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Script For An Outpatient Ostomy Support Group Presentation At A Hospital

1. Introduce the sound of your instrument. Play familiar tunes as if warming up.

I am introduced

2. Connect to the time of year and the location of the presentation. Thanks for coming. By the way, congratulations on your many wellness programs: The Cinco de Mayo 5K, your fitness lending library, your cardio jazzercise, salsa, the summer fitness program, and your support of preventive wellness screenings. These are very important things you are doing! And they sound like fun!

It is October 1 and Halloween is just around the corner, so I have to set the proper tone for this presentation and make it seasonally appropriate. I need to ask you some important questions:

Why did the skeleton have trouble crossing the road?

What does the skeleton say when you sit down to eat?

another one:

Why was the vampire fired from the blood bank?

and finally:

why did the ghost have trouble getting a date?

Question for discussion: For your presentation what  seasonal jokes would be appropriate, if any?

3. Introduce the focus of your presentation  OK, here’s what I’m going to talk about today.  (I brought my violin and viola.)

Using music for pain and stress management. Why these two things together? Anxiety is often manifested in increased heart and respiration rates, elevated blood pressure and increased muscle tension.  We may not sleep well either. And when we are tense and lacking sleep, do you think we feel more, or less pain? Think back to you or someone you knew going through childbirth and those labor pains. What did you (or they) do to try to manage the pain? What about those breathing exercises? And if you (they) had a long labor and were tired, was there a change in pain level?  Did you (they) need more pain meds?

We expend a lot of extra energy if we are chronically stressed or anxious, and what happens: we get colds, we may get sick more easily or we may get depressed. So what can we do that will help us cope?

a. Breathing

Take a deep breath. Ooh I see lots of different ways you get your air! By the way, if I try to play and I’m only breathing from up here, look what happens: tense shoulders, bumpy sound! And if my neck and shoulders are tense, I am tense, and it radiates down my arms and back. So lets stop the tension before it starts. We need to get air from down here, in the belly. (If for some reason you are not able to use your belly, do what makes sense for you)

Let me show you a quick way to start belly breathing. Sit like a guy sits when he’s watching a [Steelers] game… (Watch what they do) No, not like he’s sitting back having a beer, but like he’s watching an exciting play! From your sitting position, move your legs apart like a Vee, if they aren’t already, and lean forward, resting your forearms on top of your legs. OK, NOW take a deep breath. See if you feel it expand. Where do you feel it? You probably feel it here, in front; do most of you feel it here? (nod yes) Now see if you can feel it back here: put your palms on your back, just above your hips. The bones and structure of the upper chest inhibit expansion.  To breathe deeply we need to expand down; to fill down with air. So your ribs open up. Feel it? Keep going…(pause)… If you get dizzy, stop for awhile.

Ok let’s do this for awhile: just follow your breath…Feel the air coming in, going out…What are you aware of? (Speed changes, pauses, cold air in the nose, blowing the hot air aou, faster in or out)

OK now let’s sit up. Put your hands on your sides on your lower ribs. (Not your waist; your ribs don’t go that low) Feel the rib bones. Relax your shoulders. Feel your ribs expand and continue to breathe from the belly… On your next exhale, make a “ssss” sound…again…good, now we’re going to pretend to through a straw for five seconds (Count 1,2,3,4,5) hiss it out: “sssss”…good.

OK, keep going with that…Now, with your next exhalation you’re going to make a sound. Go “aaaaaaaah.” Open your lips. Now, open wide enough to put two fingers in your mouth without touching your lips. Take your fingers out…]

Pretend you’ve been trying without success to balance your checkbook and you FINALLY find the mistake…Say “aaah” with a feeling of discovery or inspiration. aaah…aaaaH (cup behind your ear) AAAAAAH  Wow, that’s more like it!

Make a motor boat sound, buzzing your lips, then on “are you sleeping”}

Make a ch ch ch sound. Ss ss ss, p p p k k k k. Feel the diaphragm]

So by doing belly breaths you have to have relaxed your muscles enough to let the rib cage expand. Feel any changes? Anything?

That’s enough on breathing. Let’s talk about sleeping.

