use a lot of acupuncture in my patients. The whole philosophy of Chinese medicine is more like the singer’s philosophy of singing than western medicine. The philosophy of Chinese medicine is that the body can heal itself, can send off ills and the insults as long as you support it, so the focus in traditional Chinese medicine is not on treating disease if I am treating the patient and on helping the patient get better and this is something that is very, very simpatico to singers. So I have a big interest in this and patients, we enjoy it. It also gives me something to do when a patient has seen 3 other physicians with the trivial symptom, postnasal drip I say, and they've had their antihistamine and their decongestants and their guaifenesin, and this and that, Neti Pot, and they are not better and now they come to me and I can put one needle into one specific spot in the ear and they feel the nasopharynx opening up. It just empowers me as a healer, but it also empowers them because it really vindicates the symptom that we are to get the symptom that a lot of other doctors may not have taken seriously.
DR. MICHAEL GREENBERG:
Well, I think that makes sense because true art comes from the heart from the whole person not just from a vocal cord that are vibrating.
DR. ANTHONY JAHN:
Absolutely.
DR. MICHAEL GREENBERG:
So I think that the treatment should come that way too. What's your favorite opera?
DR. ANTHONY JAHN:
That's a bad question.
DR. MICHAEL GREENBERG:
I know, that's why got it at the end here.
DR. ANTHONY JAHN:
I have a lot of favorites. Of course, my very favorite probably is themajor singer by Mozart. I love that Eugene Onegin, which is by Tchaikovsky, and then of course, the entire cannon of Puccini and Verdi. I love Richard Strauss.
DR. MICHAEL GREENBERG:
All right. Well, speaking to commonplace in art, thank you for doing what you do to help keep the arts going in New York and we totally appreciate that. Now, Tony thanks for being our guest today and speaking with us about your second career as the volunteer medical director of the Metropolitan Opera encouraging our listeners to get involved with their passions in the art too.
I am Dr. Michael Greenberg and you've been listening to the Clinician's Roundtable on ReachMD XM 157, The Channel for Medical Professionals. ReachMD XM is here for you, the health professionals, who care for your patient.
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"A night at the opera" means more than mere entertainment for some. For guest Dr. Anthony Jahn, otolaryngologist and volunteer medical director for the New York Metropolitan Opera, it's part of a second career. Host Dr. Michael Greenberg speaks with Dr. Jahn about his practiced art of caring for professional singers, addressing several unique occupational health issues from this select population.
"A night at the opera" means more than mere entertainment for some. For guest Dr. Anthony Jahn, otolaryngologist and volunteer medical director for the New York Metropolitan Opera, it's part of a second career. Host Dr. Michael Greenberg speaks with Dr. Jahn about his practiced art of caring for professional singers, addressing several unique occupational health issues from this select population.
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