Anybody have trouble getting to sleep? Getting back to sleep? Why do you think we have trouble getting to sleep and staying asleep? (Stress, too much on our minds, noises, indigestion, too much fluid before bed so we have to keep getting up, unfamiliar place, unfamiliar sounds, medications, depression) In the hospital we add several other challenges to sleep: medical staff, particularly in the first 24 hours after surgery, need to keep checking vital signs and they invariably wake the patient. Pain, noise and lots of unfamiliar sounds also contribute.

So what kinds of skills might help us sleep better at home and on the road? First we need to get into a relaxed or hypnotic state. We need to be totally in the present moment and let go of what just happened or of anything coming up.

Just be here, now… For that, we start with breathing or following the breath. You already noticed that in a short time working with breathing you were more relaxed. If you were lying down, that alone might be enough for you to let go into sleep. But what else could you do, using music?

You could start by setting aside a regular time to listen to music, perhaps just before bed, or just before you want to take a nap. Shut off phones or close the door to your bedroom; whatever you need to do to create an uninterrupted time for yourself.  Get your music-playing device and your headphones, covering the ear, like this (show them) and noise-canceling, if you have them, and your choice of music. If you are somewhat wired or still going full tilt, you might start by playing something relaxing that you really like, maybe a favorite song, or perhaps quiet Spanish guitar music, or Bach played on lute, or Bach’s Goldberg Variations for piano. Bu the way those variations were written for a client who had trouble sleeping.

Play Ashokan Farewell, or Loch Lomond.  Give the beats per minute (BPM).  Play a chant improvisation. Play a short piece with a drone.

Try pieces with 60-80 BPM or slower. You might follow this by listening to something like the sound of ocean surf, or Gregorian Chant, ragas, or a drone.

Play an example or two.

After a number of your music sessions you may notice that it takes less time to get into the state you want [the relaxation response] But find what works for you, music that you look forward to hearing and enjoy. I have given you some suggestions, but sample potential music on iTunes, YouTube or Amazon, wherever works for you. You will know if the song or piece does what you want by hearing it even briefly. Surround yourself with the music that works for you.

In the hospital setting, noise-cancellation headphones block out unfamiliar or loud sounds and bring your familiar home environment into your hospital room. You as a patient have more control of your environment. And if you as a patient sleep better and are able to sleep more while you recover, that will help you with healing.

b. Exercise

After 50 what kinds of exercise do we need the most? (Balance, core strengthening, flexibility, strengthening around the joints) How can we get it? Salsa, waltzing, jazzercise, walking, Pilates, yoga or modified yoga, even dragon boat rowing (My team had many women over 50)?  You notice a lot of these activities can include music (the dragon boat has a drummer) and you will find plenty of studies which show that if you use music while you exercise you will be more apt to stick with your diet and exercise program. These kinds of exercise also give us a chance to be around other people and feel less isolated.

Let’s try an experiment to remind us of what music contributes to our exercise. Besides, I want an excuse to play some fiddle music for you!

Stand up. Yeah, you’ve been sitting too long! Stretch those legs! Let’s start by walking in place, about this pace. (snap your fingers)  notice how this feels. We’re doing this without music… OK now I’m going to play something, but I want you to notice whether anything changes when we add the music (Play Lannigan’s Ball at a slightly different tempo than they are walking, then Drowsy Maggie. Speed up) Wow, you kept right with me!  All right, now you can sit down! What did you notice? Did you notice that without me saying anything, you matched the tempo and changed as the music suggested you speed up or slow down?

Now in the hospital, if the physical therapist uses music as part of rehab or as patients first get out of bed, the music can help get you moving, and moving more fluidly: think about what happens if you go to an exercise class. Maybe you are sleepy and feeling all kinds of aches and pains, or you just feel sluggish and you don’t want to do anything. The instructor turns the music on, and rather quickly you feel energized and ready to move.

4. Indicate that you are about to conclude. Play an ending piece that is calm but provides hope, such as Saturday night Waltz. What else could you play?

For more information on music and wellness visit http://wellness.pittsburghsymphony.org/

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